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Traumatic experiences can have significant health effects, particularly when they are experienced during childhood. Structural determinants of health including environmental disasters and limited access to mental health services and affordable housing can contribute additional stress for parents with a personal history of childhood adversity. These factors can directly affect their children, contributing to intergenerational trauma.
Pregnant people and families with young children are often referred to public health nursing maternal and child home visiting (HV) programs when there are concerns about historical or evolving childhood trauma. The strict eligibility and participation requirements of existing evidence-based maternal and child HV programs can exclude families that have experienced or are experiencing childhood trauma and its effects and can limit innovation by public health nurses, a hallmark of the field.
Therefore, we advocate and describe the implementation of the Trauma Informed Approach in Public Health Nursing (TIA PHN) model, which incorporates a trauma-informed approach into a traditional maternal and child HV program in 3 California counties. TIA PHN, which began enrollment in March 2021, involves public health nurses and community health workers and integrates program evaluations in pursuit of evidence-based status. (Am J Public Health. 2022;112(S3):S298-S305. https://doi.org/ 10.2105/AJPH.2022.306737)
Trauma, which includes adverse childhood experiences (ACEs), has long been recognized to have substantial negative effects on health and health behaviors across the life span. It is only in recent years that trauma has become recognized as a public health crisis that affects entire systems and communities across generations.1 In the United States, evidence-based maternal and child home visiting (HV) programs have shown great promise for optimizing family health and, thus, reducing the longterm health-related effects of trauma.
Programs such as the Nurse Family Partnership and Healthy Beginnings are generally funded through county, state, and federal sources.2-4 These interventions require extensive research before they can be considered evidence-based and thus eligible to be supported by public funds and disseminated widely. They also perpetuate structural bias in that the counties and organizations that are already well resourced are the ones that are able to secure fundingto implement and evaluate these types of programs.5 Furthermore, such requirements do not allow for flexible implementation of innovative approaches tailored to local needs and populations. As a result, health systems miss opportunities for public...