Healing Horizons: Weekly News & Research - April 18th, 2024
The latest news in trauma-informed care, positive and adverse childhood experiences, and psychological safety hosted by Bri Twombly and Alison Cebulla.
Here are the news stories and research we featured:
Innovative program focuses on homeless trauma: VA Boston homeless programs offers a trauma-informed care approach
https://news.va.gov/130313/innovative-program-focuses-on-homeless-trauma/
“a unique program at Boston VA (veterans affairs) is using the foundation of trauma-informed care to better assist Veterans experiencing homelessness.”
Canada's Top Fertility Specialists Introduce Groundbreaking Trauma-Informed Fertility Care Program
https://ktla.com/business/press-releases/ein-presswire/697100858/canadas-top-fertility-specialists-introduce-groundbreaking-trauma-informed-fertility-care-program/
“TRIO Fertility, renowned as a Canadian leader in advanced fertility treatment, proudly announces the launch of its innovative Trauma-Informed Fertility Care (TIFC) program. This program revolutionizes fertility care by integrating a compassionate and personalized approach to address the emotional complexities of trauma.”
New trauma recovery center opens in Brooklyn (BRI)
https://council.nyc.gov/press/2024/04/17/2592/
Trauma recovery centers are designed to reach survivors of violent crime who have less access to traditional victim services and are less likely to engage in mainstream mental health or social services. They provide wraparound services and coordinated care, including mental health, physical health, and legal services, by utilizing multi-disciplinary staff that can include psychiatrists, psychologists, social workers, and outreach workers focused on providing survivor-centered healing and removing barriers to care.
Childhood trauma can cause muscle decline in adult life
https://www.earth.com/news/childhood-trauma-can-cause-muscle-decline-adult-life/
https://news.umich.edu/how-trauma-gets-under-the-skin/
“A University of Michigan study has shown that traumatic experiences during childhood may literally get “under the skin” later in life, impairing the muscle function of people as they age. People who experienced greater childhood adversity, reporting one or more adverse events, had poorer muscle metabolism later in life.”
How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05752-w
“Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. The analysis found that both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16–17.”
Boeing whistleblower tells Congress his boss threatened him after speaking up in meeting
https://sg.news.yahoo.com/boeing-whistleblower-testifies-congress-claiming-134146767.html
“A Boeing whistleblower testified before Congress on Wednesday after claiming one of their models, the 787 Dreamliner, is unsafe to operate. Sam Salehpour, a quality engineer for the company, told a US Senate subcommittee that his boss threatened him after he voiced concerns. ‘My boss said, ‘I would have killed someone who said what you said in the meeting,’’ Mr Salehpour testified. ‘This is not safety culture when you get threatened by bringing issues of safety concerns.’”
Speaking Up and Taking Action: Psychological Safety and Joint Problem-Solving Orientation in Safety Improvement
https://www.mdpi.com/2227-9032/12/8/812
“Healthcare organizations face stubborn challenges in ensuring patient safety and mitigating clinician turnover. This paper aims to advance theory and research on patient safety by elucidating how the role of psychological safety in patient safety can be enhanced with joint problem-solving orientation (JPS). Studies in other high-pressure environments have shown that improvement efforts tend to be centralized and hierarchical rather than collective and democratic [53,54,55]. This can be an efficient approach to improvement, drawing on the benefits of hierarchical coordination in organizations. However, our measure of psychological safety also points to risks in this approach—specifically, across the items comprising psychological safety, we noted that only half of the respondents reported feeling comfortable to question decisions and actions of those with more authority, a proportion markedly lower than the other items in the psychological safety measure.”
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Audio Transcript:
Alison Cebulla 0:04
Okay, we're gonna go live here. As soon as it connects, it doesn't give a good countdown so
all right. We are trying out a new thing today. So just thank you for your patience. Where we are. Okay, cool. We are going through zoom through restream and then to LinkedIn and YouTube Live. So we are, we are getting very fancy. But it looks like everything is is happening. So, okay, welcome to healing horizons. And each week we share the latest news and research and trauma informed care, positive and adverse childhood experiences and psychological safety. I'm Alison Cebulla.
