TCOM Takeaway 6: There's No Such Thing As Recovery

Kristen Cerelli 0:00

Every week on our regular episodes of shift shift Blum, I get to interview people whose lives are very different from mine. And we talk about how each has navigated the twists and turns inherent in transformation. But I wonder what's universal about how people change? What are the common threads, the connective tissue, I tend to look at change through the lens of my own experience, for the most part, the artists life. Lucky for us, my curiosity is shared by the CO creator of shift shift bloom, Dr. John Lyons, luminary and author in the field of clinical psychology and systems change, who better to help me unpack all the questions that fill my mind when the interviews are over. I'm Kristen Cerelli, and you're listening to shift shift bloom, T calm takeaways, my conversation with Dr. John Lyons about a recent interview.

Back in the studio today with Dr. John Lyons, and we're going to fly back over my interview with Michelle McFadden who had a traumatic brain injury and see what John's perspective is on that. Welcome, John.

John Lyons 1:30

Thank you. It's good to see you, Kristen. Good to talk to you. And that's that was an incredible story, Michelle. I wonder though, you know her right? I mean, so you have a relationship with her before. So what was that like for you interviewing her?

Kristen Cerelli 1:44

Well, I want to start by saying I thought it was incredible that she sat with me for two hours, like every other guest, who I leave as much time I block off about two hours for each guest just because sometimes the conversation wants to go that long. And I wasn't sure if she would be able to stay with me stay focused, stay concentrated. And she really did, she really stayed with it. And that in itself was a really impressive feat. Because I can only imagine how hard it is for her to really take all that in, not just not just share and talk back but to take all that in that I was tossing at her. But I've only known her for three or four years. So I've only known her as a person with a traumatic brain injury. But even in those four years, I've seen her improve leaps and bounds in her her physical life, the very first time I met her she was still her walk was still impaired, obviously. And it's not so much anymore. So I've seen her change in that way. Um, this is our first guest, who you don't really have any prior knowledge of so I wonder what jumped out at you?

John Lyons 3:11

Well, I was actually found that inspiring and interesting. And there's three things that really stuck out. For me. The first is that concept that you don't recover, you know, because recovery language is such a big part of behavioral health, and suddenly this kind of dialogue. And but I thought what she said was profoundly important and really needs to be thought about in that context. I was thinking about it in the lives of the people. I know family members, myself included, who have struggled with psychiatric issues. And do you actually recover? Or do you learn how to adapt to them. And so maybe the recovery concept, although it sounds really good, it sounds nice, it sounds inspiring, is actually aspiring to something that's not real, that's aspiring to something that doesn't really exist, because you're not going back to something that you would have been or were before. You're going forward to a version of yourself. That is actualizing what you want to be in your best life. And so I just found that absolutely fascinating to think about and listen to how she talked about it and et cetera. So

Kristen Cerelli 4:29

yeah, I thought that was it wasn't, I guess it was unexpected. It was unexpected to hear her bring up addiction and then relate it to recovery and then bring up the reveal later on in the show where she said, You know, one of the biggest positives was that this accident and injury stopped her from going down a path that she would have surely gone down. I had no idea that that was part of her story. None whatsoever. So knowing her, I'd never kind of been privy to any of that information. And I really appreciated her sharing that. Because I think it's revealing and just important, I think a lot of people are gonna respond to that.

John Lyons 5:19

Like, okay, so her head injury helped her recover from her substance. i It doesn't make sense, right? It's just not, doesn't appear to be how it works, right. So there's, there's the issue of, because of her head injury, she doesn't get the same pleasure or enjoyment from the alcohol. And she doesn't have that problem now. And that's, that's a good thing. So I think that was fascinating how she's, I mean, to be a cliche, she's made lemonade out of lemons, right? She's taken what she has, and made it into something special and something good. And I think that's just a beautiful story. That's the beautiful part of that story.

Kristen Cerelli 5:59

You said, there were three things that stuck out to you what are the other two?

