Trauma-Informed Data Practices with Tristan Keelan
Whether you work in the nonprofit, corporate, small business, or healthcare industries, data and quality improvement matter. But how can we use data and quality improvement measures to build trust and safety both within client AND employee experiences? On today's episode of A Trauma-Informed Future podcast, host Katie Kurtz is in conversation with Quality Improvement Specialist, Tristan Keelan. This episode emphasizes how fostering curiosity over judgment can significantly enhance care quality and outcomes. Tristan gives us practical examples of how integrating trauma-informed care into our business strategies can impact performance and organizational efficiency, ultimately building more trust and safety within any company culture.
Learn more about Tristan Keelan:
Tristan Keelan (he/him) has had an extensive career in multiple areas of the behavioral healthcare system. He spent many years working in Electronic Health Records where he learned the various processes for mental health and substance abuse treatment for both inpatient and outpatient settings, including medication-assisted treatment.
Subsequent to that, he spent time as the Quality Improvement Director of multiple non-profit human services organizations. Here he used his technical skills and trauma-informed approach to quality improvement to drive projects that created lasting improvements on dozens of programs.
Tristan has a B.A. in English Literature from Elmira College, and an M.B.A. from St. Bonaventure University.
Connect with Tristan:
LinkedIn: https://www.linkedin.com/in/tristankeelan/
CCNY: https://www.ccnyinc.org/
QI Folio: https://www.qifolio.com/
Free eBook - Trauma Informed Quality Improvement: https://20326829.fs1.hubspotusercontent-na1.net/hubfs/20326829/eBooks/Trauma-Informed%20Quality%20Improvement%20-%20CCNY.pdf
Show Transcript:
Katie Kurtz (she/her): Hi, everyone, and welcome back to a A Trauma-Informed Future Podcast.
I'm excited to be in conversation with Tristan Keelan today to talk about a topic that I'm not gonna lie, it's not super familiar . Sometimes I step back because The word data can sometimes be a loaded conversation and overwhelming for my brain, but Tristan specializes in data and quality improvement and doing so from a trauma informed lens.
So I'm really excited to be in conversation. Welcome Tristan to the show.
Tristan Keelan (he/him): Thanks Katie. Happy to be here.
Katie Kurtz (she/her): I'm a big believer in shared language and understanding, like when we talk about data, we talk about quality improvement, what are we talking about today?
Tristan Keelan (he/him): Yeah so my work is primarily in the clinical space, right? The community mental health centers, the FQHCs non profit organizations doing social work, foster care, all of that sort of human service area. For me [00:01:00] data and quality improvement is in those areas. And just to make clear separation I'm not working in like healthcare space or in the physical health space, right?
So working primarily with behavioral health, social services agencies. So when we talk about the data involved there's a lot, but just let me use some specific measures to paint a picture, right? Like some common elements to behavioral health care, things like length of stay, how long somebody is enrolled, active enrollment in a program, or discharge outcomes.
When someone is no longer in a program, they're being released from that program under what terms positive negative to a different level of care return to family. So we're talking about, post service outcomes, we're talking about things like productivity metrics for clinicians.
Unfortunately, we have to keep the lights on. We've all heard no [00:02:00] margin, no mission. We need to make sure we're doing enough. Clinical scheduling, no show rates those types of things. So all of that data comes at operational, it comes at the clinical, it comes at the financial.
But it's all very much present. It's all here to stay and it should be all here to help us get better at what we do. So that's a big focus is to not just data for data sake, but data for the sake of improving the work that we're all trying to do.
Katie Kurtz (she/her): I know you're specifically in a more kind of clinical or behavioral health setting, but this is a common reality for any type of Nonprofit human service and also corporate business is looking at specific data points, whatever they may be, and then looking at how we can use that data to improve the quality of service, the quality of product, right?
That's a pretty typical I'm really watering it down here, but it's like a pretty typical [00:03:00] thing, right?
Tristan Keelan (he/him): Yeah, common language around quality improvement, we hear Plan, Do, Study, Act which I'm all for, a good acronym like PDSA, but it's the scientific method. It's try something try something new, see if it worked, if it did do more of it, if it didn't stop and work on something else.
We've heard Six Sigma, Lean Six Sigma, there's all kinds of frameworks and methodologies. But at its core, it is that simple. Use the data to see how well you've done in the past. But then you have to use people to contemplate how you're going to do better in the future. A lot of talk about AI tools, we'll see where that goes.
It's certainly going somewhere, but for the foreseeable future, it's humans delivering care in behavioral health. And so it's humans that need to improve the way in which they're operating as a human to, make better outcomes for their [00:04:00] clients.
