Explore the profound shift from viewing trauma-informed care as a logistical process to embracing it as a transformative philosophy. Join the dedicated pediatric care team from Petaluma Health Center's West Marin Clinics as they share insights from their Resilient Beginnings journey. This episode delves into understanding trauma's community-level impact on marginalized groups. The care team emphasizes authentic patient interactions, acknowledging the inherent resilience in individuals, families, and communities. They advocate for redesigning care environments to confront racial disparities within teams and communities, recognizing historical injustices. The team navigates the need to address racial inequities despite the complexities existing within organizational structures, essential for both internal healing and addressing external disparities. Tune in as the Petaluma Health Center's West Marin Clinic pediatric care team advocates for collective responsibility to sustain racial equity, resilience, and healing in healthcare - envisioning a future that champions inclusivity and a commitment to redefine patient care beyond clinic walls.
Explore the profound shift from viewing trauma-informed care as a logistical process to embracing it as a transformative philosophy. Join the dedicated pediatric care team from Petaluma Health Center's West Marin Clinics as they share insights from their Resilient Beginnings journey.
This episode delves into understanding trauma's community-level impact on marginalized groups. The care team emphasizes authentic patient interactions, acknowledging the inherent resilience in individuals, families, and communities. They advocate for redesigning care environments to confront racial disparities within teams and communities, recognizing historical injustices. The team navigates the need to address racial inequities despite the complexities existing within organizational structures, essential for both internal healing and addressing external disparities.
Tune in as the Petaluma Health Center's West Marin Clinic pediatric care team advocates for collective responsibility to sustain racial equity, resilience, and healing in healthcare - envisioning a future that champions inclusivity and a commitment to redefine patient care beyond clinic walls.
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Episode Teaser // Rachel Joseph (guest):
When you have a clinic that reflects your community and you have a space that centers all patients, and staff who feel seen and heard, and whose values are reflected in the way that care is delivered, you'll know that you did the right thing.
And sometimes the day-to-day work in healthcare, I think we've gotten increasingly focused on the bottom line. And I think all of us who came into this work came into it because we believe in justice, and we believe in healing, and we believe in community. And so sometimes the work that you do can just be that. And this is a beautiful way of doing that, just doing the right thing.
Health Pilots podcast intro:
Welcome to the Health Pilots podcast presented by the Center for Care Innovations. This podcast is about strengthening the health and well-being of historically underinvested communities. Every episode offers new ideas and practical advice that you can apply today!
Episode 55 intro // Resilient Beginnings Network (RBN):
What happens when health care shifts its focus from “What’s wrong with you?” to “What happened to you?” And how does it impact pediatric care delivery? To answer this and to share with us deeper insights into the work, Health Pilots is featuring care teams from the Resilient Beginnings Network — a Center for Care Innovations program dedicated to advancing pediatric care delivery models that are trauma- and resilience-informed so that 100,000 young children and their caregivers have the support they need to be well and thrive. Facilitating this conversation with the team we have today is Dr. Dayna Long, primary care pediatrician and clinical director for the Resilient Beginnings Network, or “RBN” for short.
Hear the team’s journey through this program - the valuable lessons they’ve learned individually and as a care team - and the unique, transformative impact of the Resilient Beginnings model on patient care. Find out what it means to provide care in which all parties recognize and respond to the impact of traumatic stress and resiliency factors on children, caregivers, and service providers.
With that said, I’ll pass it on to Dr. Dayna Long for our episode today!
Dayna Long (host, RBN):
Hi everyone. I'm Dr. Dayna Long with the Center for Care Innovations. Today we're talking about the fantastic work that Petaluma Health Center's West Marin Clinic is doing to make their pediatric care more trauma and resiliency informed. Our hope is that by having Petaluma share their story, Safety Nets can apply the lessons learned to their own context.
I'm here today with some super guests. I'm here with Rachel, Judith, Christina, and Fran, who are members of our Resilient Beginnings Network, which is our 15 Bay Area community health centers that are working together to make the care that we all provide and the systems that we work with more trauma informed. We partner with our member networks to develop these models of pediatric care delivery that are trauma and resilience informed so that our young patients and their families have the resources they need to be well and thrive. We're excited to share this story with you today.
