Latest / Moral Injury Support Network Podcast / Exploring the Impact of Childhood Trauma on Long-Term Well-being with Dr. Shanta Dubé: Unpacking ACEs, Moral Injury, and Resilience Training

Transcript

Exploring the Impact of Childhood Trauma on Long-Term Well-being with Dr. Shanta Dubé: Unpacking ACEs, Moral Injury, and Resilience Training · Moral Injury Support Network Podcast

• 0:03
  Speaker 1: All right well, welcome to the Moral Injury Support Network for Servicewomen podcast.
• 0:07
  Speaker 1: I'm the co-host, Jamie Peer, serving as the Senior Executive Officer for the Moral Injury Support Network for Servicewomen, and I'm joined by my co-host, dr Daniel Roberts, who is the President and Founder of the Moral Injury Support Network.
• 0:22
  Speaker 1: And in today's episode, we have the privilege of speaking with a distinguished guest who has made significant contributions to the field of public health.
• 0:33
  Speaker 1: Our guest is a thought leader and an experienced public health practitioner, researcher and instructor with a demonstrated history of groundbreaking scholarly health studies.
• 0:45
  Speaker 1: She has received national and international recognition for her work as an early investigator of the CDC, kaiser, adverse Childhood Experiences or ACE study.
• 0:58
  Speaker 1: As a social and behavioral epidemiologist, our guest possesses extensive practice knowledge in addressing social determinants of health.
• 1:07
  Speaker 1: Her expertise also extends to digital health interventions and data capture.
• 1:13
  Speaker 1: Dr Dubé Shanta Dubé, is the creator and trainer for the why and how of Trauma-Informed Care, providing invaluable insights into supporting individuals who've experienced trauma.
• 1:25
  Speaker 1: So, without further ado, we are so honored to have you here today, dr Dubé, sharing your expertise and insights, and we'd love to dive into this conversation and how it interfaces with moral injury.
• 1:43
  Speaker 1: And so we'll get started.
• 1:46
  Speaker 1: So thanks for joining us today.
• 1:50
  Speaker 2: Welcome, Dr DeBay.
• 1:52
  Speaker 3: Thank you.
• 1:52
  Speaker 3: Thank you so much, jamie and Dr Roberts.
• 1:55
  Speaker 3: I'm thrilled to be here.
• 1:56
  Speaker 3: It's a privilege and an honor, and I thank you both.
• 2:02
  Speaker 1: Yes, Okay, so the first big question that we have today and I know it's a big question is can you explain how the adverse childhood experience of research has advanced our understanding of health across the lifespan and do you have any specific insights that has provided to this research?
• 2:28
  Speaker 3: Yeah, thank you for that question.
• 2:29
  Speaker 3: So the landmark CDC Kaiser ACE study which launched in the mid 1990s around 95, really started with some findings from Dr Folletti who was one of the co-PIs.
• 2:43
  Speaker 3: Some findings from Dr Folletti who was one of the co-PIs and in those initial findings in his clinic he found that patients who were successfully losing weight were dropping out of his clinic and he learned from a study he conducted that they had experienced parental loss, childhood sexual abuse and other childhood tumultuous experiences and that really led to the launch of the ACE study at CDC in the Chronic Disease Center.
• 3:12
  Speaker 3: And really what we have learned from that study is that not only do ACEs actually impact physical health, like cardiovascular health and pulmonary health, but also mental, emotional and social well-being is negatively impacted.
• 3:31
  Speaker 3: And so I would say you know something that we already know about childhood that it's in.
• 3:40
  Speaker 3: You watch any movie actually and the theme is you know the individual, it goes back to the end of the heroine or the heroes, the main characters, childhood and I mean this is a theme that I've seen repeatedly.
• 4:00
  Speaker 3: But I would say the science of the research has really helped us to understand how common trauma is in early life, that abuse, neglect and related household stressors are very common and they're interrelated.
• 4:17
  Speaker 3: Look at them as its score, the ACE score.
• 4:23
  Speaker 3: We find positive dose response relationships with health, social and behavioral outcomes and what this has really brought to light is a better understanding to realize how common they are, how common these experiences are About 50 to 60% of adults experience at least one adversity and also to understand the underlying factors to health behavior across the lifespan.
• 4:58
  Speaker 1: Yeah, thank you for that.
• 5:01
  Speaker 1: So my next question because I think it, I definitely want to make the connection between ACEs and moral injury is is could you discuss the concept of these adverse childhood experiences as moral injury and its impact on the development of an individual self concept and its impact?
