OTS 115: Going Beyond Trauma-Informed Care
- Jayson Davies
- Jan 8, 2023
- 42 min read
Updated: Sep 20, 2024
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Welcome to the show notes for Episode 115 of the OT Schoolhouse Podcast.
What do you think of when you hear the phrase trauma responsive?
This concept goes beyond trauma-informed care. Tune in to hear Dr. Gibbs speak about her book, Trauma Treatment in Action, and how as OTPs, we need to be more responsive to the needs of a client regarding their mental health, just as if we were working with someone who had a stroke or other physical ailment.
Tune in to learn the following objectives:
Learners will identify the five dimensions of trauma and how to use these in practice.
Learners will identify what ACTION is and how it can be used in OT.
Learners will identify how an OTP can address mental health with a student.
Guest Bio
Varleisha D. Gibbs, Ph.D., OTD, OTR/L
Varleisha D. Gibbs, Ph.D., OTD, OTR/L, is the Vice President of Practice Engagement and Capacity Building at the American Occupational Therapy Association (AOTA). She previously served as the Scientific Programs Officer at the American Occupational Therapy Foundation.
Dr. Gibbs is an occupational therapist, international lecturer, researcher, and author. Her areas of expertise include neuroanatomy, self-regulation strategies across the lifespan, health inequities, and trauma-responsive approaches. Dr. Gibbs founded and operated a private therapy firm for over 10 years.
Dr. Gibbs began her career after receiving her baccalaureate degree in Psychology from the University of Delaware. She continued her studies in the field of Occupational Therapy, receiving a Masters of Science degree from Columbia University and a clinical doctorate from Thomas Jefferson University. Dr. Gibbs completed her Ph.D. program in Health Sciences Leadership at Seton Hall University.
Memorable Quotes from this Episode
“Mental health is something that we all have. That’s not a disorder… Everyone requires support. There are social drivers that could lead us to healthy outcomes or adverse outcomes” - Varleisha Gibbs, Ph.D., OTD, OTR/L
“That's what we do… occupation is about the doing and the being. And we need to make sure that we're not just informed, but that we are addressing trauma in a responsive manner” - Varleisha Gibbs, Ph.D., OTD, OTR/L
“I really don't know any other profession that does this. We look at the person. But we also look at the context and environment” - Varleisha Gibbs, Ph.D., OTD, OTR/L
“Growth could happen at any moment. Despite the child that may have a severe diagnoses, they can still show some growth on that hierarchy” - Varleisha Gibbs, Ph.D., OTD, OTR/L
"We need to keep in mind that we're supporting their students and we're doing the best job that we can do. But we also have to be mindful about their own mental health and how they are perceiving the IEP process in itself” - Jayson Davies, M.A, OTR/L
“If we don't start to use that language that relates to mental and behavioral health, then we will continue to not have that seat at the table” - Varleisha Gibbs, PhD, OTD, OTR/L
Resources:
Episode Transcript
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Amazing Narrator
Hello and welcome to the otschoolhouse podcast. Your source for school based occupational therapy, tips, interviews and professional development now to get the conversation started, here is your host, Jayson Davies, class is officially in session.
Jayson Davies
Hey there. And welcome to the otschoolhouse com podcast. My name is Jason Davies. I am your host, and I appreciate you joining us for this show today. Now we've all heard of and have probably even taken several courses about trauma informed care. But is it enough just to be informed about trauma, or do we need to go deeper and actually better understand trauma and how we can respond to trauma. I think that's the truth. I think we need to go beyond trauma informed care, and that's why today, we're chatting with Dr varlisha Gibbs to discuss trauma responsive care. It's no longer enough just to be informed as school based occupational therapy practitioners, we need to know how to respond and act when working with students who may be dealing with various types of trauma. Now, Dr Gibbs is a leader in the field of occupational therapy. She is currently the vice president of practice engagement and capacity building at aota, the American Occupational Therapy Association, and she is also the scientific programs officer at the American occupational therapy foundation. So both aota and AOTF. She has been an OT for over 20 years, and has both an OTD and a PhD in Health Sciences. Dr Gibbs has published a handful of articles and was also one of the contributing authors of the OT practice framework, otpf Fourth Edition back in 2020, so it's very fair to say she knows occupational therapy very well. She is also the co author of a book titled trauma treatment and action, all capitalized action over 85 activities to move clients toward healing, growth and improved functioning. Much of what we're going to be discussing today actually comes from that book, like the five dimensions of trauma and the action from trauma approach, which encourages movement toward healing and growth. I'm excited to have her share this with you, but really, I definitely recommend grabbing this book on Amazon. You can get it for your Kindle. It's really, you know, only about 20 bucks or so, but it not only does a deep dive into trauma, but it also gives you 85 activities to support your students with all of that. Let's go ahead and welcome Dr Gibbs to the otschoolhouse Comcast so she can share with us more about trauma and how useful this knowledge is for you and your students. So please help me. Welcome to the otschoolhouse com podcast. Dr varleisha Gibbs, hello. Dr Gibbs, welcome to the otschoolhouse podcast. How are you doing today?
Varleisha Gibbs
Great. Thank you for having me.
Jayson Davies
Yeah. Thank you so much for being here. You know, I must say, I have heard so much good about you. I mean, a lot of people that I end up having on the podcast have actually been referred to by previous podcast guest, and your name has come up a couple times, and so I'm excited to finally get you on here and have a good conversation with you. So thank you so much for being here.
Varleisha Gibbs
Thank you. It's my honor to be here. I really appreciate it. Love chatting about everything OTs.
