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TIO Updates as We Learn to Apply TIC Principles during COVID-19

From Mandy Davis, LCSW, PhD, Director, Trauma Informed Oregon

This vlog focuses on thoughts and ideas that have surfaced in office hours and meetings as we learn together how to apply TIC Principles in this time of COVID-19. The vlog is about 12 minutes long, so some highlights and resources are referenced below.

I just wrote a piece on the TIC Principle of Trust and Transparency and the importance of applying it during this time. Two things I am focusing on is 1) we need to advocate for continued transparency in information about who and how this illness in impacting people—all people. 2) getting accurate information and resources out needs to be done by trusted sources—think who is best to deliver a message or a food box and let’s support these people or organizations financially and with personal protective equipment (PPE).

There is lots of talk about how to support providers—this is excellent. Thinking about as we step up telehealth and/or working from home, how do we care for ourselves? E.g., hearing no show rates are down with telehealth but that means continuous work. How are you taking breaks? Remembering to drink water, getting rest, eating, etc. See our wellness page and Free Webinar for Healthcare by Healthcare.

Stress and productivity—things take longer and can be more exhausting—being mindful of what we/you can reasonably do in a moment or a day. E.g., it may take longer to fill out that form, make the call, or write a message. Give yourself time and allow your workforce more time. My strategy, knowing that I am not at my best, is to ask for a second opinion on something I have written or an email. This keeps me from getting stuck or hyper focused.

• Remember the basics: food, water, rest, movement, funny YouTube videos, etc. These things are important for your immune system . . . we need you in this.
• Scripts! We’ve had lots of requests for scripts on how to say things in a trauma informed way—especially thinking that many are having to share or hear hard information such as the wellness of loved ones, or loss of jobs, lack of supplies, etc. Check out this resource from Stephanie Sundborg here at TIO on The Anatomy of a Trauma Informed Script.
• I sat in on a talk by Bessel Van Der Kolk, MD and was reminded of a few things that help or hinder us in times of toxic stress (preconditions). He shares this more eloquently so check out the talk, but a few highlights I took away are:
  • Have a predictable environment
  • Connect with others and self (allow for self-connection time as well)
  • Staying present—reducing numbing out.
  • Ways to take action (reduce immobility) from cooking, dancing, caring for a plant.
  • Sense of time and sequence—ways to remember things to change
  • Find purpose—what is your purpose in time as an individual and organization
• Thinking about how COVID19 creates the simultaneous experience of both acute and prolonged stress and trauma . . .
• Being aware of judgements happening as we grapple with trauma and fear. Though we all are experiencing COVID-19 we are not all experiencing it the same way and we do not all respond in the same way. Be mindful of this—challenge myths and stigma.
• The both/and of grief and joy. Lots of grief for life, health, graduations, things we can not do and things we are having to do. Making space for this.

Thank you for prioritizing social connection while physically distancing and all the ways you show how to #bethebuffer!

Hi everyone. This is Mandy Davis from Trauma Informed Oregon, and I want to take a few moments to share some ideas, thoughts, and resources with you. The resources will also be shared on our webpage, I just wanted to have this opportunity to do a video as well. So, a couple of things and I’ve written down some notes because I know that my capacity to remember things right now is challenged, and so I may be looking back and forth. So first off, I just finished listening to the governor’s press conference where it was announced that schools will remain closed and services online for the remainder of the school year. So, first of all, thank you to all the school staff out there who are trying to figure this out to make this work, across rural and urban and tribal locations. You know, a lot of feels about this, right? So soon as it was announced, I had several texts from folks who were expressing feelings of relief, of sadness, of grief, of stress, frustration. I have a fourth and a sixth grader and they had different feelings about this. 