John Lyons 6:02

was the second one was the her acceptance of the help? The concept that yes, I need help, because it's really true of all of us, every single one of us cannot survive on our own. And yet, particularly in the US, we have this sort of false notion of individuality, this false notion that it's about me, it's about me doing what I want to do and what I want to do and how I want to do it, and all these kinds of things. But truth be told, we're all interdependent, we all need each other, for all sorts of things, you know, even just to make sure the roads are paved, you know that all sorts of ways in which we're interdependent on each other. So I thought, that was a really interesting insight on her amount of how she she was very independent and very focused on being the independent and that, you know, she, as you comment that I think in an aside, the confusion of financial independence with emotional independence and the concept of interdependence versus dependency are all inter woven in this kind of complex fabric of relationships. And so I thought it was interesting how she thought about recognizing that she needs help, and that she likely always will need help. That's not a bad thing. That's actually a good thing. That's a positive part of her journey.

Kristen Cerelli 7:32

Yeah, I appreciated that she she kind of brought in that question of would this all have changed with time, regardless of the injury? And it's really it's just a question that hangs there. It's like, yes, as we get older, we probably are going to need more help than maybe we do. And we're in our prime. But if we have no experience and asking for that help, where are we, you know, where are we left? And? Yeah, I think, you know, like I said, I didn't know her before, but the stories that she tells lead me to believe. She never asked anyone for anything. So to have such,

John Lyons 8:15

when she said she knew everything.

Kristen Cerelli 8:18

Which is Yeah, knew everything, and could do everything, you know, it was capable of everything, especially Gosh, when you're an athlete. That is a feeling, you know, I've I don't call myself an athlete, but I've run half marathons. And I've, I've done physically demanding things. And that's such an empowering feeling, you know, and to have that taken away, you have to learn how to ask for help, there's no other choice, there's no other choice, you

John Lyons 8:47

made a good point that running in particular, is a very individual kind of things. But if you're a competitive athlete, you have to have a kind of a controlled impression of wanting to win, right? You have to be competing, you had to be I'm better than the other people in that sense. You know, I mean, you could be just competing it yourself, and that, but then you really wouldn't be an athlete, you'd be somebody who's interested in fitness, and an athlete and you're by almost definition, you're in competitive sports of some type. And if you're going to be competitive, then you need to figure out that how to win. Otherwise, you're not, you're just into fitness, which is very, I mean, there's nothing absolute wrong. It's a completely different mindset. So I thought that was important insight, actually, for all of us. You know, I think about even in my job and I run a center and I have a lot of faculty and staff. And the way I think about myself is I really can't do much of anything that Senator writes and I am completely reliant on other people to do and otherwise the senator doesn't work and it doesn't really do things that are helpful and productive for others. So I think that is probably true of every single one of us in every aspect of our lives is that we need help. I mean, even in this podcast, we couldn't do it without Tim. Tim couldn't do without us. All right, Ryan. I mean, there's there's interdependence, which is, should be embraced. I mean, it's actually a good thing. Not a bad thing. Because we're talking about it as dependents. She just, I heard her talking about as interdependent. She talked about the fact that she can hope she can do other things like in her story about her sister.

Kristen Cerelli: 10:39

Yeah, she did not use that word. And she, it did not have that feeling to it, or that sense to it had the sense that she getting taken out of her environments of comfort, which were work, and athleticism and being put in this different environment. On top of the fact that she also had, it has a traumatic brain injury, just demanded collaboration. Maybe and before she hadn't had to collaborate, she could be a sort of solo artist, you know, she could fly solo. And she no longer really had that option or luxury, and she had to adapt. That's how I think of her because she's still very much. Truth be told, like in the kitchen, she is an amazing cook. You always leave her kitchen and her meals just going, Ah, a want to make that be she makes it look so easy. And I know it's not see, that is so delicious, and, and nourishing. And how did she do it? But she doesn't, because she knows when she has to say, can you get me that? Or can you do this? Which I bet she didn't do before I bet she was completely. You know, that chef who wasn't, you know, wasn't didn't have a sous chef. So

John Lyons: 12:04

well, the C and Deacon was collaboration. So it was it was positive for me to hear that because that's really kind of what we focus on. And it was on. So

