Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:19

Hey, everybody, it's Dr. David Hilden, your host of the Healthy Matters podcast. And this is episode 20, and we're gonna talk about trauma-informed care with clinical psychologist Dr. Mitch Radden . Mitch, thanks for being on the show.

Speaker 3: 0:31

Thanks for having me. It's

Speaker 2: 0:32

Great to have you here. And we're gonna talk about trauma-informed care, and so I'm gonna ask you to help us out with what that is. My understanding is that it's a , it's an approach that recognize and responds to the effect of trauma in people's lives, and then how we respond to that in, in their healthcare . I've been well aware of your interaction with our patients and our employees as we care for our communities . Could you start us off and just give us, in the most basic level, what is trauma-informed care?

Speaker 3: 1:04

That is a great question, and it sort of depends on who you ask. So when you think about trauma-informed care, what you're really talking about when you break it down to its most basic elements is this kind of framework to engage in a state of mindfulness as you're moving through your day. So what we're doing is slowing people down a little bit when we organize around trauma-informed thinking to move from a place of reactivity to a place of responsiveness and intention. And that's mostly just slowing people down to consider context. So we're not just looking at a behavior, we're looking at what might be driving that behavior.

Speaker 2: 1:43

So what do you mean by trauma?

Speaker 3: 1:44

So trauma is a very complicated word these days because it's thrown out in a lot of different contexts , isn't it , though ?

Speaker 2: 1:51

It really is. You know, I don't know. I haven't had , I haven't been in a car accident that that sounds like trauma. Is it psychological trauma? Is it your life experiences? What

Speaker 3: 2:00

Is it? Right? There are three different kinds of trauma. There's the acute trauma, which is typically what you see following a car crash or an assault or a gunshot. So what that is, is an event that overwhelms somebody's already developed ability to cope, and sort of throws them into a space of helplessness where they're unable to respond in a way that gives them any sense of control. Often that's associated with a sense of fear for one's own bodily integrity or life. Um, so it's a really kind of life shattering moment. The easiest definition for trauma, when you think about it, when you break it down and kind of understand how it impacts people, is it's any event or series of events that overwhelm somebody's nervous systems ability to make a distinction between past and present real threat and perceived threat. So when somebody is activated into a state where they fear for their life, the system gets stuck there, unable to make a distinction between past and present. So everything now feels like a threat,

Speaker 2: 3:03

But isn't it, if you, if you're experiencing some, some pretty traumatic thing in your life at this moment Mm-Hmm. <affirmative> , physical, emotional, psychological, whatever that is in your life, isn't it normal or isn't it common that you might feel very at a fundamental like cellular level? I feel unsafe,

Speaker 3: 3:20

Yes. Because you are unsafe in that moment, and yes, it is . That's the thing I think that gets really complicated is that it is a completely normal response. It's an appropriate response for the way the brain and body is impacted in a context like that. Where people get stuck is that they feel crazy because they feel out of control. They feel like they're unable to manage the world in ways that they used to be able to. And that's where this turns into a more complicated bag . You have some people who experience something really overwhelming. They may have a period where they feel overwhelmed, but return to a state of baseline where everything sort of goes back. For some people, the nervous system is just hit in a different way. That's when the trauma sort of lives devoid of space and time. The event continues to recur in that person's mind and their body as though it's happening all over again. So instead of it being a memory, it's a relived experience.

Speaker 2: 4:16

Oh, that, that is, that is helpful. So is that what we mean by chronic trauma?

Speaker 3: 4:21

Right. So when we're talking about the three different kinds of trauma, there's, there's the acute trauma, which is the singular event. There's the chronic trauma, and then there's complex trauma. Chronic trauma and complex trauma are pretty hard to parse out when you've got the chronic trauma. What you're really looking at are experiences where people are in an environment or in a relationship where there's an ongoing threat. So it could be a child living in an environment where there's child abuse, could be physical, it could be sexual, could be a domestic violence situation. It could be a situation where you are working in a hospital setting and chronically exposed to people who are , uh, engaging in really threatening behavior, or for people who've been assaulted , uh, multiple times.