Bri Twombly 1:06
And I am Bri Twombly. And we are both at 10 Collective, where we are really trying to create a world where we genuinely care for one another.
Where those relationships are genuine, we care we respect for the other person. And we really want you to consider hiring us here to help kind of walk along with you on your journey, implementing trauma informed care, as well as psychological safety, within kind of your programming within your policies, your procedures, your hiring, onboarding, just thinking about all the different ways that you care for your employees, as well as the different communities and families that you're serving and partnering with?
Alison Cebulla 1:53
Yes, so you can hire us. So feel free to reach out, send us a message, visit our website tend dash collective.com. So let's get into the news. Today is Thursday, April 18 2024. We will be addressing things that involve trauma and sometimes violence. So the first piece in trauma informed care. And by the way, I really we really like highlighting different interventions related to these topics, to help people who are tuning into this segment to see different interventions that you could maybe think about implementing. We also offer commentary on maybe like, what we might want to do differently, given our expertise in designing and evaluating interventions that are trauma informed or address adverse childhood experiences or toxic stress. So we really like highlighting these interventions. And let's yeah, let's get into it. So the first one I have is a innovative program focuses on homeless trauma, the VA, Boston homeless programs offers a trauma informed care approach. By the way, you can go to our website, after this livestream to get a list of the articles that we are referencing. So this is a unique program at Boston, VA. And I want to clarify, because I'm like, there's so many acronyms, you can't just assume that everyone knows what VA stands for Veterans Affairs. And so at Boston Veterans Affairs is using the foundation of trauma informed care to better assist veterans experiencing homelessness, spearheaded by Karen Guthrie, co coordinator and supervisor of hatch which stands for care coordination, advocacy, treatment and connections to housing. These acronyms, the program hired staff who shared trauma informed care values, and were committed to learning and practicing the model. And they're they work together as a team to develop a mission and to apply the SAMSA, which stands for Substance Abuse and Mental Health Services Administration, trauma informed care principles, and we've talked about these principles a lot. This is the foundation of a lot of trauma informed care, and these are safety, trust and transparency, peer support, collaboration and mutuality, empowerment, voice and choice and cultural, historical and gender issues. So this program is utilizing these principles. To help team members look past symptoms of trauma labels and diagnoses, to explore why people are behaving in the way that they do. You and making sure that they're empowering the people that they serve and not re traumatizing them. And so yeah, I guess I would be curious to hear other specifics. But it's always nice to know that programs that are serving really vulnerable populations are taking the time to really understand the trauma informed principles, I think that's such a great first step is to just train the whole staff to know. Now, of course, ideally, we would want to go upstream and think about, well, how can we prevent homelessness? Or, you know, why are veterans such a vulnerable population with a propensity for experiencing homelessness, that's, you know, we'd really like to see upstream solutions, but you can't have any upstream solutions if your staff doesn't even know what trauma informed care is. So, you know, it sounds like they got this really passionate person who is dedicated to integrating trauma informed care at every level, they've been training the staff, they're looking at read, not re traumatizing the people they serve. So this is such a great start. What was interesting to me is the fact that the field of trauma science comes out of, of research on veterans, so the entire field is based on veterans experiencing Post Traumatic Stress Disorder, shell shock. And, you know, coming into the doctor's office having these symptoms noticed, and over time the PTSD diagnosis was created, I believe that the Body Keeps the Score tells like a really nice, succinct history of how this this came to be a diagnosis Bessel Vander Kolk book, highly recommend, but it's just interesting to see this being labeled as innovative. Whereas, you know, those of us in the field know that actually, rather than being innovative, the entire field comes out of veteran care. So, um, you know, trauma informed care really should be standard for anyone involved in military combat. And I, and I often see that it is I often do see trauma informed care initiative happening at VA hospitals and psychiatric centers. We hear about that a lot. So, um, so but good to know that this is happening in Boston. Any comments for?