Kristen Cerelli: 12:14

tell me, the third thing that stood out

John Lyons: 12:16

is that it sounded like that her head injury created an opportunity for what I would describe as a reset. That was interesting to think about, like I was struck by her talking about seeing leaves for the first time and just enjoying the newness of things. And how does she be perfectly happy sitting on the porch? And looking at leaves. And so there's, there's a whole lot of different things that you can unpack from that, that are interesting and important in terms of you know, just appreciating the moment, you know, being mindful I mean, I mean, okay, so now we know that a head injury can lead you to recovery from substance from alcohol. And now we know that it's at a mindfulness intervention as this is the reality, right? So it's interesting, right? Because a lot of people seek that kind of way of being. And she just found it as a result of something that was forced upon her. And she may not actually be at different stages in her own kind of trajectory of her brain responding, as she may not be able to do certain things, right. And so it may just be a natural result of the trajectory of the head injury, the brain response. But it's interesting, right? Because it's that is that a mindful is that what people say is related to being happy and healthy, and relational, and all sorts of kinds of stuff, what you were describing. So being able to live in the moment, is a gift. And so it sounded like, I mean, that she really wasn't very good that that skill set really didn't exist, pre injury. And now she's exceptionally good at it almost in a way that we're reminded me of children, right. So, and there was also the piece of it that brought a lot of fear sometimes because she didn't know what was going to happen or what something was and, and so I thought about what that's like for children the same kind of and so appreciating that fact that kids are naturally mindful. And so therefore, they are very aware that they don't know what's going on, and therefore might be fearful of certain things that are new. I think as adults and as parents, we probably should remind ourselves of that reality.

Kristen Cerelli: 14:46

Yeah, when she was talking at that point, those those points you're referencing, I just wrote down the word I kept writing down the word Zen Zen, she said Wasn't she so zen? You know, she's she's a living breathing example of like you said, you know, there's a whole multimillion dollar industrial complex out there trying to get us to meditate and to be in the moment and to and to watch time go by and she's living it now. Would she ever have chosen this path towards getting there? Or would she have ever even wanted to try that path out? You know, prior? I don't know. But it was like, oh, yeah, that's exactly. I wonder if she realizes how many people aspire to be able to do to bring the simplicity and the mindfulness and the awareness of the small things in life to their days that she now has.

John Lyons: 15:53

Senator Sanders am fascinated by that, because she clearly loves that part of her new self. Interest. All right.

Kristen Cerelli: 16:05

Yeah, she's, um, we didn't talk too much about her dogs. But I know you and I have talked about how several of our guests have mentioned their pets. And she is really active, she has two dogs that are her own. And she's constantly bringing in a foster for the Buckeye, Bulldog rescue. So she has these adorable French Bulldogs usually, and they're just, you know, the house is just filled with that sort of sad I don't want to say sad that rescue dog energy you know that energy of creatures who really need help, and are fearful I think a lot you know, and have a things that they're worried about and things that they're afraid of, for no other reason than that, that they haven't learned learned to trust or been in a in an environment that supports trust. And so it's just interesting to watch. To think of her as this IT professional who was calling the shots and new everything, and kind of seeing her in her new habitat, which is, you know, this dog home and this food home, and this garden home, it's so it's everything so organic. In her life, I feel like as, as I know, her

John Lyons: 17:22

pets are soon. And dogs in particular, you know, they live at the moment, right? So dogs have mindfulness down, right, so that there's then they also, you know, live what we all should do, if they see something, they say something right, so that they live in a way that many of us aspire to live, right. And I think that's very healing, we have a group that's doing a project in the center. And what they found is that they're doing a study of organizational climate, in residential treatment for kids. And they're looking at the staff and the staffs kind of stress and burnout. And they found that those centers that had an animal's big animals, staff was less stressed, actually significantly, less stressed, less likely to burn out less likely to leave. If there's an animal, right. It's like, wow, that's who would have guessed that, but I think the power of animal human relationships is an on. It's a frontier that we've known about outside of science for millennia. It really hasn't, hasn't gotten all that much is getting more but not all that much scientific study. And I think it's fascinating that, I mean, there's research that shows that horses and humans that are heart rates blend together so that actually horses help humans self regulate, if they're having stress, and so forth. So you wonder if there's not the same kind of phenomenon with dogs is that they help people self regulate, and particularly with a head injury, since head injuries are oftentimes associated with regulatory challenges. Although she didn't really talk much about those she taught way more about the cognitive challenges for pets are not helpful in that regard, that she helps them regularly. And they help her.

Kristen Cerelli: 19:21

Yeah, I think they do. I think I think it goes both ways. You're right. I had a question about something that she said. She mentioned a couple of times, being in what she called denial, like not wanting to visit the box of letters that she had received not really wanting to go to emails not asking questions of her family about what had happened exactly, or even parts of her treatment and her care. And I just wondered if you made anything from that. From your perspective to me, I I thought, Oh, I wonder if denial can actually be an aid Sometimes in helping us move through something that is traumatic or just just make change can can actually denial or choosing not to know something be helpful.

