NEW! Listen to the full Resilient Beginnings mini-series on this Health Pilots Spotify playlist.
Embrace change and maintain openness in the journey towards trauma-informed care. -It's through this wisdom and guidance that we're excited to bring you a revealing and heartfelt interview featuring the Highland Hospital pediatrics team. Delving into understanding adverse childhood experiences (ACEs) and trauma's impact on health, you'll hear each care team member offer insights on implementing ACEs screening and supportive measures, reflecting on hurdles overcome and collective milestones achieved. As one of the exemplary teams that are part of the Resilient Beginnings Network (RBN), Highland Hospital Pediatrics invited Health Pilots to host this conversation with them in-person at their facility in Oakland, California – gathered around the table to openly share and unpack their journey through this program with their coach and medical director of RBN, Dr. Dayna Long. Take in the valuable lessons they learned individually and as a care team - and the unique, transformative impact of the Resilient Beginnings model on patient care. Below is a transcript of the episode, edited for readability. [caption id="attachment_30580" align="alignnone" width="652"]
The Highland Hospital pediatric care team with Resilient Beginngs medical director, Dr. Dayna Long, gathers for an in-person interview to speak about their journey through the Resilient Beginnings Network.[/caption]
Learn more about the people, places, and ideas in this episode:
- "What are adverse childhood experiences (ACEs)?"
- Pediatric ACEs and Related Life Events Screener (PEARLS) -- Example of PEARLS tool for screening children
- Visit Highland Hospital, Alameda Health System - Alameda Health System’s flagship, with 236 inpatient beds; a renowned regional trauma center; nationally recognized medical and clinical teaching and research; and state-of-the-art primary, specialty, and multi-specialty care. Its new Acute Care Tower is host to topflight maternal child services and other advanced care.
- Embracing Staff Training To Help Patients With Trauma - related article featuring the pediatric care team at Highland Hospital within Alameda Health System (March 2023)
- More on Resilient Beginnings Network (RBN), a Center for Care Innovations learning program dedicated to advancing pediatric care delivery models that are trauma- and resilience-informed so that 100,000 young children and their caregivers have the support they need to be well and thrive.
- HOPE Framework, or Healthy Outcomes from Positive Experiences can ease toxic stress and help children and youth grow into more resilient, healthier adults. HOPE identifies ways that our communities and systems of care can better ensure that all children have more positive experiences and that all families have support to nurture and celebrate their strengths. The Four Building Blocks of HOPE are composed of key positive childhood experiences (PCEs). The sources of those experiences and opportunities are the foundation for healthy childhood development.
Podcast production services by Wayfare Recording Company.
Episode Teaser // Sam Singer (guest): The things that are really going to affect our patient's health in the long-term, the things that may shorten their lives, are the trauma and the stresses that they experience today. And if we really want to have an impact, if we really want to move the needle and improve their health, as our children grow older and mature, we really need to be acknowledging what they're going through now. Health Pilots podcast intro:
Welcome to the Health Pilots podcast presented by the Center for Care Innovations. This podcast is about strengthening the health and well-being of historically underinvested communities. Every episode offers new ideas and practical advice that you can apply today!Episode 56 intro // Resilient Beginnings Network (RBN):
What happens when health care shifts its focus from “What’s wrong with you?” to “What happened to you?” And how does it impact pediatric care delivery? To answer this and to share with us deeper insights into the work, Health Pilots is featuring care teams from the Resilient Beginnings Network — a Center for Care Innovations program dedicated to advancing pediatric care delivery models that are trauma- and resilience-informed so that 100,000 young children and their caregivers have the support they need to be well and thrive. And for this episode of Health Pilots, we’re featuring the pediatric care team at Highland Hospital, part of the Alameda Health System. As one of the exemplary teams who are members of the Resilient Beginnings Network at the Center for Care Innovations, Highland Hospital Pediatrics invited Health Pilots to host this conversation with them in-person at their facility in Oakland, California – gathered around the table to openly share and unpack their journey through this program, joined by their coach and Resilient Beginnings clinical director, Dr. Dayna Long. Take in the valuable lessons they learned individually and as a care team - and the unique, transformative impact of the Resilient Beginnings model on patient care. Find out what it means to provide care in which all parties recognize and respond to the impact of traumatic stress and resiliency factors on children, caregivers, and service providers. You’ll hear our guests speak about adverse childhood experiences, known as ACEs, as well as the using the screening tool to address ACEs called Pediatric ACEs and Related Life Events Screener, otherwise known as PEARLS. For more information about these tools and related concepts or frameworks, please visit our