The Neurobiology of Trauma

good morning again everyone I need that because I'm going to need you to be a part of this discussion if you're looking up at the screen you see understanding the biopsychosocial impact of trauma and the first thing that triggers most people is oh my god I'm about to go down a road of sheer unadulterated boredom however as the cartoon would say you don't know me very well I'm dr. Sims brain Sims and I am a forensic psychiatrist currently practicing I have 30 years working in this category and I've been blessed with that I currently work out of seven different correctional facilities and I see a lot of inmates and I used to structure a lot of the programs nationwide for the company that I'm currently working with but as Raoul has pointed out and so often you'll hear throughout the passion transcends any of those particular pieces of your history the part that really sticks with me as far as trauma-informed began really as an issue around my residency because I was in a residency program in Baltimore and this psychiatry residency actually taught us and if you're ready for this they taught us that trauma is a problem for the patient but is not the central problem now understand how cascading that statement would become because for us what it meant was that we were then sent out as future leaders people who the Joint Commission would recognize as running teams so if we had that perspective in mind we were already functioning totally against trauma-informed care and I had my first test of it in a wonderful fashion they said to me when I was a fourth-year resident doctor we are sending you to this pioneer State Hospital called Crownsville anybody ever heard of crowns hospital within Maryland just outside of Annapolis doesn't matter because they shut it down in 2004 and moved us everywhere else but nevertheless in my tenure there I started off as a fourth year resident he said dr. Sims you're gonna be sent to this pioneer hospital where there's been no formal psychiatric training so you're gonna go in as the person that has the most knowledge about psychiatric principles and it is your job to teach these poor dumb Hicks how to do psychiatry being a fourth-year resident all I needed at that point was to have my head exploded even more and it grew and grew and I barely dragged it into my car and I drove myself to Crownsville Hospital Center took my big head into the building sat down in the group with them and notes that the Savior has arrived they looked at me and they said fine thank you for coming we really appreciate you being here and I proceeded to do what I thought I was taught to do which was to espouse my knowledge and I began to espouse my knowledge and they allowed me to despise my knowledge for 24 hours because I'm a 25th hour.the head nurse came to me and she said and I quote dr. Sims we don't like you she then went on to open the doors for my formal acceptance of trauma-informed care because what she said next was dr. Sims if you could just listen to what we do and watch what we do then maybe you might have a different opinion and we don't mind you trying to change things but it would be a good idea to kind of watch it happen first that was the opening door for me for trauma-informed care because it began to mold and restructure how I interacted with others now I have to add this little piece to it they set me up as well because the first thing they it was gave me a young lady who was in the seclusion room and they said you will go and see this lady in seclusion room and she needs you to be her doctor I went around the door was open and how many are familiar with seclusion rooms show of hands cool then what's the difference between a supposin room and a quiet room it's the door isn't it and the door in a quiet room is open so as I go around the corridor the door is opened the young lady sitting there I go inside I sit down and I begin to talk to her and I began to listen to her story and as she was beginning to tell me the things that have been happening in her life as my mentors had told me one time major depression can quite often be diagnosed by someone telling you their story and it actually brings you to tears she was bringing me to tears telling me about what had happened to her now Raoul had talked about it you all have heard this many times before the essence of trauma-informed care is about discussing what happened as opposed to what's wrong with the person and she told me that she's a lawyer and that she has two little children both twins and she was in the State Hospital because she was found driving around the White House with all sorts of inflammatory statements on her car that she had put on there in posters and she explained to me that she felt that her husband was having an affair but that wasn't her trauma what the really she was for her was that she had applied to become a Supreme Court bench judge and she received a letter back that she still clutched and carried in her possessions that absolutely berated her and it told her how ridiculous it was for her to even think about applying that was her trigger and as we talked I heard a lot of noise in the hallway so I said excuse me ma'am but could you just give me a second because I can't quite hear you and I went out and I shut the door and I went back in and sat and talked with her thank you for laughing because very rarely do people kind of get it right at that point thank you where was I guys thank you what's unique about a seclusion room door yeah don't exactly have