July 2023 Newsletter
The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) provides mental health and substance use evidence-based training, customized technical assistance, and resources to certified Medicare and Medicaid nursing facilities who care for residents with a variety of behavioral health conditions at absolutely no cost. To submit a request for assistance, complete the online request form by clicking HERE.
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In This Issue
In this month’s newsletter, we will define trauma and learn how a trauma-informed model can address the unique needs of residents with a history of trauma and triggers. This approach will provide higher quality care to residents and be compliant with nursing facility regulatory guidance regarding trauma-informed care.
In This Issue:
In This Issue:
- Trauma-Informed Care
- What is Trauma?
- What is Post-Traumatic Stress Disorder?
- Triggers & Re-Traumatization
- Trauma-Informed Care and Nursing Facility Regulatory Guidance
- What Can You Do Today?
- COE-NF Resources for Trauma-Informed Care in Nursing Facilities
- Guiding Principals to Create a Trauma-Informed Approach in Nursing Facilities
- Introduction to Trauma-Informed Care (TIC) Training
- Did You Know?
- Register for the July COE-NF Training Sessions
- You Matter – Encouraging a Culture of Trauma-Informed Care
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Trauma-Informed Care
Trauma-informed care provides nursing facilities with a model of care that addresses residents’ history of trauma. The trauma-informed model uses a person-centered, non-judgmental focus of communicating understanding, identifying triggers, and creating an environment of safety for the residents to heal from their life experiences.
What is Trauma?
SAMSHA describes trauma as an event or circumstance resulting in physical harm, emotional harm, and/or life-threatening harm. It has lasting adverse effects on the individual’s mental, physical, and emotional health, as well as their social and spiritual well-being. It has no boundaries. In the US, 70% of adults have experienced some type of traumatic event. For this reason, addressing trauma is an important part of effective behavioral health care for residents.
Knowing about a resident’s trauma history will inform the staff of how to provide person-centered care for that resident. Certain behaviors, viewed through a trauma-informed lens, allow staff to engage and connect with residents to address the underlying causes of these behaviors.
Source: https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4884.pdf
Trauma also impacts our health. Physical complaints may be connected to past trauma. For example, residents may be unable to sleep due to nightmares related to their trauma. Engaging with residents about their history can provide deeper insight into the care they need.
Source: https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4912.pdf
What is Trauma?
SAMSHA describes trauma as an event or circumstance resulting in physical harm, emotional harm, and/or life-threatening harm. It has lasting adverse effects on the individual’s mental, physical, and emotional health, as well as their social and spiritual well-being. It has no boundaries. In the US, 70% of adults have experienced some type of traumatic event. For this reason, addressing trauma is an important part of effective behavioral health care for residents.
Knowing about a resident’s trauma history will inform the staff of how to provide person-centered care for that resident. Certain behaviors, viewed through a trauma-informed lens, allow staff to engage and connect with residents to address the underlying causes of these behaviors.
Source: https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4884.pdf
Trauma also impacts our health. Physical complaints may be connected to past trauma. For example, residents may be unable to sleep due to nightmares related to their trauma. Engaging with residents about their history can provide deeper insight into the care they need.
Source: https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4912.pdf
What is Post-Traumatic Stress Disorder?
Nursing facility residents may suffer from Post-Traumatic Stress Disorder (PTSD), a mental health disorder developed after seeing or experiencing a traumatic event. Residents with PTSD may experience nightmares or unwanted memories of the trauma, avoidance of situations that recall the trauma,heightened reactions, anxiety, or depressed mood that impacts their ability to interact appropriately with other residents, enjoy social activities, or take interest in their well-being.
Sources:
• https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
• https://www.samhsa.gov/blog/posttraumatic-stress-disorder-awareness-month
Nursing facility residents may suffer from Post-Traumatic Stress Disorder (PTSD), a mental health disorder developed after seeing or experiencing a traumatic event. Residents with PTSD may experience nightmares or unwanted memories of the trauma, avoidance of situations that recall the trauma,heightened reactions, anxiety, or depressed mood that impacts their ability to interact appropriately with other residents, enjoy social activities, or take interest in their well-being.
Sources:
• https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
• https://www.samhsa.gov/blog/posttraumatic-stress-disorder-awareness-month
Triggers & Re-Traumatization
One way to address trauma in nursing facilities is to work with nursing facility residents to identify their “triggers”. A trigger is a psychological stimulus that prompts recall of a previous traumatic event. Common triggers include:
One example might be a resident who has a history of sexual abuse. Staff assisting with bathing, dressing, or toileting could be misunderstood and cause re-traumatization. The intervention could be explaining the activity and asking the resident for permission before proceeding.
