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Trauma Informed Care - Episode 1 · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:00
  SPEAKER_00: You're listening to Vital Signs, a podcast for Sentera providers.
• 0:04
  SPEAKER_00: Welcome to episode one of the Trauma Informed Care Series.
• 0:08
  SPEAKER_00: In today's episode, we're joined by Tommy Batum, Director of Clinical Practice Management, and Austin Alderman, licensed professional counselor.
• 0:17
  SPEAKER_00: Before we turn things over to the team, here are a few important CME announcements.
• 0:22
  SPEAKER_00: This episode is accredited for AMA PRA Category One Credit.
• 0:26
  SPEAKER_00: For full accreditation, designation, and disclosure information, please refer to the show notes.
• 0:31
  SPEAKER_00: And now here are Tommy and Austin.
• 0:34
  SPEAKER_01: Hello, welcome to Vital Science, a podcast for Centera Providers.
• 0:38
  SPEAKER_01: I'm your host, Tommy Bateman.
• 0:40
  SPEAKER_01: And today we're talking trauma-informed care with Austin Alderman LPC.
• 0:45
  SPEAKER_01: Austin, how are you doing today?
• 0:47
  SPEAKER_01: I'm doing well.
• 0:48
  SPEAKER_01: How about you?
• 0:49
  SPEAKER_01: I am wonderful, and I'm excited to talk about trauma.
• 0:52
  SPEAKER_01: Um, so could can you give me a brief background into you and what got you into trauma-informed care?
• 0:59
  SPEAKER_02: Yeah, absolutely.
• 1:00
  SPEAKER_02: So thanks for having me.
• 1:01
  SPEAKER_02: Um I'm Austin Alderman.
• 1:03
  SPEAKER_02: I'm a licensed professional counselor.
• 1:05
  SPEAKER_02: I've spent most of my clinical career supporting individuals at the community services board, primarily working with children, adolescents, and families.
• 1:14
  SPEAKER_02: Uh I provided a range of services from intensive in-home to outpatient, and later in my clinical career moved into a leadership role uh to help oversee the school-based services, and they provided case management and therapeutic day treatment.
• 1:29
  SPEAKER_02: Um, I would recently have uh past three years been working for with Centera Health Plans now.
• 1:35
  SPEAKER_02: I supervise a team of primary care managers in our behavioral health department.
• 1:39
  SPEAKER_02: And what we're tasked with is outreaching and engaging members that have behavioral health and medical needs.
• 1:45
  SPEAKER_02: And our goal is to try to connect them to resources and services within their community so that we can hopefully improve their functioning, their health, and health outcomes.
• 1:55
  SPEAKER_01: So, what was it about um working at the CSBs?
• 1:59
  SPEAKER_01: Now, as a counselor myself, uh the answer seems pretty obvious to me, but for our listeners, you know, what was it about your professional background that ended up uh kind of landing you gaining expertise in trauma-informed care?
• 2:11
  SPEAKER_02: Yeah, uh what really drew me to the trauma-informed care.
• 2:14
  SPEAKER_02: I had some really great mentors when I was at the CSB.
• 2:17
  SPEAKER_02: And I, you know, I think if you're familiar, I think like a big the big buzzwords maybe in the early 2000s was like attachment, right?
• 2:24
  SPEAKER_02: Like children and adolescents attachment.
• 2:26
  SPEAKER_02: Um, and I think that was an area of interest of mine um looking at the attachment theory.
• 2:32
  SPEAKER_02: And it later grew to me participating in a few trauma-informed trainings.
• 2:37
  SPEAKER_02: And I think once I started getting that trauma-informed care mindset and shift, things just kind of from a clinical side started helping me see how people's struggles would make a lot more sense when I understood what they lived through.
• 2:51
  SPEAKER_02: So, like when we look at the behaviors through that trauma lens, suddenly those clients that might feel difficult or non-compliant, it they became much more understandable and human.
• 3:02
  SPEAKER_02: And I think the shift really helped me change my viewpoint as a provider and hopefully provided more uh better care for individuals who experienced trauma or just anyone who came in my office working from that trauma lens.
