A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage

The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the “stress superstorm” of 2020 had on children of color based on their family's position on the advantage–disadvantage continuum. The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy. The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing