Trauma-Informed OT with Adolescents

Are you aware of the hidden traumas that adolescents face daily that can sometimes go unnoticed?

In this episode Dr. Park sheds light on the subtle negative experiences that may go unnoticed but have a long-term impact on these young lives. The discussion also takes us beyond traditional understandings of trauma to recognize the broader spectrum that encompasses a sense of not belonging and exclusion due to identity-based microaggressions.

Join us as we uncover the impact of trauma on adolescents, discuss the importance of inclusive education, and foster a greater understanding of how OTPs can support those dealing with trauma in meaningful ways.

Listen now to learn the following objectives:

• Learners will gain an understanding of the different types of trauma experienced by adolescents and how these experiences impact their daily lives.
• Learners will explore practical strategies to create trauma-informed classrooms and inclusive environments that promote healing, growth, and resilience.
• Learners will develop a toolkit of evidence-based interventions and approaches that can be used to address the effects of trauma in school-based settings.

Wish you could earn professional development for listening to this episode?

Members of the OT Schoolhouse Collaborative can earn a certificate of completion by listening to this episode and completing a short quiz after logging in. Learn more about this at otschoolhouse.com/collab 

Already a member? 

Log into your account here to complete the quiz. 

Thanks for tuning in!

Thanks for tuning into the OT Schoolhouse Podcast brought to you by the OT Schoolhouse Collaborative Community for school-based OTPs. In OTS Collab, we use community-powered professional development to learn together and implement strategies together.

Don't forget to subscribe to the show and check out the show notes for every episode at OTSchoolhouse.com

See you in the next episode!

