This week, we’re ready to take the next step. Part 3 of this “Ftag of the Week” CMSCG Blog series will focus on practical approaches for integrating trauma-informed care into daily practice. We’ll discuss actionable strategies for care planning, ways to identify and address triggers, and how to create an environment that supports healing for both residents and staff. If you’re wondering how to turn regulatory language into real-world results, you’re in the right place. Let’s dive in and discover how trauma-informed care can become an integral, dynamic part of your facility’s everyday practices – instead of just a checkmark next to required education.
How Prevalent is Trauma?
According to various research, it is estimated that 50% of adults in the United States will experience at least one traumatic event in their lives. The lifetime risk that an adult in the US will develop Post-Traumatic Stress Disorder (PTSD) is just 6.8%. Those numbers vary for different populations, including Veterans and adolescents. Not everyone who experiences trauma will develop PTSD, and that doesn’t mean that trauma isn’t more common than we may think.
Types of Trauma
There are many examples of trauma, but they can be generally grouped into sets – trauma which is caused by a natural event or trauma caused by people. That includes anything from an earthquake to an accidental gun shooting to abuse and neglect to warfare. Trauma survivors may experience grief – and it can be delayed or prolonged, complicating their ability to return to “usual” routines and activities.
Thinking About Emotions and Feelings
If you haven’t been to the SAMHSA library, it’s a good starting place for Trauma 101. For example, there’s a lot of great resources there to understand how to help trauma survivors cope – and also to learn more about types of symptoms trauma survivors may experience. Here are some examples of issues we may encounter with a resident, but may not think about how something could have potentially triggered the resident’s “behaviors” –
- Physical reactions to grief or anger, such as nausea and trouble eating, difficulty sleeping, trembling/shaking – often we evaluate these without additional consideration to psychosocial factors which could be impacting the resident.
- Social withdrawal – does the resident really prefer to remain in bed all the time or is there something we have missed? Do you have a resident who refuses to attend certain (or all) holiday celebrations? Maybe there’s more to it. Or maybe they’re just not into it – but sometimes it’s worth looking into.
- Long-lasting effects of childhood abuse such as easily becoming angered, feeling numb, depressed or suicidal, or being sensitive to noise, touch or even just being close to others
PTSD can develop after someone is exposed to a potentially traumatic event that is beyond a “typical” stressor, such as:
- Natural or human-caused disasters
- Accidents
- Violent personal assaults
- Combat
- Other forms of violence
Guidance from Appendix PP Review
There’s a couple of key points to review in the Interpretive Guidance (IG) in Appendix PP related to trauma which nursing home staff need to keep in mind.
In the nursing home, there is always the expectation that care and services are person-centered and honor residents’ preferences and choices. When a resident has experienced trauma, there is an added factor. Someone who has experienced trauma:
- may have lost his/her ability to trust caregivers
- may have lost the ability to feel safe in his/her environment
Those two bullet points are really key to recognizing and understanding a resident’s needs. Do we really consider that a resident’s past experiences are coloring the current situation – and maybe they aren’t just a “behavioral” resident? The resident who isn’t cooperative during care? The resident who becomes agitated in large groups? The resident who refuses showers every time staff take him/her into the shower room? Are we inadvertently re-traumatizing the resident?
Retraumatization
Retraumatization risk factors should be identified in order to help address potential signs and symptoms of distress that a resident may be experiencing. Key risk factors include:
- High frequency of life trauma – such as abuse or neglect
- Lack of access to health/mental health services
- Lack of economic and social supports
- Lack of love/support from others/ disconnection from family and others
- Living/working in unsafe conditions/situations
- History of using unhealthy coping methods, including substance use/abuse
Potential Triggers
One area that many facilities don’t have a good handle on is identifying potential triggering events which could retraumatize the resident. These triggers can cause the person to be reminded of an earlier trauma. These triggers also typically aren’t the ones that come in your generic care plan template library and may require a little more digging on your part, but potential triggers that should always be considered include:
- Sensory reminders – sounds, smells, sights, touch
- Situational cues – Anniversary dates, media coverage, TV/movies with similar topics or similar natural disasters occurring
- Interpersonal concerns – being reliant on others or in situations where someone doesn’t feel in control or in power, interactions with authority figures, conflicts with others
- Continued exposure to toxic relationships – unhealthy relationships/ relationship patterns
In the final part of our Ftag of the Week series for F699, we’ll review more on retraumatization and address some areas where providers can fall flat related to addressing residents’ trauma.