Rachel, can you introduce yourself please?
Rachel Joseph (guest, Petaluma Health Center):
Yes. So happy to be here, Dayna. My name is Rachel Joseph. I'm a family nurse practitioner and the Director of Quality Improvement for the Petaluma Health Center and a member of the RBN team out in our West Marin practice sites.
Christina Gomez (guest, Petaluma Health Center):
Hi, I am Christina Gomez. I'm a family medicine physician and the medical director of the Point Reyes and Bolinas Health Centers, which are our rural coastal sites through Petaluma Health Center. Also excited to be here. Thanks for having us.
Judith Bravo (guest, Petaluma Health Center):
Hi, my name is Judith. I'm the patient navigator for Point Reyes and Bolinas Health Center, and I've been here for about a year and a half in this role.
Dayna Long:
And how about you, Fran?
Frances Grau Brull (guest, Petaluma Health Center):
Hi, I'm the site administrator for the Bolinas and Point Reyes Clinic and I'm a nurse by trade.
Dayna Long:
Thank you so much. Every time I drive up the coast and I drive past Bolinas and Point Reyes, it's so beautiful up there. I'm always taken by the very dramatic scenery for sure. So, before you started with the Resilient Beginnings Network, what did trauma and Resilience informed care mean to you and how has that shifted during your time with Resilient Beginnings Network?
Rachel Joseph:
I think just I'll get us kicked off and say, I think trauma and resilience informed care had a meaning for me based in some of the work that we had been doing at our parent site at the larger Petaluma Health Center Clinic where we had seen the start of ACEs screening and healing conversations with patients and families of young children about their experiences of trauma and their inherent resilience. But that context and that particular approach was something we'd never tried out in West Marin. And also I think it was something that I think we expanded on greatly over the course of our work.
Frances Grau Brull:
I have to say that it was really vary, for me, this whole conversation about trauma and resilience, and I think that's one of the things that I'm taking out of it is basically resilience. I actually have left, not left out, but focused more into the resilience part of it and I just embrace that moving forward.
Judith Bravo:
I think for me, I'm not going to lie, I didn't know much about trauma and resilience informed care. When I started working with the clinic five years ago, I learned that I do have to be empathetic and understanding to people's experiences. It wasn't until I started working here that I found out that trauma really affects the way a person develops.
I've learned to be more culturally sensitive. I've learned to ask more questions, get to the deeper meaning of maybe why a person feels a certain way. So yeah, apart from just being empathetic though and sympathizing with someone, I think it also has taught me to wanting to know more, wanting to know deeper about people.
Dayna Long:
Judith, I'm wondering if you can dive even deeper into that. When you say it makes you wonder more, how are you doing that? What is your approach now?
Judith Bravo:
So, because of my role in the clinic, I try to get to know patients a little bit more personally. So apart from a medical role versus a patient role, I definitely try to be somewhat of a person that they can confide in, that the patient can confide in. So hey, this patient needs to get something off their chest, this person wants to vent. I like to feel like I can be that person for them. I like to ask maybe questions that are a little bit personal, but they know that I'm not going to share the information with anybody. And I think getting to know patients on that level, getting to know what they've been through, getting to know their experiences, helps connect dots to certain things that they may be experiencing or feeling or going through medically or mentally, physically. So that's my approach as a patient navigator.
Dayna Long:
Thank you.
Fran, in your introduction you said that you were one of the administrative leaders, and so my next question is for you about why was it a priority for your organization to embrace this approach?
Frances Grau Brull:
I have been lucky enough to hear from this team and actually what they've been doing and the progress, and I've seen it happening as it has developed. I'm committed and I am just looking forward to put more opportunities for us to engage with the community and transmit this information and hear them more to continue this work, for sure.
Dayna Long:
Thank you.
And for the providers, so for Rachel and Christina, what were you looking to accomplish through RBN?