a doorknob on the inside so she proceeds to ask me dr. Sims how are you gonna get out of here and I said to her no problem I will just yell and somebody will come and open the door she says oh no you don't want to do that because everybody in seclusion rooms yells nobody pays attention to them now I'm beginning to panic so I then inquired of her how do I get out she says don't worry about it leave it to me she then stood up she went to the doorway and she began to sing beautiful voice beautiful voice it drew not one staff person but eight and they came to the door to see this wonderfully beautiful lady singing in the doorway and this frantic doctor with his fingers Klong against the glass trying to get out okay these are introductions folks to the types of things that we deal with and who we are serving so we never lose sight of that fact because sometimes as physicians or as mental health providers we look at our patients in a markedly different way like somehow they're just not quite where we are but as Raoul had very aptly pointed out when you look at the general population statistics we are them and they are us and we need to get that in our heads in terms of how we treat other individuals so our journey this morning is going to take us through talking about our brain I have to say just from a qualification standpoint of view our brains are pretty stupid they're designed to do a lot for us in terms of keeping us alive however they're pretty stupid I have dealt with so many people who have come to me that have said the following you know somebody told me that there is a little bit of alcohol in antifreeze and if I just drink that when I can't afford alcohol I can get my alcohol intake somehow they had convinced that brain that it was okay and that brain said go for it if it makes you feel good do it that's a problem folks so when we start relying on our brains we have to be much better informed before we start asking that brain of what we might think is good and not good as it pertains to trauma-informed care I want to walk you through how our brains react to trauma and I'm going to step you through that process first by taking a look at this particular slide this slide is actually a longitudinal study that was done on children with burns and if you just take away anything you see up there on the screen and just look at it as children with burns if you can visualize how these children most likely are interacting with other children who then see the difference in that child with the burn you can see that there probably are significant stressors so this study took a look at these kids and they brought them in and they actually asked them questions that were part of a post-traumatic rating scale and then what longitudinal studies do is they actually don't do anything formal treatment wise they asked them they rate the scale they sent them out and then after a specified period of time in this case three months they bring them back again and they ask them the same questions so the lines that you see on the left extreme of the line is where they answered their questions the first time and on the right side of the line is how they answer - second time the only thing I want you to glean from this slide is these lines are all over the place aren't they this is Raul's point to you earlier about everyone's response to trauma being different now these kids don't have textbooks they have no way to reference these are feelings but these are the things that mold when you see that adult and you begin to look at that a daughter's oh my god they're just defiant or just about you bipolar they're just bored personality disorder without looking at the fact that many of them have been through this process in multiple different ways also we must avoid as Raul was talked about as well looking at leveling their stressors leveling their traumas oh well that one rates on a scale of zero to ten that one rates it's a four because I know some other people who have had a nine or ten as individualizes this as it should be teaching us a lesson that we need to avoid that at all costs now I'm gonna turn you just for a second into doctors because this slide is an MRI now all you young folks in the room I'm an old fart psychiatrist been around a long time have three wonderful grandchildren and I've gotten to the point of the realization that if you don't know what an MRI is you just need to get a little older because invariably once you get a little older you will find out the true meaning of MRIs because you'll have one done from the top of your head to the bottom of your feet this is however an MRI of two eleven-year-old boys and it's up their brains and if I'm looking at you as I'm looking at you it's a cross-section directly across this way so you're seeing their brains straight back okay this study that the bailiffs did were of multiple accounts this is not just one slide that he did of 11 year old boys kids who have been abused Hey and when I say abused I want to make it very clear the referencing dr. Bayliss makes is maltreated and non maltreated mainly because the Bayliss is a very wise individual because he couldn't talk normal or abnormal because I don't think to date in 2012 we've been able to define what a normal 11 year old actually yes but nevertheless the one on the left is a normal non maltreated 11 year old boy that's an MRI the brain the one on the right is a maltreated 11 year old point maltreated however in every respect with exception of physical no physical trauma guys no blows