{"version":"1.0.0","segments":[{"startTime":0.56,"endTime":4.2,"body":"Hi everybody, I'm Michael John Cusick. Welcome back to another episode"},{"startTime":4.28,"endTime":7.78,"body":"of the Restoring the Soul podcast. Today"},{"startTime":8.24,"endTime":11.912,"body":"our topic is trauma informed care."},{"startTime":12.096,"endTime":15.736,"body":"Now, we therapists, psychologists, psychiatrists"},{"startTime":15.768,"endTime":19.512,"body":"and psychiatrists use this term a fair amount. And over"},{"startTime":19.536,"endTime":22.968,"body":"the last several years, particularly during the pandemic,"},{"startTime":23.144,"endTime":26.824,"body":"the words in the phrase trauma informed care have taken root"},{"startTime":26.872,"endTime":30.682,"body":"all across culture. I hear this used a lot and, and I"},{"startTime":30.706,"endTime":34.554,"body":"think it's interesting that it's used frequently but not very well"},{"startTime":34.642,"endTime":38.25,"body":"understood. So today, in part one of a"},{"startTime":38.29,"endTime":41.93,"body":"two part podcast on trauma informed care, I wanna talk about"},{"startTime":41.97,"endTime":45.562,"body":"what trauma informed care is, why it's important"},{"startTime":45.666,"endTime":49.466,"body":"to understand it. And then in the second podcast, I'm gonna circle"},{"startTime":49.498,"endTime":53.274,"body":"back around and talk about five pillars of trauma informed"},{"startTime":53.322,"endTime":56.95,"body":"care. First of all, it was the year 2018"},{"startTime":57.26,"endTime":61.06,"body":"and Dr. Bruce Perry, who has written a number"},{"startTime":61.1,"endTime":64.724,"body":"of books and one of which he's co authored with the famed"},{"startTime":64.772,"endTime":68.42,"body":"Oprah Winfrey called what Happened to you? Conversations on"},{"startTime":68.46,"endTime":72.276,"body":"Trauma Resilience and healing. In 2018, Dr."},{"startTime":72.308,"endTime":75.94,"body":"Perry was with Oprah on a special about childhood trauma and"},{"startTime":75.98,"endTime":79.492,"body":"childhood adversity. And he for the first time used this"},{"startTime":79.516,"endTime":83.364,"body":"phrase in a mass context on Oprah called trauma informed"},{"startTime":83.412,"endTime":87.166,"body":"care. And his outtake in that program on childhood"},{"startTime":87.198,"endTime":90.43,"body":"adversity and trauma was only a couple of minutes long. But I believe it was"},{"startTime":90.47,"endTime":93.998,"body":"there that this term really began to catch on."},{"startTime":94.134,"endTime":97.806,"body":"Now, prior to that, it was used in clinical settings"},{"startTime":97.998,"endTime":101.646,"body":"and in inpatient settings and in research settings"},{"startTime":101.758,"endTime":105.582,"body":"to talk about an overall approach to patient"},{"startTime":105.646,"endTime":109.22,"body":"care and to client care. And"},{"startTime":109.39,"endTime":112.456,"body":"this idea of a trauma"},{"startTime":112.568,"endTime":115.912,"body":"informed approach is not just what a"},{"startTime":115.936,"endTime":119.448,"body":"therapist does with you in a counseling session, but an"},{"startTime":119.504,"endTime":122.968,"body":"overall way of thinking about providing care"},{"startTime":123.024,"endTime":126.744,"body":"and access to people in light of their childhood"},{"startTime":126.792,"endTime":130.504,"body":"experiences, in light of the adversity that they've gone through."},{"startTime":130.592,"endTime":134.408,"body":"And as a result of this trauma informed care, there's"},{"startTime":134.424,"endTime":137.41,"body":"a set of emerging best practices"},{"startTime":137.75,"endTime":141.07,"body":"that therapists certainly try to"},{"startTime":141.11,"endTime":144.01,"body":"integrate, those who specialize in work with"},{"startTime":144.31,"endTime":147.47,"body":"trauma and childhood adversity and"},{"startTime":147.51,"endTime":150.67,"body":"abuse. But it's also ways that"},{"startTime":150.71,"endTime":154.462,"body":"organizations can set up care,"},{"startTime":154.646,"endTime":158.43,"body":"access to care, and everything from the lighting in your"},{"startTime":158.47,"endTime":162.302,"body":"office to what people experience when they walk in. So as we talk about trauma"},{"startTime":162.366,"endTime":166.082,"body":"informed care, the emerging best practices prior"},{"startTime":166.146,"endTime":169.682,"body":"to the five pillars that I want to present are really in the face to"},{"startTime":169.706,"endTime":173.394,"body":"face clinical counseling situations when a person goes to"},{"startTime":173.402,"endTime":176.754,"body":"receive care, and then the other are organizational"},{"startTime":176.802,"endTime":178.99,"body":"ways of thinking about,"},{"startTime":179.77,"endTime":183.602,"body":"proactively about trauma informed care. And I'm going to give a couple examples of"},{"startTime":183.626,"endTime":187.458,"body":"that from even some recent tests that I underwent at a"},{"startTime":187.594,"endTime":191.332,"body":"cardiac clinic to deal with some palpitations, or"},{"startTime":191.356,"endTime":194.612,"body":"rather to get some assessment about what was going on with these"},{"startTime":194.636,"endTime":198.468,"body":"palpitations that ended up being caffeine and"},{"startTime":198.524,"endTime":202.34,"body":"probably a little bit of stress. The thing about in trauma,"},{"startTime":202.5,"endTime":206.16,"body":"trauma informed care is that the research is showing us"},{"startTime":206.46,"endTime":209.844,"body":"that when there is trauma informed care,"},{"startTime":210.012,"endTime":213.62,"body":"that it improves, number one, whether people"},{"startTime":213.74,"endTime":216.98,"body":"engage with treatment and"},{"startTime":217.36,"endTime":221.176,"body":"in that engagement, whether they continue and stay with"},{"startTime":221.248,"endTime":224.28,"body":"the treatment that's needed for particular issues like trauma,"},{"startTime":224.36,"endTime":227.736,"body":"abuse and childhood adversity. But it also"},{"startTime":227.808,"endTime":231.144,"body":"produces better outcomes. Trauma informed"},{"startTime":231.192,"endTime":234.616,"body":"care determines