episode’s show notes. With that said, I’ll pass it on to Dr. Dayna Long facilitating the conversation.Dayna Long (host, RBN): Hi, I am Dr. Dayna Long. Medical Director of the Resilient Beginnings Network with the Center for Care Innovations. Today I am at Alameda Health Systems at Highland Hospital with members of the Resilient Beginnings team that's here at Highland Pediatrics. I'm going to ask my guests to introduce themselves. I'm actually going to start with you, Dr. Singer. Sam Singer (guest): I'm Sam Singer. And I'm a pediatrician in the Highland Pediatric Clinic. Parish Ford (guest): Hi, I am Parish Ford. I'm a registered nurse here at Highland Pediatrics. Eliana Alonso (guest): Hi, my name's Eliana. And I am a community health outreach worker. Bretsy Valadez (guest): My name is Bretsy Valadez. I'm a medical assistant in the pediatrics department. Bob Savio (guest): And I'm Bob Savio. I'm a general pediatrician here at Highland. Dayna Long: To get started, I would love for each of you to discuss what the Resilient Beginnings Network has meant to you and to describe the work that you're doing at Alameda Health Systems as it relates to Resilient Beginnings Network. Sam Singer: I like to start by describing where we were before we joined the Resilient Beginnings Network. We've known for a long time that we deal with a population that has been through all kinds of trauma and lives with daily stressors. About 80% of our patients are immigrants or children of immigrants, and that means that they have been through all kinds of migration stresses and acculturation stresses, and they bring those to the office. In studies that we've done in other projects previously, we found that the rate of adverse childhood experience is among parents bringing their newborns to the office was almost three times the statewide average. And so we knew that our patients were going through a lot and carrying a lot, and we weren't really doing a lot to address that. When families came to us in crisis, we'd sort of panic and try to help them manage it, but we weren't proactively going out and asking them about what they were dealing with and trying to help them find ways to prevent those crises. And Resilient Beginnings has been a way for us to start asking those questions directly to figure out ways to help families deal with it and at the same time, to help us as clinic and staff and doctors to be able to manage that in ourselves, as we ask families about more trauma, we are exposed to more of it ourselves, and so we have to be prepared for that amongst ourselves as well. Parish Ford: Resilient Beginnings to me was eye-opening because I always felt like everyone has a history and a background. For me, I was only thinking about myself as a black woman and thinking about my race of people and feeling like we go through so much, and does anybody understand that it's such a long history of trauma in our lives that that could really explain what people are seeing right now? The way we look, the things that we do, the things that we go through, how we're treated. And so learning about the Resilient Beginnings network was like... I felt like, "Oh, they do understand that there is a history in people's lives that affects what's going on right now." So I felt like we were touching on a little bit of what needed to be done, but it also made me think, "Okay, it's not just you. It is many people. It is Native Americans and the Spanish culture, it's not just you." So we tend to focus on ourselves, but Resilient Beginnings Network helped me to understand that everybody has something they're going through. We're all kind of like in the same boat, different but the same. So I thought it was special and I feel like we've only touched on it a little bit, so much to be done. It's so big and so hard to grasp, but it's been a great experience and hopefully we can expand it. Bretsy Valadez: I think, like Parish said, it was just eye-opening and I like the phrase Dr. Singer says, it went from, "what's wrong with you" to "what happened to you?" I approach the patients different. Same thing as my colleagues, and it helped me better understand even my kids because I am part of this community, my kids are part of this community, so what I'm learning here, I can also see it at home. Dayna Long: In the Resilient Beginnings project, our goal is to be trauma-informed and to promote healing. What does that mean in terms of the day-to-day experience of patients that come to see you? Bob Savio: I think going to a medical place, it can be very non-healing and I think we think of ourselves as a wonderful caring group, but getting in the door, parking, the stress, literally getting into the office to sit with the provider is stressful. I feel we have such a call and opportunity to transform that experience and put the patient at the center of that. I appreciate Parish's perspective on, we have so far to go, we've just scratched the surface, which is exciting. We're at the beginning of a journey. I'm late in my career, and if there was science around resilience and trauma and what that did to your biological system, we certainly weren't taught it. And this has transformed my practice. The note technique of noticing a family, commenting on a bond, or something that you see in that interaction, offering the science, giving tools is something that is now ingrained in my practice and it is a gift and I'm grateful for it. Dayna Long: I know that you are an amazing pediatrician, and when you say that this experience with Resilient Beginnings Network and the learnings has transformed the way that you've practiced, can you talk about that a little bit more about how