that a head no strikes to the body it was excluded out of this study and I ask you the question as budding doctors do you see any changes between the non maltreated on the left and the maltreated on the right okay because I only want to point out two of them and point may be a very difficult term here because I'm not sure if you can actually see can you see the red okay good I'm glad it makes me feel good because I tell you I see a blur from right here but anyway if you look on this side I want you to I want to point out two changes wanting to see this white line up here now look over here that's one change secondly see the openings here in the middle now look over here significant differences correct let's just talk about the white line first because if you know which I'm sure you do that all this stuff is the brain here and all this stuff is the brain over here white in an MRI denotes space that's how space lights up bright white so if you know that what does that tell you about this brain versus this brain what about this not this maltreated brain yeah it's actually smaller shrunken as a matter of fact I'll give you a good analogy of what trunking actually means I'm a movie buff not so much like NCIS or anything of that nature but if you remember Silence of the Lambs an old friend Anthony Hopkins in the scene where he's got Ray Liotta at the kitchen table and he's about to feed him his own brain well if you remember he takes the cranial cap off and you get a chance to look at the brain and if you know how the normal topography of the brain is it has a lot of furrows and it doesn't those are called suture lines and if you look at this on the left you can see those openings here and here and up here and up here see those now look at this brain you don't see them and the reason why you don't see them is because the brain has been compressed jacksie squeezed inward now this is repeated this is not a single study piece this is just the slide that we have in this particular presentation it's been compressed and again no physical the second are those openings that I pointed out here on the left normal here on the right maltreated you notice the openings are significantly larger in the maltreated individual again consistently displayed by de bellas well the referencing that I'd make with that is that as a physician whenever I see an MRI that has enlarged ventricles which is what those are I see them generally in one population and that's the demented now please folks I don't know how many of you are sitting in this room but I will totally disavow if any of you take out of here that dr. Sims said that maltreated eleven year old boys have dementia because I do not want that to be out what I want instead is the opposite that despite the macroscopic changes that you see between the maltreated and Anan maltreated there is nothing that that maltreated individual cannot do they can be in receipt of every single service you have to give them but and there's always a but isn't it it's how and what happens so I'm gonna keep you or you keep you all in kind of in mystery for right now there is a reason why I'm showing you that slide now Raul had given some of this data I'll just quickly just want to bring up one point with you that a lot of them are about witnessing because when he mentioned about the servicemen and so forth I did my time with the Armed Forces through the Medical Corps I had an opportunity to actually talk to a lot of soldiers and this was back when PTSD was not a known entity through the federal government as a matter of fact they had acknowledged that it really wasn't a big issue with it so when I started interviewing the soldiers one of the things that was very clear is roughly 80% of them had talked about their traumas being from things they witnessed and not things that directly happened to them and this is something that we have to transcend and open up to look at outside the soldier in the general population in the community and when you have these data from children you actually see that reality comes to perspective when you look at the piece that talks about the children suspected of being victims of abuse but more importantly the one about 9 million witnessing acts of serious violence I want to bring up one example out of the great city of Baltimore and if you know about the great city of Baltimore you know that Baltimore really struggles with being called a safe city as a matter of fact in 1997 they were listed for six hours as the murder capital of the world and the reason why it was only six hours is because in the seventh hour Detroit had misrepresented their data and once they corrected it they then became capital but I'm just giving you that data because I want to point out something that may be prevalent wherever you go because there was an incident that happened in Baltimore that involved a mother and a father and they are in a heated argument in their apartment and this argument is escalating and escalating escalating it gets to the point where the husband reached behind him pulls out a pistol puts it to his wife's head pulls the trigger and kills her he then takes the same pistol puts it to his own head pulls the trigger kills himself now for all of you unfortunately this is not a rare event you probably have read about murder suicides over had them occur unfortunately in the community but I want to expand this just a bit further so it matches what the data is showing you because at the time that this murder suicide took place they're 11 and 12 year