• 5:25
  Speaker 3: on the development of an individual self-concept, absolutely so.
• 5:31
  Speaker 3: I looked up the definition of moral injury and, as I understand it, some of the definitions did focus on the military, but if we thought of it more broadly and universally, it refers to this lasting emotional, psychological, social, behavioral.
• 5:44
  Speaker 3: It refers to this lasting emotional, psychological, social, behavioral, spiritual impacts that can violate core moral injury and they can extend into adulthood.
• 6:14
  Speaker 3: I would say that in fact we haven't really understood how ACEs can impact.
• 6:22
  Speaker 3: You know we need to understand better, I should say, how ACEs can impact, for example, spiritual well-being.
• 6:30
  Speaker 3: But in some of the talks I've had with individuals in substance use recovery, what I have learned is, in fact, these types of experiences can really thwart spiritual development in individuals.
• 6:52
  Speaker 3: And another area that I've been studying more recently is childhood emotional abuse, which is really defined as adults verbally abusing the children, and so I would say that in that realm, when we say things, do things that can threaten children early, it can lead to because self-concept development starts early in the lifespan these kinds of experiences can thwart positive view of oneself.
• 7:32
  Speaker 3: Kids remember, kids think in black and white and so they're not abstract thinkers.
• 7:41
  Speaker 3: Yet that comes much later in development.
• 7:44
  Speaker 3: So so when they're seeing right, when they see mom and dad fighting, it is discord.
• 7:52
  Speaker 3: There is discord when they're told they're bad.
• 7:55
  Speaker 3: They are bad and so that actually can impact self-concept, self-esteem, which we know can lead to a lot of negative outcomes.
• 8:09
  Speaker 2: Yeah, so yeah, so so one of the things I think it's great information.
• 8:14
  Speaker 2: I love the way you're connecting all the dots there.
• 8:18
  Speaker 2: You mentioned you use the word spiritual a couple of times and I'd love to get get.
• 8:23
  Speaker 2: So when you say spiritual development, what do you mean?
• 8:26
  Speaker 2: What are you referring to exactly?
• 8:28
  Speaker 3: well, you know, to be honest, dr Roberts, in some of the interviews I've had with um persons in NA I should just be I mean, I'm not gonna, it's anonymous, I'm not saying any names, but um, in fact, when I was studying spirituality and health, they had actually mentioned that early in life religion had actually been somewhat abusive, like it was very strict or, you know, parent the parents.
• 9:02
  Speaker 3: Punishment was focused around something related to, you know, a religious belief, which which impacted them.
• 9:12
  Speaker 3: But as they went through NA because it's a different type of a program right, it's more ofa, it's the 12 steps they had an opportunity to reframe those spirit, the kind of those negative religious experiences, to more positive spiritual wellbeing.
• 9:33
  Speaker 3: So I don't know if that explains, but I mean I'm speaking from some of the work I've done in this area and working with substance use recoveries.
• 9:46
  Speaker 2: Yeah, that's great.
• 9:48
  Speaker 1: Yeah, I also think of spirituality as feeling connected to something bigger than yourself, and when you, your sense of self has been compromised, you know, through these adverse childhood experiences, it's so number one.
• 10:09
  Speaker 1: Are you even thinking like that Because your own situation is so hard?
• 10:14
  Speaker 1: Are you thinking about anything outside of yourself?
• 10:17
  Speaker 1: But then you also have this idea well, why would that happen to me?
• 10:23
  Speaker 1: If you know there's something outside of myself is good, why did this happen to me?
• 10:27
  Speaker 1: Or I don't care about feeling connected to other things.
• 10:32
  Speaker 1: My, you know, my situation's not that great.
• 10:34
  Speaker 1: So that's really interesting.
• 10:37
  Speaker 1: Yeah, go ahead.
• 10:41
  Speaker 3: Well, I just want to say it's not all negative.
• 10:45
  Speaker 3: Also, spirituality is an important factor.
• 10:49
  Speaker 3: Our belief system is important to actually promoting our, our positive well-being, and so thinking about that as well as is is important in all of this and in in the midst of adversity.
• 11:06
  Speaker 3: Yes, and maybe that's the thing.
• 11:09
  Speaker 1: Maybe that's the thing that actually helps make some sense of it, if, if there is such a if, we can do that, okay.
• 11:17
  Speaker 1: So, in your opinion, going back, you know, going towards the healing and the resiliency piece, what are some of the key factors that you think promote resiliency in individuals who have experienced adverse childhood experiences?
• 11:38
  Speaker 3: Well, I think that's a great question and spirituality does fit into this.