Bri Twombly 7:44
I think, I think one of the other things that was powerful about this is that they were really trying to move away from kind of labeling or categorizing people, which then be re traumatizing. Because it takes away power and right, like one experience or one part of us maybe or our like, current experience, doesn't define who we are. Being unhoused may not be how we define ourselves into go in and say, Here's the box that we're in, like, that's the box we have to check. That may not be who I who I am, and that doesn't give me the power in the situation. So I really liked kind of the commentary that the article had around that as well. Yeah,
Alison Cebulla 8:28
great. Okay, the next trauma informed care program that we're highlighting is, Canada's top Fertility Specialists introduce groundbreaking trauma informed fertility care program. So this was an article that came out March 19 2024. And so trio fertility renowned as the Canadian leader in advanced fertility treatment, proudly announces the launch of its innovative trauma informed fertility care program. This program revolutionizes fertility care by integrating a compassionate and personalized approach to address the emotional complexities of trauma. Trauma, with its profound and lasting impact on individuals necessitates specialized attention and fertility care trios program is dedicated to prioritizing a supportive environment that understands, acknowledges and responds to the aspects of the fertility journey that may trigger past traumatic experiences of patients. And one of the people from that Clinic says we understand the importance of providing holistic care that addresses not only the physical aspects of fertility, but also the emotional well being of our patients. So this was something that I saw that I thought, You know what, that's perfect. That is the essence of what trauma informed care is supposed to do. You know, sometimes we report on on these interventions and we go that's that's an interesting take on carbon from care wonder how they how they made that translation, but this is really the heart And it really can be this simple of just again, you know, understanding, acknowledging and responding to the fact that past traumatic experiences may be triggered, when it comes to fertility issues is, and applying it to the specific sector is is exactly what trauma informed care should, should do, quite simply, just understanding that people may have past wounds, traumas, things that get triggered understanding what's happening in the brain and body, understanding the types of situations and events that may trigger something like this. And just being like, hey, we totally get it. And we're gonna respond in a way that acknowledges that this is real and exists. So this is a simple one. And it's really, it's really just perfect to just hold space for the whole breadth of emotional experiences. So yeah, that's sounds like a great, a great, a great way to offer care.
Bri Twombly 10:57
Yeah, I really love that one, too, just holding all of that in mind. And I think when you're the kind of professional within that setting, sometimes, and you're seeing the same things, or hearing the same things like we can kind of become that maybe like numb to that, like trauma, like, it's just that that is what happens. And so to really continue to like be present and to honor that space and stay in a space of like distance this person's experience into actually is traumatic, just because we are seeing, and it seems very common to us, and maybe we become numb or taking our own, protect ourselves. And that work. Yeah, to being able to kind of honor that space and create those healing and supportive spaces is really awesome. Yeah, there is also a new Trauma Recovery Center, which this is something that I want to just look into and learn more about these. Because in reading this article about this one that's opening in Brooklyn, there are ones in various different locations across the United States. And so I really want to learn more about them the different models that they use, and lots of things, but we just wanted to highlight one that is just recently opened in Brooklyn. And trauma recovery centers are really designed to reach survivors of violent crime, who have less access to traditional victim services, and that are also less likely to engage in mainstream mental health or social services. And there can be many reasons why there can be those barriers in place to kind of engaging. One of the things that I really like is they provide wraparound services, and they help to coordinate care. So for things like mental health, physical health, legal services, they bring together a multidisciplinary team to be able to support and I love that there's that wraparound is thinking about what are all of the different services, who are all of the different people that a victim may interact with? And how can we help to reduce those barriers to accessing them reduce those kinds of communication barriers and those interaction barriers between people and really creating that kind of wraparound team, or community for that. So I just I really,
Alison Cebulla 13:20
really liked to see.
