The Shift: Voices of Prevention — A podcast by Prevent Child Abuse America

Quantum Leap Possibilities of Prevention

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In this episode of The Shift: Voices of Prevention, internationally renowned psychiatrist and neuroscientist Dr. Bruce Perry—co-author of the groundbreaking bestseller What Happened to You?—explores how shifting our focus from crisis response to early intervention can change the trajectory of countless lives.

With clarity and conviction, Dr. Perry unpacks the science of prevention, the power of human connection, and why investing in the creation of supportive environments for children and families isn’t just smart economics —it’s the foundation for generational change.

"If we can change the odds for children before harm occurs, we’re not just preventing problems—we’re creating potential." — Dr. Bruce Perry

Tune in for a thought-provoking conversation that blends science, compassion, and actionable hope.

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SPEAKER_02:

This is The Shift Voices of Prevention, a podcast from Prevent Child Abuse America, where we explore bold ideas, cultural change, and what it truly means to support children and families. Join us to change the narrative one conversation at a time. Hello, and welcome to the Shift Voices of Prevention, recording live from PCA America's 2025 National Conference in Portland, Oregon. I'm Nathan Fink, and I'm Luke Waldo. And today on the podcast, we're excited to be joined by Dr. Bruce Perry, renowned psychiatrist and senior fellow of the Child Trauma Academy in Houston, Texas, as well as adjunct professor of psychiatry and behavioral sciences at the Feinberg School of Medicine in Chicago. He is also the co-vice chair of the PCA America Board of Directors, where he plays a vital role in advancing the organization's mission. Dr. Perry's groundbreaking work on childhood trauma and brain development continues to shape how we understand and support children's emotional and psychological well-being. Dr. Perry, welcome to the show.

SPEAKER_00:

Thank you very much.

SPEAKER_02:

Happy to be here. So your research has shaped how we understand the brain, adversity, and healing, as well as communities. At its heart, it also gives us a roadmap for prevention, which of course this conference is all about. So a broad question to set the floor for our listeners. What does the science tell us about the importance of prevention efforts as early as possible?

SPEAKER_00:

Aaron Ross Powell Well, you know, I think most folks have a general appreciation that in almost any area it's a lot easier to prevent a problem than it is to solve a problem. And I think that this is certainly true about growing up. You know, if early on in life you are given opportunities for learning and for developing social skills, as you get older, all of that will serve you well in school and with friends and in clubs. And then there's this kind of compounding impact that having a friend lets you have more friends. And then having more friends gives you more opportunities to learn about all manner of social engagement. So the getting a good start is essentially a little bit like being at the top of a big mountain with a little snowball. That, you know, if if you kind of are standing at the very top and you start and you roll it down the hill, you're gonna get a nice big thing. If you stand halfway up the hill and you go, oh, you know, we want to make a big impact, but you're only halfway up the hill, you've already sort of walked all the way down before you start making your little snowball to roll it down the hill, you're gonna have less impact. And that's really um a general phenomenon in any biological system, human beings, organizations. Um so prevention, preventing uh the process that you're interested in from going astray is uh a lot more effective than trying to deal with the effects of something going astray.

SPEAKER_02:

Aaron Ross Powell I love the metaphor of the the hill, right? And I think that is really apt because it seems like as a society, as our policy kind of we formulate it, we have this vista that it only allows for the top.

SPEAKER_00:

Right.

SPEAKER_02:

Right? And so that's the thing that I keep wrestling with because I'm like, obviously. What you're saying is so obvious to the baseline systems, and yet it is so hard for us to actually embrace. So do we just have this predilection towards summits?

SPEAKER_00:

Well, the f that's a that's a good question. Um I think part of the issue is that people tend to view the world and and problems from their frame of reference, from where they're standing. And so by and large, really, you know, 40, 50, 60 years ago, uh, the majority of people that were f solving problems around education, child welfare, mental health were looking at it through the lenses of an adult. And you know, there was some lip service given to children, but children were kind of viewed as these uh relatively passive little creatures. Uh they were viewed as resilient, so you can say things around them, and when they're babies, they can't talk, so they don't understand, which is not really true. So we had a fundamental misunderstanding about um these things that we now know about the incredible malleability and power of early childhood. And, you know, there's there's two things that have really happened in the prevention world. One is that as this knowledge has become more available, there have been changes in policy. However, systems take many, many, many years to change. And so the development of all of what we know about the importance of early childhood and brain development, you know, we knew this 30, 40 years ago. And we tried, there was a big public engagement campaign to teach people and policymakers about this, and there was really a little bit of uptake. And but over the years, it's that uptake has changed and changed and changed and gotten better. But I think part of our challenge is that the rate of change in systems is much slower than the rate of change in people. So you can find a policymaker, teach them about this, and then go, oh, this is really important. And they'll go, I want to act on this. And then they'll come up against this big bureaucratic mess of policy and practice, and that's why it takes a longer time. So I think that's one of the things that we're running into in this field right now.