Transcript

0:00

I don't know. If it were my children, it would not have been. It would not. My microphone does a pretty good job to it, like cancel. Well, that and zoom zoom does a good job too, at noise canceling out, too. Okay, so we are officially recording. Just hit that blue button that says okay, and I'm going to start my timer, and we can go ahead and get started. All right, Dr. Park. Welcome to the OT schoolhouse. Podcast. How are you doing today? Thanks, Jason. It's really nice to be here. Thank you for having me. Yeah, I'm excited to have you here. We're going to be talking a lot about trauma and aces, and we'll get deeper into aces in just a moment, but I'm really excited to have you on. I know you are in that professor role now and director or I think it's doctoral coordinator over at the University of St. Augustine for Health Sciences. And you work a lot with that college age student. Now. However, I know what we're going to be talking about today can also be somewhat relevant to maybe some of those students who are in high school and going through adolescence or in a transition type of program. So I'm just excited to talk to you today and talk a little bit about trauma Aces and how we can overcome that. So, yeah, thank you so much for being here. Thank you. I'm really excited too. This is one of my favorite topics to talk about. Awesome. Well, before we dive into all of that fun stuff, I just want to give you just a moment to kind of share where you are in your occupational therapy profession right now. Yeah. So I'm currently a doctoral capstone coordinator and assistant professor at the University of St. Augustine for Health Sciences. I'm on the San Marcos, California campus. So our West Coast campus. And in this role, I support doctoral students in their capstone process as they work through their projects. And also I've been doing some mentorship related to kind of understanding the experience of trauma. So a lot of the students that maybe focus on children with the experience of trauma in their background or history, mentoring the students to really understand kind of the complex, holistic experience that children and youth may experience and so really focusing on helping supporting them understand that process and to be able to obviously create programs or conduct research in a way that's really going to be supporting the population. Wow, that's a very unique position to be in, not just the larger the broader aspect of doctoral coordinator, but also really honing in on that trauma for not trauma for the students necessarily, but kind of overseeing that area a little bit. So does that mean that there are quite a few students that are looking more into trauma, whether it be school age students or otherwise? Absolutely. So I used to be also a fieldwork coordinator, academic fieldwork coordinator at a previous institution. And so I think there has been kind of this emerging interest in looking at the experience of trauma in children and youth. And a lot of our students come with a background, maybe with experience working with children in general and then are noticing that maybe there are some negative experiences that they've had in their past. And thinking about as an occupational therapist, how do we really focus on the occupational impact of this for the child and also the family, the community as a whole? And so I do feel like that has been a topic that more students have been interested in. And so as we've gained more interest from our students, we've also then been able to partner with different community settings. And once we establish these partnerships, the settings are telling us there's a need here and we don't have this perspective from an occupational therapist necessarily. And so it's been a really nice partnership or a match for our students to be able to step into some of these spaces where maybe there aren't established OT services and they're able to address some of these areas that I think we really do have a really nice role for. Perfect. I'm excited to dive into that. However, there was one more thing on the personal side that I wanted to get into first, and that is that you're also the Vice President of the Asian American Pacific Islander Occupational Therapy Association. And I kind of wanted to mention that and also ask you a how's it going? And also what are some of the responsibilities and priorities that you have in that? Yeah. Yes, thanks so much for mentioning that. So I was recently elected earlier this year, so I've been in this role for maybe six months, so it's still pretty new for me. And we sort of had a rebranding the association, it was previously called Asian Pacific Heritage OT Association. And so it's been around actually for a few decades and it's been a part of the multicultural diversity, oh gosh, I'm going to mess that up. MDI network through AoTA. And so within the MDI network, we've been a part of this network for I think almost three decades, but we're in this process of kind of rebranding the association. We did come up with a new name, so now we're the association of Asian Americans and Pacific Islanders in Occupational Therapy, or Aapiot. And I think along with the Asian American experience, really emphasizing how there are some unique strengths within our community, obviously some unique challenges. I think there were some challenges and some concerns that came up especially during the pandemic with some anti Asian hate crimes and such. And so really trying to increase the visibility of dissociation within the profession because we do have a good number of Asian American practitioners in our community across the country. And so really wanting to support Asian American therapists, asian American Pacific islander therapists who are kind of experiencing some of these unique challenges, whether it's in practice or within OT communities and spaces. And so we've been creating some different initiatives. We have a really great series on Instagram right now, looking at just kind of different occupations within different cultures within the Asian diaspora. So we've had students and practitioners that have been providing some different posts that we've been able to highlight. So definitely if you're interested in learning more, follow us on Instagram and our other social media accounts like LinkedIn and Facebook. And there's some really great stories on the post. A lot I've been spending a lot of time on LinkedIn, so I've been seeing it over on LinkedIn. And, yeah, it's just been a lot more present than I know it was even maybe six months to a year ago. So that's awesome. Great. It's working. We want to mention also that we want to get individuals engaged. We want to make sure that people know that we are here. We're an established association. We are here to support the Asian American Pacific Islander community in occupational therapy. And so if there are projects or programs or research that people are interested in that we'd love to connect, a lot of the leadership were connected with different universities or different areas of practice within the country. And so there's a lot of interest to kind of growing these other aspects to be able to support our community. Great. Well, thank you for sharing. Thank you. All right, well, let's go ahead and dive into our main topic for today, and that is talking about that experience of trauma. As I mentioned, you are now at that college level, but a lot of this information, this research that we're going to be talking about today, I really think can apply to that adolescent age and transition age period. So I want to ask you, from your perspective, why is it so important to address the trauma and mental health of teens and young adults? I know this is a little loaded, but I'll let you share kind of your response. Right? So I think I've been working in this area looking at childhood trauma and complex trauma in different populations for a while now through my practice and also through field work experiences. But I think the COVID-19 pandemic really placed this increased focus on this discussion of trauma right. In children and adolescents. The disruptions that were caused by the pandemic, school closures, the isolation that children were experiencing, the fear and the grief that we all felt because of the virus, it really exposed many of our children and youth to potentially these traumatic experiences. And so I think since the pandemic, there's this growing discussion about the impact. And I don't know if we really understand even the long term impact right from what happened during those years. And so kind of understanding there's a broader picture going on. I think previously there's been more of this I don't want to say simplified, but this kind of narrow understanding of trauma that it's very individual and it's abuse and these really super what I call big T trauma. And so I think since the discussion of trauma came about during the pandemic, we're really starting to understand some of the really subtle ways that maybe our children and youth are experiencing some negative experiences in their world and within their context with our students. I do work with graduate students and I actually recently completed a chapter on adolescence and adolescent development for an OT textbook. And there's this emphasis in this time period around identity formation. And so there's an author, his name is Jeffrey Arnett. He talks about this period of emerging adulthood. And before it was thought that adolescents, they just become adults, they turn 18, they get a job, they go to college. And so there was a different shift