Bri Twombly 13:24
When they saw the word wraparound and read more about it, I was like, yes, yes. And so they really can help to stop cycles of violence. So things like gun violence, domestic violence, sexual assault, human human trafficking, as well as the hate crimes. Like I said, I learned that they've actually been around since 2001. At the University of California, San Francisco, that's where they kind of first started. And because they've been around since 2001, there's actual research out there, that's showing how they can be really effective. So they improve public safety, because they helped interrupt cycles of violence, and to increase participation in the legal process. They've also been shown to reduce symptoms of PTSD and depression, they have increased the rate of attending follow up services for sexual assault survivors. And just from a financial standpoint, they cost around like 34%, less than typical kind of fee for service care. So lots of benefits from these trauma resource centers that we've been kind of seeing already. And they're really again, just trying to remove those barriers to care. So people, and especially people of color, can access culturally competent trauma informed evidence based mental health care. And so one of the things that I'm curious about and want to learn more about is when they're talking about kind of evidence based care and the models that they're using. What are those because evidence based, has that evidence behind it of it. It works and it's simple. In to look at and ask critical questions like, Who were the participants in the study? Who were the researchers, especially thinking about race and gender? What does actually generalizable to the entire population, and thinking that there are a lot of cultural healing practices that may not be evidence based? Because they're just by white people, they don't receive funding to kind of make them evidence based? So are those being considered and utilized as well? So I'm really curious about that. And it's just some homework, I guess, that I have for myself to learn more, we
Alison Cebulla 15:38
know how tricky that is, though, about because, you know, then working at a place that doesn't, that you know, that there can be places that just absolutely make up interventions that are not culturally based and not evidence based. Like they're just, you know, and so, evidence base is like supposed to ensure that someone has decided this is a good idea. But then, of course, then there's all so many limitations with evidence base, because which populations are excluded when we've you know, studied and decided what works well, and you know, who's who's excluded from being studied? Who's excluded from being the researcher, and then, of course, all the different biases. So it's, it's so tricky, but then it's like, a lot of harm can be a lot of harm can be done out there when things are not evidence based.
Bri Twombly 16:30
Yeah, yeah. It's a really, it's a really interesting thing that I know there are continuing to be more conversations around. How are populations determined for research studies? Who are the researchers? How are we kind of thinking about in addressing potential, like bias or harm from the beginning of research studies, and it's a really important thing that needs to happen. That hasn't happened and a lot of prior research. So having that critical lens, looking at evidence based, is really important. As well as if you're thinking about interrupt interventions. Are you talking to the families? Are you talking to the people that are coming in? How is their voice being centered, talking about interventions when you're choosing interventions, when we're doing programming, we should never be making decisions without the family's voice being centered within that. So yeah, holding that in mind, too. I want to then highlight two different kind of peer reviewed studies that have been put out, kind of within the last two months, related to aces. And I excited about both of these studies, they kind of just reinforced things that has already been shown in the research. But by reinforcing it really gives us that like, Okay, here's the things for us to do to try to be preventative to try to have those interventions that can be really supportive. So one is a study out of the University of Michigan. And that has shown that traumatic experiences during childhood may literally get under our skin, later in life, because it can end up impairing the muscle function of people as they age. So this study was published in the March 2024 edition of science advances. And they use data from the study of muscle mobility and aging, and that had 879 participants. 59% are women, the mean age was 76.3 years and 86%. self reported as white. So again, when we're looking at these studies, who who participated in this study, so this had higher female, it was predominantly white studies, so important things to kind of hold in mind and look at critically, as we're kind of looking through the roof. So the study really examined the function of skeletal muscle of older adults. And then they paired that with surveys of adverse events that they had experienced in childhood. This study didn't use all of the adverse childhood experiences or ACEs questionnaire, they kind of used six questions from that, which I thought was interesting. And I'm really curious kind of about that. They also didn't include anything that kind of wasn't through kind of like interpersonal trauma. So thinking about like community