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Join Kody Sexton, a graduate student, as he sheds light on the often overlooked challenges these caregivers face. Discover how trauma-informed care, systemic changes, and social justice initiatives can better support these unsung heroes. Tune in to gain insights into reimagining caregiver services and addressing the intersection of trauma and inequity.

Kody Sexton is a graduate student.

He discusses the KevinMD article, “The impact of medical traumatic stress on families.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Kody Sexton. He’s a graduate student. The KevinMD article he co-wrote is titled “The impact of medical traumatic stress on families.” Kody, welcome to the show.

Kody Sexton: Thank you. Happy to be here.

Kevin Pho: So just briefly share your story and journey to where you are today.

Kody Sexton: I’m currently a PhD candidate at the University of Tennessee, Knoxville, in the counseling psychology program. I actually started off in higher education. I worked for a bit as an academic and career advisor, and it was really through that experience that I got interested in mental health and how it intersects with academic and career planning. That led me to seek out this PhD program. I thought I was always going to stick to working with college student populations, but I ended up in a practicum placement where I got some great experience working with younger kids and youth, and I just found that I loved that setting. I loved that developmental age range, especially as it related to preventive care. So I got really interested in that, and that led me into the field of pediatric care.

Kevin Pho: All right, wonderful, and we’ll talk about your article in a little bit. One thing you said piqued my interest: that intersection between academics, the higher education setting, and behavioral health. We hear a lot about that in the news, so talk a little more about that intersection.

Kody Sexton: Yes. Especially when I was working as a career advisor, I worked mostly with STEM students, college students pursuing technology pathways, and I realized very quickly that it was relatively easy to talk with them about what classes they were going to take the following semester. But what came up so often was just life stress. They had just gotten to college and had symptoms they had never experienced before, which were really affecting their decision-making skills and their sense of belonging, some pretty significant mental health disruptions that would affect academic functioning. Through that, I realized that it’s one thing to help you plan out your schedule, but we really can’t do that until we get you to a place where you are psychologically safe and well resourced with mental health care.

Kevin Pho: I think I just dropped off my daughter; she’s going to be a freshman undergraduate. So for other undergraduate students who may be listening to you and may be experiencing some of the symptoms you describe, what kind of advice do you have for them?

Kody Sexton: Great question. I would say, first, you’re not alone. I know that’s almost cheesy to say, and they might hear it often, but as someone on the other side of it, working professionally, there are so many students who don’t expect to have mental health concerns, or maybe hadn’t had them before, who get to college, and suddenly there’s a lot more to deal with. It’s perfectly normal; it makes a lot of sense that those things can come up. And there are so many resources on campus. That’s one of the wonderful things about the collegiate setting: There are trained professionals who are there for you and are happy to provide services to get you to where you want to be.

Kevin Pho: All right, now let’s move on to the KevinMD article you co-wrote, titled “The impact of medical traumatic stress on families.” The article starts off with a quick anecdote. Why don’t you share that anecdote with my listening audience, and then talk more about how this article came together?

Kody Sexton: We wanted to start off with an anecdote really just to bring home exactly what medical traumatic stress on families might look like in practice. I work in East Tennessee, primarily with rural populations, and I think sometimes when we talk about intersecting identities, or social identities, rurality and geographic location can get forgotten, or maybe a bit hidden. So with the anecdote, we wanted to highlight the experience of a low-income father from a rural background who had to travel a long distance to get to the hospital, where he recalls the experience of his newborn being intubated. I think that is a really practical case example, and definitely something I’ve seen play out in different ways in my own clinical training.

Kevin Pho: All right, so how does that lead into some of the points you want to discuss today?

Kody Sexton: The big takeaway of the article is that medical traumatic stress is not something that can affect only pediatric patients. It can absolutely affect those who are caregiving, and that can include parents, families and others in the caregiving system. And just like traumatic stress broadly, medical traumatic stress really intersects with people’s sociopolitical locations, their personal identities and their geographic contexts. All of those social locations really play a role in how traumatic stress shows up, and because of that, as providers we have to think about how we can intervene accordingly to address all those factors.

Kevin Pho: So what we always hear from caregivers is that their own care often comes last, after the person or people they’re taking care of.

Kody Sexton: Yes. It seems like that’s such an area for growth for us as providers: to really prioritize the caregiver mental health side, knowing that it has such a direct impact on pediatric care.

Kevin Pho: So assuming that caregiver stress, medical traumatic stress, isn’t addressed, what are some of the repercussions you’ve seen from it going untreated?

Kody Sexton: I would say one is something like disengagement. We might easily read a family as being disengaged from the treatment process, and that could be because, unbeknownst to us as providers, they’re really dealing with their own mental health concerns, with the medical traumatic stress reactions they had after watching their child undergo a procedure. So I think our framing, how we imagine or conceptualize the patients and families we work with, can really get in the way. We can view them as disengaged or nonadherent, some of those kinds of factors.

Kevin Pho: And what kinds of interventions are available for these situations?

Kody Sexton: There are some programs across hospitals and health care systems that treat caregiver mental health directly in the pediatric setting. I think, perhaps more commonly, at least for the time being, the field tends to address caregiver mental health in a small way, maybe providing some initial resources, but it tends to refer out. So I think where the field is going, and what I think would ultimately be really helpful, is having specialized services within the pediatric setting, where caregivers can get the assistance they need and deserve. But the actual interventions look really similar to what we might think of for other presenting concerns: addressing anxiety, addressing depression and addressing traumatic stress.