I and Trauma Informed Oregon are still going to focus on social connection and the need for social emotional support to buffer the stress that families and students are experiencing. I have been so appreciative of educators who are messaging flexibility in grace for parents and caregivers. At this time, I was grateful to coat Gil, the director of Oregon Department of Education, for acknowledging the stressors on families right now. I also as a side note, I want to say I also heard the Oregon Department of Education say, especially to higher schoolers if you haven’t been in touch with your school or heard from them to please be in touch with them because they’re trying to reach you. So, I just want to share a few thoughts again that are coming up and some ideas as a way just to plant seeds about how trauma informed care can continue to help frame the needs and also inform responses. It’s not organized, it’s not linear. So here we go. 

So, first thing is I just wrote a piece about trust and transparency, a principle of trauma informed care, and how this particular principle can show up at a time of crisis and the time of COVID-19 response. And I won’t go into detail, but two things I think are important for us to remember is that we, one, that we advocate for transparency and information, that we pay attention to and we ask for, knowing how COVID-19 and responses efforts are impacting all people. And that we ask for demographics. So, things based on, on race and class and gender and location. That we make sure that we’re getting the whole picture. Because though we all are experiencing this, we know it’s not being experienced in the same way for all people. Number two is that really thinking about trust, and that if we’re going to get accurate information out and resources out to folks, that that probably, not probably, that needs to be provided by folks for whom communities trust. And so, thinking of that question, like asking that question, who is it that the community will trust, and how can we support, with funds and PPE and resources, those folks to share the information and the resources. 

There’s also been some really great talk about and asking questions about how to support providers at this time, which is great to hear. And so, thinking about how, as 

we’re stepping up, things like telehealth and working from home. How are we supporting work providers in that time? So, for instance, like we’re hearing that no-show rates in telehealth are way down. But that also means continuous work. So how can we institute policies around making sure to take breaks? How are we reminding ourselves and our colleagues to drink water when maybe the rituals of filling up your water bottle in your workplace are gone? We have stepped up our workforce wellness page on our web page to address some of these issues and have some, some resources about that, as well as there’s a great webinar series happening that is referred to down below. Stress and productivity. Things take longer and be more exhausting. Have you noticed that? So being mindful of what’s reasonable to do in the moment. 

I don’t know if you found yourself taking that much longer to write the email or to fill out that form or to make that call. One of the strategies I’m using and asking Trauma Informed Oregon staff to use is really asking for a second opinion. So, knowing that we may not be at our best right at this moment, and so asking someone else to review the things that we’re doing can really be quite helpful. Remembering the basics, so food, water, rest, movement, or yourself, for volunteers out there, you know, and remember to watch funny YouTube videos, right? And not just because these things are essential, but they are essential because they help boost your immune system, and we need you to be healthy and as healthy as possible and able to be a part of this. We’ve also gotten lots of requests for scripts. So how do I say this in a trauma informed way? Knowing that a lot of things folks are needing to say or to communicate are hard, is hard information, so needing to communicate about the wellness of a loved one, or the loss of a job, or the lack of resources to provide someone. 

So, Stephanie Sundborg with Trauma Informed Oregon has put together some great resources on how to do that scripting. So, we hope that’s helpful. Let us know what else you might need around that. And then I sat in myself for myself, I sat in on a talk by Bessel van der Kolk and was reminded of a few things that help or hinder us in times of toxic stress that I wanted to share with you. He shares this much more eloquently than I. And again, the link is provided, so check it out. But some of the things that I took away were, so first was lack of predictability, right? And we’ve been talking about this, but if you’re if you’re constantly trying to decide what’s coming next or get ready for the unknown that’s coming next, or worry about the next thing that’s coming, is traumatic. That’s exhausting. And so, having you having schedules, while we’re all advocating for people to have schedules, whatever schedule, however that looks for and works for you. Loss of connection being something that can, that can make times of toxic stress worse. 

And so again, I think that’s been a really clear message we’ve been making about having connections. But also, I appreciate that mindness to have time alone as well. And some of us may need more time than that than others but scheduling that alone time as you may need that. He also talked about numbing out. And those of us who have worked in the trauma field know that this is a pretty common coping mechanism or experience for those who’ve experienced trauma is to numb out. And so, to find ways to stay present and definitely kind of 

monitor when you’re numbing out. But mindfulness practices and other ways just to kind of be in your space. I appreciate it, the reminder about immobility. 

