NEAR@Home Toolkit: A Guided Process to Talk about Trauma and Resilience in Home Visiting

For the past year, a small facilitating workgroup and a large planning committee from federal Health Resources and Services Administration Region X (Alaska, Idaho, Oregon and Washington) have come together virtually and by phone to create NEAR@Home, a toolkit for addressing Adverse Childhood Experiences (ACEs) in home visiting. The group agrees that the ACEs framework and the NEAR science has the ability to strengthen the work in home visiting and improve outcomes for children and families. Thank you to all who contributed to this process.
Home visitors knowledgeable about ACEs research are interested in bringing this information to families but worry about causing harm. The NEAR@Home toolkit addresses these concerns and provide strategies for engaging parents in discussing and using the ACEs questionnaire in a safe, respectful, and effective way for both home visitor and family.
We now understand how adversity becomes embedded into biology, behavior, and risk and how simple supports and opportunities can deliver stunning improvement in the lives of the people we are, and the people we serve. Parents deserve to know the largest public health discovery of our time. They should have the opportunity to talk about their own life experiences and consider how they might like to use new scientific discoveries to give their children greater health, safety, prosperity, and happiness than they had.
Home visiting professionals are uniquely positioned to talk with parents about what we are calling NEAR Science — Neuroscience, Epigenetics, Adverse Childhood Experiences, and Resilience — especially about how their ACE histories may be impacting their lives and may influence their parenting. Because home visiting is relationship based and occurs within each family’s comfort zone, home visitors have the opportunity to ask, listen, and affirm. They are highly skilled in building trust and creating safe spaces for meaningful conversations, and they are practiced in the art of family support.
The NEAR@Home toolkit was created, reviewed, and tested by home visitors, mental health providers, and other experts in the field of NEAR and home visiting in Region X (Alaska, Idaho, Oregon, and Washington). The toolkit is based on a theory of change with five core elements: Preparing, Asking, Listening, Affirming and Remembering. It is designed for home visitors who have some basic knowledge of NEAR science and have at least one year of experience in their model home visiting.
The toolkit is designed as a training manual with guided processes to help you learn and practice language and strategies to safely and effectively talk about the trauma of ACEs. We emphasize safety and reflective support for the home visitor as a critical element in this process. Using this process home visitors will build skills in the therapeutic use of self and discover increased compassion, patience, and stamina in their work with families.
The NEAR@Home toolkit is a work in progress. It was created by people who feel passionate about the necessity of finding a way to bring NEAR science to families and who are committed to creating best practices for home visitors. This is why we are sharing this work at no cost and through the web. We welcome suggestions on cultural adaptations, more scripts, missing pieces, etc. and your thoughts on how relevant this toolkit is to other areas of home visiting such as depression screening.