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Nurse Educator Maggie Gould discusses trauma informed care, and how the hospital setting can effect children that have suffered from trauma and anxiety issues.

What is Trauma-Informed Care

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Melanie (Host): For many patients at the Portland Shriner's Hospital, the hospital experience is often very fun and positive. With departments like Child Life who offer activities and distraction tools, kids often leave the hospital with really good memories. However, for some patients who've experienced negative events throughout their childhood, being in a hospital setting can be overwhelming. Welcome to Healing Heroes PDX, the podcast series from the specialists at Shriners Hospitals for Children in Portland. I'm Melanie Cole and we're here today with Nurse Educator, Maggie Gould, who created a team at the Portland Shriner's Hospital, specifically designed to help kids cope with the hospital experience who may be bringing in a little anxiety from their life outside of the hospital.

Maggie, I'm so glad to have you with us today. Let's start simple. It can be overwhelming for kids in any hospital or medical setting, which is completely understandable. To begin, how does the hospital experience affect so many kids?

Maggie Gould (Guest): Well, first of all, thank you Melanie, for having me here today. It's a pleasure to be here with you. That's true. Yes. Hospitals can be a scary place for children, especially for those children who have had bad or painful hospital experiences in their past. You know, here at Shriners Portland, as you said, we work really hard to make the experience for our children and families that visit our hospital, comfortable and supportive and even fun. But the fact remains, that we are a hospital and we're performing invasive surgeries on kids. And recovering from surgery can be really tough and it can be painful. So we want to be aware of that every step of the way and do the very best that we can to keep them comfortable throughout their visits.

Melanie: Isn't that wonderful what you do for a living? So it sounds like the hospital experience can be especially hard on kids who've had adverse childhood events in their life. Tell the listeners, what do you mean by that? What exactly qualifies as an adverse childhood event?

Maggie Gould: Yeah. So adverse childhood experiences or ACEs as we sometimes refer to them, can be anything from abuse to loss of a parent or someone close to you know through death, incarceration or divorce, being placed in foster care would be an adverse childhood experience for a child, household dysfunction, such as substance use disorders or alcoholism, mental illness in the immediate family and in the home, also events outside of the home like bullying or being the target of racism or witnessing community violence on a regular basis and in your neighborhood or community. Those can all be really traumatic for children as they grow. So these types of experiences, especially for children with developing brains can actually affect a child's neural pathway, in ways that change the way that they perceive the outside world. They may see the world as much more dangerous, scary, or unsafe than a child who has not had these experiences. And we know that ACEs and childhood trauma can affect our physiological health through our lifespan as well. Emotional trauma has the potential to negatively impact a person's physical, mental, emotional, and spiritual wellbeing.

Melanie: How do you know Maggie? How would a child's care provider know if they've experienced this? Are there certain symptoms or ways that they act that are different than a child that hasn't experienced these adverse events?

Maggie Gould: That's a great question, Melanie. That's a really good question. And you know, it can be tricky. All children are different. So they all behave and react a little bit differently. But once a child has experienced a trauma in their life, things that we typically may see are that that child becomes dysregulated quicker than a child that hasn't had those kinds of experiences. Sometimes they'll become hypervigilant or they'll act out in defiant ways. They often have problems with executive function and may need to have more control in a situation than a child that can just go with the flow, because they've had that trust built.

Some of these children have a real difficult time trusting adults in their life. And they can also be really withdrawn. We see that as well. Some children, if they've been traumatized in their life can just sort of shut down on us and not be able to communicate the way that they would when they're at their baseline and they're not fearful.

Melanie: Just heartbreaking. So in response to this, you created a designated team at the Portland Shriner's Hospital called the TEDI Team. Tell us Maggie about this group and what does TEDI stand for? It sounds like Teddy bear, but I'm sure that's not what you meant. Tell us what TEDI is and how it's helping these kids.

Maggie Gould: Yeah, well, actually thank you for asking. I'm really proud of our TEDI team here at Portland. The TEDI team is, well actually, you know, our, mascot for Shriners is a cute little Teddy bear named Fuzzy. So it worked out just perfect for us, but we're spelling it T -E- D- I. It's an acronym for trauma informed evidence-based driven by research and inspired. The TEDI team consists of medical staff, nursing staff, rehab, and PT staff that are educated on neuroscience of trauma, and that are experts at delivering trauma informed care.

Melanie: Wow. That's very comprehensive. So what is trauma informed care? What does that really actually look like?

Maggie Gould: Yeah. So trauma informed care is patient-centered care. We seek to place a patient's present needs, choices and actions within the context of any history of trauma that they may have. It's important to remember that trauma does not define any person or child, but we recognize that those past traumatic experiences can inform their future decisions and actions. A growing body of research illustrates that it's particularly true of trauma during rapid brain development of childhood and adolescence.

So we work to understand the patient's history and then we can better understand the reasons behind their responses, choices, and behavior. This allows us to foster and promote decisions and actions with helpful outcomes. We seek to avoid retraumatization and we promote the patient's future physical, mental, and emotional health. Resilience is a big part of what we do too Melanie. We don't want to just focus on the trauma, but we're really, turning our focus towards helping these kids learn coping mechanisms and helping them to be able to function in their day-to-day lives in a happy, healthy way.

Melanie: That's really lovely what you do. So the goal, the overall goal of the TEDI team, as you've been telling us, is really to help these children. What's the outcome you're hoping for? And what have you seen as a result of this team that you designated.

Maggie Gould: Great question. We're hoping to ensure that this special population of children receive the extra attention to safety, transparency, and compassion that they need, to decrease the stress while they're here with us in the hospital. We recognize that each child is unique and children who have experienced trauma often need a different approach from their caregivers to feel safe in the hospital. So we're looking to make sure that every staff member here at Shriner's Hospital, Portland, is able to recognize signs and symptoms of trauma and respond to those signs and symptoms in a way that avoids retraumatization and that builds resiliency and promotes healing in our kids.

Melanie: Sounds to me like the TEDI team has advanced that level of care, really taken it to the next level that's provided to kids at the Portland Shriners Hospital. Do you have plans Maggie on expanding this group even more?

Maggie Gould: Oh, I do. We have 22 Shriners hospitals and it would be my wish, and it's the holiday time, right? So it's a good time for wishes. My wish that we would have a TEDI team in each of our 22 facilities. We have facilities across the United States, in Mexico and Canada, and I would just love to see in the near future, a TEDI team in each one of these wonderful Shriners hospitals.

Melanie: I absolutely would as well. Thank you so much, Maggie for joining us today and telling us really about this amazing initiative that you've started at the Portland Shriner's Hospital. I can hear the compassion in your voice and thank you so much for all the great work that you're doing.

And that concludes this episode of Healing Heroes, PDX with Shriners Hospitals for Children in Portland. You can visit us online for more information, and to get connected with one of our providers.

Please remember to subscribe, rate and review this podcast and all the other Shriners Hospitals for Children in Portland podcasts. I'm Melanie Cole.

About The Speakers

Maggie Gould, MSN, RN, CPN

Maggie Gould has been a Registered Nurse in the Portland area for 22 years. She has worked in emergency, public health, early childhood services, and pediatric acute care settings. Maggie is passionate about providing therapeutic nursing care to children who have experienced childhood trauma and has provided training on the topic across Oregon. In 2017, Maggie created the TEDI Team, a group of nursing, rehabilitation, and medical professionals with experience in providing Trauma Informed Care (TIC) and tasked with the implementation of TIC at Shriners Children's Portland.

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