old children were seated in the living room and observed the whole thing now to all of you wonderful providers just yell out what you think happened to these kids within the next 24 hours after that event I heard foster care it sound like an auctioneer hey you don't have one foot okay what else questioning absolutely tons and tons of trauma absolutely shock horror absolutely but I'm talking from a treatment standpoint of view because the lack of responses means that you guys get it better than a lot of places I go to because in reality folks this is reality nothing happened to these kids as a matter of fact these kids were sent to school the next day now you got to understand you know when you get that kind of response what the popular thinking was the popular thinking was and unfortunately tends to be if you send them to school they'll be around kids their own age and it kind of normalized this thing that happened is there any reason why now when you see the adult that came from the child that experienced that that you wouldn't be able to identify that there may be some trauma in that individuals life and how they deal with life in general that's why we put these figures up because we want people to also remember that the adults you see at least from all that a medical school knowledge I have in my life used to be kids before they came adults in that a revelation PTSD I will say this much whatever statistics you see tend to be lesser than what they should be because to a larger degree it's hard sometimes to get people to stand up and say I'll be part of you study for the most part when you know individuals who suffer from post-traumatic stress disorder the worst thing that they have is the outside world because everything is triggering and the last thing they want is to be triggered so quite often you don't find them standing in line for a study to be done because they don't want to be around people they don't want to have any flashbacks they don't want to have any recall because part of the problem with post-traumatic stress is that when they have these recalls when they get triggered again it affects them emotionally as if it occurred that same time and sometimes years and years can go by but look at the prevalence among the persons with serious mental illness when Raul said that if you practice universal precautions you're going to be right that kind of data tells you that we're spot-on with that but you have to ask the question so if we are talking about looking at where things are and we're going to treat it we got to take a couple of things into account first of all we got to take a look at the nervous system in general and say you know what it's a bit dysregulated it's quite it's a bit off from what it normally is but secondly that the social environment is not able to contain that dysregulation that to me is an illustration of what's going on these days what is the social environment the analogous thing is that the village no longer raises the child now for all you old folks and I'm not asking for show of hands because I'm pointing a finger back at me I remember the days when I was raised in a community it's called East port in Annapolis where we had strict rules the rules were as an African American living in a mixed neighborhood there were certain places we couldn't go but being a child that was almost saying to me you got to go there and quite often I would defy and get on my bike and I'd ride across into the forbidden neighborhood and just before I would cross into the neighborhood somebody from our side of the neighborhood totally unknown to me and may even be a stranger to my mother and father would yoke my behinds off of the bike and would punish me for trying to go into the neighborhood but that was what I refer to as the primary of a tertiary form of punishment because it didn't stop what the primary did it because once that person then punished you what happened next yeah they called the parents and my was the one at home and mom would say send the boy home the boy would get on his bike and ride home because you were more fearful of not returning home than going home and when you arrived you receive the second degree of punishment and then there was a tertiary component because what would mom say thank you you guys are really on target with it here okay but I will share this little bit of information with you guys I love my father dearly you've been gone a long long long long long time but I can tell you that he's my reason for being a psychiatrist because my dad would get home after working three jobs typical story you hear all the time man just work work work work work my mother would tell him what I did and my father would then send me and as I would go up the stairs I go in the room I would take out a old crumpled up sheep and paper and I get a pencil and I begin the will all of my toys and everything to everybody else because I was very certain I was not going to come out of this alive but he never laid his hands on me he never had to because just that piece there was modifying to the behavior I'm only saying all to that to you because we don't have that anymore do we we're now in a society where if a total stranger yells at your child can you spell litigation now you also have to understand that these children that are not going through this process who have gone through these lives of trauma are ending up in our school systems aren't they I have a loving wife of 32 years ladybug looked at me and she said I'm retiring this year and I said god