Tiffany Podcast
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Mary Coughlin: [00:00:00] Well, I am so wicked excited to welcome Tiffany Gladdis to the care out loud podcast.
Tiffany, and would you mind just sharing how did you get started in psychology and further, particularly psychology
Tiffany Gladdis: within a NICU setting. Sure. The story kind of goes back. to high school, I took a psychology class and a sociology class and they were college level courses.
I was fascinated by psychology and sociology So when I went to college, my plan was to be a marketing and advertising exec. And so I majored in marketing and advertising, but because I liked psychology, I just made it my minor. in my first marketing and advertising class, I made a C and I had never in my life made a C and I was like, Hmm, maybe I should re evaluate this. And so I flipped it and made psychology my major and eventually minored in child development and special education.
But even [00:01:00] then, I had no idea that there. We're psychologists that worked with really young Children until I went on internship and I had the opportunity to do a birth to five rotation and I just completely loved it. I've always loved working with babies and young children,
And so I was like, okay, this is a really good fit for me. most of the work I had done up until internship was. Working with families who had experienced trauma with underserved populations and that was my area of focus. as I went into fellowship, I did the Harris infant, mental health fellowship.
And so I got. a lot more of that kind of didactic education about birth to five, whereas in my internship, I just got that clinical exposure. And then there I was able to kind of combine all of my interest, right? In thinking about working with people who have experienced trauma, but [00:02:00] then also working with our youngest population, it was just a, a perfect.
fit in a perfect niche to think about NICU psychology. So that's how I made my path to the NICU work. it sounds
Mary Coughlin: really well aligned though, you know, all kind of like fell into place for you. But the thought that popped in my head as you were sharing your story is this idea.
of infant mental health, Can you talk a little bit about the evolution of that specialty?
Tiffany Gladdis: Yes, yes. I always tell people whenever I mentioned that I'm a psychologist in a NICU, I see people's brains kind of working and I imagine this little thought bubble above their heads where they're thinking, like, are there babies on couches? Like, what is she doing? As a psychologist in a NICU. And so I always really enjoy taking that opportunity to explain what infant mental health is and that it's really [00:03:00] about the relationship between the caregiver and the infant and the overall well being of that adult caregiver as a foundation for that child's developing social and emotional development and how that baby Is an extension of the parents.
if the parent is unwell, if they are emotionally unstable, if they are struggling with mental health conditions, it makes it difficult for them to be a secure base to set that healthy foundation for this. little body, you know, that's growing and learning and trying to build and develop all of these synaptic connections in their brain.
And so the work that I do with infant mental health, the patient is really the relationship. It's not just the infant. It's not just the parent, but it's that beautiful dance that happens in between the two to help make both be healthy.
Mary Coughlin: that's a beautiful description, a beautiful definition you made me think of I just [00:04:00] recently read this interesting paper in the field of psychology it was talking about children and used the word dehumanization the author was talking about different schools of thought around children and being human or becoming human how many children particularly infants can be vulnerable to Disrespect and an absence of dignity because of some of our established preconceptions,
Tiffany Gladdis: about the
Mary Coughlin: humanness of that little individual and how it can actually cascade
Tiffany Gladdis: into kind of
Mary Coughlin: Dehumanizing other populations
It really made me think more
Tiffany Gladdis: Yeah, the
Mary Coughlin: field and really recognizing the humanness. I like how you focusing on the relationship because [00:05:00] then that really helps the individual appreciate the dyadic.
Tiffany Gladdis: Nature, right? Of the
Mary Coughlin: relationship, right? Of individuals, parents and babies. But am I going out too far to ask you to ask your thoughts about this idea of the humanness of babies and how that happens and how that negatively impacts the
Tiffany Gladdis: No, I think that's a great question. it used to be that this idea of attachment and nurture and bonding, people looked at it as a soft science, you know, that it's kind of just this mushy, gushy thing that psychologists say. But we have decades of data now that support That this love nurture connection to an infant it's real, it has a physiological impact on babies.
And it used to be that we thought, infants were not affected, By the things that went on around them. They're just a baby. They don't know [00:06:00] what's going on. They won't remember. But, With books like the body keeps score, we know that that is not true and that as early as birth and even in utero, we know that babies are impacted by their environment and there are over 100 different genes that are impacted by nurture.
