Healthy Living for Life – Health Care’s Response to Traumatic Experiences (Full Version)


– [Announcer] Living longer, living healthier,
living better than ever before. Welcome to Mountain-Pacific’s Healthy Living for Life,
a weekly series that gives you the information, education and expert insight you need to become
an active participant in today’s ever changing health care climate. Here now is today’s program
host. – Adverse childhood experience, or ACES, are
traumatic events endured by people under the age of 18. Studies show ACES are strongly
related to risk factors for disease and health and social wellbeing throughout the rest of
people’s lives. Healthcare organizations are working to recognize and appropriately respond
to these traumatic events, as well as learning how to prevent them. Welcome to Healthy Living
for Life, a show dedicated to helping you do just that. I’m Sara Medley, your host.
Stay tuned. – Welcome back to Healthy Living for Life.
When children suffer trauma from unstable home environments, neglect and abuse, the
effects can be devastating and long lasting. With me today is Tina Eblin, Director of the
ChildWise Institute, which is behind the statewide movement called Elevate Montana. Thanks for
joining us, Tina. – Thanks for having me. – [Sara] What is the ChildWise Institute? – Well, the ChildWise Institute was created
because Intermountain Children’s Home, which helps severely emotionally disturbed children,
decided that they wanted to prevent things from happening to children, so they decided
that they would create a separate institute that would advance awareness. They would also
accelerate knowledge and advocate for change so that we can be more preventative instead
of reactive to the wellbeing of Montana’s children. – [Sara] So, what about Elevate Montana? – Elevate Montana actually grew out of ChildWise
Institute. We were trying to think of a way that, how do you spread this information to
communities, and thought you know what, we need to elevate Montana to a different level.
So it was a grassroots movement that was created to work with communities and really wrap around
children and understand that the entire community needs to come together to really elevate the
wellbeing of Montana’s children. – So you mentioned Intermountain, and Intermountain
is in Helena. Talk to us about Intermountain. – Intermountain Children’s Home is over 100
years old. They serve thousands of kids per day, and they’re also in schools. They have
group homes, they also do outpatient therapy as well, so it’s a very large children’s mental
health network. – Are there ChildWise Institutes in other
states? – No, ChildWise Institute is strictly in Montana. – [Sara] How about Elevate Montana, a similar
program elsewhere? – Well, we were actually awarded a grant called
the Mobilizing Action for Resilient Communities grant, which we were one of 14 communities
that received this grant. There are other programs that are somewhat like Elevate Montana,
but not to the scope of having 11 communities involved. – [Sara] So, we’ve introduced the topic of
adverse childhood events. Can you talk about ACES, the acronym for that? – Yes, adverse childhood experiences are experiences
that people could experience between the ages of zero and 18, and it was actually created
from a study that took place and was published in 1994. It was two physicians, one was a
weight loss clinic physician, and another one was a cardiac physician out of Georgia.
They both realized that childhood experiences impact us as adults, and impact our physical
health. So they did a study. They had 17,000 participants, and what they found was two-thirds
of those participants had experienced an adverse childhood experience. There are 10 of them,
and they include household dysfunction, so someone in the family incarcerated, someone
in the family suffering from addiction issues, mental health issues, parent separation or
loss of parent, there is neglect, physical and emotional neglect, and abuse, physical
and sexual abuse, physical, emotional and sexual abuse. And then there is loved one
being, intimate partner violence is another one as well. So the ACE study, when you take
that, you add up the score. So you can have a score from zero to 10. – So the ACE score, and I said adverse childhood
events, and it’s really experiences, so talk more specifically about how those events or
experiences really affect a person’s health. – When a child is developing, your brain doesn’t
fully develop until the age of 25, so it’s constantly changing, and when your body is
under what we call toxic stress, what happens is that your body releases adrenaline to begin
with, and that’s short-lived, so you have about 30 seconds for your body to use the
adrenaline. But when you are experiencing something very traumatic, what can happen
is then cortisol is released. Cortisol is important for your body, but what happens
during childhood is when you’re constantly under stress, that cortisol becomes toxic,
and it can cause changes in brain chemistry. Also, if you think about a child whose body
is developing, what can happen is with the cortisol, it shunts the blood away from forming
organs, from maturing organs. And so it goes out to muscles. So if you can think about
a child who’s constantly having that cortisol pumping through their body, their organs may
not be forming as they normally would. – So we’ve got a little less than a minute
left, but can you talk about what an adult could do if they know they experienced some
of this trauma in their childhood? – Definitely, as an adult, talking to your
healthcare provider is one way. Also, mental health professionals. Really, it’s about recognizing
that these things happen, and maybe connecting those links of oh, I experienced trauma as
a child, maybe this is what is causing issues as an adult. – Thank you so much, Tina. Well, we need to
pause here for a short break, but coming up next, we will learn about resiliency and trauma-informed
care. Stay with us. – Welcome back. We’re talking to Tina Eblen
of ChildWise Institute. Thank you Tina, for addressing this important information. So
before the break, we were talking about resiliency. So, talk to us about that. What is it? – Resiliency is the ability to, when you’re
dealing with something difficult, be able to then return back to normal and cope with
the issue at hand. – [Sara] So, is teaching resiliency something
that healthcare providers and maybe educators can do? – Absolutely, different things like mindfulness,
meditation, physical activity. Also getting enough sleep can all help with resiliency. – [Sara] We hear about trauma-informed care.
