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

This newsletter is focused on SAMHSA’s Trauma Informed Care (TIC) principle Trust and Transparency. Before we delve into this topic, I want to say that the COVID-19 pandemic is causing trauma, retraumatization, and toxic stress, as well as individual and community resilience. I hope you will see how the principles of TIC are needed in our efforts to prevent and mitigate the impact of COVID-19 and related response efforts. For those doing TIC work, I hope that you can find ways to bring this lens to conversations and decisions being made at this time (let us know if we can help with this and please check out our Community Incident Response page if you haven’t already).

What is the relationship of trust, transparency, and trauma and how is it relevant in a time of crisis?

Trust

I think trust is a wonderful and healing ingredient in a relationship. Learning to trust yourself and others is often a significant part of trauma healing work.  I also do not think it is a realistic expectation for all settings and relationships. Why would we expect someone to trust a system that has caused them harm because of racist and oppressive policies and practices? In the time of a global crisis, trust and transparency are important because we need people to have safe practices and care for each other. Though who you trust for information and ask for help will be based on past experiences with each other. It is important to reflect on how you use the word trust—when is it necessary or desired, what does it look like, and for whom?

Transparency

So, let’s talk about transparency—to see through—to share information. Transparency is needed to develop trust and to repair ruptured relationships (think between systems and communities). Transparency is also important because for many survivors when information was withheld harmful things happened. Information allows us to predict and make informed decisions in a more regulated state—information is power. But how can you trust information if you do not see your reality represented or if you do not have access (withholding power)? This is happening now regarding COVID-19 and race. I often hear the sentiment “we are all in this together”—we are all experiencing this, but we are not all impacted in the same way.

Data over the last few days shows us that this illness is affecting African American and Black communities at higher rates of both illness and deaths. We see greater risk in older populations and populations where physical distancing is not possible because of a lack of housing or food delivery. We will keep learning more if we are willing to look and listen because this is about health disparities before COVID-19 that we must continue to address and work to end.

“The virus doesn’t discriminate, but it thrives on vulnerable populations who have been discriminated against.” –Cleavon, MD

Here are some ways to practice transparency related to disparity and COVID-19:

The relationship between trust, transparency, and trauma is complex, dynamic, and personal. It is worthy of much more than I have provided here, but because our attention is divided due to COVID-19, I am going to go with a “talking points” format. I hope you can use this to bring TIC to your response efforts.

Trust, Transparency, and Trauma:

  • Basic needs are necessary to engage in trust building.
  • Abuse, neglect, and harm diminishes our trust in others and is equally (if not more) damaging in ourselves. (“I thought they were safe,” “I thought the organization would help, not hurt,” “I guess it is me.”)
  • Policies and practices can perpetuate this lack of self-trust. (“You were drinking,” “I am sure it wasn’t about race,” “you shouldn’t have . . .,” “there is not enough evidence”.)
  • Relationships are important for recovery and trust is an essential part of healing relationships.
  • Transparency is necessary to build trust and those who have experienced interpersonal and systemic violence often have a keen sense of when things are being withheld.
  • There are differences in where trust is needed, e.g., to care for my child, to show up to work, to find me housing, to call me back, etc.
  • Trust goes beyond friends and family—also with community, service animals, organizations, leaders, supervisors, etc.
  • Trust during a crisis comes quicker if you have already established relationships. If you are new to a position or client/patient you may have to do more transparent work upfront.
  • Experiences are unique. (I cannot trust you to help me if you do not acknowledge my unique experience.)

Recommendations:

  • Be transparent. Take inventory of where you are not being transparent. (How you feel?)
  • Consider if you are new to a relationship (as a supervisor, provider), specifically during this time of heightened stress, take note of this and speak to this. (“I realize I do not know you all that well . . .,” “I know I haven’t been in touch in a while and I acknowledge this and will be changing this as we navigate this pandemic.”)
  • Find, collaborate, and support who is trusted in a community, group, or department.
  • Elevate different experiences across race, class, ability, gender, age, region, and more.
  • Be clear about how you will protect staff, their family, and those served.
  • Allow space for questions even if you don’t have the answers.
  • Offer regular check ins/updates on what is happening. (More frequent? Less duration?)
  • Find ways to honor unique experiences including coping strategies.
  • Use Diversity, Equity, and Inclusion, anti-racist, and TIC lens to evaluate efforts.

Transparency can create a shared reality and collective response that builds our resilience as neighbors, communities, and countries, but only if it weaves together all of our unique experiences.

Helpful Blog Posts

Trust and transparency are important when thinking about policies, practices, and relationships. Read about ways our contributors to this newsletter have woven these principles into their settings and work.

TIO Updates

Places we’ve been and things of interest before COVID-19…

  • Before COVID-19 altered our day to day we were spending time talking with SUDS providers, women healthcare providers, nursing students, volunteers, and those working in aging and disability services. How grateful I am today that these providers have TIC to implement at this time.
  • I was in Europe and had a fabulous time that feels quite distant today. I started my trip visiting and working with Dr Karen Triesman. I then traveled to Northern Ireland and presented to a cross sector collaborative doing amazing work. I will share more details about the great work happening in Northern Ireland soon.

And now our COVID-19-focused updates:

Check out our Community Incident Response page for resources. Let us know what you need. We have been hosting office hours, joining meetings, and these are some of the themes we are hearing:

  • Remember to use TIC to help with response efforts (apply the principles)
  • How do we care for the workforce (check out Considerations for a Trauma Informed Response for Work Settings), for example, telehealth is great but make sure to institute breaks for staff, offer snacks, and make sure basic needs are met.
  • Elevate the differences of impact and needs based on race, class, regions, culture, age, gender, ability, and more.
  • Think about how to keep those making decisions regulated.
  • Think about how/what will be needed to gather together again.

To Do List: