In 2021, amid a global pandemic, a national reckoning on racial justice, and human and environmental devastation from the opioid epidemic, gun violence, and climate disasters, Harvard Public Health published a feature called “The Age of Trauma”. In that feature, they describe these times as “the age of syndemics”, a theory that first emerged in the 1990s during the AIDS epidemic as a way to examine how social ills and medical illnesses collide. In other words, we are again living in a time when those who are most adversely impacted by social ills such as poverty, systemic racism, and trauma, are also most vulnerable to diseases such as COVID. These syndemic times are devastating for our most overloaded families, which in turn puts even greater stress on the people who are serving and supporting them. In our mental health, child welfare, and family well-being systems, vicarious trauma, moral injury, and burnout have become more prevalent during the past few years as professionals were exposed to not only human suffering but also the impossible decisions as to whose suffering took priority when their resources limited their ability to meet everyone’s need. These past few years have also exposed the lack of diversity and representation in our workforce, which led to a movement of Diversity, Equity, and Inclusion in and across organizations and systems. In the face of these challenging times, how might we begin to address the long-standing underlying root causes of these syndemic times that overload families and, in turn, burn out our workforce? How might we create a workforce that is authentically representative of our communities, while also nurturing a work environment that honors and elevates the lived experience of our workforce? I invited Tim Grove to help answer these questions by sharing his expertise and understanding of the impacts of trauma and moral injury within the child welfare system, and workforce culture through Diversity, Equity, and Inclusion and trauma-informed care frameworks.
Host: Luke Waldo
Experts:
:00-:33 – Tim Grove - “If we don’t fundamentally address equity, we can do all the trauma-informed care work we want quite frankly, and it probably is going to be the equivalent of making somebody feel a little bit better at the moment, but they know the world that they are going to step into when they leave the clinician’s office, or when they leave the case manager’s office is going to be full of threat and oppression. So Joy DeGruy says it quite beautifully, “Stop the oppression.”
:42-4:48 – Luke Waldo – Opening and Introduction to Tim Grove
4:53-5:16 - Luke Waldo – What are the biggest challenges facing our workforce today?
5:17-11:09 – Tim Grove – Unpacking the stress of the past 3-4 years has to be in the top 5 list. There was already a developing mental health crisis before the pandemic. If kids are our canary in the coal mine, then it has been clear for a while that. “Trauma is to mental health as smoking is to cancer.” A case manager, a child welfare worker has great exposure to trauma in their work. Families are impacted when they are reassigned to new case managers when their case manager leaves.
11:10-12:09 - Luke – What is moral injury, and how does it impact our workforce?
12:10-17:08 - Tim – Veterans of war have taught us so much about trauma and moral injury. Moral injury occurs when you are in a situation that compels you to complete an action that conflicts with your moral beliefs. In the case of child welfare, it may occur when a case manager has to separate siblings due to a shortage of placements.
17:09-19:42 - Luke – How do we understand and approach our workforce’s lived experience, particularly their own adversity, and how do we support and empower our workforce with what we know now?
19:43-25:08 - Tim – What do we mean by lived experience? Developing a shared definition could be a good place to start. How do we leverage different levels of expertise from different experiences?
25:09-27:04 - Luke – How do we identify lived expertise so that they can lean more fully into what they know and are passion about? How does bias contribute to the disproportionality in our child welfare system?
27:05-31:08 - Tim – Trauma can lead to a survival response that leads to bias towards detecting that which causes fear and then avoiding it. If we pair the fear-based bias with race-based biases that exist, we justify our reactions to situations like interpreting a Black father’s loud response to a question as threatening.
31:09-33:20 - Luke – How might the lived experience of our community and workforce inform our child welfare workforce to better support overloaded families and keep them together?
33:21-39:47 - Tim – Parent Partners. We serve 1000 kids, and have 1 Parent Partner. At Wellpoint, we have achieved representation that mirrors the community that we serve. That said, it doesn’t always mean that a Black family is going to be served by a Black case manager. This will require that we have greater cross-cultural understanding.
39:48-41:31 - Luke – How has increased representation in your workforce changed your culture and the outcomes for children and families?
41:32-49:44 – Tim - You can’t talk about trauma-informed care without talking about intergenerational and historical trauma. This pushed me to “do the work”. It struck me when a Black woman came to me during an ACEs workshop to tell me that her community had experience adversity for generations, but nobody paid attention until the adversity was experienced by middle class White people.
49:45-50:19 – Luke – What are some of the pitfalls that lead to DEI failing?
50:20-54:37 - Tim – When opportunities come up to “stay in the room” to understand and confront the oppression that has occurred, too often people step out.
54:38-55:55 - Luke – What policy, practice and mental model changes need to occur to improve outcomes for our workforce and overloaded families?
55:56-1:01:16 - Tim – To manage caregiver capacity, we need to do less while creating more meaning. 60-hour trauma-informed care deep dive. We are asking more while offering more meaningful opportunities to engage their families. “What are we going to do with the guardians?” The guardians are struggling right now, so we need to make some big decisions on how we allocate our resources.
1:01:17-1:03:25 - Luke – Stay interviews in Family Support. What is giving our workforce meaning?
1:03:26-1:07:38 - Tim – No bullshit. They want authenticity in their workplace, which includes being honest about the reality and complexity of our work.
1:07:39-1:08:16 - Luke – What makes you optimistic about this work?
1:08:17-1:11:33 - Tim – I have many moments of worry, but I am optimistic because humans have always rallied to overcome our shared challenges. Many of the strategies to overcome these challenges will likely come from the communities that have historically been oppressed. We have also found innovative ways to confront challenges throughout our history as we will need to in cases of our mental health and climate crisis.
1:11:34-1:12:23 – Luke – What book or author has shaped your thinking?
1:12:24-1:13:03 – Tim – What Happened to You? – Dr. Bruce Perry and Oprah Winfrey
1:13:04-1:13:21 – Luke – Gratitude
1:13:22-1:14:44 - Luke – 3 Key Takeaways
1:14:45-1:16:12 - Luke – Closing and Gratitude
Join the conversation and connect with us!
Tim Grove 00:02
If we don't fundamentally address equity, we can do all the trauma-informed work we want, quite frankly. And it probably is going to be the equivalent of helping someone maybe feel a little bit better in the moment but they know the world they're going to step into when they leave the clinician's office, or when they leave the case manager's office is going to still be full of threat, oppression, etc. So Joy DeGruy says it quite beautifully, "stop the oppression".