Speaker 2: 5:07

I think of that a lot, that part in our own workplace, not only for our patients, but the people who, who work with our nurses. Yep . Um , paramedics things, things like that. People who are experiencing trauma as they're trying to help others who are living with these complex traumas. We're gonna get a little bit later, I hope, <laugh> Yep . Into the basic tenets of trauma informed care. But before we leave this kind of foundational discussion, what do we know about the cumulative effects of trauma throughout someone's life? And now, a lot of people have heard the term adverse childhood events . Adverse childhood experiences. Yep . Can you talk about that?

Speaker 3: 5:44

So that's where you start to get into the more complex trauma piece of it. So you've got the chronic trauma where it's like a singular kind of trauma from a one singular individual typically, or a singular environment. With the complex trauma, what you're looking at is a really complicated set of experiences where people are living in an environment where threat is always present in some way. It could be neglect, it could be violence , uh, it might be within the home. It might also be in an environment where somebody steps out the door and is feeling unsafe. So the adverse childhood experiences study started to look at trauma. This was back in the early nineties, and it was done at Kaiser Permanente Hospital, and I think outta San Diego at the time. And they did a questionnaire of about 17,000 people, most of whom were white, most of whom were middle class , and people who all had insurance. So this is like a,

Speaker 2: 6:35

That's a subset of the world.

Speaker 3: 6:37

Yep . <laugh> . What they found, however, is that of those 17,000 people, a huge number of them had at least one adverse childhood experience. A surprisingly large number had two or more. And there was a significant number of people who had four, six or more adverse childhood experiences, which I'll explain what those are in a moment. What they found is that people with more adverse childhood experiences had significantly more complex health issues and significantly worse outcomes when trying to manage their health issues,

Speaker 2: 7:12

Physical health issues,

Speaker 3: 7:13

Physical health issues. Yeah. So what adverse childhood experiences are they? So they did this questionnaire, I think it was 10 questions, and they looked at things like, did you grow up in a home where there was physical abuse? Was anybody in your home ever sent to prison? Uh, did you witness physical abuse in the home? Were you exposed to neglect? That kind of thing. So all the things that you might think about as far as like childhood difficult experiences in a family. So when people think about trauma often, and they think about that more complex trauma, they don't typically think about it in terms of the everyday individual that they run into. They might think about it more in like a, you know, either you are working in a job like as a first responder where you're exposed to all that stuff, or you are growing up in an inner city environment where there's a lot of violence and that kind of thing.

Speaker 2: 8:01

I think of my, my wife Julie is a high or high school. She's an elementary school social worker. And every day of her life, she had to locate some of the children because they're living in unstable housing. Um, she had to send taxi cabs to abandoned buildings to locate children who were experiencing homelessness. Uh, and, and a lot of these kids were facing exactly what you've just said. Um , all of those things that you might imagine aren't healthy for a , a developing child. So my question to you is, how does that affect people's mental health, their physical health, their emotional health, not only in childhood, but even all the way into adulthood?

