Trauma-Informed Care Toolkit

Consider infection prevention and control as a metaphor for approaching trauma-informed care implementation. It's often difficult to identify where germs and pathogens come from, and we won't be able to completely eradicate exposure to bacteria and viruses that can cause illnesses. However, we know it is in everyone's best interests to act toward prevention and control. 

Ask yourself this question: In a nursing home environment, whose job is it to carry out infection prevention and control practices (IPC)? Your answer was likely: EVERYONE has a role to play in IPC! Everyone has a role to play in trauma-informed practices, as well. 

Implementing trauma or adverse life events screening can be a helpful step. There are varying approaches to how, when, and why to screen and assess for trauma among nursing home residents. Your trauma-informed leadership team will likely want to research and reflect on these approaches before making a recommendation, as they will play a crucial role in TIC implementation. 

One approach is to universally screen all residents for trauma (or their family members, when appropriate) upon admission. An advantage to this approach is that screening can normalize talking about adversity and signal to residents and their families that it is okay to talk about bad things that have happened in life and that asking for support is healthy. Screening can also help staff better understand new residents and better understand the larger NF community. A disadvantage is that some people may react adversely to being asked about the past. Also, be aware that cultures vary widely in how these types of questions are viewed. Additionally, before implementing any screening protocol, consider what support your facility can provide, how you will protect residents’ privacy, and how staff will be trained and educated to respond in a person-centered, trauma-informed way.

Before you begin gathering screening information, you’ll want to decide what next steps you might take as an organization. These secondary steps can evolve as you learn from your screening experiences. Begin by asking your team:

• How will the information be documented in the care plan?
• What supports and services will we offer?
• Who needs to know?
• What degree of detail do they need to know?
• How will this information be shared?

For example, upon screening you learn that Mrs. A. experienced sexually abuse as a child. When you ask what helps her to feel safe and supported, Mrs. A. answers that she has slept with a light on in her room for her entire life. How will you document the care plan, provide her with a night light, and protect her privacy?

Like person-centered care, trauma-informed care is a strengths-based approach. Trauma-informed approaches are concerned with avoiding triggers and re-traumatization and are equally as concerned with recovery, resilience, and well-being. As you are considering trauma screening and assessment, think also about how your facility approaches asking questions about resilience, strength, and protective factors. The best time to learn how to support someone who is in overload or distress is to ask them while they are calm and engaged. The types of questions you could ask at admissions to discover residents’ strengths and protective factors could include:

• When you get overwhelmed or feel upset, what helps you to feel better?
• If you were to feel upset or in distress in the future, what are some ways we could support you?
• Describe a perfect day; what would you do, who would you see?
• What people, places, and things are most important to you?
• What do the people who love you like most about you?

For residents with dementia, adapting these questions and approaches is crucial. For example, asking about their past routines or significant life events can provide insights into what might help them feel secure and supported. Questions can be stated and framed in a way that respects their cognitive limitations while still seeking to understand their strengths and protective factors. Examples include:

• What activities did you enjoy doing in the past?
• Are there any specific routines or rituals that bring you comfort?
• Who were some important people in your life, and what memories do you have with them?

Integrating DEIB principles into trauma-informed care involves recognizing and respecting the cultural differences in how residents express and cope with trauma. This includes asking culturally sensitive questions and understanding that resilience and protective factors may vary greatly among different cultural groups. For example, understanding the role of family, community, and spiritual practices in a resident’s life can provide valuable insights into their strengths and needs. Culturally competent questions might include:

• Are there any cultural or religious practices that are important to you?
• How does your cultural background influence your daily life and well-being?
• Are there any specific cultural foods, music, or activities that bring you joy or comfort?

Because trauma-informed care in long-term care is still emerging, we have the opportunity to draw from other sectors that have tried and tested different approaches. One practice that originated from person-centered planning with people with developmental disabilities is called a one-page profile, or person-centered profile. A similar practice evolved through trauma-informed care called a comfort card. These are tactile, physical cards that are created with and by the people we serve to help care partners learn about who they are. This approach invites residents to tell their stories in their voices and direct how they would like their lives and their care to unfold. Once created, the cards can be decorated, laminated, and stay with a resident on their door, for example. 

Learn more about this approach at The Learning Center for Person-Centered Practices, The PACER Center, FACT Oregon, and Helen Sanderson Associates.

Here is a sampling of screening and assessment tools that may be helpful as you consider the role of screening in your facility. For a more complete listing and explanation of assessments, screeners, and interview guides related to trauma, visit the VA’s National Center for PTSD.