The paradox of trauma-informed care | Vicky Kelly | TEDxWilmington

Summary

Vicky Kelly explores the complexities of trauma-informed care, highlighting how trauma has become a common topic yet challenges persist in human services systems adopting this approach. The talk underscores how childhood trauma contrasts with adult trauma and its profound impact on human development. Kelly critiques traditional behavioral health systems and emphasizes the necessity for time and new strategies in healing trauma. The paradox, she notes, lies in society's reluctance to fully grasp trauma's implications while possessing more knowledge about trauma healing than ever before. Emphasizing the collective responsibility, Kelly calls for efforts beyond human services, urging community involvement to promote healing through connection. This broader engagement is pivotal in tackling trauma, a major public health crisis.

Highlights

• Trauma-informed care focuses on understanding individuals' trauma histories rather than their symptoms. 🎯
• Childhood traumas have a pervasive impact on development, altering brain structures. 💥
• The current healthcare system needs to better accommodate long-term healing processes. 🏗️
• Traditional treatment methods may not be effective for trauma survivors, necessitating innovative approaches. 💡
• Trauma has implications beyond mental health, affecting physical health significantly. ⚕️
• Community involvement is crucial in creating supportive networks for healing. 🌍

Key Takeaways

• Trauma-informed care shifts focus from 'What's wrong with you?' to 'What happened to you?' 🌟
• Childhood trauma profoundly impacts human brain development and functions. 🧠
• Healing from developmental trauma requires time and is not a quick fix. ⏳
• The human services field needs to adapt with new strategies to help trauma-affected individuals. 🚀
• Childhood trauma is a significant public health crisis, influencing both mental and physical health. 🏥
• Community-wide efforts and connections are key to promoting healing and resilience. 🤝

Overview

In her insightful talk, Vicky Kelly discusses the importance of trauma-informed care in the field of human services. She expresses surprise at how the topic of trauma has become so prevalent in society, despite ongoing challenges in systems fully adopting and implementing this approach effectively. Trauma-informed care represents a shift from asking 'What's wrong with you?' to 'What happened to you?' highlighting the need for sensitivity and understanding when working with trauma survivors.

Kelly explores the profound effects of childhood trauma on brain development, detailing how it can alter basic functions and structures. She emphasizes the limitations of traditional behavioral health systems, which often fail to accommodate the need for extensive and flexible treatment time. Instead, she advocates for a paradigm shift that embraces new strategies to truly support individuals in their healing journeys.

Finally, Kelly calls for broader societal engagement in addressing trauma, viewing it not just as an individual issue, but a widespread public health crisis. She underscores the importance of establishing strong community connections and relationships as a pathway to healing, highlighting that anyone can play a role in this process, from teachers to neighbors. Her message is clear: everyone has a part to play in being trauma-informed and supporting one another towards recovery.

Chapters

• 00:00 - 01:00: Introduction to Trauma-Informed Care The chapter discusses the author's 30-year experience in various human service organizations focusing on healing psychological trauma. The author notes that the challenge isn't solely in discovering effective techniques and interventions for healing but also involves other factors.
• 01:00 - 04:00: Understanding Childhood Trauma and Its Impact Childhood trauma is increasingly recognized as a critical factor influencing individual behavior and well-being.
• 04:00 - 09:00: Critical Impacts of Trauma on the Brain The chapter explores a shift in perspective from asking 'what's wrong with you' to 'what happened to you', emphasizing the importance of understanding past traumatic experiences and how they persistently affect current functioning.
• 09:00 - 12:00: Healing and Overcoming Trauma The chapter discusses society's evolving understanding of trauma, emphasizing the initial reluctance to define and diagnose trauma comprehensively. It highlights the significance of the recognition of PTSD as a formal diagnosis in 1980, marking a critical step in acknowledging trauma. However, the chapter also points out the limitations of this definition, noting that it primarily focused on adult experiences, leaving out other demographics, particularly children. This indicates a need for a broader and more inclusive understanding of trauma and its impacts.