Jayson Davies
in the right place. You are definitely in the right place. Everyone listening is in the right place, because we're talking about ot today. And yeah, I wanted to first let you just kind of introduce a little bit about yourself, share some background about how you fit into the world of occupational therapy. Sure,
Varleisha Gibbs
Sure, so I'm an occupational therapist, and I've been one for 20 years, believe it or not, over a little over 20 years, which is really eye opening to me. You know, when you hit those milestones, it causes you to do a lot of reflection. And I've been really grateful about my career in OT I started off I went to Columbia University after not knowing what I was going to do with my life after undergrad. So with some introductions to OT in various ways, and even realizing that somewhere along the line, I actually received services and didn't realize who the person was pulling me out of the classroom, which was an occupational therapist at that time. So my career, my journey in OT, I should say, started well before I even realized. And so I've spent a lot of time going to school. Frankly, went to school for, you know, ot after my bachelor's in psychology, and then I end up going to Seton Hall for a PhD in health sciences. But I left that program because I love otschool. Had my own private practice for over a decade, and so really wanted the clinical piece of it, and then went back to finish that PhD once I got into academia. So to summarize, because we could go on all day about our journey, right, especially after 20 years, that could be a long discussion. But. Um, but I started the first occupational therapy master's program in the state of Delaware. So I was there at Wesley College, which is now with Delaware State University. And then from there, I was a scientific programs officer at the American occupational therapy Foundation, and currently I'm Vice President of practice engagement and capacity building at the American Occupational Therapy Association. And then I think what really pertains to our conversation today is my work, in, you know, giving talks and webinars and trainings on some of my books, and which really is a culmination of, you know, doing research as well as just being in a community and being in a clinic, working with families.
Jayson Davies
Wow, wow. You have run the entire gamut of things that you could do with occupational therapy, as far as owning a business, being a provider, getting into academics and now with our national association, wow, that's that's quite a bit.
Varleisha Gibbs
I'm tired. I'm kidding.
Jayson Davies
Definitely I understand. But I mean, 20 years, that's all that's it seems like a long time, but really, all that you just said, 20 years is not that long. I mean, to do all of that in 20 years you've been hustling. So yeah, kudos to you.
Varleisha Gibbs
That's probably the word for it. Yeah, I would say, you know, I started when I was 16, but that would be a lie, nah.
Jayson Davies
We all start when we start. And we can't get anywhere without starting, so we start exactly when we need to be starting. So yeah, you know, we were looking in, you know, just trying to find a little bit about you. And one of the things that we found was that it might have been your dream to become a doctor once upon a time. So where did that shift from being a doctor turn into being an OT microbiology
Varleisha Gibbs
is definitely a shift, being honest, that was well before I knew what occupational therapy was. But that microbiology, course, was just not my friend, um, along with some other things. And so, you know, I realized after going into college, into undergraduate work, I, you know, if you put your mind to it, yes, if you're a good student, you could figure it out, and you can get good grades. And but for me, I learned more and more that, as much as, you know, MDS, I wanted to be a pediatrician. And you know, as much as we interact and would face clients and patients, it wasn't as hands on as I wanted it to be. You know, I grew up really following my mom's lead, and she used to be an advocate in the community. She's no longer with us, but even, you know, throughout her whole life, she did a lot of work and community and supporting those who are at risk. I was actually identified as being at risk team growing up, and so it was important to me to give back and to be involved at that community level. I was also a dancer, so I loved, really, you know, the physicality of things and the artistic expression and being hands on. I love psychology, and so my advisor in college was telling me that, you know what you may want to think about something else. And she was the first to mention occupational therapy to me, because that obviously fit the gamut of those, the plethora of interests that I had. Wow,
Jayson Davies
yeah, you know, I remember back in school, I remember everyone who was pre pre med always complaining about micro. And, yeah, that is one heck of a class. Apparently, I never had to take it. But I have heard so many people say that that is a one tough class to get through so well, you know what? I will say this, I'm happy for micro because that gave us Dr Gibbs, I will say that right now. Yeah, so, so we led you into or micro led you into occupational therapy, but now you have really kind of honed in your skills with mental health. And so what drove you specifically to get into the mental health realm?
Varleisha Gibbs
Well, it's interesting, because, you know, when you're specifically, I would say in academia, and you know, you start off as an assistant professor, everyone says like, what, what is your platform? You know, what's your area of work and what's your area of expertise, which is important, because we do have standards, and you need to have faculty that run a gamut of all those different practice areas. I struggle with putting myself in a box because I work through the lifespan. People like to say I'm a pediatric therapist, which is fine, because I played that role before. You know, I definitely was a pediatric therapist. But I also, at the same time, worked in skilled nursing facilities with those who had cognitive, you know, disorders and dementia, all in the same day. So for me, I had to come up with an umbrella, even for me to understand what was my expertise, or what was it going to be, what area of research was I going to go into? And I realized that, hey, did you forget that you have a degree in psychology, and that was really. Basically, you know, like, what led you into this work and why you were interested, partially, you know, and interested in occupational therapy. And, you know, I came up with the umbrella term, really was the neural diversity and neuroscience piece of it. And you can't have, you know, neural without that psychosocial element. And so my my dissertation work for my PhD was looking at autism from a biopsychosocial lens. And so as we now look at where society is and the needs of society, we realize that mental health is something that we all have that's not a disorder. It's our mental health, it's a well being, and that everyone you know requires support their social drivers that could lead us to, you know, healthy outcomes or adverse outcomes. And so reflecting on where we are right now in society, I realized that I could lend my expertise in this way, because I've worked with families and Coney, Coney Island, right in New York, that were extremely low income, and even those who were in really upper class in New Jersey, literally mansions, that were dealing with the stressors of having a child with, you know, a genetic disorder. So I've done so much in terms of that work and redefining what mental health is that, you know, I when I first came to aota, that was one of my goals, was to kind of re reinvigorate mental health within our profession, that it's not isolated to those who work in a mental health facility, that we all do it, because we all interact with humans, and that's what mental health is. And I wasn't the only one beating that drum, but that was definitely my platform when I got into this position.