Katie Kurtz (she/her): I would love to hear, you shared a little bit with me privately before we hit record, but I would love to hear a little bit about your journey with trauma informed care, because I want to venture a guess, this wasn't something, like, when we think of numbers, data, science There typically isn't always a ton of room for nuance, right?
It's pretty binary and honoring that reality, but also when we're working with humans, especially their vulnerabilities and the humanity of our humanness, , We can't always fit into a, questionnaire or a survey or a data set or, a box, right?
So I'm curious your journey, if you could share a little bit about how you've come to applying trauma informed care to data and the quality improvement work you're leading.
Tristan Keelan (he/him): Sure. So let's talk about how I learned about trauma informed care. Let's start back at the beginning. I went to work at a behavioral health EHR company, which is electronic health records.
And, Had a client that [00:05:00] was having us configure in a trauma assessment workflow and they weren't calling it trauma assessment. They weren't calling it PTSD. I'd heard PTSD before, right? That's common. Unfortunately we've got lexicon from the military. And so we were used to hearing about trauma in that context.
And this client kept talking about the work we were doing with the terms trauma informed care. They weren't calling it anything else. This was a trauma informed care workflow. And it just seemed so, so specific that it was like a thing, right? And so my role in the company said, I need to know about things.
And so I went to my client and said, can you tell me what this is? I know the widgets we're building, but what is this thing? And why does it matter? And why are you willing to invest, so much in it?
So [00:06:00] the my point of contact at the time was Nadine Akinyemi from Bridging Access to Care in Brooklyn, which is formerly the Brooklyn's AIDS Task Force. And her explanation to me was so clear. They were doing HIV testing, still are today and a bunch of other services.
And so when clients, she said, when clients come to me for an HIV test, They are most likely in a traumatic event, and they've been in one since they decided they had to come and they're going to be in one while they're waiting for their results. And this is a thing that encounters us. And so we're not going to test people, send them on their way, and have them wait for their results.
We're going to test people and then screen them for trauma and see where they're at and whether. Instead of leaving right away is the right thing, or maybe there's somebody they can talk to, or maybe there's other services that [00:07:00] they should be enrolled in at the agency, and so using this sort of Point of entry is a place to say we know trauma informed care says let's act like everyone's experienced trauma and go from there And they know almost so certainly that these people have or are actively Experiencing it that they can provide a better service and a better outcome by acknowledging that And assessing them and talking, having a clinical conversation accordingly that just made too much sense to me, right?
So I was able to draw on my own history, draw on what I was learning here and say, you know what, this idea that what if we treated everybody, like they've been through something because we probably all probably have. And even if we haven't what harm is there in treating people? Like they have, gone through traumatic events.
I see you say all the [00:08:00] time, it's just, we're all becoming better humans if we approach each other, in that way. I stopped working in EHRs, actually, so that I could go work in quality improvement in two children's clinics here in Western New York. As the Director of Quality Improvement. , one of my roles was to introduce all new hires during orientation to our quality improvement culture.
I was always slotted in right behind part of the trauma informed care work that happened during new hire orientation. So not only did I go through it myself, I kept coming back, and I was always a few minutes early, so I would come sit in on the end of trauma informed care before it was, my part in new hire orientation. And I could not give my presentation to new hires without drawing immediate references to what I had heard them just hear in the trauma informed care work. All the things I told [00:09:00] them that I valued and that I was working on really just married directly with what we were talking about In trauma informed care principles around trust, safety all of those things.
So I stopped calling it a coincidence or a happenstance, and I said, you know what if I Actually formalize these connections between the trauma informed care principles And how I'm trying to represent data And quality improvement in the agency And the results are huge.
We can talk more if you want About specifically, how people react in one way versus another but that's just an introduction to where I started with an introduction to trauma informed care, and then it really has just followed me through multiple jobs in multiple disciplines, and it just, it makes too much sense not to be a way to operate.
Katie Kurtz (she/her): What I love so much about this story, and thank you so much for sharing it, is that [00:10:00] It started with curiosity, not judgment. Instead of being like, oh that's too clinical, or that doesn't sound like anything related to me, and then just getting the work done, you instead shift it into curiosity of maybe I should, learn a little about this.
Or you ask those questions. And I think that's such a big component of this approach, which is opting for curiosity over judgment. And then I love what you said, because I laugh because I say this all the time it does make sense. This is not complicated. It's not complicated to realize, oh, hey, maybe, just maybe we're more than these one dimensional beings.
