Episode 19: Trauma-Informed Care And Early Childhood Mental Health Support

Kay Connors, MSW, LCSW-C is a licensed social worker and instructor at the University of Maryland School of Medicine. Her work focuses on trauma-informed care, child and family traumatic stress, infant and early childhood mental health care. The podcast discusses what trauma is, how Adverse Childhood Experiences impact children and adults, and provides information on community support programs that are available throughout Maryland.

Show Notes

2:05 About Taghi Modarressi Center for Infant Study

3:45 What is the Baltimore-Network of Early Services Transformation?

5:10 About Kay Connors

6:36 Defining mental health

7:51 Impact of trauma on communities

10:39 What is trauma?

12:15 Reducing Adverse Childhood Experiences

17:07 Community support for families

21:06 Providing trauma-informed care: We all play a role

24:26 Self-care

Transcript

Quinton Askew (1:30)

Welcome to “What’s the 211?” podcast. My name is Quinton Askew, President and CEO of 211 Maryland/Maryland Information Network. I am joined by our esteemed guest Kay Connors, licensed social worker and instructor at the University of Maryland School of Medicine, Department of Psychiatry; Project Director with the Baltimore-Network of Early Services Transformation (B-NEST); and Executive Director of Taghi Modarressi Center for Infant Study. How are you?

Kay Connors, MSW, LCSW-C (1:56)

Thank you, Quinton. It’s so exciting to be here. I’m so excited about what 211 is doing for Maryland. Glad to be a part of the show today.

About Taghi Modarressi Center for Infant Study

Quinton Askew (2:05)

I appreciate it. Glad to have you. So, can you tell us a little bit about Taghi Modarressi Center for Infant Study (CIS) and its affiliation with the University of Maryland School of Medicine?

Kay Connors, MSW, LCSW-C  (2:15)

Dr. Modaressi was an innovator in infant and early childhood mental health and child and adolescent psychiatry. He immigrated from Iran, went to medical school at McGill University, and then came to Baltimore to establish his career.

In 1982, he opened the Center for Infant Study (CIS) with a very prominent guest in a symposium, including Eric Erickson and his wife, Joan Erickson, who are really the people that we still all study when we study child development.

And from there, people said, “Well, will you bring these services here to Baltimor?” We’ve pretty much been doing the same thing, which is:

• Providing early childhood mental health services, both in the clinic and in the community. Learn more about the services provided by CIS.
• Training people who want to know more about this work, including child psychiatrists, child psychologists, social workers, counselors, nurses, and medical students.

We have a robust campus here, and so we get to expose a lot of the amazing graduate students to this line of work, and then we get to work with people who have already graduated and, in the field, supporting them in their careers as well.

What is the Baltimore-Network of Early Services Transformation?

(3:45)

The Baltimore-Network of Early Services Transformation is a project that we’re really proud of. It’s a concept, and we believe in collaboration, bringing all kinds of voices into the process of change that supports families with young children.

It is a way that we try to do the work. But we have been very fortunate to get some federal funding through the Substance Abuse and Mental Health Services Administration (SAMHSA), through a program they have called the National Child Traumatic Stress Network. And that is a really transformative grant process.

And we’re very lucky in Maryland that we have several centers, and ours is the only one that really focuses on very young children. And so, in that particular grant, we have been able to advance the availability of Healthy Steps, an evidence-based model set in primary care.

So, it is about:

• Preventing traumas
• Identifying traumas
• The negative impact that traumatic stress can have on young children and families
• Giving parents the information and the skills that they need to get their kids off to a good start despite maybe difficult things that have happened.

And then, I went on to become a social worker, and we think of ourselves as change agents. So we try to develop skills in a certain area. So, I picked the area of mental health. Not just to become a therapist but also to address the barriers that get in the way of children’s mental health and the things that get in the way of people having access to mental health services. Social workers work at the individual level, the family level, and the greater community level.

It’s been a good fit, and I’m passionate about always learning. It’s an open field where there’s so much innovation happening.