Luke Waldo 00:42
Welcome to season 2 of Overloaded: Understanding Neglect, where we explore the Critical Pathways that lead to child and family well-being and reduce family separations for reasons of neglect.
Hey everyone, this is Luke Waldo, your host for this podcast series and the Director of Program Design and Community Engagement for the Institute for Child and Family Well-being, our partnership between Children’s Wisconsin and the University of Wisconsin-Milwaukee’s Helen Bader School of Social Welfare.
Luke Waldo 01:26
In 2021, in the midst of a global pandemic, a national reckoning on racial justice, and human and environmental devastation from the opioid epidemic, gun violence and climate disasters, Harvard Public Health published a feature called “The Age of Trauma”. In that feature, they describe these times as “the age of syndemics”, a theory which first emerged in the 1990’s during the AIDS epidemic as a way to examine how social ills and medical illnesses collide. In other words, we are again living in a time when those that are most adversely impacted by social ills such as poverty, systemic racism, and trauma, are also most vulnerable to diseases such as COVID.
These syndemic times are devastating for our most overloaded families, which in turn puts even greater stress on the people that are serving and supporting them. In our mental health, child welfare, and family well-being systems, vicarious trauma, moral injury, and burnout have become more prevalent during the past few years as professionals were exposed to not only human suffering, but also the impossible decisions as to whose suffering took priority when their resources limited their ability to meet everyone’s need.
These past few years have also exposed the lack of diversity and representation in our workforce, which led to a movement of Diversity, Equity and Inclusion in and across organizations and systems.
In the face of these challenging times, how might we begin to address the long-standing underlying root causes of these syndemic times that overload families and, in turn, burn out our workforce? How might we create a workforce that is authentically representative of our communities, while also nurturing a work environment that honors and elevates the lived experience of our workforce?
I invited Tim Grove to help answer these questions by sharing his expertise and understanding of the impacts of trauma and moral injury within the child welfare system, and workforce culture through Diversity, Equity, and Inclusion and trauma-informed care frameworks.
Tim Grove is the Senior Director of Trauma Informed Strategy and Practice at Wellpoint Care Network, a human services agency whose mission it is to facilitate equity, learning, healing and wellness for all. He has over 25 years of professional experience in a variety of direct care, administrative and executive positions. Tim created, developed and lead Wellpoint’s Trauma Informed Care (TIC) initiatives. He created a TIC training curriculum centered around the Seven Essential Ingredients, or 7ei, of understanding and practicing TIC. Tim and the training team at Wellpoint have used the 7ei framework to train more than 60,000 people from diverse disciplines over the past 15 years.
Tim is also a Mentor with Dr. Bruce Perry’s Neuroseqential Network and a Master Trainer in Dr. Rob Anda and Laura Porter’s ACE Interface curriculum. Tim and the Wellpoint team’s work has been highlighted and published in a number of magazines, journals and newspapers. Tim is recognized nationally as a trauma informed care expert and was interviewed by Oprah Winfrey for a 60 Minutes segment on trauma and resilience.
Tim, thank you again for joining us for this conversation, and for your partnership and guidance that you have given to our team over the years and to our current initiative.
I’d like to begin our conversation continuing our conversation from season 1 in which we talked about the challenges facing our workforce in the child welfare and maltreatment prevention systems. And welcome back!
Luke Waldo 04:56
Thanks again for being here and I'd like to start our conversation today, really from the 30,000 foot level and ask you, what do you believe are the most pressing, the most urgent or the most complex challenges facing our workforce that serves overloaded families?
Tim Grove 05:17
Yeah, I appreciate the question. Let me start off by saying I have a particular bias. In terms of how I view the world, it's steeped in 15 years of some pretty intense learning about adversity, trauma, historical, intergenerational trauma, resilience, recovery, hope, etcetera. So my my comments are no doubt going to be influenced by that particular bias. But it might just be the case, quite frankly, that my bias proves to be quite useful in terms of an objective and objective look at what's happened over the past few years, right. So when I think about this question, what are some of the most pressing issues, I honestly don't know how in a top five list or a top three list, unpacking the past three to four years from a stress and trauma perspective isn't in that list, right. And there's a myriad of ways to think about that. So by any objective measurement before 2020, there were already developing signs, or in many cases, well-developed signs of a mental health crisis. The CDC and many others were talking about data, there was state data, etc. Basically, in my humble opinion, arguing if our kids are the proverbial canaries in the coal mine, they are coming up sort of gasping for air, and in many circumstances, right, whether again, it's suicide rate, or depression, anxiety, et cetera. And I know it's virtually impossible for all of us to think back to pre-pandemic times. But that was before the past three to four years. So my bias leads me to go to the former president of the American Psychiatric Association, who says quite famously, trauma is to mental health as smoking is to cancer, which is not to say that trauma is everything. But it is to say that trauma is a really salient, or big deal or driver or dynamic and mental health presentation. So we start there. And many of us were sort of busy trying to do the work of helping systems and people get trauma-informed, figure out how to sort of ameliorate or mitigate some of those effects. And then 2020, to present came along. And history is going to no doubt offer loads of useful perspective on this four to five-year span and maybe beyond. But from a stress and trauma point of view, the exponential impact is actually almost impossible to quantify. And it even if we could quantify it, it's impossible to fully register. So here's how I think about it. I think about it as one ongoing case manager or one child welfare worker. And I think about the potential ways to sort of consider the impact from their lens. So first thing, their risk of being exposed to a potentially traumatic event went up by four or five times. Beyond that, though, just their general capacity, their mental health, their energy level, their whatever, by some experts, estimates was cut in half. All right, so we've got those two dynamics, which would be enough for volumes of research to be considered by themselves. But then we've got the people they're charged with serving have similar kinds of outcomes for them, which they then bring as additional challenge to that case manager. And not to pile on but if we keep going, every service provider, every collaborative system partner all experiencing the same thing. This is I think, what Harvard public health means when they use the term syndemic times, right? So just one final comment on this what inevitably happened in tons of child welfare systems was after so much of trying to endure that people said, I'm out. I'm gonna go I don't know do nothing or go sell real estate or whatever my plan B is I'm gonna go do win, which is great in many ways for them. But guess what that does to sort of systems for the people that stay, those families get redistributed across the existing staff. And then when you get that snowball effect, and more people leave and more people leave, those families keep getting redistributed. And now you've got the people who are left with all that same load with double or triple the caseload. I wish I could come up with a way, quite frankly, to sort of jump on a table or sort of shake my arms or do whatever, to fully convey just the profound impact of that process, which again, we will not fully understand for quite a while. And as we know, when that happens, everything gets impacted in really significant ways. So again, how that's not one of the most salient sort of dynamics that is sort of influencing Child Welfare practice is beyond me.
