Sunday, March 11, 2018

Trauma-informed care: Transformative love

            This past spring, Oprah Winfrey discussed childhood trauma and trauma-informed care on 60 Minutes.
“If you don’t fix the hole in the soul, the thing that is where the wounds started, you’re working at the wrong thing,” Oprah said in an interview with CBS This Morning, before the airing of the program. A five-part Milwaukee Journal Sentinel series on the epidemic of childhood trauma informed Oprah’s understanding. The series explored how the myriad of social problems facing Milwaukee—from unemployment to substance abuse to crime— all have their roots in unresolved trauma.  “The story was life-changing for me,” Winfrey said to CBS. “It is my hope that our story on trauma-informed care will not just be impactful but will also be revolutionary. It certainly has caused a revolution in my own life.”
It was about seven years ago that I first heard the term “trauma-informed care” applied to parenting foster or adoptive children who had survived neglect or abuse. I was on a walk with a friend who had three adopted children just a bit older than my two younger children, both adopted from foster care.  My friend had recently learned the trauma-informed approach from her oldest child’s therapist. As she spoke, I remember feeling like everything within me tilted toward clarity.
“Trauma-informed care is when you look at difficult behavior through a different lens,” she said. “It’s an internal perspective change on the part of the parent or teacher. Instead of thinking, ‘What’s wrong with you,’ you ask, ‘What’s happened to you?’”
            As we talked, my friend sprinkled bits of neuroscience over practical pieces of parenting advice. She explained that when a young child is in an unsafe situation, under extreme stress, the immune system and body’s stress response systems may not develop normally. “So even later, when a child is placed with a safe family or in a safe classroom, under ordinary levels of stress, their systems may automatically respond as if he or she is still under extreme stress,” she said.
While a child’s rush of adrenaline, pounding heart and fight, flight or freeze response are all life-preserving ways to face actual threats to safety, in the context of the normal stress of everyday life, this child will be perceived by others to be over-reactive, unresponsive or detached. Parents, teachers and coaches using techniques that may work well on non-traumatized children unwittingly trigger children of trauma, and what would normally be a simple moment of correction can escalate into a major behavioral incident as child’s fear response is triggered.
            At the heart of the approach is definitive research showing that adverse childhood experiences (ACES) such as parental mental health issues; parental separation or divorce; physical, emotional and sexual abuse; parental substance abuse and parental distance cause physiological changes in the brain and the body.
            The ACE Study found that the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and other consequences. On a scale of 10, just one out of three of us have an ACE score of zero, a childhood free of significant heartache. Twenty-six percent of people have one adverse childhood experience; 15% have two; and 22% have three or more. In neighborhoods with high levels of violence and crime, many children have an ACE score of seven or higher. Having an ACE score of four doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and risk of having serious difficulty performing a job by more than 300 percent.
            But the grim statistics are not without hope. Trauma has been part of the human condition since the beginning, and so have compassionate relationships—now proven to be the best healer of trauma. This healing approach to pain is not new; what is new is the language and research around it; techniques and data that allow more people to have visibility into what is required to fix the hole in the soul Oprah referenced. When researchers study people who have both high ACES scores and high levels of resilience, they find that these trauma survivors often have a story of a person who connected with them with understanding and compassion. It is this authentic compassion, over time, that provides healing. The research shows also that those who come in contact with vulnerable population groups can be trained to be compassionate responders. Homes, schools, youth programs, correctional facilities, and workforce training programs can be re-organized around trauma informed principles such as emotional safety, trustworthiness, collaboration and empowerment.
            For Christians, a trauma-informed response especially holds resonance. We can look to the Gospel to see how Jesus approached those around him. Trauma-informed care is all about healing through love. It’s the story of the prodigal son--  the father who welcomes his son even after poor decisions and separation. It’s the trauma-informed shepherd going after the lost sheep. It is Jesus first weeping, and then bringing Lazarus back from the dead. It is Jesus choosing not to chastise the woman at the well; and choosing to heal the ear of the soldier in the garden of Gethsemane. To be trauma-informed is to have the compassion of Jesus on the cross telling the repentant thief hanging next to him that before the day’s end, he’ll be with him in paradise. For caregivers, always at risk for compassion fatigue, we have the example of Jesus going off by himself to the mountain or the desert, to pray and regroup—and important tenant for gathering strength and patience.
Science has caught up with us, has determined a method to measure the power of hurt, but also of the power of love. Science has named our love “trauma-informed care.”  
Now we are called to go forth, to heal.

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