And we have these lived experiences and this intersection of identities. And we live in these contexts in which we have Life. That's life, right? And how do we expand our empathy and understanding and consider and be mindful? It does. I just love that so much. It makes sense. And it's not no one's asking you to become a therapist.
No one's asking you to go back to school and become a PhD in trauma informed care. And you're [00:11:00] a great example, you don't have to be a clinician to offer and think creatively about how this applies to data and quality improvement. I just, I'm nerd out so much on this. I love it so much.
Okay.
Tristan Keelan (he/him): Really quick because First of all, thank you on the curiosity compliment, I think. But it goes directly to one of the trauma informed care principles that I want to talk about in trustworthiness. And so when , people in data and quality roles are going to interact with clinical people, one of the underlying relationships That can either exist or not exist as trust.
And one of my like core tenants of. Of building that trust and trust goes both ways, right? But in this relationship, it's data and quality people who are behind and need to earn their way in to, to trust on the clinical side. [00:12:00] So sure, it takes two to tango, but there's one person behind in this race, right?
That's true. So go to clinical trainings. Show them that you're invested. You don't have to, like you said, you don't have to become a clinician, but you do need to learn what it is they're doing, what they're trying to do. The frameworks with which they're trying to do it and trauma informed care is a great place to start, right?
But there's more to it than that. If you're going to be working with PHQ 9 depression scale data. Make sure you know what the questions are, why the questions are, so that when you're doing analysis, they aren't just ones and zeros, right? You're actually considering that, that score is representative of, a heartbeat out there and how they're feeling [00:13:00] and you need to be connected to it that way.
When you are, it will absolutely seep through into that trust from the clinical team and bring you together.
Katie Kurtz (she/her): Oh my gosh. Yes. Yes. Yes. Yes. Trust is such a huge part of this. And I think again we need to move away rather delineated thinking, especially in an organization and again, I think, especially in a clinical, any type of clinical or healthcare organization, but this, again, I think it's applicable anywhere, and create a more integrative, collaborative culture, which again, collaboration, co creation, all trauma informed principles, right?
To create inner trust, because we know trust is not assumed, it's built over time. And I love, obviously, I start this podcast with folks around shared language, and that's such a great example. If you're using Instruments like a the PHQ nine, like any type of screeners and I have a lot of thoughts and feelings about screening screeners and surveys, but like a whole other podcast.
[00:14:00] Like, why are you doing this? What is the purpose? What is the shared language? It just deepens the connection and the ability and. Again, we never know what it might spark in somebody. Like it could open up a pathway for even more innovation or opportunity or possibility that can strengthen the service or the quality or the outcomes.
If we have a diverse, widen the table and pull some more chairs up to include different disciplines to the table when we're looking at delivery of services and things like that. Love it. Such a good point.
So let's talk a little bit about, from what you were saying, like trust being such an important, obviously an important thing when it comes to trauma informed care and just relationship building, communications, critical thinking, like it integrates across the board.
And when it comes to data, when we're collecting it, when we're developing, the specifics [00:15:00] of, And I'm sorry, I'm not a data person. I don't know if I'm saying the right terms, but it's, having conversations with people or you're creating some sort of tool to collect it, what are some other things you're doing from a trauma informed perspective when you're looking at data?
Collection or research or anything like that.
Tristan Keelan (he/him): Yeah. So before we get into the trauma informed care principles and how we can apply them, and I know I jumped the gun a little bit with trustworthiness, but that's okay. I want to talk about what I call the performance measurement problem. And I mentioned earlier this idea about my client who had.
An HIV testing entry point, which gave them a really reliable base of probable understanding for everyone that came in the door, right? And I started thinking about this. It's not necessarily that that anybody's been [00:16:00] traumatized by data, although it certainly can happen. And I think this is an important point, important time to note that I don't equate Some of the ways in which we're going to talk about data trauma to abuse, neglect, or any, I don't want to call anything a real trauma to suggest that any other thing isn't, but being thrown out of your comfort zone by a graph does not equal abuse, right?
And I just want to recognize quickly that what we're talking about is. Being able to use the principles that come from trauma informed care delivery and applying them to other areas that recognize that data has a history of making people uncomfortable and how that's unproductive for the work. So I want to just throw that disclaimer in there.
Katie Kurtz (she/her): Yeah, thank you.
Tristan Keelan (he/him): So the performance measurement problem to me comes [00:17:00] from a shared experience that, substantially all of us have, which is we went to school and in school we're given grades. And, when that happens we tend to develop identity around our grades. We're either a good student, a bad student, an average student.
