Maternal, Child, and Adolescent Health - Caring for the Most Vulnerable*

Miscommunication related to retirement benefits in the Public Health Division contributed to the resignation of experienced Public Health Nurses. We disagree wholly or partially with finding numbered F1. Response: Information circulating in the community in June 2016 regarding a possible settlement to a lawsuit related to retiree health benefits (Sonoma County Association of Retired Employees versus Sonoma County) seemed to be an issue of concern that spurred a number of experienced Public Health Nurse and other County employee retirements prior to June 30, 2016. The County of Sonoma did not share information publicly on confidential mediation proceedings that were underway in the spring of 2016. (Note: An August 7, 2016 article in the Press Democrat reported a total of 47 County retirements in June 2016, a 175 increase from the previous year, including ten in Permit & Resource Management Department and six in Department of Transportation & Public Works.)

Poor communication between the upper management of Department of Health Services and the staff in the trenches has resulted in poor morale. We agree with finding numbered F2. Response: It is true that the wave of Public Health Nurse retirements in June 2016 and the inability to fill Public Health Nurse vacancies created a feeling of concern and low morale among the remaining Public Health Nurse team and that a historic lack of communication between management and staff regarding fiscal challenges contributed to the low morale. The Department's Executive Team, however, has taken a number of significant steps to improve communication. Upon assuming the Health Services Director position in September 2016, the Director initiated and recently completed a series of "listening tours" throughout the Divisions to learn about program services and challenges and share with staff her vision for the future. In addition, the Director initiated all-staff meetings (webcasts) to bring issues of importance directly to staff, including sharing with staff the fiscal challenges facing the Department. Since September 2016, two all-staff meetings (webcasts) have been held. The intent is to hold two meetings per year going forward. In addition, with the goal of improved communication across the Department and increased operational efficiencies, the Director requested the Assistant Director convene an ongoing meeting with experienced administrative managers across the organization prior to new guideline and policy implementation. 3313 Chanate Road, Santa Rosa, CA 95404 phone (707) 565-4700 . fax (707) 565-7849 It is the responsibility of management throughout the organization to provide leadership, communication, and guidance to all staff including proactively sharing information with staff. Each member of the Executive Team is committed to providing additional regular and timely two-way communication with staff, with the goal of continued improvement in staff morale (see Communication Plan below).

The policy of reducing Public Health Nurse outreach to at-risk populations creates the appearance of efficiency by failing to count these clients, and thus creates a false impression of achievement. We disagree wholly or partially with finding numbered F3. Response: The Department is committed to improving health outcomes for the highest need residents in Sonoma County, including at-risk pregnant women, their babies and families. There is no policy to reduce Public Health Nurse outreach to at-risk populations. Instead, the Department continues to implement best practices, evaluate outcomes, and foster partnerships to deliver services in the most efficient and effective ways to meet the needs of our clients. There are approximately 2,000 low-income births each year in Sonoma County. Of these 2,000 births, the Department's Field Nursing program prioritizes families with the highest medical/social needs. Over 80 percent of Field Nursing clients have two or more risk factors, in addition to being low income. The most common risk factors are mental health concerns, homelessness or housing insecurity, substance use, domestic violence, and medical concerns for mother or baby. Partnership with clinics, hospitals, community-based organizations, and other county departments are critical to the success of these efforts, given that client needs are multiple and complex. The Department of Health Services is committed to identifying the right services, at the right level, in the right places. This may mean identifying partners who are better positioned to deliver a continuum of services in order to achieve higher levels of efficiency and effectiveness. Increased outreach could help engage additional at-risk women and babies who are not connected to services. The Department recognizes that an effective strategy for identifying and delivering comprehensive services involves agencies well beyond the county. Given limited resources, the Department is actively pursuing strategies to utilize existing funding in a more effective way through coordinating and leveraging expertise of other programs and providers. The Department is committed to collaborating within the Departments' divisions, with other county and community providers to ensure that we are providing the highest quality of services, breaking down silos, and sharing resources to meet the needs of high-risk families.

Maternal, Child and Adolescent Health's ability to prevent Adverse Childhood Experiences has been seriously undermined by the reduction in Field Nursing staff from eleven to six. We disagree wholly or partially with finding numbered F4. Response: Childhood experiences, both positive and negative, have a tremendous impact on the health and well-being of a child. Adverse childhood experiences include a broad range of stressful and traumatic events such as physical abuse/neglect, sexual abuse, violence, substance abuse, parental separation/divorce, incarcerated household member, etc. While it is true that home visiting professionals are uniquely positioned to talk with parents about adverse childhood experiences and how their adverse childhood experiences histories may be influencing their lives, the Department and the Maternal, Child and Adolescent Health 3313 Chanate Road, Santa Rosa, CA 95404 phone (707) 565-4700 fax (707) 565-7849 program is actively working to prevent and address the negative impacts of adverse childhood experiences in many other ways along the spectrum of prevention. For example, through its Mobilizing Action for Resilient Communities grant, Adverse Childhood Experiences and Resiliency Fellowship, and participation in the Sonoma County Adverse Childhood Experiences Connection coalition, the Department is working to build broader community understanding and expand community capacity to prevent the transmission of adverse childhood experiences to future generations. Similar to other public health issues, a successful strategy will require the Department coordinate and build relationships with community providers through strong collaborative efforts.