Defining mental health

Quinton Askew (6:36)

Fellow Baltimorean, so I understand. I know there’s many definitions of mental health and what it means to individual health. How do you define mental health?

Kay Connors, MSW, LCSW-C  (6:48)

Mental health is really central to health. You know, you can’t have good health without good mental health. I see them as intertwined and interconnected.

The way I would define it is that it’s really about being able to regulate your thoughts, your feelings, your moods. It’s also about being able to be in healthy relationships because that’s critical to your social health.

I think we’ve all gone through a period of big significant isolation and disruptions in the social network. So, I think we can all feel how that important element of mental health is something to pay attention to.

Then the last thing is taking care of your emotional health and your social health, putting you in a place to be your best self. And so that you can do well in school, or you can do well at work, or you can support your family or your community in meaningful ways.

Impact of trauma on communities

Quinton Askew (7:51)

With that definition, mental health is everyone, right? Let’s talk a bit about some of the work with children, families, and communities that are impacted by trauma that you are very heavily involved with. Can you share some of those insights into the landscape of mental health challenges you see and kind of the issues of folks who are seeking treatment?

Kay Connors, MSW, LCSW-C  (8:13)

Yeah, I think that kind of at the larger community level, it’s been incredibly inspiring. For me to hear people at all levels, politicians, newscasts, broadcasters, teachers, kids, parents, actually use the word trauma.

I hear people say it and talk about it all the time, and they really know what they’re talking about.

When I started about 20 years ago, the T word was a word that people really shied away from. Maybe they would refer to it as Shock Trauma Center, you know, something like that. But I think people, as we’ve had some shared traumas around social justice concerns, immigration issues, and the pandemic public health concerns, I think people are embracing the idea and really understand it at a deep level.

What we can do about stress

That certain types of stress and certain amounts of stress are not good for people’s health overall. And, together, we can do things about it:

• educate ourselves
• get some skills to manage the stress
• support communities
• stand up for people who might be disenfranchised

So, at the community level, I see that at the child and family level.

I would say one barrier is still stigma. Stigma still gets in the way. If parents have had concerns about their mental health growing up, they might have experienced stigma and trying to get help or trying to talk about it. I think that still shows up. But, I also see it show up in a positive way, where parents say to us, this happened to me when I was a kid, and I didn’t get help, and I want help for my kids.

I see that greater understanding showing up, but combating stigma is something we can all do together because it really gets in the way of people’s recovery.

Quinton Askew (10:17)

Yeah, I agree with that. Should we be using trauma and a sense of describing some of the experiences? Have you heard both spectrums that we don’t want to keep saying trauma because maybe that brings about emotions or feelings? Should that be the description of what it is?

What is trauma?

Kay Connors, MSW, LCSW-C  (10:39)

That’s a dilemma that we’re still sorting through. I would say I wouldn’t be flippant with the word trauma.

You know, I would only want to apply trauma to things that are:

• frightening
• fearful
• overwhelming experiences

That’s really the core definition of a traumatic event.

All of us experience and have different effects related to those events. So, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a very functional definition of trauma, which is the three E’s.

• The event, so if it’s something frightening, overwhelming, and dangerous.
• The experience. How did that individual, how did that family, and how did that community experience the frightening and overwhelming or dangerous events?
• The last E is what are the effects? So, how is it going to affect all of us in some way?

But, the lasting effects might not be that significant for some people. They have a lot of coping skills, they have some resources, and they have the support they needed when the difficult thing happened.

And that’s where services and resources and community support come in. We can buffer the effects of trauma:

• When people understand.
• They have the information they need.
• They have the skills to help with recovery.
• They have the resources.
• They have relationships that are supportive and are not shaming or blaming.

Reducing Adverse Childhood Experiences

Quinton Askew (12:15)

So, I know we’re going to use a couple of different terms and terminology. Speaking of that, some of the various terms that we will talk about is trauma-informed care. Can you explain briefly what Adverse Childhood Experiences (ACEs) are, what trauma-informed care is, and why they are important for others to understand?

