Collective Trauma Summit 2022 – a treasure trove!

Last week, it was the week of the Collective Trauma Summit again, an online conference with a huge number of lectures that you can listen to without cost if you keep up with the daily uploads. After two days, they disappear behind a paywall. With a relatively very cheap upgrade you get access to all the lectures, to transcripts, videos and other contributions in the field of trauma healing, but also mindfulness, relaxation, integration, music, and poetry. What a treasure trove of information this conference is each year – impressive.

The host of the event is Thomas Hübl and this year he also had a little thread of his own, called ‘Daily Insights’, each day of the conference a short reflection of about ten minutes in which he discussed a specific theme around trauma. I took an endless amount of notes, so that I can both read and enjoy his wisdom again myself and hand down his valuable insights during upcoming trainings organised by ACE Aware NL.

In a few of the lectures, Thomas brought up an interesting issue. We often say: ‘Ah, well, that’s just how life is’, when we notice certain processes. Thomas pointed out that we do not say that when we see something beautiful, like a mother cherishing her baby or a loving interaction between two people. We say it when we see things that we dislike, that we do not want to be a part of. In speaking about things we dislike with such wordings, however, we implicitly and often unconsciously show an acceptance of pain and suffering. By downplaying them as if they were something normal that is inevitably part of life, we distance ourselves from them. In a certain way, we break the connection between ourselves and the suffering of the other. We no longer see ourselves as part of it, although we all live in that same world where pain is ubiquitous. Thomas regularly emphasised the connection between the individual, the ancestral and the collective in relation to trauma. By becoming aware of the links between these layers, we can look for ways to change sociocultural processes, because the individual is an expression of the whole and of the history of the collective.

What we need for the connection and the change, is an awareness of the impact of human physiology, said Stephen Porges in his fascinating conversation with Thomas. We can look at an event, a stimulus, as the driver for a response, but that is a very behaviouristic approach. The point is, according to Stephen, that in between the stimulus or trigger on the one hand and the response or reaction on the other, there is our body with its physiology. That physiology has a history, like families (ancestral) and communities (collective) do. If that history carries trauma, the response to a trigger can be that someone either shuts down or becomes overstimulated. It is, therefore, not simply about behaviour resulting from an event; it is about the experiences (whether safe or unsafe) a person has gained with similar events. Their imprint on the body has built a certain kind of physiological response. That response influences what the subsequent reaction or behaviour will look like. Thus, not the event is the determining factor for what follows, but the physiology in between.

Together, they brought up crucially important topics and although not all was new to me, it was brought in such a beautiful way that it did bring a lot of new insights. The wisdom deserves to be shared here with a couple of quotes.
“Our nervous system does not care whether there is a physical or a psychological threat.”
Regarding illness: “The body screams at us, but western society says: ‘Don’t listen; keep moving, keep working’, but there is a great price to be paid for this in the form of illness.”
“Trauma should be seen as physical injury: the nervous system was impacted by a threat to life.”
“Polyvagal theory is the science of safety, understanding the innate need and quest to feel safe.”
“Education should focus on a basis of sociality, coregulation, friendship and trust, not primarily on cognition.”
“Everything that enables us to function as thriving humans, requires our bodies to not be in a state of threat.”

The basic tenet in the whole conversation was that evolution prepared us for sociality and coregulation, of a life setting in which we take care of one another. Our big brains need a lot of oxygen, so we have to remain coregulated and support one another in bringing our stress down. If not, the oxygenation of our brain is in trouble and this seriously impairs our functioning. We all know this: in fear, we have a truly hard time thinking straight and taking important decisions about the future. We are then in the here and now, merely trying to survive. The human blueprint, the model for coregulation, is the mother-baby-relationship, said Stephen Porges. If they are closely attached, they look into each other’s eyes and develop a deep familiarity, which, in the brain and nervous system, is translated as safety – crucially important for problem-solving creativity.

Well, the conference was riddled with much more of this kind of beautiful knowledge, although the conversation between Thomas Hübl and Stephen Porges was truly an exceptional one. If you want to have another go at it… an encore of a few days was announced this weekend. Find more information, also about registration and upgrades here: https://collectivetraumasummit.com/ You have a couple of precious hours left to register and watch.
And if you happen to be too late for this year’s edition… keep an eye out for next year!