What can a provider or an organization do? – Well, for a provider, what’s really important
is to understand, especially if you’re a healthcare provider, that a lot of clinical issues that
people present with could be tied to stress, and having that understanding. As for organizations
becoming trauma-informed, really understanding that all of us have stress, which is really
what trauma is, is stress, and that they have the ability to help employees or help patients
dealing with stress. – I hadn’t heard much about trauma-informed
care until fairly recently, the last year or two. It sounds like a new movement, is
it? – It is, I would say within the last five
years it’s really taken off. Yes, I think in the future we’ll see way more organizations
understand that becoming trauma-informed is an important piece to business. – [Sara] Are there organizations in our own
communities that are trauma-informed? – There are organizations that are working
towards it. Intermountain is one of those, Shodair is one of those. Also, we have a business
in town that is really working to become trauma-informed, and that’s the McDonald’s in Helena. – [Sara] Oh, that’s good to know. So what
does an organization actually have to do, is it a certification or creditation? – Currently, no it’s not. For us, working
with McDonald’s, it was training upper management and getting their buy-in with understanding,
why is it important to understand adverse childhood experiences, and being able to train
managers and supervisors to recognize when their staff is stressed or when their staff
is dealing with difficult situations. – So if I went to my provider and I’m ill
or needing some assistance, how would I be able to tell if my provider is trauma-informed?
Would I notice anything if I were a victim maybe of trauma as a child? – The only way I think you would be able to
recognize is if they asked for your ACE score, or asked you to take the ACE survey. That’s
how you would recognize if they’re trauma-informed. – [Sara] Are there a lot of providers around
that are getting training on ACE and how to administer that tool? – There are more and more providers that are
wanting to understand the impact of adverse childhood experiences. Currently in Helena,
there are pediatricians who are giving the ACE survey to parents and seeing what that
score is, and helping connect them to different things like parenting classes or mental health
providers. – Let’s go back to ACE. Give me some examples
of some of the questions, you probably have some of them memorized by now, right? – One question is, did you grow up in a household
where someone had an addiction issue to drugs or alcohol? Another one is, did you grow up
in a household where you lost a parent or a caregiver? Or, did you grow up in a household
where you went to school not fed, or you had dirty clothes, or you didn’t feel like you
had attention. So that’s a neglect question. – [Sara] And remind us again, if it’s a score
of four or more, you’re at risk? – Well, you’re basically at risk at any score,
from zero to 10, but the tipping scale is four or more. They have found that there’s
a dramatic increase in physical health problems, the possibility of having physical health
problems at four or more, so it increases. Heart disease increases over 300% if you have
a score of four or more. – Amazing. So, we talked about children and
being administered, the survey, pediatricians and the like. What about adults, should that
be used for adults as well? – I definitely think it should be. It will
give an insight to, maybe there was a lot of stress in this person’s life, and maybe
that’s what has led to the diagnosis that they’re seeing their physician for. Yeah,
I think it should be administered to adults as well. – There’s some educational programs around
that I’ve seen, maybe in the newspaper, on the ACE scoring system. Talk about that, are
there any upcoming sessions or anything that someone who wants to be educated about ACE? – People can always go to ChildWiseInstitute.org
to get some information. Also, elevatemontana.org. We have 11 communities within the state who
have become Elevate Montana affiliates, and within those communities they have people
who have been trained to present on adverse childhood experiences, so they are going out
and giving presentations quite often. – That’s excellent information, thank you
so much, Tina. Well, coming up next, talking about cultural issues is a great segue to
our next guest, who will join us to discuss trauma-informed care in Native American healthcare
organizations. Stay with us. – We’re joined now by Dorothy Dupree, who
recently retired from her position as Director of the Billings Area Office of Indian Health
Service. Thanks for being here, Dorothy. – Very much my pleasure, Sara. A little bit
nervous. – Oh, don’t be, don’t be, and congratulations
on your retirement, I’m so happy for you. – Thank you. – [Sara] A lot of years with the Indian Health
Service, how many? – 29, about 29 and a half years, never quite
made my 30. – [Sara] Well that’s all right, that’s all
right. Well, you look great, and congratulations. – Thank you. – So, what is the Billings Area Office, Indian
Health Service Office, what is that? – It’s a sub-unit, I’ll call it that, of the
Indian Health Service, nationally. The Indian Health Service is headquartered back in Rockville,
Maryland, and we have 12 area offices. The Billings Area is one of them, and we serve
the tribes in Montana and Wyoming. – [Sara] And what facilities does it include? – We have three hospitals, two of which are
critical access, and three large ambulatory programs. – [Sara] Which hospitals are they? – The two critical access hospitals are located
at Fort Belknap, and Crow Agency, and the acute care hospital is located in Browning,
it’s the Blackfeet Hospital. – [Sara] Okay, who do they serve? – The tribal individuals that reside on or
near the reservation. It could be any federally enrolled tribal member, without cost, direct
care is what we refer to that as, and then those who are residents of the reservation
are funded for care that we cannot provide through purchase referred care. – We’ve talked about adverse childhood experiences.
