Trauma-Informed Pediatric Practice

R.J. Gillespie, MD, MHPE, FAAP, is a pediatrician in private practice in Portland, Oregon. He has a particular interest in exploring the impacts of parent and caregiver trauma on health and wellness in early childhood, with the intention of supporting all families to be the best versions of themselves. Dr. Gillespie does consultation on practice-based quality improvement, particularly in the areas of screening and assessments that support early relational health, and has participated in multiple national and statewide screening initiatives through the American Academy of Pediatrics, the Oregon Pediatric Society, and the Children’s Health Alliance, amongst others. He provides guidance for state and regional initiatives on trauma-informed care and strives to make the science of toxic stress, childhood adversity, and resilience accessible and meaningful to practicing clinicians as well as all the families under his care.Amy King, PhD, is a licensed psychologist who provides training, consultation, and education to professionals and organizations. She specializes in trauma-informed work and resilience building. Dr. King advises organizations around wellness, staff vitality, and creating trauma-responsive spaces. Her specialties include working with professionals to help create resilient children, patients, and thriving families, guiding them to heal their stress and trauma through connected relationships. Dr. King has served as a statewide trainer for the Oregon Department of Human Services, Child Welfare, and as a subject matter expert to promote child wellness in pediatric settings on behalf of Children’s Health Alliance. Her current work is promoting resilience by training professionals who work with children and families, through partnership and collaboration. Dr. Amy & her team serve folks who aim to be champions in connected spaces. When she’s not working to promote resilience, you can find her with her family on their small hobby farm in Newberg, Oregon.

This book presents a down-to-earth path to becoming a trauma-responsive pediatric practice. Drs Gillespie and King give us a detailed, practical, and compassionate way forward, rooted squarely in relational health, the bedrock of resilience. Very actionable!—M. Denise Dowd, MD, MPH, FAAP, editor of the Trauma Toolbox for Primary Care and professor of pediatrics at Children’s Mercy Hospital"In this book, Dr King and Dr Gillespie recognize the pediatric advantage—and privilege—of longitudinal relationships with patients and their families. Pediatricians have regular opportunities to engage families as partners in care, taking the family’s lead to discuss adversity, protective factors, and resilience. Their emphasis for the pediatrician’s role is not to fix but to listen. I encourage practice teams to embrace this approach.—Marian F. Earls, MD, MTS, FAAP, coauthor of “Mental Health Competencies for Pediatrics” and chair of the American Academy of Pediatrics Council on Healthy Mental and Emotional Development"The Trauma-Informed Pediatric Practice is a must-have for anyone looking to move beyond just summing the suffering to, practically and effectively, building the buffering. With tools and techniques drawn from the authors’ combined years of experience, the authors move beyond the approximation of adversity to concrete strategies to build and restore relational health. In so doing, this roadmap charts a path for us all to follow.—Heather Forkey, MD, FAAP, coauthor of Childhood Trauma and Resilience: A Practical Guide and professor of pediatrics at UMass Chan Medical School"We all know we should be implementing trauma-sensitive practices, but we get stuck in the how. This masterful book respectfully guides us how to support children, adolescents, and families in their journey toward healing. These authors are spot-on by focusing on relational health. We have special relationships with families, making us critical supports in their lives. Now, thanks to Drs Gillespie and King, we have a roadmap that recognizes our skills to listen wholeheartedly and then builds our capacity to sensitively support others in their path toward resilience. —Kenneth R. Ginsburg, MD, MS Ed, FAAP, author of Building Resilience in Children and Teens; editor of Reaching Teens: Strength-Based, Trauma-Sensitive, Resilience-Building Communication Strategies Rooted in Positive Youth Development; and professor of pediatrics at Children’s Hospital of Philadelphia"This book is essential reading for anyone who has thought that doing trauma-informed work is too hard or not worth the effort! Guided by clinical experiences and the evidence, the authors share their own personal and professional journey to developing a trauma-informed clinical environment and implementing trauma-informed care within the outpatient primary care setting. The book is full of practical tips that make trauma-informed care accessible to the masses and not just rewarding for the pediatric provider but frankly enjoyable to practice! —Brooks Keeshin, MD, associate professor of pediatrics at the University of Utah"The Trauma-Informed Pediatric Practice is just the transformational book pediatricians need; it is full of practical, evidence-informed tips about identifying and ameliorating the effects of childhood adversity while promoting resilience and healing. This book reminds us all about why we became pediatricians and the joy of helping each and every child and family thrive. It is truly transformational. —Moira Szilagyi, MD, PhD, FAAP, coauthor of Childhood Trauma and Resilience: A Practical Guide and past president of the American Academy of Pediatrics"Drs Gillespie and King, in partnership as pediatrician and child psychologist, have created this seminal work, The Trauma-Informed Pediatric Practice, that brings practical guidance and wisdom from years of integrated trauma-informed care (TIC) and early relational health (ERH) clinical practice. Together, often reflecting on each other's clinical experiences, they poignantly describe their research-to-practice journey in the development of new clinical skills from relational health history taking to empathic listening and guidance in support of family’s growth, healing, and resilience. This must-read book, from nationally recognized TIC and ERH master clinicians, offers next-generation pediatricians the fundamentals and advanced practice tools, with the personal reflective processes, to become the needed innovative TIC/ERH clinicians of the future.—David W. Willis, MD, FAAP, founder of Nurture Connection, the Movement to Promote Early Relational Health

• PrefaceIntroductionPart 1. Background Concepts: Building a Foundation for Trauma Responsiveness in Primary CareChapter 1. The ACE Debate and Ethical ConsiderationsChapter 2. Addressing BarriersChapter 3. Getting Your Organization Ready: Creating Compassionate Pediatric PracticesChapter 4. Building the Case for ResilienceChapter 5. Guiding Principles of Resilience EducationPart 2. Assessing Risks: Navigating Barriers to Safe, Stable, Nurturing RelationshipsChapter 6. Understanding Early Relational HealthChapter 7. Supporting Caregivers to Strengthen Safe, Stable, Nurturing RelationshipsPart 3. Building Caregiver–Child Relationships: Finding 100 Little Conversations to Build ConnectionChapter 8. Revamping Anticipatory GuidanceChapter 9. Designing and Using Efficacious Interventions to Support Early Relational Health and Heal TraumaChapter 10. Supporting Families That Have Experienced TraumaChapter 11. Pulling It All TogetherPart 4. Building Clinical Skills: Incorporating “The Most Important Medicine” Into PracticeChapter 12. The Art of ListeningChapter 13. Self-Care and Sharing Our HumanityChapter 14. Addressing Physician OverwhelmChapter 15. Implementation Nuts and BoltsChapter 16. Sustaining Trauma-Responsive PracticesConclusionAppendix