Luke Waldo 11:10
No, I think that's a great a great way to frame up the at least the beginning of this conversation, right? And the reason why that we reason why we asked you to have this conversation, Tim, is because you bring that particular lens, right, and that very well-honed perspective on the impacts of trauma, right? The impacts of stress, and the impacts of the complexity of overloaded families lives on our workforce. Right. So I do want to continue on that thread. Briefly here, because in season one, we talked briefly about this concept of moral injury, which has emerged over the last many years. Within our field, can you tell us more about moral injury, what it is, and more specifically, continue that kind of that, that focus on how it impacts our workforce and the families that they serve?
Tim Grove 12:10
Yeah, and it's not lost on me, Luke, that we're not too far away from Veterans Day. And you know, there are 1000, if not a million reasons to pay homage to the sacrifice that veterans make for all of us. Why one of the ones that maybe isn't as fully appreciated, is what they've taught us about post-traumatic stress disorder, and trauma in general. And quite frankly, the pretty remarkable sacrifice that has been born in that context, right? And I say that because moral injury is a term borrowed from the veteran community that had its origins there, as I understand it, in basically veteran saying, Boy, sort of witnessing all that horror and violence and potentially partaking in it is one thing, but struggling to sort of connect, valid or just meaning for what I was doing feels like a different dynamic, right. So that's been co-opted, if you will, and I think in many ways, appropriately so by other disciplines to basically say, when you are in a circumstance as an individual, that that sort of causes you to engage in an activity or an action that runs contrary to your individual values or beliefs, the resulting outcome of being compelled to engage in that action sort of is moral distress. And some would say when that is super intense, or remarkably continuous or repeated, it can progress to moral injury. And that is generally where this term comes. So I'll give you a very specific context in the world of child welfare. We all dream of a world where there are enough resources to meet the needs for every kid and you care, or quite frankly, every family for that matter. But sometimes when we have to remove kids from their families in the context of keeping kids safe, and we have to place kids with other folks, relatives, foster parents, etc. Sometimes there aren't enough placements to keep siblings together. And so what we end up having to do is separate siblings. By definition, that is a requirement of our practice, right? We've got to find a safe place for them to go. There are a myriad of rules that sort of govern how many kids can be placed together, et cetera, et cetera. And so the worker who knows what it is to have to separate those siblings Emotional angst of that, but feels sort of compelled for all sorts of perhaps appropriate reasons to have to do it suffers a degree of moral distress in that act of taking one sibling from another, and sort of placing them separately. And they do their best to mitigate the effects of that ask for both themselves and the kids involved by sort of setting up visitation and making sure there's a lot of interaction, and probably, you know, emails and sort of social media exchange, et cetera. But at its core, that sort of violation of what feels like a fundamental value is how we think of moral injury from a child welfare, child and family wellbeing perspective. And that is just one example. Another, perhaps helpful example, is when I'm in that place of having to cover additional families, because of perhaps the Affer mentioned, sort of syndemic times dynamics, right? And I feel like I want to be able to deliver and give a level of service that I'm not able to deliver. And that sort of discrepancy between who I want to be professionally. And just from a survival point of view, who I'm able to be, is also often characterize as moral distress of sorts. And then again, to the degree that I continue in that fashion for maybe weeks or months, or sort of, in worst case, scenarios, years that can progress from moral distress to sort of moral injury. And what can happen is it can start to look like it's trauma presentation, and it can wreak some pretty remarkable havoc on the individual's mental health, well-being, it just, it becomes quite problematic.
Luke Waldo 17:09
So there are a lot of follow-up questions to what you just shared, in particular, to pivot towards, What do we do about it, right? But we're gonna get to that. And we're gonna finish this conversation on a higher note. I want to start really by elevating and really kind of confronting the many challenges that our workforce and the organizations that employ them face in the current state of our system, and complexity, again, that so many of our families face when it comes to the overload of stress in their lives. So I'm going to put a pin in, what do we do about it, because we're going to get to that later, I want to slightly pivot to the fact that we know that in our workforce, particularly in child welfare, but in many of our quote, unquote, social work fields, there is actually a high number of employees that bring their own lived experience, into, into their work, right. And when I say lived experience, I'm talking within the context of our conversation today, which is to have their own trauma history, or their own adverse childhood experiences, or they've experienced certain levels of adversity that really inform in many ways, their passion and their view of the people that they serve in their work, right. And so I'm curious from your perspective, how we, how we approach with now a greater understanding of that reality, how we approach our workforce, when it comes to their own lived experience, right, because I think I think back even 10 years ago, Tim, when, when, when I was hiring people in this work, there was still this kind of expectation that we would have boundaries around once lived experience, right? You have your lived experience, that's fine. It might inform your work, but make sure you keep it buttoned up. Right, you're a professional, don't overshare so on and so forth. I feel like we've pivoted to a place now, where we are honoring that lived experience. Also recognizing the challenges that that lived experience can bring into the space. I'm curious, from your perspective. How might we approach the lived experience, particularly the trauma histories, and the adversity that our staff bring into the work? And how do we support and empower our workforce? Knowing what we now know?
