And so, with that being said, we would love to begin. We are so grateful and honored that you would join us for this session titled, Seven Ways to Cultivate a Culture of Caring in a Traumatized World. I am Rosandra Day Walker. I serve as the medical director and a subject matter expert for WorkSTEPPS. I am also a PhD candidate with the NIOSH Total Worker Health Program at the Southwest Center for Occupational and Environmental Health. And I am Mark Day Walker. I am the chief health equity and wellness officer at Access Health Community Health Center. We have no financial disclosures or conflicts of interest. In a world that has been shaken by a global health crisis, societal upheaval, and economic disruption just to name a few, we've all faced unprecedented challenges. Now that we've survived the initial shockwave, I think we're all collectively figuring out where do we go from here. The purpose of this discussion is hopefully to answer some of those questions and give you a little bit more guidance. Today we'll explore seven transformative ways to create a culture of caring in your personal life, in your community, or in your workplace, even in the midst of significant trauma and stress. We're going to dive into some principles from trauma-informed care, from lifestyle medicine, and from positive psychology, and explore how to apply these evidence-based strategies to foster resilience and well-being. So I want to turn it over to Mark to tell you a little bit about his personal experience. Thank you, Ro. So I was a brand new family medicine attendee the end of 2019. In the next six months, we went through the first lockdown for the COVID-19, this thing called COVID-19, by the way, back then, pandemic. And not to mention, my wife and I, we had just had a son, six weeks old, that we were thinking about how do we take care of a brand new baby, and oh, by the way, we also closed on a home. So all of this was occurring in a very short time with a lot of different transformational things happening. And if you know anything about community health centers, and the populations that we take care of, you understand that community health workers are historically overworked and under-resourced. And this has led to very high levels of burnout, which only you could probably imagine that COVID-19 only exacerbated. So my principal concerns at that time, in addition to listening to my patients as they were kind of suffering with their stories and own traumas with COVID, and not to mention losing patients, was my own personal emotional exhaustion and compassion fatigue from taking care of patients, but also to this very real fear that I had of bringing the virus home to my family. And in short, my worldview was changing. So I mean, obviously, I was there, and I experienced this firsthand with him. And so I was fortunate to be working and studying from home at the time, but my husband was going in person every day, every day. And at that time, you know, we had no idea what to do. I mean, it was to this point where it was like, you need to get undressed outside. You know, do we need to get another place for you to stay? He's hearing stories every day of his patients losing their loved ones. Every week, he's losing his own patients that he'd been with for years, and we even lost a family member. So there's a lot going on. But we weren't alone in this, right? I'm sure everybody in here has their own story, had their own experience. So now we invite you to reflect on what that was like for you and think about what happened to you. If you want, you can reflect on your own during this time, or you can reflect with someone close to you, next to you in the room, and just discuss what your personal and your professional challenges were in the early phases of the pandemic. And in addition, what was that like for maybe your colleagues or maybe staff who were in trust in your care, if you were maybe a CMO or Director of Health and Well-Being? Which of these challenges still persist today, right? We're not completely through this. And which ones are new, or how has it evolved? So we'll give you about five, six minutes to think about this or maybe talk collectively with each other. You know, if you are kind of far from someone, maybe you want to travel and get a little space but still get to talk to somebody about it. Okay, you'll do five minutes. So share as little or as much as you feel comfortable. If you want to write it down, that's fine, too. So I tread off a bit with the previous slide when I mentioned my worldview changing. My worldview was changing about medicine. My worldview was changing about work and the impacts of how my work could directly affect my family now with this virus. And in the midst of this, guys, I was promoted to being a Director of Health and Well-Being. So I went from being a brand new doc, just trying to figure out how to take care of my patients and protect my family, to now thinking about how do I do this for 250 employees. So AccessHealth, at the same time, actually had just started participating in an organizational cohort, an organizational transformation with several other community health centers in Texas, something called Trauma-Informed Care. We'll talk about that more later. And they were going to put it on halt once COVID and everything was coming out. They said, we don't have the resources. We don't have the bandwidth. Guys, we've got to put this on halt. Stop everything. Stop the presses. But my husband said, actually, I think this is the perfect opportunity to deploy something like this. And so we were also just happening to put some baseline measures out to track what was going on with the people and our staff in the health center, and also to make sure that if we did anything, you know, sort of the programming or interventions, that we could at least