Note: This is the second blog in our multi-part blog series on the CMS Requirements of Participation.

Individual trauma is an experience (or series of circumstances, events or occurrences) that an individual considers emotionally, physically or socially threatening or harmful and that has a long-term negative impact on the individual’s emotional, physical and/or social well-being. An event becomes traumatic when the ability to cope is overwhelmed.

It is estimated that during a typical lifetime, 51 percent of women experience at least one traumatic event, while 61 percent of men experience such an episode. Statistically speaking, the longer one lives, the more likely they will have experienced a traumatic event.  Progress is underway when the individual feels they have overcome an event. A repeat event, however, can move them back down in the continuum toward feeling overwhelmed.

Trauma-Informed Care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma Informed Care also emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.

The key elements of the Trauma-Informed Approach include the following strategies:

• Realize that trauma is prevalent
• Recognize that all individuals within an organization are affected by trauma
• Resist re-traumatization
• Respond to the risk through incorporating knowledge in practice

There are five key principles of the Trauma-Informed Care system:

• Safety: Keep residents (and staff) emotionally and physically safe
• Trustworthy: Make certain that tasks and boundaries are clear
• Choice: Offer control and choice as much as possible (the perception of control is as important as actual control)
• Collaborate: Build in opportunities for participation
• Empowerment: Assure residents and staff that they are empowered with decision-making and choices

When implementing Trauma-Informed Care, you will want to use phases such as: “What happened to you?”, “How can we help you?” and “Do you feel safe?”. When the resident is talking, be sure to listen, be curious, educate about the human response of fight, flight or freeze, offer coping strategies, and build strategies into the care plan. Comprehensive person-centered care planning should focus on quality of care as well as behavioral health services.

The Gold Standard for Trauma Informed Care Planning includes the following:

1. Care and service services that assist a resident to attain or maintain the highest practicable physical, mental and psychosocial well-being
2. A baseline care plan within 48 hours of admission which includes six specified elements
3. The addition of a nurse aide and food and nutrition representative to the ID team, charged with the responsibility of developing a comprehensive plan of care. This plan should reflect the resident’s strengths and weaknesses. The right to receive care should be outlined in the plan of care, and documentation should indicate if the resident/rep do not attend the care plan meeting
4. Discharge and transition in the care plan that is focused on the resident’s goals. This includes:
   1. Discharge planning requirements mandated by the IMPACT Act
   2. Reduce preventable hospital re-admissions
   3. Effective transitions
   4. Discharge summary
   5. Medication reconciliation of all pre-discharge meds with post-discharge meds
5. The facility should, in collaboration with the resident and resident representative, document in the care plan the patient’s goals for admission and desired outcomes. Patient preferences for discharge and the desire to return to the community will need to be documented in the care planning process.

The deadline for the implementation of Trauma-Informed Care Planning is Nov. 28, 2019. You should ensure that that staff responsible for this have the education they need in order to be effective in completing their task and ultimately improving the quality of life for your residents.

Do you have questions about trauma-informed care, Phase 3 Requirements of Participation or other clinical challenges? Call Richter’s clinical education consultants  at 866-806-0799 to schedule a free consultation.