I grew up in a stable household. My parents are still married to this day. Food insecurity never even crossed my mind as I opened our fridge and pantry each day. There was never a time that I feared that I would be abused (physically, mentally or emotionally), nor did I witness abuse happen to the meaningful adults in my life. A lot of these things I took for granted, until I went on a mission trip to inner city Denver at the end of high school. I can remember standing on a corner watching people line up on one corner for shelter and across the way for a warm meal. I decided on that street corner that I wanted to spend my life investing in others. I began to realize what I had considered “normal” was not the case for many. So I began my schooling and eventually a career in the non-profit sector.
Along the way a study came out relating childhood experiences to health outcomes. Commonly known as ACES (Adverse Childhood Experiences), the study found that people with a higher ACE score were more likely to have chronic health conditions such as heart disease, diabetes, lung cancer, depression and autoimmune diseases. These individuals were also more likely to have social and emotional issues as well. The study looked at 10 aspects of childhood trauma including substance use, divorce, being abused, observing abuse, having basic needs met, mental health and if a family member was in prison.
But the study did not stop there. Researchers also looked at resiliency. If an individual has a higher ACE score, it does not mean that they are destined to struggle in life emotionally and with poor health. Individuals who had others pouring into their lives, encouraging them, caring for them and showing them how to achieve independence had better outcomes. In some cases, a person’s resiliency factor may come from a dedicated professional, but many times these are non-professionals who just take time from their own lives to show care and compassion. A neighbor, an extended family member, a mentor at church, etc. can all have a huge impact on an individual by inspiring hope for a bright future.
More and more is being learned all the time about trauma and its impact on brain development. This is especially key during childhood trauma when the brain is developing at a very fast rate. Through research on ACES, the term “informed trauma care” has become popular vernacular for those working with a high-risk population. When a person behaves in a way that seems unconventional, instead of asking “What’s wrong with you?” we are now asking “What happened to you?” This does not change our goals of helping those recovering from trauma to experience a full and healthy life, but it does help us to keep in context why certain “normal” behaviors may be things they have to consciously learn. For example, my dad works in the insurance industry. I grew up learning about the importance of having quality coverage. Recently I had one gentleman in my office. He had an injury and then wanted to buy a disability policy. When I explained that you have to have previously purchased the coverage before the accident to get a payout, he looked at me blankly. I went on to explain more about how insurance works and why you have to have it in advance. His response was, “Did you go to college?” I replied yes, and he asked if that is where I learned about insurance. I replied that my parents had taught me. That very night my husband hit a deer. He was ok, but the car wasn’t. Thankfully my parents had taught me about insurance and having savings set aside for the deductible, so it was a minor inconvenience instead of a financial crisis.
So what do ACES, trauma informed care and resiliency have to do with the way that I interact with our patients? Those factors do not mean that I compromise my standards or give up hope for the individuals we serve, just because they have trauma in their background. Quite the opposite actually. Those factors enable me to have more grace, patience and empathy for people. It means that I try to work with them to see that their past is an important part of who they are, but it does not have to dictate their future. It means that I celebrate what I call “inchstones.”
We’ve all celebrated with people major life milestones: marriage, parenthood, graduations, promotions at work. But along the way to that big milestone, there were lots of tiny accomplishments: inchstones. Some of the patients we work with have few support systems in their life. They come to His Hands for more than just medical care, they also want encouragement and prayer. We have the opportunity to celebrate with them the tiny accomplishments in order to keep them motivated to keep working towards those larger milestones. For example, we ask our patients to call in a request to refill prescriptions a week in advance. Some wait until the medication is completely out before they call, sometimes causing them to be without meds for a few days. So I would affirm a patient who called in just 2 days in advance of running out of pills before reminding them that we ask for a weeks notice. And throughout the conversation I would let them know that the policy is in place because of our limited clinic days, so that they don’t have to be without medication. That way the patient knows that I care about them and the heart behind the guideline is for their own health benefit.
Sometimes affirming inchstones can seem difficult. These small steps seem like things that we should already know…opening your mail regularly so that bills don’t get sent to collections, choosing to not sell drugs so that you can rebuild relationship with your children, making a phone call to know if your insurance is currently active or not. Again, all things I never consciously worked at. I have always opened my mail daily. I have never used an illegal substance and haven’t needed affirmation for that choice. I have my insurance card on me and know from my premium payments that it is active. These are all instances I have recently affirmed patients for here at the clinic-opening mail, staying clean and sober and calling Medicaid. If we are constantly only focused on the larger end goal, the patient can perceive it as we are missing the hard work they are presently doing and grow frustrated and quit. To them, if they put in all this effort and no one even notices, then what is the point?
When we take time to look at a person in the context of their entire life, it gives us a better picture of who they are. It gives us more patience and empathy. If you are like me, it gives you gratitude for a low ACE score and the blessings that you have taken for granted. And most importantly, it helps you to inspire HOPE that the person can have a bright future. We all take a while to accomplish big goals, so whether you have trauma in your past or not, don’t be so focused on the end result that you forget to celebrate the inchstones along the way. Those little experiences and accomplishments help to shape who we are!
Amy DeLay
Patient Advocate
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