Add ACE Information to Your Preparation for Trauma-Informed Care

Mary Madison, RN, RAC-CT,
Clinical Consultant – Briggs Healthcare

We’re all working to provide trauma-informed care to residents in our facilities.  We’re also cognizant of the effect trauma may have on our staff.  Trauma-informed care doesn’t happen overnight – it’s a process of understanding what trauma is, identifying residents and working to eliminate or mitigate triggers that could cause re-traumatization.   Here’s what F699 requires of LTC facilities:


As of this writing, we have no interpretive guidance for how to specifically proceed with this regulation.  We do have a Critical Element Pathway – CMS-20067 that speaks to how surveyors will determine compliance with F699 as well as other related tags such as F742 and F743.  We can use that CE Pathway to audit our own compliance as we wait for the updated Appendix PP of the State Operations Manual (SOM) to be posted online by CMS.  That updated Appendix should provide interpretive guidance for F699 as well as other Phase 3 RoPs (Requirements of Participation) in addition to additions and clarifications for other regulations.

Earlier this week, I found an email from CDC Vitals Signs in my inbox.  I subscribe to CDC mailings and read each one carefully as there is always great clinical information in them.  This one really caught my eye and the timing was perfect for the trauma-informed care regulation that is being implemented on Thanksgiving Day.  This CDC Vital Signs issue addresses ACEs or Adverse Childhood Experiences.  We typically don’t have children in our facilities but look at the bigger picture: identifying and preventing adverse childhood experiences has a lot to do with the adults we now and will care for.

Consider these statistics:

  • 1 in 6 adults have experienced 4 or more types of ACEs
  • At least 5 of the top 10 leading causes of death are associated with ACEs
  • Preventing ACEs could decrease the number of adults with depression by as much as 44%

These numbers are staggering and sobering.  Take a look at this Fact Sheet as well.  We have adults in our facilities that were once children and bring with them, on admission, all of their life events including trauma.  Some of those traumatic events may have been shared with others while many have not.  The generation we’re caring for now often kept such things to themselves, for many reasons.  Understanding more about ACEs will, in my humble opinion, provide us with the insight and information we need as we screen our residents for potential traumatic experiences and institute processes, measures and care plans to avoid re-traumatization.  I believe it will also help us to identify and care for the caregivers/staff in our facilities that have also experienced trauma and do what we can to make it a safe environment for all that live and work in the building.

I encourage all healthcare providers to review this information – you’ll need it in your practice.  There is a lot we can do to help the adults under our care in addition to F699 by making the appropriate referrals to mental health professionals and working in our communities to spread awareness of the devastating effects of ACEs.

I also recommend these resources to learn more about trauma-informed care:

We have a lot to learn about trauma and its effects on the individuals we care for and the individuals that provide care in our facilities. Take the time to learn more.