violence or racism, those weren't looked at as kind of adverse experiences within that, so can just being kind of curious about which ones were chosen, which ones were excluded for this study. And what they found is that people who experience greater childhood adversity, so reporting one or more adverse events had poor muscle metabolism later in life. So this is really critical because it means that the mitochondrial functioning is as technical as Going to get in this one has, um, which can end up leading to different chronic conditions as well as disability limitations across the lifespan. So it's really changing what's going on within kind of the mitochondrial functioning within the body. And so I thought this was really interesting, because it's just showing another way that trauma can actually alter and change what's going on within our bodies. For me, it's really saying like, how are interventions supporting Healing Within our brains and our bodies on not just seeing but like, what are we doing to repair our stress response system. And again, there's things that we can do on an individual level or in partnership with others to help us to support kind of healing our stress response system, and then also thinking about what are those systems? What are those policies that are in place that are contributing to that stress? And how are we changing those, again, to promote healing instead of causing trauma, or kind of activating people's kind of trauma response systems again, and then the last study that I want to share today is out of Australia. And it was looking at how much do adverse childhood experiences contribute to adolescent anxiety and depressive symptoms. So this was just published this month and the BMC psychiatric journal. And it really had two goals, the study to examine the association between aces and elevated anxiety and depressive symptoms and adolescence, and then to estimate the burden of anxiety and depressive symptoms that are true to a true attribute level two aces. Sometimes it's I feel like when I'm when I'm doing my ace interface, and I'm talking about epidemiology and epidemiologists, then it's time Yes. And so in this study, they had 3089 children again, in Australia, who they followed between, they called waves one which the children were ages four to five during that time, and then wave seven in which children were 16 to 17. During that this was part of the Longitudinal Study of Australian Children, and 51% of respondents identified as male. I couldn't within this study find any kind of racial or ethnic breakdown of participants. But what they found in their study is that before the age of 18 68.8% of the children had experienced two or more ACEs, and it found that both history so kind of historical exposure as well as current exposure to bullying, victimization, and parental psychological distress, were associated with a significantly with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at ages 16 to 17. Overall, they found that 47% of anxiety symptoms and 21% of depressive symptoms were attributable to a history of being of bullying, victimization, and 17% of anxiety and 50% of depressive symptoms at ages 16 to 17. were related to parental psychological distress distress, experienced between the ages of four and 15. So these findings are really kind of demonstrating that interventions to reduce exposure to aces, especially the parental psychological distress and bullying victimization, can help to reduce anxiety and depressive symptoms in adolescence.
Alison Cebulla 23:55
You Yeah, I wanted to say, you know, when you when those of us who work in this field often come here for, you know, personal reasons, whether we were impacted by trauma or not had someone close to us who maybe struggled with a severe mental illness. What we kind of find out on our healing journeys and through reading, you know, some of the really wonderful literature out there such as that by Bessel, Vander Kolk, or Gabor Ma Tei, or Bruce Perry, is that it's that is often not the thing itself, like say, in this example, the bullying, but it is that lack of attunement by the parent. So it's the parent missing the fact that their child is in distress. So let's say and, you know, I'm not exactly sure by what context they were looking at bullying, but let's say let's say a child goes to school, and experiences bullying at school, then they come home and they're really distressed. But as the study says, they're their parents also has some psychological distress going on. They don't even notice what's happening for the child. That's the trauma What is it doesn't Cabramatta have a thing where he says it's not the it's not the trauma, it's the lack of what is what is the quote. But it's not what happens to you, but it's what?
Bri Twombly 25:15
I can't remember.
Alison Cebulla 25:18
I'm recovering from a cold. And so my it's just things are not firing at the speed. But oh, it's it's what happens within the absence of an empathetic witness?
Bri Twombly 25:28
Yes.
Alison Cebulla 25:32
Oh, we got there. The absence of the empathetic witness, is, I think the key part here because you know, humans are so resilient and strong. And, but we need someone to notice how we're doing as as children, and of course, as adults as well. But we, someone needs to care how we're doing. And so if that is missing, that is going to be I, you know, based on what I have come to know and understand about trauma, the thing that really solidify some of the long lasting negative impacts.
