Let’s Talk About CASA
Originally produced in conjunction with Child Abuse Awareness Month, this podcast is a multi-person panel in partnership with CASA (Court Appointed Special Advocates) to discuss the program and also the impact of mental health in children from traumatic situations. **Due to the more detailed nature of some of the discussion, we want to place a possible trigger warning here for readers or listeners who may have also experienced childhood trauma.
Note: Due to extra social distancing and masks being worn during recording for the safety of all parties, some audio may sound more muffled than normal.
In this special episode, Kate sits down with Cristy Horsley, Kassie Gada, and Kevin Birnbaum to discuss the importance of the work being done at CASA (Court Appointed Special Advocates) to address and assist with childhood trauma in our area. **Trigger warning: Some content may be difficult for certain listeners to hear if they've experienced their own childhood trauma.
Speaker 1:
Thanks for joining us for this episode of Center Scripts, where we talk health and wellness and practical tips for your everyday life and now, here’s your host, Kate Kolb.
Kate Kolb:
Thank you so much for joining us for this episode of Center Scripts. We are actually doing something a little different today, something we have not done before. We have a panel of people here with us today from CASA, actually here in the community. So I’ve got Cristy Horsley, Kassie Gada, and Kevin Birnbaum that have joined us today, and we’ve got a little bit of integration from both the center side of things and our community advocate side of things. So what I want to do is give you guys all an opportunity to introduce yourselves and just give a little bit of background on what CASA is. So Cristy, let me start with you, and we’ll just go kind of down the panel and do introductions, and then Cristy, if you want to tell us a little bit about CASA and what it is for the community.
Cristy Horsley:
Yeah, so my name is Cristy Horsley and I’m an advocate manager with CASA, which means I support volunteers who plug into the cases and the children that we serve. I’ve done that for, gosh, I keep losing track but I want to say it’s going to be seven years this summer and I was a volunteer myself for a year and a half prior to that. I grew up in the Lynchburg community, tons of connections to Central I was born at Virginia Baptist.
Cristy Horsley:
My first job out of high school was a secretary, a [huk 00:01:29] at Lynchburg General Hospital and I did that for six years as I work my way through college, and then I lived in overseas for a few years and then when I came back is actually when I became a CASA volunteer and plugged into this role. Even when I was living overseas, I remember seeing it online or something and thinking, “Okay, when I go back home, when I’m back in the States, that is something I want to do.” So I saw a sign shortly after returning, a yard sign and again signed up as a volunteer and did that before I came on staff.
Kate Kolb:
Cool. Well, Kassie, what about you?
Kassie Gada:
I’m Kassie Gada, and I have been a CASA volunteer for about five years, right at five years, and I am a nurse also at Centra. Our family moved here from Tucson 10 years ago, and I started out being a psych nurse on adult psych at Virginia Baptist Hospital and since then I am doing part time case management in all three inpatient psych units, and I’ve been doing that for most of the time we’ve been here. I think that’s it.
Kate Kolb:
That’s great. All right, Kevin.
Kevin Birnbaum:
Yeah. Thanks for having us. My name is Kevin Birnbaum, as you mentioned earlier, I’m the rookie in the room, I believe. I am a volunteer advocate, fresh and I guess about seven months-ish. Came out of the fall training program last year and just kind of dove right in. So these folks are great, it’s been great getting to know them. I also work with Centra, as you said, we’ve got some integration in the room, I work up at the medical group as a part of their administrative team. Then the CASA team has just been great to work with and obviously their mission is so paramount to this community.
Kate Kolb:
So Cristy, I want to bring it back to you for a minute. At the time of this recording, it is currently National Child Abuse Prevention Month, and that was one of the reasons that we wanted to get everybody together in the room and sit down and talk about this and talk a little bit about why CASA is such an important thing. So before we go any further if there are people listening, and they’re like, “I don’t know what CASA is.” Can you define that for us and let us know what the mission of that organization is?
