Hi, I’m Mandy Davis, the director of Trauma Informed Oregon, and welcome to Module 4. So this module, we’re going to be kind of focusing on an overview of the science that’s behind the trauma informed care movement. So what we’re going to do is briefly review the science, we’re going to define NEAR science, and we’re going to do an overview of what each of those bodies of knowledge contributes to the application of trauma informed care.
Now, warning, this is just an overview, depending on your role or your interest, you’ll need to dive deeper into each of these areas of knowledge. So an acronym that’s often used to describe the bodies of knowledge related to trauma informed care is called NEAR.
And NEAR stands for, the N stands for neurobiology, E stands for epigenetics, A stands for the adverse childhood experience and R stands for resiliency. So we’re going to go through each of these with a quick overview, but I want you to be thinking about the question, what does this body of knowledge contribute to applying TIC principles?
And we’ll try to ground it in that conversation. So we’re going to start with N, neurobiology, which gives us information for how toxic stress, adversity and trauma, impacts how our brains develop and function. So one tiny example is learning how and why we flip our lids. This is Dan Siegel’s hand brain model work, which easily demonstrates what happens when we have a real or a perceived threat.
So the idea that this is your brain, that your fingers kind of represent your prefrontal cortex in your frontal lobe which is your rational thinking, your ability to make decisions, your verbal processing. And that when you have a real or perceived threat, you flip your lid. And what we mean by that is that part of your brain kind of goes offline and you go into survival mode.
Which means now, everything you care about is surviving, and what you’re not accessing are things like verbal processing, pro and con, list making, prioritization, organization and etc. So what we talk about in trauma informed care is that we often are the perceived threat. And we’ll keep talking about this, but this may be because of what you represent or what services you have to offer people or their experiences in your buildings or in your parking lots.
So, for example, maybe the uniform you wear reminds people of another time when someone in uniform harmed them. Or maybe the state emblem on your car coming down the street is activating and is going to flip the lid of the folks who may be seeing that. So there are four functions of the brain that we often talk about in trauma informed care that are impacted by toxic stress.
And I want to call your attention to these four particularly. One is sensory awareness. So when your lid is flipped, you are more heightened to senses around you. So lights are brighter, sounds are louder, touch is going to feel different, taste is going to feel different. And what I want you to kind of be thinking about is, why is that?
And that’s an absolute survival mechanism. You want to be aware of what’s around you so that you can make some decisions and you can react in a way that’s protective of you. So why do we care about that in trauma informed care? So what we want to be thinking about is that if our spaces are actually causing people to flip their lids, and our spaces have a lot of sensory input, again, if there are lots of bright lights or lots of noises around the work that you’re trying to do.
Kind of what is the ability of that person going to be able to engage in a work that you’re asking of them if they’re being distracted by all that sensory input? And so one of the things we’ll recommend to you is actually to do a sensory scan of where you do your work or where you do your practice.
So what are the sights and the smells and the sounds that people may be engaging with as they’re working with you? The second function of the brain we want to talk about is attention. So attention is also impacted as a result of toxic stress. When you’re activated or have a history of adversity you may be great at divided attention.
Which means you’re hearing everything, you kind of hearing a little bit about a lot of things. And you might start to think about why that’s a great survival technique. What may be harder to do is to have what’s called selective attention, which means you’re pushing out all those thoughts and distractions.
And you’re paying attention to the person in front of you or that one thing that you’re working on. You’re able to focus on what’s right in front of you. So when someone has a lot of divided attention, this is going to start to look like someone is distracted. Maybe they’re not paying attention.
Some people may even say they’re using substances. It also might make it hard for them to remember what you were saying or asking them to do. And what’s really important in this is that oftentimes then we blame someone for not remembering correctly, or not remembering everything we said. Like they don’t show up to that next appointment, or they don’t turn in that thing we need them to turn in.
So the third function of the brain we want to talk about is memory. Now, memory can be tricky as a result of toxic stress and trauma. You’re likely to have memories of things that were threatening. And you will most likely have good long-term memory. What can be more challenging is short-term memory.
So you may not remember the homework assignment or the appointments you have tomorrow, or where you need to be in the next couple of hours. Now the fourth function of the brain is your executive functioning. And executive functioning is what helps you organize, it helps you regulate your impulses.
And when our lids are flipped, those functions are not easily available to us, which may make it hard to make a plan, or to prioritize, or to even organize your day. So again, you want to start to think about how much you’re asking people to do things that involve their executive function, and how successful or what expectations we should have on those that we work with as well as ourselves.
In trauma informed care, we pay attention to how we, or our procedures, or how our organizations may be the perceived threat. How this may flip someone’s lid and in turn impact their ability to engage in our services and our ability to engage with them.
We use this knowledge to provide better care. For example, by providing reminders in a variety of modalities. Making sure our lobbies are both welcoming and calming. Focusing on basic needs so that we can have the whole brain as available as possible to work with. So what I always say is we want our environments, and our services, and our organizations to promote someone having their whole brain available and that may not always be possible.