make sure it worked and that we weren't just burning rubber, you know, and turning our wheels in fruitless efforts. So we started with a baseline survey, well-being survey, in August 2020, right, in the midst of probably the worst parts of the pandemic. And we did a follow-up about a year later in July 2021. This included measuring things such as the WHO Well-Being Index, the professional quality of life, which includes things such as burnout, gratitude, as well as questions regarding the workplace and coping mechanisms. And we frankly just asked the staff, what do you need from us? Lo and behold, from 2020 to 2021, in the midst of everything that was going on, we actually saw improvements in overall well-being, compassion fatigue, burnout, gratitude, positive supervisor relationships, and the sentiment that the staff felt like the organization listened to and addressed worker concerns. Everywhere else, right? People's well-being was going down, and their burnout was shooting up. People were leaving the workforce. It was a mess. But somehow, people were maybe doing a little bit better than they were before, which is really interesting and a little counterintuitive. So you're probably asking, how did we do it? So before I tell you what we did, I want to give you some background on some of the frameworks and strategies that we used to inform the work. The first is the trauma-informed approach, or you've probably heard it referred to as trauma-informed care. Or raise your hand if you've heard of trauma-informed care. Oh, man. OK, good. Good. We've got some allies in here. So really quickly, according to the Substance Abuse and Mental Health Services Administration, trauma is the result of an event or circumstances that is experienced by an individual as physically or emotionally harmful, and that has lasting adverse effects on that individual's functioning and well-being. So people can be exposed to the same event or experience, for example, a burning building, and have completely different responses, have completely different experiences of that. For example, if you're a five-year-old who's trapped in the burning building versus the firefighter who rescues that five-year-old. The point is that traumatic experiences are not the same for everyone. Their experience of it varies. And the effects can be long-term and debilitating. So these are the three E's of trauma. And trauma can arise from a variety of sources, as you can imagine, everything from abuse to personal illness, accidents, workplace violence, historical trauma, job loss, vicarious childhood neglect, poverty, racism, natural disaster, and more. And the vicarious and the secondary trauma, like what my husband was experiencing, is that even if you're not the one experiencing it directly, watching the images, hearing the stories can make you feel as if you're living it, and it has the same effects on your mental and physical health. And obviously that's not an exhaustive list, but just something to give you an idea that there are a lot of different ways that trauma can occur. So now trauma-informed care is a strengths-based service framework that is grounded in an understanding of and responsiveness to the impact of trauma that emphasizes both physical, psychological, and emotional safety for both healthcare providers and trauma survivors, right? Not just our patients, but also for us who are trying to take care of them. And it creates opportunities for survivors to rebuild a sense of control and empowerment, because one of the big things about being a trauma survivor or incurring trauma is this loss of control and disenfranchisement, feeling powerless. It represents a paradigm shift when you're looking at someone who's struggling, or who is noncompliant with treatment, or who isn't showing up, or is struggling in school, or quote-unquote acting out, and you see the dysfunction, and you say, what is wrong with that person? What is wrong with you? But trauma-informed care says, no, don't look at them as their dysfunction, but think about what happened to them. What happened to them that is causing these things to manifest now? And it also reminds us to presume that it's very likely that somebody that you're interacting with in different settings probably had some kind of traumatic experience in their lifetime. Before COVID, it was estimated that it was 70% or upwards of US adults who had at least one traumatic exposure. And I'm sure post-COVID, it's probably closer to 110%. And so it says, even if a person hasn't, you don't need to know if I've experienced trauma, but you're going to use universal precautions. You know universal precautions? Just assume I have, and create an environment and a system that doesn't re-traumatize me, and create preventive rather than reactive systems of care. All right. So just to piggyback off of what Ro was saying is that with the trauma-informed approach, you do not need to be a licensed social worker or a counselor or psychiatrist. This is not trauma-specific therapy, but if you practice these four R's, you can have a trauma-informed aligned approach to dealing with people that may have experienced trauma. With the first R being to realize. Just realize that psychological trauma exists. We know this from the ACE studies that we talk about, the adverse childhood experiences. And if you take that in every exam room or in every workplace, even in your social interactions at maybe your grocery store, you at least give yourself the opportunity to be able to address someone in a trauma-informed way. The next R is to recognize. Recognize that there are real long-lasting effects that someone would have after they experienced trauma. These things may manifest in what we may feel like or see as dysfunction, but those exact same behaviors may have been the behaviors that helped them