And so, When you talk about the humanness of the baby, it's not like they reach some special age and then there's an awakening and they are impacted. They are impacted from day one. people used to think, oh, you could just sit baby in the car seat. And if they're hearing, you know, arguing or witnessing X, Y, or Z, they're not impacted by that.
babies don't have language and so at that age, they're not processing what they're experiencing in a verbal way, but their brain or their body keeps the score of the trauma that they're exposed to. And those things do show [00:07:00] up in their body and in who they are, as they do grow up,
There's so much data to support that humanist piece as early as birth. Thank
Mary Coughlin: you so very much for explaining that because I think that that's also a piece of psychology and the NICU environment that many, at least I'll speak from my own discipline, right? Many NICU nurses don't really recognize the role that they play.
In the nurturance piece of the baby, we can get really hung up on all of the tasks and all of the doing things and the love stuff. Oh, that, well, that's the parent's job, right? I mean, they've got that covered. But as you mentioned earlier, when the parents are in overwhelm, when they're traumatized by what's happening and whatever the backstory is too, right?
There's, it's not just this.
Tiffany Gladdis: And then everything else was
Mary Coughlin: hunky dory before that. It's that other story that makes it super important for the nurses and for the healthcare team at Lodge, [00:08:00] to understand that our role also includes that nurturance piece.
Tiffany Gladdis: And one of the things I try to impress upon our NICU nurses and our neonatologist and really any person coming in contact with the baby is that we're a little bit under the gun when it comes to time. John Bowlby, who's the creator of the attachment theory, says that there is a critical period of time that we have to establish this healthy foundation in brain development related to attachment.
And some theorists believe that that window is zero to two. Some people believe it's even smaller window, like zero to twelve months. I work in a level four NICU and it is not uncommon for our babies to be in the NICU for a majority of that first year of life. And so I try to explain to people, it's not something that we can just wait until baby goes home and then we can work on facilitating bonding, facilitating attachment, having [00:09:00] loving, respectful touch.
It's something that has to coexist with the necessary medical care that we're providing. The nurture love attachment is also a necessary care that we have to provide.
Mary Coughlin: I like that you point out that it's not either or, from a nursing perspective, we would.
Think about developmentally supportive care, which I view as an operational strategy for me to be trauma informed but oftentimes they can become part of a checklist. And we prioritize and we'll say, Oh, they're too sick, too sick to be held, too sick to be loved, too sick to be this, that, the other thing we need to just keep them isolated.
Touch times should have been for the clinicians, not the parents, but oftentimes parents were also held hostage by these touch times because of these perceptions and a knowledge gap,
Tiffany Gladdis: think, you know the importance
Mary Coughlin: of the nurture science that you shared earlier and really understanding that[00:10:00] And so given your unique position, I don't see yet that a psychologist is a standard
Tiffany Gladdis: you know
Full time. Yeah.
Mary Coughlin: In the NICU environment. Is that accurate
Tiffany Gladdis: or that is very accurate. I I'm happy to say it is a growing role in NICUs, but we have so far to go. when I was in fellowship and deciding, you know, I think the perfect culmination of the things that I'm passionate about
would be a job as a psychologist in the NICU. I was told by many of my mentors, Ooh, that's probably not going to happen. The NICU is a very closed system and I feel very lucky that it was one of my first career opportunities to be a NICU psychologist at my institution.
They had placed a Position. It was a new role, and I interviewed for it, I've been at my institution for eight years now, but I've gotten to really develop what the program looks like and provide a lot of education.[00:11:00] I'm a part of an organization I helped create actually National Network of NICU psychologists, which is the parent organization for us is National Perinatal Association.
And so. We are a growing group. There are at a lot of the major hospitals like CHOP nationwide, Children's Hospital L. A. They have NICU psychologists, but there is the need for so many more. To me, it feels like It's a no brainer, right? Like this is the perfect place for a psychologist because you have parents who have come to be here by way of some type of trauma, like nobody gets to the NICU because everything went well.
There's fear, there's anxiety, there's depression, there's the processing of the trauma that they've gone through, and there's the need for a well parent in order for this baby who's also been through trauma to get them there, to have a secure base. And so to me, it's kind of like, of course a psychologist should work here, but [00:12:00] we are working really hard to make.
psychology more well known and try to advocate for more positions and slowly but surely that's happening.
Mary Coughlin: at a cutting edge facility those are the organizations that recognize the need and appreciate the evolution of the science and.
serving patients at their highest level. I remember presenting with you at the A1 conference along with Kimberly Novod, and there was a powerful presentation that highlighted the challenges of women of color, families of color in the NICU setting.