whether people engage"},{"startTime":234.728,"endTime":237.7,"body":"in therapy, whether they"},{"startTime":238.64,"endTime":242.44,"body":"continue in therapy. That's what we mental health professionals call"},{"startTime":242.48,"endTime":246.216,"body":"client retention. In other words, if people will stay throughout"},{"startTime":246.248,"endTime":250.04,"body":"the course of treatment, that's needed and most mental health is not,"},{"startTime":250.08,"endTime":253.688,"body":"here's your problem, that'll be 3.5 sessions and then you'll be on your"},{"startTime":253.744,"endTime":257.512,"body":"way. It's an unfolding process. So client retention is"},{"startTime":257.536,"endTime":260.664,"body":"important. And then finally, trauma informed care"},{"startTime":260.752,"endTime":264.26,"body":"improves client outcomes. This approach"},{"startTime":264.8,"endTime":268.616,"body":"actually impacts whether or not people"},{"startTime":268.688,"endTime":272.392,"body":"will be helped and to what degree. Now it's important, as I keep using the"},{"startTime":272.416,"endTime":276.186,"body":"word impression, approach or care. Trauma informed care"},{"startTime":276.258,"endTime":279.834,"body":"is not a modality. It's not a way of doing"},{"startTime":279.922,"endTime":283.21,"body":"therapy particularly, or a model of therapy like"},{"startTime":283.25,"endTime":286.634,"body":"cognitive therapy or EMDR or gestalt"},{"startTime":286.682,"endTime":290.474,"body":"therapy, or psychodynamic therapy, or interpersonal"},{"startTime":290.522,"endTime":294.298,"body":"therapy. It's a broader lens and approach"},{"startTime":294.434,"endTime":298.09,"body":"that can allow other forms of therapy to kind of come"},{"startTime":298.13,"endTime":301.57,"body":"in underneath it. So typically"},{"startTime":301.73,"endTime":304.978,"body":"when a person has trauma that could be"},{"startTime":305.034,"endTime":308.242,"body":"abuse, neglect, life threatening"},{"startTime":308.306,"endTime":312.034,"body":"events. But as I like to define around"},{"startTime":312.122,"endTime":315.778,"body":"here, that trauma is most simply defined as"},{"startTime":315.834,"endTime":319.07,"body":"any experience, event"},{"startTime":319.45,"endTime":323.09,"body":"or environment that overwhelms the"},{"startTime":323.13,"endTime":326.968,"body":"individual, including their central nervous system, and leaves them"},{"startTime":327.024,"endTime":330.792,"body":"without caring, loving resources to"},{"startTime":330.816,"endTime":334.5,"body":"cope. I'll say that again. Any event,"},{"startTime":334.8,"endTime":338.54,"body":"experience or environment that overwhelms the individual,"},{"startTime":339.68,"endTime":343.304,"body":"that leaves them without loving, supportive"},{"startTime":343.352,"endTime":346.66,"body":"resources to cope. Now"},{"startTime":347.04,"endTime":350.856,"body":"this can also include in light of that environment. And this is really important"},{"startTime":350.928,"endTime":354.634,"body":"to say that trauma in terms of"},{"startTime":354.722,"endTime":358.03,"body":"environment can be persons of color,"},{"startTime":358.37,"endTime":361.626,"body":"minority persons, people that are in"},{"startTime":361.698,"endTime":365.47,"body":"poverty situations, people that are experiencing discrimination."},{"startTime":366.05,"endTime":369.19,"body":"So there are systemic issues"},{"startTime":369.65,"endTime":372.442,"body":"that those like myself, a"},{"startTime":372.626,"endTime":376.41,"body":"Caucasian privileged male, may not think of."},{"startTime":376.45,"endTime":379.698,"body":"People living in and under discrimination or"},{"startTime":379.754,"endTime":382.55,"body":"in lower socioeconomic"},{"startTime":383.05,"endTime":386.11,"body":"status with fewer resources to"},{"startTime":386.49,"endTime":390.21,"body":"food, to education, to going from month"},{"startTime":390.25,"endTime":393.954,"body":"to month to pay their bills. Those kinds of situations can be chronic"},{"startTime":394.002,"endTime":397.57,"body":"stressors and be part of or actual"},{"startTime":397.65,"endTime":401.41,"body":"factors in causing trauma. There can"},{"startTime":401.45,"endTime":405.12,"body":"be so many realities that cause trauma in"},{"startTime":405.25,"endTime":408.836,"body":"environments as well. For people who grow up with a family"},{"startTime":408.908,"endTime":412.708,"body":"member with mental illness. For people who grow up in a family"},{"startTime":412.764,"endTime":416.484,"body":"where there is substance abuse or alcoholism. You know, oftentimes"},{"startTime":416.532,"endTime":420.308,"body":"people will say in the therapy offices that I've been in over the last 30"},{"startTime":420.364,"endTime":423.652,"body":"years as a professional and I've had my fair share of being in them as"},{"startTime":423.676,"endTime":427.396,"body":"a client as well. You know, I didn't have any specific abuse. I wasn't sexually"},{"startTime":427.428,"endTime":431.172,"body":"abused, I wasn't physically abused, I don't think I"},{"startTime":431.196,"endTime":434.952,"body":"was emotionally abused. But just the environment of growing up in"},{"startTime":434.976,"endTime":438.6,"body":"a home where there's mental illness or some kind of significant"},{"startTime":438.72,"endTime":442.14,"body":"addiction that can be a history of trauma."},{"startTime":442.8,"endTime":446.46,"body":"So we know that there's massive evidence"},{"startTime":446.88,"endTime":450.712,"body":"that where there is an environment of"},{"startTime":450.736,"endTime":454.552,"body":"trauma that that exposure to trauma, especially in"},{"startTime":454.576,"endTime":458.296,"body":"childhood, increases the likelihood of"},{"startTime":458.448,"endTime":462.286,"body":"health risks long term over the person's life."