Speaker 3: 8:40

That's a really complicated question in that it's not only adverse experiences that happen in childhood that change the way that our bodies and our brains operate, it's also adverse experiences that happen as adults. So as children, you know, our brains are developing, our nervous systems are developing. All of our hormones are starting to kind of do what they need to do to make us grow trauma, or living in those kinds of environments where you're chronically exposed to stress is an inflammatory experience. The whole body is trying to respond to a chronic state of threat. I won't go too much into the nervous system stuff, but you know, we like to think that our brain is the primary source of our ability to manage stress. In fact, it's not of the nerve fibers that go from brain to body and body backup to brain that dictate how stressed we are, how calm we are. Give us information about the world. Only about 20% of those nerve fibers go from brain to body. 80% go from body to brain. So if you think about it, your brain's just in this little dark box getting information from all these sensory nerves. And our brain is then trying to make sense out of that information. So what happens is, under the right conditions, that body and that brain are communicating in all the ways they need to communicate to assess the world in all of its goodness, all of its badness, and learn from it. But under conditions where there's chronic threat or somebody's physical wellbeing is chronically under threat, that body is constantly activated into that stress response where the body is sending a signal to the brain in a really consistent way that something's wrong, something's not okay. So instead of that prefrontal cortex being online, that part of us that is super intentional and tells us where we're gonna go, how we're gonna do it, be really thoughtful about things, our limbic system gets lit up, that fight or flight part of our brain, that part that attunes us to threat and promotes a kind of reactivity to the world, because it's not appropriate for me to be thinking about how beautiful the leaves are in the trees when I'm being chased by a bear. So if the bear is around every corner, it becomes harder and harder for my brain to just slow down and think about everything around me. I'm constantly scanning the environment for threat. And that doesn't always happen along, you know , unconscious levels. It happens very much on an unconscious level because the body is hyper attuned to scan the environment for threat. And so the way the body and brain start to develop starts to shift, if you show images, brain images of a child who's been significantly neglected as compared to a child who is growing up in a healthy, loving, safe environment, what you see is almost no activity in the prefrontal cortex. It's almost all dark of the, of the children, of the children who are neglected neglect . And what you see is that that limbic system is pretty lit up. That midbrain part of it, that's that part that's always like , lit up to be , how does that child learn? Then they don't in school. They don't learn at the same rates . What you have is a child who has a lot of difficulty focusing, a lot of difficulty sitting, still, a lot of difficulty taking feedback in a way that is measured and is able to integrate into the way somebody might learn. What you get is somebody who is reactive and , uh, fearful and doing anything they can to just try to survive in an environment because they can't make a distinction between real threat and perceived threat.

Speaker 2: 12:13

That's really, really helpful, Mitch. So we're gonna take a short break, and when we come back, we're gonna talk about the components of trauma-informed care. Stay with us. We'll be right back

Speaker 4: 12:25

When he up in healthcare says, we are here for life. They mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, and a network of clinics both downtown and across the West Metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 13:02

And we're back talking with Dr. Mitch Radden , a psychologist at Hennepin Healthcare. We're talking about trauma-informed care. Mitch, could you talk us through the , the components of trauma-informed care? What is it?

Speaker 3: 13:14

It , it depends on who you talk to. There are basic kind of elements of it. Everybody calls it something a little bit different. But the framework that I was teaching here, and the way that I make most sense out of it, where I typically start with it, the first step in engaging in a trauma-informed learning or approach to something is understanding interpersonal neurobiology. So when I teach it here, and this is particularly effective in working with medical professionals, other first responders, because it, it can feel complicated for people when they think about trauma-informed care, which again, when I introduce this, it's this exercise essentially in mindfulness where you're just slowing down to notice the moment so that you can respond versus then versus react .

Speaker 2: 13:58

Because neurobiology does sound complicated, but being mindful and slowing down, it does. Is that what it is?

Speaker 3: 14:03

Yes. So when I talk about the neurobiology, what I'm doing is just helping organize around the fact that when people are practicing this stuff, when they're slowing down and kind of changing their intention to engage with something, they're not just doing something for the sake of doing it. When they slow down, they're literally regulating their nervous system. They're slowing their brain down, moving from that limbic system space to that more prefrontal cortex space, which allows them to assess an experience or situation or environment with a lot more complexity.

Speaker 2: 14:36

We could all learn to do that. Totally.

Speaker 3: 14:38

And this is the thing. So one of the most important things, like if you tell somebody to take a breath, it's kind of the equivalent of telling somebody to like, calm down, and then they just kind of wanna slap you because nobody wants you to tell 'em to calm down.