bless you go for it but she would come home every single day and tell me about incidences that have occurred and about a month and a half ago she told me about an incident of a kindergartner who came into the school and the teacher sent the kindergartner to my wife's office because she wanted her to see this and the child walks in and the child has stars done with magic marker all over her face all over her arms and my wife's going all geez look at this you know I don't know what this child doing where these stars come from and the child said oh my mom's real mom me and my wife looked a little bit closer and inside of each of the stars was a bruise and that child was then sent to the help office assistant years ago folks this is a month and a half ago so when we talk about where we're going there is an importance there is a timeline there's a following but there's also how it affects what goes on upstairs here and that's what we want to do because we need to understand about how our brains develop and our brains develop rather uniquely and individually but they're also contingent and dependent upon a lot of different factors and these core concepts of development help us to understand that because the first one talks about how kids developments do they unfold a long individual pathways what you already understand but they're characterized by what are called continuities and discontinuities as well as significant transition what does all that mean it means folks that as parents caretakers we are in consistently inconsistent believe that don't believe that absolutely in terms of how we present Bill Cosby said it the best way he said we function as parents of the first life and parents of the second life you ever heard of that before he says parents are the first life this is what happens you come into your kitchen as a parent of the first life and you see your child dragna rotten tomato tied to a string across the kitchen floor as a parent of the first like you say what are you doing and a child freezes looks at your face sees that you're upset knows that probably they shouldn't have been doing that and they answer you the following way nothing he then says that as parents of the first life you don't give up at that point so you say well then why are you dragging a rotten tomato across my kitchen floor and the child goes from nothing to psychosis because the very next statement they make is I don't know and at that point you've got no place to go because they know how they are they know how old you are and they can nothing you to death so he then talks about parents of the second life who come in at a kitchen see the child dragging a rotten tomato tied to a string across the kitchen floor they walk over pick up the string in the tomato throw it in a trash can and say I really would prefer that you not drag rotten tomatoes across my kitchen floor Pole to the audience how many of you are 100% parents of the first life show of hands how many of you a 100% parents of the second life show of hands liars whoever whoever raised their hand I give you that and I give it to you in one way in one way only that is to remind you that all of you who raised your hands have been to the mall haven't you of those who raised their hand and everyone for that matter how many you been to the mall without children who went to the mall before you had kids how many times when you went to the mall did you ever observe another child behaving badly and how many times when you observe that behavior going did you say to yourself oh my god if that was my child I would never have any kind of behavior like that happen right and then what did you do you went out and had them on your own did and they invariably said we want to go to the mall and you find yourself at the mall and they're behaving badly and what are you here in the background oh my god that was my childhood but never have any kind of behavior like that you see so there's this inconsistency that we see now taking the humor from it and moving to a serious note this is how neglect is seen this is how abuse is seen because this is not routine behavior is it but it is something that the child unfortunately has nothing to do except work with it because there's no book there are many times that that child is abused by somebody that the child considers to be a caretaker and even if it isn't a direct caretaker if it's a family member they then go to the one that they consider to be their caretaker and they say grandpa touched me in this spot and the parent says oh no no that would never happen and you're not ever allowed to talk about that what do you think the child does with that where does it go from there so you see there's a lot to be said about this developmental pattern because it really makes a big difference so I'm going to go through because I want to take you through a couple of elements involving triggers and responses Raoul's started talking about triggers and responses I don't want to kind of highlight what happens in our brains with triggers and responses and then later I'm gonna have you all participate and a little exercise that's going to get you so excited that what I would ask that you do is during your lunch hour forgo lunch don't even eat lunch but I want you to do instead is walk out the door go around and see it on the other side who is the tour guide for the beautiful theater that's over on the other side and I want you to get up on stage and even though there's nobody in the whole audience I want you to espouse the neurobiological