Christina Gomez:
Well, I feel like Rachel's the better person to answer that because she really led and guided this. But I think what I can say is, one of the things that has been enlightening is thinking about just this more as a philosophy rather than just the logistics of how we're doing it and really having a trauma informed approach to patient care in general. And I feel like even not having myself directly been a part of all of the meetings for RBN, but also being involved in the work and the trainings that we've had and the discussions we've had, I think with staff and providers, just how that shifted. At least personally for me, the way that I approach patients, the way I sort of getting to what Judith was saying, the way I feel like I can try to understand a little bit better, people's experience of trauma and take that in a different way that I didn't necessarily before because I don't think I understood exactly how it impacted people and also how we could help mitigate that and help people respond to it and what services and support we could provide.
So I think it's really for me, opened up the way we can approach not just our patients but our community and looking within our community at what trauma experiences people are having, which we've seen on some of our ranches with some of the farm workers and our Latino community who are experiencing a lot of housing instability and housing injustices. So I think it's all that to say, I think it's really spanned from how we approach our patients on an individual level within the clinic and also how we're really approaching the community.
That's very broad, I feel like Rachel can dive into the details, but that's how I've really taken this work in.
Dayna Long:
And how have you seen the work that you do actually impact patients' experiences?
Rachel Joseph:
Yeah, I mean, to echo what Christina is saying, I think and what Judith has said, I think I've certainly, my understanding of how to have conversations with patients about their lived experiences of trauma and my, I think also philosophy about seeing that in the context of the larger community has evolved tremendously over the course of this work. And I think we came into RBN knowing that our organization had a lot of room to grow, both in the way that we took time and paused and engaged with patients in healing ways and also in the way that we as we grew as a team, found more space to think about our patients' broader experiences in the community.
I think now, to what Judith and Christina have said, I see my work with patients as a provider in RBN as a small point of entry where if I can pause and take time and create a little bit of space to ask questions and identify points of resilience that I'm seeing all the time in our patients and their broader communities, and then get them connected to folks like Judith who are out on the street and in the field shoulder to shoulder with folks as they're navigating some really complex struggles, we can double down on our efforts and expand well beyond the clinic,
Dayna Long:
And so you've been referring to this moment of pause. Doing screening, responding, and then there's a moment of pause. Can you describe what that's taken for you - what it feels like in terms of the difference about before you did that and then after?
Rachel Joseph:
I think in the frantic pace of primary care that I think probably all listeners and all of us who are here gathered, recognized very well, I think it can be very easy to lose sight of the root of what healing is, which I think what I've come to recognize over the course of RBN is it's actually taking time for seeing people authentically. And I think the orientation towards authentic interactions with patients where we're really truly hearing what their lived experiences are has been a reminder to in encounters with children and families, sit and take in and actually appreciate what people are already doing to promote the health and wellness of their kids and of their broader community. So I think what I've feel in encounters now that I maybe wasn't as keyed into before is just like a deep appreciation and gratitude for the strength that folks have that's already there and been there. And the moment of presence where somebody sees you, recognize that in them, not see a deficit, but see their inherent value and experience, their own moment of pride and gratitude.
Dayna Long:
I think that was so well put. You also had commented that then families are connected to Judith who is shoulder to shoulder with families. Judith, can you describe what you do in the clinical setting and how that referral and linkage goes for you?
Judith Bravo:
Yeah. So I do spend some time in the office getting back to patients, getting back to providers. When I'm out in the field, I go see patients maybe at their homes, I connect with them on the street, in the store. I'm lucky enough to live in this small community. I live in Inverness, so just 15, 20 minute drive from the clinic. So I'm lucky to know a lot of the people that already live here and be a part of this community. So events, whether they're put on by the clinic or not, I like to go out to the events, say hi to people that I've met through the clinic work. I like to, like I said, visit the patients and their families in their homes, maybe. I volunteer on the weekends. I like to call different organizations in Marin County, in West Marin and find out what they do. If I find someone who is in need of an organization that I've come in contact with, I make sure to share their information.
So it's just a lot of that being a middleman, trying to connect the clinic's work to the actual community and being involved and being a part of the community, not just a healthcare worker.