from adolescence to adulthood. But now we're starting to consider this period of emerging adulthood which is really kind of encompassed by this developing self identity, kind of this feeling of in between and kind of this uncertainty too, of I'm not exactly sure where I'm going. Adolescents and young adults are taking a little bit longer figuring out their careers. They're not settling down in committed relationships as frequently or as early as in the past. And so really kind of thinking about this emerging adulthood and that identity formation and how potentially kind of everything that's happening in the world that is challenging, that is really difficult to understand and to manage, how that really impacts the way that we might develop and form that identity is something that I try to really emphasize in the work we do. Absolutely. I mean, developing your self identity is just huge, especially for that adolescent, young adult age. And there's a lot of things that we're seeing at high school that's very different from when I was in high school, 20 years now or so. And we're seeing teens get much more involved in politics. We're seeing a lot of policies put in place that they don't necessarily agree with and we're just seeing them take on more of that activist role. And part of that is that self identity that they're starting to see the impact that they can have on politics. I think a lot younger, which I know again, when I was younger, they were like begging us to get out, to do more political type of things, get out and vote. But I think nowadays we're seeing, like you mentioned, maybe they're not getting into their career as early, but they're still starting to be much more of an advocate for themselves and individualized, but also as a community. And they're coming together as a community to self identify as well. Are there any other things you want to share a little bit about addressing trauma with this age group? Right. I think the point that you bring up about kind of these social justice movements within the adolescents, currently young adults. I think that it's so wonderful to see people getting so engaged in causes and speaking up and voicing concerns about some of the problems that our country and our world is facing. So I wrote a little bit about this in the chapter, too, the increase in social media, the access that we have now to news and kind of varying perspectives and just more information that comes from social media. And so I think that's something that's so interesting to see young adults, even my own children, I have teenagers, I have a 13 year old, a 16 year old, and an 18 year old. And sometimes they'll share something with me that they learned on social media. And I'm like, Where did you learn that? And they'll say, oh, I read that, I heard that on TikTok. I'm like, oh. And they always say, See, TikTok can be educational. But also, because of the social media presence, especially in the youth and adolescents, we also see them having that exposure to some of the really traumatic experiences happening around the world. So the images of violence and images of these really terrible events that are happening, there's so much more exposure to those kinds of events and also just the emotions that come about from that exposure. I think it's really important to be able to communicate with the youth and to be able to process through, because sometimes the experience of just being exposed to the images can be also seen as a somewhat traumatic event. Yeah, I mean, social media is huge, right? You think about even ten years ago, much more so 2030, 40 years ago, parents and adults had much more say, much more control over what teenagers were exposed to. And now with social media, you're just getting so much more information. And we're hoping that social media is starting to, in a way we want them to filter, but we don't want them to filter. It's a hard balance. I know it's hard for social media, right? But they can get the information from any side, from any point of view, rather than just getting the point of view of the adults in their life. And also being able to critically think too critically analyze and see. Different perspectives and to really kind of decide for themselves, like, what is important to them, what is a value for them, and to be able to support some of the causes that they really find value in. Yeah, and there was one other term that I wanted to mention before we move on to talking more about aces and trauma was the age of feeling in between. That was something that you've mentioned in the past. Can you explain what that means for this? That's another that's part of the concept of emerging adulthood that Arnett has talked about, where, again, in the past, there was kind of this more clear path that our adolescents would take. They would graduate high school. They would get a job, go to college. And now we find that emerging adults are kind of choosing very different paths. And so you mentioned the activism piece, but people are taking gap years and traveling more and just kind of taking more time to decide for themselves what really is important to them. Is it really important to settle down and be in a committed relationship or partnership more long term? Or is it more important to kind of explore different thoughts, different causes in the world? And so I think that's something that we're seeing more of, especially in this phase of emerging adulthood. And so it's interesting to see with our OT students because obviously they're in a program, a rigorous graduate program, and they've chosen this path. But I think at the same time, in the process, especially of the Capstone, we're still trying to facilitate kind of this thought process, this critical analysis, this critical thinking of all kind of the events that are happening in the world and how it relates to them and how they connect with their communities. Great. Well, thank you. Let's go ahead and move on to asus I kind of brought it up in the intro, but I think a lot of us understand the term Aces. But you also kind of mentioned a capital T, so maybe there's a lowercase T. So I want to give you an opportunity to kind of explain Aces to your understanding and how you define it. Yeah, so Aces, for those that may not be familiar, it's adverse childhood experiences. And so this was a study conducted in the 90s by a physician through Kaiser. And he started to find that a lot of the patients that he saw, adult patients that maybe had these ongoing health concerns, chronic health conditions, he started to just ask some questions, just in conversation and then starting to identify this pattern that a lot of these individuals that had some of these ongoing, chronic health conditions later in life had very similar negative experiences in childhood or toxic experiences or toxic stress. And so based on that initial observation, he conducted this study where he created, like, this ten item questionnaire asking, have you had exposure to childhood physical abuse? Sexual abuse, emotional neglect, physical neglect? Did you have a person in the home that had a mental health condition? Was there a person in the home that was a substance user? Did they witness domestic violence? And so based on that, the responses he found this relationship between Aces and later health concerns, that the more Aces you had, the more that you reported these negative experiences in childhood, that it turned out that these individuals struggled with more of these conditions later on. And so that's something that he published in the there's been so much discussion around this, and I think initially there was I think this kind of doom and gloom sense of like, oh my gosh, well then if this is the trajectory, then oh my goodness, these individuals are just going to have all these problems. And one of the findings was that there was also early death some of these individuals. But as an OT, I think really kind of criticizing the whole notion that this is the only trajectory for individuals, for all of our kids that maybe do experience some type of traumatic event or pervasive trauma in childhood, that as OTS, we argue that there is a way to really turn the ship around. And so there have been some criticism of the Aces, especially because initially the study was done through Kaiser, and so it certainly included a certain demographic of patients. And so it didn't really take into consideration multiple socioeconomic classes or ses status levels. And it really kind of negated an understanding of some of these other traumatic events that now we're a little bit more attuned to. So that includes like, systemic racism and oppression, the global pandemic. So the pandemic is definitely an ace. All of our children, we can count that. And also the experience of collective trauma. So maybe it's not something that we as an individual may experience directly or individually, but as a community, I think there's a lot of communities that have been targeted in our country that have experienced violence. And so this collective trauma of having an identity with a certain community and feeling this fear and feeling the sense of loss from that, I think a lot of people are now arguing that there is a need to really think about all of these other factors too, and also really understanding the value of trauma informed care. So, again, not to paint this picture of doom and gloom, if you have these aces, you're headed down this path of having all these health conditions. But there's this value in really thinking about trauma informed care as protective factors for our kids. So there's literature