Tim Grove 19:44
Yeah, I think one of the interesting dynamics that is going on, which is often what happens when sort of there's this organic change process, is the organic change process gets out in front of our attempts to sort of make sense Have it and try to sort of create some parameters for it, etcetera, right? So in many ways to your point, you've got a younger generation of our workforce that is saying, hey, look, this is the world I grew up. I'm used to sort of constant feeds on my social media of all sorts of really distressing things. And, you know, we know, especially looking back at these syndemic times, mainly in the past two to three years that there is a significant increase in sort of people with exposure to and potential resulting difficulties from trauma, right? That's really important, though, because as those numbers maybe go from 10, or 15, or 20%, to 30, or 40, or 50%. There are some fundamental things that need to be rethought. What are the implications of that? And if we use to historically, either subtly, or not, so subtly encourage people to keep that under wraps? Don't talk about that, don't bring that up, if you've got some issues with that that's an HR EAP thing, et cetera, et cetera. I think we have an opportunity to catch up to this organic sort of change and say, how do we start to think about this difference? And one of the ways in my humble opinion to start that is to say, what do we mean by lived experience? So, you know, I'm not aware of a good clarifying definition in terms of what that means. So that might be a really good place to start, or at least for communities that sort of want to sort of kickstart this conversation, to say, what are we thinking? And if we're talking about lived experience, from a trauma point of view, are we talking about people who have been exposed to trauma, but for whatever reason, haven't been overwhelmed by it? Are we talking about people who have been both exposed and overwhelmed? Are we talking about people who've been overwhelmed, and then sort of healed and recovered and sort of gotten to a different place? I would encourage us to think about that much more broadly. And say, how do we leverage different forms of expertise connected to different levels of need? So what I mean by that is, if I've got a medical procedure, there are times where I want the best, quote unquote, expert to treat and care for my medical procedure, right, whether it's a surgeon or whatever, that might mean that I'm sort of matching a certain level of care and service provision to a particular need. The challenge is for me to get convinced that I should go have that procedure. There's probably a place for quote, unquote, lived experience with others who have maybe been through the same experience, maybe who can talk about, oh, Tim, it's not that bad, or it only takes 20 minutes or whatever, then we're matching a particular expertise, that process or lived experience expertise to a particular need in the process of getting good care and recovery. So Right. So I kind of quite frankly, dream of a world where we get a little more nuanced and saying, What is the family's specific need? What is the individual-specific need within that family? And what kinds of expertise are a good match for sort of what particular that is kind of a both-and approach to the expert lived experience sort of conversation, that that in my mind leaves a place for everybody at the table, and in some ways, does a lot to sort of empower those who eat have sometimes look, I don't want to say down at but sort of we've looked at as maybe not being at the equivalency as the professional with expertise. And I would argue if the person's not going to go to the professional for the the expert procedure, then what value is the professional for the expert procedure, which means that lived experience and expertise is on par from a value point of view, with whatever that expert is going to do in that procedure using that medical exam. So in summary, a more nuanced way of thinking about what is the individual need profile and sort of whatever phase of development or change they might be in and how do we match that to sort of different or varying forms of expertise, including lived experience to help create the best outcome.
Luke Waldo 25:10
I want to stay on this idea of lived experience. And I appreciate the point that defining lived experience is still, in some cases, a real challenge, right? Because we may have very, very different perceptions of what that truly means. But I want to look at the kind of the other side of the coin that you were just talking about, which is kind of this lived expertise, right? And how do we identify that and really leverage that so one, that that professional can really lean into what they know, what they may feel passionately about? But on the other side of the coin, right, our lives, our lived experience, right is what shapes in many ways our mental models, right are deeply entrenched beliefs, our worldviews and so on. And as we know, those deeply entrenched beliefs at times can emerge as bias, right, as you mentioned, and bias is not necessarily a negative thing, right, we oftentimes think of it that way. But it means that we see through a particular lens, what we do know is that bias has at some level contributed to the disproportionality that we see in our child welfare system, amongst other systems. In particular, when it comes to families of color, and poor families, making up the majority of families that are investigated by our child welfare system. So I'm curious, from your perspective, how does bias impact our decision-making and ultimately, the disproportionality in our child welfare system? And then, consequently, how does it contribute to kind of the mistrust that exists between our workforce and families? I know there's a lot there. I'll let you take it wherever you'd like to start.
Tim Grove 27:05
So I want to go where this conversation doesn't often go, big surprise, right? And talk a little bit about fear, trauma, bias, and then maybe segue into some of the more traditional ways we think about bias, right? Whether it be gender-related bias or orientation-related or race-related. So what we know from a trauma point of view is that by definition, survival requires an adaptive bias that says I have to get really good at detecting threats. By definition, that's how I adapt to the fear and threat, right, I get really good at detecting. But that generally means in a 50-50 split Hmm, what's going on here? Is this a safe gesture? Is this a threatening gesture, I'm generally going to default to the threatening gesture. That means there will be opportunities where the gesture is safe, that could lead to some degree of sort of, you know, interaction, some degree of even recovery, that will be rejected, if you will, in favor of the threatening bias. Right. And the reason I bring this up is it's quite practical and quite relevant for a child welfare workforce that's overwhelmed by what we've discussed before. And when we couple that with other existing biases, the commonly held bias, for example, that black men are aggressive or angry or violent, right? Let's now pair those two together, we've got a father on a child welfare case who is verbally aggressive, or verbally loud, let's say, in whatever kind of interaction we might have. So if I've got a threat-based bias coupled with a sort of general race-based bias, the pairing of the two can be really, they can really solidify my perspective on what's going on in which I will defend vigorously. And the challenge is, if I, if I don't uncouple those two, and I only address the race-based bias, for example, without co-addressing the threat or fear-based bias from a stress and trauma point of view, I won't fully address the bias for that worker. So if we are going to have a sort of child welfare system that truly makes decisions in as equitable a way as possible. It's kind of a different way to think about it, but we've gotta unpack what is the driver of the bias. And if there are multiple drivers of bias, how do we untangle each one of them separately or together? If we get lucky, there may be some that the intervention to untangle the bias sort of does both of them at the same time. But that's not usually the case. Right? So that I quite frankly, like to see a little more attention to what I call this sort of threat-based bias or this adaptive, survival-based bias. Cuz I think it's an underappreciated contributing cause to some of the more other common forms of bias. And I don't say that to make a case for trauma as a priority, I say it to make a case for creating the outcomes we all want to create, which is a worker after whatever we do to try to intervene to in the next situation where a similar process occurs, make a different decision, based on whatever we've done to try to compel that decision.
