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Sonoma County PACEs Connection (CA)

Grand jury uses ACEs science to issue stinging critique of local health department

Editor's note: The Sonoma County Department of Health Services Public Health Department's response to the Grand Jury was filed in September 2017. It is attached to this post.
The 2016-2017 Sonoma County (CA) Civil Grand Jury issued a remarkable  report today. Tucked among the "Sales Tax Report" and "Elementary School Truancy" was — "Maternal Child and Adolescent Health: Caring for the Most Vulnerable".

The 10-page report casts an unblinking eye on the consequences of adverse childhood experiences in Sonoma County, a large rural county of more than 500,000 people north of San Francisco. It examined how the work of public health nurses in the Maternal Child and Adolescent Health (MCAH) section of the Sonoma County Department of Health Services' Public Health Department is crucial to preventing ACEs in the county.

What led to this report was an MCAH advisory board meeting attended by the civil grand jury, whose members were surprised to witness "visibly distraught"  board members. A few days later, grand jury members learned that 16% of the already understaffed section was taking early retirement because of a new county contract that public health nurses said resulted in a reduction in health benefits. The grand jury members took it upon themselves to look into this, and discovered that Department of Health Services was further reducing staffing and not filling empty positions. 

The report concluded: The misunderstanding about retirement benefits that resulted in losses of experienced staff is an example of the disconnect between management and front-line employees. Poor communication has resulted in low morale and a lack of knowledge of DHS long-term strategy. Preventing ACEs with upstream investments pays long-term dividends, and yet it appears that DHS is reducing its commitment to the effort.
Here's the beginning of the report: 

Adverse Childhood Experiences (ACEs) is a well-researched constellation of traumas that affects the overall health of Sonoma County. The term ACEs specifically refers to childhood trauma that may lead to social ills, such as truancy, mental-health issues, drug use, and incarceration. The population most at risk of ACEs is children born into poverty. Prevention of ACEs in families eligible for Medi-Cal is a responsibility of the Public Health Division (PHD) of the Department of Health Services (DHS) of Sonoma County. However, Maternal Child, and Adolescent Health (MCAH), the primary entity responsible for prevention of ACEs is being allowed to wither. DHS Administration has reduced staffing in crucial programs, and morale has declined. Research strongly suggests that programs supporting expectant mothers and their very young children, called upstream investments, are an effective way to reduce the occurrence of ACEs. MCAH manages the programs that address ACEs, which are:

  • Women, Infants and Children (WIC)
  • Nurse Family Partnership (NFP)
  • Field Nursing (FN)
  • Teen Parent Connection (TPC)

MCAH supports Medi-Cal recipients who are mothers and their children. NFP and FN are the supportive programs that use Public Health Nurses (PHNs) to make home visits to these families that are expecting or have a new infant. They work with WIC and the Teen Parent Connection to provide care for the first 1,000 days of a baby’s life. These upstream investments by MCAH result in healthier children who have improved chances to become productive adults, and who will likely rely less on public resources during their lifetimes.

Current DHS priorities for this Division are balancing the budget, reorganizing, and updating policies and procedures. The important role that MCAH plays in the upstream investments in Sonoma County’s neediest children and families has been undermined by significant staff reductions. While the DHS focuses on budget cuts, it could be shortchanging the most vulnerable members of our County.

The Civil Grand Jury recommends a plan to fill and maintain PHD positions that will prevent compromising service for the most impoverished. Without increasing staff, the rates of drug abuse, teenage pregnancy, school dropouts, incarceration, and homelessness are likely to rise.

To read the entire well-written, fascinating report, go to:

And you may notice that at the root of the other civil grand jury reports — on school truancy, the homeless emergency, and support for programs in the county's detention facilities — are....ACEs.

btw, is this a first? Does anyone know of any other local grand jury that's incorporated ACEs science in a report?
Also, here's some additional information about how the Sonoma County (CA) Civil Grand Jury is selected and operates:
The Sonoma County Civil Grand Jury (CGJ) is an independent institution with the principal function of overseeing all aspects of county, special - districts and city governments in the County to ensure that the best interests of its citizens are being served. The 19 Grand Jury members are selected annually from applications submitted by County residents to serve a one - year term. 
Selection Prospective jurors are summoned to appear before the Presiding Judge in a public session in late June. The Judge selects a few members of the existing CGJ to serve an additional one - year term to provide institutional continuity. The court clerk draws individual names at random from the pool until a 19 - member plenary is reached. This body constitutes the CGJ for the next fiscal year. All 19 members take the oath of office and are “charged” by the Presiding Judge concerning their duties and responsibilities.
Investigations The GGJ conducts investigations based on citizen complaints and on its own initiative. A minimum of 12 members of the plenary must authorize an investigation. In conducting its inquiry, the Grand Jury is authorized to: 
 • Inspect and audit the financial expenditures of county and city departments and special districts to ensure that public funds are properly accounted for and legally spent. • Inquire into conditions of jails and the treatment of inmates. • Inquire into the performance of any county, city, or special - district public official or employee. 
 Committees The CGJ four investigative standing committees are: 
 •  Cities and Special Districts •  Law and Justice •  Human Services  •  County 
 Committees carry out authorized investigations under the supervision of the plenary. They evaluate the procedures, methods, and systems used by the various agencies to determine if their operations are fair, efficient, economical, and legal. Ad hoc committees are created as circumstances warrant. 


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