},{"startTime":462.358,"endTime":466.046,"body":"There's a wonderful ted talk by Dr. Nadine Burke"},{"startTime":466.078,"endTime":469.918,"body":"Harris. She's a physician and she has done a lot of great"},{"startTime":469.974,"endTime":473.09,"body":"research, but she's one of the people that has popularized"},{"startTime":473.59,"endTime":476.75,"body":"the ACE test, which is used to"},{"startTime":476.79,"endTime":480.222,"body":"measure adverse childhood experiences. That's what the"},{"startTime":480.246,"endTime":484.014,"body":"acronym stands for. And here at Restoring the Soul, that's one of the assessments that"},{"startTime":484.022,"endTime":487.532,"body":"we give. It's one of the broadest assessments. But the data"},{"startTime":487.636,"endTime":491.484,"body":"that supports this very simple test, I think it's eight questions"},{"startTime":491.612,"endTime":495.26,"body":"is the higher your ACE score is the greater your"},{"startTime":495.3,"endTime":499.1,"body":"adverse childhood experiences, the likely higher level"},{"startTime":499.14,"endTime":502.956,"body":"of trauma you are? And with or without a trauma diagnosis,"},{"startTime":503.068,"endTime":506.748,"body":"the higher your ACE score, the more likely you are to have"},{"startTime":506.804,"endTime":510.412,"body":"health related issues and health risks"},{"startTime":510.556,"endTime":513.936,"body":"that are seemingly unrelated to psychological or mental"},{"startTime":513.968,"endTime":517.552,"body":"health reasons. And so again, I would"},{"startTime":517.576,"endTime":521.424,"body":"encourage you for a compelling and concise explanation of childhood"},{"startTime":521.472,"endTime":525.088,"body":"adversity to visit ted.com for Nadine Burke"},{"startTime":525.104,"endTime":528.576,"body":"Harris TED talk entitled specifically how Childhood Trauma"},{"startTime":528.688,"endTime":531.94,"body":"Affects Health across a Lifetime."},{"startTime":532.52,"endTime":536.256,"body":"So what is trauma informed care? I've been talking a lot"},{"startTime":536.328,"endTime":539.69,"body":"about the overall approach. It's an"},{"startTime":539.73,"endTime":542.698,"body":"understanding of how life"},{"startTime":542.834,"endTime":546.27,"body":"experiences shape the individual"},{"startTime":546.61,"endTime":549.67,"body":"and how that life experience"},{"startTime":549.97,"endTime":553.29,"body":"impacts how a person experiences their"},{"startTime":553.33,"endTime":556.97,"body":"care. So my life experiences have affected"},{"startTime":557.05,"endTime":560.81,"body":"me, my nervous system, my mind, in terms of my"},{"startTime":560.85,"endTime":564.538,"body":"cognitions, how I see the world, whether I'm hypervigilant, whether I'm"},{"startTime":564.554,"endTime":568.062,"body":"not, whether I'm even open to receiving care."},{"startTime":568.226,"endTime":571.574,"body":"You know, over 30 years, three decades in the mental health field, I've seen a"},{"startTime":571.582,"endTime":574.886,"body":"lot of different kinds of people. And there's a category of person"},{"startTime":575.038,"endTime":578.822,"body":"that for 30 years they've never been to a doctor. And I'm not"},{"startTime":578.846,"endTime":581.622,"body":"judging that. If you can do that and you don't have to go to a"},{"startTime":581.646,"endTime":585.462,"body":"doctor, great. But it's oftentimes this reluctance of I don't want"},{"startTime":585.486,"endTime":589.19,"body":"to go and depend on anyone. I don't want to go and find"},{"startTime":589.23,"endTime":592.982,"body":"out if I'm vulnerable for advanced testing or screening. I"},{"startTime":593.006,"endTime":596.422,"body":"don't want to find out if I've actually got some kind of disease and if"},{"startTime":596.446,"endTime":599.82,"body":"I'm sick. So there's this avoidant way of"},{"startTime":599.86,"endTime":603.612,"body":"relating to healthy care that this person might even have"},{"startTime":603.636,"endTime":606.94,"body":"insurance to receive. So it's not a financial issue. And that"},{"startTime":606.98,"endTime":610.78,"body":"avoidance of care is actually a result of how their"},{"startTime":610.82,"endTime":614.46,"body":"life experience has shaped them and therefore how"},{"startTime":614.5,"endTime":618.188,"body":"they relate to receiving and accessing care. I've"},{"startTime":618.204,"endTime":621.212,"body":"worked with so many people over the years who as a result of their trauma,"},{"startTime":621.276,"endTime":624.86,"body":"they say I'm really great at helping others, but I'm not so great"},{"startTime":624.9,"endTime":628.568,"body":"at. At taking care of myself, and I'm not so great at receiving."},{"startTime":628.664,"endTime":632.392,"body":"How can you help me to receive? And oftentimes it's not"},{"startTime":632.416,"endTime":635.288,"body":"getting out a book called you know, how to receive, or go to"},{"startTime":635.344,"endTime":639.016,"body":"howtoreceive.com, it's an issue of looking at the person's nervous"},{"startTime":639.048,"endTime":642.664,"body":"system and how they have shut down or closed themselves"},{"startTime":642.712,"endTime":646.2,"body":"off to that vulnerability. And it might seem like an obvious thought,"},{"startTime":646.32,"endTime":650.008,"body":"but that they never were able"},{"startTime":650.064,"endTime":653.244,"body":"to receive grace growing up or in their earlier childhood"},{"startTime":653.292,"endTime":656.588,"body":"experiences because that was too vulnerable. They were"},{"startTime":656.644,"endTime":660.252,"body":"shamed, they were punished for being needy or for"},{"startTime":660.276,"endTime":663.932,"body":"receiving, or that they simply couldn't receive because there"},{"startTime":663.956,"endTime":667.772,"body":"was nothing there to give them. Nothing was being poured into them in"},{"startTime":667.796,"endTime":669.96,"body":"terms of their basic developmental needs."