• 11:42
  Speaker 3: It's a great kind of transition, but I think it's important to recognize that in recent years, well, resiliency research has been there, for been around for a long time, but in the midst of ACEs there's been a whole new body of research around positive childhood experiences and the importance of what those look like, for example, safe, nurturing, supportive relationships.
• 12:11
  Speaker 3: You know it does go back to Bowlby's theory around attachment, secure attachment between caregiver and children.
• 12:19
  Speaker 3: So I would say, starting early in the lifespan, it's important to consider specific types of or types of positive childhood experiences that can actually, and what the research shows, lead to what they call stress adaptability, so they can adapt to stressful situations as and if they occur.
• 12:42
  Speaker 3: And so, as I mentioned, safe, supportive, nurturing relationships are important toward that.
• 12:50
  Speaker 3: But in a study that I actually published amongst adult survivors because one of my areas that I've really tried to focus and bring greater awareness to is to get to that primary prevention of these what we call traditional ACEs we looked at in the ACE study we really have to work with the adults right.
• 13:11
  Speaker 3: The adults have to recover and heal so that it doesn't get transmitted to the next generation.
• 13:16
  Speaker 3: That's why we continue to see that intergenerational cycle.
• 13:20
  Speaker 3: And so in the study I was curious, I'm like, well, what leads to well-being amongst adults who've experienced at least one ACE?
• 13:28
  Speaker 3: So I did a study with the Behavioral Risk Factor Surveillance System, which now implements ACE's measures, and looked at 12,000 adults who reported at least ACE.
• 13:42
  Speaker 3: And then I created a health promoting score and looked at smoking abstinence, regular physical activity, social support and their educational level being high school or greater.
• 13:54
  Speaker 3: And then the outcomes that I examined were two measures physically unhealthy days, so the respondents basically say in the last 30 days, how many days were you physically unhealthy?
• 14:09
  Speaker 3: And then physically, I'm sorry, mentally unhealthy days, which is a similar measure around mental health, in the past 30 days.
• 14:17
  Speaker 3: And what I actually found is if the adults engaged in all four of those factors, on average, they had a week less of unhealthy days that prior month.
• 14:32
  Speaker 3: And so there's I can't make causal, we can't make causal inferences because it's cross-sectional data but we can definitely say there's a correlation between adult survivors, you know, engaging in what we know are evidence based health promoting factors and reducing unhealthy days for them.
• 14:53
  Speaker 3: So I would say, all in all, these are factors that increase social support, increases oxytocin hormones, neurotransmitters such as serotonin, dopamine, and having those safe, supportive, nurturing relationships.
• 15:12
  Speaker 3: Time in nature, not being exposed to stress, giving our sensory, our senses, nutrition.
• 15:22
  Speaker 3: So that means trying to be in nature, trying to engage in things that just really provide us sensory nutrition rather than sensory toxins.
• 15:36
  Speaker 1: Yeah, I really like that.
• 15:38
  Speaker 1: I like that term sensory nutrition.
• 15:40
  Speaker 1: I like to spend a lot of time in nature and, yeah, you do feel like you're feeding yourself a bunch of goodness.
• 15:47
  Speaker 1: So that's a new term.
• 15:49
  Speaker 1: I love that.
• 15:49
  Speaker 1: Dan, do you have any thoughts before I move on to the next question?
• 16:15
  Speaker 2: elements with the physical and physiology type things you know, to be able to connect spiritual concepts or ideas or activities with dopamine and these other physiological kind of things.
• 16:25
  Speaker 2: And it just helps, you know, reinforce the idea of holistic health.
• 16:30
  Speaker 2: You know, reinforce the idea of holistic health, that we're all connected, it's all connected and that how you feel and how you think affects, you know, the physical body.
• 16:49
  Speaker 2: And so you know holistic health has a good bit of research on there, but in practice a lot of times it's still.
• 16:56
  Speaker 2: It still ends up being like a focus on.
• 17:00
  Speaker 2: You know, if you go see the doctor, the focus is on physiology.
• 17:04
  Speaker 2: Or if you're, you know, in the chaplaincy where I work, you know the focus is on spiritual.
• 17:12
  Speaker 2: But we're not as practitioners, we're not all always connecting all those things really well, and so I love that bit about seeing how this is all connected and interrelated.
• 17:28
  Speaker 3: Absolutely.
• 17:28
  Speaker 3: I love that, dr Roberts.
• 17:31
  Speaker 3: It is about holistic health, it is about mind-body connections and it's in, I should say, mind-body-spirit connections.