Luke Waldo 31:09
Thank you, Tim. I think that framing, as you said, may be new for many is really helpful in thinking about the complexity and the multitude of our biases, right? And the interplay can make it very, very difficult to really kind of put a finger on how we address this neatly, which is what we're going to try to do now. Maybe not neatly, but we're going to, we're going to shift now to towards the conversation, specifically around how we might support our workforce, support our institutions really, in many ways to address these long-standing challenges within our organizations, right and within our workforce. So I'd really like to start, again, kind of 30,000-foot level, as we shift into more of the solutions. You and I of course talked last year on the podcast, predominantly about the impacts of trauma, a lot of the work that you and WellPoint have done in the trauma-informed care space. You've also done a lot of work in addressing the lack of representation, which I think is in some ways, contributing to kind of the the bias, right, or the disconnect that often occurs between what is a predominantly white workforce and a predominantly black and brown community that is being served specifically here in Milwaukee. So you've you've done meaningful work in the Diversity, Equity and Inclusion space, you've also done, I think, meaningful work in really elevating the lived experience of our workforce and our community into the workforce itself. So I'd like you to start by just imagining broadly, how, how might the lived experience of our workforce and client, inform our child and family wellbeing systems that might better support, empower and keep families together?
Tim Grove 33:21
Yeah, I kind of categorize this Luke into two ways of thinking about this. And quite frankly, one is very comfortable. It's what systems are used to. So maybe we can call that the low-hanging fruit bucket. Right. So we, like many others have worked to sort of get a parent partner, somebody with remarkable Child Welfare lived experience, who can sort of partner with parents to help them navigate a sometimes very difficult-to-navigate system. We have care navigators in our outpatient clinic, who are also folks with lived experience by the classical definition of that term, that are sort of used in very similar ways. So that I think is maybe the low-hanging fruit, there are systems who are saying, oh, okay, I get it, we could maybe post a position we could hire for a position we could support that position. It's interesting to me, this is not a call out to anybody, but we have oh, about 1000 kids. And we have one parent partner. So from a volume point of view, that's a really good start, perhaps, but is there an opportunity to think about well, presuming there's good feedback and good outcomes connected to sort of, you know, leveraging that quote, unquote, lived experience? Do we need two more or three more and then people start to ask good questions around well, where are the budgetary sort of dollars to pay for that? Where do they come from? Etc. Right? Which is my segue to our conversation earlier. I think if we start to go back and look at those numbers around potentially the number of folks who've experienced sort of exposure to trauma or been overwhelmed by trauma in some way, shape, or form, getting into close to a majority, mean, which, which is a pretty remarkable fact, in and of itself, there is an opportunity in there to rethink lived experience in really new and kind of fundamentally novel ways. I don't know, is there a safe and legally okay way to leverage parts of the trauma conversation formally? Tell me about your coping strategies. Tell me how you manage overwhelming stress. Tell me how you engage in relationship when your instincts tell you that you don't want to. I mean, I'm trying to just sort of brainstorm different ways to think about how we could structure process and procedure to kind of bring that out from a lived experience point of view, and perhaps more appropriately leverage it to sort of have better impact for the clients and families we serve. I wonder, too, if that might lead to a professional relationship with the people were charged with serving. That I mean, maybe call this pollyannish. But that diminishes some of the barriers that currently exist. Yeah, you know, one of the things I think about quite a bit while I have the utmost regard for the professionals who are caring for me, I also need some degree of reassurance that there's a human in there, too. And when I discover that human and of course, a professionally appropriate way, right, I start to feel oh, I can relate to this person, I can share more with this person, that one thing I wasn't sure I was gonna bring up, maybe I'm, I'm okay, bringing it up with that person. So to the degree, that's true, maybe there are ways to sort of, as I say, leverage that lived experience perspective to break down some of those barriers. Because to your point, we have made really remarkable progress on the goal of trying to have our workforce mirror the folks we serve from a demographic point of view. And that's another podcast, perhaps around what a lot of those efforts and activities were. The data is pretty clear, though, that last I checked, we were either there or very close to there, in terms of the goal of mirroring, right. That's really powerful, too. But at some point, we're probably going to have some fluctuations in that. And even when we are mirrored, that doesn't allow every African American family, for example, to be paired with an African American case manager. It's just not logistically possible. Right. So what are some of the other ways we can start to think about breaking down those barriers? And the other thing I would bring up on this is this quintessential question. In a context of overwhelming stress and trauma, can you work cross-culturally, in a meaningful way? And people are going to hear that comment and say, What the heck is he saying? Of course, you can. I would argue, yeah, I agree with that. But as soon as I get stressed, or overwhelmed, by definition, my survival instincts kick in. And I sort of restrict my trust interaction to only the very closest people I can trust. And not exclusively, but generally, that can mean those are people who look like me who are from my community, etc. Right. So that's one of the other insidious parts of all this stress and trauma that we've all been experiencing. Generally, it's sort of causes some of that restriction in terms of who we believe we can trust and be safe with. That's a very normal and adaptive process. So I just start to think, well, can we leverage lived experience in a different way that can maybe make a little bit of progress on some of those dynamics?
Luke Waldo 39:48
Well, Tim, we will always have more conversations. I'm not going to save it for another podcast conversation, because I do think it's, it's both relevant and very salient. For our audience today to explore the progress that has been made, particularly at WellPoint, in this space of of representation, and diversity, equity and inclusion, of course, has become trendy across our country in light of George Floyd's murder a few years ago. In many cases, we've seen those efforts come up short, that there's oftentimes been a certain level of tokenism. I spoke with Jermaine Reed, our colleague here in Milwaukee, who expresses some real concerns, of course, about tokenism within diversity, equity and inclusion efforts and campaigns. But I do want to spend a little time with you talking about Wellpoint's efforts that preceded 2020. And, and how you have seen a change in not only your organizational culture, in the actual demographics of your workforce, but also in the outcomes with the families that you serve. Right, you've spoken to it a bit, but I would appreciate it if you'd share at least a few examples of how representation in your workforce has really changed not only your culture, but again, outcomes for families if you don't mind.
Tim Grove 41:32
Yeah, I was trying to think about where to start with this particular conversation. So um, let me go back even farther, Luke, and go back to about '13 or '14. And I remember noticing, when I would do trauma trainings with varying groups, you know, one of the things you're always measuring as a trainer, is you're reading your audience to say, is this registering? Does it seem to be having an impact, et cetera. And, quite frankly, there was starting to be this pattern that audience members of color, were generally speaking resonating more with the material than audience members who were white.