Rachel Joseph:
Judith is really incredibly humble about her work and impact, but she is a living example of solidarity work and it really embodies the values of RBN. It's such an honor to watch her shine, and families really connect with her very deeply. I think there's no substitute for her presence.
Judith Bravo:
Thank you.
Dayna Long:
So much love, Judith. I love it. And I also can't stress enough how important patient navigators and community health workers are to making sure that we provide wraparound services and support to our families.
I would like to be able to illustrate very concretely to listeners the way that you have incorporated the key drivers of RBN into the work that you're doing, both in clinic and also with community partners, to remind folks of what those key drivers are for us. It involves:
- Change in organizational culture and environment to become a healing organization,
- Adopting tools for clinical transformation screening and response, and
- Strengthening networks of care and community relationships.
So, can you speak to these three drivers and help us understand how you have been incorporating these drivers into the work that's happening in clinic and in community?
Rachel Joseph:
Maybe I can jump in with the piece about organizational culture. I think everyone in this room can speak to that. We recognized, I think as an organization when we very first started this work, we were coming out of a big merger where a large organization, Petaluma Health Center, was joining with the West Marin sites. And there was a lot of fear in the organization, a lot of sense of, I think growing trust, but still some roots and mistrust about what this partnership was going to look like. And RBN came on the scene right at the perfect time where we could actually start to have some conversations within our teams about who we were and what our vision might be in our partnership.
And in that context, there are also some team dynamics that we have started to navigate with RBN and RBN's support and we'll be continuing to navigate moving forward. So with regards to navigating the merger and developing some more healing relationships, we started conversations as a team about trauma and resilience and personalized some of that. So with facilitated support, started the conversation about what are our own lived experiences of trauma and our own experiences of having conversations with patients? What might our fears or hopes be around that?
We also started conversations about what is our environment of care look like and how might we make that more reflective of the communities that we're honored to accompany and serve? And then rooted in those conversations have started to make some concrete changes in our environment and in our work as teams. So putting up artwork throughout the clinic that's reflective of the patients and communities that we serve explicitly, pro BIPOC, explicitly resonant with migrant communities, is explicitly inclusive. We also have started to look at our teams. Our teams when we first started were very racially and linguistically segregated, and that segregation is replicated out in community where there's a lot of separation between the Latinx or Latina community and white folks. And so we've started conversations as a team about structural injustice internally and structural injustice out in community and how we hope to move forward on both fronts.
Christina Gomez:
Yes, I think looking into our own inequities within our staff and organization and realizing that we can't begin to address the inequities outside of our organization unless we're really talking about the inequities within - which is a long, hard, uncomfortable, importantly uncomfortable conversation that's ongoing. And we're still working on that and I think we'll continue to, and that it's a priority and important I think for all of us. And then I just want to add one other thing to what you said, Rachel. I think also asking the question through the merger even of, who's our community? Who is our community? Who are we reaching out to? Who are we not reaching out to? Who have we not been reaching out to? And I think that's really been important, and having Judith be a part of our team has been incredibly important in connecting with a part of our community that I think we were not often connecting with, which is the Latina, Latinx community, the farm workers.
I think a part of the community that's often been, I've heard the word invisible. And so I think that's been a really, really important part of what's come of this and having these conversations.
Judith Bravo:
I owe a lot of my connectedness to the community, to Christina and Rachel. Just because before this role, I wasn't all that connected, I wasn't all that active in my own community. I was active in Marin County doing work on the side, volunteer work, but not inside my own, Point Reyes, and Bolinas, and Inverness. So I owe a lot of that to Rachel and Christina. And I've told Christina this when she first came in, I thought she was like, "Oh, she's just another white savior." I thought she knew what to say, knew the words, but wasn't actually going to follow through. But, I mean, I was wrong and I'm glad I was wrong. They've both just really pushed me and supported me and made me feel like I am part of this community and I do have maybe the expertise or the experience to go out and talk to these people and find out, just get to know them on a deeper level, and be able to connect that with my own work.