• 3:17
  SPEAKER_02: It helped me remove that judgment of the what's wrong with you to like what happened to you.
• 3:22
  SPEAKER_02: And that's a really common phrase that they use in a lot of trauma-informed care, so that we can help promote healing and hopefully not uh reinforce harm that they may have experienced.
• 3:33
  SPEAKER_01: Right.
• 3:34
  SPEAKER_01: So and yeah, with attachment, people think a uh a poor attachment with uh a child and the parent figure in in his or her life, uh, well, that what what what does that have to do with trauma?
• 3:47
  SPEAKER_01: But you know, the lack of attachment, the uh the uh um the lack of boundaries or whatever it is could be traumatizing on themselves.
• 3:55
  SPEAKER_01: And that sounds so broad.
• 3:56
  SPEAKER_01: And so maybe a listener is going, well, geez, what isn't trauma at this point if we're expanding it to even the parent-child bond?
• 4:03
  SPEAKER_01: So clinically speaking, how would you define trauma and and um and really how common is that uh that trauma compared to you know, the word trauma is thrown around all the time, you know, if this is traumatic, but there's a specific thing when we're talking trauma in a clinical context.
• 4:18
  SPEAKER_02: Yeah, absolutely.
• 4:20
  SPEAKER_02: And I think uh there's been a lot of people who threw out definitions.
• 4:23
  SPEAKER_02: I think the CDC has really adopted a what I think is a good definition for it, and what they refer to trauma is is really an event or a series of events where someone experiences something that was either physically or emotionally harmful or life-threatening, and it has left lasting adverse effects, like kind of breaking it down more from a person that we're working with or ourselves.
• 4:46
  SPEAKER_02: Some we experience something that overwhelmed our ability to cope.
• 4:50
  SPEAKER_02: So we are left with a lasting impact to how we think, feel, relate to others, or even our environments that we're put in.
• 4:58
  SPEAKER_01: And so it I think that they're there that definition, there's a bit of subjectivity to it in that it has to have a lasting impact.
• 5:08
  SPEAKER_01: So why do some let's just use the common thing with uh soldiers in war, why do some develop uh a traumatic response and others don't, even though they may have experienced the same exact thing?
• 5:20
  SPEAKER_01: It's not the it's not the event itself that's traumatic, right?
• 5:23
  SPEAKER_01: It's it's also the reaction to it with the individual person, right?
• 5:28
  SPEAKER_02: Absolutely.
• 5:29
  SPEAKER_02: Yeah, there's there's a lot behind the other understanding of the brain chemistry and and even just resilience, right?
• 5:35
  SPEAKER_02: They've all the time we've worked with multiple sibling groups where maybe they both came from an abusive home and as adults had two different life experiences, even though they came from the same background, right?
• 5:47
  SPEAKER_02: That one child may have had something more resilient in them or someone in their corner that helped build resiliency.
• 5:54
  SPEAKER_02: And that's really what I think trauma-informed care really strives to when we do this trainings for community organizations and other organizations, is if we can have a trauma-informed approach, that there's a lot of research that says just one supportive person can undo years of trauma, right?
• 6:14
  SPEAKER_02: So if we can be that supportive person, hopefully break down a lot of those experiences and allow them to feel safe and heal from those.
• 6:22
  SPEAKER_01: And so let's say someone, you know, as as we said, the same same event, different reactions, and often it comes down to things like resiliency.
• 6:34
  SPEAKER_01: I I should the listener hear that some people are stronger than others, uh, you know, or some of them have better thinking than others when it comes to trauma traumatic experiences.
• 6:45
  SPEAKER_01: What is the difference between someone that becomes traumatized and one that doesn't?
• 6:49
  SPEAKER_02: Yeah, I I think that a lot comes down to that that mind shift, how they're interpreting that event.
• 6:55
  SPEAKER_02: I think people see some traumatic events and see it as something that they overcame and that they've grown from and they're able to use it as a learning experience.
• 7:04
  SPEAKER_02: And other people see it as them being a victim, and they were a victim of this event.
• 7:09
  SPEAKER_02: And they for me, I think most trauma events come down to a loss of power, right?
• 7:13
  SPEAKER_02: Like the individual for that event felt like they lost power and control.