John Lyons: 20:12

I think yes, I think if you look at the the folks who did those the soldiers from World War Two, that when they came back had the best recovery, or were oftentimes the ones who simply refused to think or talk about it, they just put it, compartmentalize it, and moved on, you have a personal experience on that dimension that that came to mind on Shisa. That's when I was I don't know how old I was maybe eight or nine. I'm running back from swimming or basketball or something, practice. And I wrote into a swarm of locusts, I crashed. And I got a head injury. And I walked apparently, I don't remember the accent. I remember that logo. And, and then, apparently, I told my mother, that some lady helped me up and the bicycle was rather mangled. And I got, I got home. And my mom said, well here and have a popsicle. And we'll sit down and watch the Donna Reed Show. Most of our listeners listeners are too young to know, Donna Riva is like the Brady Bunch for somebody your age is I don't know what it would be now. But it's a very common TV show. And I apparently, and my mom has a fairly honest woman, I think, apparently I watch it every day. I could never watch it again. I never wanted to watch it again. Because the concept was too bizarre to watch something that you think you might have seen. But you can't remember. It's just a bizarre, it's just I just didn't want to do it. I had no desire to see something again, as if it was for the first time. So I can understand. It's like, well, that was then and this is now and I don't really want to know about then because that's not me or who I am. I just want to move forward with who I am now. So I don't know. I mean, that that came to mind with that aside. I thought I was probably healthy. I mean, I don't know what she would gain from knowing that. I mean, she didn't know that people cared about her. But they cared about the other her. And she is now at different her random and she's in a particular important way I think, I don't know, I I found it likely healthy.

Kristen Cerelli: 22:28

Yeah, that what you're saying also connects to I think it connects to what you've said, and what she said very explicitly about when she's moving too fast, or when she has moments where she starts to, as many of us do, list all the things that they need to get done in a day, and your mind just starts to go really fast. And she said, Oh, I have to remind myself, that's just the past me, like creeping up and into conversation with the now me and it was such a great example, I think of her just strength of will to just go I'm sorry, past past self, you don't get a seat at the table anymore. Because, you know, new self is having a much better time here taking a walk with my husband. And it's not that's not denial, but it is a decision, a really active decision to compartmentalize, like you said, to just not allow a thought to enter the room.

John Lyons: 23:31

I can't help but think that's a fundamental principle of sustaining change. Because if we know anything about changes, that is very hard to sustain it right, you can, you can say I'm gonna, it's like you don't quit something, you stop. And then you decide his day that you're still going to stop and you get this creeping so I'm on my hemoglobin a one C just crept up to 6.3. So I have to give up sweets, right. And it's hell for me personally, because I love sweet things, right? So, but I have to decide every day like, I just went to the grocery store yesterday. And I'm in the bakery section, because the very first section, which is very clever on the part of grocery stores, if you know, if you go when you're hungry, the first thing you see are baked goods. And I had to linger there at but then I had to tell myself, you know, this really reminds me a lot of how Michelle was talking about she knew me does not need a donut, right? Yeah, as much as the old me would have wanted on its own, I deserve a donor and I can have, as long as I just have to donate, it's okay, and all that kind of stuff. So I think that is likely that kind of notion that you have to suppress your old self if you're going to sustain a new version of yourself as probably a principle that we can take home from these conversations and how you actually make a change. This was also interesting, as you pointed out, this was the first of our interviews that the stimulus of the change was forced upon Michelle, it wasn't her choice. It wasn't her vision of herself. But I thought, despite that, the similarities are pretty profoundly important.

Kristen Cerelli: 25:17

Yeah, what other? What other similarities or threads? Did you hear between Michelle and Jordan de Lacy, Rachel and Juliana? I think we'll get to before miss this episode with Michelle air. So I think we can talk about that too.