about how a stable, consistent caregiver in the life of a child is going to be that protective factor buffer the environment, the social, cultural context, it could either be a buffer, it could be also a barrier or a cause for more negative experiences too. And so there's been kind of this need or push to redefine aces. And there's this one resource through the Paces connection. So paces being positive and adverse childhood experiences. And there's a really nice website that has a lot of information on this. So Paces being that we want to consider all of these things, it's a very holistic picture of not just here are these negative experiences which leads down this terrible path, but how do we also support the buffering of our children, right? How do we now think about how to increase those positive experiences to then support our children in their development? Very interesting. I had not heard of paces yet. So thanks for sharing about that. And earlier. One thing that I'm really interested in, and you kind of alluded to it earlier, is that capital T? Because I think when a lot of us think of trauma, we think of the household, right? Things that happen in the household. A lot of those Aces that you mentioned earlier were like experiencing and or witnessing domestic abuse or whatever it might be. It's usually in the household, but obviously trauma doesn't just happen in the household, right. So what are some other factors outside of the household? You mentioned a little bit with society, but I think environmental was one of those that you wanted to discuss. Yes, absolutely. So environmental factors, I think the Pandemic is a great example of that. But in certain areas of the world, natural disasters, the climate crisis, access to resources or not, or having some of that deprivation, when it comes to resources, there's also community factors too, that wasn't really addressed or explored in the original Aces study. So thinking about poverty and food scarcity and housing instability, I think with the understanding of more structural racism and oppression, all of these things within the community environment, I think those are factors that we're starting to understand a little bit better and how that may impact a child. And I also want to bring up kind of this idea of ambient trauma. So ambient trauma is this term where it may be a very seemingly insignificant event. So that's what I call the little t. So a really minor event, but as they accumulate over time, that can create a more negative impact on the child overall. And so I talk about my youngest child, Amelie. Omali is gender diverse, has a more masculine gender expression. And so when they're in their middle school, they signed up for the girls volleyball team. That's something that they're really interested in. And comments from the leadership and other girls like, oh, this is the girls volleyball team, this is for girls. And having those are like little events that they'll come home and talk to me about. And as that accumulates over time, getting looks when they go into the bathroom, the women's restroom, things like that, those kinds of things can again have this greater traumatic impact over time. So I think those are things that I also want to point out that it may not be these big traumas that we are more aware of and are knowledgeable about, but it could be these really seemingly insignificant minor events that kind of target a certain identity as well that over time can really contribute to a sense of not belonging and exclusion. Basically. Yeah, I'm glad that you used that example, just kind of because this is a school based occupational therapy podcast, right? And to hear a little bit about your child's experience in school, one of the things that I'm seeing a rise in with school based occupational therapy practitioners is the idea that OT practitioners should be supporting in some way bullying. And I agree with that. There is that traditional thought of school based occupational therapy only focusing on an IEP and students with special education. But I think we can definitely move more broad and support the other realm of general education students. And I think that bullying can be a part of that. And we should absolutely be on different teams at schools to potentially support or improve bullying on campus. So I think that that is something that we can use, this trauma informed practice, this trauma informed idea. We might be the profession to bring it to the rest of the school campus. Like, teachers might not hear about trauma informed practice, but that's just something that maybe we can bring to the table and support the team with. I want to reference Dr. Susan Basic. Who's? From Cleveland. Cleveland area. I'm sure a lot of people are familiar with her work, but she looks at it from a public health perspective, the three tier perspective, and thinking about larger promotion of mental health. Right. Positive mental health. And so when you bring up bullying, it's not necessarily targeted interventions, but can we do school wide programs related to that? I think there's absolutely a hugely valuable role for OT, and I think considering students with very diverse identities and intersectional identities, and I think OTS have an understanding of that as well and can contribute to that sense of belonging for our kids. Absolutely. And while you were talking, I was trying to look it up, and I can't remember susan Basic has been on the OT schoolhouse podcast. I can't remember what episode it was. Yes, she is amazing. She has several programs that are designed to be school wide programs, from a recess program to a cafeteria program. There's probably a specific bowling program. I'm not sure if they got that yet. But everymomentcounts.org, I believe, is the website. If it isn't, we will link to the Real website in the show notes. Yes. I recently saw a post. She's doing something with something new with every moment count. So it's continuing to expand. So a great, great program. And yeah, definitely needed in our schools. Episode 36. That's what it was. All right, so episode 36 if you want to learn more about Dr. Susan Basic. Great. All right, so we talked about some of the trauma that can impact our students. Let's talk about some of the outcomes. You've done some research into this and have learned what some of those long term outcomes may be. So I'll give you an opportunity to share a handful of what those outcomes can be for our students who do experience trauma. Absolutely. Yeah. So kind of going back to the neurobiology of trauma, I'm just fascinated with the brain, and I feel like when I learned about neuroscience, maybe I wasn't paying attention, but I don't remember learning about the limbic. I'm sure we learned about it. But, like, the limbic system processes and kind of the physiological processes of how trauma affects our brain, which is so critical for our children and youth and adolescents, because their brains are still developing, their brains are still continuing to be constructed. And every experience, positive and negative, is going to change the trajectory of that brain development slightly, too. And so I can go a little bit through the neurobiology. That's okay. Yeah. And so, yeah, the limbic system is where trauma lives. And I want to credit actually one of my friends and former colleagues, Stephanie Bodison, I took a course with her on sensory integration, and she kind of frames the limbic system in four different processes, and she uses the acronym Move So M being Memories. So memories are really stored in our limbic system, in our hippocampus. It could be positive memories. It could be negative memories. I use this example of when I went to Sonoma and I was in a lavender field. And now that every time I smell lavender or see lavender, that always takes me back to that beautiful and positive memory. But in the same way, when there's a negative memory, there's some type of memory that we store in our hippocampus and something triggers it, right? Whether it's a smell, whether it's the sight of something, whether it's a comment that someone makes that can be triggered in our hippocampus. And as I have mentioned, smell. So that was the second part of Move So olfactory. So the olfactory bulb is also part of the limbic system. And so the way that we process smells, sometimes it goes straight to our brain. It doesn't get filtered like other sensations do. And so that may be the first sign of something negative, like the smell of smoke or fire. It could be the smell of alcohol. It could be something that they smell that to someone else may not seem very negative, but is associated with a negative interaction with another individual. Right? And then another part of the limbic system is the amygdala. And that's where the emotional responses live. And so that's where we store emotions, and that's where we process some of these emotions, especially when we experience these negative experiences. How we process the emotions is such an important piece for our kids because we see moments where they're being challenged to kind of regulate in a classroom and they're trying to regulate in a certain setting where maybe learning needs to be happening. Right? And so how do we regulate these emotions? And then the last one is the visceral experience. The somatosensory experience. I kind of went out of order for Move M-O-V-E but the somatosensory or visceral experience, Karen, memories that we hold in our bodies. And there's so many books on this. The trauma keeps a score. I'm sorry, the Body Keeps the Score talks about how we store this. Trauma in