• 7:18
  SPEAKER_02: And either people feel like they regained that power and control, or they still continue to feel re-expose themselves to that time where they lost power.
• 7:27
  SPEAKER_02: They can't feel like they're in a safe enough environment to get control back.
• 7:31
  SPEAKER_02: So the trauma-informed approach is for those individuals who are still having those lasting effects and those negative things happening in their life, how can we give them a sense of control again?
• 7:42
  SPEAKER_02: How can we build that resilience in them where not maybe someone who experienced the same thing didn't doesn't need as much support to get back up from what occurred to them?
• 7:52
  SPEAKER_01: What type of lasting effects are you talking about?
• 7:56
  SPEAKER_02: Yeah, so I think when um it ranges from a little bit of everything, right?
• 8:02
  SPEAKER_02: Some people interpret a trauma event and depending on that event, not trust others, right?
• 8:07
  SPEAKER_02: Maybe be more standoffish to certain individuals.
• 8:11
  SPEAKER_02: Um, I think um there's a lot of research around like even smells, right?
• 8:15
  SPEAKER_02: Like if someone was uh abused by an individual, like if they smell someone who wears the same cologne or something, like that can be triggering uh to them.
• 8:23
  SPEAKER_02: Like a fight or flight response will be initiated.
• 8:27
  SPEAKER_02: And I think that's really what it comes down to is if you're exposed to something, whether here or in the community or in your home, in an event and it triggers that fight or flight response in us, then that that's when we know that might be an area we want to work on, right?
• 8:43
  SPEAKER_02: Like we shouldn't necessarily always be in a state of hyperarousal or hypervigilance.
• 8:48
  SPEAKER_02: Because we know from the research that they've done, being in that state constantly is going to link us to that negative health outcomes that we that they've tracked through the adverse childhood experiences, right?
• 9:02
  SPEAKER_02: That the fight or flight mode that we have is very helpful to us.
• 9:07
  SPEAKER_02: Uh Nadine Burke says it best in one of her TED talks, like, right, if you're in if you're in the woods and you see a bear, your body saying, Okay, it's time to run or fight the bear, that's that's a life-saving thing.
• 9:21
  SPEAKER_02: However, when that bear comes home every day and your body's constantly triggered, something that is life-saving starts pumping those cortisol, your body starts pumping all the hormones in there that we know have detrimental effects to us.
• 9:37
  SPEAKER_02: And so it's finding ways to get to a safe place where we can turn that off, where we're not constantly triggered to where we can end up having a better health outcome and not have something that's uh life-saving and adaptive to something that's maladaptive and harmful.
• 9:54
  SPEAKER_01: Yeah, and even when you were, you know, your brain processed the bear experience, you know, that is your brain protecting itself from future bear experiences, right?
• 10:04
  SPEAKER_01: It's working as it should.
• 10:05
  SPEAKER_01: There's nothing wrong with your brain, necessary, right?
• 10:09
  SPEAKER_01: Right.
• 10:10
  SPEAKER_01: Absolutely.
• 10:10
  SPEAKER_02: Absolutely.
• 10:11
  SPEAKER_02: Yeah.
• 10:11
  SPEAKER_02: It is uh it's your it's our it's our primal brain saying there's danger and we need to protect ourselves, right?
• 10:19
  SPEAKER_02: And and it's it's a good, it's a good thing to have, right?
• 10:22
  SPEAKER_02: It's a good thing to be able to react in those ways when we need it.
• 10:26
  SPEAKER_01: Yeah, I can imagine the person that doesn't have that primal response to bears.
• 10:29
  SPEAKER_01: Uh I think uh um they didn't make it to the next generation, they didn't pass on their genes, right?
• 10:35
  SPEAKER_02: Right, that's right.
• 10:36
  SPEAKER_01: We we got we're we're descendants of bear runners.
• 10:39
  SPEAKER_01: Um that's right.
• 10:40
  SPEAKER_02: Some Darwinism there came in.
• 10:42
  SPEAKER_01: Absolutely.
• 10:42
  SPEAKER_01: That's some evolutionary psychology right there for you.