Tim Grove 42:21
And I don't honestly know if I can say that. But that was my true full perspective at the moment, right? And I remember not fully understanding that at the time, until I got introduced by a number of our staff of color who said, you know, basically, they kept repeating this adage, look, we aren't really trauma informed until we talk about intergenerational and historical trauma. And quite frankly, I don't know that I fully appreciated that at first, but it was certainly compelling enough that it sort of piqued my curiosity. And I just started to do my own digging. What sort of many people call in the DEI space doing the work. Right. So you get introduced to people like Joy DeGruy, who Jermaine has sort of brought to Milwaukee on more than one occasion, and many others with some really profound and provocative perspectives, although in hindsight, not so provocative, but when you first hear them, they, they can come across that way. And you start to ask really tough questions like, wait a minute, I had a woman I'll never forget this sort of interaction, early on in training, come up and talk about the ACEs study, the Adverse Childhood Experiences Study. And she said, I have to share this with you this happened at one of the breaks, she said, I find it interesting and a little bit ironic that when 18,000 mostly middle class, mostly white folks in San Diego, California, had their adversity documented the world said, Holy cow, what a big deal. And she said in my community, African American woman, this has been going on for forever, and no one seemed. Right. So there was this sort of bounty, if you will, of wisdom that people kept putting on the table for me to sort of ignore and consume. And I kept consuming more and more. So we got to a place quite frankly, where we infuse this historical trauma conversation into our DEI. And many of us would argue that strategic I don't know how strategic it was, quite frankly. I mean, I'd love to pretend that we thought we were all that smart. But we quite frankly, weren't. It was maybe more luck and happenstance, and quite frankly, the willingness to sort of consume and listen, right? So we had some initial meetings in the attend to put on an all-agency discussion about historical trauma that were very raw and very real, again, doing the work. My bias, there are probably people at WellPoint care network who would have different perspectives on this. But my particular bias is that was one of the dynamics that kind of unlocked the full dei motivation. It certainly did for me. I mean, I was always a dei champion, but I don't know that I had done the work that I've done, since pursuing it from a historical intergenerational trauma perspective. So what I think is sometimes absent in some of these, you know, sort of tagline dei initiatives that are out there that are basically the AI in name only is the underlying motivation and sort of, you know, substantive commitment behind. I think we got a lot of work to do, I think, you know, there's things we have done not so well. But I don't know that there is I'm sure there is and probably appropriately so. I feel like the key players at WellPoint, are significantly invested in this outcome, not just sort of the tagline, but the outcome. And I feel like that's in large part because of us weaving in this historical intergenerational trauma. And the simple way I talk about that is, if we were to go back to the veteran community, and take a veteran and remove her from combat, and put her through our best evidence-based trauma intervention we've got and get her as close to healed and recovered as we can help her become and then redeploy her into combat, we would say, well, you're gonna get a bit of pretty predictable outcome, right? Probably a better strategy is to not have to redeploy her into combat problems. I think that's apt sort of comparison to what it can be to live as a person of color in America, if we don't fundamentally address equity, we can do all the trauma-informed work we want, quite frankly. And it probably is going to be the equivalent of helping someone maybe feel a little bit better in the moment, but they know the world they're going to step into when they leave the clinician's office, or when they leave, the case manager's office is going to still be full of threat, oppression, etc. So Joy DeGruy says it quite beautifully "stop the oppression". And for me, and I think for many others at Wellpoint, that fundamental drive, to be part of the very sort of concerted effort to stop the oppression just sort of lends a lot of motivation, a lot of energy to this concept of sort of doubling down on DEI. So we do things like, Okay, how do we get more kids when they're originally removed from families placed with relatives? Now, we could sort of put that on a piece of paper and say, here's a goal, let's sort of get a 20% increase, but we partially because we're driven by this underlying motivation, say, what resources are needed to make that happen. So then when we fundamentally reallocate resources towards that goal, which inevitably means kids are going to be placed with people that look like them are often let alone family members, you achieve that outcome. And I know that maybe is a little subtle, but it's literally the difference behind between an aspirational goal with no resources or teeth, and an aspirational goal with then there's sort of concomitant resources and teeth that allow that goal to be executed. That I think is basically how we've tried to sort of execute RDI strategy for the past, I guess, seven or eight years now. So it's, it's earnest. It's, if we're going to try to do this, this is not just going to be a goal we make up and look at in a couple of years and say, oh, shoot, look at that. I guess we didn't pull it off. We want to sort of then say, how do we actually pull it off?
Luke Waldo 49:45
So that makes me think a little bit about how I framed up the the previous question, which included the recognition that many organizations have come up short, right? And so I'm curious from your perspective where you've seen some shortcomings in in Wellpoint's own efforts, but more broadly, where you see the greatest pitfalls, or failures when it comes to genuinely achieving representation through kind of diversity, equity and inclusion efforts?
Tim Grove 50:20
Yeah, I think one of the things that just to point out from my perspective in our own journey and WellPoint Care Network that we didn't fully understand was just how raw and emotional the conversation is yet. And not that that's a bad thing. I mean, I think sort of that raw energy can drive a lot of change, it can drive a lot of process. But it can also leave people sort of retreating, if you will, to their collective corners, and prevent some of that very much needed sort of, you know, cross-community sort of engagement. Right. And again, I can't underscore it enough in the context of overwhelming stress and fear and anxiety, all that gets worse anyway. So when that's the world around you, it just gets even harder and more tricky to sort of produce that outcome. But quite frankly, one of the things that was really helpful is those kinds of mistakes were made was a phrase that's used oftentimes by communities of color, where the the adages stay in the room. And how I understand it is, you know, there are scores of times hundreds 1000s of times where the room gets oppressive. And the instinct is to say, skip it, I'm out, which I can only sort of try to sort of possibly understand, right, the adage, as I understand it, that is offered sometimes is where possible, sort of try to stay in the room. And I assume that is towards the quite remarkable goal of producing a different outcome. Right. And I presume sometimes that's happening. We did a pretty good job, in spite of all that sort of, you know, clumsiness, if you will, it keeping or helping people stay. And I assume that was nothing more than I think people recognizing there were big hearts and genuine interest in sort of the broader outcome. And maybe that led to a little bit of grace, both. But I can also imagine, on a broader perspective, that some DEI initiatives sort of struggle, because when those opportunities come up, people kind of, you know, appropriately go back to their affinity groups, and then get a little more reluctant to sort of engage in some of that cross sort of, you know, community way, right. And at some point, then, when that gets to be too entrenched on both sides, somebody says, well, it was a valiant effort, which is dripping with irony for me for people of privilege, quite frankly, when people of color who have been on the other end of the oppressive dynamic, have an adage of staying in the room. My argument would be if they can find time to stay in the room, we can certainly find time to stay in there. If that makes any sense. I also think I was talking with a colleague about this, just this morning, actually, you know, there's all this conversation about wokeness gone too far. Right. And, again, separate perhaps podcast conversation for a different time. If we're going to leverage that as people of privilege as an excuse to scuttle the DEI initiative, then I would go back and challenge the commitment and fortitude of our initiative to begin. I mean, even if you buy the argument that there is such a thing as wokeness, that's gone too far. Right. Again, another conversation for a different time. If that's all it takes to scuttle your initiative. Again, I wonder if the initiative didn't have the full sort of buy-in or commitment that it needed.