Professionals and ACE-awareness, Episode 7 – This week: Chris Vleesman

We left with a group of about fifteen people from the location where we had enjoyed coffee and tea and delicious Valentine’s pastries. Many of us had not met before or only briefly and we would go for a brisk walk to enjoy the fresh winter air and get to know each other. Moreover, in this way we would have a good appetite for lunch after returning from the nature reserve. One of those joining was Chris and after walking with others for a while I got into a conversation with him. He is the coordinator of the Port of Kloosterveen, part of the Phusis Foundation. I already knew that he did various things, but I was especially curious about his ‘core business’: “We take care of young people who have to deal with hard-to-raise parents”, was his answer, while he looked at me with shining eyes. I burst out laughing: “Wow, what a great formulation! I like it!” He smiled back, and through my exuberant reaction he quickly noticed that I understood what he was referring to. Conversely, I quickly noticed that he understood what intergenerational transmission means. We got into a fascinating conversation that lasted the rest of the walk.

I told him that I had experienced a similar reversal just the week before. I had seen a text that spoke about confused people who end up in acute care and pose a ‘security risk’ to the social environment. While reading, I had thought of what happens if it is not possible to lay a solid foundation in childhood for the rest of life and how a ‘security risk’ arises for children. That way of looking at the term also has a different interpretation than the most common. The term ‘difficult to raise’ usually refers to the result of parenthood, to a child who is ‘difficult’. The term ‘security risk’ is usually thought of as the result of a life with so many obstacles that it leads to aggression and uncontrollable behaviour. What Chris meant, however, was that the kids are having a hard time because their parents do not really understand what they need and how to provide it. That was what I meant, too: if children do not receive what they need to thrive in their ‘first 1,000 days’, if they do not build secure attachment, they are in for an extra hurdle. Then the social environment creates a ‘security risk’, a chance that these children’s sense of security will come under pressure.

Ultimately, of course, it comes down to what approach you take when people go through their daily lives searching or wandering or getting lost, and then need support. Still, it is fascinating to see how a change in your language can help you express your mindset in a creative way. Such an innovative formulation also visualises a range of human images and worldviews. Who is responsible for what? What objectives are you pursuing? From which core values ​​do you offer a lost other a place in life, in your life? How do you want to contribute to a situation where the person you care for can find, can choose, can have their own place in the world? In the healthcare sector, it is often about how much money it costs when people ‘derail’. Chris also had ideas about this: “An ounce of well-being saves a kilo of care!” he said, as we walked a foot-wide path through a field of grass and heather in winter dress. Chris talked about the daily impact of his philosophy. The colleagues, as they are called, find their place in the care company as kitchen assistants, as recreation supervisors, as salesmen, and thus get a full-fledged life again.

Not that it is always easy and without bumps… He smiled at the memory of a week away with a group of guys who smoked way too many joints. He had gone with them to an environment where there was no weed available, but where there was plenty of attention and time for wonderful shared activities. A shaman had led a spiritual session with contemplation and music, and its effect had lasted for weeks and weeks. Even after returning home, hardly a joint was smoked. Other forms of difficult behaviour were also reduced by 50% in settings where he worked with this approach. This was the result of dealing attentively and on an equal footing with young people and young adults who, year after year, had hardly been listened to. “Although things are going well, you should not think that you can just put them somewhere else. Their history has made them vulnerable and if they lose such stable, sensitive care again, the structure in their lives can be destroyed again. Then everything falls out from under them once more, something we still see happening in many places.” We spoke about the great importance of mental well-being and meaningfulness, also and especially for those who do not succeed in shaping this completely on their own.

This also brought us to the subject of Positive Health, which is based on the salutogenetic principle: not looking from pathogenesis (where does disease come from and what should I avoid?), but from salutogenesis (how do I maintain health and what can I do best to achieve this?). At the very least, then, you need a roof over your head and a bed to sleep in. For many troubled young adults, even that is quite a challenge. Chris told about a young person who had come to them from North Africa through all kinds of wanderings and who had found temporary shelter and a safe haven at Chris’ location until a more structural solution was found. Chris and his team use the physical, organisational and legal space available in these types of emergencies. “Here, we work from unconditional love”, he described the essence of their policy. That was very different from what I had heard the week before from a manager who unfortunately had to conclude that still quite often, not compassion, but repression is the standard when people in an institution are ‘unmanageable’.

