The Role Of The Trauma Social Worker

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This is a presentation that I give to medical professionals educating them on the role and potential use of social work in the hospital setting. I presented this on May 22, 2009 to the Trauma Education & Research Committee.

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  • There are specific words and phrases we look for when talking with the patient to establish their readiness for change.
  • Physical: Fatigue, thirst, headaches, visual difficulties, vomiting, grinding of teeth, weakness, dizziness, profuse sweating, chills, rapid heart rate, nausea, muscle tremors, twitches, chest pains, difficulty breathing, elevated blood pressure, shock symptoms (fainting, etc)Cognitive: blaming someone, confusion, poor attention, poor decision-making, heightened or lowered alertness, poor concentration, memory problems, hyper-vigilance, difficulty identifying familiar objects/people, increased or decreased awareness of surroundings, poor problem solving, poor abstract thinking, loss of time, place, or person orientation, disturbed thinking, nightmares, intrusive imagesEmotional: anxiety, guilt, grief, denial, severe panic (rare), emotional shock, fear, uncertainty, loss of emotional control, depression, inappropriate emotional response, apprehension, feeling overwhelmed, intense anger, irritability, agitationBehavioral: Change in activity, change in speech patterns, withdrawal, emotional outbursts, suspiciousness, change in usual communications, loss or increase of appetite, alcohol consumption, inability to rest, antisocial acts, nonspecific bodily complaints, hyper-alertness to environment, intensification of startle reflex, pacing, erratic movements, change in sexual functioning
  • Everyone is different and requires different levels and styles of support while in the acute care setting.
  • When a patient is looking like they are not going to make it, this is an extremely stressful time for the patient’s family and friends. The trauma social worker (TSW) can help alleviate the stress from the bedside nurse. TSW is trained in crisis intervention and can provide support. Also, if there is some discussion about whether or not to make the decision to remove life support, TSW can be a good facilitator during the discussion between the physician and the family.
  • Physical health problems are rather obvious: cuts, welts, broken bones, etc. However, emotional health problems can be more vague and sometimes more detrimental to the woman (or man). Low self esteem, prolonged periods of stress, and constant worry cause fatigue, GI problems, heart problems, weight loss/gain, unexplained pain, etc.
  • The Role Of The Trauma Social Worker

