Using the Delphi method to develop trauma-informed practice guidelines for neurorehabilitation

Traumatic stress is common in persons with acquired brain injury. Untreated trauma not only negatively affects mental health but can also impact rehabilitation outcomes and overall recovery. However, not every neurorehabilitation professional has the scope of practice to treat traumatic stress, and providers may not feel well equipped to support patients dealing with significant trauma. Trauma-informed practice (TIP) is an approach in health care where traumatic stress is assumed to be common, and where the environment can be made to feel safe and welcoming without needing to address trauma directly. The objective of our study was to create draft consensus guidelines for TIP within the neurorehabilitation context.

Researchers, trainees, neurorehabilitation professionals, and adults with lived experience of acquired brain injury and traumatic stress were recruited to participate in our study. We used the Delphi method-a methodology used in health care to develop consensus-over the course of 12 months, whereby panelists participated in group meetings and individual qualitative interviews to generate preliminary items for our guidelines.

Items from the interviews were rank ordered, and a final set of items was used to create a draft set of guidelines, formatted into a brochure for ease of dissemination.

The current guidelines can serve as an initial starting point for the implementation of TIP in a variety of clinical settings. Future directions would be for these guidelines to be implemented and tested in diverse rehabilitation environments, in terms of outcome data and patient/provider satisfaction. (PsycInfo Database Record (c) 2026 APA, all rights reserved).