Cristy Horsley:
Yeah, absolutely. So CASA stands for Court Appointed Special Advocate, and basically, we serve in cases of child abuse and neglect that are moving through the JND court system. There has to be an underlying case of abuse or neglect, we don’t serve custody cases, for example. So when there is childhood abuse or neglect, the judge appoints the CASA program, the case, and then we try and plug in a volunteer to serve the case, and when a volunteer is appointed to the case, they will visit the child monthly and their placement wherever they’re living to make sure that they’re safe, and really, their job is to act as a sponge and soak up everything that there is to know about that child’s world, and to absorb that information and give it back to the judge in the form of a court report so that the judge can make effective and safe decisions for the child as to where the child should live, or any services the family or the child might need.
Cristy Horsley:
If you think about it in very high stakes decisions, judges are making decisions about whether to return a child home to a place where previously they experienced abuse or neglect, but where the child still has very strong ties. The person in the room making those decisions, the judge is the one that knows the least about the case. So it is critical that they have good reliable information to make those decisions. So that’s part of what we do, and advocate for the child along the way in between court hearings.
Kate Kolb:
Now, Kassie and Kevin, you both have been through the advocate training, in your experience, how many cases have you advocated for in those five years? Do you even have a number that you can count?
Kassie Gada:
So I’d say that I’m maybe not typical in that I still, in general cases are intended to once a child is removed from the home to be done, a decision made in some sort of permanency placement accomplished at the period of 12 months, and there are different stages along the way that things are supposed to happen. I have one child that I’ve had since for five years from that initial case, he had siblings that were adopted, but I still have that one, I have another one that is a long term. So mine have been more long term. So I guess I’ve had eight children total, that I’ve been advocating for in that five years. But again, that is, I’d say, not typical.
Cristy Horsley:
But I think Kassie’s case, so eight children total, but also she has had one child for five years. I think that her examples, her advocacy really demonstrates the high touch advocacy that we want to deliver. So if you talk to any of the professionals that work on Kassie’s cases, she is there for that child. Not only is she seeing the child monthly in their placement as they’re supposed to, but also she has probably been the person that has independently reviewed the most medical records for the child before they came into care, that can continue to impact current functioning from previous abuse or neglect. Also, to the school checking in to make sure everything is needed there, we may have to participate in some educational advocacy to make sure the child’s placement or the services they’re getting at school are appropriate.
Cristy Horsley:
She’s been with them through every single placement that they’ve been. Again, a lot of our kids may need residential placement or switch foster homes, the social worker might change throughout the life of the case, the attorney may change, but Kassie has been the consistent person in the child’s life. She also has so many back pieces of the story. She has talked to family members, parents, again, she may hold more of the child’s story than anyone else in the world at this point.
Kate Kolb:
Well, that’s amazing. Kevin, I want to ask you too because you jokingly said that you were the rookie of the team in the room here today. What was behind your decision to become an advocate? Why was that important to you and what got you introduced to that program?
Kevin Birnbaum:
Sure. Yeah, no, certainly the rookie, like I said, seven months in and went through Cristy’s training program, and she’s absolutely great. So I want to give her a shout out just publicly here, because that training program certainly equipped us well to advocate for these children and do that effectively. But my calling, if you will, was personal experience, really. I had an advocate through just some events that transpired during my childhood and that advocate, I don’t want to say, I attribute a lot of good things in my life because of that advocate. But certainly, that person was there to speak for me when I didn’t have a voice in that courtroom.
Kevin Birnbaum:
So, personal experience really is what did it for me, and certainly the need. Cristy probably has a better understanding of what the list is for children that don’t have an advocate but need an advocate currently, and I understand from this area, it’s just been growing and growing. COVID, as we’ve come back into more of a life of normalcy, if you will, you have more professionals getting eyes on children now and discovering more cases of abuse and neglect. So for me certainly, this has been a little bit of a soft spot for me, these children that really don’t have a voice that need a voice and were able to provide that independent voice to the judge.
Kate Kolb:
Yeah, I love that so much and I love that this program gives such an opportunity for people who have had either a background in dealing with some of that court stuff in their own lives, or just somebody who has been in Kassie’s case, like on the medical side of things, or something where you can just lean into something in a volunteer status and really make a difference in your community. So from a health care stance, because obviously, this is a healthcare podcast, we did want to launch into some of the things that are surrounding Child Abuse Prevention Month, and why this is important to be discussing and kind of bring some of that awareness to the forefront.