our bodies and it really does live within us and we carry it throughout our life. And so we're really thinking about how those visceral memories can also be triggered is something that's really important. And I think what's also really important to point out is that the limbic system has kind of this inverse relationship with the frontal lobe. So there's this really interesting connection there where the more active our limbic system is, right. Again, trauma lives in our limbic system. So the more active it is, the more that we are stressed because of something in our environment or some type of trigger that we're experiencing in the moment, our frontal lobe is less active. And so frontal lobe I always say, is where executive functioning lives. So that's where tension comes from, that's where regulation comes from. That's where processing and problem solving and judgment all of these important skills that our children are learning to develop. Right. And so if our children are in environments where there is a very active limbic system that they're trying to manage the frontal lobe development, executive functioning development is not going to be as optimal. And so that's something that we need to really take into consideration in some of these environments and settings that we may think. Again, going back to ambient trauma, oh, that seems like such a minor thing. Not really significant, not a big deal. But for that child in that moment, they're processing this trauma now in their limbic system and now they're not able to pay attention. They're not able to engage in whatever they need to be doing in the classroom. They're not able to transition between activities. They're not able to regulate their emotions. And so that's a really important piece to understand kind of that relationship with the limbic system and frontal lobe. Great. I'm glad you got Move in the right order. Sorry. I know you said a lot after that I was fixated because at first I wasn't sure if it was move or mose and I was like, all right, it could be either or the way you're going through it. But it worked out well. Yes, move. M o ve? Yes. Perfect. And I wrote it down. Memory for everyone out there listening. Memory, olfactory, visceral and emotion. We got it. Very cool. All right. Kind of while we're on the topic of the brain, the polyvagal theory, I know that polyvagal theory and asus kind of go hand in hand a little bit and so I want to give you that kind of opportunity to share how the polyvagal theory kind of fits in with understanding the experiences of trauma and right, right. So the polyvagal theory was developed by Dr. Stephen Porges and it's a neurobiological framework and it really considers how individuals behave and act and respond to stress or just experiences in the world. Sorry, really quickly I'm going to ask you that question. You're not doing anything wrong at all. It was a good time for me to stop, so I remember exactly where we're at. Jenna, are you there? Yep. My EarPods died on me. Have you heard any feedback or anything coming through either person's microphone for the last few minutes? Nope. You guys supposed to OK, that's what I thought. I just wanted to double check. Thank you. I appreciate it. They did not charge when they were supposed to charge this morning, apparently. I did want to talk about the HPA access, too, so I don't know if that okay. Well, let's take a step back, then. All I have here is HPA access. Does kind of relate to the neurobiology, and so I can talk a little bit more about impact. Modulates response to trauma. Okay, so the limbic system is where the trauma lives, and then the hypothalamic HPA is more what? Modulates the trauma. Okay, I got it. I got a question for this. Okay, cool. All right. So the limbic system, as you mentioned, is what kind of it's where trauma live? That's kind of how you mentioned it. Now, the hypothalamic that is not how I wanted to word that question. This is what happens once you stop. Things get weird. That's okay. All right. Make sure I'm on the right track. Sorry. Go ahead. Go ahead. All right. So the limbic system is where trauma lives, as you mentioned. But what is the part of the brain that can kind of maybe help us overcome that side of the brain? If there's a lot of trauma living in the limbic system, is there another part of the brain that kind of helps to potentially modulate that a little bit, overcome those right. Right. So there is the HPA access, which is the hypothalamic pituitary adrenal access. So this is kind of our alert system that's activated in our brain, in our body, when we perceive any type of stress or trauma. When people talk about the HPA axis, a lot of times they'll use the example of seeing a bear. Right? You see a bear, you react, your fight or flight kind of goes activated, and we respond to that. Right. And so the hypothalamus is where hypothalamus is where we kind of perceive that stress initially. And so once it perceives that stress, it sends a signal to pituitary gland that signals kind of this trigger a release of the I want to get this right corticotropin releasing hormone. That's what I which is a lot easier. And so once the pituitary releases CRH into our system, then the pituitary gland receives that signal and is alerted. Okay. Danger. Danger. And then releases the adrenocorticotropic hormone ACTH into the bloodstream. And then once ACTH is released into the bloodstream, that reaches the adrenal glands, which are located above the kidney. That tells our adrenal glands basically help. SOS, right. We're stressed here. We need to do something about this. And so that creates this process of releasing stress hormones into our system, typically cortisol. And so cortisol is a major stress hormone. It increases our heart rate and our blood pressure. It kind of provides this burst of energy that prepares us for that fight or flight response. And a little side. Like, I really enjoy backpacking. And so when I'm in the woods, maybe I backpack for 10 miles. I'm exhausted. I'm settling down, setting up my tent, and I'm laying down to relax at the end of a long hike. And then I hear a rustling, right? And you think, oh, my gosh, there's a bear. And no matter how tired I am, no matter how I feel like my muscles are not on my side anymore, and I quickly jump up, right? You quickly jump up and you respond. The cortisol in our system really alerts us in a way that makes us respond for our sense of safety. And so, related to the HPA axis, the concern with our children is that when there is the present, we want cortisol to help us respond to stress. That's a good thing. But when we have children that are experiencing ongoing abuse, maybe witnessing ongoing violence in the home or community, whatever, it may be ongoing traumatic experiences. What happens with the HBA access is that the cortisol is being consistently released over and over, and that can create a sense of hyper vigilance for our kids. So they're on high alert all the time. They're not always able to discern what truly is safe, what's not safe. And so especially as the brain is developing, that's a really big piece of we need to be able to identify, okay, what's truly a safe space for me, or what is something that is truly dangerous that I need to respond or my body needs to go into that response mode. And so that's a big concern with young children, again, as their brains are developing, because the more cortisol is kind of left in our system, we could see decreased immune system processing or function. We might see changes in metabolism, differences in glucose levels. And that's why we see kind of this connection of early childhood stress causing some of these conditions later on, like diabetes or health condition or heart conditions and et cetera. I hope that makes sense. Yeah, absolutely. And you mentioned flight or fright. I can never say that correctly. And I know you also can have freeze, right? Flight, fright, flight or freeze. And when I hear those, I often think of the polyvagal theory. Do you kind of reference the polyvagal theory in the work when you like to talk about this? Definitely. Yeah. So the polyvagal theory, for those that may not be as familiar, was developed by Dr. Stephen Porges. And it is a neurobiological framework, and it really helps us to consider how we respond or act based on stress in our environments or in our world. And so, as you mentioned, the fight flight or freeze. So that was previously identified as being the sympathetic nervous system versus the asympathetic parasympathetic. Sorry. Okay. Yeah, let me say that again. Go ahead. Now I start over. Okay, so you mentioned fight or flight and freeze. And so, traditionally, what we believed in the past was that this is a very dualistic system, the sympathetic nervous system, which activates fight or flight, and then parasympathetic nervous system, which activates kind of that freeze and shutdown. And so Porges challenged that duality of the autonomic nervous system and identified that there are actually two pathways down on the vagus nerve. So there's the ventral vagal pathway, and this pathway actually responds to cues of safety. It really supports feelings of being engaged and socially connected. And so it's a positive pathway that we want to be able to support and facilitate for our clients and for our children. And then there's also the dorsal vagal pathway, which is what we typically would see as kind of that protective state of collapse that freeze or shut down. And so understanding that there are these different pathways on the vagus nerve is really important to kind of promote opportunities to