knowledge that we were about to give you in just a few moments but just hang in there for a few moments and we'll get to it the thing about triggers and responses is that in all our formalized treatment if someone gets triggered do we know necessarily want to see what the response is going to is it necessarily going to be a good response how are we not so wouldn't it be a nice thing if it were a way to keep the trigger at the trigger level and not have it get to a response well in our treatment profiles folks that's simpler than we think and I want to give a couple of examples of what happens when a trigger makes it to a response with no intervention I want to also point out that when I mentioned the word trigger I also want you to understand that there are two other words that are similar a trigger is a stimulus is a traumatic reminder all three are the same got it this is audience participation time so if you can say yeah okay great so stimulus trigger traumatic reminder all on the same page good with that great this first particular case involves Robert and Roberts 22 years old and the history you have with Robert is that Robert was abused physically by his stepfather this went on for 11 years out of his life and at 22 years old he's now sitting in a psychiatric facility and the green ball they are two talks about calm continuous engaged he's sitting in a day area he's watching television the situation is quite calm behind Robert out of his view is a table and they're male and female staff persons sitting at the table and they're talking with one another so everybody see that scene all right how many of you have written in your notes all of a sudden without provocation so-and-so jumped up turned table over and hit a couple of people all right let's follow that with Robert all of a sudden without provocation Robert jumps up out of the chair huge look of anger on his face he charges the staffs table and he tackles one of the male staff persons to the floor immediately forces a call then they grab Robert they start heading towards the seclusion room and they noticed that that angry look on Roberts face suddenly turns into one of abject fear and by the time they get him to the seclusion room he's now in a state of dissociation he's no longer responding to verbal commands he's obviously living he's obviously as good vital signs but he's not respond now in a long-term sense which we do not have the time for we would have explored with him the normal way that our hospital would have done it we would have bought Robert in we would have said to Robert do you know what you did yesterday and Robert would have answered in kind no but I'm sure y'all gonna tell me instead we try to approach it from a trauma-informed perspective we bring Robert in we don't put him through the Spanish Inquisition which I call which is an arc of chairs with a bunch of staff persons and one chair just for Robert and we proceeded to just bombard him with questions instead one person being the lead would say to Robert Robert what happened to you yesterday and when that question was posed to Robert he said you know I was fine I was sitting there watching television and I thought I heard the voice of my stepfather that was Roberts trigger there were no intervening elements to keep him from getting to the response and that's the response you saw now we're gonna build on that but the second one is a young lady 12 years old the history you had with her was that she was sexually abused for a while by her one of her family members at this point she's in school and it is calm it's engaging it's quiet learning is going on and a male peer leans over and says something sexually inappropriate in her ear just whispers it she jumps up out of the chair a huge look of shame on her face the teacher tries to engage her but she runs right past the teacher and runs out of the classroom teacher knows that the principal's office is at the end of the hall calls the principal she steps out of her office the child runs towards the principal principals expecting the child's going to stop she runs right past the principal and goes out the front door the principal knows that this child is three blocks away calls the mother and says we don't know what's going on your child is very upset but she's headed home mom steps out on the porch sees the child coming can see the abject look of fear in his child's face fully expecting her daughter to stop and say mom this terrible thing happened but she runs right past mom and runs into the house now mom is turning around what's wrong talk to me tell me what's going on the child runs upstairs goes into our bedroom goes into our bathroom where she's hidden a nice behind the medicine cabinet and she proceeds to start cutting herself all the while mom is still asking talk to me what's going on what's wrong we don't necessarily need an explanation on the second case what we are talking about triggers getting two responses without any intervention and you can see how prevalent that is in the lives of the people we are currently serving because of how many times you've had these quote/unquote unprovoked elements happen a lot of times they are triggers that just do not have any kind of alternative strategy or anything put in its place but we're real good at picking up the symptoms aren't we we can tell the change in effect can't wait we can see the thought process change we can see how the behavior changes we can see how the meaning and somewhat low their own self-esteem tends to be but we