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

This is our 31st newsletter! Most of our newsletters have had themes based on a sector or population. We are going to do something a bit different in 2020 and focus each newsletter on SAMSHA’s principles of the trauma informed care (TIC). The first of these is safety. As you read the newsletters this year, please let us know if you have ways you’ve put these principles into practice.

As we got excited about organizing the newsletter in this way we also realized that SAFETY is no small topic. What I appreciate about this principle is that striving to provide physically and emotionally safe environments for those you serve, the workforce, and the community is complex and dynamic.

Why is Safety Important?

As many of you know, it is important to me that I know why I am doing something. When I know why, I can modify and innovate to best meet my practice. So why is safety important in TIC? I realize that this may seem like a simple question and often people say, “Well, safety is important because a survivor has experienced so much harm so it is hard for them to feel safe.” But why is the sense of safety even necessary—or is it necessary—to show up to school, to go to a doctor’s visit, or to get on a bus. Is the goal to feel safe or is the goal to not experience fear—or is this the same thing?

For me, safety is a critical component because of the physiological response when we feel unsafe (e.g., feel fear) and how this impairs our ability to engage by focusing our internal resources to reduce the perceived threat. I also see many of the other TIC principles (e.g., transparency, choice, collaboration, empowerment, historical context) being in service to creating safety.

Types of Safety

This principle asks you to consider both physical and emotional safety. I often see policies and procedures that promote physical safety and are less related to emotional safety. So how do you understand these types of safety? Physical safety is often talked about and practiced through fire drills, crisis response protocols, building access, earthquake preparedness, and/or de-escalation practices. Practices that are intended to keep our bodies safe from harm and are important (see Sharon Ross’s blog). However, it is equally important that these strategies that may seem routine need to be developed or assessed through a trauma-informed (TI) lens. This is done by asking for whom is this a safety issue, what are potential consequences (protective glass may make staff feel safer but create a loss in connection for those accessing services), and are the procedures inclusive of all bodies and abilities (see Olive Wood’s blog).

How do you practice, define, and experience emotional safety? Words used around the TIO office include validation of feelings, connectedness, sense of belonging, being understood, heard, and seen, and “like you have my back.” What I believe to be different about emotional safety from physical safety is that I can experience the benefits and consequences of feeling emotionally safe without having a concern, in the moment, for the physical wellness of my body. Here are some examples of situations where emotional safety can be jeopardized.

Examples:
The receptionist moves their glasses to the end of their nose and looks at you. You interpret this (based on your history of experience or the experiences of prior generations) to mean they do not think you deserve to be there.

A person seeking services comes into the community space. They start yelling racial slurs at you (a staff at the clinic). No one interrupts this behavior. You may feel physically unsafe with the person yelling racial slurs. You also notice that none of your coworkers are helping you.

You’re at a training and the facilitator invites everyone to introduce themselves using their names and pronouns and many participants don’t say their pronoun or say, “It doesn’t matter to me, call me whatever you want.”

You attend a staff meeting and it starts out (unknown to you) with a mindful practice that is limited to focusing on your breath and body.

You are at a training and the facilitator says, “I have a loud voice, does anyone really need me to use this microphone?” You do have a hard time hearing but no one else says anything.

You attend an appointment and you complete paperwork on why you are there, then the intake person asks why you are there, then the nurse asks you the same thing, and finally, the physician you are seeing asks why you are there once more!

You ask to be seen by a Native American provider and are told, “We don’t have anyone who identifies as this but I think you will be well treated by our providers.”

From these examples we can see how our emotional safety can be threatened, not because we believe we will be physically hurt but because these situations invoke feelings of not belonging, not deserving, not being valued, not being cared for, etc. The important part is that these feelings (e.g., not valued) actually signal danger. Danger that you will not get your needs met or you will be hurt more, which feels in our bodies similar to a threat of physical violence. Please read Felicia Eckstein’s blog—they do a much more eloquent job describing this.