pursue the ventral vagal pathway or those experiences that really can promote that safety and connection. And so Deb Dana, she's an occupational therapist. She created this visual. It's called the polyvagal ladder. So if anyone's interested in looking that up, it's a really nice visual that kind of talks about the different levels of how we may respond. And so at the very top of the ladder is safety or psychological safety and connection. And that's where we hopefully want our children and students to be at. This is kind of what we call the optimal level of engagement. That's where we learn best. That's when we feel most connected with educators, peers, et cetera. And so that's something that we want to be able to support our children, to be at the top of that ladder and to explain a little bit more about that ladder. For those that are interested in viewing it, the next step down is the sympathetic nervous system, which we're again familiar with as it relates to fight or flight. And then at the bottom is that parasympathetic shutdown. And so it's a nice visual, kind of explaining there are these different experiences that we can support to get our children and our clients in a space where they feel that connection and that optimal level of engagement. And then one other piece that I think is really important from Porridge's work was this idea of neuroception. And so my background is sensory integration, so all the different senses. And so he kind of brought out this idea of neuroception, that it's this feeling of danger and kind of paying attention to the signals, right? And so maybe there's something that I feel crawling up my arm, right? And so I've got to respond, like, what is that? What is that? Is it a spider? Is it a bug? What is it? Or oh, it's just my shirt. There's just a little thread. Right. And so that neuroception that we maybe experience multiple times during a day, but it mobilizes us to respond and really take action when we maybe don't feel safe to get us to a place, back to safety. So it's kind of that listening to our gut so that we aren't placing ourselves in these dangerous situations. And again, going back to the HPA access, we need to be able to differentiate what is safe, what is not safe. And again, some of our kids may have some difficulty with differentiating that. Absolutely. And if our kids aren't moving up that ladder to the safe area, to the socially engaged area, and they're somewhere near the bottom or maybe they're in the middle today, I'm sure that can have an impact on their occupations, on what they have to do every single day at school. So, again, I know you're kind of at the college level now, but a lot of times high schoolers and college kids, there's some overlap there. So what are some things that you have seen, that you have identified that this type of transitioned age person can exhibit difficulties with when trauma is kind of in their background? Right. There's so many ways that it can impact occupation. I think we're talking a lot about occupations related to school and so important things like paying attention, being attentive attuned being engaged even for a longer period of time. I think that's so important. That self regulation piece too. And I think we talked a little bit about that emotional regulation when there is something that happened maybe an hour ago or happened to our community last week that we're still processing, that our body is still kind of working through in terms of our physiology, that there may be this increased fear, increased anxiety. It can also absolutely impact sleep. So insomnia, especially in young children, we may see that somatic pain, somatizations where maybe they're really nervous about a test or maybe they are experiencing bullying at school and so they start to have stomach aches where there's nothing really wrong with their GI system, necessarily. But that fear, anxiety, that worry is now being stored kind of in that gut and so presenting in a way that feels like a physical manifestation when it may ultimately be something related to a traumatic event. Yeah, I know from my own personal experience in my realm of life that that is definitely something that has impacted people that I know. And it's something that they almost feel sick when they're invited to do something that has an experience related to some of their trauma. And that can impact a lot of things. It's not just that they're feeling sick, but it's also impacting their entire day, their entire week, potentially. So that's hard. All right, we had that question. We already did that one. Did you want to go into more of that, or was that enough for the associations with occupations? I think that's good. Okay. Yeah, that's really fun. I think that's enough, too. I have a lot for the trauma in the classroom. One, I don't know how. I know. We talked a little bit about that one. I know you shared the story with your daughter, so we shared a little bit, but let's go ahead into that one, too. Okay, let me read this really quickly. All right, so taking a step back, you mentioned a little bit about one of your kiddos and how on the volleyball team there's just those little ambient traumas, I think you called it, inside of school, maybe in the classroom. What experiences that the students that we as school based OT practitioners maybe can have an impact on? How are students maybe even experiencing trauma on campus? Yeah, so I think that's something we need to be aware of attuned to that this is possible. We want to believe that our environments, our communities, and our school settings are safe, but we have to also be aware that there is this potential for some traumatic experiences that our students are experiencing. So there are some specific ways that there may be trauma in the classroom. One experience is through curriculum violence or just the programming or the curriculum that maybe is. And I want to relate this also to OT education, too, where maybe there's something in the curriculum that is misrepresenting their identity. Maybe is racially profiling a certain community or group gender profiling? Or maybe some stereotypical portrayals of certain cultures and groups. And so I know in OT education, in academia, we have so many discussions about case studies. How can we get more inclusive case studies that are not stereotypical, that really do portray different identities and experiences in a very positive light without misrepresenting them? And so that's something that we might see in the classroom, especially in higher education related to case studies and such. But there also might be some, again, I don't know, ambient trauma or big T trauma related to this underrepresentation of identities. So we know within our profession we are lacking diversity and representation for individuals from diverse backgrounds. But when a student shares a story in an institution and maybe okay, I'm struggling with this one. Sorry, let me start again. Would you like me to re ask all the way back to that question, or do you want to start somewhere in the middle? Yeah, do you mind if I start back with this one? Yeah, I'll start back with this one. Okay. I'll re ask the question then, really quickly. Okay. I don't want to go back to curriculum violence, though, but I'll start. Okay, I get what you're saying then. Yeah, go ahead. Then you can start whenever you're ready. Okay. Yeah. And also the underrepresentation of identities. So we know that our profession is lacking diversity and representation from diverse backgrounds. And so when we think about a student walking into the classroom, do they see faces? Do they see others that may share a similar identity or experience? Or do they feel like they're already underrepresented in this environment? And so that can be something that our students have to navigate this social climate where they may feel possibly invisible, like no one really is understanding their experience that may be very unique from others. Maybe they feel very disempowered, they don't feel like they have a sense of confidence to speak up about certain things or challenge certain ideas or perspectives that may be different. Or sometimes we may experience this like tokenization of well oh, you're struggling with. This one a hard one to talk about. I know it is. Okay, I don't want to start again, so I'll go back to the tokenization. Yeah, that's fine. Right, okay. Or we might feel a sense of being tokenization, the words, okay, let me start again. Or we might feel this sense of being tokenized where maybe we're being put on the spot to share experience because we may be the only individual with a diverse identity. Or we may be asked to participate in marketing campaigns and be in those photo shoots to potentially represent a diverse community that may not necessarily be representative of the actual setting. So that's another concern that we might see with students. I think we're really familiar with microaggressions, so these oftentimes very unintentional interactions and behaviors that communicate some sort of bias towards a marginalized community. I've also seen this experience also with graduate students tone policing, where maybe there's a discussion or a debate happening and maybe an individual that has greater privilege, maybe an instructor. It could also be another student from a more privileged background, maybe dismisses or invalidates the thoughts or opinions of another student based on the reaction to the emotional tone. Well, I didn't like the way you said that, you just seem very angry right now. So instead of listening to the message and the point that the