that's felt to you? Bob Savio: First I would say this team and getting to know and build deeper relationships and the field that I have coming to work is different and we are still at the beginning of that journey and have a long way to go. Realizing as Parish said, everybody has a story and everybody has trauma. And the other very transformative thing for me I think is part two of the PEARLS screen, which is systemic racism, it's poverty, it's the hard parts that people are experiencing in our community, our beautiful community that we're all involved in. Ingrained in my mind, one of the teaching tools from the grant was a cartoon of a kid running and then trying to sleep and he's trying to get home safely and the noise, the endless noise, gunshots, loud street time disrupting your sleep, your adrenal glands are squeezing, squeezing, squeezing, and then months, years later you got nothing. You got just this kind of flat affect and so painful to see and feel and those teachings are with me. And that wasn't something I was taught in medical school, and that was not something that I was taught to this passionate degree until this Resilient Beginnings. Dayna Long: When you began in Resilient Beginnings, you weren't talking about toxic stress, you weren't necessarily talking about ACEs. Although all of us that come from community that have worked in community have long known that we experience trauma. You were starting from the beginning with screening and responding though, to ACEs. Where did you start? Sam Singer: We started screening for adverse childhood experiences in the youngest children, and there were a few reasons for that. Some of that was just for convenience. Some of it was because we knew that when we found high rates of adverse childhood experiences in the youngest children that many of the solutions were sort of parent-child based, and we could refer for sort of dyadic therapy and parenting help and really try to intervene at an early age. And as we got more comfortable screening the youngest kids three to five years old, we have since expanded and are now screening children when they come for well-checks from ages three to 11. We hope to expand to older children soon. And our barrier there has just been that there's so much paperwork in our office and that we are all reluctant to add one more questionnaire to the piles that our patients get. Dayna Long: What kind of buy-in did you have to generate in order to encourage the staff to make this change and to standardize it? Parish Ford: I didn't see much resistance in the staff. Our pediatric clinic is very much a family, and so sometimes change is hard, but then there's a lot of love in our clinic. We have mothers and fathers and siblings, and so you might complain a little bit about having to do extra work, but really this was something important and I didn't see really too much pushback at all. And I've even seen other people interested. I think about when we first started showing the recordings and people were coming to watch when we first started kind of introducing it to our clinic. It's an amazing thing, but it is difficult too. It's challenging, it's emotional. And when I just heard Dr. Singer saying that we think about introducing it to older teens, it kind of scared me because - do you know what you're opening? Do you know what you're opening up? Do you know what you're going to get? So yeah, I wish that we have more answers. Sam Singer: Parish said something important there. She said that people were able to buy in and get on board because they knew it was important. And I think part of our process before we just started using a new questionnaire was to make sure people understood why we were using it, maybe before people had the background in the science and understand that this was not just a new questionnaire, this was something that was really crucial to the lives of our patients. And I think that was a key part in laying the groundwork and getting people to buy in. Once we understand why it is, why it's so important, it's easier prepared for our staff to not just hand out the questionnaire, but to explain why we're doing it. To orient families so that they know and sort of understand why we're asking questions that can be really intimate and seem invasive sometimes, but that's a key part of the process as well. Dayna Long: So Parish, you alluded to the trainings, which it seems that there were some tender places with those trainings. Can any of you talk more about what the trainings looked like? You referred to some videos and then how that went for y'all? Parish Ford: They were really hard for me. They were so hard for me because you know how you hear something and you're like, you know it's true, but until it actually gets put in your face it's... I don't know. My feelings were so hurt watching those videos, I felt so emotional... because I was the only black person in there, and so I felt like I was in this tunnel and I don't know, I felt upset. I felt angry. I felt hurt. I felt frustrated, but it was good. I wanted other people to see it and don't really know how they felt about it, don't really know... Did you really care about that? Did you hear that? But I think it was good for all of us to experience together. And so again, it's a hard thing to discuss, right? You're all here together and you're going to be sympathetic and careful, but you just don't really know how people really feel. Yeah, those were hard videos for me, really hard. Bretsy Valadez: I was lucky enough that out of the medical assistants, I was able to get more training, so I was able to explain to them a little bit better. And like Parish said, they