In This Issue

• National Post-Traumatic Stress Disorder Awareness Month
• Health and Human Services Office of Inspector General Report Highlights
• Nursing Facility Guidance: Trauma Informed Care F-Tag 699
• SME Article: Symptomatology of Post-Traumatic Stress Disorder
• COE-NF Resources
  • Understanding Post-Traumatic Stress Disorder
  • Trauma-Informed Care Bite-sized Learning
  • Introduction to Creating a Trauma-Informed Culture in Post-Acute and Long-Term Care Facilities Part 1
• Columbia Protocol – Suicide Prevention
• Did You Know?
• Save the Date: Upcoming Trainings
• You Matter – Social Wellness

June is National Post-Traumatic Stress Disorder Awareness Month, a time to spread awareness of effective Post-Traumatic Stress Disorder (PTSD) treatment.

PTSD is a brain disorder that some people develop after experiencing or witnessing a terrifying, traumatic event. To be at risk for PTSD, the trauma must be a shocking and dangerous event that the person sees or that happens to them. During this type of event, the person thinks that their life or others' lives are in danger.

Most people associate PTSD with veterans of war, but anyone can experience PTSD. Some common examples of traumatic events include:

• Natural disasters
• Serious accidents
• Witnessing a traumatic event
• Mass violence
• Assault/Abuse
• Historical trauma
• Intimate partner violence
• Bullying
• Pandemic

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear, or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch, according to the American Psychiatric Association.

Supporting Residents with PTSD
Once a qualified clinician confirms a PTSD diagnosis, collaborate with the resident and their family to provide education about the disorder, gain insight on known triggers, and identify effective strategies to manage their symptoms. Include the strategies in the resident care plan and communicate them to the team. 

Getting Started

1. Pledge to raise awareness about the prevalence of PTSD.
2. Partner for training with COE-NF to educate your team.
3. Share COE-NF resources on PTSD in your team meeting.
4. Participate in PTSD Screening Day on June 27 by helping residents take a PTSD self-screen.
5. Connect residents with health care providers who can talk to them about their screening results and treatment options.

Find treatment through the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locators and helplines. These services are often free, confidential, anonymous, and available 24/7.

Nursing Home Residents with Endangering Behaviors and Mental Health Disorders May Be Vulnerable to Facility-Initiated Discharges

Why Was This Review Done? 

• Facility-initiated discharges that do not follow federal regulations can be unsafe and traumatic, leading to resident harm.  
• Centers for Medicare and Medicare Services (CMS) and state long-term care ombudsmen have raised concerns about the extent to which nursing homes follow federal requirements for these discharges.  
• This review provides insights into a sample of facility-initiated discharges from nursing homes.

What Was Found?

• Nursing homes discharged 72 of the 126 residents in the HHS review because of behaviors that endangered them or others in a facility. In most cases, the residents exhibited aggressive or violent behaviors. 
• Prior to discharging these residents, nursing homes most commonly tried changing medications and counseling. 
• Residents discharged due to behavior shared some characteristics, such as a mental health disorder and admission for long-term versus short-term care. 
• Lastly, most residents in the HHS review were discharged to acute-care hospitals, and 10 residents were discharged to an unknown location, a nonspecific location, or a hotel. 

What Did The Office of Inspector General Conclude?
The findings highlight the challenges nursing homes face in caring for residents with mental health disorders and raise questions about nursing homes’ admissions and capacities to care for them. 

More research is needed on how to provide safe and effective long-term care for residents with mental health disorders and behaviors, especially as the demand for such care grows. To that end, the COE-NF, established by SAMHSA in partnership with CMS, holds promise.

F699 in the State Operations Manual (SOM) Appendix PP states that the facility must ensure that trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents’ experiences and preferences to eliminate or mitigate triggers that may cause re-traumatization.

This requirement aims to meet professional standards and ensure facilities deliver care and services using culturally competent approaches that account for experiences and preferences. The aim is to address the needs of trauma survivors by minimizing triggers and/or re-traumatization, thereby enhancing the quality of care provided.

Per the SOM, nursing homes are required to provide culturally competent care due to the increasingly diverse demographics among nursing home residents. Cultural competency, which includes language and cultural preferences and other cultural aspects such as thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups, is an important aspect of person-centered care. These elements influence the beliefs surrounding health, healing, wellness, and the delivery of health services and are critical to reducing health disparities.

Trigger-specific interventions should identify ways to decrease the resident’s exposure to triggers that re-traumatize the resident and mitigate or decrease the trigger's effect on the resident.

What You Can Do Today
Trauma-informed care starts with learning and understanding a resident’s lived experiences. Nursing facilities can use SAMHSA’s Six Guiding Principles to support an environment that promotes quality of care, safety, and well-being for each resident.