• 17:41
  Speaker 3: In another study of trauma survivors we asked what would have helped or what hurt, and when we looked at what helped, it was being validated having individuals to speak with and, importantly, they also mentioned the use of body work like dance therapy, yoga, massage.
• 18:05
  Speaker 3: So I mean, I think we have to understand ACEs.
• 18:09
  Speaker 3: They aren't you can't prevent them with antibiotics.
• 18:11
  Speaker 3: You can't prevent them with't you can't prevent them with antibiotics, you can't prevent them with vaccines and you can't treat them with antibiotics.
• 18:16
  Speaker 3: And once they occur, you can't prevent them.
• 18:19
  Speaker 3: And so it's a little different.
• 18:23
  Speaker 3: Stress and trauma and that whole area is just a little.
• 18:26
  Speaker 3: It's quite different from what we might deal with if you have a strep throat or if you're trying to be vaccinated against the flu.
• 18:35
  Speaker 3: It's a different beast from a public health perspective.
• 18:39
  Speaker 3: And we do know from population level data that a large proportion of adults have experienced ACEs, the traditional aces, the abuse and the household stressors.
• 18:52
  Speaker 3: And you know, while there have been reductions in physical and sexual abuse, for example, largely due to campaigns, they still are prevalent, but we are seeing an increase in emotional abuse through the BRFSS and again I believe that's largely due to childhood verbal abuse.
• 19:14
  Speaker 3: It could be displacement because of all the work to prevent physical abuse.
• 19:18
  Speaker 3: So I mean I think we just need to draw attention and be very aware of these various exposures and that they do impact not just physical health but our spiritual and mental well-being as well.
• 19:39
  Speaker 1: Yes, so I know I sent you the questions ahead of time, but as you've been talking, I want to put a different spin on the next question, which is you know we're the Moral Injuries Support Network for Service Women.
• 19:56
  Speaker 1: A big part of our mission is doing the research, hearing these women's stories, extracting from them what you know they wish they would have known what they wish the people in their lives would have known what they wish their leaders would have known what they wish the people in their lives would have known what they wish their leaders would have known at the time.
• 20:15
  Speaker 1: And then we're infusing that into what we provide as training to practitioners.
• 20:21
  Speaker 1: But another extension of that is what we would love for military leaders, the leaders of these service women, to understand about them so that they can be better leaders.
• 20:34
  Speaker 1: So, knowing what we know about you know we we grow up, having lived through these adverse childhood experiences they affect our how we see the world and the lens by which we see and hear information.
• 20:51
  Speaker 1: How do you think or what would you say to military leaders, not just about things that happen in the military, but just to better understand the population that they have, because we kind of all come into the military with stuff right and how that stuff presents itself, some leaders might react to it and say, well, you're not a good soldier, you're not a good person, you're not a good fit.
• 21:19
  Speaker 1: But there could be something else going on and, in their awareness and their understanding of ACEs and how it affects people, could actually help them be a better leader to their folks.
• 21:35
  Speaker 1: So what would you say to military leaders about how ACEs can manifest and also how to help people move through that so that they can be more effective at their job?
• 21:48
  Speaker 3: I appreciate that.
• 21:49
  Speaker 3: That's a great question, jamie.
• 21:51
  Speaker 3: So, as you mentioned earlier, I have developed the Y&H trauma-informed care and I have delivered that not to the military but to, for example, educational systems, healthcare systems, juvenile justice.
• 22:06
  Speaker 3: It is about educating and bringing awareness, and the beauty of the trauma informed framework from SAMHSA, which is informed by the ACE study, is it really lays out like what do we need to do?
• 22:20
  Speaker 3: And what we need to do is help bring awareness to realize how common ACEs are, how common trauma is.
• 22:30
  Speaker 3: Help leaders to realize the outcomes of early toxic stress developmentally, how it impacts us, our systems, but also what it can lead to behaviorally, socially and health-wise.
• 22:47
  Speaker 3: And really the only way to do that is to get in front of them and hope that they can be ready to have an open mind.
• 22:55
  Speaker 3: I mean and presenting the data.
• 22:58
  Speaker 3: Like I am an epidemiologist, data speaks.
• 23:03
  Speaker 3: Everything we do in public health is informed by data.
• 23:05
  Speaker 3: That is one of our core functions is assessment through data and, you know, getting in front of military leaders to show them the data that's out there and it's not in the DOD, although I know that the DOD has done some of their own surveys.
• 23:22
  Speaker 3: So it's just a matter of building that awareness, that acceptance of the science.
• 23:28
  Speaker 3: And it's not just the awareness, but we have to accept this is what it is.