We tend to either be labeled or label ourselves around that. And the other thing that happens while that's ongoing is, for the most part, we don't take the same class twice. We don't take the same test twice, maybe twice, but certainly not three times, four times. And if we think back when you get a, let's say you get a B in math in second grade, you move on to third grade.
And you do third grade math. You don't stay in [00:18:00] second grade math until that B becomes an A, right? There's a threshold with which we say that is U, and now U moves on to the next level. And so the idea of performance measurement gets taught to us in a very permanent way. This is you at this moment and you will forever be the math you in second grade in this moment.
So we go to school for a not small amount of time, right? And so by the end of it, whenever you come out of high school into the workforce, college, master's levels, doctorates, what have you we get to the working world and all of a sudden we're no longer advancing grades. We're staying in the same work.
The measures don't actually change, but what we're being asked to do is continually improve on the same measurements in the same class. But that's not really the way our brains were [00:19:00] trained throughout our careers as students, is it? It was taught to be As good as you can. And as long as you're good enough, you move on.
So now we're saying the metrics don't change, get them as high as you can, or as low as you can, whatever they are, and then hold the line of as good as you can for as long as you can, without them coming back down, back up and it. Kind of flies in the face of the way we've been trained, and I can recall people for whom grades were traumatic.
There are parents who put a an emphasis on academic achievement, especially in like lower, levels in a way that could have been punitive if they weren't achieved. There could have been maybe privileges lost. Let's just make it simple and say toys revoked if grades were achieved.
There, there are people who I'm [00:20:00] certain have had legitimate traumas around the idea of their performance being measured in such a finite way. So I say that to say that everybody enters the idea of performance measurement from a place of of newness. This idea of continuous quality improvement for the sake of continuous quality improvement is unnatural at best, right?
And so it's that. , you know that first year in work where your boss says, it's time for your six months review, and we're gonna look at your numbers. Find me a person who didn't have anxiety going into their first adult performance review. And I'll be impressed. I don't think you'll find it.
And what I want to do is say, let's not just call that what it is. Let's not just say, Oh we've all had to do that. You need to get over it. You need to figure it out. And what if we instead [00:21:00] recognize that for what it is, and we can use trauma informed principles to actively work to break that down and I use the The window of tolerance concept, right?
We have the comfort zone, we have hyper aroused, we have hypo aroused, but suffice to say outside the comfort zone is not where we want to be when we're asked to, how are you going to be better? How is your program collectively going to be better? Those require creative thoughts. And brainstorming, and they require an access point in the brain that's not accessible if we're in fight, flight, or freeze modes.
So if you're a person with data responsibility and wants data to be used for people to improve their service delivery, What [00:22:00] happens if you throw a graph in front of them that pushes them outside the comfort zone and your next question is how do you think you could do better at that? You're not going to get a good answer.
You're not going to get actionable steps that you could try. You're not going to get anything other than, even if you do get a response, it's going to be coming from a place of fear and a, it'll be a non, it will be a non optimal answer.
Katie Kurtz (she/her): Tristan, did you just solve every problem in the entire organizational company culture? I so appreciate this example. I went through a visceral memory of my own narratives around school and grades, and then also people in my life who've shared that, and how many narratives we have, especially shame narratives, tied to performance.
Quote unquote, from school or experiences within school, whether that's [00:23:00] related to our own neurodiversity our health, our mental health, , what we're experiencing at home, the maybe intentionally marginalized identities people hold Oh, my goodness. And then that narrative just begins to spin because we do, we move up grades, right?
We just keep going up and then we're in the workplace. And I can think of countless again, performance reviews where, to be honest none of them were ever like a thing that actually inspired me to be a better person, better professional, better leader. It was always something that was a box to check to either continue working there to secure a job, or to say what I needed to say to keep the job, or, whatever it may be. It was never authentic, and it was never something that made me feel inspired to be, like, creative. Yeah again, makes a lot of sense if we were to apply these [00:24:00] principles to these things, right?
Tristan Keelan (he/him): So let me step out. Let me step outside the clinical for a second. Because if you work in and around behavioral health and you're listening to this podcast if we're if Katie and I are the preachers, you would be the choir right now. And so we understand that, but the godfather of quality improvement, W Edwards Deming, who set up quality improvement principles in big healthcare, but before that in manufacturing, waste in car manufacturing plants.
He really pioneered the language around plan, do study act and those kinds of things. He's got a a book out of the crisis and in it he defines, he's got this nice tidy list of his 14 points for management. Number eight, I'm going to read it, drive out fear so that everyone may work effectively for the [00:25:00] company.
