Anatomy of a Safety Incident #5, Part 2

Content warning: PTSD, generational trauma, suicide, self-harm

As passionate as I am about trauma informed care, it was definitely not my goal to put on a demonstration of the need for it. (I love my work, but not that much!) My goal was to get through the site visit without drama. The staff and students of POCA Tech put huge amounts of time and energy into preparing for a well-organized, productive event. It’s demoralizing that we failed.

My first clue that things were going off the rails came when the team leader and I were working on what they call a “Gap Analysis”, meaning the difference between the voluminous documentation we had already provided and what the team felt they needed in order to establish our compliance. The Gap Analysis list asked for a lot of information about our assessments, which I was a little confused by because I thought we had already provided a lot of information about our assessments.

But the real sign of trouble was this exchange:

Team Leader: You describe POCA Tech’s diploma program as being like a Master level degree program.

Me: It IS a Master’s level program. We received accreditation in 2018 under the Master’s level standards. There is not to our knowledge a different set of standards for diploma programs.

That should have been my notice that a focus of the site visit was going to be whether POCA Tech was really a Master’s level program, as opposed to a low-class impostor. I didn’t recognize the warning that site visitors would obsess over whether we were grading point location tests properly (“within one cun”) or ask so many times how we knew that our treatments were effective that it was clear they didn’t believe that our treatments could be effective. (Side note: if anybody has solid efficacy data related to styles of acupuncture treatment that offers more actionable information than this study or this one, please get in touch!)

Okay, let’s back up. This blog post is about unpacking a safety incident, so I don’t want to set a tone of blaming individual site visitors for what happened, though I’m not happy about some things that were said. The point of these blog posts is to collectively learn about safety practices by analyzing what happens when things go off the rails. Trying to practice trauma informed care means failing at trauma informed care sometimes and I’ve failed more times than I can count. And -- spoiler alert -- it’s actually pretty amazing how much the take home messages from this safety incident overlap with those of Safety Incident #4, which obviously didn’t involve ACAHM at all.

So here’s what happened from my point of view, how I felt about it, and how I ended up triggered.

The first day of the site visit was mostly okay but the beginning of a pattern was established: site visitors asked for documents and didn’t read them, they asked questions and didn’t listen to the answers, they kept asking the same questions over and over as if we hadn’t understood. See previous post for “psychological costs that certain information collections impose on individuals”.

By the second day of the site visit, the pattern of asking questions without listening to the answers had escalated into outright badgering. A hot topic was POCA Tech’s attendance policy, which is in compliance with what our state regulators asked us to do the last time they sent us a notice -- to be as flexible with students as possible in light of the disruptions of the pandemic -- but which the site visitors were sure was noncompliant. Also, one site visitor mocked our quizzes and tests for being “too easy”. When I complained (politely, I thought) to the team leader, I was rebuffed. They followed up with a statement to the effect of, “I understand where you’re coming from, I come from a union family and a blue collar background so I get it and I love your mission BUT...”

There was an overarching theme of, “We love your mission BUT”. When it came to our pedagogical philosophy and all our operations that are aligned with our mission, though -- they most definitely didn’t love those. The implication was that we weren’t making acupuncture education hard enough.

On the morning of the third day of the site visit, I tried to address what I saw as a pattern of adversarial conversations about assessments based on some of the site visitors apparently not understanding Bloom’s Taxonomy. The team leader snapped at me, “We’re trying to be open to you but you need to be open to us and accept our guidance” (or something to that effect). I said, “We are never going to do some of the assessments you’re asking for, so please just write us up for that and stop talking about it, it’s not helping. From our perspective our paper trail is robust. We are at our limit of how much of a paper trail we can produce for you, with the resources that we have. There’s a point at which this becomes unsustainable for us and we’re really close to it.” I was starting to cry at that point but still able to stop myself and get out of that conversation almost like a normal person.

But about ten minutes afterwards I thought, I have tried in every way I know how to build POCA Tech so that it’s in compliance with ACAHM standards. I HAVE been open to their perspective, most of my job is to track the minutiae of what they want and do the best I can with the resources that we have to fulfill their requirements, I am trying ALL THE TIME.

And then I remembered the comment about “I understand where you’re coming from, blue collar union family, etc” and I thought, that’s not actually where I come from. I come from precarity. (For anyone wondering how precarity found its way into POCA Tech’s Vision and Values statement, now you know!) My family aren’t the kind of people who join unions, they’re the kind of people who shoot themselves in the head and drink themselves to death and get their kids taken away by the state. And on top of all the bad things that can happen to you when you’re poor, many of which happened to my extended family, there’s the layer of well-meaning authorities who want to help you and improve you and who end up destroying whatever foundation you’ve been able to create for yourself because that foundation isn’t good enough for them. And that’s what this site visit feels like to me.

And there you have it: the point of no return for me. Apparently the tone of conversations with the site visitors improved considerably after that last conversation but I wasn’t there to see it. I had my hands full with being triggered.

It took another four days before I felt like there was no longer a chemical spill in my brain. And then I thought, wow, this is SO FRACTAL. What triggered me in the site visit is such a great representation of the dominant attitudes of the acupuncture profession towards patients, especially the kind of patients who use community acupuncture clinics. They’re not trying hard enough; they need to be more receptive and compliant; providing answers to a barrage of questions from an authority figure is the price of access to treatment. And patients who can’t handle that kind of pressure don’t deserve to get acupuncture. The site visit was like a four day reenactment of why we needed to make POCA Tech in the first place.

In order for me to get through the site visit without getting triggered, I would have needed the site visitors to embrace the safety practices that POCA Tech students use with their patients in clinic, particularly:

  1. Watch carefully for signs that people are getting overwhelmed or feeling cornered. Make it easy for people to take breaks or disengage altogether.

  2. Be mindful of the cost of providing information, especially when people have limited resources. All the cognitive and emotional energy I spent on answering the same questions over and over was energy I didn’t have to hold myself together.

  3. If you’re in a position of relative social power, it’s your responsibility to set a tone of neutrality when it comes to boundaries. Navigating boundaries needs to be approached with care and with as little emotional charge as possible. Try to set boundaries simply, clearly, calmly, and kindly, no arguing or badgering. (I’m not saying boundaries are easy, everybody I know has to work at them -- but there’s a world of difference between trying to be neutral and not even realizing you should be trying.)

  4. Be VERY careful when you ask about or talk about somebody’s past experiences, ESPECIALLY their family history. It’s probably best to treat that stuff like it’s radioactive.

Finally, nothing is more important for overall safety than having back up support. I don’t know what happens to a school in the reaccreditation process if the point person walks out in the middle of the site visit, but I bet we wouldn’t want to find out -- and thanks to my co-Directors who took over for me, we don’t have to. We’ve known for quite awhile that having a single person in the Executive Director position was risky, because there’s too much pressure. Just like in Safety Incident #4, a major take home message is that if things do go off the rails, it’s crucial to have more humans who can step in to help.