Chris had touched me with his vision and stories. When he asked where my professional interest lay, I told about ACEs, about the influence of insecure attachment on adult health and about how, after two strange years, we as ACE Aware NL finally want to show the film ‘Resilience’ through live encounters. As I had listened to him, I had realised that I would very much like to watch the documentary film with the experienced young adults. I fantasised out loud about how wonderful it would be to listen to their thoughts on it and then hear in a focus group what had appealed to them in the film and what they had recognised. Chris, too, saw the beauty of that.

Back from the walk, during lunch, we miraculously ended up speaking about trauma again with the four people at our table, about how it can lead us to want to follow our care instincts, so that someone else does not have to experience what was so difficult and sad for ourselves. We also talked about how current circumstances touch on a lot of pain from the past and create pain for the future: after all, humans are not made to function in isolation from others. We also realised how such situations hold up a mirror to us: what do we find difficult in what we feel and see happening? Do we really want to help the other person? Or are we often feverishly looking for relief from the pain that still slumbers within ourselves…? One table companion would like to delve deeper into this, given their own life story. That intention is now there.
And Chris and I will soon be sitting down together to see how a movie screening can take shape. Is it not a wonder how sometimes at the most unexpected occasions you come up with inspiring ideas and meet the most beautiful people? What a Valentine’s Day meeting!

Professionals and ACE-awareness, Episode 6 – This week: Jessica Boerema, Part 2

Last week we heard how Jessica Boerema switched from medical pedagogical care provider to independent entrepreneur in her practice ‘Contact in Beeld’ (Contact in View/Images); she tells how looking at the interactions with young children has become the core of her work. Today we hear a lot more about her vision and mission.

We ended last week with the statement that not one single method will always work. However, there is one aspect that is almost always true, which is that crying is stressful for a child, and that not taking it seriously is problematic, as is thinking in terms of ‘the child should know who’s boss’. How does she look at that?
“Yes, I agree… I often say… try to imagine what it was like when you still lived in a cave; would you leave your child alone? Very often, the link is not yet made that proximity and sensitivity of caring adults are the basis for a child to develop self-confidence!”
Jessica’s attention to the importance of closeness has grown substantially during the time she worked a lot with preterm babies and after completing the Infant Mental Health training. When she would stand next to the incubator with parents, she saw their emotion when she explained what their baby was already able to show them. She has built her workshops and all her other training courses with visual material on that experience. “I notice that looking at images where training participants are not in the video themselves makes it easier for them to absorb what can be seen. After all, everyone has a need for safety and looking at yourself can be very complicated…”

We pause in silence and let ourselves be distracted by the sparrows, who eat the insects from the butterfly bush. A blackbird also flies in and out: “Maybe that blackbird also has a kind of daily rhythm”, says Jessica with a smile, “because he often feasts on the ripest blueberries around this time!”

She thinks for a while and picks up the thread again: “Communication consists of building blocks; if you understand what they are intended for and what their importance is, you will become consciously competent and you can take the sting out of a difficult situation in the event of stress. Images are then extremely helpful to see what is happening; you see, for example, a child grinding their teeth or showing other small body signals. If you look frame by frame and you’ve seen it once, you cannot stop looking like this and ‘unsee’ it!”
This was also a learning process for Jessica and the experiences of the parents themselves helped her in this, even before she laid the theoretical foundations. Once they were there, she was able to combine theory and practice. If she would then translate the parents’ story to the baby, the healing tears often came. “Then you see the child listening very carefully and being alert, no matter how small, and the parents, who now suddenly understand what it was like for their baby, can also release their own worries and sadness. Through crying a baby tells a story and listening to it validates the emotion of both child and parents. Being heard is also hugely deguiltifying. Babies often fall into a deep sleep relaxed on their parents’ lap after such a conversation, something they often never experienced before and which is surprising. Recognition, being seen and heard… that is basically what we all need.”