get through that trauma that just now shows up habitually that now may be more of a maladaptive kind of coping way of dealing with situations, especially if they just get a little stressed. And the next R is to respond. So once you're able to realize and recognize these effects of trauma, again, you don't need to do any CBT. We're not asking you to unpack and help someone deal with their trauma, but to acknowledge and recognize that. And if you are in a space where you can maybe refer someone to see someone else or just validate how they're feeling and things like that, you're acting in a very trauma-informed way. You're not doing the next R, which is to resist or avoid retraumatization. So as long as you're approaching situations such as this, you're having a trauma-aligned approach. And retraumatization is very important, because what tends to happen to people who have longer-term effects from trauma or are dealing with different challenges, such as substance abuse or the loss of a loved one, grief, that sort of thing, they tend to be more vulnerable than the general population and need more health care services or other support. But sometimes they go into spaces where it may not necessarily be trauma-informed, even though everybody is very well-intentioned. But there are things that can inadvertently bring them back to a space of powerlessness. For example, a survivor of sexual abuse in a doctor's office being told or ordered to remove their clothing or stick out their tongue, right? And so it's just being thoughtful and mindful about how we interact with others, but also how we interact with ourselves. Because one of the first things you need to be able to do is recognize what's going on in your own body, in your mind, when you're dealing with your own problems or others. All right. And there are six guiding principles of trauma-informed care. Those are safety, both physical as well as psychological safety, trust, and you can increase trust by transparency. Just being able to share with someone ahead of time some information that you may already know can help take care of someone's anxiety or stress over something where they're expecting something to occur. And I'll add, right? Because that was one of the things that made the early phases of, for example, the pandemic so challenging was the unknown. There were so many unknowns. What was going to happen next? What decisions were being made about what we were going to do or when we were going to work or what PPE we were going to have? There were just so many unknowns. And when you have information, it empowers you, because then you can make informed decisions and you can have more sense of control and autonomy. The next guiding principle is peer support. And many of us are medically aligned, so I'll try to bring this analogy up or something we are familiar with is like fight, fright, or freeze. Anybody familiar with those kind of responses to maybe stressful situations? So what peer support really allows us to do, because we're no longer those ancestral cave men where we had to run away from whatever things that we were kind of dealing with in the environment. Now it's a lot safer for us, but we still deal with those same kind of emotions. So what we've adapted to do now is that when we have those emotions, you may think to yourself now like, hey, I may call someone that helps me kind of deal with this, and it doesn't have to be a counselor, it could be a friend or something like that. But peer support really leverages that piece of responding to stress. Collaboration is the next guiding principle. Empowerment is a really big one, because when people have been traumatized, a hallmark of that typically is powerlessness or loss of control. You feel like you don't have control over much things in your life. Loss of agency. Yes. And then lastly, which probably should be what we lead with here, actually, is cultural, historical, and gender issues. And I flip that a bit to saying more of cultural, historical, and gender humility and responsiveness. And we should take that into every single situation that we have with the understanding that we cannot be experts in anybody else's culture apart from our own, their history apart from our own, and their gender apart from our own. That is lived experience. And the most we can do is get as informed as possible, but we can never be experts. So to have that humility and just be responsive to someone is important. And understand that because none of these things occur in a vacuum, that those experiences can also be shaded or have a different lens based on your personal, cultural, and lived experience as well. So I'll give you an example. I come from a cultural background where sometimes we speak, when we're excited, we might get a little loud. And it doesn't mean we're mad, we're just passionate people, okay? And sometimes I might get excited in the midst of a conversation, and I can get a little loud inadvertently. And my husband comes from a culture where people are, when people get loud, it means they're mad. There's something wrong. And that can be activating, or triggering is another term for that, but that can be activating. And so understanding, I mean, even with someone who you might assume we have the same cultural background, we still have very different experiences and can interpret the same exact event very differently. So that was trauma-informed care, everybody. And that was one of the large underlying frameworks that informed a lot of our work and efforts during that time. So the next one I really want to highlight is lifestyle medicine. Lifestyle medicine is the medical specialty that deals with evidence-based approaches to integrate lifestyle factors, including a whole food plant-based diet as a centerpiece into patient care in order to prevent, spend, or even