Kay Connors, MSW, LCSW-C  (12:36)

Yeah, that’s a great question. So, Adverse Childhood Experiences (ACEs) are really a term that came out of probably one of the most important public health studies today. In the late 1990s, Dr. Vincent Felitti and Dr. Robert Anda were the principal investigators of the Adverse Childhood Experience Study. They started the work to try to understand the growing cardiac disease and weight problems of adults.

What they found in the study was that these Adverse Childhood Experiences both affected chronic heart disease and the relationship to food and trouble with increased weight, but also other things like diabetes and other chronic diseases that are often linked to stress responses.

The science is really helping us to understand and unpack that when these kinds of high-stress situations, when these adversities happened in childhood, it sets the stage for both mental health conditions later on, but also physical health conditions. That’s why the focus from an advocacy public health perspective is to reduce the kinds of stress children have in childhood. So, we can set the stage for better health as they grow.

Quinton Askew (14:03)

I know growing up in Baltimore City, there were experiences and events that I experienced or even remember, you know, that would be traumatic experiences. How does Early Childhood shape a person’s development overall as they grow older and still have these thoughts or experiences? How does that affect well-being as they function as an adult?

Kay Connors, MSW, LCSW-C  (14:27)

Well, I don’t want to be totally negative about stress because there’s always a little bit of normal stress that both kids and adults experience every day. A lot of times, stress is what motivates us to do well on a test, to show up on time for work, or to meet expectations.

For children, that means to help them meet their developmental expectations. So, it’s a motivating force that helps them try new things, learn to explore, and then further develop all their skills.

There’s a middle-level stress that researchers at Harvard called tolerable stress. That is when one of those frightening, dangerous, overwhelming events happen. Like someone dies, or unfortunately for children in Baltimore City, the main trauma is witnessing community violence – living in places where you don’t feel safe.

Children need protection and safety, particularly when they’re young because they don’t have all the developmental skills to protect themselves. We’re not born with spikes or hard armor or any of those things. We’d like to sometimes think we’re super powerful, but really, we have very soft skin, and our bones can break, and there are all kinds of things where we’re physically vulnerable.

So, the best power protection is each other. So, when people take care of each other and are protective shields for each other, that’s what really helps to buffer the stress of difficult things.

So, when kids are very young, that’s their parents and their grandparents. The tighter circle that you would call family and even close neighbors.

As kids get older, teenagers and middle school kids will also include friends, teachers and other folks.

So, when there’s a rift in any of those protective shields, that can put kids at risk of having traumatic stress symptoms. That’s when we want to use some of our services to identify when a kid is negatively impacted or feeling the stress to the point where they have traumatic stress symptoms.

That would look like nightmares, and having trouble concentrating because the worries and the fears are what you have to concentrate on. Because the brain is always going to focus on safety first. And if you’re worried about your safety, it’s really hard to be able to focus on other things that kids need to do to learn and grow.

Community Support

Quinton Askew (17:07)

That’s true. What role do schools and communities play in providing that support, resources, and information? I guess that is an important part of a child’s development to have the school resources and community to be able to help.

Kay Connors, MSW, LCSW-C  (17:21)

I think what we’re learning as a really important part of trauma-informed care is that we’re all in it together.

And the more we integrate these social-emotional wellness services, and including, I would say, mental health services into places where kids and families show up every day, so that it doesn’t feel hard to access mental health supports, I think that is central to trauma-informed care.

You asked earlier about our projects. We have a clinic here, and we serve about 80 families a year that actually come to a traditional outpatient clinic where we’re part of the whole Department of Psychiatry. We see babies to seniors, but we also have learned that parents want us to go where they are. They want this information. They want this support, but they would like it in the Head Start. They would like it in the childcare programs. They would like it in pre-K and Kindergarten and schools for the older kids, including primary care.

We have a project called HealthySteps, where we put someone like me into the primary care setting so that we’re a resource and provide mental health support and resources to families when they come to see their pediatricians. (Editor’s note: Find a HealthySteps provider in Maryland.)

In the first year of life, there are 13 appointments. So, you really get to know families in those early years. And that’s how pediatricians are both trusted and critical to the family’s support network. So that’s a good place to be.

