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Research: Trauma-Informed Organizations

Change Package: Choice


Informed consent

Sharing all the relevant information in a way that people understand it so they have full knowledge of the possible benefits, risks, and consequences before making a decision.

Participation in decision making

Sharing all the relevant information in a way that people understand it so they have full knowledge of the possible benefits, risks, and consequences before making a decision.

Supporting autonomy, freedom, control, and flexibility

The right of individuals to make decisions about their experiences without others trying to pressure or coerce them. Autonomy allows for others to educate and inform, but does not allow someone to make decisions for another person.

Staff Experience

  • Develop a written policy to solicit and incorporate staff feedback on organizational or programmatic changes.
  • Develop a written policy that protects staff from reprisal if they report behaviors or incidences that could be considered emotionally/psychologically unsafe or misaligned with TI principles.

  • Develop procedures to regularly evaluate staff perceptions about decisions that impact the program.
  • Create regularly scheduled focus groups to actively solicit feedback about specific organizational practices or changes.
  • Acknowledge when executive leadership and/or supervisors are actively making changes and subsequently create meeting space to solicit opinions or perspectives from staff before decisions are made. Staff should be given opportunities to provide feedback privately (for safety) and within a larger group (for accountability).
  • Record all feedback on organizational processes and share widely with staff. This offers accountability for decision-makers and communicates that staff opinions are valued, especially if feedback is not implemented.

  • Coach supervisors on soliciting feedback prior to making a decision, and how to solicit and respond to staff opinions or perspectives in a non-defensive, open manner.

  • Train leadership to value staff input in decision-making.
  • Coach executive leadership and/or supervisors on how to ask for staff’s consent, rather than telling/commanding staff.
  • Train leaders and supervisors to use language with subordinates that equalizes power, especially regarding how staff meet job requirements (e.g., “What do you think…?” “How would you feel if…?”).

Consumer Experience

  • Work with consumers/consumer representatives to review organizational policies and workflow with regard to where consumers have choices, and where those opportunities for consumer control/direction can be expanded.
  • Develop a process for consumers to provide feedback or file grievances if they have a complaint about their care.

  • Review and assess all policies to determine and address any barriers that consumers may have in accessing services.
  • Develop a written policy which states that services are not contingent on participation in other services.

  • Develop, post, and make accessible “Consumer Rights and Responsibilities” in multiple languages.
  • Create a section in the case notes/treatment plan specifically for consumer feedback/ comments. Coach staff to ask each consumer and record feedback accurately.

  • Develop a process for consumers to change providers if needed, without fear of retribution or diminished care.
  • Create a process to ensure consumers are offered the option to select a provider based on gender preference and that those options are available.
  • Ensure there are multiple choices as to where consumers may sit when entering a provider’s office.

  • Coach staff to communicate and work with consumers on how to think through choices (not direct them to make a specific choice), including how to approach consumers using “if…then” statements to help think through choices.
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