• 23:36
  Speaker 3: There is a high burden of ACEs in the population, in adults, and until we address it in the adults, it's going to keep cycling.
• 23:47
  Speaker 3: And so that is the other key message to military leaders is understanding your, you know the military population, that they will be coming in.
• 23:59
  Speaker 3: I'm not saying they can.
• 24:00
  Speaker 3: He will be coming in with you know past experiences, moral injury, and it's important that it's considered and understood.
• 24:10
  Speaker 3: So it's really about realizing the burden, recognizing the impact and then being able to help military leaders, help everyone they work with, to respond, to respond with support, transparency, all the things that survivors really need in the face of difficult situation.
• 24:42
  Speaker 3: And then resisting re-traumatization.
• 24:44
  Speaker 3: Those are actually the four core areas of trauma-informed care.
• 24:47
  Speaker 3: The resisting piece is really about building our own resiliency and helping others to build their resiliency.
• 24:58
  Speaker 1: Yeah, I see Dan's got a comment or a question.
• 25:01
  Speaker 1: What do you got, Dan?
• 25:03
  Speaker 2: Yes, I think it's a great point and I think with military leaders, I think at the higher levels, there's a sense of you know, treating people with respect and that kind of thing.
• 25:18
  Speaker 2: I think where I've seen some real issues is in the basic training program, right, with drill sergeants.
• 25:26
  Speaker 2: So you've got these young kids, yes, and you have drill sergeants with their own aces, right, and then they have tons and tons of power, not unlimited power, but an exorbitant amount of power, like the power differential is very big between and I've just seen you know that there's can be where abuse can happen.
• 25:50
  Speaker 2: So you need tough, realistic training you need.
• 25:53
  Speaker 2: I mean, if you're sending the soldiers to combat, you can't talk them through that, right, they need tough, realistic training.
• 26:00
  Speaker 2: But where sometimes you see young leaders with that kind of power is they confuse.
• 26:06
  Speaker 2: They don't understand the difference between tough, realistic training and abuse, right.
• 26:14
  Speaker 2: And so if you're a drill sergeant, you can yell at a soldier, you can get in their face and not demean them at the same time.
• 26:23
  Speaker 2: You don't, you know, by not calling them names and giving that, you can still do training that really challenges them and and and actually builds their self-esteem.
• 26:40
  Speaker 2: By doing that without abusing them and making them feel you know so the name calling that that used to go on.
• 26:50
  Speaker 2: I don't know to what extent it does now.
• 26:52
  Speaker 2: It's certainly against policy.
• 26:53
  Speaker 2: But the name calling that used to happen when I first came in the Army versus what's supposed to happen now is one good example.
• 27:05
  Speaker 2: You can be extremely tough on soldiers and yet make them feel like they're growing in their military professionalism and strength, not being abused.
• 27:17
  Speaker 2: So.
• 27:17
  Speaker 2: But when you get in front of these young, young NCOs and officers, you're trying to send that message.
• 27:25
  Speaker 2: It can be difficult for them to hear because it sounds like, oh, you just want me to be soft and it's like no, you have an obligation to do tough, realistic training, because these soldiers might go to war.
• 27:39
  Speaker 2: But you can do that in a way that builds them up, and so having those conversations with military leaders can be difficult and tricky, and it can be difficult to get beyond their own internal resistance and not make them feel like you're taking power from them, but you're just helping them understand hey, these people are coming in fragile in a sense, and it's your job to build them, not tear them down.
• 28:16
  Speaker 3: So yes, absolutely Build them up, not tear them down.
• 28:20
  Speaker 3: I love that.
• 28:21
  Speaker 3: Dr Roberts, you know, one thing that comes to my mind when you say this the power differential.
• 28:30
  Speaker 3: That's why parents for so long have said you can't tell me how to discipline my child.
• 28:36
  Speaker 3: It's a power, you know.
• 28:39
  Speaker 3: Parents want to feel that they still have the power to tell their kids what to do.
• 28:45
  Speaker 3: But, like you said and I'm not trying to compare parents to military, but it's about power, you know, and the adult to child, in an adult to child power in this case that you were explaining, it's a military leader to a new recruit power differential, right, and so I completely see where you're coming from, and but I do think there is a way to communicate, as you mentioned, that they can be built up, they can be trained without being torn down.
• 29:20
  Speaker 3: The other thing I want to just mention about, you know, educating or talking to leaders is these new recruits, if I'm not mistaken, are 18, 19, 20 on average.
• 29:32
  Speaker 3: If I'm not mistaken, are 18, 19, 20 on average.