Speaker 2: 14:50

So I bet you you don't do that when you're seeing people . I do not . You don't go take a deep breath, calm down.

Speaker 3: 14:54

I don't. I will . I say, well, let me explain something to you, and then we might do an exercise. So what I do is explain to people really basic stuff around the nervous system, but what I do really highlight is the , the control mechanism. That control center of our entire stress response is actually our heart. And you can't control your heart by thinking about it that much. You can to some degree, but you can control your heart through your lungs. When you breathe in, your heart rate goes up a little bit. When you breathe out, your heart rate goes down a little bit, and it's the downbeat on that heart rate that literally changes the signal from body to brain. That puts what we talk about as the rider in the horse. But I can explain that later.

Speaker 2: 15:32

Would you explain the rider in the horse? Yeah . Because most listeners, I would bet the vast majority don't know what the Yes . Heck you just said, but I do. Okay . And I, I would love you to explain the rider in the horse. Yep .

Speaker 3: 15:41

So the rider in the horse analogy is thinking about the brain, like the rider in the horse. So the, the rider in the brain is like that prefrontal cortex. It's the thinking part of us that is the jockey who sort of tells the horse where to go. The horse is that limbic system or that emotional beast that carries us from place to place when everything's operating the way it's supposed to or the way we want it to. And under calm circumstances, the rider is planted firmly on the horse, and our thoughts and our emotions are meaningfully intact. And we're going about our business, thinking about all of the dynamic things we need to think about. But when a threat moves in front of that rider and that horse, the horse bucks the rider, because in that moment, a horse does not need a rider to tell it what to do. The horse's job is to attune specifically to that threat, so it knows how to fight it or get away from it. The problem with that is we rarely know whether our rider is on our horse or off our horse, because we're so impressed with our ability to think about how we managed a threat after the fact that we're not aware, that we were completely tuned out to a lot of the things

Speaker 2: 16:48

That , yeah , I got through . Look at the way I, my , I thought my way through that one. And you were bucked off the horse.

Speaker 3: 16:54

Yep . Which is the way it's supposed to be. That's super adaptive. But now, when the threat is around every corner, what happens is. The rider is more and more bucked from the horse. And what you find is that somebody's walking through the world with just a hand on the main of that horse rather than firmly planted on that horse. So you have somebody who's a lot more reactive to the world, not looking at context, not looking at threat, and misinterpreting cues from the environment. Again, that's where you get the kid in school who gets really reactive to a teacher who just asks them to sit down when they're not hearing it as sitting down. They're hearing somebody demanding. They do something that is like extremely difficult or insulting or whatever.

Speaker 2: 17:37

So that's the neurobiology.

Speaker 3: 17:39

That's the neurobiology. So when, when you go to that stuff, what we're saying is how do you figure out whether you're on your rider or your horse? Are you thinking as a rider or a horse or when you are engaging with another human being, are you talking to a rider or a horse? The reason that's important is because if I'm aware of whether I'm a rider or my horse, how do you figure that out? You check your body. If you're holding tension in your body and you're breathing is tight and shallow, you're being chased by a predator. If you're holding your breath, you're caught by a predator under either one of those conditions, you're not thinking clearly, you're gonna be reactive. So you slow that down. You take one slow deep breath, you reregulate your neurobiology enough to get that prefrontal cortex or that rider on that horse a little bit. You've already moved from a place of reactivity to a place of intention because you thought through the fact that something's going on. So if I'm aware, whether I'm a rider or a horse in that moment, what I can do is tune into the individual that I'm talking to. Horses do not understand language. So if I know that I'm talking to somebody who's super activated or super shut down, I cannot use a lot of words to engage with them. And you don't run up to a horse waving