Jayson Davies
I love that, you know, I I've had that same type of thought process. You know, you go to a to aota, to conference, or you go to your state conference, and there's a few different courses going on at the same time. And sometimes, you know, you see a keyword, mental health, and you wonder, Is that the right course for me as a pediatric or as a school based OT? And internally, you kind of go through the thought process, right? You try to look for keywords. And if those keywords aren't there, you, like you said, kind of assume maybe it is for therapists who work in a mental health facility, and that isn't always the case. I mean, we all, like you said, we all have our own mental health. We all have to take care of our own mental health, and and other people need help with their mental health at all ages. And so I like that you said that, that you know, we can at all areas, that all parts of life support clients in their mental health. So awesome. Now, when we were planning for this, you said something that really captured my attention, and trauma informed care has been a buzzword for a while now, but you took it a step further, and you use the term trauma responsiveness, or trauma responsive. And so I wanted to give you a moment to kind of talk about just those two terms in general and how they relate to each other, or maybe how they're a little different.
Varleisha Gibbs
Yeah, great question. So for me, I was really intrigued when I started hearing about this thing, trauma and trauma informed care. I knew of trauma, you know, growing up in in the area I grew up in, and having some wonderful services that were available, resources available to me and other children in a neighborhood. And so I've heard about it, but I never quite heard it professionally until recent years. And so I was really intrigued. What is this trauma informed thing? And so the more I learned and the more I explored, I realized that, wow, this relates to the work that I've been doing. You know, all along, talking to a colleague, you know, she had expressed some interaction she had with another therapist, some of the intervention strategies that they were using. I'm thinking, this is what I've been using. And so, you know, it was really exciting to learn that we were already been doing that work, but a lot of the work had been and especially in the schools, and we can specify school based, there is a lot of attention, and and I would say trainings and support by the social workers, school psychologists, not occupational therapy. Just from my anecdotal view, I can't say for sure, but just from my experience, occupational therapy was not part of that conversation. Their trainings really were about this is what trauma is, and how we could be aware of it, acknowledge that it can exist, and be careful, kind of of how we interact, how we engage. Even speaking to one of my colleagues, who's a social worker, who really appreciates that self regulation, sensory piece that I work on, and she loves, you know, some of the content, you know, said to me that this is really. An area for OT and we're not seeing that, that interprofessionalism And so talking with her and her experience within the schools, I said, you know, the difference for me would be that you are informing. That's the first step, right? Because this is like a school wide initiative, parents and caregivers and teachers alike should all be informed that what trauma is, how it could impact us, and that it exists, and also do some, take some measures to make sure we're not re traumatizing, that we're providing support. As occupational therapists, we provide intervention services, right, direct services, or even at that you know, the different tiers and universal services, we need to be more responsive. That's what we do. We do occupation right? Occupation is about the doing and the being, and we need to make sure that we're not just informed, but that we are addressing trauma in a responsive manner as we would with any other condition or diagnosis that we work with, we wouldn't just be simply informed about a CVA or stroke, right? We would have to respond to the needs of that client with the stroke. And so I really wanted to highlight it for us in other professions, for example, even PT, you know, we don't like to double ourselves all the time, but you know, even our other profession, speech therapy like they need to recognize that they we need to do more responsive work as it relates to trauma.
Jayson Davies
Yeah, and I can speak to that type of training. I can remember about, probably about five years ago we had a trauma informed training at my school site. You know, we learned about ACEs, the adverse childhood experiences, if I'm recalling that correctly. And you know how, if there's so many, then you know that that's not great for the child, right? But we didn't really get the Okay, now what? What do we do beyond that? And so that's great to hear that you're kind of going above and beyond that first part that you know, being informed is great, but let's go on to the next part, what can occupational therapists do? And so I'm excited for that, because the title of your book is actually trauma treatment and action over 85 activities to move clients toward healing, growth and improved functioning. So it's not just about teaching them or teaching the OTS to read this book about informed care. It's about telling them here, here's 85 activities that you can actually do to help a student's mental health. Awesome. So, getting into your book a little bit, you speak about five dimensions of trauma. Could you elaborate on those a little bit?