Identifying these triggers during the assessment and care planning process puts the facility staff in a position to provide trauma-informed care and eliminate or mitigate re-traumatization.
One way to address trauma in nursing facilities is to work with nursing facility residents to identify their “triggers”. A trigger is a psychological stimulus that prompts recall of a previous traumatic event. Common triggers include:
- Crowded or small spaces
- Loud noises or bright flashing lights
- Certain sights, such as objects that are associated with those used to abuse
- Sounds, smells, and even physical touch
One example might be a resident who has a history of sexual abuse. Staff assisting with bathing, dressing, or toileting could be misunderstood and cause re-traumatization. The intervention could be explaining the activity and asking the resident for permission before proceeding.
Identifying these triggers during the assessment and care planning process puts the facility staff in a position to provide trauma-informed care and eliminate or mitigate re-traumatization.
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Trauma-Informed Care and Nursing Facility Regulatory Guidance
The CMS State Operations Manual (SOM) for FTag 699 states that facilities need to ensure that residents with trauma receive culturally competent, trauma-informed care in accordance with professional standards of practice. The SOM also requires that residents’ experiences and preferences be accounted for to eliminate or mitigate triggers that may cause re-traumatization of resident.
Key components of compliance include:
Source: CMS Appendix PP State Operations Manual, Pg. [242, 433, 843]
- Universal screening of residents for trauma history. You must know residents’ individual history and experiences to address their trauma.
- Developing individualized care plans based on trauma history, preferences, triggers, and goals of eliminating or mitigating re-traumatization.
- Consistently using approaches that are culturally competent and/or are trauma-informed. Approaches should be individualized for residents based on their history.
Source: CMS Appendix PP State Operations Manual, Pg. [242, 433, 843]
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What Can You Do TODAY?
According to the National Center for PTSD, about six percent of the population will have PTSD at some point in their lives. About 12 million adults in the United States have PTSD during a given year.
Individuals may think that a traumatic experience occurring years or decades prior no longer has an impact on their mental health...this is not true.
Significant life changes can bring back feelings and memories experienced during a traumatic event, especially if the changes are beyond the individual’s control.
Source:https://www.samhsa.gov/blog/posttraumatic-stress-disorder-awareness-month
Individuals may think that a traumatic experience occurring years or decades prior no longer has an impact on their mental health...this is not true.
Significant life changes can bring back feelings and memories experienced during a traumatic event, especially if the changes are beyond the individual’s control.
Source:https://www.samhsa.gov/blog/posttraumatic-stress-disorder-awareness-month
The COE-NF is available to support and provide guidance to your facility in any of these areas.
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COE-NF Resources for Trauma-Informed Care in Nursing Facilities
COE-NF has developed the following resources related to trauma-informed care in nursing facilities. Whether you have already implemented trauma-informed care practices, or are just getting started, these resources can help you and the rest of the nursing facility staff become more knowledgeable about trauma-informed care and successfully implement trauma-informed care practices in your facility.
Guiding Principles to Create a Trauma-Informed Approach in Nursing Facilities
The COE-NF developed this one-page resource to demonstrate the concept of trauma and guidance for trauma-informed approaches in nursing facilities. This resource an be shared with all team members to help orient them to the trauma-informed concept and specific approaches that can be applied. Click HERE to view and download.
The COE-NF developed this one-page resource to demonstrate the concept of trauma and guidance for trauma-informed approaches in nursing facilities. This resource an be shared with all team members to help orient them to the trauma-informed concept and specific approaches that can be applied. Click HERE to view and download.
Introduction to Trauma-Informed Care (TIC) Training
The 2nd session in the trauma-informed care series, continued the exploration of TIC concepts including the difference between trauma screening and assessment, the impact of an activated nervous system, and how to integrate that knowledge into daily interactions with residents. Click HERE to view the video recording of the session and download the slides.
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According to the National Center for PTSD, about six percent of the population will have PTSD at some point in their lives. About 12 million adults in the United States have PTSD during a given year.
Individuals may think that a traumatic experience occurring years or decades prior no longer has an impact on their mental health...this is not true.
Significant life changes can bring back feelings and memories experienced during a traumatic event, especially if the changes are beyond the individual’s control.
Source:https://www.samhsa.gov/blog/posttraumatic-stress-disorder-awareness-month
Individuals may think that a traumatic experience occurring years or decades prior no longer has an impact on their mental health...this is not true.