Speaker 2: 18:47

Hands and start trying to reason

Speaker 3: 18:48

And yelling at it. Right . You use the tone and posity of your own voice to sort of calm them, to get them into alignment and establish a sense of safety. And then you can start to use those words because you, you get a sense of when that rider is back on there. And so that's the first step. Once you have that neurobiology in place and you understand how you react and how you respond, we move to this notion of cultural humility. So cultural humility is really different than cultural competence. When we think about cultural humility, what we're really, I mean, as far as cultural competence goes, I'm not cultural competent in my, in my own culture. It's like I know parts of it, I know all sorts of things, but you're not an expert on it . No. But what I can be is humble about kind of being curious and knowing what I don't know, and asking questions and understanding context, and being curious about that context. So if I understand my own nervous system reactions and my neurobiology, that slows me down enough to be able to be curious about things that I'm engaging with in unfamiliar environments, or for people with people who might be different than me. So I'm not confusing how I think things should be from my perspective with how things might be from their perspective. Once I've established that within myself, I can move to this idea of safety, which is one of the most important components of trauma-informed care. It is only when we feel safe that we're able to meaningfully engage with another human being, that we're able to take in information, that we're able to make sense out of anything. How many times as a doctor have you spoken with a patient, given them very clear instruction, they come back the next time and are like, wait, you didn't tell me to do any of that.

Speaker 2: 20:30

You didn't tell me any of that. Yeah . Oh, that is listeners so common. Yep . <laugh> ,

Speaker 3: 20:35

Right? They're anxious. They're, they're thinking, what the heck is going on?

Speaker 2: 20:38

And I thought I explained it

Speaker 3: 20:39

Clearly, and you did probably, you weren't aware about whether or not their rider was on their horse or not. Right ? And so you were speaking to the horse who wasn't understanding. Yeah . And so, but people feel a lot of shame around that. But when we can understand that stuff, we can really normalize it and let people know, oh, there's nothing wrong with there. That was my bad Mm-Hmm. <affirmative> , you know ? Mm-Hmm . <affirmative> , I wasn't paying attention. And so let's slow down again and figure out what went wrong and how we can help you, because now the person feels safe. They trust us enough that we can move into a space where we're really cultivating a collaborative relationship with the patient, rather than that more typical hierarchical relationship. We think about in medicine, I'm the doctor, I'm gonna tell you what to do. We wanna partner with people to get them to fully understand what we're trying to do with them, how we're trying to help them and understand from their perspective what they need. Are the interventions that I'm offering you actually useful to you? Do they make sense in the context of your life? Or do we need to adapt some of this so that it actually makes sense for you and your life so you can actually use it? Once we move from, from that kind of safety and co-regulation piece of it, where we're kind of creating a space that's meaningful for both of us, we really then move into a place where we're, we're focused on empowering the patient to like really take agency and ownership of what they're doing. And from there, once you have all that stuff put together, you're already cultivating a kind of resilience and effort at self-care because you're regulated, you're understanding and making meaning out of what's going on with you and your patients, your coworkers , and you're moving through the world in a way that is connecting you to a sense of meaning and what you're doing, rather than the slog of patient after patient after patient. And the frustration of sometimes not feeling like you can be fully helpful to some people.

Speaker 2: 22:20

So you moved from neurobiology riders and horses, cultural humility all the way through collaboration and empowerment. What a powerful model. How often do we do this in healthcare?

Speaker 3: 22:34

We don't <laugh>, we try. Yeah . I mean , and I think everybody who's out there engaging with patients is amazingly well-intentioned has extraordinary skills and abilities to do this stuff, but I was down in the ed , uh, the emergency department several months ago, and I was talking about this with somebody, and they just said, I would be the most empathic, amazing doctor on the planet, but I've seen 15 people and it's only 10 o'clock. And how am I supposed to like, stay attuned? You can, if you are aware of this stuff, and taking moment by moment as , uh, like assessment of what you're doing and whether you are staying aligned with that, meaning making process and staying connected to the moment.