Kevin Pho: Any tips you could share with clinicians who are seeing a family, seeing caregivers? Anything they should be on the lookout for, to perhaps suspect caregiver stress and perhaps intervene?

Kody Sexton: I would say one thing to look out for could be almost a sense of overcompensation. We might see a parent or caregiver who says, “Oh yeah, this all makes sense. I’ve got it all figured out. Everything’s good to go.” In some cases, that might be a great strength, something the caregiver really experiences. But in other cases, it might be a sign that they’re struggling, and they’re just so used to being put in the position of the caregiver, holding all the knowledge and understanding all the medical information, that it’s hard for them to say, “You know what? I’m actually really confused. I’m really overwhelmed about how to engage in this aftercare plan.” So it’s really about slowing that process down, getting curious about the caregiver’s experience and just checking in with them. I think a small way a clinician can do that is just by saying, “We may not have asked you enough in our visit today, but let’s just slow down. Is this all making sense to you? What else can I clarify today?” That can be a way to break the pattern.

Kevin Pho: Now let’s talk about what caregivers themselves can do, because, as we talked about, they’re often just overwhelmed with so much information, and there are so many things they have to do to provide caregiving services to their loved ones that they may not even be able to recognize the stress they themselves are under. So what kinds of tips do you have for caregivers, not only to recognize it but, if they do recognize it, to take those next steps?

Kody Sexton: I would say it can be helpful, as much as one is comfortable, to talk with others about it. I think the experience would quickly be that there are other caregivers, other people and families out there, who’ve gone through similar experiences and can share some tips, or even just normalize it: “Yeah, when my child was hospitalized, or when my child received this diagnosis, here’s what I was going through, and here’s how I decided to manage it.” So definitely reach out. I do think there are some really useful caregiver voices out there, caregiver organizations with free trainings and free opportunities to talk, get to know and build some community with other caregivers of kids with chronic illness.

Kevin Pho: One intervention you mentioned was acceptance and commitment therapy. What exactly is it?

Kody Sexton: Sure. It really focuses on building some tolerance for tough emotions and tough thoughts, with the recognition that we can’t get rid of those things. That struggle is an inherent part of life; difficulty, and difficult emotions or thinking patterns, will come up in our lifetime. If we can build some reasonable, or creative, acceptance of those things, then we don’t have to spend so much time and energy fighting them, fighting not to have the symptoms, fighting not to have those thoughts. It’s a really effective therapy, not only for caregivers but more broadly, for children and adults.

Kevin Pho: So can you give an example, an anecdote or a story, of what acceptance and commitment therapy would look like in a real-life setting?

Kody Sexton: Yes. One of the big practices in acceptance and commitment therapy is mindfulness. One metaphor we use often, especially in my work with kids, is imagining our thoughts as if they were people, or other kids, on a bus, and we’re sitting in the house watching that bus, filled with all our thoughts, or all those people, just drive and ride by us. So instead of saying, “Oh gosh, this thought I keep having really bothers me. I wish I could just get rid of it,” we embody that mindfulness skill to say, “I can’t get rid of it, but I can create some distance between me and that thought, as if it’s just driving past me in that school bus.” That’s a way to practice that acceptance piece.

Kevin Pho: We’re talking to Kody Sexton. He’s a graduate student. The KevinMD article he co-wrote is titled “The impact of medical traumatic stress on families.” So Kody, tell us the next steps and how we could better manage caregiver stress. What are some suggestions clinicians and their offices can implement to address this?

Kody Sexton: A recent article identified three main strategies for providing caregiver mental health services. The first is to take caregiver mental health and subsume it as part of the child’s care. Another option, which right now seems perhaps to be the most common, is to refer the caregiver out to another provider, or to another service outside the pediatric setting. And the third option would be to treat the caregiver directly in the pediatric setting. Ultimately, what I personally would like to see is moving a lot closer to that third option, where parents and caregivers of kids with chronic illness can come in to receive treatment for their child and, at the same time, receive treatment for their own mental health concerns, especially medical traumatic stress. In terms of what clinicians can do about it, I really think screening is going to be important for all providers: screening parent mental health, especially among those who have kids with chronic illness.

Kevin Pho: So, talking about that third option, addressing caregiver stress right in the pediatric office, what would that look like? Would you have behavioral health specialists embedded within the pediatric practice to address it?

Kody Sexton: I think that would be a great start: having a designated caregiver support team, somewhere that, while the child is receiving help in the moment, the members of the caregiver system can also receive behavioral health care. I think it would be a wonderful thing if there were more support groups just for parents and caregivers, maybe running during the day or even later in the day, so that parents and caregivers know that while they are there to focus on their child’s care, the pediatric portion, we as providers serving pediatric populations recognize that the best work we can do is always going to foreground caregivers, because their mental health and their experiences directly affect child outcomes and care. If we can have those support groups, and those specialized behavioral health services within the pediatric setting, that provides a bit more wraparound care for families.

Kevin Pho: And tell us some of the take-home messages that you want to leave with the KevinMD audience.

Kody Sexton: I would say the first, again, is to stay curious about what parents and caregivers might be going through as they are receiving care for their child. And also to really be mindful that medical traumatic stress is not one-size-fits-all. It can really intersect with the other identities and cultural backgrounds that parents and caregivers hold. Some of those factors can be cultural strengths, and some can be cultural barriers, but it’s really important for us to be mindful of how medical traumatic stress directly intersects with things like race and racism, gender and genderism, and even geographic location.

Kevin Pho: Kody, thank you so much for sharing your perspective, time, and insight, and thanks again for coming on the show.

Kody Sexton: Thank you.