},{"startTime":671.3,"endTime":673.72,"body":"So there are a number of"},{"startTime":674.66,"endTime":678.152,"body":"organizational competencies that trauma"},{"startTime":678.216,"endTime":681.912,"body":"informed groups use. Generally speaking, those are"},{"startTime":681.936,"endTime":685.736,"body":"going to be hospitals and larger clinical settings. But at restoring the soul"},{"startTime":685.768,"endTime":689.448,"body":"here we have started to think through what are the core"},{"startTime":689.544,"endTime":693.32,"body":"values that we want to put in place for how people will relate"},{"startTime":693.4,"endTime":697.208,"body":"to us, what are the kinds of protocols that we'll"},{"startTime":697.224,"endTime":700.952,"body":"put in place? And we've done, I think, a pretty good job about this. From"},{"startTime":700.976,"endTime":704.624,"body":"when people walk in, you know, we don't have fluorescent"},{"startTime":704.672,"endTime":708.352,"body":"lights. We even did a remodel. And we don't have LED lights which have a"},{"startTime":708.376,"endTime":712.192,"body":"certain still not fluorescent, but kind of intensity to it. We"},{"startTime":712.216,"endTime":715.392,"body":"have a lot of ambient lighting. And I'm going to come back to things like"},{"startTime":715.416,"endTime":718.992,"body":"that more and more. But a part of trauma is"},{"startTime":719.016,"endTime":722.064,"body":"often neurodiversity or sensory"},{"startTime":722.192,"endTime":725.792,"body":"sensitivity in terms of touch, taste, sight, smell, sound."},{"startTime":725.856,"endTime":729.008,"body":"There's sensitivity there. And we have to be"},{"startTime":729.064,"endTime":732.606,"body":"proactive and thinking about how clients will experience"},{"startTime":732.758,"endTime":736.542,"body":"those kinds of things. There's also a number of guidelines."},{"startTime":736.686,"endTime":739.93,"body":"And today I want to spend just a little bit of time"},{"startTime":740.39,"endTime":743.726,"body":"talking about some of Those guidelines as it relates to these five"},{"startTime":743.798,"endTime":747.598,"body":"pillars. Before I wrap up this particular episode, I want to talk"},{"startTime":747.654,"endTime":751.262,"body":"about some key ingredients of what trauma"},{"startTime":751.326,"endTime":755.07,"body":"informed care looks like in an organization and then"},{"startTime":755.11,"endTime":758.45,"body":"in a clinical setting. And the first thing in an organization"},{"startTime":758.89,"endTime":762.11,"body":"is that, let's just say a hospital,"},{"startTime":762.73,"endTime":766.098,"body":"a dentist office, and"},{"startTime":766.154,"endTime":769.458,"body":"then a physician's office. Those"},{"startTime":769.514,"endTime":773.266,"body":"three typical points of contact and care, which outside"},{"startTime":773.338,"endTime":776.946,"body":"of the therapy office may be the most common, the first"},{"startTime":777.018,"endTime":780.738,"body":"key ingredient is for the organization"},{"startTime":780.914,"endTime":784.434,"body":"to communicate and lead"},{"startTime":784.522,"endTime":788.354,"body":"their patients and clients in a process of transformation. Now,"},{"startTime":788.362,"endTime":791.922,"body":"what does that mean at the dentist? That means"},{"startTime":792.026,"endTime":795.522,"body":"that in light of understanding trauma and childhood"},{"startTime":795.586,"endTime":799.25,"body":"adverse experiences, that from the time that the"},{"startTime":799.29,"endTime":803.042,"body":"patient walks in to check in at the dentist office, till the"},{"startTime":803.066,"endTime":806.754,"body":"time that they sit down in the dentist chair, to the time when the"},{"startTime":806.762,"endTime":810.402,"body":"dentist starts drilling or the hygienist starts doing what they're doing, to the time that"},{"startTime":810.426,"endTime":813.95,"body":"they check out, that they're proactively thinking through"},{"startTime":814.25,"endTime":817.732,"body":"what is the outcome that's desired here today"},{"startTime":817.906,"endTime":821.488,"body":"and what might we be needing to think about"},{"startTime":821.624,"endTime":825.44,"body":"in terms of serving people well so that they can a not"},{"startTime":825.48,"endTime":829.28,"body":"simply be comfortable so that they come back and remain our patient, but"},{"startTime":829.32,"endTime":832.928,"body":"so that they will not be activated, dysregulated, or"},{"startTime":832.984,"endTime":836.832,"body":"even traumatized by this experience. Now, nobody likes going"},{"startTime":836.856,"endTime":840.592,"body":"to the dentist, but after I was diagnosed in 2003 with complex"},{"startTime":840.656,"endTime":844.212,"body":"PTSD, which was a 7 to 10 year process of"},{"startTime":844.236,"endTime":847.7,"body":"overcoming, I remember a number of times when I had some major"},{"startTime":847.82,"endTime":851.332,"body":"dental work done and prior to going to the dentist"},{"startTime":851.396,"endTime":855.156,"body":"office, I had some major triggering. There's"},{"startTime":855.188,"endTime":858.852,"body":"something about laying down in that chair and they tip it back and you"},{"startTime":858.876,"endTime":862.324,"body":"may put your sunglasses on and they just kind of start"},{"startTime":862.412,"endTime":865.972,"body":"in and if they're not aware of trauma, that can be very"},{"startTime":866.076,"endTime":869.812,"body":"dysregulating. And I remember because there was, as"},{"startTime":869.836,"endTime":872.946,"body":"I've talked about so often on this podcast, sexual"},{"startTime":872.978,"endTime":876.626,"body":"abuse. As part of my story, and part of that sexual"},{"startTime":876.658,"endTime":880.37,"body":"abuse involved photographs being taken of"},{"startTime":880.41,"endTime":883.762,"body":"me as a child. The dentist and his assistant"},{"startTime":883.906,"endTime":887.03,"body":"wanted to take photographs of my tooth"},{"startTime":887.45,"endTime":891.202,"body":"for the before and after they did this implant for where one of my"},{"startTime":891.226,"endTime":895.042,"body":"teeth was knocked out. And I remember sitting in the chair all the"},{"startTime":895.066,"endTime":898.642,"body":"way back and they put this big retractor in my mouth, so my mouth"},{"startTime":898.706,"endTime":902.55,"body":"looks like it's about 6 inches wide. And, you know, there's everything just"},{"startTime":902.59,"endTime":906.118,"body":"wide open. And without asking my permission,"},{"startTime":906.294,"endTime":909.798,"body":"without having me sign a release of information, they took those"},{"startTime":909.854,"endTime":913.462,"body":"photographs and then they were posted on the website as a"},{"startTime":913.486,"endTime":917.126,"body":"before and after example of this doctor's excellent care."