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Sonoma County Field Nursing was highlighted during 2018 ACEs Conference Project Showcase


On October 15-17, the Center for Youth Wellness in collaboration with the ACEs Connection presented the 2018 ACEs Conference and Pediatric Symposium. The theme this year was, “Action to Access,” and communities from around the United States shared current research, programs, tools, and initiatives that use ACEs science to address childhood adversity and its impact. The Sonoma County Field Nursing team was selected to showcase their work to address ACEs with caregivers during home visits.

Since Dr. Fellitti visited Sonoma County in 2013, the Field Nursing Program has worked to incorporate trauma-informed care and ACEs into daily practice, including the use of ACEs questionnaires with the families served. The team serves low income, high risk pregnant women and families through home visiting with 38% having substance use history or active use, 38% experiencing insecure housing or homelessness, and 16% medically fragile. About one third of the clients are monolingual Spanish speakers. The poster presentation at the ACEs Conference highlighted how the home visitors provide concrete support and education regarding building safe, stable, and nurturing environments for children. Field Nursing shared educational material they developed for caregivers exposed to ACEs, which includes ways to improve health and well-being to be more resilient.

The Field Nursing team has moved towards evidence-informed practice by linking ACEs prevention and mitigation of toxic stress exposure with the validated screening tools they already use. In time, the team hopes to correlate the data on ACEs with pertinent outcome measures appropriate to their client population.

Spearheading this new model is Julianne Ballard, Field Nursing Supervisor, and Liz George, Public Health Nurse and a trained Presenter for the ACE Interface materials. Below is a list of the findings and lessons learned to date about this new model:

  • Home visitors are now addressing the effects of ACEs on every caregiver/child dyad we visit, resulting in improved relationships and identification of the steps caregivers can take to improve their own health when they have been exposed to multiple ACEs
  • Home visitors help caregivers to increase their capacity to be a healthy buffer and to create safe and stable nurturing environments by administering ACEs questionnaires in a culturally competent manner, e.g. creation of an educational flyer for clients in English and Spanish that is also low literacy
  • Home visitors acknowledged the need to document all evidence based tools we were using as supporting evidence to our model
  • Home visitors created a data collection instrument in our electronic health record to effectively demonstrate the prevalence of ACEs among our client cohort; this in turn informs our funding sources and politicians regarding this Public Health issue in our community
  • Home visitors are committed to consistent and individualized reflective supervision for all staff members

The next steps identified by Julianne and Liz are the development of a tracking mechanism to demonstrate the effectiveness of the Field Nursing team’s ACE related intervention over time. They are researching linkages with the school system as well as use of satisfaction surveys to clients. Attached is the tool being used by the Field Nursing team. It is a double-sided handout with one side being “The Truth About ACEs Flyer,” developed by Robert Wood Johnson Foundation and the second side being a list of ways to build resilience which already are educational/intervention components of Field Nursing.

Congratulations Field Nursing on being invited to present at the 2018 ACEs Conference Project Showcase, and thank you for being a community leader in the ACEs/trauma-informed work in Sonoma County!


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Flyer used in field nursing when discussing ACEs/Resiliency with clients

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