What is that like for the folks that are living on or near reservations and experiencing that? – Well first of all, maybe I can talk a little
bit about why adverse childhood events, why trauma-informed care. I’ve been an area director
in four other areas. This is my fourth area. In coming to the Billings Area, I was always
asked, why is it so different? Why is it different, why is it that we’re not making the gains
that we have in other areas here in the Billings Area? And after a lot of close observation
and listening to the patients and patient complaints, it really is about trauma, and
the retraumatization when they come into our facilities, because we’re not taking the time.
Every patient complaint that I received I would respond to personally or have conversations
with the patients, and it really came down to the trauma. And of course, trauma, there’s
a lot of discussion now about adverse childhood events, and there’s the survey that you can
take to determine what your level of trauma is, if you’ve had X, Y or Z within your history,
and the trauma measures are very, very high. We probably know that already, just intuitively,
without even having to administer a survey, and some programs do and some programs don’t.
But it relates back to, there’s historical trauma and there’s current day trauma. The
historical trauma, of course, that leads back to the Great Indian Wars, the plains tribes.
I think it’s more raw trauma up here, because the 130 years ago, 140 years ago, was not
that long ago, really, and we still have individuals who are still alive and great-great-grandmothers
and grandfathers who can still talk about the trauma way back then when they started
seeing individuals disappear or be killed in war, hand to hand with the Army and so
forth. And then we have modern day trauma, with the level of isolation that we have here
in Montana, the poverty that we see on the reservations is also supportive of the trauma
and the ongoings. So we see a lot of ongoing behaviors that are really based in trauma. – Can you give us some specific examples about
historical trauma? Give us a few examples of things you’ve seen. – Maybe things I’ve read about, not necessarily
seen. I know I’m old, but maybe not that old. – Sure. – One of the books that I started reading
that I hadn’t read before is based upon a lot of research by two historians, non-Indian
historians. It’s called The Heart of Everything That Is. It’s really about Red Cloud, who
is one of the great American Warriors, who is Lakota, Sioux. The story is absolutely
amazing. It’s based on fact, it’s based on history, it’s based on written words back
and forth, and letters shared with the Army at that time, and sending information back
East to The Great White Father. It was based also on winter counts and stories of the individuals
that they still had available when they started investigating and really looking at the history.
Things such as counting coup. Counting coup was really a warrior’s game to show how brave
they are, where they would go up to an enemy and tap them but not kill them, and when it
started, what happened when they came into the conflict or into contact with the Army,
they would go up and count coup, and run away and be killed. And that was shocking, and
it talks about that in this book, and it’s really from that perspective of what’s going
on, this is not how you play this game. That’s not the rule, we don’t murder. We count coup,
we show how brave we are. We run in, we tap, we leave. So that change in the rules was
very significant, very traumatizing when they saw things like that occur. Driving us from
our homes, our traditional hunting lands and so forth. Bozeman is a good example, where
there used to be a large meeting area and we’d come together as tribes, and we could
no longer do that in safety, so that in itself is trauma. – Thank you so much, Dorothy. Thank you Dorothy,
and thanks Tina for being with us today, and I hope you enjoyed the show. Be sure to come
back again next week. In the meantime, stay fit, stay well, and stay healthy for life
with Healthy Living for Life. – [Announcer] Healthy Living for Life is brought
to you by Mountain-Pacific Quality Health. We’d love to hear from you. If you have suggestions
for future programs, visit our website at MPQHF.org, or call us at 406-443-4020. You
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Special thanks to Fire Tower Coffee House and Roasters. Production facilities provided
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