},{"startTime":917.278,"endTime":920.854,"body":"Now, I Think that was around 2007"},{"startTime":920.942,"endTime":924.678,"body":"or 8, somewhere back in there. I don't know what the ethics were"},{"startTime":924.734,"endTime":928.39,"body":"at that time in dentistry. I don't know if the Health Insurance Portability"},{"startTime":928.47,"endTime":932.016,"body":"act, known as hipaa was in place place at that time. But I would"},{"startTime":932.088,"endTime":935.888,"body":"say that at the very least that dentist and"},{"startTime":935.944,"endTime":939.78,"body":"or the assistant should have had a policy in place that said, hey,"},{"startTime":940.12,"endTime":943.68,"body":"this is your mouth, these are your teeth. This is an"},{"startTime":943.72,"endTime":947.408,"body":"incredibly vulnerable situation to be in. A, laying in the"},{"startTime":947.464,"endTime":950.96,"body":"dentist chair, B, having your mouth open with this"},{"startTime":951.08,"endTime":954.704,"body":"retractor, C taking a picture of your face, albeit"},{"startTime":954.752,"endTime":958.116,"body":"not identified because it was just my mouth on the"},{"startTime":958.188,"endTime":961.892,"body":"dentist's office website of no tooth with this big gap and then one"},{"startTime":961.916,"endTime":965.76,"body":"with the tooth in place. And we'd like to ask you to consider"},{"startTime":966.7,"endTime":970.196,"body":"being on our website as a before and after."},{"startTime":970.348,"endTime":974.02,"body":"Now, here's a particular struggle with this, and this is why"},{"startTime":974.06,"endTime":977.78,"body":"this conversation is so important, is because if I'm laying in that"},{"startTime":977.82,"endTime":981.396,"body":"chair and if I've had trauma and abuse and if I'm a people"},{"startTime":981.468,"endTime":984.596,"body":"pleaser and I happen to be on the enneagram personality"},{"startTime":984.708,"endTime":988.532,"body":"type A2, which is I'm a helper and a giver, it's really hard for"},{"startTime":988.556,"endTime":992.372,"body":"me to say no, and particularly to an authority and especially when"},{"startTime":992.396,"endTime":996.036,"body":"I'm in a place of vulnerability. Do you hear how this is working out? There's"},{"startTime":996.068,"endTime":999.716,"body":"no proactive protocol or"},{"startTime":999.868,"endTime":1003.156,"body":"communication about this process. They're just"},{"startTime":1003.228,"endTime":1007.04,"body":"acting perhaps ethically with what works for them."},{"startTime":1007.58,"endTime":1011.332,"body":"So they might have said beforehand, before you sit down"},{"startTime":1011.356,"endTime":1015.058,"body":"in the dentist chair, or we'd like you to take this one page form and"},{"startTime":1015.114,"endTime":1018.642,"body":"review a practice that we ask clients to"},{"startTime":1018.666,"endTime":1022.418,"body":"participate in. And here's all the parameters of it. Here's what will"},{"startTime":1022.474,"endTime":1025.986,"body":"and will not happen with the photographs. Do you hear how this is all about"},{"startTime":1026.058,"endTime":1029.89,"body":"empowerment and it's about giving me choice or giving the"},{"startTime":1029.93,"endTime":1033.746,"body":"patient or the client choice. It's about giving control,"},{"startTime":1033.898,"endTime":1037.682,"body":"if you will. So I can say no, but I have the opportunity"},{"startTime":1037.746,"endTime":1041.494,"body":"to say no sitting in the lobby when I'm not in a vulnerable"},{"startTime":1041.542,"endTime":1044.934,"body":"position with the retractor in my mouth. By the way, how does one with a"},{"startTime":1044.942,"endTime":1048.582,"body":"retractor in their mouth go? All right, you take the"},{"startTime":1048.606,"endTime":1051.99,"body":"picture, that's not going to work, right? So this is a really good"},{"startTime":1052.03,"endTime":1055.574,"body":"example outside of mental health, about a clinical"},{"startTime":1055.622,"endTime":1058.758,"body":"setting. So that is communicating about"},{"startTime":1058.814,"endTime":1062.486,"body":"transformation and being aware and"},{"startTime":1062.558,"endTime":1066.294,"body":"proactive. And in the dentist's office, the transformation is how do you"},{"startTime":1066.302,"endTime":1070.136,"body":"go from your tooth knocked out to having a tooth and leaving the office"},{"startTime":1070.208,"endTime":1074.04,"body":"after however many sessions, appointments or treatments and be satisfied with"},{"startTime":1074.08,"endTime":1077.608,"body":"that outcome for many, many, many months."},{"startTime":1077.744,"endTime":1081.576,"body":"I was very uncomfortable and even had to go and talk to my therapist"},{"startTime":1081.688,"endTime":1085.272,"body":"about what this stirred up in me to have these photographs taken."},{"startTime":1085.456,"endTime":1089.224,"body":"And you know, I considered filing a complaint and ultimately"},{"startTime":1089.272,"endTime":1093.032,"body":"I made the decision to not go back to that doctor's office. Now why did"},{"startTime":1093.056,"endTime":1096.76,"body":"I make that decision? Because they did not have, even"},{"startTime":1096.8,"endTime":1100.472,"body":"though I didn't know the phrase at the time, they did not have a"},{"startTime":1100.496,"endTime":1104.152,"body":"trauma informed approach. As a result of that,"},{"startTime":1104.256,"endTime":1108.04,"body":"my therapist re engaged with something that she"},{"startTime":1108.08,"endTime":1111.752,"body":"used to do long before this moment at my"},{"startTime":1111.776,"endTime":1115.256,"body":"dentist's office. But my therapist used to go to doctors and"},{"startTime":1115.328,"endTime":1118.968,"body":"dentists and educate them back in the 1980s in the early"},{"startTime":1119.024,"endTime":1122.508,"body":"90s about how to work with clients with abuse and"},{"startTime":1122.564,"endTime":1126.316,"body":"trauma and sexual abuse and physical abuse in particular. The second"},{"startTime":1126.388,"endTime":1130.028,"body":"key ingredient for organizations is"},{"startTime":1130.084,"endTime":1133.868,"body":"helping clients through involving them in the"},{"startTime":1133.924,"endTime":1137.772,"body":"planning process. So walking them through and