• 29:34
  Speaker 3: So, from a neurobiological perspective, their brains aren't fully developed, right?
• 29:47
  Speaker 3: The brain doesn't fully develop until mid-20s.
• 29:48
  Speaker 3: We know that that's a fact 25, 26.
• 29:50
  Speaker 3: And so they're still adolescents, they're just older adolescents and I don't know if that fact is really well understood and how.
• 30:02
  Speaker 3: Yeah, they're probably maybe coming in with some things from home childhood, but they're still developing childhood, but they're still developing no-transcript.
• 30:21
  Speaker 1: Yes, and I was thinking, and Dan kind of alluded to this when we progress through our military career and we continue our education and leader development and those kinds of things, sometimes you're not learning about things like emotional intelligence and ACEs and moral injury until you're so far removed from those 18 to 20 year olds that by the time what you're trying to convey to your subordinates gets down to that level, it's it's all but lost.
• 30:54
  Speaker 1: And it's interesting to me that you know I get it by design.
• 31:01
  Speaker 1: It has to be this way.
• 31:02
  Speaker 1: But I think we could be better in the military when you have 18 to 20 year olds being led by 20 to 24 year olds and nobody's brains quite there yet, you know, and the stuff that comes with experience over time and the lessons learned that could really be getting infused into that youngest generation by the the more most experienced people.
• 31:32
  Speaker 1: That's not, that's not happening and so it's kind of like I I've said the blind leading the blind in the past, but it's more.
• 31:41
  Speaker 1: You know the, the lack of life experience, the lack of life experience leading the lack of life experience, and we could be so much better than we are and getting those leaders who are informed on ACEs and moral injury, and you know trauma informed.
• 31:59
  Speaker 1: I know we don't really talk about trauma informed leadership, but I do think that that is something you know.
• 32:05
  Speaker 1: Just being aware of what people are coming in.
• 32:09
  Speaker 1: You don't have to know all the details, you just have to know that everybody's got stuff Right, absolutely.
• 32:17
  Speaker 3: I didn't mean to cut you off, I just, yeah, I can't agree with you more.
• 32:20
  Speaker 3: And that's what trauma informed is all about.
• 32:22
  Speaker 3: Like there's this whole area in our field and public health, like you, should be screening for ACEs.
• 32:28
  Speaker 3: We even did a project when I was at CDC with the DOD around screening ACEs and new recruits and we did a feasibility study and we found that there wasn't a lot of acceptability at that point for screening for ACEs.
• 32:43
  Speaker 3: Acceptability at that point for screening for ACEs, Because at that point and I want to say this was around 2004, you know, we didn't know about trauma-informed care, there weren't interventions and one of the key findings was well, don't screen if you don't have something to an intervention, which is true, we don't screen unless we have an intervention right, or do diagnostic screening even for that matter.
• 33:09
  Speaker 3: But my point of this is trauma-informed care doesn't say to screen.
• 33:14
  Speaker 3: Trauma-informed care says to assess so that you know your population, you understand your population, not to diagnose, not to judge, but to understand.
• 33:27
  Speaker 3: And I think that's an important distinction because there's all this.
• 33:32
  Speaker 3: You know, some people are doing research around screening, for example, in pediatric settings, which I think that that might be warranted because that's a critical period to make sure that you know, understand if aces are occurring and to kind of intervene or not kind of but to intervene as a pediatrician.
• 33:51
  Speaker 3: But generally speaking, when we take a trauma informed approach, it's really to understand, assess, to understand who we are working with.
• 34:01
  Speaker 1: Yeah, we are working with.
• 34:08
  Speaker 1: Yeah.
• 34:08
  Speaker 1: So you mentioned several times about interventions and I would love to hear about any examples of successful interventions or programs that have been implemented, based on ACEs research, that have shown positive outcomes.
• 34:47
  Speaker 3: Um, well, I don't know of any specific programs I can talk to, but I can talk to the research around different methods and ways and approaches that trauma survivors can promote their well-being.
• 34:51
  Speaker 3: I know there have been a lot of programs Now.
• 34:52
  Speaker 3: Bessel van der Kolk in Boston has done a lot of research around the use of trauma-informed yoga for actually for combat veterans with PTSD, and so I think that that is one area that and what he has done, cause I actually took a training on trauma-informed yoga and what he has done is, I believe, created train the trainer program where people can go there, learn and then take that back and um train others in in that work.
• 35:19
  Speaker 3: And in fact when I took that training, they talked about the ACEs study.
• 35:23
  Speaker 3: So it was really nice, I wasn't expecting, and then she was talking about ACEs in her first lecture.