Luke Waldo 54:38
I appreciate that. That final point. And I think it's a good segue into going back to the beginning when I put a pin in our kind of moral injury conversation, the impacts of stress on our workforce and so on, in the pin being that we weren't going to quite yet get to. So what do we do about it? We've talked a lot about what I just shared, we've talked a lot about how we integrate the lived experience and honor the lived experience of our community in our workforce. We've also talked about as you've just shared, the importance of representation that can be promoted by diversity, equity and inclusion efforts. So where do you see kind of the broader practice, policy, or even mental model opportunities that will help us overcome some of the barriers that you've identified today to more effectively support, empower, and improve really the representation in our workforce?
Tim Grove 55:56
Yeah, so maybe I'm gonna take a personal approach to this particular question. 30 years, next year will be my amount of time in the child welfare arena. Right. And I mean, that is lovingly as I can, I have generally no regrets about that 30 years. And there's a lot of lessons learned. So there have been times when I've tried to manage my what we call caregiver capacity. So basically, whether or not I'm, I'm too overwhelmed by the things that can overwhelm me, or whether or not I'm buoyed by the things that kind of keep me going keep me motivated, etcetera, that tug of war is what we call caregiver capacity. And most people over a long career have moments where they lose the tug of war and moments where they are neutral, and moments where maybe they're right. I learned a number of years ago that my go-to strategy for managing caregiver capacity was to focus on doing less. So I had a moment a number of years ago, where I thought 55 to 60 hours is too many hours a week. Your only solution to sort of solve this problem is to cut it back to 45. Or shoot for cutting it back to 45 would be more realistic, right. And I tried that for a decent amount of time, only to find quite frankly, that that wasn't my sweet spot. Because it diminished what I was able to provide and do for the people I was charged with doing stuff. So what I discovered was maybe there's a different strategy. How do I cut back a little bit but without compromising the powerful meaning that can come from doing this very different. So my argument is, you can just if you're hyper-focused on doing less you can cut so far back, you will lose your opportunity to create significant meaning in your work. And maybe there's a both-and kind of solution there that says Can I cut back a little and not sacrifice some of that meeting, because I've had 55-hour weeks that have felt like 20-hour weeks, and I've had 20-hour weeks that have felt like 70 hours. Right. And one of the things I came to a conclusion about was that I think one of the common ingredients, there was how much meaning I was able to create or facilitate. So I don't know, I mean, one strategy is maybe it's not always about last. It's about maintaining your level of meaning or creating more meaning. So I'll give you an anecdote on that. We pursued a theory five or six months ago that in spite of all the work we've done to train and sort of coach up our staff on trauma-informed practice, there was more that needed to be done. So we invited all of our child welfare workforce 100 plus people to be part of a 60-hour trauma-informed care practice deep dive. And we sort of waited on our fingers, or at least I did thinking is anybody going to sign up? Because we're asking more from them. We got 30-plus people to volunteer. And we selected about 20 of those folks to go through our initial code. The reason I bring that up is while we're asking more of them, we also in many circumstances help them facilitate more meaningful outcomes with their families. And what they are reporting to us not universally but many of them was this is why they got into the work. This is what I wanted to do. And yeah, it's appreciable all this time and sort of effort we're spending, but it's well worth it. Something about rethinking that formula is, at least in my mind the solution. The other solution I would point to, though, is structural. As a society, we're going to have some tough choices to make, but one of them is going to be what are we going to do with the guardian? The people who are by definition, sort of trying to do their best, at least most of them, in my humble opinion, to care for protect, provide health care, provide sort of security, safety, etc. They're struggling right now, for a whole host of reasons. And we've got some tough decisions to make about what we want to do about that from allocation of resources from, you know, how do we hold them in regard as a collective group of people? Those are structural conversations that I would argue have to be part of the discussion as well.
Luke Waldo 1:01:18
Yeah, I think it's really important that we recognize going back to the early part of the conversation around moral injury, that if we continue to ask our workforce, to, to follow through on policies that just further right further traumatize or further marginalize families that are already overloaded by the many challenges that you've just identified, we're going to continue to struggle with keeping a workforce that, as you pointed out, finds real meaning in their work. So I appreciate you. And finishing on that note, I want to round off our conversation, harkening back to my days in the child welfare system, more formally, at least, when I ran our Family Support Program here at Children's. I had decided that while we had always done exit interviews with staff that were leaving, I found great value in conducting stay interviews, to get a good sense as to why our champions, those that would kind of find great meaning in the work and stay what was behind that decision, what was driving them to come into work this very difficult work each and every day. And so I'd like not to I expect you to have a top three list here again. But if you right now, looked at our workforce, both at Wellpoint Care Network, but just kind of broadly within this child welfare system, and really child maltreatment prevention system, that that in many ways supports us. What, what do you believe is giving our workforce meaning what is keeping them in this work, and serving overloaded families in this very, very difficult moment?