quite often miss this last one which is that level of consciousness because sometimes we are triggered by their triggering and we tend to label that last pieces they're just being obstinate defiant they don't want to talk to me we got to keep that peace in mind that that peace is very prevalent now what's our goal if we're going to treat these individuals what is our goal is our goal to maintain a calm continuous engaged environment because if it is then you're talking about getting back to what I used to do now as a physician if you called on me and you said dr. Sims we have an emergency John it's just turned over several tables and he's punched a couple of people dr. Sims we need the cocktail you all familiar with the cocktail cocktail usually ask the doctor for three items usually an anti-psychotic usually something to calm them and then in a compassionate way give them something to prevent extrapyramidal side effects now the doctor being the doctor and understanding that he still has to work with that stay the next day and was not a part of the emergency to begin with says go for it and the medication is administered and another call comes back to say thank you so much dr. Sims because everything is quiet now my question to you if you get it back to the con continuous engage environment have you settled the problem good I'm so glad you all are so spontaneous and so loud with that response now I know that I set you up but I failed on this because I wasn't supposed to show you that second one I was supposed to be the first one up and have you guessing but you know that it's not there it's not about that being a shock to you but you know if you just make the environment quiet you haven't figured out why it happened to begin with and you haven't figured out if it's going to happen again and for a lot of you that have worked in these settings you know those two could happen at any time so what we need to do is not only get it back to the calm continuous engaged state but to prevent it from happening again by putting in things that allow this individual to have choices when they're triggered choices when they have a traumatic reminder choices when they have that stimulus got it good I like okay so you just follow him so folks now audience participation for every stimulus there is a oh that's a it's really sad let's try to want to get for every Stevens there is a ok that made the button come up alright so here's the thing about stimulus in response a stimulus is a trigger it's a traumatic reminder right how much time do you have between the stimulus and response is it slow like what you guys just did no you don't have a whole lot of time between the stimulus and the response so you know you have to act fast don't you so how do we act quite often we act in the following fashion we put together two things one is called social environmental intervention the other one is called neuro regulatory intervention what is social environmental intervention it is the most powerful tool that is so underutilized in treatment I told you guys in the beginning our brains are dumb but we gotta use them more we have to use what works because sometimes what we're guilty of is we actually start to use something that works and then we stop using we don't have a reason why we stop we just don't do it anymore but in this situation quite often we don't use social environmental intervention because we move towards new or regulatory well what is social environmental it's what you've been doing all along it's what you do with your kids it's what you do in your settings you see someone upset you walk up to them and you say you know what you look upset would you like to take a walk with me how about let's go down the corridor together how many times have you done that show of hands and the person has actually gotten calm and actually de-escalate it like god what a powerful tool how much did it cost you by the way okay cool why aren't we doing that why aren't we doing that more often if we're that good at it if we're that productive with it well it's because for the most part you keep calling on me which is where neuro regulatory intervention comes in because it's a lot easier to say oh my god they're upset they need a PRN and they call dr. Sims and I told you I'm gonna say yes but I want you to understand that when you ask me for medication I grant it and you provide it for the individual are you eliminating the stimulus or are you eliminating the response response thank you and you can say it more comfortable now response that is what the old folks call shutting the barn door after the horse got out because in essence you've done nothing about what started the process you just shut down the response that's where I want people to begin to focus I've been promoting and prescribing medications and still do for the past 30 years guys I'm not sitting here telling you or standing here telling you that medication does not have its place I just want people to better understand that when you call on medication you're not taking care of the situation medicines do not cure there are very few medicines that cure the only one I know of is athlete's foot but beyond that when you use psychotropics and you use other types of agents you're not talking about curing are you

Channel: Trauma-Informed Care Videos

Views: 13,211

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Keywords: Trauma-informed care, neurobiology, trauma, brian sims

Id: QrKNYUMw31w

Length: 43min 31sec (2611 seconds)

Published: Tue Oct 04 2016