Varleisha Gibbs
Yeah, so. And let me also preface this by saying the book is interprofessional, but you all know I had ot in my mind. You can't get away from that, right? And so, you know, when you are looking at trauma itself, I have to, I guess, give accolades to I'm trying to think your Body Keeps the Score. It escaped my mind for a second a wonderful book on trauma that talks about trauma living in the body, okay. And so when you think about trauma living in the body, that there is a physical aspect to someone's experience with trauma. And so I took that thought process in terms of looking at a framework, if you will, almost in terms of trauma being trauma responsive to better understand that it is something that is neurological, that is connecting to our nervous system, as well as there will be physical elements right that exist in terms of someone that's experienced with trauma. Now, not all, not all the time. You know, we all cope differently. Just because you're exposed to trauma or adverse experiences does not mean that you're going to your quality of life, for example, would be impacted. And so, you know, I started off thinking about the structural trauma, right? So when I say structural, you know, the structures that are actually part of your nervous system, that there are actual and people give the amygdala a lot of attention, because, you know, the amygdala is really connected to that, the fear and the emotions, which is great. However, the amygdala is not the only structure you know that is impacted by trauma. There's others. And so in summary, because don't get me on my soapbox of neural because I could wear all day. In summary, you know that those structures in your brain, as well as the neurochemicals, start to change based upon those lived experiences. Hence, I almost see it as micro, almost micro brain damage, if you will, in certain aspects. And so the structural trauma of the five dimensions is just that, you know that there are actual structural changes that occur in our neurological system beyond just the brain, but neurologically. Yeah. If that makes sense, yeah, and then yeah, okay, the other piece, right is the physical. The physical piece of it, as I mentioned the book, The Body Keeps the Score. That really talks about those, you know, the element of physical stress, the sympathetic nervous system really constantly being on watch, kind of like that watchdog waiting for things to happen. And we know when that occurs, you're going to have, you know, stress hormones, neurochemical reactions that are really impacting your body, even wreaking havoc on your body. I experienced children and even family members that had back pain at very early ages, and with is kind of that idiopathic pain, right? There isn't any reasoning why they would have this. They don't have jra, juvenile rheumatoid arthritis or anything like that. And so I started reflecting on that, as well as the children that I encounter that would do different things that may appear to be ticks, right and but they weren't, and they didn't have Tourette syndrome, or, you know, anything like that. And so researching trauma, I realized that a lot of those, the physicality of it, was connected to the adverse experiences, especially when it was pervasive. Which brings me to another of the five dimensions of trauma, which is complex trauma, right? Which happens over time? That is, it's pervasive. It's repeated. For example, someone living in a low income area or unsafe neighborhood, or an abusive, you know, relationship with a caregiver, would be examples of complex trauma. So I think I named three. So the next one, I think, would be intergenerational trauma, which And mind you, there the beautiful picture, and there's certain orders I'm just I'm kind of just giving it organically as I'm speaking. So intergenerational really speaks to how our loved ones experiences or our cultural experiences can be passed down through generations, whether it's stories, stories about enslavement, stories about those who are Native American Holocaust survivors, all those are examples of cultural trauma that we all get to hear sometimes, right? And you're exposed to it, but when it's within your own culture that exposure can impact you over time, and so that would be what we call vicarious trauma, in a way, or hearing stories about abuse or traumatic experience from your grandparents or your mother or father vicariously you then are impacted by it, in a way. But the other piece of it is epigenetics, that we carry trauma within our DNA. And there's a lot of research for those who are the ants or descendants or ancestors are met were in Holocaust or enslaved people, that there are actual there's actual proof that there's genetic changes that occur based upon those experiences. And so there's an aspect of the the book that goes into intergenerational factors, and also how you can do some family mapping, especially if they're if this is an area of work for you, you're working with clients with trauma, and you have permission to do this great way, to take family history and almost to better understand what you're seeing. Um, when you hear those things, I've done it for myself, and I better understand who I am and why I react in certain ways, whether it's through the vicarious kind of training of my caregivers, or also that epigenetic piece, as I mentioned. And then lastly, social and you have social and community trauma. Really looking at that social and collective, I should say trauma that we've all experienced through the pandemic will be the perfect example of that collectively we've experienced that, but socially, there are different aspects. For example, some that are in marginalized populations experience this trauma differently within their society versus everyone as a whole. So that's the five dimensions of trauma kind of just redefining what it is. It's not just PTSD for those who have been in war and return home.
Jayson Davies
Gotcha. Wow. And just to kind of recap, structural, physical, complex, intergenerational and social and cultural, those are the five dimensions that you kind of talked about in your book. I want to go back, actually, to the intergenerational. Because, as you mentioned, you know, the book that has been an influential book, The Body Keeps the Score. I mean, that goes beyond the body, Keeps the Score. That's like your ancestral line, keeps the score right. I mean, you're showing, or studies have shown, that we almost passed down some of our anxiety, some of our just mental health, in a way, I want to ask you this, and this is a little. Off the cuff, maybe you do, maybe you don't. But do you know of any authors, any books for someone who might want to learn more about intergenerational complexes, and I guess just this area of work, do you have any authors or books or journal authors that you might recommend
Varleisha Gibbs
trauma? I was going to name my book.
Jayson Davies
any other books, obviously we need to get trauma treatment, right. I
Varleisha Gibbs
would say Dr Joy DeGruy, and the spelling of her last name is escaping me at the moment, but she talks about, I think she calls it post traumatic enslavement disorder. So her work is specific to the descendants of those who are enslaved, but certainly the research and the messaging is similar in terms of how it's passed down. And there's another author, and I cannot think of her name at the moment, but her work, if you were to Google, is specific on she really looks at those that were in the Holocaust. And so if you look up epigenetics, Holocaust, her, she doesn't really have a book. This is a lot of research articles, and there are some publications that aren't as heavy in research. So if it comes to me, I will give you her name, but I would definitely start with Dr Joy DeGruy, and I will say I have cited a lot of those individuals in the work that have done that research. But very interesting topic, very interesting.
Jayson Davies
Yeah, I can imagine diving deep into that you're you're sure to learn a lot. Thank you. Yeah, and for anyone listening, we will find all of these pieces together, all the books, all the authors, and we'll put it into the show notes. So check it out there. Even if we can't recall the name on the podcast, we will be sure to grab it, find it, and put in the show notes, so check it out there. All right, so we just kind of talked about the five overarching dimensions of trauma, kind of more in the academic sense, in a way, right? We kind of broke it down into what it is. But how do you see this playing out with the children that you work with. How have you taken this knowledge that you have and implemented it into action in.