John Lyons: 25:36

Yeah, I thought humor, I thought most folks use humor to survive and right. I think that's, that's right. So I thought that's a core concept. I think a new version of a vision of yourself is also a common theme that people have a kind of a sense of who their they are aspiring to be. And they use that as a template to make their decisions or to guide them and in how they approach things. I think that's been consistent across our guests. And just kind of this it'd be interesting to talk to some folks who weren't doing real well, because all of our guests had been amazingly resilient, amazing grit. Amazing. You know, they get knocked down, they get right back up. I mean, fierce, although it's hard to call Michelle fear, she seems like the sweetest person in the world. But But I suspect she's fierce right in terms of her insistence on getting better insistence on mastering things and, and she's not going to give up she's because if it took takes her two hours to move the rock on the patio, she's going to spend two hours and move the damn rock and, and I think that's been consistent across everybody that is that when they put their mind to doing something, they do it, and they don't let things get in the way of stopping them from it. Even if it's not easy, even if it's not perfect, even if it's not at the timeframe that other people would want, they get it done.

Kristen Cerelli: 27:06

I think what you're pointing out is also extremely counterculture. And in a way, kudos to us for getting these guests to have are examples of long term change, like not quick changes, not lives that have necessarily supported Quick Change, either. And so just yet, you you reminding me about her talking about moving the brackets, like the amount of patience this woman has, or has developed. Just to make really, ultimately, what are very small changes, you know, especially physically, it's, it's just remarkable. And she she talked about PACE, she talked about when I go too fast is when the Aphasia kicks in, or I just can't keep up, I can't process and I thought yay, that is so counterculture to just this idea of. And it's something that Jordan talked about just being patient with time unfolding and being patient with it, that you're not always in control, you might want something to happen one way, but it's not going to happen that way in that moment, necessarily. And can you live with that? Can you accept that? Can you let time go by?

John Lyons: 28:22

Yeah, that whole concept of acceptance. I mean, he sort of used it and then took it back. And, and I can understand your ambivalence about that word. But there's, there's something there that we probably need to learn how to put all description on, it's not so glib, that it's about you know, exactly what you described, figure out how you understand who you are, and are comfortable with that are happy with that. I wouldn't know that that of all the folks even if he chose so far when he got to that rapid fire answer, what would you change in your life? She did not say I would be on a different street corner. So I didn't get hit by the car. Right? She does not say that. Right? I mean, so if anybody's gonna say something like that, I would imagine it would be somebody like in Michelle circumstance, but that is not what she would change. She would not go back and not have her accent. She'd actually go back and address food issues, food insecurity for children who have substance abuse problems. So I was I was struck by that. So that actually is everybody so far right that you are who you are kind of component of people who do big sustainable change. And I think that might be an important thing.

Kristen Cerelli: 29:43

Yeah, you're reading my mind with that because as I was asking that question, as I was the rapid fires, I pretty much have, you know, their standard, I might tweak them just a tiny bit for each gasp but as the words are coming out of my mouth, I'm thinking, how can you possibly ask her this because, of course she wants to not have been hit by a car. And then she just says nothing to do with that, you know, she says this other thing and

John Lyons: 30:09

and she wasn't even aware that that would be like an expected response. Right. So it's not like she was faking it. Or he didn't say why I'll say this, but I will know how she did. She didn't even go there didn't even

Kristen Cerelli: 30:21

know. It wasn't. It wasn't a thought.

John Lyons: 30:26

I think that's actually extremely healthy.

Kristen Cerelli: 30:30

Yeah, right. Because imagine that imagine the desire to want to go back in time and change something that's unchangeable. That's like the definition of hell.

John Lyons: 30:39

Yeah, exactly. So that also was a piece that struck me most personally, is, I think, in combination with what she talked about losing her being judgmental of others. And so I don't I mean, I've published on traumatic head injury, right, I've done some research on it. But I never really thought about it at this personal level that she described it. And I must admit, I felt a little embarrassed or myself or ashamed of myself, or how I would, perhaps judge people in that sense, right of like, Oh, I'm sorry that you don't have those cognitive abilities anymore, as if it's some sort of deficit or something, when that's not how she sees it, right. I mean, she sees this as who I am. And this is what I'm living with. And this is how it works. And I think that's important for us all to kind of understand as we look at other people in different circumstances, and not judge them as Oh, poor them. Like one of the things that irritates me enormously is how some people talk about vulnerable children. But if you actually talk to the children, they never describe themselves as vulnerable. And so there's this elitist lens that we sometimes put on other people who have struggled. And I think she brings that out in the open as something, that's probably not a very good way for us to be, even if we care about doing right for people in need. That doesn't mean feeling like they're somehow lesser, because they have those needs, that they're somehow damaged, that they're somehow vulnerable, but that they are people and they are working to be their best selves within the context of their existence. That's profoundly important.

