F699 Trauma-informed Care is one of the many areas with changes to the LTC Survey process effective October 24th — is your facility prepared?
According to SAMHSA – Substance Abuse and Mental Health Services Administration seventy percent of adults in the United States have experienced some type of trauma. Notably, there is a direct correlation between trauma and physical health.
Facilities must ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents’ experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident.
The following principles have been adapted from SAMHA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.
- Safety – Ensuring residents have a sense of emotional and physical safety.
- Trustworthiness and transparency – Efforts to establish a relationship based on trust and clear and open communication between the staff and the resident.
- Peer support and mutual self-help – If practicable, it may be appropriate to assist the resident in location and arranging to attend support groups which are organized by qualified professionals. It may be possible for the group to meet in the facility.
- Collaboration – There is an emphasis on partnering between residents and/or his or her representative, and all staff and disciplines involved in the resident’s care in developing the plan of care. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making.
- Empowerment, voice, and choice – Ensuring that resident’s choices and preferences are honored and that residents are empowered to be active participants in their care and decision-making, including recognition of, and building on residents’ strengths.
The best way to ensure residents’ needs are met is by a thorough assessment, care planning, and monitoring delivery of care and services.
You should use a multitude of approaches to identify a resident’s history of trauma and cultural preferences. Interview the resident or their caregivers to identify previous traumatic events and triggers as well as use screening and assessment tools such as the Resident Assessment Instrument (RAI), history and physical, and social history, and others. Proactive Medical Review has a Cultural Competency Tool Kit and a Trauma Informed Care Toolkit that offers PowerPoint slides, assessments, and “take away” handouts.
You should collaborate with residents, family, friends, and health care professionals to develop and implement person-centered interventions. In situations where a resident is reluctant to share their history, the facility is still responsible for trying to identify triggers and implementing interventions to minimize or eliminate the effect of the trigger on the resident.
Facilities must monitor the effects of their approaches to ensure they are implemented as intended and are effective in meeting the goals for care.
Ensure that your facility has systems in place to:
- Identify cultural preferences of residents who are trauma survivors
- Identify a resident’s history of trauma, and /or triggers that may cause re-traumatization
- Consistently use approaches that are culturally competent and/or are trauma-informed
During survey, other tags that can be cited for noncompliance related to trauma-informed care
- F656: For concerns related to development or implementation of culturally competent and/or trauma-informed care plan interventions
- F699: For concerns related to outcomes or potential outcomes to the resident related to culturally competent and /or trauma-informed care
- F726: For concerns related to the knowledge, competencies, or skill sets of nursing staff to provide care or services that are culturally competent and trauma-informed
- F742: For concerns related to treatment and services for residents with history of trauma and/or history of PTSD
In preparation for surveys after October 24th
- Review care plans to ensure interventions reflect the resident’s history of trauma. Does the care plan describe interventions for care that account for the resident’s experiences and preferences to eliminate or mitigate triggers?
- Review screening and assessment tools. Do the tools used assess for history of trauma and possible triggers?
- Review policy and procedures for trauma-informed care. Can staff report how to care for trauma victims?