Kate Kolb:
So we’re going to kind of work through some concepts here for just a little bit, and the first one that I wanted to kind of present to you guys was a lot of these children are coming into this program in need of an advocate because of trauma in their lives. So how would we define the trauma that they’re Experiencing in general? Then maybe go into like the types of trauma that you guys see on a regular basis and how you would deal with that from an advocacy standpoint.
Cristy Horsley:
Kassie, double check me because I feel like there are so many definitions of trauma. So I want to give first of all, a generalized definition of trauma and then we can talk about some of the specific trauma that some of our kids experience. So I would say a definition of trauma would be an event where there is threat to life or perceived threat to life or safety such that it overwhelms and floods the coping mechanisms. Does that feel like a fair definition? What would you add to that?
Kassie Gada:
I’d say an event or a series of events, more and more we know that. So it’s not just what we think of as trauma, physical and sexual abuse or the sort of big things I think people think of when they think about trauma, and then child abuse. But what we know is that emotional neglect, physical neglect, having the presence of mental illness, or somebody in prison, or divorce, or all the family stressors that happen have this tremendous impact on both physical and mental health. That’s all I would add to it, and it’s not necessarily, different children will react differently to the very same event and that’s important to realize as well.
Cristy Horsley:
Lots of children and adults can have trauma that doesn’t necessarily lead to coming into foster care. So a lot of the trauma that our kids have experienced, and a lot of them experienced very layered on trauma. So there may be, for example, I’ve had multiple kids on my caseload that have had lead poisoning, and here I am, I practically forgot the lead poisoning even exists and that’s still a thing. But a lot of our kids and families may be living in poverty or areas where they’re exposed to more environmental toxins. So that’s a piece of it, and poverty and the scarcity, that in itself can be a trauma, food scarcity, uncertainty about if those basic needs are going to be met, and then also, a lot of our kids have experienced neglect.
Cristy Horsley:
So for example, parental incapacitation due to substance use falls under that definition of neglect, and I would say, at this point, the vast majority of our cases do involve parental substance use of some sort. Also, it’s worth noting that more and more, if a parent has used substances, we almost always try and test the kids when they come into care because meth especially is very easily absorbed through the skin. So that can be absorbed through the carpet or furniture, or the parents clothing. So that’s an element, but also, things like Kassie was talking about. So physical abuse, sexual abuse, observing, witnessing domestic violence is extremely traumatic. Also, it’s worth noting, so this is a general principle in terms of what we call adverse childhood events, these categories of the most common types of child trauma. If you have one adverse childhood event or one trauma, then it’s likely you may have had more than one, they co-occur and that’s definitely true for our kids. But it’s also worth noting that the separation from family is also in itself a trauma.
Cristy Horsley:
So it’s really important that we keep that in mind that even though we want the children to be safe, we also it’s that cost benefit analysis of what is going to be gained versus lost when we are marginally and suddenly take the child from their home and family. So I will say too for whatever it’s worth in July, we have new federal legislation that’s coming. So currently, when kids come into foster care, it unlocks a lot of funding to address these things like parental substance abuse and trauma in the child and parents relationship, et cetera. What we really want is to unlock that funding while the child is still in the home, we want to as a community wrap around the family and children to help them stabilize, so that we can do that in the family remain unified, and help everyone stabilize without adding more trauma on top of it.
Kate Kolb:
Yeah, I think that’s great. I think that taking a look at the trauma from not only what is acutely happening, or maybe that chronic level of events that are occurring, but the fact that you are aware of the fact that there is some trauma when you’re changing environments and things like that, that are happening as well. Talk a little bit about then I guess the types of trauma and Kassie, maybe this is for you or whoever at the table wants to answer it. But, we’ve kind of overlaid some of that in the way that you’ve been talking but from a medical standpoint, what are the differences between acute, chronic and complex trauma?
Kassie Gada:
I would say, I’m not sure that I’m completely equipped to answer that question. I think that what we know about the effect of trauma and especially like the ongoing neglect or ongoing abuse, say or ongoing exposure to parent that is abusing substance or things like that is that it has a great effect on the child’s nervous system and their brain’s ability to recognize safety and unsafety, and being safe and not safety and it’s a physiologic state that might not be obvious from the outside that a child that’s been exposed over and over again to say, violence or neglect, or that sort of stress, not enough food will become hyper vigilant, the way that they learn the way that they are able to interact, especially with other people, their behavior.