And so I just owe a lot of that to Christina and Rachel because they've really supported and motivated me and pushed me, really, to my full potential.
Rachel Joseph:
Judith, I was going to. You are and have always been a leader, so it's great to see you doing that work. Yeah, total honor and privilege to work by your side. I was going to pick your brain and Fran's brain, because I feel like y'all both... When we were talking when Dana was asking the question about our work in community and the community to clinic referral and connections and that partnership, I was going to ask about Lotería. Dayna, I don't know if it's okay for us to talk about that, but that's been such an important part of this work and a place to connect parents and families and community, and Judith and Fran and Christina we're all part of launching that.
Judith Bravo:
Well, I was going to let Christina start off a little bit. Because she got the ball rolling. She had someone that she worked with at Petaluma that did the Lotería group. But, I mean, ultimately we got it here in West Marin Point Reyes, Tomales, and Bolinas. And it's just been a great opportunity to connect with patients outside of a medical role. We de-stress and talk to each other like friends, and we get to know each other. We listen to music, we have fun, we dance, we sing. It's a space where people can unwind, really.
I think there's a correlation between stress and the way that we might feel sick or maybe diseases that we develop. And so if you provide, not just Lotería, but any group participation that lets someone take a break from their usual routine that lets someone be themselves for a little bit and play and not think about everything else that's going on. It allows them to really just flourish a little bit and lets people just really be themselves and have fun and it just takes you away from everything going on in your life. So, it's just been a great part of the community, I think, to have a group where we can just come together, including myself. I don't have to think about anything else but just being there in that moment.
Christina Gomez:
I can add to that. And also just want to say, Judith, that we would never be where we are without you. We are just so grateful, I know we could have the whole podcast be about how much we love. We love and appreciate Judith, but it is an honor to work with you. I can talk a little bit about when that came about. So I came from Petaluma Health Center and there was a Latina physician assistant who started it as a space for Latinx community and patients to gather. And it was super successful. And so I was able to see that and convivencia was the word that I heard from everyone, which is, I don't know, how would you translate that, Judith? Just, "being together." Being together.
Judith Bravo:
Yeah, “socializing.” Yeah.
Christina Gomez:
So it was beautiful. And then the pandemic came and so that kind of squashed it. And so, when I was out at the coast, I brought together Judith and Carmen Hiro, who's a social worker from the county as well as Maria. Can't remember, she changed her name, she got married. But she heads the promotores. And so gathered those three as local leaders working with the Latina community to try and figure out what would be a good way to connect and suggested Lotería because it had been successful, and people seemed excited about it. And so that was sort of where it was born and was important for me to learn as I moved out to the coast through this merger, who were the local leaders connected to the Latino community. So, I just want to put that out there, because that was really important to start from that place.
And I think also what's been really wonderful about it is that, as with most spaces, we are a very white predominant space. And especially in a small community, there's just not a lot of places where Latino, Latinx people can gather and have a space for themselves. So, I think that's been really important for that and that's been a learning process for even our staff who sometimes may see that as divisive or want to integrate that space. And there is a time and place for integrated spaces, but I know that Judith can speak to or I imagine, I know you have spoken to how important it is for people of the Latino, Latinx community to be able to gather together and have a protected space where they can play a game that they relate to, understand, have played in the countries that they, many of them came from. So that's been really nice and important and I think has pushed the conversations around equity and our equity focus and how we work through an equity lens in important ways in our conversations that we're continuing to have.
Rachel Joseph:
I'll add too just that one of the cool things that has been initiated by this group in the context of Lotería is bringing other community partners into that space with the permission of the Lotería participants to connect folks to resources and added support. So many folks who come to our clinic and who are privileged to partner with have very busy, very hard jobs that require all of their time. And so breaking away and joining Lotería, they don't necessarily have access to childcare. It's a space where we can provide childcare and connect the people who are providing that brief respite with training in things like early childhood literacy or development promotion, which they're teaching both to parents and caregivers and also modeling in the context of their work with kiddos.