Can We Operationalize Emotional Safety?

So how do we operationalize emotional safety in policies, procedures, and practices? In some cases it’s clear like developing protocols for interrupting racism, hiring providers who can identify with those being served, providing implicit bias and attunement training for staff, doing the hotspot activity, and instituting feedback practices so you can learn what is felt/experienced.

Other times it is less clear or predictable. Let’s take the intake paperwork example because it happened to me recently. I felt I had not been listened to because I had said why I was there in writing and verbally FOUR times! I was agitated and losing all my nice words. Afterwards, I asked friends in the field about why this happened. I was told that people often tell different parts of their information based on who and how it is asked . . . sounds trauma informed right, well maybe not four times but . . . So the suggestion I would make is to say this, “I know you have said [repeat what is known] to my coworker so I am going to ask again to see if there is anything we missed.”

In the first example above, there is nothing wrong with putting your glasses on the bottom of your nose AND this may make someone feel unsafe. To operationalize emotional safety in these moments is to have the skills to notice and attend to a threat of emotional safety in the moment or repair after the event. You may continue to put your glasses on the bottom of your nose but this time you will say, “I know for some this looks as though I am judging you, but I have bifocals and this helps me see you better.”

I think safety is critical so we can access the skills and relationships needed for healing. I think safety is universally needed but individually defined. Assessing your physical spaces for safety concerns is necessary (see Christine Stone’s blog) but also insufficient. Finding ways to notice, assess for, and attend to a continuum of feelings of safety is to practice the principle of safety.

It is also not TI to rely on the status quo. Because of racism and structural violence, there are spaces and places where feeling safe is not possible for many. I am reminded that I used to call my trainings “Do No Harm.” But this isn’t enough. The work of TIC, of organizational culture shift, is more than the absence of harm or fear. It is striving for a sense of belonging and value for all. This will manifest in different ways for different people and will require anti-racist work, self-reflection, peer support, agility, inclusion of lived experience, humility, and grace. It is the active, continual practice of this principle – safety – that creates safety.

Helpful Blog Posts

I am excited to share these blogs with you as a varied approach to the practice of safety.

TIO Updates

We are LAUNCHING a new plan so we can better engage and hear (emotional safety 😉) from you all about what you need and what you are learning. We wanted more diverse options because we want diverse voices to help us think about what is next. The new format is a four-method approach that includes:

  • Holding 2 – 4 webinars per year that are open to all. TIO will present what is being worked on and request feedback for what is needed.
  • Creating a place for continual feedback about what is happening at TIO via the website/email/phone.
  • Facilitating focus groups.
  • Creating a steering committee to provide input and advice about what is needed in communities and identities represented by you. Our goal is to have representation from multiple systems, agencies, identities, and regions across the state. We’re looking for members – click here for the application.

We hope you can find a way to be heard in one or more of these methods.

TIO, after revisions and vetting, is excited to share our statement and commitments regarding diversity, equity, and inclusion work. We look forward to this evolving over time with your input.

We are going to be updating resources and content on the website. If you have suggestions let us know by emailing pcamilla@pdx.edu.

Another TREM Training took place. It was great to spend two days with 13 people and learn about TREM.

TIO Participated in a Trauma Informed Care Panel at OHSU’s Global Health and Urban Underserved College

We attended a Native American Health Seminar: Climate, Identity and Our Health: Indigenous Lessons and Voice from the Front Lines of Climate Collapse by Tara Houska, Campaigns Director, Honor the Earth

To Do List:

  • Watch Storiez Guide The Truth About Trauma Informed Care. Meagan Corrado shares several important things to remember when providing trauma informed care.
  • This is a great resource for considering the emotional and physical safety through the lens of those with disabilities.
  • This fact sheet provides Oregon-specific Adverse Childhood Experiences (ACEs) data compiled by the Child & Adolescent Health Measurement Initiative.
  • Don’t forget, this is a short legislative session!