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UNIVERSAL PRECAUTIONS for Trauma Informed Care
Losing Skills/Independence
Injury
Loss of Loved One Death of a Pet
SURGERY
Prison
Abandonment
War
Terrorism
CrimeCAR ACCIDENT
BULLYING
Unemployment
Natural Disaster
Divorce
Bankruptcy
SCHOOL VIOLENCE
Number your 6 favorite things
When IMPORTANT THINGS are impacted by CHANCE not choice.
First Roll = Flip it Over
Second Roll & Third Roll = Crumble it Up
“GOOD NEWS” – If you work really hard,You might get this important thing back.
“BAD NEWS” – No matter how hard you try, you CANNOT get these important things back.
Facing New
Reality
Healthcare settings can cause distress, especially for people with trauma experiences:
Moving to a Nursing Home has Emotional Impact
- Invasive Procedures: “WHY ARE YOU TOUCHING ME LIKE THAT?”
- Removal of Clothing: “I am embarrassed… Please don’t hurt me.”
- Physical Touch: “You are being rough, uncaring… What did I do?”
- Personal questions that may be embarrassing or distressing
- Power dynamics of patient/caregiver/provider relationship
- Gender relationships
- Vulnerability of “patient”
- Loss of Privacy
Source: Kathleen T Grimm, MD MHSc UB
- Restraints- Caregiver checks at night- Medication side effects- Witnessing another person being restrained or dying- Power differential with medical provider “orders”- Caregivers providing, “ordered treatment”- Fire Alarm/Drill
Examples of interventions in a healthcare
setting can potentially trigger a person
who has experienced trauma:
Think About the Commonalities…
Physical/Sexual Abuse
• Abuser separates them from others in a punitive way and to keep them dependent on them.
• Forced action taken on the part of the perpetrator.
• The perpetrator being the opposite sex as the person.
• Psychological manipulation on the part of the perpetrator to decrease chances of abuse being reported or believed.
Care in a Nursing Home Facility
• Isolation/seclusion as a response to “inappropriate” behavior.
• Restraints as an intervention to manage unwanted behavior.
• Care occurring with staff of the opposite sex while client may be in a distressed state.
• Reports of abuse not believed, investigated or retaliated against.
Adapted from: Susan A Green, LCSW UB
Treat individuals with care that accounts for trauma that has likely happened in their lives.
Just as you would treat all biological fluids as if they were
contagious.
How to Create a Safe Environment that Promotes Healing
and Lowers the Chances of Re-Traumatization
MCH utilizes a comprehensive person-centered process for assessing and understanding an individual’s mental, emotional, and psychosocial well-being to create care plans that not only reflect how that person currently thinks and feels, but also take into account their history, experiences, preferences, and goals.
The people living at MCH who have experienced trauma will receive culturally-competent, trauma-informed care accounting for individual experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization.
UNIVERSAL PRECAUTIONS: Safety & Privacy
- What makes them feel safe?
- What makes them feel vulnerable?
- Do they know how to call for help?
- Do we need better lighting or blue phones in some locations?
- Does everyone knock before entering & wait for permission to open the door?
- Will the behaviors of other residents remind them of an abuser or traumatic event?
- Do our residents receive clear messages about their rights? We need to establish ways to maintain safety and protect privacy.
- Be mindful of overall volume/noise.
UNIVERSAL PRECAUTIONS: Collaboration
We do not inform a person of their plan – It is their plan – We involve them in the process to develop their plan. Nothing about them without them.
UNIVERSAL PRECAUTIONS:Trustworthiness
Cultivate a closeness and sense of trust, while maintaining interpersonal professional boundaries. Relationships have to be one-sided in that we cannot
share our burdens or worries with someone we are assigned to care for.
UNIVERSAL PRECAUTIONS: Sense of ControlBeing person-centered means that the person’s goals and preferences set the tone for EVERYTHING.
As much as possible, they should have control over their lives and have choices:
- Bed and Bath Times- Menu/Food Items- Personal Clothing- Visitors and Visitation
Hours- Going on Pass- Religious Participation- Participation in Resident
Council and Community Meetings
An autistic woman vs.A woman with Autism
UNIVERSAL PRECAUTIONS: Empowerment
Instead of thinking, “What do I need to do for them” try…
UNIVERSAL PRECAUTIONS SUMMARY
• The setting and our approach make the individual feel safe.
• The individual’s privacy is respected, a trusting partnership is created.
• The individual’s strengths are recognized.
• The individual is supported in shared decision-making, choice, and
goal setting to determine the plan of action.
• The individual is empowered and self-advocacy skills are fostered.
• Staff are facilitators of recovery rather than controllers of recovery
Heather M. Burroughs, MS Crystol Mihaly, LMSW
Therapeutic Program Coordinator Director of Social Work