So this isn't even just a sort of, Clinical conversation that makes sense in our clinical context that should only live in here. I, this is keeping people from being afraid, keeps them at their best performance level. And that's coming from a person who attacked quality improvement in non clinical, settings and had never heard of trauma informed care.
So here's the, originator of trauma informed care. Quality improvement framework saying, if people are afraid they don't perform their best. So if you accept what I'm saying, that data scares people and makes them afraid, then your job is to make data, not make them afraid so that they can perform their best for the company.
So this is not just fluffy clinical talk for clinical folks who already believe it.
Katie Kurtz (she/her): Yeah, and a win, right? We have [00:26:00] to always acknowledge the reality of capitalism in all of us, right? Because of the body, we're always, we've worked enough systems to say People are going to be looking at the bottom line of anything, right?
But when we're expanding more, we're seeing more and more, especially in the healthcare world of patient experience and provider experiences and things like that. We're expanding what, quality improvement looks like in different areas, especially in fields, health and human services, where we're burning out at a quicker rate.
It's so important to be looking. Yes we have to hold the and both of we need. We live in capitalism. We need money to sustain the services we're providing. And also, are we caring about the humanity of the humans that work with us and for us and We're providing services to you. And I love this idea of if we want to, it, it makes every, it makes this approach, again, make sense in so many different ways.
If we want people to be [00:27:00] creative, to be authentic, to show up and offer their gifts for why we hired them. We can't do so from a survival state. We can't access those parts of our brain and our nervous system from survival states. We can get into a flow of creativity and authenticity and full expression when we're able to regulate our nervous systems and we do.
We learn to self regulate through co regulation in our spaces. When we're working with somebody like yourself, if you're in a regulated state where you're not, when you're able to promote safety and trust, I am more than able to access that felt sense of safety and trust in your presence. What, I always say what could be possible if people actually just, took this approach and applied it.
I was like what could be possible? So many things.
Tristan Keelan (he/him): Yeah. So setting up the interactions around data is huge. And to get [00:28:00] into the applied principles I start with, a clinical comparison. So if trauma informed Care in like a clinical modality setting it calls for a reframe right instead of asking a client the proverbial, right?
But instead of the focus being what's wrong with you, we want to change the lens to what happened to you, right? As a means of getting to root cause, type stuff. So let's crosswalk that to data and quality improvement, whether it's an individual or program. Individual or collective instead of why aren't you performing to a certain level?
What if the question was what's happening so that you can't perform to a certain level? Either one can get you to the right answer. One of [00:29:00] them's gonna get you there faster, and it's the one that doesn't lay blame and shame on the person with which, who, who is going to be called upon for the answer.
Let's not start out by throwing people's nervous systems out of whack. Let's start by acknowledging that We hold the ability to throw someone's nervous system out of whack. Let's take that seriously and then let's not do it or work hard. Not to do it and be willing to acknowledge that it might still happen anyway.
And maybe we can bring them back before we, jam it down their throats and force move forward. So what's happening so that you can't perform allows us to think of ourselves as part of a system and not just ourselves as part of our own, delivery system and in clinical Not clinical rather, but in a clinic setting where there's multiple people delivering services in the [00:30:00] same buildings, they're part of a system.
And you don't want to individualize what is really a systematic set of processes and behaviors. Now, I do, however, love Individualized data, not for punitive purposes. And it's really important that your culture acknowledges that not just does it tell people, I don't look at your data so that I can tell your boss that you're fired. People don't do that, but people don't tell people that they don't do that. Talk about it. Let's let all the cats out of the bag so that we can know what color all the cats are, right? Let's do that. So I think that's an important framework to bring into the the interactions.
Now, safety. Safety is one of the most critical ways to prevent Nervous system [00:31:00] deregulation. So data folks need to be the therapist a little bit, right? Around their subject matter. So when interactions occur, it should be data folks bringing data to the clinical and saying, here's, here it is, here's what we're seeing.
Here's what we think it means. Let's make sure it translates into your real life. Do you believe and see how this data represents, your work. And if you skip over that process, And jump right to how are you going to make this better? Again you're going to get fight, flight, or freeze.
You need to make sure that those folks like, exercises, say it back to me or put this in your words and make that safe space for, okay, that's. That's not accurate. Let me tell you why, and let's keep making sure I love how [00:32:00] you started this. Let's make sure there's common language and common understanding about what the data means.
And let me give you an example. If you put in front of somebody, a dashboard of referrals and say, what is this, you might get an answer like, Oh, that's the number of clients that have been referred into our program. It's incumbent on the people working with the data to slow that down for a second and say, before we agree on that, what this really is the number of charts that were created in your health record with referral status and a referral date and, whatever the data is.
