Trauma-informed care integral to quality care

In a highly diverse sector like aged care, it is likely your facilities, services or organisations will come across older clients or aged care workers who have experienced traumatic events.

Many older Australians and their carers have been impacted by trauma in some capacity in their life and felt its impacts on their wellbeing and mental health.

Special needs groups like members of the Stolen Generation, care leavers who experienced institutionalised care as a child, and older people from migrant backgrounds need to have their traumas considered when providing them care. 

Similarly, aged care workers may also be a part of these special needs groups or have experienced trauma within the workplace by being assaulted by clients or being the target of bullying amongst staff which can cause them to live with the effects for years afterwards.

This is why it is essential for providers to understand how to accommodate the effects of trauma for both staff and residents through support and education – a factor that was recognised by the Royal Commission into Aged Care Quality and Safety. 

So how do you move towards a trauma-informed care approach in your organisation?

Caring with trauma in mind

Trauma-informed care involves having the complete picture of someone, their past and present, and taking that into consideration when it comes to caring for them.

It should be an organisational approach that is interwoven at all levels so all staff know how to deal with trauma and the behaviours it presents in people.

Trauma-informed care does not mean pressuring people into speaking about the details of their trauma, nor is it considered a form of counselling or treatment for trauma. 

Trauma-informed care principles

The four trauma-informed care principles you should work to address when supporting clients or staff are:

• Understanding the effects of trauma
• Promoting safety and trust
• Providing choice and control
• Building connections, focusing on strengths and promoting quality of life

Providers should foster a trusting relationship between aged care workers and their clients so older people feel comfortable expressing their feelings and preferences, giving them a sense of control over their care, according to Phoenix Australia, Australia’s National Centre of Excellence in Posttraumatic Mental Health.

“Trauma-informed care helps us understand why people behave the way they do,” said, Anne-Laure Couineau, Phoenix Australia’s Director, Policy & Service Development. 

“Some older people may be a bit more vulnerable, agitated or aggressive when entering aged care and often that is because they’re feeling distressed, not because they’re being difficult.”

Common Signs of effects of trauma in patients

There are some common signs an older person is experiencing the effects of trauma, including:

• Displays of heightened emotions, including distress and anger
• Are agitated, wound up, sad, withdrawn or mistrustful
• Disengaged or withholding information
• Refusing care or food
• Not engaging in group activities
• Disorganised in their thinking
• Having difficulty remembering what they are told or filling out a simple form
• Having difficulty interacting with staff and other older people

In order to properly support aged care workers to care for clients who have experienced trauma, it is important to change how your organisation views trauma and the behaviours surrounding it.

Trauma should not be seen as a “challenge” or “problem”, but instead something you should make space for and allow staff to talk about solutions for some of these behaviours.

Taurma-informed care approach

Some other ways you can move towards a trauma-informed care approach include:

• Appropriate staff training about trauma and its impact
• Encourage aged care workers to ask permission of clients before they touch them, introduce themselves and explain what they will do before providing care to avoid triggers
• Employ bilingual staff and interpreters for people of culturally or linguistically diverse (CALD) backgrounds 
• Encourage socialisation among care staff and aged care clients
• Support staff to report elder abuse 

Caring for carers 

While it is important to have trauma-informed care at the forefront when looking after your older clients, supporting the staff who are directly implementing this practice is equally important.

The work done by aged care workers is often confronting and challenging, both mentally and physically. 

Adequately supporting staff to handle traumatic events they experience inside the workplace and allowing room for them to practise self-care are just some of the ways to show understanding and compassion to your staff.

Everyone has their own way of coping with trauma and it can look different depending on the person, so showing this type of tolerance and understanding towards staff allows them to feel supported while they provide vital care services for older people. 

Some common signs of trauma in staff can include:

• A higher number of absent days or extended periods of leave
• Signs of burnout or compassion fatigue or a lack of interest in work 
• Overly negative worldview
• Taking on too much
• Poor decision-making
• Not meeting commitments

“[Staff] need to feel emotionally and physically safe too for them to be able to support older people. If they feel they are being supported, they are much more likely to be responsive to the needs of older people,” Ms Couineau explained.

Support for staff

To support staff in performing trauma-informed care while also having their own instances with trauma be respected, providers should:

• Ensure that you (or direct supervisors who work under you) have the training to identify staff who are not coping, support safe disclosure of trauma and talk to staff who are not coping or have wellbeing issues
• Regularly discuss the importance of self-care
• Create opportunities for staff to discuss their wellbeing
• Ensure staff have the information they need to access support through a designed Employee Assistance Program

If your staff are able to feel supported by your organisation, you will reduce your likelihood of staff issues, improve workplace culture, and see a return in quality care.

Resources to help

Knowing the trauma-informed care essentials for staff is vital to help you refine your thinking around your workplace and trauma, and ensure you can then address key elements of trauma-informed care when delivering services to older Australians.

Phoenix Australia’s checklist for residential aged care providers outlines what you should consider when formulating and implementing strategies, policies and practices at your facilities in relation to trauma-informed care.

You should take note of whether your facility or organisation has achieved or implemented each of these principles, is in the process of implementing them, or needs to address them on your checklist as areas to improve on.

Providers can access a “how-to” guide on trauma-informed care to help look after their clients who have experienced trauma and properly support their carers who look after them.

For more resources about trauma-informed care, visit the Phoenix Australia website. 

Do you use trauma-informed care practices in your organisation? Let us know in the comments below.