So it's a space where the parents and caregivers can play as Judith and Christina were saying, and have fun and experience joy without anything imposing on it. And where when we know that something's cooking with the family and they might benefit from some added holding, we can provide some of those connections to resources and support that we imagine and have heard from them would be of benefit.
Christina Gomez:
Fran, can you speak to, do you feel like Lotería, how do you feel it's engaged the Latino community? Or do you feel like it's empowered the community? And in what ways, if so?
Frances Grau Brull:
Oh, I, completely, yes. I have to say that when Christina brought the idea of Lotería to me and I said, what are you talking about exactly? I said, "Don't you know what Lotería is, Frances?" And I said, "Well, I know what Lotería is, but I don't know. I've never played Lotería before." And I remember that at the beginning it was like, there are cards for Lotería, it's like, "What are we talking about?" I didn't even understand the game itself. And I'm Latina, but we don't play that back home. And I say, "Oh, this actually is going to be cool," because I feel so awkward at times when here want to play all these games that I don't really understand them and I have to learn them in order to just play them. It is like, okay, so this is going to be familiar to everybody, because everybody's going to know how to play it. So actually just by the game part of it's like, well, this is going to be cool.
And at the beginning I had this like, "Oh, and we can also actually tell them about hypertension and tell them about diabetes." And Christina is like, "No, that's not what we're doing here. Well we're actually just having a space for people to just come together and do whatever they want most, basically. Just share time and share stories and share whatever they want to. We don't want to impose an agenda here, Frances." And I said, "Okay, okay, okay, I get it. I get it. That's totally fine." So now actually I have through Judith and through some other people that I live also in the community, they've been like, "Oh, the community is cool. The Lotería is actually going really cool. I love to have the space." So they feel that we're connecting, that we are actually trying to do make that connection between, even though we're not imposing an agenda, we're not telling them anything about health, they feel closer and we feel closer. So, I think it has opened that door and I'm really grateful for that, for sure.
Dayna Long:
I love hearing about the space that you were able to create and in the spirit of having hard conversations, I wrote down a quote from you, Christina, that you had to have hard conversations with some of your white colleagues about integrating that space. Say more. Say more about what those conversations included and why racial affinity can be important.
Christina Gomez:
I think it came up in a meeting with providers and we are all white providers, so [I'll] absolutely name that. And Judith was there talking about Lotería and about patient navigation. And I think a provider said, "I wish that we could invite white people to Lotería or other people to that space." So I felt very aware in that moment. I didn't want to call out Judith to have to explain why that was important. So explained that again, what I had said that, we live in a white space - every space is a white space - and that there aren't spaces for our Latinx community to gather and that this is a space for that and it's important to protect that. And then ask Judith, she wanted to explain a little bit more, and I think it was really helpful when you said, Judith, I live here and even for me to have this space, it's really nice and important because there is not another space like that.
So, that's sort of the beginning of that conversation, but it's ongoing. I mean, we still have... there's definitely pushback, I think, against that idea. I get pushback from some providers who may not understand, or in conversation with providers around the work with our Latino, Latinx community, needing to be led by people who are from that community, and not by myself or any other providers who are white - been very clear about that. And I would say providers don't always agree with me on that.
So as the medical director, then I get to say, "This is how we're doing it," which [laughs] I don't lead in that way at all, but I think it's me learning as a leader and the director of the clinic, how do we move towards an equity framework and say, this is how we are going to operate because this is how we should be working in connection with our BIPOC community and know that some people aren't on board yet, and that we just have to keep having conversations. I think two things - just support the work, just make the work happen and support people like Judith and people that we have who are working with our BIPOC communities, and then have the conversations at the same time, which take longer and we'll take time. And I think we'll be ongoing.
Rachel Joseph:
I was going to say I think it really helps to have Fran as a leader in the clinic as well, and also a resident in the local community. And I think sitting in these challenging conversations, I think both Frances and Judith have been really courageous in speaking up about what they see and witness both what's happening in the context of what's happening in staff, Judith, what you've seen in community and experience personally. And I think in the harder conversations with providers, I think white supremacy and white fragility are themes that we will continue to rub against and grind against. And I think being committed to a culture that centers the identity of the entirety of our community and appropriately centers the patients who are most impacted by structural violence is something we're really lucky and proud to do. And I think the leadership is pretty relentless in its commitment to that. So kudos to Christina for that and for stepping aside and centering leaders who can speak to their lived experience, that's its own courage.