• 35:33
  Speaker 3: So I would say yoga, mind-body practices are definitely some of the key programs that have been developed, researched and utilized.
• 35:46
  Speaker 3: There are other mind-body or complementary and integrative approaches that are being researched and developed, but many of these programs there's also even I think there have also been some exercise programs but generally speaking, you know they've been researched.
• 36:07
  Speaker 3: I would say they're evidenced, informed and can really be beneficial around healing and recovery.
• 36:17
  Speaker 1: Well then, it sounds like there's still a lot of work to be done in regards to creating programs that help people, which is part of what our mission with missions is, is we're we're trying to again take the research that we're learning and infuse it into spaces where service women are already showing up for help or healing or treatment.
• 36:46
  Speaker 1: Um, and just you know, understanding moral injury and ACEs can be a huge compliment to what they're doing.
• 36:55
  Speaker 1: So I think that's, it's uh.
• 36:58
  Speaker 1: It's uh I don't want to say it's discouraging that there isn't more out there, but it does does speak to the need for this greater awareness that we're all trying to create and how, how our respective fields of study can compliment one another in in providing that help.
• 37:16
  Speaker 1: We're going to start talking about technology and then we're going to start to wrap this up and this has been such a great interview with you, dr Dube, we feel so blessed by your willingness to join us today and social epidemiologist, what are your perspectives on the potential of digital health technologies to help promote health and well-being in populations affected by ACEs?
• 37:52
  Speaker 3: I think that's a great question.
• 37:54
  Speaker 3: Well, first of all, we know that mobile apps, mobile health, can reach a lot of people.
• 38:02
  Speaker 3: Why?
• 38:02
  Speaker 3: Because almost everybody owns a cell phone.
• 38:05
  Speaker 3: It doesn't matter and this is based on Pew Research and surveys that even beyond socioeconomic strata and I mean everybody, owns a phone.
• 38:19
  Speaker 3: And that's why I mean, let me just take a step back.
• 38:21
  Speaker 3: That's why large surveillance systems respondent telephone-based surveillance systems, like the behavioral risk factor surveillance system, moved to a dual, what they call a dual frame to include both landline and cell phones, because without the cell phones, a large population was being missed.
• 38:45
  Speaker 3: So, you know, cell phones are very critical because everyone has one and with a cell phone, usually a smartphone we all have apps and there are some very creative, innovative apps that have been created.
• 39:02
  Speaker 3: I've actually developed one myself.
• 39:04
  Speaker 3: Apps that have been created I've actually developed one myself and I'm still kind of working on it and researching and trying to get it out up and out there but just innovative ways to reach vulnerable populations, you know, innovative ways to gather data, and so I think that it's an important means through which to reach individuals.
• 39:26
  Speaker 3: I mentioned we were talking about programs, you know I forgot to mention there's also mindfulness programs and meditation programs that have been developed as well, kind of go a little hand in hand with yoga, but maybe slightly different yoga but maybe slightly different.
• 39:48
  Speaker 3: And so there are apps out there that you know provide exercises and approaches for individuals to build their resiliency through some of these mind body techniques.
• 40:09
  Speaker 3: So I know that work is ongoing and is happening.
• 40:14
  Speaker 3: So, short answer, incredibly important, moving forward.
• 40:20
  Speaker 1: Yes, and I think Dan will smile when I say this one population who always has a cell phone are soldiers.
• 40:29
  Speaker 1: So even even now in the basic training environment, I'm seeing that they're, they have their phones and so, yes, it is a very powerful platform that can reach, you know, vast audiences and and I love that you're kind of on the cutting edge of taking the ACEs research and figuring out how we can help more people this way.
• 40:54
  Speaker 1: Okay, so one of the reasons we are doing these podcasts right now is to highlight some of the speakers that are going to be joining us for our comprehensive moral injury conference this September, and you are one of those speakers and we're really looking forward to sharing space with you.
• 41:14
  Speaker 1: You know, not just virtually but in real life, and that's one of the benefits of people who can attend in person is that we'll have you know, we'll get to listen to you lecture and then maybe we'll even get to talk over.
• 41:23
  Speaker 1: We'll have you know, we'll get to listen to you lecture and then maybe we'll even get to talk over lunch or dinner.
• 41:29
  Speaker 1: You know those kinds of things.
• 41:30
  Speaker 1: But what are you most looking forward to during your attendance at the Comprehensive Moral Injury Conference this year?
• 41:39
  Speaker 3: Oh, I'm excited because this is the first time I'll be in person.