were willing to, it was more like it's new to them, they're not very familiar, but I think it was videos helped a lot. Parish Ford: And they were great because they brought us together. I mean, it was just a way for us to be together when maybe you would not have been in a way to discuss something that's really important and to see that other people care about things that you feel like maybe they don't. So it was good in so many little ways. Dayna Long: I don't want us to miss being able to feel like all the empathy of how hard it is sometimes and how hard it is as a person of color to be in these dialogues, to feel like we have to explain ourselves, to feel like we have to represent other black people when we're really representing ourselves and our experience and this constant pressure that is on us to always be excellent. It's a lot. It's a lot to carry. And so I just want to acknowledge that it's hard. I'm wondering, as one of the medical assistants, if you can walk us through what is your process for ACEs screening and response, Bretsy? Bretsy Valadez: I typically try to give my patients a questionnaire and explain to them what the questionnaire is about. We have this short little two sentences at the top of the questionnaire that we read off to the patient and we basically explain how to fill out the questionnaire. I like to do it once we're in the room because these are hard questions that we're asking and I like to give them that private setting. I'll say, "We have another questionnaire that we like for you to fill out. We know many families experience stressful life events and over time these events affect their child's health. We would like to know if your child has been through any of these events, any of the questions that you answered yes to, that's one point. You add the total points and you put it at the bottom. You do not have to specify what you answered to, but just like the total. Dayna Long: And what has your impression been of how that's landed with families? Bretsy Valadez: I think it's very new to them, and these are hard questions that you're asking. And I will use my example - I have done the PEARLS screener at my kids' pediatrician and the first time that they did it, I was like, "Why are they asking me these questions?" And I'm not going to lie, I was not truthful - I was zero. I didn't want to talk about the things that they had been through. So I can understand why some patients just put zero, because it's like, "Why are you asking me these questions all of a sudden? Last visit you were not asking that." But I think the more we do it and the more comfortable and the more not normal, but a lot of people, you're not the only one that goes through this. When I went back again and I did a PEARLS screener, I was more truthful on the answers, but it was the second time or third time. Dayna Long: And what made the difference? Bretsy Valadez: I was just like, "Why would the doctor want to know if my kid has been through violence or this? What are they going to think about me? Why am I putting my kids through that?" That's what my first initial... Before I even joined the RBN, but now I know that it's important, it's part of my child's health, it matters. So now I'm more truthful, I'm more open. Dayna Long: And you explain the questionnaire and then what happens next? Bretsy Valadez: I will let them finish it and I'll tell them to give it to the doctor. So I won't ever look at the answers. Dayna Long: Then Dr. Savio, you walk into a room and Bretsy explained the questionnaire, the family has filled it out. What happens when you come in the room and how does that affect your visit? Bob Savio: It is really different from interaction to interaction, and part of that is I think I come in knowing the score and it shouldn't probably change my approach, but it does a little bit and I really appreciate Bretsy's perspective because there may be a very high score, but on the paper it's zero. And we're just getting around to doing an annual screening a year or so later, and the scores do seem to be going up and I think a lot of that is the honesty. Sharing gratitude: "Thank you for filling this out. I know these are really difficult, tough questions. I appreciate you sharing that." But we know as pediatricians and as parents, part of the passion is to be upstream and try to give tools to affect the future of a young one. "I noticed that your child was very fussy when I came in the room and he's clinging to you, but look how quiet he is now and he's looking at your reaction to me as we're talking, and he's so secure. You give him such security and warmth and protection and what a powerful tool. We know that that relationship, and I could say simply that relationship, but that relationship, there's nothing more important. Having one person that has your back, that loves you, unconditional love. And we as parents are wired like that. So, what you're doing is amazing and it gives him the security that you're demonstrating and I can see it. And science shows..." So, maybe I'll talk about the adrenal glands and stress and the stress that coming into the building, institutional racism, poverty, no trees, disrupted, sleep, whatever may be particular to the patient I'm talking about and saying, "You having time like this before he goes to bed and trying to be consistent in the bedtime and reading a little story and being together, that is a more powerful medical tool than I will ever have for your kid." And I think those... I say a lot like, "antibiotics are nothing. That's the easy stuff. It's what you're doing, what you can do, what I'm seeing you do, that is the true medicine for your kid." Dayna