SPEAKER_01:

So working off of that, you often emphasize relational connection as central to healing and resilience and development, for that matter, which becomes even more resonant when we consider, for example, the Surgeon General's recent report coming out of the pandemic on the epidemic of loneliness and social isolation, the uh boom of our technologies that are in many ways replacing kind of social connection uh with actual humans in our lives, right? And the destructive impacts they have on individuals and communities. And yet many of our systems, as you've just mentioned, which are composed of people, right, um, whether that's schools, hospitals, or government agencies like child welfare, they can feel transactional because of the fact that they're made up of humans who are, of course, relying more and more on technology and are being raised again in homes that are shrinking, as you mentioned in your presentation today. Considering your experience, right, how would you advise a school district or a health system or a child welfare agency, and what are some key actions you'd recommend to embed relational health practices in their everyday practices and in their broader kind of policies and procedures?

SPEAKER_00:

Well, you know, fortunately, uh I we actually do as an organization, our the the community I work with, we are given many opportunities to do just that. We work in mental health settings, child welfare, educational settings, even in corporate environments. And, you know, the one of the first things that we try to do is is help the leaders in those systems better understand the power of connectedness. You know, that really you want, you know, let's take a corporation, right? You want to make money. The the truth is you'll make more money if you treat the people in your system better. And in educators, you want kids to graduate and do well academically. You'll do better if you create relationally sensitive and supportive uh policies and practices. And I think when we talk, when we teach about this, people generally are open, but they're also under tremendous pressure for performance. And so when you're under pressure for performance, it's very hard to change what you do. So we start by just recommending very simple introductory things. What we do, the our group that works in the corporate environments, for example, is we say, listen, have a two-minute conversation. Um, make look at all the people that report to you, figure out a schedule when you can have a two-minute in-person conversation with, you know, ten of them a week, right? And if you have more than 10 report direct reports, you should re-evaluate your system. Um, you know, you need to think about stuff like you're wasting time in meetings, um, you're not having sort of fully present moments with somebody. And when when you give them this tiny little recommendation, it's amazing how the the out literally we see economic outcomes in corporations related to productivity, related to employee satisfaction, related to less turnover, related to better communication in the system. And it it's the great thing about doing something, creating a practice that takes advantage of our normal biological desire, it goes like wildfire. It's it's it it begins to become more than a two-minute conversation. It becomes, wow, I had a really nice talk with my boss. And he sees me, he knows what I do, he asked me about my kids. And he came back the next week and said, How's so-and-so doing? Did he make the team? And that that glue, that relational glue, is what makes groups of human beings function effectively. And this is true whether or not it's education or mental health or you know, selling widgets or whatever it is you want to sell. And so that's what we do very we a little bit of education, because it nobody likes to be told what to do without understanding why. So if we give them a little bit of the why, and and it helps when we talk about the brain, because the brain's interesting, and for many people it feels and and this is probably not fair, but it feels more like science than when you talk about social science or psychology, um, which a lot of people have weird biases about. We're saying the same thing, but if you use kind of brain examples, people go, oh, the brain. So that's what we do, a little bit of psychoeducation, and then a few practical uh recommendations about how to act on that.

SPEAKER_02:

Luke, you had mentioned systems are made of people, right? And so as you were saying earlier on when I asked that question about the summit about changing these kind of mental models of how we, you know, are approaching this, we run oftentimes into ourselves, right? So it's hard to escape that. So as you embed some of these recommendations from the top, a lot of the work that I had done previously is in the meetings then with the people in the middle and at the bottom, right? So do you have any thoughts on getting from system then into the everyday to the person who's actually picking up the phone and part then of a user's experience of the system itself?