And we see that there's more and more research that's, you know, being published talking
Tiffany Gladdis: about
Mary Coughlin: the disparities in outcomes, the disparities in the quality of care that families of color are receiving in the NICUs. Say, being, from a white perspective that, it's very, it's jarring.
And, and I, again, just to paint a very,
Tiffany Gladdis: honest
Mary Coughlin: and [00:13:00] transparent picture here, in first reading that you think, oh my gosh, no, that can't be happening. nobody's going to work, to, Practice their racism, I mean that that's just not what's happening.
But I think what I've learned over, pursuing a reading more into it and really understanding the nature of health disparities in general and how it manifests itself in the NICU environment. It's not about intentionality. It's really helping folks wake up to the realization that we, we live and work in a traumatized world.
We live and work in a society that has structural trauma, structural racism, and, it is ever present. if we aren't acknowledging that reality, then we are just perpetuating the situation. I know that's not [00:14:00] what my colleagues want to have happen. I really, loved listening to your presentation and Kimberly's presentation and wanted to explore that topic with you here on the podcast, because I think.
it feels taboo. I mean, I think it's just an evolution of talking about things that we don't usually
Tiffany Gladdis: talk about. Right. Right. Yeah.
Mary Coughlin: and so we have to get comfortable with being uncomfortable so that we can address these inequities. just recently I came across The neonatal justice collaboration, and I had the privilege of listening to Diana Montoya Williams, neonatologist speak at the Delphi conference.
Back in February of last year. she is a proponent of addressing the inequities and the racial disparities in neonatology and wondered how that work informs informs the work that you're doing in your specialty [00:15:00] within psychology.
Tiffany Gladdis: Sure. I wasn't familiar with her work, but I did a little bit of research and I love what she's doing. it's so important. one of the things I love most about it is that it's physician led. And I think, you know, sometimes it's sad to say, but how we get some of these more like.
trauma informed care, perspectives, family centered care, just attachment and bonding. How we get that kind of push forward and, and adopted by other physicians is to have a physician lead, you know. So I really loved that aspect of it. You know, I think my institution just because psychology is new in the NICU and I'm introducing some of these ideas and really starting to help people.
With the conversation it's a process. One of the things, though, that I am really proud that my institution in particular has done. Is we do have a racial disparities work group, the intention of that group is to look at the data from babies at our institution [00:16:00] and try to find disparities that exist so that we can evaluate those further understand them more and get to the root cause.
of it so that we can create awareness for other providers and then institute change. So we're looking at, you know, is it more likely that a white baby receives a trach sooner than a baby of color or that a diagnosis is delayed for a certain population? And so we're at an investigative stage, which I think is a really important stage of change because, like you mentioned before, oftentimes there's just the lack of awareness.
And if we don't explore and try to understand what the disparity is, then we're not positioned to address that disparity at all. You know, when we approach it from the mindset of. course that doesn't happen here. Or of course, we're giving everybody good care. Then we we kind of cut ourselves off at the knees, right?
Like you said, there's a structural component to it. And so it does happen at every institution. until we are open [00:17:00] to exploring that we aren't positioned to really address that.
And that's the approach we've taken. I've been fortunate enough in the last year, actually, of being the medical director of our Office of Equity and Diversity. I've been able to push a lot of initiatives through that address program.
infant and maternal mortality for BIPOC populations. Last year in May for Maternal Health Month, we did a community screening of The documentary aftershock that addresses black maternal mortality. we had a panel after the documentary with providers in the community, researchers, obese other people who.
Are familiar with these topics, and it was really just an opportunity for the community to ask questions to learn and grow we want to impact the greater community. And so, children's Mercy really is looked to as a leader in our community.
So to be able to bring providers from other institutions and[00:18:00] other hospitals in and have this rich conversation with these intelligent people. And if you haven't watched this documentary, I recommend it It's called Aftershock and it will open your mind to, like you said, some of the structural things that impact women of color.
Differently than it impacts other women. Yeah,
Mary Coughlin: there was a couple of really recent good papers that talked about particularly that intrapartum experience of of women and, and particularly women of color. She was, I'm, I'm forgetting, I'm forgetting the, the art, the name of it.
I'll have to shoot it over to you. Yeah. Yeah. All right. But it was talking about the role of the labor and delivery nurse their role in being an advocate and, and using the language, right, of, of trauma informed care to really stop a lot of that it's patriarchal, it's hierarchical. Some of the language and some of the way we treat[00:19:00] I mean, we treat a lot of patients in a lot of different settings.