Bri Twombly 26:14
Yeah, I think, to your point, Allison, there's been research over the last few years related to positive childhood experiences and protective factors. And a big one of those is relationships and the power of having relationships with caring, safe, stable, kind of adults within the child's life. So right, that adult that can be attuned to them, that adult that is asking them questions that is helping them to feel special to feel valued, to feel cared for. And we want that to be happening at that relational level. And then again, I think there's the systemic things to think about what is happening within kind of our communities or environments, that makes it so a parent maybe can't parent in the way that they would like to, or can't be as present as they would like to, because they're trying to earn enough money to be able to pay their bills. As if the hours that they work, they can't access mental health care. There's so many systemic barriers there. And what would happen if all people were earning a living wage, they didn't have to worry about that financial stress, would they then be able to be more present and be the parent that they wanted to be with their child to have kind of that bond, and to really strengthen that kind of protective factor for their child? So I think there's that individual relationship piece, and then also of that systemic piece that we have to look at, how do we change systems, so we can be preventative rather than continuing to have to provide intervention and treatment to people because things are always happening.
Alison Cebulla 28:01
100% And then I just want to respond to Carrie, thank you so much for following along and offering comments on on LinkedIn. We kind of can't respond in the chat, based on the platforms that we're using. I hope we figure that out at some point. But I'm just validating the kind of the neglect piece being so harmful. So thank you. So psychological safety. Yeah, I have a little a little bit of a doozy that I want to address when it comes to employee psychological safety. I think that we have all been watching the Boeing whistleblower case happening before Congress. And I know that a lot of us, myself included have been really distressed about the original whistleblower John Barnet, who was going to testify in this case, and then was found dead in his car a few weeks ago at age 62. With you know, what seemed to be a self inflicted wound. So there is a new whistleblower, testifying in his place Sam Siler, poor, quality engineer for the company. And he told the US Senate subcommittee that his boss threatened him after he voiced his concerns about various bowing protocols going awry. Quote my boss said. Okay, and carry puts in the chat suicide? I think not. Yeah, then that's why this is a super scary case that I would love to hear us all continue to talk about as we work together to create psychologically safe work environments. Because this is this has an impact on all of our mental health when we see things like this happen and there's questions about whether some When you know they're live their life may be in danger if they bring up whistleblower concerns. So Sam Salah poor said, my boss said I would have killed someone who said, what you said in the meeting. This is not this is not safety culture when you get threatened by bringing issues of safety concerns. And so what we've covered in a past webinar about coercive control in the workplace is that oftentimes threats are made at work, even if they're not overt, they can be covert threats. And the implicit threat being if you don't do XY and Z, or if you bring up XY and Z, your job and your livelihood is at risk. And that tends to be the underlying piece two course of control in the workplace that makes it so psychologically unsafe is that people are afraid they will lose their job if they either speak up or don't do exactly what they're told, even if that violates their moral beliefs. So I'm watching this case and hearing that, you know, these types of even though it wasn't a direct threat, but saying I would have killed someone who said what you said in the meeting. This is, of course, really, this is a really scary thing to hear. And the thing about the Boeing planes is that these are having real consequences for users of, of Boeing flights. So you know, most notably, the door plug fell off the Alaska airline, Boeing 737 Max aircraft, at an altitude of 16,000 feet in January, we all saw that. And then we've continued to see various accidents happen since then, we've been watching with horror. So this is having a real safety impact on a large population of people in the United States, or anyone flying in a Boeing aircraft. A preliminary investigation revealed that that door that popped off was missing four bolts. And that it you know, we've come to find out, there just hasn't been a culture where employees felt safe to say, Hey, I think we need to slow down and think about this. So yeah, let's keep let's keep following this, I hope that this whistleblower, continues to be safe to speak out. And of course, we know that that CEO of Boeing has stepped down. And so hopefully they can, they can turn this around and create a psychologically safe culture. And hopefully, because we're all watching, this can be a great example of holding a company accountable so that we all can feel empowered to create psychologically safe work cultures, wherever we work. That one is, yeah, that's, you know, such a big story right now in psychological safety. And it's a lot. It's a lot to take in. Yeah. So lastly, this is our last piece for today on psychological safety. And this one is this, this one's from the journal healthcare from April 2024. And again, all of these links will be on our website for this