JENNIFER R. AYERS, LMSWTRAUMA SOCIAL WORKER

SCOTT & WHITE TRAUMA SERVICES

The Role of the Trauma Social Worker

Overview

• Screening & Brief Intervention (SBI) for Alcohol & Drug Use

• General Assessment & Intervention for Trauma Patients

• Domestic Violence Task Force & Disaster Behavioral Health Committee

Teamwork

• Trauma Team includes: Trauma Nurse Coordinators Physicians (Medical Director, Staff Physicians,

Residents, Interns, Medical Students) Bedside & ICU Nurses Registered Dietician Trauma Registrars Trauma Performance Improvement Specialist Support Staff ( Health Unit Coordinators, food service,

etc) Patients & Families!!

“YOU CANNOT TEACH A MAN ANYTHING; YOU CAN ONLY HELP HIM TO FIND IT

WITHIN HIMSELF.” ~GALILEO

Part 1: Screening & Brief Intervention (SBI)

Screening & Brief Intervention (SBI) for Alcohol Use

• 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

• This does NOT necessarily mean referral to a treatment program

Why is this important?

• Alcohol is involved in half of treated injuries (Treno, 1997, Cherpitel, 1993, 1999)

• Intoxicated patients are 2.5 times more likely to be readmitted for injury in two year follow-up (Rivara 1993)

• Problem drinkers average 4 times as many days in the hospital as non-drinkers mostly due to alcohol related injuries

Severity of Alcohol Problems

Harmful drinking/Abuse

Risky/Hazardous drinking

Safe drinking

Abstinent

Dependent drinking/Alcoholism

SBI

Screen

The Screening Tool

• Multidisciplinary Approach to Reduce Injury and Alcohol/Drug Use in Trauma Patients (MARIA) Dr. Craig A. Field, Ph.D., M.P.H. Associate Professor, University of Texas at Austin School of Social Work, Program Director of the Behavioral Health Services at University Medical Center at

Brackenridge

• Exclusion criteria: <14 years old, >65 years old, or their GCS is below 14

• Reasoning: Patient needs to be able to participate in the process; kids and the elderly are less likely to have alcohol/drug problems

• Target Population: Young people 18-34 years, high risk drinkers

EXCLUSION CriteriaAge < 14 years or Glasgow coma score < 14 or ground level falls age > 65

Criteria 1: Clinical Indications Yes No

Positive blood alcohol content level: __________ (≥.08 or 80g/dl)

Illegal drug use including positive drug screen:Cocaine Phencyclidine (PCP) MethamphetamineMarijuana AmphetaminesOther ___________________Route: Oral Inhaled Intravenous Intramuscular

Criteria 2: Self Report Yes No

Were you drinking or using drugs within 6 hours before you were injured?

Criteria 3: AUDIT-C (Alcohol use Disorder Identification Test – clinical) Screen

0 1 2 3 4 Total Alcohol Use

How often do you have a drink containing alcohol? Never Monthly or less

2-4 times per month

2-3 times per week

4 or more times/week

How many drinks containing alcohol do you have on a typical day when you are drinking?

1 or 2 3 or 4 5 or 6 7-9 10 or more

How often do you have 6 (men) 4 (women) or more drinks on one occasion?

Never Monthly or less

Monthly Weekly Daily or almost daily

AUDIT SCORE

MARIAMultidisciplinary Approach to Reduce Injury and Alcohol/Drug Use in Trauma

Patients

Criteria 4: Drug Screen Yes NoDuring the last year, have you been preoccupied with using drugs?

During the last year, have you experienced problems caused by using drugs and you kept using?

During the last year, have you used drugs more than you intended?

During the last year, have you needed to use more drugs to get the same effect you used to get with less?

During the last year, have you tried to stop using drugs but couldn’t?

TOTAL YES RESPONSES

Make referral if AUDIT score > 4 (3 for women), patient responded yes to any drug questions and/or positive screen for criteria 1 & 2. Notify psychiatric services to perform brief intervention.