Long: That's so powerful. Thank you for sharing that. What's the most common response? Bob Savio: We know as parents you don't get a lot of positive feedback. You really don't. [Laughs] You don't from your kids a lot and you certainly don't from power, whether that's a cop or a doc or a teacher. I think we try, but we fall short. And the response of showing positive praise to someone in the moment, it's so beautiful, wonderfully accepted, tearful hugs. "Thank you. No one's ever told me that before." So this training is a gift that then gives a healing gift right back. Sam Singer: I agree with what Bob said. I think what I would add is that one of the really amazing things about the ACEs science is that it's both very profound and also very obvious and apparent. So when you present it to a family, and I often say it sort of similar to how Bob did say, "We know that these things are common and we know that when these things happen when we're young, we carry them with us our whole lives in our bodies, in our minds, and our hearts." And when I say that, the parent just starts nodding right along because it is clear and obvious to us, it's something we all know intuitively that we carry our stresses with us and people get that. It doesn't take a lot of deep science to explain it. So they nod along right along with me and then that lets me sort of pivot to say, "So let's talk about how we can decrease the bad effects and build up your kid's strength and resilience." And to me then that's a chance to really talk about all the other stuff I want to talk about in primary care: "You know how we talked before about eating more vegetables? More vegetables are going to make your kid more resilient against stress, and we all handle stress better when we get more sleep. So let's do that." And then I always try to end with, as Bob said, with the love and security that children feel from their parents because I think that's the number one thing we can do to empower the parents to continue to support their children's resiliency. Dayna Long: Well said. Eliana, I want to bring you into a conversation because you're a critical part of the pediatric care team. I know that the community health workers - you're just so important to the providers and family members. Can you reflect on, first of all, what your day-to-day looks like, but also now that your clinic is standardizing ACEs screening for zero to 11 year olds, how does that impact your workflow? How are you responding to those ACEs? Eliana Alonso: So I know that every day is definitely very different. I was able to attend the Hopeful Outcomes For Positive Experiences training, and I know that I have been incorporating the four building blocks into every meeting with my patients. I know that a lot of times it may not be easy to speak about trauma, it may not be easy to speak about what the family is possibly going through at that moment, but it's definitely an open door to be able to further support them with not only linking to counseling, to behavioral health, but also to maybe an after-school activity where they can further engage in their community and further develop different abilities. Dayna Long: Say more about the HOPE Framework, and I just want to clear any record about there being any conflict between ACEs and HOPE. I think that the two of them balance each other and that HOPE is the necessary healing response to ACEs. You had mentioned the four building blocks. Can you tell us more about them? Eliana Alonso: Yes. So the HOPE training did focus on how viewing situations through a positive lens has a better impact on the patient. The four building blocks that the training focused on was engaging into their... Or having the child engage into their community. Being able to connect to an adult outside of their home, making sure that they live in a safe and stable environment, along with also including making sure that they're either attending an after-school program or an activity of their interest. It has definitely been great being able to learn more about it, to further use it when meeting with patients has definitely been great. I know that at times during that first meeting, even the child could be a little more guarded and after the second or third meeting, they're definitely more engaged. They're able to speak more about how they're feeling. Definitely thankful that they were informed of a resource that maybe they were not aware of before. So I always try to consider a little bit more of what is currently going on with the family to determine what resources I will be referring them to. First, I always handle the behavioral health portion, whether counseling would be sufficient or if they would benefit from a little more support. I also always ask about the child's interest, how school is going, if they're already participating in any activities or what they would hope to participate in or to practice. I know that a lot of times what could be creating stress is not having a safe and stable living environment. So, at times assisting them with that 211 call, supporting them with linking them to the health advocates, which is a team that we have within here, Highland, that can support them with additional resources, whether it's legal, housing, linking to food. Dayna Long: Thank you. Thank you for sharing. I do feel like when we respond to ACEs, so much of the response is how we show up and our hearts and listening fully. And then a lot of it is the resource and the linkage. And so your role on this team is, I just can't say enough about how important it is. Sam Singer: Eliana has referred patients of mine for things like swimming lessons and soccer