Tim Grove 1:03:26
Yeah, it's interesting. Sometimes when we do presentations on stress, adversity and trauma, we, we talk about this concept of syndemic times from Harvard Public Health. And it's one of the situations where when I've got a younger audience, I will generally see them turn their phones over, in a good way, and engage in this conversation. And quite frankly, when you read some of the good publications or data about their about the younger workforce, one of the themes I keep seeing is they want to be interacted with in a genuine way. So I'm not sure if I can cuss on this podcast, but that means no bullshit, right? They don't want oversimplified platitudes that either sugarcoat or, you know, somehow diminish or downplay what's going on. Because again, as I mentioned before, this is the world they've grown up in. So one of the things I think if my theory is right on this that they appreciate is sort of the context being given to them in a way that says, here's how we see the world as well. And if it aligns on some level with how you see the world, then that's a really good start. So it tends to engender a bit of trust, it tends to reinforce that element of genuine, right? The other thing that's true really compelling about the younger generation, in my humble opinion is they want to solve big problems that, so to that point about oversimplified platitudes, or sort of diminishing or downplaying, they've got really good radar around that. But they also have really good radar that says, Don't give me a sort of simple solution for a complex problem. It's okay, lay out a complex problem for me. And guess what, I'm pretty good. I'll figure out a way to rally some ideas or resources that can match complexity of solution with complexity of problems. And in so doing, they, I surmise, anyway, feel a sense of contribution. And because, you know, I was just reading the paper this morning, and there's an article about whether or not we're going to exceed the target global warming temperature by double. Pick your article in there, quite frankly, the world can be a pretty distressing place, we've got one or two choices, we can be ostriches around that, or we can follow that generation's lead and say, Let's at least try to solve these problems. Right. So then, if we can pair all that with enough consistency of practice that shows them, hey, one family at a time, one sort of client at a time, you can make a difference for these folks. And they can then influence the people in their circle. It all kind of ties together. But people aren't bullshitting me, they aren't sort of giving me platitudes. They aren't sort of underplaying what's going on, I can clearly see how my work here is contributing to a sort of broader macro outcome. That's a place I want to be a part of. We have people under the context of practicing trauma-informed care who leave and then come back and say, I came back because you're actually doing. So somehow, at least in some circumstances, we have, again, I think more haphazardly than strategically woven together enough of a compelling narrative to sort of get people to come. And to sort of when those folks come for many of them anyway, craft out a lane, where not only their immediate needs can be met, but they feel like they can make a difference. That's one particular thing.
Luke Waldo 1:07:38
I think it's a really good one. And you may have beaten me to my final final question here. But I want to give you an opportunity to either expand on what you just shared or share something else. But what makes you optimistic about the future of this work? And I know we've talked about a lot today. So what makes you what makes you optimistic about the future of trauma-informed care of diversity, equity and inclusion, right, of really honoring and elevating the lived experience of our community in our workforce? Your choice, but what makes you optimistic about this work?
Tim Grove 1:08:16
Yeah, well, I appreciate the question. And I want to be a hypocrite and offer a platitude, right? So I mean, there are 1000 platitudes I could choose from people are inherently resilient, yada, yada, yada. In honest response, I have plenty of moments where I am really worried. And quite frankly, what pulls me out of those sort of moments of being really worried, is a couple of things. Humans have historically, generally rallied to solve problems when the problem has been honestly put in front of me. I think we can find a way to do that here. I'm very worried that the size and scope of this problem is still vastly underappreciated. And some people I think, urge caution against laying that out for people for fear of overwhelming them. I think the opposite might be true. I think we might compel people to rally and say, You know what, that makes sense to me. Now, dammit, let's figure it out. Here's the other thing that gives me great optimism. I think many of the strategies around this are going to come from underappreciated sources. So when we talked about lived experience when we talk about communities that had been disenfranchised. Can you imagine for example, as an indigenous American or an African American figuring out how your people survive 1000 years or 400 plus years of ongoing forms of oppression? There are some remarkable stories and right and, and maybe it's time to sort of do more to bring some of those stories to bear. As we all try to figure out what that process looks like. And if ironically, that means we start to sort of place greater value on people with lived experience in whatever form or another, that would be a welcome change. The other thing that is a little more strategic for me is I think we can figure out if you think about it, and you all taught me this, I think the current sort of load of mental health need by clinician availability is about 440 to one, or something along those lines, right? So if you think about that, that's an impossible scenario, given the normal clinician caseload needs to be about 30 to 40 at max, right, so that's more than 10 times what a clinician can handle? Can we start to rethink this and say, well, that presumes our model is one on one for 50 minutes? What if we did five on one? What? I'm not even talking about a typical group setting? What if we did 30 on one psychoeducation? What if we found new and creative ways to start to fundamentally alter that ratio towards the goal of sort of meeting the size and scope of the problem? That if we can figure some of that out, and there are people already trying to do that and figure that out, I think we're gonna be just fine.
Luke Waldo 1:11:34
That's a great, great way to finish what has been a really thoughtful conversation, Tim, which is always expected when we spend time together. So I appreciate you for sharing all that you have, and particularly really elevating the many examples in your career in the work that you you've done and from the community experiences that you've been, you've been a part of. But before I let you go, I do have a fun question. As I know, you are very well read, as example, by the library behind you. Do you mind sharing a book or author that has shaped or that you believe represents your thinking around the work that you do?
Tim Grove 1:12:25
If I only get to choose one, I would sort of encourage people to get the audio book of "What Happened to You?" with Dr. Perry and Oprah Winfrey. Only because in many different groups of people, I have seen what it can do when they have a collective conversation around some of those concepts. And one of those chapters, I could probably wrap it some person is a pretty good chapter on some of the dynamics we've talked about today. So that would be one that I would recommend.
Luke Waldo 1:13:04
Thank you, Tim. Again, I can't thank you enough for taking the time today. It's always a pleasure, spending time with you and sharing your experience. So thank you again. Likewise.
Luke Waldo 1:13:23
I hope that today’s episode and insights from Tim Grove have you thinking more about how we might confront and overcome the complex challenges facing our workforce today. Before we go, I wanted to highlight three key takeaways to reflect on as we move into our next episodes.
Luke Waldo 1:14:44
Thank you for joining us for today’s conversation. We hope that you will come back and listen next week as we continue to explore the Critical Pathways that lead to child and family well-being and reduce family separations for reasons of neglect.
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To learn more about the experts that you heard today, visit the Show Notes, which is where you will also find links to sources or information that were mentioned in today’s episode.
Thank you again for joining us. See you next week.
This podcast would not have been possible without the support and talents of Carrie Wade, who is responsible for our technical production and original music composition. I can't express my gratitude enough to Carrie for all she has given to this project. I'm also grateful to my team at the Institute for Child and Family Well-being at Children’s Wisconsin, who drive the Strong Families, Thriving Children, Connected Communities initiative and contributed to the ideas behind this podcast. Finally, I would like to thank all of our speakers that you have heard today and throughout the podcast for their partnership, their willingness to share their stories and expertise with me and all of you and their commitment to improving the lives of children and families. I'm Luke Waldo, your Host and Executive Editor. Thanks again for listening and see you next time.