individual was trying to communicate, the other individual maybe invalidated that because of the tone. So that's something that may be considered to be tone policing. I think another thing that we might see also with students is code switching. So maybe a student comes into an environment that they see that their identity is not well represented. They do feel like they are part of a minoritized group and they walk into an environment and they feel like, well now I have to adjust my speech, I have to adjust my behavior, my appearance, my expressions so that other people don't misinterpret my behavior. And so that could be cone switching that we see between different classroom settings. It could be with peers, it could be with teachers, instructors, educators and such. And I think this is something that comes up a lot in OT education, in particular around professionalism because professionalism historically has been related to Eurocentric values. Right. It's very role dependent. And in an OT education, there is kind of this sense of gatekeeping where, well, if you don't act or look or talk like me, you don't belong. Right? And so that's something that's come up a lot with students, where students have felt marginalized when they're in maybe a fieldwork setting. And the fieldbrook educator is reporting a concern about professionalism because of the way that they may have expressed themselves. And I was actually at SSO, the study for sorry. I was actually at SSO, the Society for the Study of Occupation, this past week in St. Louis, and I was at a presentation talking about the experience of belonging for black students in PhD programs in our profession. And one of the presenters had talked about being an academic field coordinator and getting more calls about professionalism for black students. Right. And so because they may not speak the same way or behave in a way that the site is deeming to be professional, that they are now being called out about some concerns that may not be valid. Yeah. And I think we could see that on a high school campus, a middle school campus, even an elementary campus to some degree. So I think those are all very important factors to keep in mind. And I know that you kind of have gone the next step to kind of make sure that you yourself are engaging in trauma informed teaching. And I want to give you a moment to talk about that. But as I do, I just think that this is something that it's not just about teaching, it's about being a practitioner as well. Everything you're about to say, this is kind of just front loading everyone that's listening. I think what Dr. Park is about to say, even though she's kind of going to be saying it in the realm as a college professor, I think this is actually completely applicable to us as practitioners in the school as well. So tell us about trauma informed right. Right. So it's grounded in the principles of trauma informed care. So for those that may not be as familiar with trauma informed care, safety is so critical. Safety, trust, transparency, that peer support, having peers that really see them and understand them, collaboration, mutuality, other principles, empowerment, voice and choice, and also considering cultural, historical, and gender issues where those identities have been historically marginalized. And so those are the principles of trauma informed care. And so those are the principles that we want to make sure that we're grounded in in teaching as well. But in terms of trauma informed teaching, we want our classroom or learning environments to be inclusive and transformative, and we want to also share or center our shared humanity. And so as an instructor, I really do try to dismantle the hierarchy in the classroom. A lot of instructors may try to establish that hierarchy of, well, I'm the teacher, I have the knowledge and that I grade you. Right. But I think especially as a doc coordinator, I try to really establish a space where we can all grow as a community. So I always share with my students. I am also here learning from you. Some of our students who are their capstone topics are topics that I may not be as knowledgeable about or familiar with. They may become experts on these topics and these projects much more than I am I may be. And so I always emphasize that we're all learning together. And so the more we can understand our humanity, that we're not asking our authentic selves to be left at the door, our humanities being left at the door, but that we establish a space where all of these factors are really welcome and all of our identities and positionality are embraced as a community is really important as well. Another principle that I think is really important is equity and social justice focused. And I don't mean that to say everyone needs to know about all the events happening in the world and we need to talk about it all the time. I know there isn't a lot of time and space for that, but I think it's really important to have some awareness of it, to know that our students may be carrying some of that grief and that pain. I think about the violence happening right now in the Middle East and Gaza and having students that are really struggling, that maybe have family in the region that they're worried about. I can't ask them to leave their humanity at the door so that I can give my lesson. Right. And so I think that's so important in a therapeutic relationship, too, or within classrooms in elementary, middle school, and high school, where we have to understand that all of our students are kind of bringing these world experiences into the classroom, and we have to allow space for that to happen. Allow that for gosh, why am I struggling so much? Sorry. You're doing fine. I thought. Okay, I'm going to start again. I'll keep going. Okay. I hope you can piece these things together. Oh, definitely. Trust me. My brother in law is like a film major or he's already a film. Yeah, he's a good editor. Fantastic. Okay, so let me go back. Okay. So we want to make sure that we have some awareness of the issues that are happening in the world that may be impacting our families. Sorry. Okay. We want to have some awareness of the issues in the world that may be impacting our students and the pain and the grief that they may be carrying so that we don't ask them to leave their humanity at the door. Right. So learning is the primary goal in all of our settings. Right. In all of education, learning is a primary goal, but psychological safety is truly a necessary condition. There has to be a sense of psychological safety in the classroom for our students to be in that optimal range, right. Optimal level of engagement, of learning, to be at that top rung of the ladder, to be able to engage with the curriculum. And another really important piece is that it needs to be universal. This goes back to this idea of code switching, right. If one teacher, or maybe this teacher is super empathetic and is super invested in dismantling these hierarchies, and then you go to another teacher and that teacher is not the student is now having to code switch between classes as they're moving throughout their day. And so it needs to be universal approach across campuses, across programs so that there is, again, a sense of safety universally throughout the institution. Yeah. And there's just so much going on. I don't want to get into specific examples. I know you mentioned what's going on with War in the Middle East right now. There's a lot of gender issues going on right now within individual schools and districts that are impacting the students and the adults on campus. This is tough, and we all need to be mindful of that going on in order to practice this trauma informed teaching, trauma informed occupational therapy, trauma informed care. As we get closer to wrapping up, I want to ask you for the occupational therapy practitioners that are working on a high school. Maybe they're working with an individual student, or maybe they have the opportunity to go a little bit more broad and support the entire school. Do you have one, too? Just a few strategies that you might want to pass off to them that maybe they can try using in their school to make it a little bit more inviting, more friendly for students on campus. Right, yeah. I think that psychological safety is such a critical component of that because psychological safety really does kind of pave the way for a sense of belonging. And so belonging, inclusion, all of these things are where we can bring our authentic selves to the table. Right. And to be able was that your. Computer or my computer? Oh, never mind. Sorry. The 1 hour timer went off and it wouldn't have impacted anything. I'm sorry. I realized what it was right after started to talk. Otherwise I would not have cut you off. I'm sorry. Okay. We're okay, though, because we kind of stopped and paused. Yeah. We're wrapping up, though. Yeah, we're fine. Okay, so let me start again. Psychological safety is definitely an important factor because psychological safety really paves the way for belonging. And belonging leads to inclusion. And inclusion means that we can bring our whole Selves and our authentic Selves in these settings that we can comfortably and safely voice opinions and challenge ideas and thoughts and bring different perspectives that others may learn from and may not fully understand. And so I think fostering. That environment where students can be authentic is a really important component that we can do across all of education. And so this idea of not having to worry about being found out that I'm actually neurodivergent and I learn differently, I