Varleisha Gibbs
your otschoolhouse being in a clinic, one of the the last, I shouldn't say the last, but one of the, the biggest events that I could relate this to has to do with some advocacy work I was doing with a family, with a young man who was having severe challenges within the classroom, as they would call it, and anyone that knows me, I define behavior differently, but as the school would call it, he was a behavioral child, and so during those encounters, we had a lot of discussion about him choosing to not do, making a decision, a conscious decision, to not follow the rules. And the justification was, will we seen him do it before he's capable of doing it? So when he's not doing it, he's choosing not to do it. And so my job was to, for one, have them acknowledge the trauma, which is one of the hugest pieces of trauma, informed care, right? And that's actually where the action approach starts with. A is about acknowledging and being aware of the trauma, and so telling his story. And without that story, the individuals that were, you know, challenged by him, challenged by what he was presenting, didn't understand the source of it. And once I got them to do that, then yeah, I can explain further about structural trauma. What does it mean to have those structural changes in your brain? So if you had a child that you knew, for example, had seizure disorder, brain injury, right? Or, you know, some other diagnoses, you would kind of give them a little grace, right? You know, I understand this is, let's give them some more support if we need to do A, B and C. Well, this child had an IEP, left the school district. Left the school district. When he returned to this school, they refused, or had neglected, to give him an IEP. But if he had a diagnosis right that wasn't simply Oppositional Defiant Disorder, then maybe he would have had an IEP and his services that he needed. So back to your original question. For me, it's a way of reminding ourselves of what does this really mean? It's not just simply someone stressed out and having poor coping skills and so they're just acting out. No, there's actual neurochemical aspects of it. There are changes from a child like him that has been exposed to trauma from in utero that we the expectations have to be realistic with him, and perhaps the setting may not be appropriate for him as well. And so when you're looking at that, it's really helping you to better frame realistic goals, right? That you know that's this part of having our smart goals that we need to make. Sure that you know that they're really supporting the needs of that child, and they're not going beyond what they're capable of, and not just that they're not capable of it, but they don't have the support in that moment to optimize right their their performance. And you know, with this child, you know, really thinking back to the things that he experienced, that I could form, formulate goals that are more about, and we'll get probably, I think, right to the hierarchy. I'll talk about that in a bit, but not at that level that he was at. We would call that, almost like brainstem level function. He was reactive based upon his trauma, based upon those structural changes, based upon the physical things he experienced, he reacted to things. That means that talk therapy is probably not going to be best for him, and I need to do more sensory based approaches to support him.
Jayson Davies
Oh, wait, okay, I want to expand on that part a little bit, because, as we mentioned previously, you alluded to, you know, there's a lot of trauma informed care for counselors, school psychologists, and maybe they're also getting kind of the what to do next through more counseling psychology perspective, OTs aren't necessarily getting that what to do next. We're getting the information right, what to look for, but not what to do next. So before we dive into the next question I want to ask you, how do you kind of see the difference between maybe how a psychologist or a counselor might address mental health with a client, as opposed to how an OT might address mental health with a client?
Varleisha Gibbs
Yeah, and certainly there may be some overlap. For example, if we use some breath work and coherent breathing, diaphragmatic breathing, right? Could be an overlap, but the biggest difference for me is really tapping into the body, preparing them for occupation, for the occupation of living. That's our job, for OTs and OTs as well. We don't want to forget about our our OTs, right? And so our job is to allow them to be in a space you know, to be able to do the work, to be able to learn, and so we need to do, as I said, more hands on, responsive treatment and intervention so we have an understanding of neuroscience and neuroanatomy. All of us have been trained in that, even if we may need a refresher so we understand better what fight flight means and what happens right to the nervous system. We understand threshold and so how we can address those needs first, so that they can be available then maybe for that talk piece of it. And so I stress the use of and I don't specify any theory, but sensory based approaches that allow the body to get to that state so that they can be available. That's the word I was looking for, to be available, right to engage and to provide for themselves, to do self care. So I would work with a lot of kids in the schools and what? What do we always hear handwriting, right? And so some of the children that I saw didn't need any real work on hand, on graphomotor skills. They needed me to allow them to feel safe. That's the first thing. So occupational therapy techniques and strategies can allow them to feel safe and empowered by being able to provide for themselves.
Jayson Davies
You are, in my mind. Dr Gibbs, I was just going to ask you a follow up question, and you answered it because I was going to talk about, right, we've all had those students where you pull them out one on one, and they've got the skills. They they do it, and then they go into the classroom, and, you know, the environment's different, and they don't have it. And I'm not saying the answer is always mental health, but that could be one of the things that we should look at when we see a student doing one thing in an individual session, but then not quite the same quality of work once we push into the classroom, potentially. And we've all had those kids, and so that's definitely something we could look into.
Varleisha Gibbs
Right? And, you know, Jason, to your back to your original question, one of the biggest differences, I think, from that, we stand out. I really don't know any other profession that does this. We look at the person, but we also look at the context and environment. Who else will go into the classroom and say, You know what? He can tie his shoes with me, because I dim the lights and open up the curtains and I we sit on a nice fuzzy rug that he enjoys. You need to make some changes in the classroom, and then maybe we would see him being able to perform the same way here. Let me help you with making some alterations to, you know, the flooring and the lighting and the seating. Who else does that? I don't know anyone else, except for occupational therapy, so that, to me, is a vast difference, right, in terms of supporting your needs?
Jayson Davies
Yeah, absolutely. I love tangents sometimes, because that's when some of the best things come out. And so speaking of tangents, now I can't remember who I was having the conversation with, but we actually. Talked about the stressors of school in itself, and how some students who have a disability more of a visible or invisible disability, they have gone through education very differently than a lot of their their peers, and they've gone through occupational therapy once a week for the last, however, many years, they've had speech once a week or twice a week or three times a week for the last so many years, ABA, the you could go on and on, psychology counseling and even that itself can almost be a little trauma inducing, having all those different services and whatnot. I don't really have a question here, but I wanted to open that up to.
Varleisha Gibbs
You, yeah, I talk about the intersection of trauma and diagnoses a lot, because that is exactly what you're talking about. That is it's one of those things that goes a little unacknowledged. We don't acknowledge that children that in adolescents and even adults, right? Let's say we'll use autism as an example. Have experienced trauma based upon their diagnoses itself, based upon the social piece of it, so the social trauma, but also the complexity of their day to day. And even when it comes to those children that are oppositional, as they like to define them, I don't choose that that word, but they're oppositional. They have experienced physical trauma, even with when we're talking about restraining things to that nature, including the caregivers, they've experienced their own trauma, as well as having a child that has either a visible or invisible diagnoses that they've been dealing with for decades. Some some of them right. A lot of the children I worked with were from the age of three to 21 within the school, so these parents have gone through a lot and the trauma also, let's talk a little bit about those who are receiving services. But, you know, they get to the point where they, they're, you know, services are no longer. They're going to go to high school, and maybe there's a consultation, maybe there's not, you know, the trauma that goes along with that of this huge transition, and typically you don't see the OT OTA at the table for this transition of care, and also outside from high school then to the real world, that we need to be more involved in that process.