Christina Gomez:
Thank you, Rachel. It's really the team that does it.
Can I give an example, Dayna, that I think was really meaningful? We have a ranch out in the community where we've become aware that about 65 people live who are all Latino, mostly immigrants from Guatemala, Mexico, living in deplorable housing, paying really high rents. They're moving off the property just last week, which is great. It's been this ongoing community effort that we've worked very closely and Judith and I have visited in person several times and we've put extra resources in clinics to the community there who's being impacted. The owners are our patients as well. They're white. And then everyone, almost everyone who lives in the community or on the property is Latino, Latinx. And so there's been a lot of conversations around that and a lot of tensions, and it's been really interesting to navigate that knowing we serve everybody there, but our energies are going to go towards those who are most impacted and center those who are most impacted.
And we were able to bring a tenant to an all staff meeting because of a lot of white fragility and denial of some of the conditions in which people were living connected to biases and towards the owners. It's very complex situation, but we were able to bring a tenant to speak to our staff, which was really incredible and hear her lived experience. And Judith was there right next to her interpreting, and it was a really special and important space to be able to connect with someone from the community, hear their experience, and have that impact how our staff could understand what our patients were experiencing.
Rachel Joseph:
That person also is an incredible community leader and a parent of two young children. And has been an essential link, Dayna, to bringing other parents of young children from the Latino community into our clinic to both receive care and engage with our team, but also we've had the opportunity to have conversations about the impact of this environmental disaster on their lives, and identify opportunities to build community on solidarity in partnership. So, I think this, what Christina's talking about, has touched lots and lots of families in our community and I think is also just a seed and hopefully the beginning of a lot more work with a lot more families who will be centered in similar ways.
Dayna Long:
I hear that at Petaluma Health Center, your work is at this intersection of race and class and power and privilege and you have leaned into it. You are in the midst of it.
What advice do you have for those of us that work in health centers who also are seeing these dynamics play out every day with our patients and in the community?
Frances Grau Brull:
Not easy. Not easy, but worth it. And I think that understanding that the work that has to be done is going to have a lot of blocks and not a lot of openings, but the openings are so much stronger and the right thing to do to understand that this job is going to take a lot of energy and work, and that's the right thing to do and move forward.
Rachel Joseph:
I think from a leadership perspective, looking at people like Frances who has been so willing to align resources to support this work, it's telling leaders to invest in this, that it's not going to be something that's going to show up in your ROI, your return on investment, in a year or two years, but five years from now, when you have a clinic that reflects your community and you have a space that centers all patients and staff who feel seen and heard and whose values are reflected in the way that care is delivered, you'll know that you did the right thing. And sometimes the day-to-day work in healthcare, I think we've gotten increasingly focused on the bottom line. And I think all of us who came into this work came into it because we believe in justice, and we believe in healing, and we believe in community. And so sometimes the work that you do can just be that. And this is a beautiful way of doing that, just doing the right thing.
Judith Bravo:
I think it's important to recognize the hierarchies in your own place of work. First of all, recognize that, and educate yourself on why those hierarchies exist and how to dismantle that. Have the hard conversations with each other, with your colleagues, with your staff. And also just kind of back what Rachel said, it's not exactly about solidarity. You get more done as a community. And so just really, really working together with your community, getting to know them, and I mean just doing the work every day.
Dayna Long:
What's come across so clearly to me is your courage. Each of you within your roles have had so much courage.
Any last words, any last words about the courage that it's taken or what inspires you?