And so, our natural response in times of stress is fight or flight. And yet right now we don’t have flight, so most of us don’t have flight to utilize and yeah, we need to move those stress hormones around. And so, he offers for us to think about how to take action, right? So, things like cooking or gardening. I also appreciated that he offered things like caring for plants. So, focused on the care of something else, right? I personally, though very reluctantly, have participate in two Zoom dance parties and it has been quite effective. And so, finding those ways to, to counter immobility. He also talks about a loss of sense and sense of time and sequence. And what this is about is when we work in trauma, a lot of survivors, we have experiences of like this is never going to end. And I feel like that’s happening to COVID- 19. And I don’t know about you, but there are times when I don’t know what day it is, or it feels like the days have merged together or the days are taking forever. 

And so if I need a way to orient to time and sequence, things like watching the leaves change on the tree, noticing the dates on a calendar, or marking them off, you know, seeing things kind of in a future-oriented way, and not that it’s going to be better tomorrow, but to just help us remember that things do evolve and move forward. He also talked about the need to have purpose and identity, which I really appreciated that reminder. And Trauma Informed Oregon in our staff meeting did this recently. And what we did is asked everyone to speak to kind of how, what was on their mind. How are they experiencing the world right now for them? What was most important for them? And they were really different experiences for folks. And then we talked about those are your individualized unique experiences, but then what experiences would you, what purpose do you want Trauma Informed Oregon to have at this particular time of COVID-19 response and experience. And so be able to take those individual stories while also find a collective purpose. And we’ll definitely keep that up, because it just helps us stay grounded. 

A couple other things I want to point out is I want to share this thing that’s really off the top of my head, so allow that. But I think that we have in COVID-19 something unique, at least from my experience, is that we have both acute trauma, acute stress happening, as well as some of the long-term impacts that we tend to see. So, for instance, in my disaster response type work, you know, we talk about if there’s an earthquake or a fire, or an event. We talk about what to do in those first 24 hours, in 72 hours. And then we’ll slowly start to get to what happens weeks later, or months later, and even a year later. And yet I feel like with COVID-19, we have literally had both happening for folks at the same time. So, some folks are in acute stress, and need crisis response because of the type of work they do, or their life circumstances, what they have access to. And then others seem to be experiencing more of that long-term. So, job loss and trying to rebuild and figure that out. And I don’t know where to go with this, but it just has resonated with me and the conversation, the different types of conversations I’m having, that this feels like something different and important to pay attention to. 

And then finally, just paying attention to that there, you know, we’re seeing lots of judgment and there’s a lot of stress on kind of how to do COVID-19 and stigma and mythology happening around this. And so, paying attention to the ways in which you can definitely challenge mythology and stigma and judgment. And also paying attention to, with all the information coming in quite fast and sometimes not always consistent or not even in agreement, that’s trying to figure out how to do this is not easy. And it’s also different. Though we are all experiencing COVID-19, we’re not all experiencing it in the same way. And so just kind of again, taking note of that. I feel like we’re also holding grief on so many levels. So today I’m holding grief for seniors who will not have the traditional milestones and rituals of that, of those moments. We hold grief for the things we can’t do or wish, had hoped to do, or for the things that we’re having to do. And in the terminal world, I think we’re pretty good at the both-ands. A lot of what we work on and work with people on. And so, holding, allowing grief to be present, and it’s not a beginning or end or do it for a day. 

I had a colleague and a friend once talk on actually spending time on grief, like scheduling time for grief, which I think is an interesting idea too. So, while we are allowing grief to be present for us in the ways that it is showing up, that we also allowing those moments for noticing the good and the joyful. There are so many amazing things happening, from the delivery of food at food pantries, to school personnel doing parades so that students can feel connected, to our healthcare providers who are providing service, and also to the healthcare providers who were doing their best to get ready. So just a super big thank you to all of you who are prioritizing social connection, while we are physically distancing, and all the ways that you’re working to be the buffer. I look forward to talking to you soon and be in touch. 

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