Kristen Cerelli: 32:29

Yeah, and in fact, when you when you take all that you've just offered there and you kind of put that over the landscape of, of all of our guests, I think those quote unquote, vulnerable children are those quote unquote, children who've had trauma are extraordinarily resilient. changemaking, adults, all of our guests so far have have either had talked about, or alluded to some things in their childhood that were less less less than ideal. And have had impact on them, admittedly, so And yet, they're all they've all been so brave, and facing those things, and living differently because of those things.

John Lyons: 33:23

Yeah. And that's probably true of most of us, I suspect. Right at all of us. I mean, some of us are, are, I mean, we all have different circumstances, right. But we all have circumstances and those circumstances, flavor, who we are, who we become. And I think it gets tempting to judge those circumstances. And that's probably not a very good idea. It's just, it is what it is. But he's a cliche that and people adjust and heart our job then in helping people is to help them learn, number one, who they are and then how they can live within that context. I think I mean, that's, that's what I would take home as a message from that. Was it sound like her healthcare was quite good, that are quite lost in that sense. I thought it's kind of early to advocate for better health care, because the US system is so uneven, that I'm sure there's people from less privileged backgrounds that would not be having a conversation with a neurosurgeon.

Kristen Cerelli: 34:34

Yes. When you think of her story, is there one image or one metaphor that you take away more strongly than any of the others?

John Lyons: 34:46

I think the reset piece of it, I'm calling it a reset. You didn't call it a reset, but that that tabula rasa, you know, there's the starting over again, however you want to describe it, I think was the most profoundly The moving piece of it and the fact that you don't recover, I think that I think go together, actually. So because you're starting a new, so you're not going back to what you were, you're you might be going back in some ways in terms of function, but you're not in any way going back in terms of identity or anything remotely close to that. Yeah, I think that's profoundly important. And that's gonna stay with me moving forward. But I think that it has applications for a lot of what I've been trying to do, both personally and professionally.

Kristen Cerelli: 35:40

I think no matter how many times I listened to her episode, I always get moved. And I always learn, again, over and over, I learned in the moments that she's talking about going up and down the spiral staircase. And needing those three points of contact are two points of contact, the center rail, and the rail on the side. And I, I always walk away from the episode holding on to that image, like don't forget, you know, look for the center rail and look for the side rail. And it's like you were talking about the C and T calm being collaboration, if it's not a literal support. It was a great little nudge for me to look for the support system, whatever that might mean.

John Lyons: 36:28

Yeah, I think it's different for different people are at different times. I think for the same people, it changes over time, right? So it's, it's an ongoing, kind of Moveable Feast, right? And so if you kind of approach it as that, and you've got people coming in and out of your life, I've been thinking about that quite a bit. Because I have a number of elderly relatives. And you know, that's, as you get older, the number of people who care for you changes and you don't know, right, and you don't know them at all, they come and go them right, and but you still need them. And you need them for different things. And you need them in a way that you've never needed anybody since you were an infant. So it's just an interesting kind of way of thinking about life and the people who are always circling around you. Yeah.

Kristen Cerelli: 37:19

Well, this has been really illuminating both the conversation with Michelle and reflecting on it with you. So thank you for your perspective. And I look forward to our next fly back.

John Lyons: 37:33

I do too. It's always interesting. And we've been so lucky to have such inspiring and compelling guests to have inspiring and compelling stories.

Kristen Cerelli: 37:44

Yep, we've got a few more coming up. So I hope our listeners will keep on listening and we'll keep making good episodes.

John Lyons: 37:52

So good luck, take care talk to you soon.

Kristen Cerelli: 38:07

shift shift Blum is a co production of T comm studios and actually quite nice. engineered by Tim fall and hosted by me, Kristen Cerelli episodes are available wherever you download your podcasts and are made possible by listeners just like you please consider supporting our work by visiting us@patreon.com forward slash shift shift blue

Tim Fall: 38:35

shift shift Bloom is made possible in part by the prayed Foundation, a nonprofit organization committed to improving the well being of all through the use of personalized timely interventions and provider of online training in the T comm tools T calm is transformational collaborative outcomes management, a comprehensive framework for improving the effectiveness of helping systems through Person Centered Care online at prayed foundation.org and AT T comma conversations.org. And by the Center for Innovation and Population Health at the University of Kentucky online@iph.uk y.edu