process information differently. And so students, especially in middle school at that really critical age of development, identity formation, at that age where they fear how other people may think of them, right? They may be worried about being found out that I learned differently, or that maybe I'm a first generation college student and I may not have the educational privileges or generational legacy of my peers, or maybe I have caregiving responsibilities as well. My husband's actually a high school teacher, and he does talk about some of his students where they're tired, they're sleeping in class sometimes. And again, we can perceive that as, oh, this student is a bad student, they're lazy, blah, blah, blah. We have all these negative labels that we can attach. But once he really talked to the student, he realized that this student, as a junior in high school, has to work, has to work on weekends, has to work in the evenings to really support their family. And so taking all of those factors into consideration allows us to see the entire person. And so that's something that's super important, too. I do want to touch a little bit on belonging. I've mentioned that I was at SSO, which is the study for this. I always mess that up. I do want to touch upon belonging. I was at SSO, which is the Society for the Study of Occupation in St. Louis this past weekend. And we had this conversation about belonging. And we were debating Wilcox framework of doing, being, becoming belonging. And know what type of belonging did Wilcox intend for us to understand in that framework? And was it like belonging, oh, you fit in, and that's how you belong? Or was it this sense of liberatory belonging where you could bring your full self, your whole self, as authentically as possible, and to show up in these spaces and still feel like, oh, I'm accepted I belong here. And so I think about middle school age where that's such an awkward period. When I think about my middle school years, I cringe a little bit, not feeling super confident in myself, still figuring out myself. I think these are the spaces that we want to be able to allow our children, our adolescents, to explore, explore identities and to challenge what they're learning as well. And I think that takes a lot of critical reflection on our part as occupational therapists. One of my Capstone students, she did a research study on OT's understanding of trauma and how they use trauma informed care and practice. And she continued her study after she graduated. And we worked with her in identifying some codes and themes, and we're hoping to get it published. It's in review right now. But one of the themes that she identified was this idea of reckoning with self. So being grounded in this reflection of our own regulation, really decentering ourselves in our therapeutic interactions with clients, students, et cetera. And that's so important so that we're not potentially causing retraumatization to our clients and students. And so this reflection that we have to go through or we should be going through to say I do have best intentions, but I may not always get it right. Right. And so I hear sometimes in our classroom settings where people just say, well, it's safe here, this is a safe space. And despite best intentions, we can't always assume that our classrooms are safe. And so we want to make sure that we are not misunderstanding trauma symptoms in the classroom that may be showing up again. Labeling the student that was sleeping in class with negative labels, but understanding their experience that they've got a lot going on in their life and they have a lot of other responsibilities that their family is depending on them for. And then so really kind of centering empathy, having that empathy, that awareness of self and how we show up is just really important in establishing these relationships and connections which can really support more empowered healing in the work that we do. Great. Well, I just have one more question for you. And this comes directly from questions that I get all the time from school based occupational therapy practitioners. So I want to ask you, if you talk to a principal and they're like, hey, Dr. Park, we would love for you to give a 30 minutes training to our teachers, something related to trauma informed care, what topic would you go with that you would want all the teachers on campus to? What would be the goal, I guess, for the teachers to take away from a talk that you give that maybe another school based OT who is listening to this could also give at their high school. Oh gosh, there's so many right? There's so many topics. I am really kind of a neuroscience nerd, so really understanding the neurobiology I think is so important. And sometimes I do presentations when I talk about trauma and I always have a piece where I discuss neurobiology and I worry kind of people tune out. Not as interesting talking about the brain, but I think it's so important to understand how the limbic system works and that connection with the frontal lobe because again, that inverse relationship of if a student is struggling with something that we know nothing about, right? And that's usually the case. We know nothing about what they may be going through or what trauma they've been experiencing or what trigger they just may have just experienced in the moment. And so again, we can really misinterpret behaviors really quickly. And there's this really great article, I'm blanking on the author's name, but there's this really great article that talks about secondary microaggressions. And secondary microaggressions are kind of that process of where we misunderstand a behavior or maybe we misunderstand something, because that's not our experience, so well, that's not my experience, so I don't understand it. So almost invalidating the student's experience. Like, well, that can't be true. That can't be real, because I haven't experienced that, and I don't understand that. So there are these multiple ways that we might enact these secondary microaggressions because of our misunderstanding of potentially what may be a trauma symptom. And so I think going back to the neurobiology and understanding how all of that is related and how we show up in the world, how we may behave and respond to interactions that we have with other individuals, I think that would be absolutely core. All right, everyone, you got that? You just have about 30 minutes to present that to all your teachers, though. You got to keep it short. But no, I think that's great. I think a lot of people, occupational therapy practitioners, teachers, educators, they understand trauma informed practices. But I think having that neurobiological side of it, neuroanatomy side to really kind of sometimes use pictures when you're talking about the brain, right? So you show them those pictures, it just makes it a little bit more real sometimes to better understand how the brain is processing the trauma and how the limbic system is working and how the HPA is all working. So thank you so much. I really appreciate that. And before I let you go, where can anyone who's interested in learning a little bit more about you and maybe the St. Augustine program go to learn more? You can find more information about me on our USA website. So our homepage is Usa.edu, and we do have faculty profiles on there. So if you search faculty, you can learn a little bit about more about my background. But I'm also on social media. I do have a public Instagram profile. It's Karen Park OTD. That's my Instagram profile. And then I'm also on LinkedIn, too, so you can find me on LinkedIn. And I do try to share kind of different thoughts and ideas, know, work that I'm doing. I think that came about actually, during the pandemic, where I started to share some things, and people really resonated with it, and it's a very vulnerable space for me being so public. But I'm there, and I really do love to engage with the community. I think we have just such a wonderful community of OTS, and students start following me, and we become friends after they graduate. And I just really love to stay connected and be able to support others in their journeys. I think I really do find the work as a doctoral coordinator to be super meaningful. And so when I'm able to stay connected with our graduates and see just wonderful things that they're doing in the community sorry, it's a proud moment. For me. That is awesome. That's great. Yeah. It's always great to see all of our hard work be rewarded, in a way. And maybe it's not in accolades, but to see the people that we mentor and just improve themselves and become an occupational therapist or an occupational therapy assistant or whatever they're aiming for. So, yeah, it's always nice. Speaking of mentor yeah. If you connect with me on social media, I may ask you to be a mentor for one of my capstone students. If anyone's looking connected with the university, especially alumni. We love to connect with alumni and have them come back and mentor our yeah. So that's one thing. If you connect with me, I might ask you to be a mentor. You're not the first one on the podcast to say that, so people yep. All righty. Well, Dr. Park, thank you so much for coming on. It's been a real pleasure. And I know that a lot of school based OT practitioners, karen going to walk away from this episode with a better understanding of aces and the experience of trauma and how they can make the world a little bit more friendly, a little bit more tolerable for everyone that they work with. So thank you so much. I really appreciate it. Thank you. I appreciate it. Jason?