Kassie Gada:
So often, they might go to school or be in situations where their behaviors are very aggressive, or very violent or things like that. We focus on changing those behaviors, of course, because we don’t want those so that we don’t focus on the causes of behavior and the traumas really are the causes of those behaviors. That response and the physiologic response to that sort of toxic ongoing stress, that leads kids to come into trauma leads to huge increases in things that you would think about like suicide and ending up in prison, and not graduating from high school and high risk behaviors, but also heart disease and lung disease and cancer.
Kassie Gada:
It’s accumulation, so I guess it’s having more than one and the more adverse childhood experiences. This is one particular study is, is that a lot of the trauma research has been and the interventions have been directed towards. It doesn’t actually seem to matter which four you have, which four times of adversity that you have, whether it’s, you might think, well, sexual abuse and physical abuse must be worse, but that doesn’t seem to be the case. So that affects people throughout their lives and when I was first exposed to this, and I’ve sort of been immersing myself in it ever since I was at CASA, this information, what really stuck to me and what really stood out to me, what I think is so important is that it’s not us and them. It’s not something that just happens to a certain community, a certain race, a certain socio economic status.
Kassie Gada:
I mean, certainly in CASA, the kids that come into care, the kids are going to be perhaps those with lesser resources, but that doesn’t mean that it’s exclusive to certain communities or certain… It’s all of us. So the best thing that we can do for kids is to have emotionally regulated caretakers, adults. So like Cristy was speaking to was really supporting families, wrapping services around families from the very beginning so that they have the resources to stay together and to be emotionally regulated and to take care of their kids because many of the parents of the children that come into care are certainly I could say exclusively the cases that I’ve dealt with at CASA have had tremendous trauma and adverse, I mean, unspeakable trauma and themselves.
Cristy Horsley:
I think something that Kassie is saying here is a central idea that I really want to draw out for the listeners. I think that this is true both for children and for adults, because Kassie is exactly right, the parents that we see on our caseload today or the CASA children are five years ago, or 10 years ago, and that’s not an exaggeration. I’m seeing parents on my caseload that I served on their cases or supervised their cases when they were teens. So, general principle, every time you see dysfunction, you’ve got to rewind to find the wound. What was the trauma? It’s kind of like if you see someone gushing blood on the street or if someone comes into the ER, if you can’t find the wound and you’re searching and searching, you might, we’re not just going to say, “Oh, they must just have a really strange body, they’re a typical. We can’t find anything, it’s them, okay, it’s them.”
Cristy Horsley:
No. Anytime we see dysfunction again, whether it’s in adults or children, it doesn’t come from nowhere it always comes from somewhere, so you have to rewind to find what that was, and sort of to your question, Kate, I want to circle back to the question you asked about the types of trauma. But also I looked up stats this morning and like their ranges of numbers, but at least one study said that for every child, for one child victim of childhood abuse, it’s a cost of $1.8 million over their lifetime and that’s in terms of medical cost in childhood, of productivity losses, probably for the parent, but also throughout their adult life. Additional services they may need at school to help calm their over activated nervous system or learning loss that they experienced as a result, counseling, just tons of costs.
Cristy Horsley:
So the most cost effective thing is to prevent child abuse, but also again, to come around and to support children and families that have experienced it, and to your question about the types of trauma. So yeah, I think this is a good thing for your listeners to understand. So the first kind of trauma, acute trauma. So this might be again, a lot of your listeners may have experienced acute trauma when they had a medical event, or had to have a hospitalization or a car crash. So it’s something that maybe is short lived kind of a one time thing., and the goal, the hope is to if your child have a well regulated caregiver to be able to help you absorb and cushion that flow and help you return to baseline process through it. If you’re an adult, hopefully you have support network and resources that can help you do that.
Cristy Horsley:
The second type is chronic trauma. So this is just like its name suggests, it’s a long lived ongoing trauma that you can’t really escape from. So this might be something like poverty, or living in an unsafe neighborhood or having an unsafe school. So again, it’s long lasting. Then there’s a third type that’s called complex trauma, and this is what a lot of the kids and parents on our caseload have experienced. So it is many multiple acute events of trauma that are profound, incidents of abuse or domestic violence, as well as it’s inescapable and ongoing, but the hardest thing about complex trauma a lot of times is that it’s coming from the safe place. So think about, for example, sexual abuse from a school teacher or a priest or a parent. You can’t escape to regulate because your safe place is where the danger is coming from. Again, how do you cope or process around that because some of your most fundamental definitions of life and understanding of life come from your safe places, but also very relevant to current events is generational or historic trauma.