Jayson Davies
Yeah, absolutely. And you know what I have been pounding my fist on the table that that needs to change. OTs need to be at the table when we're talking transitions. We had an episode on it just a few episodes ago with Justin lundstedt talking about transitioning from middle school to high school and then even into junior college or just beyond, right? And yeah, OTs need to be, to be at that table, both from the Mental Health sense, but also just from the physical skills and and all the other different occupations that that kids, young adults, and eventually, adults have to do. So yeah, thanks for touching on that. All right, kind of back to back to where we were going. You actually mentioned the hierarchy already, and I wanted to ask you to share a little bit about the seven level self regulation and mindfulness hierarchy that you talk about in your book. You have so many helpful charts in there. Yes, we did buy the book so that we could look at everything, but and everyone else should as well. But if you could share a little bit about that hierarchy, it'd be great.
Varleisha Gibbs
Absolutely. So the hierarchy started with as the title states self regulation, mindfulness, right? So it started in that that book self regulation and mindfulness, and when I got to do the work on trauma, I decided to expand upon it. Because I often, if I did a workshop, would get questions on, you know, how do I use this for, you know, helping me with my goals, treatment interventions. How do I didn't take this to align with what treatment intervention I should do, and we know that we're not prescriptive, like that's that's just not what we do. But having some guidance in that was something I wanted to do based upon the feedback and questions that I was getting. And so the hierarchy really is based on Maslow's hierarchy of needs, and it talks about how, you know, one's basic survival is the foundation of everything, and so you have despite diagnoses, because that's also one of the objectives of the hierarchy, is to eliminate that Need for diagnoses, and how we align intervention based upon diagnoses. We should be looking at the individual. And so it allows us to look at where they're at with their self regulation and how they, you know, the based upon the foundation all the way up to the top, how they progress and how they could grow towards being more mindful and more present, that can then help them with their, you know, with just engaging and with their occupations. And so we start at the base, at level seven, all the way up at number one is hopefully where most of us are, where we're mindful of, you know, our self regulation, as well as others, and the needs of others, and how we can support others. So. I acknowledge that it's, you know, it's not like one is good or bad. It's just where you are, you know. It's just where that person is. And that growth could happen at any moment. Despite the child that may have a severe diagnosis, they can still show some growth on that hierarchy.
Jayson Davies
Gotcha. So we're starting kind of with that base level, kind of the things that every single person needs. And then building up to where the top of the pyramid, or self regulation, self actualization, potentially in there a little bit to help people, so to help the kids in particular, we're talking about school based OTs, all right, so moving on from that hierarchy, then within the title of your book, you capitalize action. And so action has a big emphasis, and I'd love for you to share a little bit about what a C, T, I O N really stands for, and how you use that in practice,
Varleisha Gibbs
absolutely. So that is really guiding the program right from the beginning all the way through to how you're going to address trauma in your own practice. And so a is about acknowledging the trauma, and then you know ways to really assess for that. Now, the book doesn't have standardized assessment tools within it. It has some listed that you can utilize on your own, but really screening tools that are available for assessing trauma, as well as assessing your own preparedness to address drama, whether you need a referral out, or if this is something that you could address on your own as a practitioner, the C is about creating growth, and so creating growth is the way I like to look at what's our goal. And our goal isn't necessarily to heal. That's great, but there's a lot of weight right, and onus on the person. When we say heal. And so I say, in any moment and any day, we can show aspects of growth. And so we focus on growth, and there's ways of having growth charts and things like that available to be able to look at that. And then we look at teaching. And so as I mentioned in a story about the teachers that were working with that child that had experienced a lot of trauma, teaching them about the neurological aspects of trauma, teaching children about their brain. I use this wonderful video. It's not one of my owns when I found that shows how your experiences can actually make changes in your brain, that you don't have to be, you know, this person that is that has ADHD, that doesn't have to define you, that you can make growth and really improvement in your life based upon basic activities and things that we can do in in therapy and so really teaching that aspect of it is very important. And then when you look at the, you know, we talked about the intergenerational factor, so we had a nice conversation about that. So that's that next area of the action. And we also go into, you know, the L with looking at organizations and systems. And so that is really, really important, because we need the rules and the guidelines and supports within the general environment to be able to really do optimal work, and so I can, you know, pull out of the classroom as much as I want push in, but if I don't have the support or the resources, then how am I going to do that? This also speaks to the work going into not just pediatrics, but looking across the lifespan. And so that really is geared towards also, how can you support people within the work environment? How do you look at burnout, caregiver burnout, or workplace burnout as a form of trauma? So that's you know, that chapter is really expanding into just kind of different practice settings and population almost population health as well as community health techniques. And then lastly, the end is a call to action. It's now is the time for us to address trauma, and so it's really speaking to where are you within your work, reflective practice, how you can assess where you are as a practitioner. What things do you need to do to improve upon your work when it comes to dealing with individuals with trauma, and how do you acknowledge your own trauma? Is that last piece of it is really vital before you even consider Dawn care. So way back in the beginning of the book and a there's charts to be able to do a practitioner readiness checklist is available. But before you close the book, it's kind of that reminder of, okay, now that you got all this, what are you going to do with it?