We talk about how learning processes with parents are often very instructive for yourself as a professional and reveal connections with your own life history. More insight into your own triggers and your own pain helps to approach your target group with more compassion and gentleness and also often contributes to the formulation of your professional goals. In line with that, I ask Jessica what she considers the essence of her work.
“I really want people to grow from unconsciously competent to consciously competent, so that they can go through their own learning process and contribute to ensuring a good start in the lives of the children they care for, as professionals or as parents.”
She thinks for a moment and says: “There is still so much to gain in this area… We almost always look at what we see from our own perspective; the first look is coloured by our own experiences. On closer inspection, different people usually see the same thing, but initially we often fill in what we think we see. The trick is to really listen to the voice of the young child, which we often do not know very well. We are used to the spoken language, but can we hear the child in their own language?”
We pause for a moment when exactly at this moment we hear a baby crying in the background.

What are the tricky things, the things that Jessica runs into?
She ponders in silence. “Sometimes I think I mostly run into myself, because I always want to offer more than I do, while it is regularly already more than enough. What I find very difficult is when I hear things that make me think: ‘Is that really not possible in 2021?’ An example of this is that in some hospitals, vulnerable babies waiting for an operation are not allowed to be picked up, while we know that kangaroo care is the way to make them grow and strengthen them. I find that very disturbing; these families need each other’s proximity so much. Incidentally, these are also the situations where I think: ‘This is what I am here for!’ And the work is still really necessary, because there are plenty of professionals who would also like to do this, but are bullied in the workplace by those who are not yet familiar with this evidence. Those are dire situations…”

This brings us to the concept of EBM and EBP, evidence based medicine and evidence based practice. It can be very frustrating to see parents and children and colleagues not getting what they need because systems make it difficult to integrate new insights. The United Nations Declaration on the Rights of the Child speaks of the right of the child to the highest attainable standard of health. Why is this so often not feasible?
Jessica: “I think that can have to do with a lot of things, such as ego or being triggered by your own experiences, when new information clashes with your own approach.” I explain how it was actually very enlightening for one of our interviewees to learn that things she had attributed to herself as negative personality traits might in fact just be coping strategies for the trauma she had endured. She realised she had reacted out of grief. For her, hearing the knowledge about this was a revelation that made her look at herself in a very different way. Because of the new perspective, new knowledge can therefore be painful (at first) as well as healing thanks to the different categorisation that can arise as a result. Could it not also be the case in many organisations that trauma stands in the way of innovation?
Jessica: “Oh yes, I definitely think so! And at the same time… what science tells us now is completely different from what we heard, say, 50 years ago, so… how sure can we be about what science tells us today? The more I learn, the more I realise how much there is that I don’t know!” We laugh together at this recognisable feeling of very conscious incompetence and the importance of looking at your own survival mechanisms with mildness and compassion. It is better to replace the question ‘What is your problem?’ (in which a judgment can easily resound) by ‘What is your story?‘, a question that invites you to tell and reveals an intention of sincere listening. This creates security and allows the narrator to peel off layers, while insecurity adds layers of defense.

“Yes, that’s how I see it, too”, says Jessica, “because basically we are not focused on nasty, destructive actions towards the other. After all, if you think that way, you’d have to believe that some kids are just born as rotten kids and I don’t believe that…” She looks at me and we both laugh: we both really want to say ‘that is not true’, instead of ‘I don’t believe that’. We are deeply convinced that in the course of life, things happen that can lead to defense mechanisms.
“And I notice,” says Jessica, “that you have to question those events very specifically, because people are often inclined to say that it was all okay and that it wasn’t that bad, while when I subsequently hear their story, I conclude that it really was intense and possibly traumatic.”

We discuss that it can make people anxious to research past events, especially when people lack a supportive social environment. I ask Jessica if she feels that there is already enough knowledge available about these kinds of things.
“Well, a lot has already been written about it, but in daily practice it still has to start spreading like wildfire before it is widely supported and used. The Infant Mental Health vision is currently rapidly gaining ground and that is great, but well… in your own bubble you can sometimes overestimate the application of certain insights… I also get people in my training sessions for whom this is still completely new and knowledge transfer, therefore, also very much depends on how well I, as a professional, can tie in with their life worlds. Here, too, basic communication plays a major role. I often start with something intense, such as the ‘still faceexperiment, so that we immediately get to the core. Then I hope that the penny drops in such a way that people draw their own conclusions about what a baby needs and how they can provide it.”

It’s lunchtime. We continue talking, however, for quite a bit longer. We forget the time and only finish our fascinating conversation towards the end of the afternoon.