reverse chronic disease. And I want to mention two specifically that were really highlighted, that were really helped us to inform what we were doing, which was the pillar known as managing stress, right? Because there was a lot of stress. And again, forming and maintaining relationships. There's just a breadth of literature that supports that our relationships and connections, even if it is a micro-connection of five minutes with another person, and good consistent healthy positive connection does wonders for our health, our sense of safety, our well-being, and even our ability to heal from emotional and even physical trauma. And not only that, but any of the other four pillars, such as physical activity, healthful eating, avoiding risky substances, and improving sleep can also have great effects on health, well-being, and well-being. And then finally, the other framework or field that we wanted to highlight is positive psychology, of course, and that was founded by Martin Seligman, many of you are probably familiar, and it is the scientific study of what makes life worth living, okay? And it really focuses on studying human thoughts, on feelings and behaviors, with a heavy emphasis on focusing on people's strengths instead of their weaknesses. And what contributes to building a good life, a desirable life, a fruitful life, things like happiness, joy, inspiration, love, gratitude, resilience, compassion, and really applying this throughout your community, your organization, your household, your personal life, or whatever that might be. And so, it's really something that we use, you know, again, it focuses on learning how to help people flourish and live their best lives. And a lot of these concepts, they overlap, or they dovetail with each other, right? And so we kind of brought together and made this casserole of things that we thought would be helpful based on the feedback that the staff were giving to the organization and what we sort of knew was evidence-based and would support good health, well-being, and safety. So specifically from the world of positive psychology, we really leaned on psychological capital. This is the work of Dr. Luthens and others, and I'll call it PSYCAP for short because I'm hip. PSYCAP refers to an individual's positive psychological state of development characterized by high levels of hope, efficacy, resilience, and optimism, which together makes a really spiffy acronym, HERO. And so studies show that high levels of psychological capital positively influence well-being, including health outcomes like BMI, cholesterol, right, who knew, and even satisfaction with your relationships. So we were looking for ways to compound, you know, to create a compounding effect. And it also shows that those who have higher psychological capital at baseline, it also helps support things like lower employee absenteeism and lower employee cynicism and intentions to quit and higher job satisfaction and more. And so basically it supports a healthy, engaged, high-performing workforce as well as just healthy, happy, fulfilled people. So now we get to connect again like we did earlier with another activity. So you talked about your struggles. You talked about your challenges. You talked about the fear. You talked about, you know, just what was your experience of sort of the really intense throes of the pandemic early on. So now you get to reimagine how you could use any or all of these principles that we just discussed to help yourself or your loved ones or your employees, your coworkers through these kinds of challenges, either past or present. And so I'll give you a few moments, again, to either reflect individually or to do like you did earlier and find someone close by to sort of have that discussion and connection opportunity. You have about five minutes. And then there will be an opportunity, of course, to share with the large group. All right. All right. Thank you, everybody. If you can hear me, clap once. If you can hear me, clap two times. If you can hear me, clap three times. All right. So I just want to say, I know that you're having, I'm so sorry to interrupt you all. And I hope and pray that you can continue these conversations with each other for sure after this session, because I'm sure you have a lot to talk about. And it really warms my heart to see how vulnerable you are being with each other. You probably, several of you probably just met for the first time today. So I'm really impressed, and I appreciate the engagement and the willingness to connect. So again, we're going to give you an opportunity to share maybe something you learned or something that you just imagined today. Or maybe you've already been using several of these principles to get yourself or to get your employees through different challenges. So who wants to share first? Who wants to share first? Oh, right there. What's your name? Hi. My name is Laura. I'm a modern American. I'm from Australia. I'm a motivational speaker. I was invited to come over here and study in North America. I got involved with this because it was connected to a program that I ran. We were contracting for a mining company who wanted us to take care of people, employees and people with disabilities, even bisexuals or sexual harassment in the workplace. They introduced me to trauma-reportable care. And as a practitioner, I found this to be, to me, like life-changing. And now there's a really good way of being able to structure my consultation in a new way, encourage my professionals to also go through trauma-reportable care education. And I actually use my time as an emphasis builder there to structure the content within my consultations. So everything seems to flow together. How do we go about that? Thank you so much for sharing. I think one of the things we really, really want to emphasize that we