Jayson Davies
Wow. And so kind of narrowing this scope down to school based OT, I feel like there's a few different ways that you could go about it. Maybe you want to start with one and then branch out to others. But in school based OT, you often have more of the individual side of things, one on one therapy. You have the smaller group side of things, you know, you with maybe three, four kids, and then you have the large scale RTI approach, right where you're providing training to maybe a few different grade level to. Teachers or the entire district, if you are really into RTI and you're in your school district, do you feel like this caters more to one of those particular types of intervention, or do you feel like it's just it can be broad, and it really lends itself to each part in a different way?
Varleisha Gibbs
Yeah, I think it does lend itself to each part. Certainly, there are a lot of techniques that are geared to one on one, and so the worksheets that are available really do highlight if it's something that the practitioner would do in terms of observation or support, or something that the client is expected to perform in a one on one session. So there is a little bit of both of that within each aspect of the work, the work in terms of the separated within two parts the act, and then the ion is the second part of action. So the two parts of the book really highlight the need to do all of that, and so I think it's important to acknowledge that we do need to do more universal approaches, and it's also an opportunity for our profession.
Jayson Davies
Yeah, yeah, definitely. And that's actually a great transition to this part of our of our conversation, because we alluded to this earlier, right, talking about OTS sometimes have this perspective, or just the general population, when mental health is is discussed on the news, right, instantly they go to talking about counselors. They go to talking about psychologists. They don't talk about OTS. And so OTS sometimes have a sense. Or OT practitioners, all of us have a sense. Well, wait, I don't necessarily know mental health. Maybe I had a few weeks of or maybe even an entire term back in college 1020, years ago, but I haven't done much more beyond that. I don't know what to do for mental health. What do you say to those ot practitioners who aren't quite sure how they can support mental health or even if they're able to.
Varleisha Gibbs
And that's understandable. I mean, I would say, of course, we want to make sure that we are doing our continuing education, because it doesn't stop when you know you finish and you get that degree and you pass your boards, it continues. So that's where that readiness checklist comes into place, because there may be gaps in your learning that you need to expand upon. But I would challenge them to really reflect on what we do in general. We're not simply helping someone that has, you know, physical disability get up to, you know, have better balance and to walk and, you know, to even just simply dress themselves, but we're helping them with that psychosocial aspect of, how do we address that? If they have anxiety, you're doing that work, right? So if you have a client that has anxiety and they don't want to get up to do, you know, an ADL with you because they're afraid of falling What do you do? I bet you do you do something to prepare them first before you get them up to do that activity. So for sure, you're already doing this work. When you have to work with, you know, a child that is expressing some aggression or frustration or fear, that you are doing something to prepare them for your session so that you're not getting rice thrown at your head every time you engage with them. You're already doing this work. And so one of the things that we've done at aota, I'll put that hat on for a second, is that we have developed a tool resource that looks at mental health and nine non psychiatric settings, and it does exactly what you're talking about. So there's a block on school base that talks about how you address mental health in schools, just in general, and everything that you know you do on a daily basis. And so you can get out a pencil and a paper, a pen. I encourage everyone that's listening after you're done in this podcast, write down how you're addressing mental health in your own time and again. I'm not necessarily talking about diagnoses, but how do you address mental health? How are you supporting caregivers? How are you supporting the teachers that are stressed out within a classroom? I bet you you're doing a lot of things that you are trained in and based upon your training and psychology based upon your training and human development that's addressing mental health already.
Jayson Davies
Yeah, yeah, absolutely. I mean, I have done that kind of exercise before, and really, I think it came out of a result of another podcast, but kind of looking at my practice and just seeing, where do I address mental health, and sometimes that's in that that three minute walk from the classroom to the OT room and having a conversation with the student. Sometimes it is with that teacher event session during lunch, whatever it might be, you know, just telling them that they are doing a great job, even when they don't necessarily feel like it. Sometimes it's with the parents before, during or after. An IEP, just sitting with them and really hearing out their concerns and and, you know, you talked about caregiver burden and caregiver stress. That's a real thing, and we have to remember that when we're in an IEP, you know, we we talked about how difficult it is sometimes to be the OT or the SLP or the or the administrator teacher in an IEP, but it is, I'm sure, darn hard to be the parent in an IEP, and so remembering that they're going through their own things, and that we could be a stressor for a stressor to them, I guess, or one of their stressors during that 60 minute IEP, three hour IEP, and we don't always remember that, and we need to keep in mind that we're supporting their student and we're doing the best job that we can do, but we also have to be mindful about their own mental health and how they are perceiving the IEP process in itself, because too often IEPs go downhill fast because of poor interactions between the district and the parent, and in a way, that's causing stress for everyone, which is good for nobody. So let's keep that in mind.
Varleisha Gibbs
And you know, as you're speaking, I could assume which I try not to do a lot of, but it seems as though you have reflective practice, and that's one of the reasons why. And I could be biased that I think in those meetings, a lot of times, I'll hear from parents and even family members that have OTS. I love the occupational therapist. I love the OTA, right? I love them. And why? Because, you know what, we have that training we can that we understand how validation of someone's experience is important, and not to say that other professions don't, but that's a huge part of what we do. That's the that's the mental health training that we received when we were in school.
Jayson Davies
Yeah, absolutely, it is funny, because that is often the case, right? The OTs, or the parents often do appreciate the OTs, and I kind of want to go to the different end of an IEP, right? What actually goes into the physical IEP, and that's goals. And the last, you know, maybe 10 minutes or so, we've really talked about bigger picture, supporting the teachers, supporting the students, supporting everyone. But when we get down into the the individual part of this, working with a student, is it out of line for an occupational therapist to create more of a mental health type of goal within an IEP. Or I'm sure you're going to say absolutely not, right? We totally can. But if OTS are feeling that pressure from their administrators, do you have any advice for them?
