The heart of medicine is healing. Ultimately, the goal of working with patients (and their families) is to support, encourage and move toward healing, together. Just as in all professions, as we become more aware of new information we have to adapt, continuing to keep the larger mission at the forefront of practice. Awareness about Adverse Childhood Experiences (ACEs) and related stress physiology is increasingly informing how we provide care and move toward that healing.
“A consensus of scientific research demonstrates that cumulative adversity, especially when experienced during critical and sensitive periods of development, is a root cause to some of the most harmful, persistent, and expensive health challenges facing our state and nation.”
– ACEs Aware
We are increasingly becoming aware of how the trauma of the past informs the issues of today, whether we name it or not. Trauma exists in the hearts, minds, and bodies of so many of our patients. We have long recognized how trauma impacts mental health issues, and in the past two decades research has also demonstrated the detrimental biological impacts of toxic stress and ACEs. (Roadmap to Resilience, 2020) Education and awareness about adverse childhood experiences are critical in understanding each patient’s story.
Screening for ACEs is the first step in better understanding the experiences of those we serve and connecting how those experiences might be impacting present-day physical, mental, and emotional health. By gathering this information, we have the opportunity to better connect with patients in pursuit of their wellness. This type of connection and healing is what drives Dr. Nadine Burke Harris, the first California Surgeon General, as she leads system reform that recognizes and responds to the effects that ACEs have on our biological systems and as well as the other lifelong impacts of ACEs.
ACE screening can be both prevention and intervention, but providers need to be prepared for what happens in the process. Along with ACEs Aware training (which focuses more on what happened to the patient and how to recognize it), providers need to be directly trained in evidence-based, practical resilience skills to be able to pass those along to their patients. The We Are Resilient™ approach for healthcare providers helps them respond to the screening in ways that can disrupt the perpetuation of multigenerational trauma. This resilience training supports healthcare providers with the skills to connect and be a caring buffer to a patient’s stressors. Through teachable moments, providers can practice, model, and coach specific skills and strategies to help their patients to write the next, more restorative chapters of their lives. We Are Resilient™ reminds providers of what they already know in their hearts – the conversations, inquiry, and the co-regulation that they provide in their care of patients are the causal factor in the ‘network of care’ that is essential for healing. Person-to-person, the connection, the human element of our work is what makes it all worth it.
It is important to recognize that trauma and toxic stress are not only an issue for patients. They also affect providers. The very personal conversations that ACE screening can lead to can bring up old wounds for providers as we see ourselves in our patients and are triggered by our own history of trauma. It can be hard to remain centered and regulated during these moments. This vicarious trauma, and the ghosts of our own past, can deeply affect us if not managed in a healthy way.
This vicarious trauma, when our own stress response is triggered when hearing or dealing with someone else’s stress, is particularly important to be aware of as we support others. Vicarious trauma can lead to compassion fatigue, where we have no energy to connect with patients in a truly healing manner. Vicarious trauma and compassion fatigue are cumulative over time and evident in our personal and professional lives. They are also an occupational hazard of working in the helping field. (Saakvitne & Pearlman, 1996)
Additionally, many providers are hyper-caretakers who neglect their own needs AND work in systems that encourage providers to sacrifice their own mental and physical health to care for others. To move towards sustainable healthcare practices, providers have to be encouraged to attend to their own needs, first. Specifically, administrators and supervisors need to use trauma-informed practices for their staff and provide self-nurturing opportunities as part of the structures of their day. Providers who themselves are feeling overwhelmed and are not showing up as their most resilient selves are not going to be able to give proper attention and presence to their patients. How are we going to implement emerging best practices for patients unless we change our model of provider support?
Providers need strategies and training in resilience for their own health and healing. Providers must be given permission and invitation to develop their skills to nurture themselves and care for their own wellness so that they can model and coach it for others. Fortunately, We Are Resilient™ for healthcare providers was also designed to give providers skills to recognize their own ACEs and deal with potential vicarious trauma. The resilience training starts with helping healthcare providers notice what is getting in the way of their own resilience and then helps them strengthen their own resilience skills. Since personal practice is an integral part of the We Are Resilient™ approach, this resilience training helps healthcare providers better nurture their own wellness needs along with their patients.
This is a perfect time to investigate ourselves and our current medical model. There is no app that replaces people. We cannot rationalize ourselves out of the fact that healing is done with and through people. It is our collective opportunity to be — and become — the network of care that we are needing. How can we be supportive, nurturing, and empathetic to one another? The silos that have historically separated medical and behavioral health are being brought closer together. We are being called to add more humanity and connectivity to how we care for and support ourselves and those we serve.
“Working together, we can heal ourselves and generations to come. It’s all of us; We are the cure.” – Dovetail Learning
By Bryan Clement, Director of Policy and Partnerships, Dovetail Learning
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