saying"},{"startTime":1137.796,"endTime":1141.004,"body":"here's all the different ingredients of what's happening and it's all about"},{"startTime":1141.092,"endTime":1144.48,"body":"power. Or rather it's about empowering the client"},{"startTime":1144.98,"endTime":1148.788,"body":"in the midst of the vulnerability of care and allowing them to"},{"startTime":1148.844,"endTime":1152.388,"body":"plan. Okay, rather than doing your treatments"},{"startTime":1152.484,"endTime":1155.812,"body":"three days apart because you can't do it any sooner, would it feel better to"},{"startTime":1155.836,"endTime":1159.652,"body":"you to have this a week apart, two weeks apart? Would it"},{"startTime":1159.676,"endTime":1163.156,"body":"also be better for you to, in a dentist's office to have"},{"startTime":1163.228,"endTime":1167.012,"body":"nitrous oxide, you know, where you're semi conscious, or"},{"startTime":1167.036,"endTime":1170.804,"body":"would you like to be awake? A lot of people, they would"},{"startTime":1170.892,"endTime":1174.5,"body":"with trauma and abuse and childhood adversity, the last thing they would want"},{"startTime":1174.54,"endTime":1178.252,"body":"is, is to be out of control. And on nitrous oxide and others, they"},{"startTime":1178.276,"endTime":1181.692,"body":"don't want to be awake for that. So all of that is just consideration. And"},{"startTime":1181.716,"endTime":1185.564,"body":"you may be thinking, wow, this would take a lot of extra time"},{"startTime":1185.732,"endTime":1189.516,"body":"and energy and thoughtfulness on the part of these caregivers."},{"startTime":1189.628,"endTime":1193.308,"body":"And I would say yes, that's correct. But remember, the evidence suggests"},{"startTime":1193.404,"endTime":1197.164,"body":"that the outcomes are better outcomes in terms of engaging"},{"startTime":1197.212,"endTime":1200.48,"body":"in treatment, being retained in treatment and the outcome."},{"startTime":1200.95,"endTime":1204.67,"body":"The third piece of this trauma informed care for an organization"},{"startTime":1204.83,"endTime":1208.366,"body":"is training for key staff members, both"},{"startTime":1208.438,"endTime":1212.03,"body":"clinical and non clinical. That would be the person at"},{"startTime":1212.07,"endTime":1215.582,"body":"the check in when you come and say, hi, I'm here for doctor dentist"},{"startTime":1215.646,"endTime":1218.894,"body":"appointment. If you're really nervous, they might"},{"startTime":1218.982,"endTime":1222.414,"body":"say the doctor will be about"},{"startTime":1222.502,"endTime":1226.286,"body":"15 minutes. We're so sorry that they're running behind as opposed"},{"startTime":1226.318,"endTime":1229.95,"body":"to that nervous or anxious client sitting in the lobby and just"},{"startTime":1229.99,"endTime":1233.822,"body":"waiting, wondering when they're going to come out. They may say"},{"startTime":1234.006,"endTime":1237.39,"body":"if there's something in the client's chart about a history of"},{"startTime":1237.43,"endTime":1241.022,"body":"trauma. They may say, you know, we have another section of the"},{"startTime":1241.046,"endTime":1244.718,"body":"waiting room or if you'd like to step inside, here's an empty room"},{"startTime":1244.774,"endTime":1248.19,"body":"where the lights are lower and it's a little bit more quiet. Would you be"},{"startTime":1248.23,"endTime":1251.854,"body":"more comfortable sitting there? So sometimes clinical"},{"startTime":1251.902,"endTime":1255.662,"body":"training allows for the employees"},{"startTime":1255.726,"endTime":1259.422,"body":"and the caregivers and non clinical people to engage in other ways"},{"startTime":1259.486,"endTime":1262.41,"body":"that are extra intent. By the way, years ago"},{"startTime":1263.27,"endTime":1267.022,"body":"I had over a period of about three or four years, I"},{"startTime":1267.046,"endTime":1270.734,"body":"had nine kidney stones and some of those involved"},{"startTime":1270.782,"endTime":1274.366,"body":"surgery. And I remember going to my doctor, the urologist, and telling"},{"startTime":1274.398,"endTime":1277.71,"body":"him, I am in the midst of healing from"},{"startTime":1277.75,"endTime":1281.422,"body":"trauma, an extended course of therapy regarding"},{"startTime":1281.486,"endTime":1285.052,"body":"sexual abuse. Can you please put a note in my file?"},{"startTime":1285.196,"endTime":1288.892,"body":"And the doctor took a deep breath and he exhaled and he said, thank you"},{"startTime":1288.916,"endTime":1292.54,"body":"for telling me that. Let's deal with this right now. And he literally"},{"startTime":1292.62,"endTime":1296.332,"body":"stood up, invited me out of his office, walked over to"},{"startTime":1296.356,"endTime":1299.948,"body":"this big room that was the medical records section. And he"},{"startTime":1300.004,"endTime":1303.564,"body":"very kindly and gently spoke to this young woman that was the"},{"startTime":1303.652,"endTime":1307.468,"body":"medical records specialist. And he said, we're going to"},{"startTime":1307.604,"endTime":1311.324,"body":"put a label on the outside of this chart and at the entry"},{"startTime":1311.372,"endTime":1314.236,"body":"point when people click into it. And I'm not sure if this was a policy"},{"startTime":1314.308,"endTime":1317.614,"body":"that they had at the time or if the doctor just initiated this, but I"},{"startTime":1317.622,"endTime":1321.374,"body":"remember being so touched. The doctor wrote history of trauma"},{"startTime":1321.422,"endTime":1324.97,"body":"and childhood abuse. And then there were certain"},{"startTime":1325.59,"endTime":1329.262,"body":"things of awareness where I wanted to have certain kinds of"},{"startTime":1329.286,"endTime":1332.574,"body":"medication. I wanted to be basically"},{"startTime":1332.702,"endTime":1336.094,"body":"anesthetized fully as opposed to just a mild"},{"startTime":1336.142,"endTime":1339.662,"body":"sedation for kidney stone treatment because of how that could be re"},{"startTime":1339.686,"endTime":1343.256,"body":"traumatizing. And to think of not having that, it"},{"startTime":1343.328,"endTime":1347.032,"body":"really became a big deal. And I'll just share this because"},{"startTime":1347.056,"endTime":1350.84,"body":"it's what