With exerting power over them and how that plays out in the interpartum environment was really shocking. I mean, incredibly distressing to a point. I know this is a strong word, but like horrifying when I think about this is 20, you know, 2020s, what the heck is going on?
I mean, from a psychological perspective being in A level four Children's Hospital NICU is a unique experience in and of itself because you don't have a direct connection with that antipatum experience, the moms are, in another hospital,
That they usually have to then, drive to get discharged
Tiffany Gladdis: and drive to,
Mary Coughlin: to your hospital to be with their child. But do you get to be part of that healing [00:20:00] journey as you're working towards facilitating a healthy relationship with the infant? Do you find that their lived experience before this, may impact the relationship that you're trying to, you know, facilitate and support in that NICU setting?
Tiffany Gladdis: Yes, absolutely. And we do have a fetal health center in our within our Children's Hospital. I do get to work with some birthing people during the pregnancy, and those are already high risk pregnancies where they know those babies are going to go straight to the NICU. So that trauma starts very early for them.
But with all of my family, the antepartum experience is usually my first thought. It's because something went wrong, awry. And so that's usually my first thought is to utilize narrative therapy.
And invite them to share with me what brought you to our NICU. I always [00:21:00] invite them to give as much or as little information as they feel comfortable with, I want them to be in the driver's seat.
I'm walking alongside them as they're going through this journey, but they are in charge. They are the expert on their experience. I've heard so many stories by just giving that invitation of what people have experienced.
The resilience of our families impresses me every single day, because some of the stories that I have heard about the treatment that people have experienced at the hands of medical professionals or a medical system, It is horrifying.
And like you mentioned before, that layers on top of whatever other traumas that they're experiencing, they have children with medical issues. They potentially had a NICU experience that did not turn out so well. And maybe they lost a child. Maybe this baby is being conceived after multiple miscarriages and it's like their last and only hope to bring life into the world.
Families sometimes have [00:22:00] a ailing parent at home or a spouse that just passed away. there's just so many things that are going on for the person that's sitting in front of you You may not even know or recognize that they are lugging, through this NICU experience. Yeah.
Mary Coughlin: with that level of insight, Tiffany, how has the work that you've been doing expanded your understanding of the needs of this unique population? And how can you help the bedside clinicians, expand their compassion, and understanding for those that they're serving?
Tiffany Gladdis: Yeah, you would think that it would be really technical or like some big psychological theory that I'm going to say to you to answer that question, but the answer is so basic, which is to make sure that families feel seen, heard and respected.
Mary Coughlin: you find that you are able to share that [00:23:00] very simple Insight with your colleagues and that it is adopted do you find that there's a shift in the culture as a consequence of your presence in the work that you're doing that families may be feeling more seen, not just by yourself, the team at large.
Tiffany Gladdis: that's a really good, really good question. My hope is yes. And I think one of the things that is important is the renewal of this education, because most people adopt it immediately. Like, it's not something that you say, I don't want to be on board with making somebody feel seen, heard, and respected.
we've all gone into this field because we care about people and we want to help them be at their best. But sometimes over time, we can revert back to what is easier, or, to the humanistic experience of critical care providers. It's hard to work in a critical care.
environment, [00:24:00] you are trying to maintain or save a life. And sometimes those other skills can go out of the door pretty easily. So I think it's a renewing of information regularly to remind people this might be what's happening Maybe this mom is feeling invisible when you walk in and you just changed the baby and do the feeding and don't even offer.
This mom is already feeling like she's not a parent because she has to ask permission to hold her baby or she's feeling like her body failed because her baby was born at 24 weeks and this is one maybe Seems like a small thing to you, but this is one huge thing to be able to change her baby's diaper and feed her baby that makes her feel like a mom, you know, and so I hope the answer is yes, there has been a shift since I've been involved.
And then the other thing too is, We have 300 plus nurses, and so there's continual turnover. that's why we have to like, keep it [00:25:00] fresh, you know, keep reminding people and our monthly reminders and our our baby bits, which is our newsletter. these things are important, Let's keep them at the forefront of our minds so that our families and our babies can benefit.
Well, and I
Mary Coughlin: think legacy staff also benefit from those reminders, too, the work bearing witness can really deplete you. And it's not just patients, families that are toting around a bag of stuff,
Tiffany Gladdis: right? I mean, every single person.
Mary Coughlin: on the planet, but certainly every single person in that NICU has their own bag of stuff, their own challenges that they're, you know, toting around.