teams, and to me, I think in a lot of cases that goes just as far as having a therapist. Dayna Long: Without a doubt. Eliana Alonso: You're right. I know a lot of times families may not be ready for therapy or they may want to think about it, but even linking them to the after-school activity is definitely all they need at that moment. Dayna Long: When you started doing ACEs screening and responding, you started with zero to three year olds, right? Sam Singer: Three to five. Dayna Long: You started with three to five. It's been an iterative process for you. I'm wondering, can you share more about why you decided to start with the three to five year olds and then how you expanded outwards? Sam Singer: The original choice of three to five was that under age three, we had a lot of other questionnaires for families. We screen mothers of infants for postpartum depression, and then we have developmental screeners and autism screeners at well-checks up through 30 months of age. But at three, we sort of had a gap in questionnaires and we thought we could introduce a new one. And then the other consideration there was that we were concerned that we might overwhelm our behavioral health resources and we thought, "Are we going to be making a lot of new referrals?" We were able to partner with Help Me Grow, who agreed to take on referrals for kids with high ACEs scores in that under five age group. Now, I'll be honest, I have made very few referrals because of that, and one reason is because the ACEs scores tend not to be that high in the younger group, they have not had enough time to accumulate a lot of ACEs. But the other reason is because the screening itself and the conversation around it is often the most important step, is that if you have a good conversation, if you've now built that trust with a family through that conversation, in many cases they don't need to go to a therapist also. Dayna Long: I want you to say that again [laughs]. Sam Singer: I really do think this is really important and sometimes this is true even for quite high ACE scores. So I always do a safety check. I want to make sure there's no immediate safety concern, but families have been through a lot. But many times in that moment they're sitting with me, they're safe, they're in a better place. It's really important to imagine where they came from and what they've been through and bring that into the room and talk about its impact on health. But it doesn't mean that the child has to go to a therapist right away, and in most cases the parent knows that. But what you do have to do is talk about it and make it clear and acknowledge it because it's there in the room. I am surprised in how many cases it does not lead to a referral. Dayna Long: What are you most proud of? Parish Ford: I'm most proud of us even just doing it, jumping in and doing it, having the heart and the will to do it. I'm just proud of us making the attempt, starting it. Bretsy Valadez: I think getting our meeting time back, that was huge for us. We didn't meet, but because of this, we're able to meet as our pediatric clinic once a month or twice a month for like an hour. But we didn't have that before. We've done picnic retreats, we've gotten closer together as a clinic. We get to hang out, close the clinic down, go to the park, just be outdoors, hang out with each other. Sam Singer: I think those team building times have been really powerful and much more than that one hour a month, but it's a time to share with each other to reflect on what we've been through, to share stressful moments, but also to share sort of happy or inspiring moments that we've had, to recognize each other if we're doing a good job. It's been really great, and I think part of taking on more of our patient stress means we need those outlets for each other. And yeah, I agree, having the RBN team and being able to advocate for that reflective space for our clinic team has been really great, and that's something we're going to keep on going forward. Bretsy Valadez: Another thing is that hopefully we'll be doing dyads soon. Dayna Long: What are dyads? Tell us. Bretsy Valadez: So right now we have about six MAs (medical assistants) and seven providers and we all rotate. We don't have that pair of doctor and MA that work together. We're always rotating, so hopefully we're going to move to where it's a team. It's that MA and that provider that work together all the time. Dayna Long: Relationship building. Bretsy Valadez: A relationship. Yeah. Sam Singer: I think the key part of that is not just the relationship between the doctor or the medical assistant, but with the patient too, that we want patients to understand this is your care team that they come through, that they come to see. Bob Savio: I think, like Parish said, it kind was like that we did it. It did take... I think I had fear of asking such potentially triggering and intense personal questions that we pull a bandaid off and then we don't have any resource or place to... "Oh my gosh, we're going to open the floodgates and what do we do?" But as Sam just said so eloquently, doing this, what the Network has taught us is that this is the work. This is most of the work and I'm really proud of that. I'm proud we're... There's a lot of love. It is a lovely family. And RBN has helped us, I think, rebuild in the backdrop of a global pandemic where I think our clinic bond was maybe disintegrating a little bit because of masks, because of no team time, because of not looking each other in the eye, having intense, emotional, tearful discussions. This has brought us back as a team and it's on this path forward. We got a long way to go, but we're like, it