And what if the answer back to that is oh, we don't enter all of the referrals in that way. Okay. Now we've just found a gap in our understanding and let's solve that because if we don't, we're about to trudge forward with. Bad [00:33:00] information. And you said it earlier, people like to think that data is absolute and people say the data doesn't lie.
Data lies all the time. And it's important to talk about it. And so that you can uncover those lies because data lies, but it does so unintentionally, and you need to flush all that out and get on the same page. So I have a visual that I show sometimes. It's two dashboards. One of them safe and one of them is not the one that's safe has one visual on it.
The one that's not safe has 17 visuals on it, right? If you want to you want to attack somebody, put too much on a dashboard, throw it in front of somebody and say, what do you think?
Even for people who are data minded, that's an on the spot. You're asking me to do analysis that I would usually do quietly with my favorite album on my headphones and I would take an hour to do it.
Don't even put an experienced data analyst on the spot [00:34:00] like that. So bringing this idea of. Data in a safe way that matches the data literacy of the opposite side of the table, right? And as their data literacy grows, maybe your analysis can deepen and become more advanced. But if people aren't living and breathing data every day, you've got to bring it in the right way at the right time so that it says something that they're ready to read, react to, interpret, and again, not be afraid of.
So the analogy I use is you wouldn't lift heavy weights without a spotter. Don't toss heavy data on somebody without being there and being a spotter to see that conversation through. That's safe.
Katie Kurtz (she/her): I love that. So simple, right? Being transparent. Again, this stuff is not complicated. We're not, like being transparent, slowing down a little bit.[00:35:00]
One visual over 70. Simplifying. Checking in. These things, this is not rocket science. This is not hard. Yeah, it does take a shift. And sometimes shifting it, It can be a little sticky, especially because we're forming your neural pathways to create a new habit. Sure, not dismissing that, especially in a culture, talk about systems like shifting trauma informed care within a system is a culture shift.
So yeah, those things take time, especially if the system's designed to not, to produce rather than to protect the people and honor the people. But these concepts. In and of itself, not complicated, can be easily applied, and I believe firmly, I, and this is why I have this podcast and do the work I do, I think we can make anything trauma informed.
Tristan Keelan (he/him): I agree. A hundred percent. If you if you took this [00:36:00] recording and you stripped out any of the clinical language and swapped it for generic business, work, life language, it would still make sense.
The next principle of choice, right? So we, you walk into a meeting, it's not started, people are milling around getting their seats at the table and this still happens on zoom too, right?
People are getting ready and what do you do? Hey, how are you? How's it going? How's your day? When the pleasantries begin, if you were to take a friend, if you were going to meet a friend for lunch and they were going through a traumatic moment. They would probably, not probably, they may or may not cancel, right?
Hey, I'm having a day, lunch isn't going to work. And we wouldn't bat an eye to that, right? Oh yeah, do what you got to do. We'll rain check on lunch. But we feel this sense of obligation at work where we're [00:37:00] supposed to push past those moments. And so I encourage. Data and quality folks to have your antenna up in those early moments of gathering.
And, if, Hey, how are you is met with a, a sigh or, I'm okay. Anything other than raring to go to be very clear, it's not your job to start therapy in that moment. But it's your responsibility to give them a choice. Oh, hey, I don't know what's going on, but do you need to not be here right now?
Because that's an option that's on the table. Do you want to do this another time? And 99 times out of a hundred, they choose to stay, but they, then they choose, right? It's now their choice. And when people make a choice to be somewhere, there's a recommitment to being there. They have a chance to re center themselves and say, okay.
I'm not being forced to [00:38:00] be here. I just chose to be here. And so I'm going to, I'm going to go for it. Now, if they choose not to be there, you're still going to win. Even if you have to cancel that meeting that you've been waiting forever to have, because if you have that meeting where that key person and everybody's key, or they shouldn't have been there in the first place, and they're outside that comfort zone, you're going to make a level of progress that makes no sense.
Too small. Hey, we need to brainstorm solutions for this, this new workflow. You just had them be there when they didn't want to be there. You're going to have to redo the meeting anyway, because you're not going to make the progress you want, but now you've upset somebody, or you've become that person that's there when they don't want you to be there.
And this is where my clinical language breaks down. But like now you're the problem, right? Not that the helper. And so for me. Choice going into data [00:39:00] interactions. Absolutely critical.
Katie Kurtz (she/her): I love this example. Again, so simple. A simple check in. No one's asking you to get your shovel out and start digging into people's lives, or their trauma, or whatever.