We’re also in Head Start and Judy Centers, and Maryland has a wonderful network of Judy Hoyer Centers in early childhood, and that’s another place to put mental health supports for the whole family.

My colleagues here at the University are part of a big National Center for School Mental Health (NCSMH). So they advocate for that not just here but across the country.

Quinton Askew (19:25)

I’m very familiar with the Judy Centers as well. You mentioned trauma-informed care. That would mean someone who’s working in the schools or providing support that I am aware of, being able to identify whether my youth are going through troubles or barriers, or I’m better informed to provide support to them.

Kay Connors, MSW, LCSW-C  (19:44)

I would say each of us, depending on what our roles are, can make a difference in trauma-informed care. You and 211 are doing a lot to connect people to resources and also get information out there.

I think awareness is really kind of the fundamental part of trauma-informed care, understanding that adversities, particularly in childhood, could turn out to be traumatic for kids. How can we buffer the negative impact of those adversities, and how can we respond if there is a known trauma – a death in the family or a violent incident at the school or the community?

We know certain things are already traumas. And so being able to respond to them, we can prevent negative traumatic stress symptoms down the road if we can really address them early on.

Awareness is one, and then resources and critical relationships.

That’s why being there is so important. If you can be a trusted person in the community, school, or the pediatric office. People know to turn to you when there’s a concern. Relationships are critical to trauma-informed care.

Providing trauma-informed care: We all play a role

Quinton Askew (21:06)

So, anyone can be in or provide trauma-informed care.

Kay Connors, MSW, LCSW-C  (21:120

I think so. Yeah. One of the mantras of trauma-informed care is it comes out of the work at the federal level at SAMHSA is we have to shift from what’s wrong with someone to what happened to them.

And so traumas and in mental health care, it’s one of the few things where the etiology of the potential diagnosis of traumatic stress starts with:

• What happened to you?
• Was that thing frightening and overwhelming?
• How did you experience it, and what were the effects of it?

It’s really critical to get that question in your mind.

• What happened to that person?
• And how do I want to respond with compassion and empathy, and information and resources to help them with their recovery?

Quinton Askew (22:04)

That’s a very powerful way to look at it. You touched on some of the approaches that you take, the key highlights, and some of the other innovative treatment approaches that you’ve seen or are utilizing to help address some of the mental health concerns.

Kay Connors, MSW, LCSW-C  (22:17)

I feel very lucky to have been part of the National Child Traumatic Stress Network for quite a while now. And I would say that’s influenced my career and understanding of traumatic stress.

So, for example, when there were tragic shootings in Brooklyn, we were able to respond with resources for responders.

• How to talk with young kids about scary things happen in their neighborhood.
• How to talk with teenagers.
• What to look for.
• How to help parents be able to monitor their kids reaction to what happened.

So, I’d say that’s one. I sed the resources of the National Child Traumatic Stress Network, so that I could get as much information out to everyone as I could.

The next is then how to how to respond. So both teaching other professionals about trauma, what to look for, what are the signs and symptoms of traumatic stress, and how you can access help.

Then, to be fortunate enough to be on the health side, we provide evidence-based trauma treatments for very young kids and their parents and in our child service line here for older kids as well.

I’m really proud to say that because of the collaboration of families and researchers and clinicians. We’ve been able to move the field forward, and we have good evidence for therapies that work and really reduce trauma symptoms and can recover very quickly.

One of the things we find is that parents have had those ACEs that we talked about earlier, and maybe traumatic events happen in their adulthood, so we need many more services for the parents. Parents always want to get their kids what they need first, but what we notice is that we need to do a better job of trying to get them the services and resources that they need. They can’t quite take care of their kids if they don’t take care of themselves.

Self-care

Quinton Askew  (24:26)

That means self-care and taking care of themselves. And, you mentioned providing help for the caregivers. What’s the importance of self-care for those who are are providing the services and supports? And hearing and seeing this information on a daily basis? What do you do, and how is it important for those doing this work?

