First, Do No Harm

October 03, 2019

Photo by Dominik Lange on Unsplash

Dr. Eleanor Feldman Barbera’s article in McKnights, “What worries me about trauma-informed care,” raises key concerns about implementation of the Phase 3 CMS mandates for nursing homes, and is a must-read as we seek to do the right thing in meeting the mandate and, more importantly, caring well for our Elders and their care partners.

Having specialized in trauma care for Elders and as an Educator and Mentor for The Eden Alternative®, I want to reinforce Dr. Barbera’s concerns and add some brief thoughts of my own about how we might embrace trauma-informed care more safely, and with integrity.

The list of ills that rightly keep Dr. Barbera up at night can and will cause more pain and suffering, if we think of trauma-informed care as screening instruments and treatment alone.

We need to understand Trauma-Informed Care (TIC) as culture change.

TIC is a philosophy and mindset that requires the soil of a person-directed care environment to grow and thrive. Without a shift in heart, an open mind, empowered teams, and care partnerships where people can become deeply known and trust can grow, trauma-informed care will never take root, and implementation will create more trauma.

You can’t be trauma-informed, if you’re not practicing person directed care.

I’d also like to remind our community of one of our greatest hidden resources, and urge you to find a way to harness the power of your social workers.

Professional social workers are prepared by training and philosophy to collaborate in interdisciplinary teams, provide person-directed behavioral health services, design and facilitate group programs, and offer staff education.

Social workers are uniquely suited to support Elders, family, and staff at the intersection of the individual and their environment, and to support transitions at all levels of the organization.

Still, this professional is underutilized in the nursing home setting.

We can avoid the perils listed in this article by recognizing how important it is that the whole organization transform the culture of care to one that shifts awareness (and practice) to person-directed, trauma informed, and culturally competent care.

This must be the standard. If we’re truly practicing person-directed care and undertake the journey to become informed about trauma, AND we integrate behavioral health professionals, such as psychologists and social workers into our teams, we will dramatically lessen the chances of causing harm, and greatly increase opportunities to heal.

Read the McKnight’s article, “What Worries Me About Trauma-Informed Care”.

Lisa Kendall is a social work psychotherapist and clinical gerontologist who speaks and consults on trauma-informed care. Hear her speak on trauma-informed care implementation at the 2020 Eden Alternative Conference in Denver, and contact her at

2 Comments. Leave new

Really appreciated your thoughts on all the potential consequences of asking about trauma in aged care settings.


Thanks so much for tuning in, to this issue and to the needs of folks who may be living with trauma. While it’s important that we know how to support people who may be dealing with specific issues, our first priority is to create a safe setting, where trust can develop.


Leave a Reply