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We Are Resilient™ Gives Providers Tools For Trauma-Informed Care

Through the state of California’s  ACEs Aware Initiative, the California Surgeon General Nadine Burke Harris has put out the clarion call: We must cut adverse childhood experiences (ACEs) and toxic stress in half within one generation.  This bold target is based on the 1998 study (and twenty years of subsequent research) which highlighted how ACEs and toxic stress can damage both mental and physical health and can reduce life expectancy by 20 years for those with 4 or more ACEs. 

To reduce ACEs by half within a generation, we must stop the multi-generational transmission of trauma and provide resilience skills to pediatric providers and their patients to mitigate the effects of toxic stress.  We Are Resilient™ for healthcare providers gives practical skills to do both. 

Some health providers are resistant to begin ACE screening because they are unsure about what to do after a positive score. If mental/behavioral health is unavailable or inaccessible and if providers are unable to “offer a solution,”  they may feel like screening could re-traumatize the family.  Our training helps providers understand how to provide appropriate trauma-informed care. It is designed to help providers feel more comfortable with screening by giving them concrete skills to both increase their own resilience and pass these skills to their patients and families. The We Are Resilient™ approach strengthens resilience skills in people of all ages to disrupt cycles of trauma and to promote healing in families across the generations. 

Our curriculum is an experience-based, immersive program designed to provide pediatric providers with practical skills for trauma-informed care.  We do this through four methods. First, we use experiential training to strengthen providers’ personal resilience.  Second, we expand the concept of anticipatory guidance so providers can coach their patients in resilience skills. Third, we teach connecting and collaboration skills to enhance team-building. Finally, we provide free Open Educational Resources, expanding providers’ ability to train thousands of patients.  

We Are Resilient™ for healthcare providers first focuses on helping providers and their staff deal with their own ACEs and the vicarious trauma that can emerge from working with patients and families with ACEs.  This is an important foundational concept of trauma-informed care that is too often neglected. When providers and teams have a safe place to address their own stress and ACEs, they are more able to access their own resilience. This openness can prevent the vicarious trauma and compassion fatigue that lead to attrition. With stronger skills for resilience, health providers often gain a new perspective on themselves, their job, their team, and their patients. Medi-Cal providers can remember why many of them became providers: to become partners in healing with patients in difficult circumstances. 

We Are Resilient™ for healthcare providers also uses Anticipatory Guidance to prepare providers to guide families in strengthening their own resilience skills. Integrating the work of Meri McCoy-Thompson (Dovetail Learning, COO) who was Project Director and a primary editor for the original Bright Futures for Health Supervision for Infants, Children and Adolescents (1992),  We Are Resilient™ expands the concept of anticipatory guidance to include ACEs. Through a booklet of Anticipatory Guidance Cards,  it guides providers and teams in how to model resilient skills and coach families in using the skills.  Moreover, providers gain a deeper understanding and awareness that the heart of trauma-informed care is the relationships they develop with patients and families themselves, which may be more important than anything else they offer in difficult times. Even when referrals to mental or behavioral health are not available (or not utilized),  providers can be the “buffering relationship” that families need when stress rises, making all the difference.  

Fundamentally, our training methodology helps providers and staff form cohesive teams that are a critical building block for creating resilient communities. With a focus on collaboration, We Are Resilient™ is being taught to teams in health clinics, schools, and other organizations so that whole communities have a common language to foster wellness together and create a world of kind, connected human beings.

We are publishing our We Are Resilient™ materials as Open Educational Resources (OER) because OERs are free, shareable, and can be customized to different needs. In a world needing help, few OERs are available for mental health, self-regulation, or resilience. The Open Educational Resources model is the fastest and most effective way to inspire great change, as it encourages others to co-create sustainable solutions as well as wide sharing of the materials. OERs leverage limited investment into exponential impact.

What are these Practical Skills for Resilience?

Our inner capacities are enormous. Even though we don’t have control over many aspects of our lives (our environment, upbringing, and the hard knocks of life),  we tap into our resilient nature to help us survive. If we are dealt blows from trauma, racism, discrimination, poverty, or violence, these forces can both reduce our wellbeing but also can strengthen our resilience. 

We Are Resilient™ for healthcare providers first honors the importance of “survival” skills, the Protective Patterns that are vital for surviving trauma or toxic stress. These Protective Patterns inform how we react to the world. They encompass the freeze/fight/flight reactions, and may include distrusting, hypervigilance, hyper-caretaking, avoiding, defending, and attacking.  Though these Protective Patterns are often perceived as negative, they enable us to move through moments of hardship.  They supply us with Reactive Resilience. On the other hand, we need to learn when/how to use them or they can become obstacles to growth.  

We also look at our Cultural Patterns, which inform how we view the world.  These patterns are made up of messages we have received in all these different areas of life: ethnicity, construct of race, gender identity, sexual orientation, religion, language, socioeconomics, political affiliation, family stories, and community norms.  All of these messages come together as our Cultural Patterns. They give us our core values and provide shortcuts to understand and navigate the world, but they also can be a source of bias and discrimination as they prevent us from seeing others’ truth. These are acquired characteristics, which means we don’t have to identify with them and we can choose other Cultural Patterns for ourselves.  Being able to notice our own and others’ Protective and Cultural Patterns help us deliver trauma-informed care.  

The training then teaches a series of practical resilience skills, all with research demonstrating their importance for our wellbeing. These skills are taught in three categories:  skills that help us better Center ourselves, Connect with others, and Collaborate on the solutions we care about together.  Centering skills help us listen to our internal cues, accept what is true, be kind to ourselves, find gratitude, and find a strong way forward.  Centering includes developing self-awareness, self-regulation, self-empathy, self-trust, and self-forgiveness. Connecting skills help us build relationships, be kind, and create intimacy. Collaborating skills help us work together with others for a shared purpose. When we learn how to use all these skill sets together, we can better create community and shared wellbeing. The book We Are Resilient™ Anticipatory Guidance for Healthcare Providers explains the science in simple terms for providers to use in their discussion with families. 

As we discover more about these skills and learn how to use them deliberately, we become more able to make choices that better serve our needs over time.  By practicing essential resilience skills, we strengthen them.  We can mitigate the effects of ACEs and truly provide trauma-informed care.