probably didn't do earlier is what you said. A lot of times, especially if you're someone who is in charge of caring for others, you usually have to put your own self-care in the backseat, right? But we know, and we really found out the hard way, that if we don't put that oxygen mask on first, we might pass out before we get a chance to put it on the person next to us. And so I think one of the reasons I really love these principles is that it reminds you and gives you a way to also take care of yourself in the midst of being that hero for another person. And it helps you to preserve your mental health, your physical health, your emotional health so that you can continue to serve another day. Because what happens to us is we fight and we fight and we work and we work and we don't get a chance to take care of ourselves or to connect or to recharge. And this one reminds you that you have to recharge and you have to take care of yourself. And it's okay to not be okay, even if you are a health care hero. So I think it's a way for us really to get that sustainability back in our professions and to give us renewed vigor and energy. So thank you. Anybody else want to share? Last chance. Last chance. Okay. Thank you. Okay. So earlier we told you that we did some things. We put some programming in place. We did some initiatives. 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The matching occurred in a different department. And the very other strategic part of it with the buddy system is that we didn't guide so much the direction of how they interacted with each other. We allowed that to kind of evolve very naturally. So we found it to be very effective and fit really into that pillar of trauma-informed care, that peer support part of it, as well as the lifestyle, medicine, stress management, and connection piece. Of course, it was voluntary, but I think you had a pretty good turnout, and people used it, you know, almost in a sense to have someone that regularly checked in on them and also to share their struggles or to run things by each other and not feel so alone. There's just something about not feeling alone in something that really changes your experience of something, right? And COVID, right, was very isolating for a lot of us. And so this was a way to reintroduce some kind of connection, some kind of connection that we so desperately needed. And then from that psychological capital that we discussed earlier, they created, they took that acronym and created this play on words called Hero Building or Hero Building Campaign, and it really used this to tie all the different programming together. It was the theme throughout communications. There was always an emphasis on at least one of those concepts in the mental health and well-being workshops. There was these discussions or activities centered around each of these concepts, and it was just sort of the North Star that guided the interventions, always, you know, a way to home. Like, what are we doing, and does it come back to our real mission and vision, which is to increase trust and to support each other at the end of the day. And then there were some other, there were several other minor short-term or longer-term programs, such as working to optimize operations. Someone mentioned administrative burden, and the organization listened. People said, you know, we're just, we need to be able to focus on the patient care. And so they figured out ways. They interviewed people, went around and figured out, okay, where's the redundancy, what needs to be streamlined, and they literally cut the fat, and that made a difference. And then similarly, there were some people who made the experience hard for their coworkers, right? There's this saying that people don't quit the job, they quit the people at work. He's shaking his head. He knows exactly what I'm talking about, right? You can have the best job in the world, but if your supervisor is a terrible person, it makes that feel like, it makes you anxious. You don't want to come into work. It changes your whole experience of things. And similarly, if you are going through tough times at work, having supportive people, and especially a supportive supervisor, makes all the difference for you to be able to make it to the next day. So there was some discussions. Some people reported in that digital suggestion box that their supervisors were not very supportive. And there was some coaching done and some conversations and some resources and training. And, hey, some people felt that maybe it was better if they separated. And that's a reality. Sometimes, if you know anything about total worker health or the hierarchy of controls, you have to eliminate the hazards in the workplace, and they were hazardous. But it was for the best for the collective well-being of people. Sometimes you have to make tough decisions, too. It's not all cotton candy and kittens and rainbows. So this is what you came for. This is what you came for. So no more suspense. Let's talk about the seven ways to create a culture of caring in a traumatized world. So all of these experiences and all this discussion and all these frameworks and research, we've sort of distilled into these gems that you can take with you. If you remember anything else, I hope you take this with you. Number one, design. We're talking about designing for physical and psychological safety and also making sure that you have a supportive environment that starts from the top down and being intentional. Number two is protect, protect. So we're talking about addressing and mitigating psychosocial risks and hazards in the workplace. Number three, recognize. Recognize and understand and empathize with individual experiences and provide trauma-informed support. Number four is connect, connect. Build strong connections among team members, family