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The Role Of The Trauma Social Worker
- 1. Jennifer R. Ayers, LMSW Trauma Social Worker Scott & White Trauma services The Role of the Trauma Social Worker
- 3. General Assessment & Intervention for Trauma Patients
- 6. Physicians (Medical Director, Staff Physicians, Residents, Interns, Medical Students)
- 7. Bedside & ICU Nurses
- 10. Trauma Performance Improvement Specialist
- 11. Support Staff ( Health Unit Coordinators, food service, etc)
- 15. Intoxicated patients are 2.5 times more likely to be readmitted for injury in two year follow-up (Rivara 1993)
- 17. Severity of Alcohol Problems Dependent drinking/Alcoholism SBI Harmful drinking/Abuse Risky/Hazardous drinking Safe drinking Screen Abstinent
- 20. Reasoning: Patient needs to be able to participate in the process; kids and the elderly are less likely to have alcohol/drug problems
- 22. MARIA continued Comments: _______________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Clinician Signature: __________________________________________ Date: __________________ Time: _______________
- 23. “Standard Drink”
- 24. Readiness to Change Among Injured Patients Precontemplation = Never Contemplation = Maybe Preparation = Soon Action = Now
- 25. Style Matters Pt A Pt C Pt B Not Ready Unsure Ready 1 10 Each patient moves around within their range of readiness… How you talk to them can bring out their “best side” or “worst side.”
- 27. Creating a partnership for change, not authoritative prescription
- 29. 32 trials of BI in 14 nations reviewed
- 30. BI is more effective than no counseling, and often as effective as more extensive treatment
- 31. Wilk et al. (J Gen Intern Med 1997)
- 32. 12 RCTs of BI reviewed
- 33. odds ratio 1.9 (95% CI 1.61-2.27) in favor of BI
- 34. D’Onofrio & Degutis (Acad Emerg Med 2002)
- 35. 39 clinical trials reviewed
- 40. People respond differently to each situation
- 41. Physical, cognitive, emotional, and behavioral effects
- 43. Assess for coping skills, intention, etc
- 44. Coordinate with psychiatry for follow up if inpatient treatment is not recommended
- 46. Identifying coping skills used in the past
- 48. Provide appropriate interventions during times of loss
- 50. Amputation
- 51. Change in physical functioning
- 52. Being available for indefinite periods of time for the families
- 54. Nightmares & flashbacks are common
- 55. Acute Stress Disorder (ASD) can transform into Posttraumatic Stress Disorder if effects last long enough
- 58. IPV resulted in 1,510 deaths in 2005; 22% male & 78% female
- 59. IPV affects physical & emotional health
- 60. This can affect anyone regardless of age, race, socioeconomic status, profession, etc
- 62. Enlisting the help of nurses, physicians, and anyone else with ideas to improve DV resources and connections to resources in the community
- 64. Emergency Medicine Resident education on DV & reporting procedures
- 65. coordination with ED social worker to more quickly triage DV cases for the appropriate referrals
- 67. Critical Incident Debriefing training
- 68. Goals:
- 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. To develop the mental health policy section of the Disaster Plan for Bell County
Editor's Notes
- 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.