    1. 1. Jennifer R. Ayers, LMSW<br />Trauma Social Worker<br />Scott & White Trauma services<br />The Role of the Trauma Social Worker<br />
    2. 2. Overview<br /><ul><li>Screening & Brief Intervention (SBI) for Alcohol & Drug Use
    3. 3. General Assessment & Intervention for Trauma Patients
    4. 4. Domestic Violence Task Force & Disaster Behavioral Health Committee</li></li></ul><li>Teamwork<br /><ul><li>Trauma Team includes:
    5. 5. Trauma Nurse Coordinators
    6. 6. Physicians (Medical Director, Staff Physicians, Residents, Interns, Medical Students)
    7. 7. Bedside & ICU Nurses
    8. 8. Registered Dietician
    9. 9. Trauma Registrars
    10. 10. Trauma Performance Improvement Specialist
    11. 11. Support Staff ( Health Unit Coordinators, food service, etc)
    12. 12. Patients & Families!!</li></li></ul><li>“You cannot teach a man anything; you can only help him to find it within himself.” ~Galileo<br />Part 1: Screening & Brief Intervention (SBI)<br />
    13. 13. Screening & Brief Intervention (SBI) for Alcohol Use<br /><ul><li>Purpose: To identify at-risk/high-risk drinkers upon admission to Scott & White Trauma Center; then providing support and/or motivation for change in drinking behaviors
    14. 14. This does NOT necessarily mean referral to a treatment program</li></li></ul><li>Why is this important?<br /><ul><li>Alcohol is involved in half of treated injuries (Treno, 1997, Cherpitel, 1993, 1999)
    15. 15. Intoxicated patients are 2.5 times more likely to be readmitted for injury in two year follow-up (Rivara 1993)
    16. 16. Problem drinkers average 4 times as many days in the hospital as non-drinkers mostly due to alcohol related injuries</li></li></ul><li>
    17. 17. Severity of Alcohol Problems<br />Dependent drinking/Alcoholism<br />SBI<br />Harmful drinking/Abuse<br />Risky/Hazardous drinking<br /> Safe drinking<br />Screen<br />Abstinent<br />
    18. 18. The Screening Tool<br /><ul><li>Multidisciplinary Approach to Reduce Injury and Alcohol/Drug Use in Trauma Patients (MARIA)
    19. 19. Dr. Craig A. Field, Ph.D., M.P.H. </li></ul> Associate Professor, University of Texas at Austin School of Social Work, <br /> Program Director of the Behavioral Health Services at University Medical Center at Brackenridge<br /><ul><li>Exclusion criteria: <14 years old, >65 years old, or their GCS is below 14
    20. 20. Reasoning: Patient needs to be able to participate in the process; kids and the elderly are less likely to have alcohol/drug problems
    21. 21. Target Population: Young people 18-34 years, high risk drinkers</li></li></ul><li>MARIA SCREEN MARIA SCREEN<br />Multidisciplinary Approach to Reduce Injury and Alcohol/Drug Use in Trauma Patients<br />MARIA<br />Multidisciplinary Approach to Reduce Injury and Alcohol/Drug Use in Trauma Patients<br />
    22. 22. MARIA continued<br />Comments: _______________________________________________________________________________________________<br />__________________________________________________________________________________________________________<br />__________________________________________________________________________________________________________<br />Clinician Signature: __________________________________________ Date: __________________ Time: _______________<br />
    23. 23. “Standard Drink”<br />
    24. 24. Readiness to Change Among Injured Patients<br />Precontemplation = Never<br />Contemplation = Maybe<br />Preparation = Soon<br />Action = Now <br />
    25. 25. Style Matters<br />Pt A<br />Pt C<br />Pt B<br />Not Ready Unsure Ready<br /> 1 10<br />Each patient moves around within their range of readiness…<br />How you talk to them can bring out their “best side” or “worst side.”<br />
    26. 26. Brief Intervention<br /><ul><li>After establishing readiness for change, then we can move to the intervention
    27. 27. Creating a partnership for change, not authoritative prescription
    28. 28. Use of motivational interviewing techniques to inspire change or to introduce the idea of change in drinking behaviors</li></li></ul><li>Studies of BI in other medical settings<br /><ul><li>Bien et al. (Addiction 1993)
    29. 29. 32 trials of BI in 14 nations reviewed
    30. 30. BI is more effective than no counseling, and often as effective as more extensive treatment
    31. 31. Wilk et al. (J Gen Intern Med 1997)
    32. 32. 12 RCTs of BI reviewed
    33. 33. odds ratio 1.9 (95% CI 1.61-2.27) in favor of BI
    34. 34. D’Onofrio & Degutis (Acad Emerg Med 2002)
    35. 35. 39 clinical trials reviewed
    36. 36. 32 studies found positive effects for BI</li></li></ul><li>Drug Use<br /><ul><li>Assess for dependence
    37. 37. Brief intervention
    38. 38. May require more formal referrals to further psychiatric treatment</li></li></ul><li>“People only see what they are prepared to see.”<br /> ~Ralph waldo Emerson<br />Part 2: Assessing Trauma Patients & Families<br />
    39. 39. Critical Incident Stress Intervention<br /><ul><li>Intervention provided after a traumatic event (e.g. MVC, MCC, stabbing, shooting); shown to reduce psychological problems down the road
    40. 40. People respond differently to each situation
    41. 41. Physical, cognitive, emotional, and behavioral effects
    42. 42. Crisis resolution </li></li></ul><li>Suicide<br /><ul><li>Initial evaluation
    43. 43. Assess for coping skills, intention, etc
    44. 44. Coordinate with psychiatry for follow up if inpatient treatment is not recommended
    45. 45. In the works: Suicide prevention program in conjunction with Injury Prevention</li></li></ul><li>Coping with Life Changes<br /><ul><li>Assess for acute psychosocial support needs
    46. 46. Identifying coping skills used in the past
    47. 47. Provide support as requested by the patient and/or family</li></li></ul><li>Grief & Loss<br /><ul><li>Assess for needs & coping skills
    48. 48. Provide appropriate interventions during times of loss
    49. 49. New para/quadriplegic
    50. 50. Amputation
    51. 51. Change in physical functioning
    52. 52. Being available for indefinite periods of time for the families
    53. 53. Connection to resources as indicated</li></li></ul><li>Brief Overview: Psychology of Trauma<br /><ul><li>Patients will have lasting psychological effects from both the incident as well as the medical care
    54. 54. Nightmares & flashbacks are common
    55. 55. Acute Stress Disorder (ASD) can transform into Posttraumatic Stress Disorder if effects last long enough
    56. 56. These things are discussed with the patient as appropriate or requested by the physician</li></li></ul><li>“The world is a dangerous place to live; not because of the people who are evil, but because of the people who don’t do anything about it.” <br />~Albert Einstein<br />Part 3: Domestic Violence Task Force & Disaster Behavioral Health Committee <br />
    57. 57. Intimate Partner Violence (IPV)<br /><ul><li>Women experience 4.8 million intimate partner related physical assaults & rapes. Men are victims of about 2.9 million intimate partner related physical assaults
    58. 58. IPV resulted in 1,510 deaths in 2005; 22% male & 78% female
    59. 59. IPV affects physical & emotional health
    60. 60. This can affect anyone regardless of age, race, socioeconomic status, profession, etc
    61. 61. Risk Factors: Use of alcohol/drugs, seeing or experiencing violence as a child, unemployment</li></li></ul><li>The Task Force<br /><ul><li>Working with Dr. Hardy & the Child Abuse Prevention Support Center
    62. 62. Enlisting the help of nurses, physicians, and anyone else with ideas to improve DV resources and connections to resources in the community
    63. 63. Current projects:
    64. 64. Emergency Medicine Resident education on DV & reporting procedures
    65. 65. coordination with ED social worker to more quickly triage DV cases for the appropriate referrals
    66. 66. connecting with community organizations already working in this area (e.g. Aware Central Texas, Families in Crisis, & Fort Hood Family Advocacy Program)</li></li></ul><li>Disaster Behavioral Health Committee <br /><ul><li>A sub-committee of the Regional Advisory Committee (RAC) for Region 7
    67. 67. Critical Incident Debriefing training
    68. 68. Goals:
    69. 69. To develop a call schedule for area mental health providers to provide behavioral health services in the event of a natural disaster or community need (e.g. fire, floods, school shootings)
    70. 70. To develop the mental health policy section of the Disaster Plan for Bell County
    71. 71. To be a resource for the area on mental needs of the community.</li></li></ul><li>Questions??<br />

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