Professionals and ACE-awareness, Episode 6 – This week: Jessica Boerema, Part 1

It is a sunny summer morning when I arrive on my folding bike at my interviewee for today, Jessica Boerema, who has been a medical pedagogical care provider for many years and is now an independent entrepreneur in her practice ‘Contact in Beeld‘ (Contact in View/Images). From the station I bikes across the city, which, well into July, is still suffused with the sweet scent of linden blossom. It’s only eleven o’clock, but I already feel clammy when I lock my bike. On the window is a poster of Dunstan Baby Language, a method that helps parents to better recognise and understand their child’s crying. I ring the bell and Jessica opens with a big smile. She leads me through the hall and the kitchen to her lovely little garden. The yellow dotted loostrife stands brightly, flanked by dark pink astilbe and a two-meter-high tree with apples still ripening. The berry bush, moved here from elsewhere in the spring, has taken root beautifully and the fruits are already turning a marvellous deep purple. The blue door of the bicycle shed, in combination with the bright pink hydrangea, almost gives a French countryside atmosphere. Two chairs are ready and when the mugs on the table are filled with tea, we feast on the biscuits and get started.

How did you get to where you are now, I ask Jessica; with her practice ‘Contact in Beeld’ she provides training to professionals and parents to illustrate the importance of effective communication with young children in difficult and challenging moments.
“My job as a medical pedagogical care provider in the hospital was perfect for me. In the clinical environment, stress can build up very quickly and you can then play a crucial role for a child. By looking closely and really seeing the child in what they experience, we can very actively give the medically necessary treatments in a more sensitive way. Of course certain things have to happen, but can we really see the child and take the child’s story into account? After all, you can offer and implement all kinds of interventions in many ways!

Although people were enthusiastic about my working method, it was sometimes difficult as a soloist in this position and I wanted to be trained even better. When I was trained as a video interaction supervisor in 2007, I suddenly understood why this job suited me so well. Reviewing my own interaction in the videos, I noticed I was able to maintain my basic communication in difficult situations, where emotions rose in the child and the parents. I could remain calm, choose my words carefully and thus ensure coregulation and thus reduce the stress in the other person again. These insights have brought me so much! If you view contact moments on video, you can observe again and again and talk about how you experience what you see. Video images are really powerful, positive ‘eye openers’ for parents and professionals!
I have since seen many parents with concerns about their child having trouble pooping, eating or sleeping. Through video images they discovered how they could support their child with good basic communication by focusing on contact and connection. A good example was a child (3) with constipation complaints. The child missed the acknowledgment of receipt from the parents about the fear of defecating. By understanding and acknowledging this, the complaints disappeared like snow in the sun.”

I ask Jessica if she can explain that term, ‘acknowledgment of receipt.’
“Yes, of course! The first thing is to see what the child shows with what they do or say and whether you can follow that, whether you understand it. From there you will see what the child needs; does the child ask you something, do they want to be heard, do they need something? By naming what you see (“You find it exciting, I believe, don’t you, to go to the toilet?”), you ensure that the child feels seen and heard. That is a crucial building block in communication! It is also a very different approach than to say with compulsion and overweight: ‘You are going to the toilet NOW!’ Very coincidentally, I ran into the mother of this child again not so long ago. The mother saw me and said: ‘Wow, your tips then gave me so much insight! They have helped me enormously and as a result I got on a completely different track and made a career switch: I am now a remedial educationalist!’ I thought that was so special to hear! The point with that child (as well as in many other situations) was that parental concerns disrupted communication, resulting in faltering bowel function and a vicious circle in the overall interaction. We all know that feeling when you have unpacked your holiday suitcase and haven’t quite landed yet, and that you can’t go to the toilet properly. How you feel affects the whole system. The way of communication, how the baby was born, how the baby was received, even at conception, their experiences… I am convinced that all those things are related. Looking at the images together with parents helps them to become aware of how they can support their child with the help of sensitive and responsive basic communication.”