Cristy Horsley:
So this is where maybe the individual themselves didn’t experience trauma, but it is passed down, potentially, even in genetics, but also through conversation and kind of through the community. So think about things like the Holocaust, or even there have been studies done, like descendants of prisoners of war in the Civil War descendants, their bodies stored energy differently, it kind of held on to food, carbohydrates more. So think of, for example, policing of communities of color, and the way that communities of color experience that. So these are wounds that are handed down and again, it is meant to be protective. I want to make a point, kind of like Kassie was saying, the way that children or parents, bodies and brains change around that trauma, it’s absolutely appropriate. It’s a protective thing.
Cristy Horsley:
So think about what happens in the body, like if you’ve ever been in a car accident or something like that, like in that moment, you’re probably grateful that your body isn’t focusing on let’s do a long, slow, luxurious digestion of a meal that we just had, or let’s sit down and do some calculus, no. Your heart rate spikes, your breathing is going fast, you’ve got hormones like adrenaline and cortisol spike, and those are all very protective in the moment. But think about if there’s a child that is experiencing that chronically. Yeah, how is that going to affect them long term? We have children in classrooms, kind of like Kassie was saying that become hyper vigilant, and you can imagine a child that’s lived through domestic violence or physical or sexual abuse at home, they are going to be hyper vigilant for threats in their environment, they’re going to be scanning the environment, kind of like a cop doesn’t like to be seated with their back to the room, similar to a child who maybe has experienced abuse.
Cristy Horsley:
Also, there are very real impacts on the brain, like it damages language, executive functioning, cause and effect all kinds of things. So it shows up in very real and concrete ways in the classroom, but a lot of times, and this is a great medical connection too. A lot of times in our kids that ends up being diagnosed as ADHD or autism. PTSD can look very similar to ADHD and autism, it has a lot of the same characteristics.
Kate Kolb:
Yeah. So clearly, this is a very, very complex topic, this is not something that there’s maybe just step A, B, C, and then we get to D and then there’s an event that we can just erase it all. I love that you brought in that that idea of the generational pieces of it, and the fact that these kids are dealing with things that their parents have been dealing with, but then it goes into the way that they develop into their adulthood as well.
Kate Kolb:
So coming out of that discussion of trauma and how we define it, and seeing how these kids are dealing with it, I guess the big question here on the table would be well, what do we do with this? What is the “cure” for facing childhood trauma and how do we help that? I think that’s a huge piece of what you all do at CASA and what you’re doing as advocates for these children. So let’s talk a little bit about that. I hate to just use the word cure, because it feels like it’s just an overall blanket to this, but how are you helping to treat the trauma in these kids when they come see you and they’ve been in these varying states of trauma.
Kassie Gada:
I think it starts with relationship both with this child at the center, deep listening to everybody involved, and get them safe first to ensure that they are in a safe placement as you evaluate the rest of it. There are various services that are offered to everyone, the child, the parents, the caregivers, you look to see if there is a family relationship that can be supportive because we know that it’s better if kids can be with a family member. It’s not always possible, but it’s better. So there’s different supports of parenting coaching, counseling and evaluations for the parents, substance abuse treatment. Sometimes it’s criminal things, you know that the parents are… But that’s I guess that’s a little bit different.
Kassie Gada:
Supporting them in school and making sure that they have the right testing and IEPs if its value or services. School stability is a big thing, trying to keep them and that’s also can be very hard. Sometimes kids as placements end, they might be, and Cristy touched on this, but it’s super traumatic to be literally they’re picked up from their house like pack a bag and picked up and taken to a strange place they’ve never been before, but there are a lot of different kinds of services, both health wise and psychologically and resource wise that are offered to parents.