members, community members, while also fostering wellness and inclusivity. Number five, appreciate, appreciate. Encourage healthy balance between work and personal life and make sure to show people that you value and appreciate them. Number six, empower, empower. Support employee autonomy and create opportunities for personal and professional growth. And finally, cultivate, cultivate. Nurture and foster health-promoting behaviors and an environment that embraces fun and creativity. Okay? Design, protect, recognize, connect. Appreciate, empower, and cultivate. Let me know if I'm missing one. So last but not least, you've heard so much. You've learned so much. We've talked about a lot. I want to know what is one strategy that you will implement or champion once you leave here. Just one, just one. Go ahead with the microphone. It could just be one word, just one word. You don't even have to explain. Yes, right here. Thank you. Thank you. That's awesome. He said that he would check in with his staff and ask, just ask, what can I do to support you better? Thank you for sharing. Anyone else? Back there. Hi, I'm Anna Novos at Banfield in Nashville, Tennessee. And at Banfield we have an initiative called Women in Medicine. So it's for women to help advocate for each other and be more visible on the path to promotion and things like that. And once I was on my way to the gym and there's this woman who does an amazing hip-hop dance class here. So I was able to bring her to campus and, you know, do some more grinding and figure out fittings, get the key, reserve the room. And, you know, we had a small turnout, but everyone had so much fun. And the purpose was connection. You know, just to save time for me to have these gastroenterologists dancing and nephrologists dancing, you know, just kind of having fun and not necessarily talking about work. And I was a little discouraged at the beginning of the activity because it was a small turnout, but at the end they expressed such, you know, enthusiasm and gratitude and they were like, we've got to make this happen again. So that has made me realize that, you know, when things start small, it doesn't happen overnight trying to build a connection, trying to build these programs. So I'm going to keep trying. Yes. And that's all you can do and that's all we ask. Thank you so much for sharing, Dr. Novus. That's awesome. So in the interest of time, we'll move on and close out so that people can have a chance to ask questions. But essentially, you know, connection is going to be a theme that comes up again and again and again and again. And just, again, remember to look out for each other and take care of yourself too. So I just want to leave you with this teaser. Maybe you've heard of this International Standard ISO 45003 that came out in 2021 that is related to occupational health and safety management because we are at an occupational and environmental health conference. And it addresses psychological health and safety at work and actually provides guidelines for managing psychosocial risk that is accessible online for a small fee or maybe you have access to it. But if you e-mail me, I can send you some white papers that I found online as well that different organizations have put out. They're sort of summary and understanding of it. But basically, it's the first global standard that gives employers and organizations practical guidance on how to manage psychosocial risk, at least the staff in the workplace. So if that's something that you're trying to deal with or implement now or in the future, this is probably a great place to start, okay? In addition to all the other things we mentioned, trauma-informed care or lifestyle medicine or positive psychology and psychological capital, this is just one more tangible concrete thing that you can take with you today when you walk out of this room. It also provides help in identifying conditions, circumstances, and workplace demands that could potentially impair psychological health. So there's a lot more conversation about mental health in the workplace, right? It's the big elephant in the room, but not really because I think we're a lot more comfortable now talking about it, and that's where it starts, with dialogue. But this actually gives you, it builds on what's covered in ISO 45001, which is designed to prevent work-related injury and illness and to provide safe and healthy workplaces. Psychological health is part of a safe and healthy workplace. And so this is a way to define psychologically healthy and safe workplaces as those that promote workers' psychological well-being and actively work to avoid harm to psychological health, including any negligent, reckless, or intentional ways. So if you're looking for a way to get leadership buy-in, to get your resources together, this might be a good framework to use to start that dialogue in your workplaces and organizations. So thank you so, so much. As we conclude this enlightening journey, I just want to say let us remember the power of cultivating a culture of caring, compassion, and connection. And by embracing the strategies that we've explored today, we can uplift one another and foster resilience during even the most challenging times. I want to thank you for your unwavering commitment to well-being of those around you and of yourself. I want to thank you for being so engaged with us and connecting with us. And as you move forward, I hope you continue to spread kindness and empathy and create a ripple effect to transform this place we call home and together continue to bring hope and optimism no matter where you go so that we can shape a better future for everybody. Thank you. Applause

cultivate

culture of caring

traumatized world

trauma-informed care

positive psychology

safe environment

psychosocial risks

empowering employees