happened. But I remember spending many sessions over a period"},{"startTime":1350.88,"endTime":1354.488,"body":"of weeks and weeks talking with my therapist about whether or"},{"startTime":1354.544,"endTime":1358.088,"body":"not I was actually worthy of requesting this"},{"startTime":1358.144,"endTime":1361.912,"body":"certain kind of care. So you can again see how important this"},{"startTime":1361.936,"endTime":1365.72,"body":"is not just at the organizational level, not just at the clinical level, but"},{"startTime":1365.76,"endTime":1369.552,"body":"in terms of how people can self advocate and how the invitation"},{"startTime":1369.616,"endTime":1372.656,"body":"is there for this. Overall,"},{"startTime":1372.768,"endTime":1376.336,"body":"organizationally, a trauma informed approach is about"},{"startTime":1376.408,"endTime":1380.192,"body":"creating a safe environment from what I call soup to nuts,"},{"startTime":1380.256,"endTime":1383.968,"body":"from beginning to end of the experience. And that is really"},{"startTime":1384.024,"endTime":1387.2,"body":"to prevent secondary"},{"startTime":1387.28,"endTime":1390.4,"body":"traumatization from staff that are not"},{"startTime":1390.44,"endTime":1393.936,"body":"intentionally doing this. That means that with certain"},{"startTime":1394.008,"endTime":1397.756,"body":"people they're going to have information ahead of time"},{"startTime":1397.828,"endTime":1401.58,"body":"or to anticipate or simply to have a way of relating and being"},{"startTime":1401.62,"endTime":1404.812,"body":"in the office so that there's not ongoing"},{"startTime":1404.956,"endTime":1408.748,"body":"trauma that happens as a result of policies and practices."},{"startTime":1408.844,"endTime":1412.492,"body":"Another example from the dentist office. And if anybody wants to hire me as a"},{"startTime":1412.516,"endTime":1416.252,"body":"consultant to work with dentist office to give my"},{"startTime":1416.276,"endTime":1419.16,"body":"opinion, I'm half kidding about that. But"},{"startTime":1419.54,"endTime":1423.238,"body":"so I've been in the dental chair and they come"},{"startTime":1423.294,"endTime":1426.69,"body":"after drilling and examining and doing an exam and they say,"},{"startTime":1426.99,"endTime":1430.662,"body":"so would you like. No, they'll say, it's our policy to give you"},{"startTime":1430.686,"endTime":1434.13,"body":"the financial information about this. So while laying back"},{"startTime":1434.59,"endTime":1438.374,"body":"with these sunglasses on, completely vulnerable, they come and they bring a"},{"startTime":1438.382,"endTime":1441.974,"body":"clipboard and they start reading numbers and figures about"},{"startTime":1442.062,"endTime":1445.078,"body":"how much this is going to cost. So it's going to cost"},{"startTime":1445.134,"endTime":1448.974,"body":"$2,500, let's say, to repair"},{"startTime":1449.022,"endTime":1452.75,"body":"your tooth. Would you like to go ahead and do that? Now, I"},{"startTime":1452.79,"endTime":1455.902,"body":"would suggest that that's not only not trauma"},{"startTime":1455.966,"endTime":1459.102,"body":"informed, but that that has the potential to be re"},{"startTime":1459.126,"endTime":1462.83,"body":"traumatizing. I mean, if I was at a car dealership and"},{"startTime":1462.87,"endTime":1466.622,"body":"the salesman said to me, would you, you know, like to take that"},{"startTime":1466.646,"endTime":1470.094,"body":"car home with you today? I would feel pressured and maybe"},{"startTime":1470.142,"endTime":1473.742,"body":"anxious and I'd want to leave that situation or at"},{"startTime":1473.766,"endTime":1477.046,"body":"best say, hey, I need some time. Let me go to lunch with my wife."},{"startTime":1477.078,"endTime":1479.702,"body":"And we're going to come back, we're going to think about it. But in the"},{"startTime":1479.726,"endTime":1483.286,"body":"dentist chair, with the power differential of expertise,"},{"startTime":1483.478,"endTime":1486.21,"body":"with that vulnerable physical position,"},{"startTime":1487.07,"endTime":1490.838,"body":"I don't think it gives people the ability to make good choices and"},{"startTime":1490.894,"endTime":1494.342,"body":"good decisions. So the trauma"},{"startTime":1494.406,"endTime":1498.118,"body":"informed perspective is about creating safety in a way"},{"startTime":1498.174,"endTime":1501.884,"body":"that prevents secondary trauma from staff."},{"startTime":1502.052,"endTime":1505.82,"body":"The clinical aspect of trauma informed care, this is what it would look"},{"startTime":1505.86,"endTime":1509.212,"body":"like specifically in medical"},{"startTime":1509.316,"endTime":1513.052,"body":"situations, in the face to face at"},{"startTime":1513.076,"endTime":1516.54,"body":"a level lower than the 30,000 foot"},{"startTime":1516.58,"endTime":1520.412,"body":"organizational level. And it's involving people in the treatment"},{"startTime":1520.476,"endTime":1524.14,"body":"process. So it would be the dentist, the hygienist, or"},{"startTime":1524.18,"endTime":1527.822,"body":"even the medical assistant where I recently had a physical who comes in and"},{"startTime":1527.846,"endTime":1531.15,"body":"says, I'm going to put the blood pressure cuff on your arm right"},{"startTime":1531.19,"endTime":1534.17,"body":"now. Are you ready for that? Is that all right?"},{"startTime":1534.63,"endTime":1538.078,"body":"And you prefer left or right arm? That may happen."},{"startTime":1538.214,"endTime":1541.966,"body":"But then if they need to ask you to take off your shirt"},{"startTime":1541.998,"endTime":1545.486,"body":"or your top, you know the blood pressure cuff isn't going to work"},{"startTime":1545.558,"endTime":1549.262,"body":"over that sweatshirt or over that flannel shirt. So I'm going to need you to"},{"startTime":1549.286,"endTime":1553.092,"body":"take your top off. Would you like me to step out and would"},{"startTime":1553.116,"endTime":1556.804,"body":"you like to have a gown on? Because what happened"},{"startTime":1556.852,"endTime":1559.764,"body":"at my office was they said, take off your shirt and I'm sitting there from"},{"startTime":1559.772,"endTime":1563.54,"body":"the waist up with bare chested and in ever so"},{"startTime":1563.58,"endTime":1566.932,"body":"subtle a way they could have said or may have had a"},{"startTime":1566.956,"endTime":1570.516,"body":"proactive stance that was more anticipatory,"},{"startTime":1570.628,"endTime":1573.956,"body":"proactive and considerate of that situation. Now, in that instance, it didn't"},{"startTime":1573.988,"endTime":1577.748,"body":"traumatize me, but I know many, many people that that"},{"startTime":1577.804,"endTime":1581.626,"body":"would traumatize. And I've sat with people over and over and over again and"},{"startTime":1581.698,"endTime":1585.082,"body":"said, what would it have been like for you to speak up in that moment?"