SPEAKER_00:

Right. Well, this is why when we do our work, we typically our work we will we will want to do work at every level of the way they're organized. And we have found, by and large, that if you have both a bottom-up um process where there's collaborative uh engagement and you you ask the people on the front lines what part of this makes sense to you? How would you act on this? What should we do? It's a collaborative process. Um and then at the top, you engage them so they understand the rationale of what you're doing. And a lot of times you're successful at the top if you just neutralize the inhibitory tendency to say no to anything new, which is kind of what happens. So um all of that is only possible if in this process they trust us. So we work on the very thing, we it's a parallel process, right? We know that a frontline uh steel worker is like gonna see me as some shrink, and they're like, why the hell should I listen to this guy? And we see, you know, you somebody that's forced to come to a meeting with these mental health people, you go when I would listen to this bullshit. Um we know the people at the top are like, uh, another another stupid coaching thing I gotta listen to. Um you have to form real relationships, and then you have to do work together. You have to be in the work with them. And so once people see the credibility of, you know, form a relationship, see that there's some credibility to what you're saying, then it can really take off. So this is how, you know, how we ended up working with the FBI. You know, we work with people in the military. In the beginning, it's like, who is this guy? But we typically get into these settings because someone from the FBI says, I've worked with this guy, he's solid. And so it's one of those any friend of mine is a friend of yours, you know. So, but but if I had come into those situations cold, it just wouldn't have worked.

SPEAKER_02:

Yeah, it wouldn't have. No, and I think that's the instinct. And part of me, when I as I'm listening to this, it makes me want to flip it then, because all of a sudden I'm very aware of the times we're in. So then taking that, and we've got a super leadership. We got a super top, right? So now we're on the bottom, but then pivoting all the way up. What do we do now to span the gap if we have government systems that don't seem to be responsive to even that economic engine that's driving the society? Do you have any thoughts on that?

SPEAKER_00:

Well, let me just say this: that I have failed at influencing policymakers for over 40 years, and miserably at that. Um I'm not kidding, really. I mean, I it's interesting. I've been given many opportunities, right? You know, talk to presidents, talked to senators, talked to national governors associations, and the interesting thing is the uptake of what I have to say or what other people that are with me have to say is tremendously variable. And if there isn't some personal anchor to the topic, it just is like more noise for them. So, for example, 30 years ago, when I was working with Rob Reiner and we were involved in this public engagement campaign about early childhood brain development, we there were some senators that were like all over this, both sides of the aisle. They were grandfathers and they had seen some of this stuff happen. And then there were some people that younger who had not were not yet, you know, they didn't have like young kids and they were not, they just they kind of were respectful, but they're like, whatever. Right. And so it's incredibly dependent upon relationships. And if a person in a position of influence doesn't have some contextual connection to what you're trying to communicate, it just doesn't, it doesn't stick. Trevor Burrus, Jr.

SPEAKER_02:

Yeah, there's to me, I mean that it I'm annoyingly optimistic. It means to me that there's humans in there, though. And those humans then have that experience that that is part of the obligation of the work that we're doing is to remember that. Humans live here, regardless of what it is we're talking about.

SPEAKER_00:

Trevor Burrus, Jr. Some of the most interesting and positive progressive policy around foster care and child welfare was supported and passed by one of the most arch-conservative uh uh senators, along with um Hillary Clinton. And they worked together to create, you know, the law and wrote the law and and and promoted policies that made positive changes in the field. And it really had to do with um the ability to come together uh with a shared understanding of what's good for kids. And it really was not, you know, uh on almost any other area of policy, you know, you'd people would look at either one of them, you know, depending upon which side of the aisle you're on and go, oh, that person. But they were able to come together on that. And I think that that is a hopeful thing. Although I have to say, that has been much harder to see in the last 15 years. There's so much more polarization, I think.

SPEAKER_01:

Right, right. So I want to stay on this conversation for just a moment longer, uh, because I I think a lot about the challenges in the prevention field. Um I I previously worked in the domestic violence world and but was doing generational kind of prevention work, right? Working with children who'd been exposed to domestic violence, for example. And that work at that time was much more difficult to get funded than, say, uh domestic violence shelter work, right? Because again, policymakers and so on would could see the impacts today on their investment uh through that investment in in a shelter versus what's going to happen to this four-year-old that you're doing education with when they're 20 years old and in a relationship will it have had the impact?

SPEAKER_00:

Right.