Speaker 2: 23:20

Makes sense. So Mitch, you care for patients in our communities, and you also care for the people of this large downtown Minneapolis level one trauma center. And, and where the nurses and the paramedics and the medical assistants and the respiratory therapists, you name it, the patient care coordinators at the front desks. And yes, even the doctors are caring for people who have experienced trauma, who are probably experiencing some their own. Could you give us some examples about how you approach your work here in this big

Speaker 3: 23:56

Hospital? Yeah. So I do a number of things. So I , I have a team , um, of psychologists on a , what we call a critical incident support team. So we're available to respond to people immediately following , um, a difficult event that happened. Sometimes it's for an individual who is experiencing something and having a hard time getting back into the fray of work. Sometimes it's for a whole group who is exposed to, to something really difficult with a bad outcome. And what I tell people is that I'm not suggesting that anybody is traumatized. I don't know if they're traumatized, I'm not doing that assessment. But what I can pretty well guess is that it's very much like when I think about a baseball pitcher throwing a ball for nine innings, what that pitcher knows is that they're gonna experience some pain and inflammation between innings. They're gonna ice, they're gonna keep it loose. They're gonna do everything they can to perform at optimal efficiency throughout that game between games. They're gonna do everything they can to stay in shape, to continue to do that with minimal pain and perform at professional levels for people in healthcare. I talk about how it's a really, a very similar thing. We're talking about these repetitive strain injuries. It's not one experience, but it's typically experience after experience after experience over time. It's kind of a complex trauma for medical professionals or people who work as first responders. The nervous system becomes more and more adapted to be lit up to be expecting threat because threat is part of the job. But we operate as though we're just going to work, which is not effective. And in medicine, we're trained to be objective. We're trained not to have big emotional reactions to things. What that does is position most people to be looking around, seeing everybody else around them looking very composed, very regulated. But the person who's looking around is looking inside, feeling completely dysregulated and outta control, feeling like, there must be something wrong with me,

Speaker 2: 25:55

With me. W but but you , and you're in this like emergency department where people's bodies are insulted in injuries and emotions and pain and you know , the emergency department, and it's not just the emergency department. It's all over. It's all over . It could be on the hospital unit , it could be in clinics, you know ? Yep .

Speaker 3: 26:12

So when I give that framework, I am basically telling people, this is not a failure to cope. It's not a weakness. You're having appropriate emotional responses. It's just not part of medical cultural to really acknowledge that stuff.

Speaker 2: 26:26

And plus there's another patient over there in that unit, right. That you gotta go see.

Speaker 3: 26:30

So when I give that framework and I kind of organize people around, this is normal. You can, you can manage this, check your body. If I go down to the ED after a really intense event, and I work with a group who is just kind of dealing with something really catastrophic, I will say, not gonna use a lot of words. I know you can't hear this right now. You're still like up. What I want everybody to do is just kind of notice your body, check it head to toe where you're noticing tension, release it. And I will say, when I talk to most assault survivors or most car crash victims or other people who've been through a trauma, if they describe to me what happens, their bodies always move into the position they were in at the moment of impact, at the moment of assault

Speaker 2: 27:12

Everybody . And you're making that. Yep . You're making it . You're like, yep . You're tensing up your body, your arms are going closer to your chest. Yep .

Speaker 3: 27:18

I'm protecting myself. Yeah . From the threat. And so almost

Speaker 2: 27:21

Fetal position.

Speaker 3: 27:22

Yeah. <laugh> . And so what I tell people is their body just went through something. We don't wanna store that as a reference point. We wanna do the opposite of what your body wants to do right now. Don't hold the tension because that threat is over. I know there's another threat, but you want to move to that in the most responsive way possible. Release this, notice your breathing. I will say, if you're breathing tight and shallow, you're being chased by the predator. If you're holding your breath, you're caught by the predator, even that out. And I will say, I talk with first responders about this all the time. You can go code three, which means lights and sirens to a call and breathe at the same time. You can do compressions and breathe at the same time. You wanna stay responsive because you do not wanna show up to a scene reactive, or you don't want to go to that next patient in a reactive manner and reactivate a trauma that

Speaker 2: 28:12

Somebody , I've never thought of it that way. You've got a paramedic racing down the street code three lights and sirens, blast into this horrible situation. Breathe. Yep .