Significant life changes can bring back feelings and memories experienced during a traumatic event, especially if the changes are beyond the individual’s control.
Source:https://www.samhsa.gov/blog/posttraumatic-stress-disorder-awareness-month
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Register for the July COE-NF Training Sessions
Tuesday, July 18, 2023
2-2:30 p.m. EST
Culturally and Linguistically Appropriate Services (CLAS) Standards provide a blueprint toward improving health equity, patient safety, and patient satisfaction. This presentation is an introduction to CLAS standards and provides ideas for implementation in your organizations.
Learning Objectives:
1. Describe what CLAS is and why it is important for improving health equity.
2. Classify CLAS standards into operational objectives.
3. Learn your role in implementing CLAS standards in your organization.
Learning Objectives:
1. Describe what CLAS is and why it is important for improving health equity.
2. Classify CLAS standards into operational objectives.
3. Learn your role in implementing CLAS standards in your organization.
Wednesday, July 19, 2023
2 – 3:30 p.m.
This half-hour workshop is to introduce staff to schizophrenia and psychosis with the goal to provide participants with a basic understanding of thought disorders.
Learning Objectives:
- Provide a basic understanding of schizophrenia, its onset, symptoms and treatments.
- Understand that psychosis can be caused from other sources besides schizophrenia
- Identify the symptoms of psychosis
Wednesday, July 26, 2023
2-3 p.m. EST
In Part 3 of this series, we’ll explore the difference between trauma screening and trauma assessment and why this distinction is so important in supporting a trauma-informed culture. Participants will learn about direct and indirect screening and when to use each approach and what to do if a resident shares details about a traumatic experience.
Learning Objectives:
- Differentiate between trauma screening and trauma assessment and why this distinction is crucial.
- Explain direct and indirect screening techniques and how staff can always use indirect screening as part of a trauma-informed culture.
- Name two things a staff member can do if a resident discloses details of a traumatic experience.
- THIS SESSION IS FULL -
Friday, July 28, 2023
11 – 4:30 p.m. EST
Mental Health First Aid (MHFA) gives you the skills to reach out and provide initial help and support to someone who may be developing a mental health or substance use challenge or experiencing a crisis.
This session provides a MHFA certification for three years.
Certification Details: This session provides a MHFA certification for three years.
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You Matter!
Encouraging a Culture of Trauma-Informed Care
Encouraging a Culture of Trauma-Informed Care
Trauma-informed facilities also acknowledge that staff have their own trauma histories and may experience compassion fatigue and burnout while caring for residents. Here are some things that can be done to promote a culture of trauma-informed care for staff:
As an individual…
Set intentions for yourself. There are things that we can’t control at work, but what we can control is how we approach our work using intentions.
“I will [intention] during [time frame].”
Examples:
- I will go to the gym after work today.
- I will learn one new thing during my next interaction with a resident.
- I will take 5 minutes to meditate during my lunch break.
Initiate a debriefing exercise with another staff member. After a shared stressful event, find a safe space where one person can talk for 2-5 minutes about whatever is in their heart or mind while the other person listens and provides a nonjudgmental, calming presence. After the time is up, switch roles and repeat. This exercise provides social connection while simultaneously allowing energy to move through the body and restore the nervous system after encountering a stressor and/or trauma trigger.
As a facility leader…
Create spaces where staff can routinely share gratitude. Finding things to be thankful for in challenging times builds resiliency, fosters connection, and increases team morale.
Examples:
- Facilitated time to thank one another during staff meetings
- Bulletin board where staff can post thank-you notes anonymously
- Host an employee-of-the-month lunch for staff to celebrate together
Sources:
- van Dernoot Lipsky, L. (2010). Trauma stewardship: An everyday guide to caring for self while caring for others
- https://www.ncbi.nlm.nih.gov/books/NBK207201/pdf/Bookshelf_NBK207201.pdf
- van Dernoot Lipsky, L. (2010). Trauma stewardship: An everyday guide to caring for self while caring for others
- https://www.ncbi.nlm.nih.gov/books/NBK207201/pdf/Bookshelf_NBK207201.pdf
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Contact us:
For more information, please call 1-844-314-1433 or email coeinfo@allianthealth.org.
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Alliant Health Solutions (AHS) was awarded a three-year cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with the Centers for Medicare & Medicaid Services (CMS), to create a COE-NF. AHS has over 50 years of experience working with nursing homes and behavioral health in nursing homes.
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This newsletter was made possible by grant number 1H79SM087155 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services Administration.
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