But we want to strive that it’s not our environment, which is the cause of the flipped lid. And if it is, we want to take responsibility for how that’s going to change how that person can impact, or how that community or that organization can engage with services and change. So the E in the NEAR science acronym is epigenetics.
And epigenetics needs attention because it helps us understand how toxic stress and adversity is transmitted and experienced across generations. So it helps us also to learn about the impact of historical and collective trauma for populations who have experienced depression. I’m not a geneticist, and this is really important information that we learn more about.
But as the slide says, the take home message for me is that you’re not what you ate, you’re what your grandparents ate. So this field of knowledge is helping us understand kind of how trauma and the impact is transmitted across generations. Now, we go to the A in the NEAR science acronym, which is the adverse childhood experience study.
So this study took place between 1995 and 1997 by Kaiser Permanente. And what it did, the take home message of the adverse childhood experience, is that it linked adversity in childhood to adult health outcomes. Now, when we talk about childhood adversities, the ones that this study looked at were the experience of physical, emotional and sexual abuse, physical and emotional neglect, an adult in your home who had an untreated mental illness, an adult in your home who was incarcerated, a mother who was treated violently, untreated substance use in the home, and divorce.
So those are the ten adverse experiences that this study looked at. Adversity in childhood leads to disrupted neural development. Because if that lid is being flipped all the time as a result of that adversity, it’s going to have an impact on neural development. Disrupted neural development then leads to social, emotional and cognitive impairments. Those social, emotional, and cognitive impairments then lead to the adoption of health risk behaviors. So things like substance use or smoking. That those things lead to social problems and disease, and then those things lead to early death.
So it’s important to know this is a pyramid and not a rectangle. Not everyone is ending in early death. That we have interventions that restore, repair and reverse that process. The pyramid on the right was done by a group in California called R-Y-S-E, RYSE. And this was a group of youth and providers who looked at the ACE study and added to it and evolved it into this different pyramid, which I really appreciate.
So it begins with historical trauma and then moves from that into how that experience leads you to social location, like what you have access to in your community. And then that leads you to either adverse childhood experiences or complex trauma. You also notice that they reworded the adoption of health risk behaviors to coping.
I think it gives a better picture of what causes adversity and then the impact of that on both individuals, families, and communities. Knowledge about resiliency helps us know what we can do to reverse, prevent, and heal from adversity. What opportunities does your organization, program or community provide to connect people?
What opportunities do you have to provide service? What opportunities do you have to have mastery or self-efficacy? And finally, what opportunities do you have for self-reflection or for reflection, again, as an individual, as a group or as a community or within an organization? So in summary, this has been a quick overview of the bodies of knowledge that are kind of supporting the trauma informed care movement.
The bodies and knowledge around neural biology, epigenetics, adverse childhood experience and resiliency. How do those bodies and knowledge inform how we’re going to do our practice differently? It’s not that you need to be an expert in neurobiology or in epigenetics, but we’re going to learn from those bodies of knowledge about maybe how we do reminder calls for folks to make their appointments.
Or how we want to change our lobbies to be more calming. For instance, how does neurobiology help us do that differently? How does understanding something about adverse childhood experience help us do healthcare in a different way? And most importantly, how are we making sure as we’re preventing and addressing adversity and trauma that we’re also promoting resiliency in both our organizations, in our workforce and our communities?
Here’s a brief review of the concepts covered by Dr. Mandy Davis in Module 4. NEAR is a body of science that has contributed to trauma informed care in a great way. As you consider some of these review concepts, think for yourself. How does this knowledge help me better understand people’s behavior and presentation?
How does this knowledge empower me to be of service in a less activating way? Why is NEAR science important to my own well-being in the workplace? And how does it help me understand the experience of my colleagues and teams? The N for neurobiology. Neurobiology helps us understand how our brain developed based on experience.
Here, we can look at the various functions of the brain that are impacted by toxic stress, adversity and trauma. Functions like memory, sensory regulation, and executive functioning. E, epigenetics. Epigenetics, in a sense, rediscovered or scientifically affirmed that individual and collective trauma can be passed down from generation to generation.
A, the ACEs study. The adverse childhood experiences study scientifically linked early childhood adversity and adult health. And here, it’s important to recall that this is not a causal study. Remember, it’s a pyramid, not a square. And R, resilience. Knowledge about resilience lets us know which buffering variables can reverse, prevent, and heal adversity.
That is resilience of a community, a family or an individual. In conclusion, these four sciences are intended to broaden our understanding of people’s presentation and behavior. So for example, while it could be that the last person you interacted with is just a jerk, the effects of adversity, trauma and stress could help explain some of the behavior that helps inform our actions.
The four sciences empower our ability to create procedures, policies, practices, and spaces that invite the whole brain into the room in a way that’s not re-traumatizing or activating.