Speaker 3: 28:20

And they can, they can do

Speaker 2: 28:21

It , and it can be done.

Speaker 3: 28:22

And you see people, their eyes light up, they're nodding their heads, they , it's remarkable how you can give somebody just such simple instruction if you put it in a framework that makes sense to them. And you see people start to change. And so before I started the critical incident support team, nobody really knew how to get support or what kind of support to get. I think there were like six requests for emotional support in the hospital from staff before I started in the six months before I started. And the six months to a year afterwards, we had somewhere upwards of like 200 requests. And that was not only , um, individuals, but for groups doing debriefs and other things. So, you know, that's hundreds of, of staff in the hospital who were supported.

Speaker 2: 29:05

I can attest to that before, before I've been here 25 years , um, before Dr. Radden came and did our critical incident support team. It was like that I didn't, we didn't talk about, well , frankly, we just didn't talk about any of this stuff, right ? <laugh> , we didn't. Right. And now we do, and we have resources and professionals to help. Yep . Uh , um, largely thanks to this program that you lead. And so , uh, I really thank you for that. Mitch, before I let you go talk about if you would, the outcomes of trauma-informed Care. What is the result of practicing in this manner ? Yeah,

Speaker 3: 29:39

I always go with this, and it sounds weird because we're talking about trauma, but this is trauma-informed Care is one of the most optimistic approaches that you can take when thinking about any environment that you're operating in. It contextualizes things so that we are not having reactions and responses that are just out of nowhere that are confusing. We're actually understanding there's a source to this, the main tenet of trauma-informed Care is not what's wrong with you, but what happened to you. So when we don't think about, oh my gosh, there's something wrong with me here. What we do get to do is slow down and think, oh my gosh, something happened. I'm actually responding appropriately. Now that I know that something happened, I can actually deal with that, address it, or at least not feel like I'm spiraling out into the atmosphere. So what we're really doing is organizing people around, again, affording people context, understanding there's a source to their distress, which makes it a more manageable thing. What I'm seeing throughout the hospital is staff starting to think about themselves differently, think about how they're showing up to work differently and making meaning out of the work that they're doing, rather than just focusing on where the next threat is gonna be . And really engaging patients differently to think about, okay , this guy's yelling at me. Maybe the problem of yelling is not really the problem. That's an attempt to solve some entirely other problem. I activated something. Maybe he's vulnerable. Maybe he's afraid I'm fearful, but I'm regulated. So if I'm regulated and my rider's on my horse, I can actually not look at that as an immediate threat, but as a need. And so now I'm looking at this person as somebody who is asking for something rather than trying to push me away. And so I can think through it more dynamically and support them. Sorry, I didn't mean to upset you. What's going on? This doesn't seem like it's really about what I said, or something along those lines

Speaker 2: 31:35

That's transformational. That isn't how I learned medicine. Yeah . Know , frankly, nobody said anything like that 25 years ago. And that is, that resonates so deeply with me, and I know it does across this organization. 'cause I talk to a lot of people who have been the benefit of a new way of thinking about , uh, uh, trauma-Informed Care. Mitch, thanks for being on the show. Pleasure. We've been talking with Dr. Mitch Radden , clinical psychologist at Hennepin Healthcare about trauma-informed Care listeners. On our next episode, we're gonna be talking about long covid , what is it? What do we know about it, and what to do about it. I hope you'll join us 'cause it's gonna be a great show. And in the meantime, be healthy and be well.

Speaker 1: 32:13

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive Producers are Jonathan, CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.