},{"startTime":1585.146,"endTime":1588.714,"body":"And those the person says, I never would speak up, I wouldn't"},{"startTime":1588.762,"endTime":1592.346,"body":"possibly speak up in that situation, even though I felt ashamed,"},{"startTime":1592.378,"endTime":1595.93,"body":"embarrassed and terrified. The second thing, and this is"},{"startTime":1595.97,"endTime":1599.802,"body":"just so obvious, but it doesn't happen. And that is screening"},{"startTime":1599.866,"endTime":1603.706,"body":"for trauma. At my particular doctor's office, there's"},{"startTime":1603.738,"endTime":1607.354,"body":"two assessments that you get when the minute you go into the examination room and"},{"startTime":1607.362,"endTime":1610.64,"body":"they say the doctor will be here shortly, they hand you a clipboard with the"},{"startTime":1610.68,"endTime":1614.432,"body":"PHQ9. That's the patient health questionnaire. And we use"},{"startTime":1614.456,"endTime":1617.92,"body":"this at restoring the soul on the first day of every intensive"},{"startTime":1618.08,"endTime":1621.28,"body":"because it's like taking vital signs. It's like taking pulse,"},{"startTime":1621.36,"endTime":1625.008,"body":"respirations, blood pressure. And it's just"},{"startTime":1625.064,"endTime":1628.704,"body":"a simple way of finding out people's level of depression and"},{"startTime":1628.792,"endTime":1632.0,"body":"anxiety. And then we give a trauma"},{"startTime":1632.08,"endTime":1635.664,"body":"inventory. And that is somebody might have filled out the"},{"startTime":1635.672,"endTime":1639.52,"body":"paperwork one, two or three months ago. But this allows there to be a"},{"startTime":1639.56,"endTime":1643.392,"body":"fresh report and a way of screening for this. That even if a"},{"startTime":1643.416,"endTime":1647.18,"body":"person doesn't have post traumatic stress disorder or something"},{"startTime":1647.56,"endTime":1651.2,"body":"that significant, we know whether there are adverse"},{"startTime":1651.28,"endTime":1655.072,"body":"experiences in their life that might make it important to relate to them"},{"startTime":1655.176,"endTime":1658.576,"body":"in a particular way. At the clinical level, it's important for"},{"startTime":1658.648,"endTime":1661.968,"body":"staff to be trained in specific treatment"},{"startTime":1662.064,"endTime":1665.85,"body":"approaches. So in therapy this"},{"startTime":1665.89,"endTime":1669.722,"body":"would be things like emdr, brain spotting, which"},{"startTime":1669.746,"endTime":1673.29,"body":"is a popular trauma treatment, although we don't do that at restoring the"},{"startTime":1673.33,"endTime":1676.362,"body":"Soul. Somatic experiencing, somatic"},{"startTime":1676.426,"endTime":1679.99,"body":"interventions, attachment work,"},{"startTime":1680.69,"endTime":1683.306,"body":"polyvagal work, interpersonal"},{"startTime":1683.338,"endTime":1686.682,"body":"neurobiology, cognitive therapy and"},{"startTime":1686.786,"endTime":1690.352,"body":"spiritual kinds of interventions. All of these approaches"},{"startTime":1690.546,"endTime":1694.132,"body":"would be about helping understand a person's nervous system"},{"startTime":1694.236,"endTime":1697.876,"body":"as it relates to their life experience, with the assumption"},{"startTime":1697.988,"endTime":1701.28,"body":"that they have the potential to be activated or"},{"startTime":1701.58,"endTime":1705.076,"body":"dysregulated in a situation where they're"},{"startTime":1705.108,"endTime":1708.9,"body":"vulnerable. The final aspect of trauma informed care at the clinical face"},{"startTime":1708.94,"endTime":1712.788,"body":"to face level is knowing lots of"},{"startTime":1712.844,"endTime":1716.212,"body":"resources so that if you are not a"},{"startTime":1716.316,"endTime":1720.052,"body":"shotgun, one size fits all kind of mental health clinic where you can deal with"},{"startTime":1720.076,"endTime":1723.638,"body":"everything, let's just say that you specialize in sexual abuse"},{"startTime":1723.734,"endTime":1727.398,"body":"or in addictions treatment with trauma as part of that"},{"startTime":1727.454,"endTime":1731.158,"body":"background. Having referrals is we can't help you,"},{"startTime":1731.214,"endTime":1734.742,"body":"but we know a really great resource that will and"},{"startTime":1734.766,"endTime":1738.582,"body":"oftentimes people will make referrals in mental health. For I"},{"startTime":1738.606,"endTime":1742.102,"body":"saw this person's name on a website and it says that they do trauma. So"},{"startTime":1742.126,"endTime":1745.942,"body":"I'm referring you there versus a referral that can"},{"startTime":1745.966,"endTime":1749.698,"body":"be made. We have a specific relationship with this"},{"startTime":1749.754,"endTime":1753.506,"body":"particular person and we know that they're safe. We know that they're going to respect"},{"startTime":1753.578,"endTime":1757.186,"body":"your trauma, understand your trauma and help you get the care"},{"startTime":1757.338,"endTime":1760.834,"body":"that you need. So that is trauma informed"},{"startTime":1760.882,"endTime":1764.498,"body":"care from the 30,000 foot view, from this overall"},{"startTime":1764.594,"endTime":1767.858,"body":"approach to patient care. And in our next"},{"startTime":1767.914,"endTime":1771.762,"body":"conversation, we're going to talk about the five pillars of trauma"},{"startTime":1771.826,"endTime":1775.57,"body":"informed care as it relates to restoring the soul. We'll talk to you next"},{"startTime":1775.61,"endTime":1775.69,"body":"time."}]}