• 41:42
  Speaker 3: I think I did it, I did, I've been twice, I think Right, dr Robert, I can't remember, but I've presented, but it's been virtual, maybe just once.
• 41:53
  Speaker 3: And I'm excited about being in person and really networking and hearing from others actually and learning.
• 42:00
  Speaker 3: I'm a lifelong learner so I love to impart my knowledge where I can and help others to gain their knowledge.
• 42:09
  Speaker 3: But, most importantly, I am kind of a sponge and I like to learn what others are doing in this area, especially since this is been primarily focused on the military, merely focus on the military.
• 42:27
  Speaker 3: I have, you know, I have an interest in understanding various populations and settings.
• 42:29
  Speaker 3: So military is a setting in a population.
• 42:30
  Speaker 3: That that's what we do in public health is.
• 42:32
  Speaker 3: We look at settings and populations.
• 42:34
  Speaker 3: So I think it's going to be a very rich experience and I'm really looking forward and I'm very honored to be presenting amongst the other researchers and practitioners and I think it's going to be just as the other conferences have been.
• 42:51
  Speaker 3: I learned a lot, even virtually, even though I wasn't there in person from the other speakers in terms of how they're framing and research, moral injury, trauma and what are the key action steps, programs, interventions that they're examining to either prevent or mitigate the adverse outcomes?
• 43:17
  Speaker 1: Yes, wonderful Dan.
• 43:19
  Speaker 2: Yeah, it was great Last year.
• 43:23
  Speaker 2: You attended, you spoke about ACEs and it was.
• 43:26
  Speaker 2: You attended virtually and that was great, and so we're really looking forward to having you again this year.
• 43:34
  Speaker 2: I think one of the things we've tried to do with the Comprehensive Moral Injury Conference, a lot of the presentations maybe most tend to be focused on military, but we really want to broaden the scope and get people to think about moral injury as a human problem, not a military problem, and so ACEs and what you bring talking about ACEs really helps do that and helps build that understanding of this is not a military veteran issue.
• 44:05
  Speaker 2: It was originally coined by Shea who worked with you know, military veterans returning from Vietnam.
• 44:13
  Speaker 2: But the more we get into it and look at it and and what ACEs definitely proves is that it's by far a human problem and that most people at some point in their lives many early on in their life experience these potential moral injury experiences that then go on to shape the rest of their life.
• 44:42
  Speaker 2: If we don't get a handle on it, start helping them work through it.
• 44:49
  Speaker 2: And the other thing I would say is that with the program that Operation Unified Support, that Moral Injury Support Network for Service Women is launching, where we're looking, where we're going to help women veterans find those holistic health type resources, should create a lot of data for us to use as we look at various programs that a lot of different nonprofits are doing that we just don't know about but are really making a difference, and that'll help us gather some data based on, you know, our surveys of women veterans after they attend and and as we continue to follow up with them, so that we can then inform practice care and and those programs that are really doing well, we can elevate them and help them have access to more clients and so on.
• 45:48
  Speaker 2: So, yeah, the conference is going to be great and you're going to be a huge part of it.
• 45:53
  Speaker 2: We're really excited about that and it should create.
• 45:58
  Speaker 2: You know, the idea is to create ongoing conversations, to leave the conference and continue to work together, support each other, find ways to care for the folks that we're trying to help.
• 46:08
  Speaker 2: So, yeah, we appreciate you.
• 46:18
  Speaker 3: Well, I appreciate both of you, dr Roberts and Jamie, for putting this together.
• 46:21
  Speaker 3: It is so critically important and I'm grateful and appreciative that ACES is getting integrated In terms of my advocacy around that it's getting integrated it's, you know, in terms of my advocacy around that is really helping to build awareness, acceptance and adoption of the science and I do appreciate that opportunity.
• 46:38
  Speaker 1: Well, thanks again, dr Dubé, for joining us today.
• 46:41
  Speaker 1: For those that are listening, we will have all the information about our Moral Injury Conference, along with information about missions and what we're doing.
• 46:50
  Speaker 1: We'll provide some links to Dr Dude Bay's work so that you have any other interest in learning more about ACEs research.
• 46:59
  Speaker 1: We'll have that provided.
• 47:00
  Speaker 1: And thanks for joining us today.
• 47:03
  Speaker 1: And if you do know of any programs that are working to help service women or people with moral injury or trauma, let us know.
• 47:14
  Speaker 1: Let us know that you're out there and we would love for you to attend our conference for sure.
• 47:18
  Speaker 1: So thanks again, everybody.
• 47:21
  Speaker 1: Have a great day.