And some are better than others of leaving it on the curb and coming in. It doesn't mean that it isn't affecting them. Is, Are there referrals that you're able to provide or how do you have a role in supporting the clinicians mental health and wellness as well?
Tiffany Gladdis: Ideally, the [00:26:00] NICU psychologist would include staff support. I don't have enough F. T. E. In my role to include that. We do have other like hospital programs and initiatives that our clinicians can utilize to help them process the trauma.
And then we have a couple of like NICU specific initiatives. Like we have the code lavender, which allows our clinicians if they're having a really tough day or the death of a patient or significant decline. We have a lavender cart that rolls around and it has, you know, chocolates and coffees and teas and all those things.
And they can also ask for someone to come and give them a break so that they can step away. We really want to empower, as we are preaching and teaching about trauma informed care and burnout and vicarious trauma, we really want our. Nikki nurses, I think, in particular, because they're the ones that are on full time to take [00:27:00] care of themselves.
And in the same way that I talk about the parent being well, in order to be able to care for the baby in a healthy way, the same is true for those bedside nurses, they need to be well. Also, and I think when you work in a critical care environment, it's really easy to feel like you just have to push through everything.
And we want to empower them to feel like they don't have to, that there is help if they need to take a moment that they're human too, They're not robots. That's wonderful. And I
Mary Coughlin: love that you brought up the code lavender and that there are those resources and awareness, and that's the other thing I think about being trauma informed is just the awareness that each of us have our own lived experience that maybe most days we, we, you know, we're feeling pretty resilient, but because of the nature of being human.
You know, you, you're going to have days where you're not going to be on top of the game, and there are resources out [00:28:00] there for you So I'm going to transition to my last question for you. the name of the podcast is Care Out Loud. And without, disclosing
Tiffany Gladdis: where that came
Mary Coughlin: from, I would just love to hear, your thoughts about that.
What's your take on that? what does it mean to care out loud
Tiffany Gladdis: to you? Yeah, I think that's a really powerful question. for me, the word that bubbles up for me is advocacy that my responsibility As a psychologist, as a human being who has my own lived experience, but also my own privilege is to be an advocate for other people.
Maya Angelou has a quote that says, I come as one, but I stand as 10, 000 and I always think about that whenever I'm at a table or a decision making a space or I'm at a place where I'm able to, to help a medical team. Understand the [00:29:00] perspective of a family and why they might be reacting or responding in the way that they are and what they might need
I have an opportunity that I've been given. I have been blessed to be in a position where I can advocate and potentially shift the trajectory of someone's experience. And so I always think about that the responsibility that I have of, you know, to whom much is given much is required.
And so for me, carrying out loud means making an impact, advocating, making change, helping others that may not have those same opportunities or privileges or be in those same decision making positions.
Mary Coughlin: so beautifully articulated. I can feel like tears
Tiffany Gladdis: coming
Mary Coughlin: up on my way. The eloquent way in which you just described that
I mean, I could feel your passion for the work that you do. And certainly all the children and families that you're serving are super blessed by your presence Is there any last thoughts that you'd love to share [00:30:00] with? The world that's listening to this podcast
Tiffany Gladdis: Thank you, for saying those kind words. my last thought would be specific, really for anybody. But I know we're talking about NICU families here. In every interaction or encounter that you have with a family, remember to think about What else they might be tugging around, you know, and thinking about how it might be impacting the way that they show up or don't show up right there in front of you.
Because I think when we're able to slow down and engage that empathy, it allows us to meet families. Where they are in a way that hopefully makes this really terrible experience just a little bit better, right. Of being in the nicu. Oh,
Mary Coughlin: could not have said it any better. And I, I love the visual that you had.
I mean, that's what kind of helped me articulate that piece was, you know, the bag, I know a lot of [00:31:00] folks use that. The iceberg imagery. Yeah, the bag, toting the bag. I think for me, it's at least it's an easier visual to really understand. So that was just beautiful.
Tiffany, thank you so very much. I literally could just
Tiffany Gladdis: pick your brain for hours.
Mary Coughlin: I don't want to torture you in that way, but thank you so very much.
Tiffany Gladdis: this was wonderful. Mary, it's such an honor to be here in your podcast because I followed you for so long.
and to be able to nerd out with you about these things that I know both of us are really passionate about is just. It's really an honor. So thank you for having me. I just really appreciate it. Oh, you're most welcome.
I love that you just said nerd out.
Mary Coughlin: we definitely have to stay in touch, my friend.