You don't, no one's requesting, or we're not creating worthiness of who gets this approach who receives it. You're just, You're demonstrating, first and foremost, the level of self awareness that is important to offering trauma informed care, so I'm being self aware, I'm able to attune. to myself so I can better attune to the person or persons in front of me.
And by offering choice, we're not only modeling and mirroring what trauma informed care feels but we're also encouraging trust to strengthen because that person is then able to practice self consent. What they're centering themselves and they're experiencing, what is best for me right now, what's best for me is to reschedule.
I didn't know that was an option. [00:40:00] I don't know how many times I've offered this to people and they're like, so much. I didn't realize that was an option. Oh my goodness. Of course it is. Yeah, sometimes we don't have a choice. And we, we just are transparent. We move through the best we can.
But most of the time we have choice. And if we can offer that choice, we're going to have a better trusting relationship to be built, and we're going to have better results in the long term because we're going to be able to honor each other's capacity in the moment. So simple. Makes sense.
Tristan Keelan (he/him): And at a bigger level, like at a, call it a system wide level or at an agency level it's a big room, but you can read the room sometimes, right?
And I don't mean the conference room. Like the culture room and there's one big example that will resonate with everybody. We weren't ready for the tactical implementation of a global pandemic. So on March 16th of 2020, like we didn't go back [00:41:00] into work. If you were a data analyst, you definitely did not go back into work, right?
You were the first group that was sent to your basement and, got your zoom account and was not, mandated back to the office, right? The first thing I did was wipe everything related to my interaction with clinical people off the calendar. I'd canceled everything. There was absolutely no way that the upcoming data review meetings were going to be useful when the people that I was going to be meeting with were concerned every day about having enough masks.
Like a little bit of this was just like, know your place, you have a place, but it's not right now. And we shifted to, can I do anything for you? And they'd say, I don't even have time to think about what I could do for you. So we went and looked for ways to be helpful. And, data we [00:42:00] used to look at quarterly, we started looking at daily cause that's how things were day by day.
And we started just saying to our clinical people if we noticed something that we thought would be helpful for them, we'd send it not here's all the KPIs and all of our breakdowns. And we did the analysis for you. So clock it. No, we'd send one visual on March 16th. You did zero service. 17, 18. But by March 18th on Wednesday, you were back up to like almost full capacity. And my clinic director goes, wow, you just validated that we implemented telehealth in two and a half days. Okay. That's what you did. Great. And she said, that's, and that was it. That's what we could offer, in that moment.
And really we couldn't do anything else. It'd be a while before things got back to normal, but is data important? Absolutely. On the opening week of a global pandemic no, or [00:43:00] at least not in the traditional sense, right? And so that kind of. That's collaboration, right? That's being part of the team, not another not on a different team.
And I don't know, sometimes you're not the most important person in the room.
Katie Kurtz (she/her): Yeah. And it's a great example of adaptability and flexibility, which if we're thinking The nervous system, our individual nervous systems, when we think about what resilience is, it's that adaptability, that fluidity to be able to move.
The same for the nervous system of a company, a team, a culture. Our collective nervous system needs adaptability and flexibility to be resilient for when things like, major things like pandemics happen. And I think when we have the ability to be fluid and flexible, we're more likely to be able to collaborate and co create to be more resilient.
When we're stuck, that's when [00:44:00] that it's going to be harder and nearly impossible.
Tristan Keelan (he/him): So one more principle cause we talked about trustworthiness already is empowerment. And the simplest way I can explain this is bring people up in their data journey, rather than keeping them on the outside. Like you can't hold the journey all for yourself. And what I mean by that is, we talked about being simple, we talked about not scaring people, and we talked about that in the context of data literacy, right? As somebody's data literacy levels rise, so too can the advanced level of the analytics that they're willing to meet, right?
But how do you think their data literacy is going to rise? These are people delivering clinical services. They're not going to go find, they're not searching for [00:45:00] data TED talks and, LinkedIn courses on data 101. That's not where they're going. What they are doing is interacting with you.
So be that Sort of teacher or coach that helps bring them up once they're comfortable with all the simple visuals, introduce a new one, because then in that meeting, they can be 95 percent comfortable and 5 percent trying something new come along with me. But if you've done a good culture job, having people not be afraid.
And then those kinds of things can be introduced, right? Appropriately. Enable people, bring them up. If you can teach someone how to refresh their own data, if they're, some people, I love this, but we only meet quarterly. Can I get this updated monthly? Sure. It's a training exercise. Would you like to go along with learning that?