SPEAKER_01:

You, on the other hand, have done a lot of work in this space of research on the the longitudinal impacts of prevention. Can you talk a little bit about how that has evolved, recognizing that we're in a very polarized time politically, but had you seen progress in that regard in in response to the growth in understanding of the impacts of prevention work on future generations? Trevor Burrus, Jr.

SPEAKER_00:

You know, I I just I I wish I could get tell you great stories.

SPEAKER_01:

That's fair.

SPEAKER_00:

Here's the dilemma. And and I I'm actually working on a book, and I have been for a few years, about sort of the neurobiological elements of group functioning that result in systems being extremely difficult to change, much harder to change than individuals. So, like if I have an opportunity to sit with somebody and talk with them, form a relationship, I can actually get them to the point where that person feels safe enough, respected enough, that they're open to the idea, they'll consider it, they'll think it through, they might literally change their mind. Systems are bigger than that, and they they have mechanisms to inhibit change. You know, all see-and again, this is part of the natural reality of any physiological system in equilibrium. There are systems, there are mechanisms that want to put you back in equilibrium. So the status quo of a group is very hard to change, and there are lots of mechanisms that keep maintain the status quo. So this is one of the things that I, you know, in the beginning I was very optimistic. I'm like, hey, we'll just tell you what, you know, the research shows what's good for kids. That's it. They'll go, bing, we'll do that. Let's change that. They're like, no, we won't. Um, and like, oh, okay. But this is the, you know, the one of my favorite examples around that is around in education. Um American educational researchers have shown all kinds of things about what would be really good to improve outcomes, but American educational systems will not act on that information. One of my favorite stories is a uh researcher, or actually an educator from Finland came over to the United States, went to Stanford School of Education Education to get advanced training, because Finland was at the bottom of the Western countries in all these academic metrics. So he goes there and like five years later they change everything, and and all of a sudden they're at the top. Somebody from Stanford is for this like alumni magazine is interviewing me, interviewing the guy at the ice. He says, Well, how did you do that? He said, Well, I just came to the United States and I saw all the research done by American researchers about what was good, and we implemented it. So now they have shorter days, they professionalize education, they get paid more, educators get paid more, they don't test as much, they spend a lot of time outdoors, all the stuff that, you know, we did the research to show that that's effective for cognitive acquisition of information, but we will not act on it. We still use taking recess away as a punishment. We still use the whole class is punished if one kid does a bad thing. We still use contingency-based um, you know, reward systems that we know don't work very well. So it's that's part of the dilemma is that all of these systems that we have that we've created with good intentions now are kind of they have a life of their own and they have a power of their own. And you can bring in a new superintendent, you can bring in a new principal, and they can work and work and work and work, but fighting the status quo is exhausting and it will eat you up and it will spit you out. So change is incremental. It can happen, but it takes time.

SPEAKER_02:

Yeah. So the mechanism that you mentioned to remain in equilibrium, have you been able to break that mechanism apart to see its component pieces? And if so, what are you finding?

SPEAKER_00:

Aaron Powell Well, there's a couple things. You know, and again, you will not be surprised that it it boils down to people, right? So here's kind of what happens is that if you envision this pyramidal powered, you know, typical organizational chart, right? At the top is just a couple people and then in the middle and then the bottom. The people at the top, once you get to the top, you have a certain view of the world. And usually your view of the world is something that centers you, that involves the system accumulating resources and power and taking it up to you. And so it's the very rare person who is open-minded enough to actually see that we need to change something that will take power away from me.

SPEAKER_02:

Yeah.

SPEAKER_00:

And so what happens is the major shifts we see are when those people at the top are replaced either because they retire or they're kicked out or they die. And then people who are younger and who have been exposed to other ideas that they haven't been able to quite act on get up to the top, and now they say, you know what, let's do this. And so what happens is there's this 30-year process of what they learned when they were in school, it was just coming out, and they percolate up through the system and they get to be a leader. We're gonna do something that was new 30 years ago. And it just happens. And so there's this weird 30-year cycle that's kind of dependent upon the life cycle of the leadership.

SPEAKER_02:

Yeah. That's it's fascinating because I all of a sudden I was thinking of, say, that individual in my head, of what is their then relationship to identity and career. Or say down the line, the pressure is fear.