Cristy Horsley:
Kassie and Kevin, tell me if this seems accurate, I know Kassie and I have had a lot of conversation. So a lot of the things that Kassie was describing, there are a lot of things therapeutically available to our kids and families. But also, I feel like a lot of our role as CASA, like we talked about how Kassie has large pieces of her child story, I feel like a lot of our role is as CASA coming to the tables of these different systems that our children are engaging with, the court system, the medical system, educational system, and a lot of times it may be educating those systems about trauma, and hey, no, this child, the snapshot, the Polaroid snapshot that you have in the moment is not the sum totality of this child, you don’t know all the backstory, and not that it’s our role to educate them about the child’s full backstory.
Cristy Horsley:
But also to say, “Hey, what you’re seeing, this is what trauma looks like.” Let’s preserve the positive vision of this child and kind of speak of that positive vision, and everything that they can become back into the system to remind and keep reframing it positively. So a very concrete example, like when I sit down at IEP tables, terminology that I sometimes hear is, this child is attention seeking and I will say, “So are they attention seeking or are they relationship seeking? Are they esteem seeking? Because what you’re describing to me seems like they’re really looking for a way to connect with an adult and receive feedback.
Cristy Horsley:
So I really do feel like a lot of times, it’s sort of us re-educating systems and also, I will say and again, curious to hear you guys’ perspective, but I feel like there can be a lot of overlap between the advocacy that we do, and also advocacy that happens like medically sometimes. So I’ve sat with a lot of people in the hospital, family members, a lot of times advocacy is shushing the room enough to be able to hear what the patient or the person that we’re serving wants, because a lot of times like we have our way of doing things as a system and we kind of centered around the convenience of us the professionals and our procedures. But sometimes we may have to say, “No, we’re not going to do it that way, because this is what’s best for this child who this case in the system is supposed to be serving or this family.” Does that feel accurate to you guys? Does that ring true?
Kevin Birnbaum:
Yeah, I think certainly, and at the core of what you described is the foundation of what we do, right? It is advocacy in general. But being able to establish a relationship with a child based on like you said, Kassie’s safety. There has to be safety in the relationship between us the volunteer and the child, you don’t just walk into that situation. So in order to get to know them better and be able to advocate other than going through all of the different documentation that’s available and resources that are available to you, you have to really get to know that child and know what to say at those tables that Cristy is alluding to. You have to be able to know that, hey, this treatment plan, this group of professionals, we know in the back of their mind has the right intent, and they want to be able to do the right thing for the child, but they don’t know all of the backstory that we get immersed into.
Kevin Birnbaum:
So for us to be able to learn those things, and it’s just spending time with this child and spending time doing a lot of the investigative work that goes on behind the scenes to be able to add that instance, be able to advocate for what we think is the right path for that child, which may not always be in line with some of the professionals and sometimes those are difficult conversations. But if you just think about how pivotal those conversations are in the lifespan of that child, and what type of decision at that point really has everlasting impact.
Kate Kolb:
I love that. I think if you have heard any of the other episodes that we have talked about recently, even just in this last quarter, Centra has a just cause that we are putting out there, and it’s, we’re partnering with you to live your best life. I think Kevin, what you just said really kind of draws on that same idea of, yeah, sometimes these conversations have to happen, and they might not align with what the original care plan might have looked like, or maybe conversations that are being had in the room. But what does that look like from a perspective of helping the patient, helping the child live their best life.
Kate Kolb:
So that I think is where we get excited about these partnerships with programs like CASA and with other things that are going on in the community because it is a way for you all as advocates, for these patients and for these children that we’re seeing, but also as a way for us as an organization to learn better about what is actually going on outside the doors of our hospital system and what is going on outside the doors of our clinics. You’re absolutely right, we don’t see 100% of the story when these children come in for care. So I personally love the reflective nature of the fact that you guys talked about relationship being a huge, huge part of what you’re doing to help prevent trauma in the lives of these kids when you see them, and I think relationship is hugely impactful between organizations as well.
Kate Kolb:
So I think just from a personal standpoint, on the Centra side of things, that rings so very heavily true with how we want to partner with you all as an organization, and then with these individuals, as patients. Because we do, we want these kids to be in a safe and healthy environment, and for their parents to find that safe and healthy environment too and to really start to change the tides of maybe what’s going on in the community around us. So I so appreciate those perspectives that you’re sharing. I did want to talk real briefly here about just one other thing, Cristy, that you had brought up in some of these notes that we’ve looked over. This idea of universal precautions, and what does that look like in terms of trauma and dealing with the longevity of this going forward with these kids.