Comments: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Clinician Signature: __________________________________________ Date: __________________ Time: _______________

MARIA continued

“Standard Drink”

Readiness to Change Among Injured Patients

Precontemplation = NeverContemplation = MaybePreparation = SoonAction = Now

Not Ready Unsure Ready 1 10

Style Matters

Each patient moves around within their range of readiness…How you talk to them can bring out their “best side” or “worst side.”

Pt APt C

Pt B

Brief Intervention

• After establishing readiness for change, then we can move to the intervention

• Creating a partnership for change, not authoritative prescription

• Use of motivational interviewing techniques to inspire change or to introduce the idea of change in drinking behaviors

Studies of BI in other medical settings

• Bien et al. (Addiction 1993)• 32 trials of BI in 14 nations reviewed• BI is more effective than no counseling, and often as

effective as more extensive treatment

• Wilk et al. (J Gen Intern Med 1997)• 12 RCTs of BI reviewed • odds ratio 1.9 (95% CI 1.61-2.27) in favor of BI

• D’Onofrio & Degutis (Acad Emerg Med 2002)• 39 clinical trials reviewed• 32 studies found positive effects for BI

Drug Use

• Assess for dependence• Brief intervention• May require more formal referrals to further

psychiatric treatment

“PEOPLE ONLY SEE WHAT THEY ARE PREPARED TO SEE.”

~RALPH WALDO EMERSON

Part 2: Assessing Trauma Patients & Families

Critical Incident Stress Intervention

• Intervention provided after a traumatic event (e.g. MVC, MCC, stabbing, shooting); shown to reduce psychological problems down the road

• People respond differently to each situation• Physical, cognitive, emotional, and behavioral

effects• Crisis resolution

Suicide

• Initial evaluation • Assess for coping skills, intention, etc• Coordinate with psychiatry for follow up if

inpatient treatment is not recommended• In the works: Suicide prevention program in

conjunction with Injury Prevention

Coping with Life Changes

• Assess for acute psychosocial support needs• Identifying coping skills used in the past• Provide support as requested by the patient

and/or family

Grief & Loss

• Assess for needs & coping skills• Provide appropriate interventions during

times of loss New para/quadriplegic Amputation Change in physical functioning

• Being available for indefinite periods of time for the families

• Connection to resources as indicated

Brief Overview: Psychology of Trauma

• Patients will have lasting psychological effects from both the incident as well as the medical care

• Nightmares & flashbacks are common• Acute Stress Disorder (ASD) can transform

into Posttraumatic Stress Disorder if effects last long enough

• These things are discussed with the patient as appropriate or requested by the physician

“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.” ~ALBERT EINSTEIN

Part 3: Domestic Violence Task Force & Disaster Behavioral

Health Committee

Intimate Partner Violence (IPV)

• Women experience 4.8 million intimate partner related physical assaults & rapes. Men are victims of about 2.9 million intimate partner related physical assaults

• IPV resulted in 1,510 deaths in 2005; 22% male & 78% female

• IPV affects physical & emotional health• This can affect anyone regardless of age, race,

socioeconomic status, profession, etc• Risk Factors: Use of alcohol/drugs, seeing or

experiencing violence as a child, unemployment

The Task Force

• Working with Dr. Hardy & the Child Abuse Prevention Support Center

• Enlisting the help of nurses, physicians, and anyone else with ideas to improve DV resources and connections to resources in the community

• Current projects: Emergency Medicine Resident education on DV & reporting

procedures coordination with ED social worker to more quickly triage DV

cases for the appropriate referrals connecting with community organizations already working in

this area (e.g. Aware Central Texas, Families in Crisis, & Fort Hood Family Advocacy Program)

Disaster Behavioral Health Committee

• A sub-committee of the Regional Advisory Committee (RAC) for Region 7

• Critical Incident Debriefing training• Goals:

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)

To develop the mental health policy section of the Disaster Plan for Bell County

To be a resource for the area on mental needs of the community.

Questions??