Varleisha Gibbs
Yeah, and this is it's a struggle with that, because I would say yes, absolutely. They also understand, you know, the challenges with that. I personally would put goals that related to communication back in a day, and I would get told, that's not your lane, you know, that's the SLP, stay in your lane. I'm like, No, it does pertain to this specific activity that you know. So we understand that sometimes there is that pigeonhole based upon a district or, you know, the director of special services may not always agree, but if we don't start to use that language that relates to mental and behavioral health, then we will continue to not have that seat at the table. So we have to find a way to use the language, but always remember, connect to scope of practice. And what is our scope of practice? It's occupation. It's occupation based, right? And so as long as we are tying it to that, then we're able to certainly justify a goal. And remember, we're the experts of our profession. You know, I don't care if someone has a PhD in another discipline, we are the experts of occupational therapy because we have that background and that training. So that's where advocacy comes in. Advocacy is great on the hill. It's great with our congress people, but it starts, you know, at that level of really justifying what you're doing and how it is within your scope of practice.
Jayson Davies
It's funny that you talk about that right through the advocacy, even through like an IEP and as you're saying that I've just recalled over the years, you know, 10 years that I've been a school based OT, what I have been known for personally on IEP teams has changed. And at one point it was Jason. He's the OT he's really understanding of, like, assistive technology. If you need an app on an iPad, go to Jason. But then over time, it's evolved a little bit, right? Originally, it was handwriting, because that's what I that's what school based OTS. We really start right? We list, like, everything's handwriting, but you start to shift around. And the more you talk about something in an IEP, the more you talk about it with the teachers at lunch, the more you talk about it after school with parents, whatever it might be, the more that people are going to remember you when it comes time to talk about mental health for their students. So even just by. Talking about mental health, talking about how you can support students in general with mental health strategies. You are slowly going to become known as a mental health expert, not because you have newfound knowledge, but because you started to talk about it more and advocate for yourself a
Varleisha Gibbs
little bit. Absolutely. I love that. Love that.
Jayson Davies
Great. Well, we're going to wrap up here in a bit. This conversation has flown by. Thank you so much for being here. But before we do, you mentioned aota a second ago. You talked about a mental health capacity form that they have right where you can go on and and kind of see examples potentially, about how a school based ot interacts in mental health. But what else is aota doing with mental health? I know there's a conference a few weeks ago, or maybe just happened, I don't know, by time this episode comes out, it'll be about two months ago, I believe. How was that, or what was, what was the response there?
Varleisha Gibbs
That was great. I didn't attend. One of our team members attended, you know, really, to kind of carry some of the work our group has been doing, and they had just a wonderful turnout. Registration was higher than expected. Student registration was higher and, you know, really, I think it reinvigorated the passion for mental health. And so it's a it's an exciting time. So that mental health specialty conference, I think, was kind of not just anecdotal data for us, but that, you know, quantitatively, we're seeing in Numbers, numbers, an increase in this area, and really an increase in mental health across practice settings, as we've been discussing. And so that's one thing that we've been doing. But as as a whole, in terms of across the association, we really put a lot of attention in this area, not just the resources that I mentioned, but there's also now a web page mental health and well being. So think the easiest way to find it if you Google aota mental health and well being, there is a page that we have just curated recently that really talks about a lot of different areas of practice and connects you to a lot of our resources within the practice team. And so that's going on. We also have worked with Jenny Stoffel, and a lot of you are probably familiar with Jenny as one of our past presidents and other titles within aota in terms of her work with the board. In other areas, she's now working with wolfet being a representative, and she has done so much work in mental health over the years that we knew when we started to delve into pulling members together that we should have her support, and she has been great in terms of volunteering her time. So we have a group that we call a micro volunteer group that has come together to really address what's called 988, and 988 if you're not familiar, is this. It's a number like 911, but it's specific to mental health support. And so you can look at our website, aota, 988, as well. And I can go on and on. We have members stepping in. We have presentations you can download, go to commune. OT, our commune. OT, page for 988, as well as the mental health. Sis, if you click on joining that commune, OT, you'll be part of that conversation about some of the meetings that are coming up. We have another one that's meetings that we are planning for inspire in April, and so you can get involved in a lot of these initiatives we have going on.
Jayson Davies
Great, great. You know, that's so much, and I'll give you, I'll give you the chance now to just kind of share, where is the best place for people to learn more about you and your initiatives going forward?
Varleisha Gibbs
Sure, I guess the best place would be@drvgs.org I'm also, I'm trying to do better with social media. I have ebbs and flows, but I totally understand. Yeah, I'm on Instagram, probably more so, but I'm also on Twitter and LinkedIn. I like LinkedIn. It's a little less intimidating for those who grew up in the 80s, but you can find me on social media. I'm, you know, once you get the spelling of my name, I don't think there's another Alicia out there. So you can find me on social media platforms and as well a OTA on our website, you can reach out, especially what it has to do with some of the work that I mentioned. Feel free to email me there as well.
Jayson Davies
Sounds great. Dr Gibbs, thank you so much for joining us today. We will make sure to put links to all of those different resources in the show notes, so they'll all be in one place, easy to find for everybody. And yeah, just I really appreciate you coming on to share with us a little bit about mental health and how OTS can support the mental health of their students and also faculty we talked about today. So thank you so much.
Varleisha Gibbs
wonderful. Thank you. It's been a joy.
Jayson Davies
Please help me one more time say thank you so much to Dr Gibbs for coming on and talking about trauma responsive care. Such a pleasure. Having her on she is so well versed in trauma and supporting students or people of all ages who have gone through trauma. So thank you so much. And please, please, please, feel free to check out Episode 115 show notes at otschoolhouse com slash episode 115 to see all the resources that we talked about today with Dr Gibbs, so thank you so much. Dr Gibbs, thank you so much to you for listening to Episode 115 of the otschoolhouse com and we will see you back soon for Episode 116 Take care. Bye.
Amazing Narrator
Thank you for listening to the otschoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse com Until next time class is dismissed.
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