SPEAKER_00:

Fear. Fear is fear. Both of those. You know, but both of what happens is kind of your brain kind of organizes around what you thought would work. And then when this is the way that our brain works, right? Once you sort of think you've figured it out, any piece of evidence that suggests otherwise, you kind of don't pay as much attention to. And then along comes one piece of evidence that you go, oh, see? And you you glom onto that one piece of evidence. So you you need an overwhelming amount of counter evidence to your beliefs for you to finally go, I guess I was wrong. Unless you're just a very emotionally secure person, and you go, you know what? I have a lot to learn. There's a lot of stuff out there. Now, every once in a while you find a leader like that, that which is great. And then the interestingly enough, that leader tends to be the kind of person that takes a system and then makes it so innovative and unique that everybody else wants to be like Mike, right? And that's kind of what happens. But like if you're in child welfare, we see this. You know, we see somebody comes along and go, wow, they're really, they're they're gonna kind of say, no, we're not gonna remove kids anymore, we're gonna try something different. And you know, there's this does happen, but it really requires uh courage because you have to step out and you have to get ready to get whacked, and you have to get ready to get, you know, sometimes, you know, the the this has been written about in many ways, but uh, you know, even in the Middle Ages, people, you know, some philosophers talked about the introduction of new ideas, and then said there's there's a three-stage thing. The new idea initially, the innovation is ignored, and then when you can no longer ignore it, it's attacked. And then when you when the attacks don't work, then it's co-opted. And and then the system takes over the idea, and um usually it takes over the idea in part, right? So it creates, let's say, for example, in a modern era, it it creates a DEI office. You know, it it will hire uh, you know, someone of color uh who uh and they will be kind of invited to meetings, but they won't be given power. You know, and this this is the kind of systemic co-opting of innovation and new ideas that systems put in place.

SPEAKER_01:

Probably ending with the question that you could have spent 45 minutes talking about. Um but I think it's important, right? So so let's flip this on entirely on its head and let's let's let's assume that that 40 years of, as you put it, failure to convince policymakers and systems to implement this research, right, that we know about relational health, right, early childhood development and and prevention and the impacts on on not only children, but the adults that they will become if we were to invest right in all of that research that you shared this morning and that you've done over your career, uh what would be the impacts? What would what would our society look like? What would our next generation look like?

SPEAKER_00:

So there are first of all, that this will happen. I mean, you know, the the wonderful thing about truth is it's like gravity. You can deny it as much as you want, but ultimately it's going to come through. And this is one of the great, this is why I try to give the the message today about this is a transgenerational process, and don't lose hope. It may feel like you're what you're the energy you're putting in isn't having impact, but it is. It just may not be fully manifest. But here's what we know. We know that if you take um early individuals early in life and you give them safe, stable relational experiences, that they have a much higher probability of really taking advantage of the existing educational models we use now. So they'll do better in school. They'll have a higher probability of succeeding in school, graduating, becoming employable and paying taxes, which will be good for society on a lot of levels. We also know that if you do the same thing, high quality investment in uh early childhood for kids that come from struggling backgrounds where there's lots of challenges, these kids actually have a much lower probability of entering the mental health system, and they have a much lower probability of entering the juvenile justice system. So there'll be less morbidity that goes with those systems trying to struggle with their anxiety, their depression, their alcoholism, their suicidality, uh, you know, their antisocial behaviors, and all of that. And then the third sort of broad domain we know is that one of the key consequences of early developmental adversity is that your cortex, you know, this most remarkable human part of your brain, all of our thinking, all of our language, all of our values are stored in our cortex. And that's where creativity comes from. And that's where invention comes from. So you're going to see, if you take care of young kids, you're going to see a much higher percentage of cortical activation in all of these kids, more creativity, more invention, more sculpting, more poetry, more music. It'll be awesome. There could be a quantum leap in the creativity, the productivity, and the humanity of generation that benefits from consistent, predictable, relationally mediated safety and opportunity. Opportunities for this healthy development. It really, it really uh is could be just like mind-blowing.

SPEAKER_02:

Well, Dr. Perry, thank you so much for sharing your insights and your vision. Your work reminds us that prevention isn't just possible, but it's powerful when we put the science, relationships, and compassion into practice. Thank you for being on the show.

SPEAKER_00:

My pleasure.

SPEAKER_01:

Yes, thank you so much for being here. And to everyone listening here at the conference and beyond, let's take what we've learned today and keep building the future our children deserve.

SPEAKER_02:

And you can invite upstream solutions into your feed by subscribing to The Shift Voices of Prevention today. Join us to create an ecosystem where children and families live purposeful and happy lives with hope for the future.