Cristy Horsley:
I love that you brought up the just cause, I love it because I think you’re just cause slogan really captures something about trauma informed principles and strategies of centering the voice of the person that we’re serving, and also viewing them as the expert. They are the expert on their own life and their own stories. So we have to sort of sit at their feet, and let them teach us about their story and their experiences and how they want to move forward from here, and we also acknowledge that sometimes it can take some participation in therapeutic services to gain further insights into patterns of awareness, et cetera, but really this concept of universal precautions. So I love the phrase because it goes back to this concept of kind of like during the AIDS, HIV epidemic, maybe we gloved up initially for specific patients but now, it’s the universal precaution, and it should be. It’s good for caregivers, it’s good for the patient.
Cristy Horsley:
So similarly, trauma informed principles. So things Kassie and Kevin and I have talked about of centering the voice of the person that we’re serving relationship, making sure that we have achieved safety for the individual, not just what we think, “Oh, you’re safe, now you’re good, why are you still acting like that?” They need to feel safe, and what they need to feel safe. So all of those things fall under what I would call universal precautions. So things like schools and medical practices, things that we want systems to be practicing, and kind of the comparison I draw is so children who are receiving free school lunches, if a child is getting three meals a day, then that school lunch maybe whatever, they may still get fed at home. But if a child is not receiving three meals a day and is experiencing food scarcity, that free school lunch could be the difference that could really be their lifeline.
Cristy Horsley:
So similarly, trauma informed strategies and principles, universal precautions aren’t going to hurt anyone. They’re good for everyone but it can be the thing that allows a child to achieve success and nurturing relationships and a school or legal system where they might not otherwise. I’ll give you a very concrete example. So a lot of our cases may involve domestic violence. So we may be bringing a mom and a dad into the courtroom. So sometimes I’ve made recommendations in a court report, can we please not seat mom where either she is able to make eye contact with dad or dad is able to be staring her down. We need mom to feel safe in the courtroom for her to be able to participate effectively in the process. So that’s one example.
Kate Kolb:
What I love, I’m just looking through some of these notes as you’re talking to about this universal precautions idea. I love the way that you phrased it on the paper, it’s not what’s wrong with you. That’s super important and we’ve we’ve talked about that in a few of our other podcasts as well when we’re coming along inside our patients and trying to help them and advocate for them. You don’t want to just, “Well, what’s wrong with you?” It’s not that, that is that the key to get to the end of the existence of helping to treat the trauma, and so how would you change that narrative, I guess from what’s wrong with you to what we want it to be?
Cristy Horsley:
Exactly, because it’s not what’s wrong with you, it’s what happened to you. Because like we talked about a lot of those changes that our bodies undergo or even coping mechanisms that we pick up that may, to a medical professional’s eye or a counselor’s eye say, “That’s not pro social or that’s hurting your health.” Well, the reason that we know about childhood trauma, adverse childhood events and the impacts is because of a big study that was done in the 1990s through Kaiser Permanente. So it was actually a weight loss clinic there. There was a clinic that was serving to help people lose weight, and there was a battery of questions that was asked, and especially the doctor was concerned, because the individuals who were highly successful in the weight loss program kept dropping out, and they thought, “Well, that doesn’t make sense, right?” Because the people who are most successful, you would think that they would be motivated and want to keep going.
Cristy Horsley:
So one day completely by accident, he actually mixed up some of the questions that he asked one of his patients, a female patient, and he asked her, “How much did you weigh when you first became sexually active?” And she said, “40 pounds.” He said, “Well, that doesn’t make sense clearly.” Let me ask it again, just to clarify and she said the same thing, and she admitted that it was because of sexual abuse from her father when she was very young. So he was dumbfounded, and he said, “Well, this is only the second case of in-family sexual abuse I’ve ever heard of, in my 26 years of practicing as a physician, this can’t be right.” When I read that, I’m thinking, “Okay, bro, well, all right, that’s a little naive.”
Cristy Horsley:
But anyway, so basically, he replicated the experience again the next day, and he thought, well, I might just be like, excellently injecting some bias, let me get my other physicians that are part of the group to also ask some of these questions. I think they’ve found about 50% of the women in their study had experienced sexual abuse, and it turned out that for them, gaining weight, eating, it was either a coping mechanism or a protective factor, protecting them from further abuse.
