Organizational Intervention/Program Development Proposal Assignment Description

Physical Environment

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

Community spaces are clean, well-maintained and comfortable areas for learning, relaxing and socializing.

1

2

3

4

5

0

There is enough community space for gathering with seating that can become a circle.

1

2

3

4

5

0

Office spaces are comfortably furnished and contain personal items.

1

2

3

4

5

0

There are adequate spaces for staff to gather for meetings (e.g., treatment planning).

1

2

3

4

5

0

Client’s rooms are clean, relatively neat and have client-friendly and appropriate furniture.

1

2

3

4

5

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

General Social Environment

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

Staff welcome visitors immediately upon entry, introduce themselves, and ask how they can help.

1

2

3

4

5

0

When I walk through programs I often hear angry / tearful sounds.

5

4

3

2

1

0

Clients treat each other respectfully.

1

2

3

4

5

0

When I walk through programs I often see and hear staff responding to clients in a calm and nurturing tone.

1

2

3

4

5

0

Staff treat clients like they are bad.

5

4

3

2

1

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Staff Social Environment

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

Staff treat clients respectfully.

1

2

3

4

5

0

Staff treat each other respectfully.

1

2

3

4

5

0

Staff often schedule different activities to take place simultaneously.

5

4

3

2

1

0

Staff freely ask questions of each other and exchange information.

1

2

3

4

5

0

I often feel my co-workers do not support me.

5

4

3

2

1

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Nonviolence

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

The community has a clear set of boundaries, limits, or rules understood by all members.

1

2

3

4

5

0

Destructive or violent incidents are addressed nonviolently and openly reviewed as soon as possible.

1

2

3

4

5

0

I often feel unsafe at the facility.

5

4

3

2

1

0

Destructive or violent incidents are viewed as problems of and for the entire community.

1

2

3

4

5

0

Staff are quick to physically restrain a client.

5

4

3

2

1

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Emotional Intelligence

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

When staff members discuss a client, there is always an emphasis on thoughtful exploration of complicated issues.

1

2

3

4

5

0

Regular team meetings are held with representatives from all levels of staff.

1

2

3

4

5

0

Staff members usually do not recognize or understand clients' nonverbal communication.

5

4

3

2

1

0

My supervisor talks with me about work-related stress and helps me manage that stress in appropriate ways.

1

2

3

4

5

0

Most staff do not have regularly scheduled supervision.

5

4

3

2

1

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Social Learning

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

There is an expectation that leaders, staff, and clients will learn from everyday experience and from each other.

1

2

3

4

5

0

All major decisions are made using a team approach.

1

2

3

4

5

0

Educational materials (e.g., books, handouts and videos) are easily available to clients and staff.

1

2

3

4

5

0

Problem solving involves parties affected by the problem and is generally done by consensus.

1

2

3

4

5

0

Destructive or violent incidents are viewed as opportunities for new learning and information gained contributes to change.

1

2

3

4

5

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Shared Governance

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

Clients are not involved in their treatment planning.

5

4

3

2

1

0

I feel I can openly question or disagree with decisions made by administrators, managers, or other staff if needed.

1

2

3

4

5

0

Managers and administrators regularly take time to listen to what I have to say and respond in meaningful ways.

1

2

3

4

5

0

Policies, procedures, and practices are reviewed regularly by staff at all levels.

1

2

3

4

5

0

Important community/facility decisions (e.g., hiring, program changes, etc.) are often made without warning or discussion.

5

4

3

2

1

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Open Communication

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

The schedule of program activities and events are available and accessible to clients and staff.

1

2

3

4

5

0

There is regular and helpful communication between staff in different shifts or groups (e.g., direct care, clinical, etc.).

1

2

3

4

5

0

We are a team in name only; treatment decisions are made by a select few.

5

4

3

2

1

0

All staff are aware of decisions made around policies and procedures.

1

2

3

4

5

0

Difficult topics can be discussed openly and directly within the community.

1

2

3

4

5

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Social Responsibility

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

Problems between staff are usually ignored.

5

4

3

2

1

0

Longer-term clients take responsibility for mentoring newer clients.

1

2

3

4

5

0

Most administrators, managers, and staff do not model positive behavior.

5

4

3

2

1

0

Staff and leaders are able to challenge each other, disagree, collaborate, resolve conflicts, and learn from the process.

1

2

3

4

5

0

Relationships problems (e.g., between clients, clients and staff, or staff and leadership) are addressed and viewed as an opportunity for learning.

1

2

3

4

5

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE

Commitment to Growth and Change

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

N/A

Score

Administrators, managers, and staff truly believe in the potential for positive change in the clients we serve.

1

2

3

4

5

0

Clients are routinely encouraged to think about, plan, and work on goals for the immediate, short-term, and long-term future.

1

2

3

4

5

0

Activities of creative expression (e.g., the arts, games, etc.) are a regular part of our environment and are often tied to clients' therapeutic goals.

1

2

3

4

5

0

Change is often discouraged and not supported.

5

4

3

2

1

0

Inspiration in any form is sought after, appreciated, and supported.

1

2

3

4

5

0

Add all 5 scores together =TOTAL SCORE

Divide the total score by 5 = MEAN SCORE