• 10:46
  SPEAKER_01: Uh so you know, how prevalent is uh uh trauma?
• 10:51
  SPEAKER_01: And you know, why do why do providers really need to know um or have some information about trauma-informed care, not just us LPCs, why would a physician, um a PCP or nurse, anybody, why would anybody need to uh know this beyond us?
• 11:08
  SPEAKER_02: Yeah, so I I think the one thing that we know is is trauma is prevalent.
• 11:14
  SPEAKER_02: I think you said like the word trauma gets thrown out a lot.
• 11:16
  SPEAKER_02: Yeah, um, and I think it's a a much larger growing trend as there's been more awareness to it.
• 11:23
  SPEAKER_02: But really, the adverse childhood experience was a study done back in 1995 by Kaiser Primenite in conjunction with the CDC.
• 11:32
  SPEAKER_02: And what they did is they looked at 17,000 participants and they discovered that there was a powerful link between people who experienced childhood trauma such as abuse, neglect, had household dysfunction, and they would have an increase in chronic diseases, mental health illnesses, or other negative health outcomes as adults.
• 11:55
  SPEAKER_02: Um, and so it really showed that this is a it's a problem.
• 11:59
  SPEAKER_02: And the more the more adverse childhood experiences someone experienced, the worse health outcomes that they had.
• 12:06
  SPEAKER_02: Um, and this led to those higher risk problems with obesity and heart disease and depression.
• 12:11
  SPEAKER_02: Um, but the prevalence uh unfortunately, uh his study found that about two-thirds of the participants reported experiencing at least one ACE.
• 12:21
  SPEAKER_02: And uh one in five reported three or more.
• 12:25
  SPEAKER_02: Um, and that was back in 1995.
• 12:28
  SPEAKER_02: And I think there's been a lot of people who have attempted to replicate the adverse childhood experiences, and a few people have.
• 12:35
  SPEAKER_02: And I think the most recent data I looked at was in 2017, um, and they found that about 80% of people have experienced at least one adverse childhood experience.
• 12:47
  SPEAKER_01: Right.
• 12:48
  SPEAKER_01: And I do think, you know, and this is my my um observation is that there is becoming a much more awareness and advocacy of mental health things, you know, in general, and people are more able to identify, hey, what I experienced there maybe wasn't right.
• 13:06
  SPEAKER_01: So, you know, um I don't personally think that 80% is overinflated, right?
• 13:11
  SPEAKER_02: Um Yeah, yeah.
• 13:12
  SPEAKER_02: And I think the you know, if that happened in 2017, right?
• 13:15
  SPEAKER_02: It since then we've lived through a pandemic, right?
• 13:18
  SPEAKER_02: And we know health outcomes mentally, well, for mental health have worsened, right?
• 13:23
  SPEAKER_02: So I I imagine that number is probably even larger if someone was to uh do that study at this point.
• 13:29
  SPEAKER_01: Yeah, absolutely.
• 13:30
  SPEAKER_01: And in 20 years from now, for those kids that, you know, or adults 20 years from now that went to kindergarten during uh COVID, you know, and suddenly they're staying home and you know, some home environments aren't great, or you know, they're wearing masks in the school and that's odd, and that sort of thing.
• 13:48
  SPEAKER_01: So yeah, that's uh that's a very interesting uh uh um thought thought experiment for the future.
• 13:54
  SPEAKER_01: But Austin, thank you so much for introducing the topic.
• 13:57
  SPEAKER_01: When we come back, we want to talk about the core principles of trauma-informed care itself, and we'll see you then.
• 14:04
  SPEAKER_01: Thank you.
• 14:06
  SPEAKER_00: Thank you for joining us.
• 14:08
  SPEAKER_00: Be sure to keep an eye out for episode two of the trauma-informed care series.
• 14:13
  SPEAKER_00: You've been listening to Zentera Vital Science, a podcast created for Zentera providers.
• 14:19
  SPEAKER_00: As a reminder, please check today's show notes for details on how to claim your continuing education credits.
• 14:25
  SPEAKER_00: That's it for now, but we'll be back soon with another episode of Vital Science, the podcast that delivers evidence based education for physicians and healthcare providers on the go.