In line with the influence of birth, she says: “A few years ago, I attended a presentation by Anna Verwaal for the first time and I thought wow… I really need to know a lot more about this and so I did a few extra in-depth days. I saw many parents of excessively crying babies on the ward and after this training, I took that knowledge about pre- and perinatal psychology into the anamnesis. This showed that there was often a burdened history around the start of the baby’s life. This also confirmed how important it is that we see families in day care and avoid hospitalization as much as possible: separation of parent and child is so harmful!”
I look at Jessica and before I know it, I say, “How wonderful it is to hear you say that!”
She gives me a big smile: “Yes, with knowledge of pre- and perinatal psychology that is really no longer justified. With one or two day admissions you can help parent and child well under intensive, coordinated guidance. Preferably, however, the paediatrician and I already looked at the ‘story behind the story’ at the outpatient clinic and then we tried to offer support at a much earlier stage, before parents were completely in way over their heads. That was sometimes complicated, because many parents, like many professionals, lack the knowledge necessary to understand why children cry and which previous experiences can play a role in this. The idea that the birth and the pregnancy influence how the child functions…” She looks at me with a mischievous smile and I grin back, because I feel where she wants to go: “… that is not obvious to everyone yet! And yet… if you talk about the influence of smoking and alcohol on the unborn child… then people somehow understand that the idea that a child in the womb is not affected by anything from the mother’s life is simply not tenable.”

We continue to talk about how difficult it is to see that children and parents are still often sold short on this point. Once this knowledge is an integral part of your professional baggage, it is impossible not to see its relevance everywhere. At the same time, it can also be very complicated to find a good form for sharing this kind of knowledge. Jessica: “Anyone who has not come into contact with these insights in any way, or who notices that they completely clash with what was said in their own education, can have a hard job integrating them seamlessly into their own course of action. It may help to read scientific underpinnings, but it still takes time and dedication to familiarise yourself with the material. Of course it helps if you have an open learning attitude! If you are consciously incompetent (you know what you don’t know) and sit down with someone who already knows more about it and then follow a training or workshop, you can expand your own knowledge. That is not a sign of weakness, but rather a very powerful, professional step to take!”
She talks about another method that she uses a lot, Dunstan Baby Language, about interpreting the crying of newborns, and as far as she is concerned, no single method is always true or the right one. There are many methods and applications that have a certain amount of truth in them, but not everything fits for everyone. “In my view, you always first take the anamnesis, listen to the story behind it and then see what is helpful.”

Next week we’ll continue listening to what Jessica has to share about the healing effect of looking at video images and how that learning process supports basic communication and the sense of security and competence for all family members.

Professionals and ACE-awareness, Episode 5 – This week: Kelli van Gerven, Part 1

It’s a sunny Wednesday as I walk underneath the tall trees to the main entrance of the health center. My interviewee today, youth healthcare doctor Kelli van Gerven, has a consulting room on the top floor. She is waiting for me and we walk the last part together. It is special to meet again after such a long time. As she makes tea for both of us, we notice that it feels like yesterday that we were talking about our concerns regarding advice about excessive crying. More recently, we have been in touch about a document that did not seem to do justice to children’s need for a deep sense of safety.

I tell Kelli that my colleague and I had a conversation with a healthcare professional earlier today about the first 1000 days and stress in early childhood. A while ago, Kelli was also at a meeting on this topic. Scientific insights into the needs of children in the early stages of life have been greatly expanded in recent decades. Regularly, they appear not to correspond with what is often still being told to parents and the general public in western societies. During the meeting, Kelli noticed that the consequences of this new knowledge for day-to-day practice still met with a lot of resistance from some people. This is understandable, because it demands a lot from professionals when new insights require a change in the usual working methods. It calls for reflection: ‘How have I always done that?’, ‘What have I taught parents?’, ‘How did I approach this in my own family?’ The answers to such questions can be confrontational, because on closer inspection, you may no longer endorse your own previous choices. You may be struck that the new advice clashes with how you always handled things professionally and personally. In addition, a different approach may require knowledge and time that are not available within the current system.

Kelli says: “You may be right to… how should I put it… ‘disapprove’ of your own former course of action… even if that is too strong a word, but with additional knowledge you can decide to make a shift to something new. This requires you to become aware of these changed insights, that you allow their impact to sink in and that you do not oppose them, because that makes change very difficult. Well, of course such changes are certainly not easy. Taking an eye test or weighing a child… that is fairly easy. When it comes to things that are more parenting-related, such as sleeping and crying, it is much more complicated. That is why I always hope that at policy meetings there are not only managers and supervisors present, but also the people who actually do the work with the parents. They can then share their valuable experiences and from there you can look at how changes might be implemented, based on the new evidence.”

