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Social Workers in Trauma Settings —
Team Players

By Maura Keller

When traumatic events unfold, such as the recent school shooting in Newtown, CT, first responders—police officers, firefighters, and medical professionals—play a key role in helping those affected. At trauma centers that receive and treat victims and survivors, social workers also are part of the team providing individuals and families with ongoing support for myriad issues.

A Key Role
According to Sheri Richardt, LCSW, behavioral health manager for CL/crisis/aftercare at Advocate Illinois Masonic Medical Center in Chicago, there are several different roles social workers play in medical trauma centers.

In the emergency department (ED) at Advocate Illinois Masonic Medical Center, the social workers are identified as crisis workers. The crisis worker is present with the trauma/ED team when the patient arrives, gathering information about the scene from the paramedics, police, or patient, if possible.

“The social worker suits up in gloves and X-ray armor just like the rest of the team and jumps into the trauma bay,” Richardt says. “If the patient is able to speak and give an emergency contact, the social worker gathers this information. If the patient is unable to speak, the social worker becomes a detective, utilizing cell phones, receipts, business cards, tattoos—whatever is available—to help identify the patient and locate the appropriate next of kin. It’s very important to have family or next of kin available if the trauma patient is critical or expires in the ED.”

In this setting, the social worker also is the person who reaches out by phone; brings family in; coordinates communication with the family; brings in the hospital chaplain; assists with grief support; coordinates medical examiner information, and organ and tissue donation contacts; shows the body; and advocates for family needs with the medical examiner.

“If the patient is stabilized, there’s a referral to the trauma social worker on the unit,” Richardt says. “The ED social worker will settle the family onto the unit and provide a warm transition. While training new social workers in the ED, I explain working with a trauma family as peeling an onion: It is traumatic and comes in layers. I can’t tell you how many times I’ve sat down with a family getting unexpected news from a physician about a loved one who is critically ill or has died. The doctor does a fantastic job of explaining what has happened, but when he or she gets up to leave, the family looks to me and asks, ‘So can I go talk to them now?’ The family member often can’t grasp that the loved one is intubated or worse. This is a result of the shock that can occur when loved ones are jarred out of their sleep at 3 am, finding that someone close to them is now critically ill or dead.”

Depending on the prognosis and type of injuries, the trauma social worker will help the family in working together regarding difficult topics such as grief, adjustment, guilt, loss, and next steps.

“Critical trauma patients could be hospitalized for a long period of time,” Richardt says. “They could interact with a social worker upon entry to the emergency department, on the surgical or medical intensive care unit by someone assigned to a trauma service, on a less intense general medical floor, in a rehabilitation setting, or when followed in outpatient care.”

As Richardt explains, the type of social work needed in an outpatient care setting also can vary significantly based on the unique needs of the trauma. “Many trauma patients—not all—experience loss, grief reactions, adjustment issues, or may have chemical dependency issues to address through a behavioral health clinic,” Richardt says.

A Team Effort
Richardt explains that a holistic approach is needed while being treated for a traumatic injury, sometimes requiring more than one type of social worker. “If the treatment team notes the individual has been involved a traumatic event due to a behavioral health-related issue, there’s an separate team of clinicians called in—many of them clinical social workers—to support the patient from another angle,” she says. “These clinicians are highly trained to screen in collaboration with psychiatrists for depression, suicidal ideation, or chemical dependency needs. Social workers are frequently the key to coordinating communication between the patient, family, and many treatment providers dedicated to patient recovery.”

In the case of Newtown or other mass shootings, social workers in trauma centers also can provide intervention, assist with organization when there are numerous victims who need to be identified, connect victims with their families, try to get certain information to certain families, act as a liaison between the families and law enforcement, and assist in talking with the families while they are waiting to hear about the well-being of their loved one.

As Kelly Kimble, LISW-S, social work coordinator at MetroHealth Medical Center in Cleveland, explains, in addition to the crisis intervention/trauma counseling, social workers can help with the organization of family members who are present, track lists of victims and survivors, assist families looking for their loved ones, determine what victims have been taken to what hospital, and notify families who aren't already aware of the situation.

“From my experience, when something horrible happens and first responders are upset about what they've just seen, I've been informally involved in providing some crisis counseling and support to them,” Kimble says. “An emergency medical services supervisor might come to me and ask if I would touch base with one of the paramedics or notice someone is upset and ask me to check in with them. I've had some of our own ED staff that have come to me to talk about how they are feeling about a case. We support each other.

“I have worked in this ED for almost 15 years, so I think people know that I've seen a lot myself and I'm someone who speaks about the effects our chronic exposure to trauma have on us,” she continues. “We cannot forget about those professionals involved in these cases; they are greatly affected by bearing witness to traumatic events.”

The Right Fit
Kimble stresses that a social worker’s role in the trauma setting is critical, as he or she can provide trauma-focused clinical intervention to help the patient and/or family cope with the psychological effects of the trauma.

“A social worker has the clinical expertise and knowledge to know how to manage certain emotional reactions, help with coping, reduce anxiety, and essentially sets the stage of how the person or persons will manage or function in the future,” Kimble says.

That said, medical trauma centers often are high-energy areas of the hospital, requiring a special kind of person to work as a social worker in this setting.

Kimble says a trauma social worker should be comfortable managing an array of emotional reactions, conflict, and confrontation both on an individual and/or family/group level.

“For example, there are many times when crowd control is part of the social worker’s role along with the hospital police or security,” Kimble says. “For example, when someone is shot and several family members and friends present to the ED. There are many times when the social worker must be assertive. Remaining calm and empathic is also critical.”

“It’s difficult to find social workers that are a good fit for a level 1 trauma center,” Richardt says. “When you find the right fit, the individual often stays long-term. Most medical social workers are comfortable with being at the bedside of a critically ill patient. However, fewer social workers are willing to cover overnights, weekends, and holidays on a 24/7 service exposed to the critically ill patient coming in on a stretcher, not yet sutured, stapled or cleaned up. I believe ED and trauma service social workers need to be excellent problem solvers, creative, resourceful, great communicators, and full of energy with the ability to remain calm during intense moments. Social workers in these areas also need to be trained in recognizing compassion fatigue and vicarious traumatization.”

Finally, Richardt says it’s important for trauma social workers to remember that individuals presenting with a medical trauma have not only physical injuries but also the psychological injuries that do not show up on a CT scan.

“Clinicians have learned from events such as 9/11 that people are much more resilient then we had anticipated. The last thing a trauma social worker would want to do is cause more damage by utilizing the wrong approach,” Richardt says. “In graduate school, social workers learn to join with the family. I always tell social workers in this area the goal is to never join with the crisis.”

— Maura Keller is a Minneapolis-based writer and editor.