Kay Connors, MSW, LCSW-C  (24:44)

That was the biggest lesson out of the COVID-19 pandemic years. You know, when we saw our first responders and our colleagues here at the hospital making heroic efforts to help people and to help the community at large. We saw families working both out in the community, so many of the families that we see here in our clinic are holding down two and three jobs, and they’re often the caregivers in childcare programs and nursing homes. So, they’re keeping things going. We learned a lot from looking at the levels of stress that they were under.

So how does one recognize, you know, the importance of their work? Gratitude is a really important part of self-care. Not only for myself stepping back and thinking about what I’m grateful for but also for expressing gratitude to others. I think that those things are fundamental.

Many people are experts in breathwork and mindfulness, and I learned a lot from them about how they apply that both for themselves and the people they’re working with. But I think it also happens at a higher level. And I think we’re really in the beginnings of that, but how agencies, programs, and state governments think about policies and practices. One of the biggest things is families need time off to care for other family members. So, thinking through those things, what are equitable policies and practices?

Quinton Askew (26:27)

And that makes sense. And so how are cultural factors impacting how mental health is perceived and addressed in communities? Or how services are provided? I know that mental health is everyone. We all may experience something differently from me, being African American male and here in Maryland, or some of our community members where English may not be a first language. Do you see many differences in the way services are provided or available?

Kay Connors, MSW, LCSW-C  (26:56)

I do, unfortunately. There’s lots of research about equity concerns for communities of color. And I do think that also for good reasons. People of color are concerned about relationships with institutions and institutions that its mission is to help.

In the past, people have experienced discrimination or racism. So I think some of the positive movements, and I can say a couple of good policies happening in Maryland:

• There is a rise in the behavioral health side for recovery programs, peer-to-peer support, and are really valued members of those teams. And now there are even ways, I think, just this spring, opening up ways to bill for those services. So that’s a real recognition that peer-to-peer providers are integral to that service line.

• Another is integrating care behavioral health care into various primary care and other medical settings. And I think we will probably see some movement in that in the next couple years. Some policies are being looked into around that.

• Understanding how fundamental mental health is. We have had policy barriers that made that hard to build and to be able to sustain someone in those programs. So, a particular point of pride for our team is that we worked really closely with Maryland Medicaid and Behavioral Health Administration and the Maryland Family Network to advocate for enhanced code from the HealthySteps model. That means it can spread, be sustained, and have much more access across the state. So we have the only two right now. And I think we have seven more opening because of that code.

Quinton Askew (28:48_

As we’re winding down, how can Marylanders interested in supporting your work learn more about the programs and training opportunities that you provide?

Kay Connors, MSW, LCSW-C  (28:58)

If they ever have concerns about wanting services for children’s mental health, they can email me, and I’ll help them get connected. We do a lot of that work for our colleagues. We have many programs here at the University of Maryland that can help people connect to services.

If it’s not our services, we work collaboratively with other mental health people across the state. So that’s one.

In terms of the community level, that really gets back to the idea of finding more and more opportunities to work with community anchors or community partners. We work closely with the Thriving Communities Collaborative that Eliza Cooper leads with other community members. So I think the more we can integrate into community programs as they open their doors to us. We can walk through them and be good partners in providing resources or services, writing grants together to bring the services to the community, and have the community lead them. I think she is kind of the next wave of important work in trauma-informed care. So my email is kconnors@som.umaryland.edu

Quinton Askew (30:23)

Thank you. And so, in closing, is there anything else? We’ll give you a final word. Is there anything else you’d like to share or just for us to know as we continue our work in his area?

Kay Connors, MSW, LCSW-C  (30:32)

I think I’ll end with gratitude for the increasing partnership with 211 and gratitude towards the trauma-informed efforts, including the Trauma Informed Commission and the things unfolding, from people collaborating and being brave enough to talk about a topic that was once taboo: mental health services and traumas.

What we know from families is that though it’s hard to talk about traumas, they want to be able to talk about it and get resources and support around it. We’re starting to build those bridges.

Quinton Askew (31:14)

Thank you. We appreciate the partnership. Gratitude is the right word, and I look forward to continuing to work with you. Thank you for joining us.

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