Kassie Gada:
Also was biologic changes in their nervous system that caused them to hold on to weight. So it was psychological, and I think to whatever extent we can rid ourselves of shame and blame and the universal precautions. The other thing I guess I wanted to say around that was, it’s not us and them, it’s us. It’s all of us, it’s the people that work at Centra, and we’ve all been through a huge dose of stress in this past year and with this pandemic, and we’re still going through it, and I think we have to honor ourselves and each other and to whatever amount of growing empathy and kindness and relationship.
Cristy Horsley:
Again, it’s really important. So Dr. Nadine Burke Harris is one of the foremost voices on this, if you read her book, The Deepest Well, or she’s got a great intro TED Talk, or even an Armchair Expert podcast episode with Dax Shepard, where she goes into the science a lot more. But really and truly, it’s not only the connections between childhood trauma and what we would consider behavioral health choices like drug use, or high risk sexual behavior, or smoking or all these things, but it’s also so many connections to cardiac disease, cancer, autoimmune disease, chronic lung disease, childhood asthma, all of these things. So if there’s anything, if there’s any doctors listening, or medical professionals, what I really want, what I think is a great part of the potential solution is more and more of the systems that we work in are becoming alert to this concept of trauma and learning about it and how it affects our populations that we serve.
Cristy Horsley:
But as Kassie said, it’s all of us, right? I feel like a lot of us that are drawn to these helping roles, our superpower became empathy, right? Because we’ve had experiences that have honed those skills, but also I would love for our medical community to truly understand how that childhood trauma piece impacts the entirety of the lifespan. Dr. Nadine Burke Harris’s book opens with her brother experiencing a stroke, and the doctor asking about all these risk factors, and she said, “Well, he doesn’t understand that there was childhood trauma, and that’s an even stronger link of a risk factor.” So I would love for our medical community to better understand that and we look at maybe pediatricians and people who are serving families to really think about how can we do maybe screenings for adverse childhood events, not even so much for specific events. But again, just to more wraparound and that generalized precautions. I’d love to see like a nurse home visiting program. I know Centra is doing their community screening right now. So I’m throwing out ideas, just in case.
Kate Kolb:
We love that. No, that’s great. Just as we’re starting to kind of wrap up this episode here, I just want to thank you for everything that has been brought to the table, I think these are important discussions that need to be had, not only from the CASA side of the advocacy discussion, but Kassie, to your point, I think you brought up a lot of really great integrations that happen from the medical standpoint as well, and just gaining that knowledge, but also being able to integrate that into care. I love, love, love what you said a few minutes ago, Kassie about we need to get better about not being so ashamed about things that happen in our lives or the experiences that we come from. A very good friend of mine is always saying, “Well, shame off you.” I think that that’s a great phrase that we can definitely adopt and also just, as you mentioned before, I mean, everyone has sort of experienced this heightened level of stress this past year.
Kate Kolb:
So just kind of taking into that effect, the things that maybe we don’t think about that are going on in everybody else’s existence and in their lives and in their homes and things that people have had to experience this past year that have maybe been heightened, because they’ve spent a lot more time in one of those unsafe environments that you were talking about Cristy before. So we’re quickly running out of time, and I hate that because this is such a good discussion. But I just wanted to give you guys the opportunity to toss out some places where people can find more resources about CASA and about these things that you have talked about. So what would be maybe a website or the best place for them to visit if they’re interested in getting involved?
Cristy Horsley:
Absolutely. So our website is cbcasa.org. But we’re also on Facebook and Instagram, and if people are interested in becoming advocates, like Kassie or Kevin, then the first step would be to sign up to attend an information session, one hour where we kind of talk about the role and next steps. I would encourage you to follow us on social media because we do try and post about trauma and the way that it’s real in our lives and our community, and what we can be working on around that.
Kate Kolb:
Yeah. Well, thanks again, and Cristy, Kassie and Kevin, it was such a pleasure to have you guys here today, and we will include that information at the bottom of the blog that will accompany this episode so that you as our listeners can get as much information as you want or need about that. We would love to invite any of our caregivers and our listeners to apply for that kind of program and get in there and do the advocacy thing. So once again, thanks guys for being here and you can tune in more next time.