The paradox of trauma-informed care | Vicky Kelly | TEDxWilmington Transcription

• 00:00 - 00:30 for over 30 years it has been my privilege to work in a variety of human service organizations and the common thread of that work has been about helping people heal from psychological trauma and it's often been an uphill struggle but not as you might imagine it's not just about finding the techniques and interventions that help people heal although that is a challenge more often it has been helping the
• 00:30 - 01:00 larger systems in which we do our work appreciate the impact that trauma has on people's lives so imagine my surprise in the last few years when trauma has now become so commonplace in our conversations and in media representations so the field of Human Services is embarking on a new approach an approach called trauma-informed care in its most basic simple way it is a shift in the basic questions that we ask
• 01:00 - 01:30 a shift away from the question of what's wrong with you to a question of what happened to you and more importantly how does that continue to live on in your life and impact how you function today so a trauma-informed approach would seem to call for greater sensitivity and a deepening of understanding and therein is the paradox because quite frankly as
• 01:30 - 02:00 a society we've been somewhat reluctant to come to terms with what trauma means after all the diagnosis of post-traumatic stress disorder or PTSD was not approved until 1980 now that was a really important milestone for us but PTSD has always been a limited diagnosis limited because it was based on adults experiences of trauma adults who had the
• 02:00 - 02:30 ability to describe to us what it was like to live with those intrusive memories of the traumatic event and live with their coping strategies which were so much about avoiding any minder of the trauma but the reality is that after decades of research only 25% of children even those with corroborated histories of significant dramatic histories ever meet the criteria for
• 02:30 - 03:00 PTSD why because childhood trauma is so profoundly different it happens in the crucible of those early critical relationships and can have devastating effect on a person's development so we owe an incredible debt of gratitude to dr. bezel Vander Kolk and his colleagues who continued to tirelessly advocate for another additional diagnosis the one
• 03:00 - 03:30 that they now call the developmental trauma disorder now that disorder has still not been a formally approved and yet it offers a very powerful framework for understanding how pervasive and persistent the impact of early trauma can be on a person's development and not just on the child but on the adolescent and the adult that they will become if
• 03:30 - 04:00 we don't successfully resolve the traumatic reaction so what do I mean by human development I'm going to go real simple here in good human development what we expect to see is that a person can reliably perceive the world in a fairly objective way and can problem solve and plan for the future in a flexible way we expect to see that a person can recognize their feelings and
• 04:00 - 04:30 tolerate them long enough to learn from them and most importantly learn to manage them we expect that a person will be able to develop a stable sense of identity and a capacity for self efficacy and we expect that a person will be able to form trusting relationships and rely on those relation chips for support and assistance when most needed now all of those domains of
• 04:30 - 05:00 human development depend on a healthy well regulated brain now in healthy development what we see by adulthood is it a person's thinking brain and their emotional brain can work well in tandem so that when we experience stress or distress the brain is able to cope and get us back to a steady state this is the foundation of development and this is the foundation that is so profoundly
• 05:00 - 05:30 affected by childhood trauma what we see in a traumatized brain are three really critical impacts the first has to do with that emotional brain becoming literally a survival brain why because the child growing up in significant trauma has pervasive experiences of feeling fear unsafe in the very
• 05:30 - 06:00 relationships that are supposed to nurture them and guide them unsafe in their bodies and unsafe with their feelings and ultimately even unsafe with their thoughts as they try to make sense of a chaotic and dangerous world so what we see is an individual with a traumatized brain relies consistently on basic automatic survival responses fight
• 06:00 - 06:30 flight and freeze now those can look very different in a child versus an adolescent versus an adult but they become automatic responses that brain sciences now tell us literally hijack the thinking brain so much so that one brain science is called it a hostile takeover of the conscious mind by powerful negative emotions now think about that the implications of that are
• 06:30 - 07:00 profound because we have a core belief that people basically make good decisions or bad decisions and I think what brain science is teaching us is that it's not that simple that the traumatized brain cannot reliably access and use the thinking brain to make the kind of decisions that people need to make the second implication that we see with the brain
• 07:00 - 07:30 is that the alarm system in the brain becomes terribly distorted now we all need an alarm system to register danger right but if the alarm system becomes so distorted that it perceives danger everywhere danger in dangerous situations and danger in neutral situations and most tragically in situations that most of us would consider good or positive situations think about what it is like to grow up
• 07:30 - 08:00 with an alarm going off in your head all the time Danger Danger Danger it is a profound interference in being able to be present and to make use of the resources and relationships around you now the third profound impact we see in the traumatized brain is the ability to appraise the present and to learn from experience some have called this that
• 08:00 - 08:30 the traumatized brain becomes like velcro for bad and Teflon for good think about that it's pretty profound image isn't it I think that speaks to the power of those early experiences and literally wiring the brain so these profound negative experience are so powerful and weighty that the good experiences that happen later in life while important and needed just simply cannot easily unbalance the
• 08:30 - 09:00 early experiences and so what do we think about that we often think that people can't heal or that they're resistant to heal or they're not amenable to our services because we've built a behavioral health system and we espouse treatments that are are more and more short-term developmental trauma cannot be healed in the short-term it takes time now the sad
• 09:00 - 09:30 reality too is that many of the people that most need our help are the most difficult to engage and so it begs the question do people with traumatized brains have to get better before we can help them makes us uncomfortable to contemplate that and yet the answer might be yes if we persist in holding on to our traditional toolboxes but the answer should be a resounding no never
• 09:30 - 10:00 have we known more about how to heal trauma after decades of research in trauma attachment and brain science we don't know it all but we've never had more information and more hope about what to do in helping access and calm brains so that they can then make use of the services that we already have now some of you may be sitting there and thinking wow good luck with that to
• 10:00 - 10:30 those of us in the human service field and clearly we've got a lot of work to do but my message today is bigger than that because trauma affects us all you have only to look at the work being done by the Center for Disease Control on the adverse childhood events study that show the profound effect of childhood trauma childhood trauma is demonstrated to be not only the most powerful predictor of the things you might guess like anxiety
• 10:30 - 11:00 depression substance abuse and suicide childhood trauma is the single most powerful predictor of a host of chronic medical illnesses like cardiac disease so much so that many researchers now say that childhood trauma is the single most profound public health crisis in our country what do we do about that well clearly
• 11:00 - 11:30 in the human service field we have our work but we as a community have work to do - I would ask you to think back to the core of childhood trauma it happens in the crucible of those powerful relationships so many people say the hurt happened in the relationship and it takes new relationships to promote healing the thing is we can never predict which relationship might be the catalyst that sets a person on a path to
• 11:30 - 12:00 healing it might be a teacher it might be a coach it might be a neighbor a cop it might be any one of us so I would ask you to take from this message the idea that we are all impacted by trauma we are all paying the cost whether personal or societal we help people heal when we promote connection to one another and connection back into our communities
• 12:00 - 12:30 that's how we heal the future so being trauma-informed is something that we all have an interest in thank you