Cause it's going to require, Learning and if they want to do [00:46:00] it. The joke that I like to tell is if you teach a person to fish, you feed them for a day, but if you teach a program director, how to refresh their own dashboard, you'll feed them for life. But if that willingness and that desire is not there, then don't force it, right?
There's a certain amount of. This is your job. Don't try to offload all of your job onto clinical folks. That's not the point. The point is to empower and make people feel like, they own the data. It's their data. Data analysts and quality improvement people aren't making any of it. It's the clinicians who are writing progress notes or dare I say, slaving over progress notes at, a rate that's unfortunate and causing a lot of burnout, right?
But they're the ones making the data power them around it.
Katie Kurtz (she/her): Thank you so much for walking us through that. It's such a helpful example to hear. What trauma informed care looks like and feels like in real life, and especially for something that may be harder to [00:47:00] conceptualize, like data and quality improvement.
Again, everything you shared here, very simple, intentional shifts that make sense. And, dare I say and I talk about this a lot, when we shift into this approach, We're going to see more possibilities, better out, like better outcomes, better quality, like everything lifts and rises, and more engagement.
I wish we saw more data around this, the outcomes of trauma informed care. I think we're starting to see more of the impact. I hope we see more to just, have the, we need the quote unquote proof. We feel the proof. We feel and we can see and we can demonstrate that shift when we apply trauma informed care.
And I really appreciate you being on this podcast to show too that it's applicable to all of us. And again, like it's an ongoing evolution, but anyone can adapt this approach. It's that willingness and curiosity to do
So Tristan, thank you again for [00:48:00] being here. Is I always like to close our time together with this gentle spritz of three questions.
And then I would love for you to share, just how people can connect with you, learn more about you and the work you're doing. So if you're ready, if you could describe trauma informed care in one word, what would it be?
Tristan Keelan (he/him): Common sense.
Katie Kurtz (she/her): Love it. What is your current go to care for your own nervous system or self care?
Tristan Keelan (he/him): Exercise. Yeah I'm a lab. You gotta walk me.
Katie Kurtz (she/her): Love it. And what does a trauma informed future look like for you?
Tristan Keelan (he/him): Can that be more than one word?
Katie Kurtz (she/her): Oh, absolutely.
Tristan Keelan (he/him): So I have a very specific thought about this.
Big picture, trauma informed care needs to find its way into big corporate culture. I think that this clinical behavioral health and human service culture in which it's really born and blossomed is The [00:49:00] place where it might be needed the least and in the overall like terms of humanity, right? so for me a trauma informed future is an emphasis on trauma informed care in corporate America and startups in the fortune 500s in the big companies and There's a very obvious very specific place to start if anybody wants to get started Train your customer service teams.
on trauma informed care. Nobody calls customer support because they're having a good day. You have a probable moment of at least anxiety. Again, having trouble with your bank account balance does not equal major trauma. But if customer service people approach every caller, like there's something going on that they don't know about, they're going to get better call [00:50:00] resolutions, happier people, happier customers, right?
And, better nervous system regulation worldwide. That's my take. Treat everyone who needs to cancel their phone plan. Like it's because somebody died and that's why they have to do it. Just come at it from that lens. So if anybody in corporate America is listening, call Katie, get your trauma informed care, customer service reps ready to go.
Katie Kurtz (she/her): I love that. Like slow. emphatic clap to that. Yes. And that's why we see we always leave those folks out in any organization when I train them. Bring them on in. Your front desk folks, customer client engagement, patient experience. Let's bring these in. HR, come on in.
It's, again, not , that complicated. , but in the end, what brands do we trust the most are the ones we've had good service with. So yeah, [00:51:00] I'm here if anyone needs me.
I'm hopeful that we're slowly but surely, Starting to get there, but it all starts with those people who are willing to be curious and not judgmental. . Thank you so much again for joining me today. How can folks connect with you or learn more about you and your work?
Tristan Keelan (he/him): I'm on LinkedIn talking about this, data, other topics. You might even find a humorous video to make data fun again. I have an organization that does data work always with a trauma informed mindset for our clients Community Connections of New York, more affectionately known as CCNY.
You can find us at ccnyinc. org.
Katie Kurtz (she/her): Awesome. Yes. Tristan and I connected on LinkedIn. I was just like so delighted to see you talk about trauma informed care and data and quality improvement. So that's how we connected. And I'm so grateful that we did. And I think this is an excellent, really rich conversation that folks will really benefit from no matter [00:52:00] where, you know, what industry they're in.
So thank you again.
Tristan Keelan (he/him): All right. Thanks for having me.