seemed like we've righted a ship a little bit and I'm super proud of that. Sam Singer: We're hoping to move towards team-based care with the way we work in the clinic. We are going to continue our regular team time with reflective space for people and with stories of hope. So to make sure we are not just talking about the stressful moments, but we're talking about the inspiring moments in our work, too. And I hope that we will expand ACEs screening to our teenagers as well. They may need it more than anyone else. Parish Ford: And we're going to continue to be sensitive to our patients and patient with our patients and listen more to our patients. Dayna Long: And to each other. Parish Ford: Yup. Bob Savio: Amen. Dayna Long: What advice do you have for other clinics that might be starting this journey? Bob Savio: Take the leap. The benefits of doing it together and the moments in the room with a family. The empowerment is so powerful. And I do think there is good buy-in. Pediatric clinics, pediatric systems, people that choose pediatrics I think are intrinsically optimistic. The getting upstream and trying to prevent the downstream effects of toxic stress, the things that consume the healthcare dollar - hypertension, cardiovascular disease, obesity, and its side effects. We're in this moment with young families and young kids and empowering them with that knowledge is so worth all the administrative fights it takes to get it done. Parish Ford: Yeah, I would say be willing, be open, be open-minded, and know that it may not be easy, but it's going to be worth it. And just, if you care, just know that it has to start somewhere, so why not try? Sam Singer: I would tell people that this does take time and it does take some focus and attention to it, but it's not as scary as it seems. I think you told us once, Dayna, that the trauma's always been in the room, you just aren't talking about it. And that is true, and we've known that. And the truth is, it's not as hard to talk about as it seems, once you start doing it. Families are ready to talk about it, especially that second time around, they're ready to open up. That it's not that... The content itself can seem scary, but getting it out in the open has to be done. It's there hiding anyway. So it's worth talking about. If you are willing to put in the time and attend to this, it really pays off. And it's not as scary doing the work as it might seem at the beginning. Eliana Alonso: I agree. I think the more we talk about it, the more we inform patients of it, the less guarded we'll be for future visits. Dayna Long: Because you can't recover until you uncover. So, Dr. Savio, last words. Bob Savio: Gratitude to you, our coach. Gratitude to this team. Again, I think the timing of this and the motivation and understanding of how important this is will keep us moving ahead. Bretsy Valadez: Honestly, this has been a very wonderful experience to be a part of. I got to learn to approach my patients different, and even just in my life, my personal life, that's where I learned a lot. Eliana Alonso: I'll go ahead and share a little bit more. I actually started the Resilient Beginning Network under a different position. I was a patient services representative, so at the time, I know that trauma was there, but with my previous position, I was limited to how I could support patients. So during the transition of the program and also with the transition of my position, it was definitely very rewarding being able to further support patients, work with them a little closely. I know that I'm working with the same patients and it's definitely amazing. So, thank you. Parish Ford: There is a lot of work to do in this world, but it is possible even if we affect one life or two lives, it's possible and it's worth it... and just stay hopeful. Sam Singer: We have always been good in pediatrics at doing things like giving vaccines and doing school physicals, and that is still really central to the work we do. But, what the ACEs science tells us is that the things that are really going to affect our patient's health in the long-term, the things that may shorten their lives are the trauma and the stresses that they experience today. And if we really want to have an impact, if we really want to move the needle and improve their health, as our children grow older and mature, we really need to be acknowledging what they're going through now. These traumas, these stresses, that this has a much bigger impact overall in their health than things like a polio vaccine. Dayna Long: Well said. Thank you so much to the Highland team. You guys are beautiful and inspiring. Parish Ford: Thank you. Bretsy Valadez: Thank you. Eliana Alonso: Thank you. Health Pilots podcast outro:
Thank you for embarking on this episode of Health Pilots hosted by the Center for Care Innovations, with podcast production services by Wayfare Recording Company. Special thanks to Dr. Dayna Long, the Resilient Beginnings Team at CCI, Trauma Transformed, and the featured pediatric care team that has joined us today. Check out this episode’s show notes for relevant links, resources, and opportunities. And, if you like what you heard, please spread the word - we’re available on all major platforms and be sure to subscribe where you listen to podcasts. For more information about the Center for Care Innovations or for upcoming programming, events, and funding opportunities, please visit our website - careinnovations.org - and connect with us on our socials: LinkedIn, Facebook, and Twitter. This is Wes Gabrillo at the Center for Care Innovations, and we appreciate you tuning in. Catch you on the next episode of Health Pilots!