We talk about how behind certain things, such as an eye test, there is not so much an ideology or a belief that you can disagree on. “That’s certainly an aspect of it,” says Kelli, “because I myself find that sometimes I get annoyed by the way children are viewed in some documents. If I, as a parent, go somewhere with my child, I expect the care provider to be aware of the latest scientific developments. If I should notice that this is not the case and I receive advice that I do not agree with at all, then that is very difficult. Maybe they don’t match with information I have collected myself and with my own world view. I can understand that in such a case, parents might think: “Why am I going there, to the well-baby clinic?” Such feelings undermine their willingness to take advantage of that care. I think that is something that deserves attention from us as professionals.”

I ask how she navigates through those difficult situations. Kelli: “I almost always manage to get on the same page with parents. I slip into the parenting role with them and then it rarely happens that we cannot work things out together. In my experience, finding that common ground is often much more difficult between fellow professionals. For example, I was once at a training about brain development in children and the question was raised whether or not certain forms of damage are reversible, so whether you can undo them. The impression was created that this is always possible. That did not match what I had learned about it, so I kept asking. The speaker then indicated that there are indeed certain processes that become so ‘built-in’ in the brain that they are irreversible, or at least very difficult to reverse. To me, that seems very important information, because it means that we as care providers have to handle such processes very carefully. However, the speaker’s answer led to a lot of angry unrest in the room: how I could have asked that, what I did to parents, that I had gone too far… I noticed that the subject was very triggering for many of those present.
What I missed afterwards was that we all come together to talk about why we are so strongly disturbed by the idea that certain forms of approaching and treating  babies cause damage that is difficult to undo. Those are dynamics that I never really have with parents that way, barring extreme situations and exceptions. The fellow caregivers believed that it is too harsh to say to parents that certain things are harmful, but that wasn’t my point. I agree that care and sensitivity should be at the heart of discussions with parents. In my opinion, this does not alter the fact, however, that we must first establish that some things really are undesirable or even harmful. We need to have that discussion first and then move on from there. Such criticism does not affect me personally, but I hope that with such a question I can contribute to a thinking process that we really have to go through with each other about the underlying principle: the most recent insights are the basis for plan A, the best scenario. If Plan A does not work, sometimes you have to go for plan B and then you make the best of that second-best option. Now it sometimes seems like plan B is the first choice and that if you advocate plan A, you hurt parents or overask them, while I believe that parents have a right to the information of plan A. They have to choose what they want to do and we guide them in doing so.”

I ask Kelli how parents react when she discusses these topics with them.
“That depends a lot on which parent is sitting in front of me. One thing is always certain: we sit together in that consulting room because everyone wants the best for that child. Often in such a conversation, a question arises from the parents, for example regarding disagreements about where the child sleeps and whether they should learn to sleep alone. Then the goal is for me as a youth doctor to work in accordance with the JGZ guidelines. Parents will be influenced and informed by these guidelines to the extent that information leaflets are made for them on the basis of those guidelines. Parents do not always have the same employee in front of them at the ‘consultatiebureau’ (well-baby clinic). Continuity, therefore, largely comes from applying the guidelines, but not everyone interprets them in the same way. What I do then is that I explain that there are multiple visions and that the choice for how parents want to approach their child is of course always theirs. I explain the basics of what a baby or young child needs and provide additional information. What I think is important is that they dare to put everything on the table that they struggle with or about which they have questions, so that we can discuss it. After all, those parents have to do it together! After the consultation, they should not go home with the idea that they have to do what the doctor says, but with the idea that they have enough information to continue to put the puzzle pieces together, also in contact with others in their social environment. I think those conversations are very nice, because you notice that you have something in common, which is the well-being of the child. When there are concerns about issues such as possible child abuse, that is a different story, but of course that is not the case for the majority of parents. They want to see what is the right thing to do. I enjoy that interaction and because of that, you get a positive exchange with each other. I never say, “This is how we are going to do it”, because it is not about what I want; after all, I am not the one who has to feed the child, change the nappies and carry the responsibility for the daily care, right? These parents should be comfortable in their roles. Guiding that process… that I find really fantastic!”

Next week in Part 2 you will read about the challenges Kelli experiences in contact with parents and with guidelines and the way in which she sees scientific insights embedded in daily practice.