PHC6937: Addressing and Preventing Adverse Childhood Experiences through Targeted Home Visits and Social Support

Adverse childhood experiences (ACEs) are associated with several negative birth outcomes, as well as maladaptive health behaviors during pregnancy including smoking, substance use disorders, depressive symptoms and suicide^1,2. Alachua County has higher than average rates of poverty, as well as preterm birth and low birth weight, representing a need for additional support and access to services³. To address these needs, this program aims to support pregnant women with a history of ACEs in facing their own past trauma, receiving mental health or substance abuse recovery services and learning about the impact of ACEs on a developing child as they prepare to become parents. The program will also support these new parents as they transition into the caregiver role by providing parenting education and social support through the child’s first birthday. Through this, the program aims to heal past trauma, improve pregnancy outcomes and prevent the occurrence of ACEs in their children.

Towards these goals, the grant provides monthly home visits with a nurse or social worker; participants will have three prenatal home visits followed by monthly visits through their child’s first birthday, individualized based on need over a range of topics including substance use recovery, prenatal support and education, parenting education, breastfeeding and nutrition support, mental health services, healthy stress management, contraceptive services, infant developmental screenings, and connection to additional resources as needed. The grant will additionally provide participants with the opportunity to develop a network of social support through monthly gatherings, including a shared meal and two hours of paid childcare by qualified caregivers. The gatherings will include structured activities lead by the social workers and interested participants to promote connections between participants and further program goals, and unstructured time for participants to connect informally.

Trauma Informed Principles

This project emphasizes the incorporation of trauma-informed principles into all levels of program development and implementation.

The first key principle this project with utilize is safety by ensuring all staff are trained in the concept of safety and how to recognize early signs that an individual may be experiencing trauma^4,5. The program will work carefully to ensure both staff and participants feel safe during home visits, as well as social and group activities. Care will also be taken to ensure physical spaces are warm and inviting.

The second key principle is trustworthiness and transparency^4,5. Program staff will work consistently to ensure participants understand the project and its goals. Additionally, within the organization, leadership will ensure transparency with all staff. All program staff will also actively seek input from participants on their needs and interests in developing program components, and program results will be made available to all participants.

The third key principle addressed is peer support and mutual self-help through the creation of peer support networks and the opportunity for social gatherings with other program participants^4,5.

The fourth key principle addressed is collaboration and mutuality^4,5. As described above, participants will play an active role in project development, and home visits will be tailored specifically to meet their needs. Additionally, the participants themselves will offer input on topics for discussion/activities at the social gatherings; participants will further be encouraged to take a leadership role at these gatherings.

Levels of Social Ecological Model

This project will focus primarily on the intrapersonal and interpersonal levels of McLeroy’s social ecological model⁶. The intrapersonal level of the social ecological model is addressed through the services aimed at helping participants heal past trauma, as well as other mental health and substance use recovery services, and the direct education offered through the program. The interpersonal level is addressed by the creation of a peer social support network and the opportunity for supportive interactions in this context. The interpersonal level is also addressed because of the benefits to the participant’s children through the establishment of a positive home environment and the prevention of future ACEs.

Public Health Framework

The project utilizes several concepts of a public health framework, including utilizing an upstream approach while also recognizing the value of each of the three levels of prevention. Within a public health framework, the project incorporates a multi-level, multidisciplinary approach including services from both social workers and health care providers, as well as connection to services offered by other community organizations as needed.

References

1. Graham M. Creating a Trauma Informed State A Showcase of Florida’s Cutting Edge Trauma Initiatives.; 2018. www.floridatrauma.org. Accessed February 12, 2019.
2. Smith M V, Gotman N, Yonkers KA. Early Childhood Adversity and Pregnancy Outcomes. Matern Child Health J. 2016;20(4):790-798. doi:10.1007/s10995-015-1909-5
3. ALACHUA COUNTY COMMUNITY HEALTH ASSESSMENT 2016 ALACHUA COUNTY COMMUNITY HEALTH ASSESSMENT (CHA). http://alachua.floridahealth.g...cuments/2016-cha.pdf. Accessed February 12, 2019.
4. Samhsa. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.; 2014. https://store.samhsa.gov/system/files/sma14-4884.pdf. Accessed March 8, 2019.
5. Philanthropy Network Greater Philadelphia. Trauma-Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley. https://c.ymcdn.com/sites/www....maGUIDE_FinalWeb.pdf. Accessed March 20, 2019.
6. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351-377. http://www.ncbi.nlm.nih.gov/pubmed/3068205. Accessed February 25, 2019.