The six key principles of a trauma-informed care approach include:

1. Safety: Ensure that all residents feel emotionally and physically secure.
2. Trustworthiness and Transparency: To nurture meaningful relationships, build a strong foundation of trust, and foster open, honest communication between staff and residents.
3. Peer Support: Coordinate peer support and mutual self-help to help the resident discover the benefits of attending support groups led by qualified professionals. If possible, the group could convene in the facility.
4. Collaboration and Mutuality: Recognize the importance of partnership between residents, their representatives, and all care staff in creating the care plan, emphasizing the healing power of relationships and meaningful decision-making.
5. Empowerment, Voice, and Choice: Honor residents' choices and preferences and empower them to actively participate in their care and decision-making while recognizing and building on their strengths.
6. Cultural, Historical, and Gender Issues: Value cultural and gender differences and recognize and address historical trauma.

The COE-NF developed a flyer to use as a daily reminder of ways staff can take a trauma-informed approach. <a href="https://engage.allianthealth.org/SixPrincipals">Download Flyer</a>

New Research Articles: Keeping you up to date with the latest research, advancements, and best practices in managing and addressing behavioral health conditions in nursing facilities.

The root cause of PTSD is the experience of a situation that violates a person’s core sense of safety and well-being. While the common image of PTSD is combat, it can be any event that is perceived as dangerous or life-threatening. Being in a car crash, suffering abuse as a child, witnessing the loss of a loved one, and other events can result in PTSD for anyone. Even vicarious trauma from helping others with trauma can trigger PTSD. 

While most people respond to traumatic events with a decrease in functioning, those who develop PTSD experience a lasting impact. This often is a direct result of the individual being unable to deal with the experience. Neurological studies show that some people with PTSD have a brain state that is persistently similar to the Fight Flight or Freeze response, meaning parts of their brains are not communicating effectively to process the event. 

Symptoms often begin within a few months of the event but can emerge much later. The symptoms fall into the following categories: Re-experiencing, Avoidance, Arousal, and Cognition. 

• Re-experiencing symptoms include things such as flashbacks, intrusive thoughts or memories, dreams, and physical symptoms that match the time incident. 
• Avoidance includes staying away from events, places or objects that can be reminders. Often, this results in restrictions on activities that can worsen over time. 
• Arousal symptoms include being easily startled, hypervigilance, agitation, a short temper, loss of sleep, and poor concentration.
• Cognition can range from gaps in memory of the event, loss of sense of safety, increased blame on self or others, and depression. All these things can be triggered through unconnected events. 

Reference: National Institute of Mental Health
Article written by Bryan Stephens, LPC

The COE-NF developed the following resource that nursing facilities can use to educate the team about behavioral health conditions.

Understanding Post-Traumatic Stress Disorder
This resource provides an overview of post-traumatic stress disorder, its causes, symptoms, and treatment options. Download Flyer

Trauma-Informed Care Bite-sized Learning
Explore the keys to creating a trauma-informed approach in nursing facilities. Watch Video

Introduction to Creating a Trauma-Informed Culture in Post-Acute and Long-Term Care Facilities Part 1
This is an introduction to key components that support staff can use to integrate trauma-informed approaches in facility operations and all resident interactions. View Recording and Slides

Six simple questions from the Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), can be used to identify whether a resident is at risk for suicide. The scale was created by the Columbia Lighthouse Project.

Join our upcoming training on Wednesday, June 12th - Building A Better Suicide Risk Assessment: The Nuts and Bolts of the Columbia Protocol C-SSRS - to learn how to utilize the tool. 

According to the National Council for Mental Wellbeing, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That’s 223.4 million people.

There are many people around the world who suffer from depression, anxiety and other mental illnesses. According to a study published by the National Institutes of Health (NIH), 65% to 90% of nursing home residents have a mental disorder ranging from common mental health problems such as anxiety and depression to serious mental illnesses (SMI) like schizophrenia and bipolar disorder. This session will introduce SMI, an understanding of SMI, and how using a five-step model for care is effective in assisting staff in supporting residents when a serious mental illness is diagnosed.

Learning objectives:

• Define serious mental illness and list the four major categories of SMI. 
• Describe the differences between SMI and dementia and note misperceptions about SMI.
• Describe the recovery model and list the five steps in the CARES Approach for SMI care.

• Explain the concepts of historical, race-based, and intergenerational trauma.
• Consider the intergenerational and historical trauma experiences of Black, Latinx, and Native Americans. 
• Discuss how the biology of trauma can negatively impact trust in caregivers.

• Distinguish between substance use, misuse, and substance use disorder.
• Recognize the signs and symptoms of possible substance use.
• Describe how recovery-oriented language can engage and support people with SUDs.

• Define and discuss common mental health disorders in nursing facilities.   
• Discuss causes contributing to the onset or exacerbation of symptoms.   
• Provide awareness of suicide prevention.  
• Identify helpful de-escalation strategies nursing home staff can use to support residents with mental health conditions. 

• Define substance use misuse, use, and co-occurring disorders. 
• Explore prevalence and trends in co-occurring disorders among nursing facility residents.
• Understand risk factors and common presentations of co-occurring disorders in nursing facility residents.

In the fast-paced and demanding world of nursing facilities, where the focus is caring for others, the crucial act of self-care for yourself is often overlooked.  Self-care means taking the time to enjoy things and activities that will improve your physical and mental health. Here are a few self-care activities you can start today:

• Take a walk
• Listen to relaxing music
• Start a gratitude journal

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