August 18, 2020

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

Choice and Voice

This newsletter is focused on the trauma informed principles –  Voice and Choice. I appreciate dedicating each newsletter to one of the trauma informed care principles (thank you to staff who suggested this). It gives me (and I hope you) an opportunity to evaluate and critique the purpose of each principle and an opportunity to refresh my commitment to practicing it.  This principle about Voice and Choice is big, packed with centering the needs of the those served, focusing on resilience and healing, understanding power differentials,  eliminating coercive treatment,  prioritizing staff wellness, and more. I found it helpful to take a moment to read/re-read through this definition of the principle (tip: search for the word voice).

Let’s start with exploring the call to elevate and utilize the VOICE of those with experience and those impacted by services, and how this relates to trauma and toxic stress.

Survivors of trauma have been denied their voice and often repeatedly. This can mean literally being silenced. For example, by an abusive partner who cuts off access from friends and family. Additionally, it can mean being silenced by messages society sends that they should not speak up (e.g. seeing those who harm elevated in a community). One’s voice can also be denied when it is directly ignored – for example when someone asks for help and there is no answer. There is also the experience of one’s voice being minimized, misunderstood, and/or used against them.  Survivors of sexual assault often report the added layers of trauma experienced as they seek help after an assault-having their experiences not believed, details challenged and misrepresented, or being told “nothing can be done”. When voices are suppressed by systems –  and this part is important – it  leads to more trauma. This is why this principle is critical in our work.

So how can we include the voices of those impacted (survivors, staff, partners, etc.) in planning, evaluating, designing, and delivering services? Organizations can contract with partner agencies doing this work and/or hire staff with lived experience in an area(s) relevant to its work. A note – it is not sufficient to have colleagues who identify as survivors speak to and influence decisions from this experience, if it is not part of their job. We have written before about this, but it is worth repeating that including survivor voices as part of developing a trauma informed organization is not about just passively listening or bearing witness but is, instead, for the purpose of influencing decisions about how the organization functions. I find that a combination of external and internal critique from those impacted is necessary.

TIO implements this principle by actively seeking and sharing other’s voices and experiences. We do this by listening to the Oregon Trauma Advocates Coalition (OTAC)—our youth advisory board. We listen to our Steering Committee, and our staff and interns. And, importantly, we listen to and elevate the affinity group feedback we hear. The blogs and vlogs are also ways we share voices and experiences. I am grateful for each person that contributes and as I engage with their words, I think how I can use what was shared to transform practices.

Sharing your experiences and having it help others is often healing. For organizations, hearing from those impacted leads to better practices. As you seek input and guidance from staff and those supported, you are likely not to get one answer but instead several which can lead to  more creative solutions. Seeking input and incorporating voices takes time and relationship. Stories are shared when someone feels safe and they feel you will not exploit their story or harm them for sharing. We must build this into our timelines. “Not having time” for people’s voice perpetuates the pain of being ignored or unseen, which leads to more violence.

Now let’s talk about CHOICE. Similar to a survivor’s Voice, Choices have also been denied by an abusive person/people or by systems. An abusive partner will deny the choice of where to go or who to see, and the system will deny the support needed to move to a safe space or see one’s children, for example. In this way,  the choice is really  that which will cause less harm. It’s an illusion of choice because harm will happen either way.

It is worth taking the time to reflect on how policies and procedures deny or elevate choice for those served and staff. Take a moment and assess how you feel when choice is denied or not offered to you. As an organization or a provider, if you can not change a policy or procedure, at least understand what feelings will result and be transparent and accountable to causing this. There is much to the concept and application of Choice – here are few thoughts/lessons I have experienced.

1. Being offered a choice is often a new experience.

Having someone offer you a choice and honor your decision is a rare experience for many who have experienced harm. Be prepared to make this a practice. Talk about the connection between trauma, oppression, and decision making. Offer lots of opportunities for choice and follow through. Peer support can help model and teach. Do not retraumatize by offering options and then not delivering.

2. Offer actual choices and strive for “No” to be one of those choices.

Offering choices is about building resilience, self-confidence, and relationships. If the choice does not support this purpose reconsider calling it a choice. Consider, for example, the student who struggles to stay focused in a typical classroom who is told to stay still or go to the principal’s office in front of classmates. This is technically a choice, but it does not promote self-confidence or resilience. Or a person who requests to be seen by a person who speaks Spanish and the answer is that there is no such provider in the county, but a translator is an option.  Also strive to offer choices in a way that a no (or none of the above) answer feels comfortable for the person having to make the choice. This is more likely to happen when an emotionally safe relationship has been built (Who do you feel safe with to say no?) When there is not a safe enough relationship — a common scenario in much of our work — we need to accommodate for this by offering time (e.g. take 48 hours) to make the choice and/or recommending a support person be consulted and join the process.

3. Making a choice can feel risky, as can offering a choice.

Making choices can feel and be risky. This job or that one, pay for medicine or food, speak out or stay silent, this purchase or that one… (by the way – picking between 3 is easier than 2 or 4). Offering choices can also be risky. This is often the case when we don’t think the choices are adequate or if we are holding too much perceived or actual responsibility for the consequences of the choices we’ve offered, as providers for example. When this happens, take a moment and think about what is feeling risky and why and what support you can access to sort through this.

I consulted once regarding a mother who was being asked to attend residential substance use treatment services. The judge offered her some time to consider the choices- clearing stating the consequences regarding visitation with her children for either choice (a trauma informed practice). She consulted with her peer support specialist and others. She returned a few days later and her final choice was not to go into residential services. She was able to use her voice and choice to say she was not ready. This was not easy for the providers working with her to hear. Some said she didn’t know what she needed and leaving it up to her was not fair to her. Providers had been working hard to connect her to services and were scared for her. If she had been mandated into treatment would she have found what she needed? Or would she have run out feeling more of a failure? Choices can be risky. I do believe offering voice and choice in a trauma informed and inclusive way contributes to building resilience and makes a difference – sometimes that difference is with the next time services are offered.

Learning from our choices – the successes, failures, and the “good enoughs” – builds resilience, self-worth, and self-confidence. I believe to be trauma informed we must strive to offer as much choice as possible, expect and provide space to learn from these choices, and offer people opportunities to change course as available. I do not say this lightly. I constantly evaluate in my work role whether I am offering enough choice without burdening staff while also being able to change course while keeping focused – that fabulous trauma informed phrase of being consistent but flexible and knowing there are different needs based on experiences.

Helpful Blog Posts

From this newsletter’s contributors, here are some blogs posts that show the importance of voice and choice.

TIO Updates

  • We collaborated with state and national partners to move trauma informed care work forward through committee work, consultation, and policy change.
  • We continued to offer presentations and trainings virtually (it is working better than expected). Check out our Hosting a Virtual Meeting Using Trauma Informed Principles tip sheet.
  • TIO has increased accessibility of our offerings.
  • We are beginning to evaluate our products using the National Culturally and Linguistically Appropriate Services (CLAS)
  • Jonicia Shelton,  Zadora Williams, and Isha Charlie-McNeely were interviewed for an article in Street Roots.
  • TIO is prepared to teach Trauma informed Care this fall at Portland State University in the School of Social Work.
  • Isha Charlie-McNeely is an advisory committee member on Developing Equity Leadership Through Training & Action (DELTA). They are currently reviewing applications and still accepting applications.

To Do List