Christina Gomez:
I just want to add to the question before, which is also part of this question, Dayna, just and to echo what Judith's saying, I think we have to lead with recognizing our privilege. So recognizing our privilege if we're white, recognizing our privilege if we're providers, recognizing the power dynamics that exist as a first step in even changing them. And I think really reflecting on our own biases and being honest with ourselves and talking openly about those, because I think if we're not doing that, it won't change and we can't change it. So I think that's what I've learned. I think to your point of leaning in, and thank you for recognizing that and saying that because I forget that we're doing that because it feels so uncomfortable. And I remind myself that, if it feels uncomfortable, that means that growth is happening and to lean more, even though we want to run away from it.
So I've definitely learned that, and I think personally try not to walk around other people's discomforts or other people's fragility. And I've learned that, and Judith has really helped me with that because as I've received pushback and trying to bring attention to the injustices that we may see in our community and what our role should be in that, I think I've paused sometimes when I get pushback and I shouldn't do that, and Judith reminds me not to do that, and that we should keep moving forward and just keep moving forward.
And I think also to Rachel's point, that these should be collective approaches and collective efforts. And I need to remember there are some of us that are very much on board and others that are not quite on board, and we all have our spectrum of evolution and understanding and reflection, but that we should all be moving together and moving in a collective way towards equity, and towards resilience, and towards healing.
Rachel Joseph:
I just add when Fran said that the work is hard, but that it's worth it. That for other folks who are doing this work, I just would urge you to not give up and in each moment that you sit with a patient, and again, take the time to reflect on their strengths and courage or outside of an encounter, take the time to have a hard conversation about your own bias or privilege or actively work to dismantle an oppressive structure in your organization. But each of those things which can feel so minuscule or easy to lose track of is significant and it matters. And that I would just urge you to keep going. I think when we take stock of what we've accomplished and where we're headed, it feels like we are unstoppable, so.
Christina Gomez:
To what Judith said earlier, asking questions, being curious, learning more about our patients and our community and our staff and our colleagues. And I learn and keep learning that as I do that, then I see more. And the more I keep doing that, the more it opens up my own eyes to understanding people's lived experiences and where they're coming from. And so I think by continuing to do that, we'll continue to learn more and grow and be able to do better and provide, or... I think we can all continue on this journey of healing together, if we are open.
Rachel Joseph:
I guess, RBN, just want to express a real deep gratitude to RBN for giving us the space that Resilient Beginnings Network team for giving us the space and permission to be curious together. Sometimes when you're in your own role or in your own world, it can be easy to identify lots of problems and forget to look up at the person across from you and recognize that they are in all likelihood holding a part of the solution, if not the solution itself.
So I think RBN has enabled us to be courageous, and curious, and have a framework to use to guide us that is explicit about its commitment to things like racial justice and equity and promoting resilience in kids and families in a way that day-to-day life and work might not have been. So yeah, just really, really grateful that we've had that opportunity and really excited and hopeful about all that's coming ahead.
Dayna Long:
I want to thank all of you for sharing and for inspiring and for encouraging us to have the hard conversations that we need in order to heal and get better. So thank you.
Christina Gomez:
I feel like even just having this conversation feels really good and special and I don't know, I'm experiencing all the emotions I feel like I've experienced through this past year or two, three years, and so thank you for bringing that out and giving us chance to talk about it and be together and appreciate each other because we have such an amazing team. We couldn't do any of this work without each other. And I feel like Judith, Fran, Rachel, you all have really helped push things forward and push the conversation forward and helped us move to a more resilient and healing space. So, thank you for that.
Health Pilots podcast outro:
Thank you for embarking on this episode of Health Pilots hosted by the Center for Care Innovations, with podcast production services by Wayfare Recording Company.
Special thanks to Dr. Dayna Long, the Resilient Beginnings Team at CCI, Trauma Transformed, and the featured pediatric care team that has joined us today.
Check out this episode’s show notes for relevant links, resources, and opportunities! And, if you like what you heard, please spread the word - we’re available on all major platforms and be sure to subscribe where you listen to podcasts.
For more information about the Center for Care Innovations or for upcoming programming, events, and funding opportunities, please visit our website - careinnovations.org - and connect with us on our socials: LinkedIn, Facebook, and Twitter. This is Wes Gabrillo at the Center for Care Innovations, and we appreciate you tuning in. Catch you on the next episode of Health Pilots!