episode. So you know, if you want to follow up and read any of this stuff on your own, go to our website, we'll typically have it up within 24 hours. So this one is speaking up and taking action, psychological safety and joint problem solving orientation in safety improvement. And this one is so jargony. Um, I think this is I think this is the one that is Yeah, Harvard Business School. And Harvard Chan School of Public Health is where this came out of, and I shake my fist at how jargony this piece is because I just don't think it needs to be it could be written in a way that's a little more friendly to the layperson, but let's try and get through it. So healthcare organizations face stubborn challenges in ensuring patient safety and mitigating clinician turnover. This paper aims to advance theory and research on patient safety by elucidating, how the role of psychological safety in patient safety can be enhanced with joint problem solving orientation. So I was like, What the heck is joint problem solving orientation? And this is actually something you know, I worked as a one on one health coach for a number of years, five, six years. And we would often say in the coaching world that a person is going to have more self efficacy want to tackle the problem if they come up with a solution on their own. So joint Problem Solving orientation seems to be just that, if you are working together with your patient to come up with a solution, they are going to be more likely to implement it as opposed to a top down authoritarian style approach to, to health solutions. So that seems to be from my understanding what this article is saying. So I'll go on to share that. Studies and other high pressure environments have shown that improvement efforts tend to be centralized and hierarchical, rather than collective and democratic, this can be an efficient approach to improvement, right, obviously, just telling everybody what to do. See, you don't have to decide and discuss and agree as much. So it can be it could save time, sometimes sometimes that might be the right approach. However, our measure of psychological safety also points to risks in his approach, specifically across the items comprising psychological safety. So what they're saying is that patients may actually feel more safe and comfortable having that joint solution being a part of their own care. So, and this, you know, this really does go in line with things that we have done webinars on, which is that authoritarian style, or hierarchical style interventions in which you have someone at the top telling everyone else what to do, they just don't make people feel safe. And so what this is also saying is, is that this could decrease patient safety, probably also some certain patient outcomes, and potentially increase clinician turnover as well. Because what you're going to have and you know, Bree did a thing on parallel process is that if you have a hierarchical control and organizational control from the top, that parallel process is also happening between the clinician and their patient. So. So if they're saying, you know, if you're going to have a more democratic style approach to giving care, you probably are going to want to also have that mirrored in the way that you take care of your employees, thereby reducing clinician turnover. That's my interpretation. Is that fair? Barry? Yeah,
Bri Twombly 37:19
yeah, I really think that that is a really fair interpretation of you need, you need people at each level, to have that sense of safety, to be able to have that democratic process to be able to ask questions to bring up concerns. And if that's lacking from the top down, that there often isn't going to be that space for those things to happen within that kind of, kind of client provider relationship as well.
Alison Cebulla 37:49
Yeah, absolutely. And so to wrap up, let's see, our study emphasizes the importance of the interpersonal aspects of a safety climate and enhancing patient and clinical outcomes in health care. And so this does really can confirm, you know, work that we've, we've done here at 10. Collective as consultants, you know, I worked with nursing students in one consulting program that we've done, and just learned that interpersonal communication is not something that's part of the curriculum, necessarily, when it comes to being a clinician. And this can often be one of the most impactful ways to make a difference in someone's life is to really enhance your ability to communicate. You know, what I was hearing from nursing students was like, these are really hard conversations, to have this. These are really personal issues, different health care concerns can be really sensitive, really personal, they can potentially be life or death. And yet, clinicians are not necessarily trained on how to talk about these things in a way that makes everyone feel safe. And so there is a real opportunity here to offer what we've traditionally called soft skills, which of course I hate it because it really should be the core, the foundational skills, of how we relate to each other and how, how we can make people feel safe or unsafe based on how we're able to communicate with them. So hey, bring on bring on Tim Collective, we will help you with this, we can help your, your healthcare setting with with all of these things, this is what we were founded to do. So that that's it for today. Wow. We had that was some good ones. And so we will see you again next week, same day, same time to go over the trauma informed care, positive and adverse childhood experiences and psychological safety news. If you see anything you want us to cover, send it our way. And we so appreciate you joining us here
Bri Twombly 39:59
Thanks for tuning in everyone
Transcribed by https://otter.ai
