An alumna hires social work students to find out

A ghastly workplace accident. One of the 6 million car crashes that happen every year. A mass shooting. In any of these events, victims are rushed to emergency rooms, where trauma surgeons and doctors stop the bleeding, prevent sepsis, and repair the immediate damage.

But what happens to trauma patients after their lives have been saved?

This question nagged Katherine Houck (MSSW ‘98) ever since she joined Austin’s University Medical Center Brackenridge as the social worker for trauma patients.

Brackenridge is the only adult level I trauma center for Central Texas, one that every year admits over 3,000 patients with severe injuries due to car crashes, bicycle accidents, workplace accidents, and physical assaults.

Once patients are stabilized and moved to acute care, one of Houck’s duties is to provide counseling for those whose injuries are related to alcohol or drug use—40 percent of all car accidents in the country in 2015.

post traumatic stressHouck realized that many of the patients she saw had traumatic stress symptoms such as flashbacks or intrusive thoughts.

“For example, someone who was in a car crash might be continuously going back to the moment of the impact, or keep seeing the image of an arm covered in blood,” she explains.

Brackenridge had no protocol or requirement to address these symptoms, and Houck could not help wondering how patients fared once they were dismissed and sent home.

“I did a little research and I realized we were not unique. A survey from a few years ago found out that only seven percent of trauma centers were screening patients for traumatic stress symptoms. That was incredible low to me. And only screening patients! Not even delivering an intervention,” she says with disbelief.

Houck’s demeanor, by default thoughtful, changes to quiet excitement as she talks about how her realization triggered a now year-long study at Brackenridge to assess the prevalence of traumatic stress symptoms, and find out if they persist once patients are dismissed.

The study, funded by a Center for Health and Social Policy (CHASP) grant via a UT and Seton research collaborative, employed extra personnel qualified to screen and assess patients, deliver a preventive bedside intervention, re-assess at 6 and 12 weeks via telephone follow-up calls, and enter documentation into a data-management software.

Houck recalls that when she was working on the proposal with Dr. Ben Coopwood, director of critical surgical care, and Stacey Stevens Manser, associate director at the Texas Institute for Excellence in Mental Health, she was asked where this qualified personnel would come from.

“And I responded, social work students! This is what they are trained for. It’s a perfect marriage: they learn about clinical skills in the classroom and then can apply these skills in a real setting by working with us,” Houck says.

The team received more than 60 applications for only two graduate research assistant positions.

“I wanted experience working directly with clients and I’m also interested in medical social work, so this was perfect for me,” says Natalie Peterson, a first-year master’s student who was selected for one of the positions.

Meghan Graham, a second-year master’s student when she was selected for the other position, and a graduate from the School of Social Work (MSSW ’16), agrees with Peterson and adds that she enjoyed delivering the preventive bedside intervention.

“There is a psycho-educational piece where we talk with participants about fight or flight, and we let them know that it’s very common to have symptoms after a traumatic event, and that it’s not about them being weak. I like the part where I get to normalize the experience for them and provide information and resources,” Graham says.

Left to right: Katherine Houck, Meghan Graham, Natalie Peterson

The study found that 35 percent of trauma patients hospitalized at Brackenridge presented with at least one traumatic stress symptom. 72 percent of patients who presented with two symptoms met post-traumatic stress disorder criteria at the 6-week follow up call.

Symptoms can severely disrupt a person’s life. Graham remembers the case of an older woman who, after a car accident, was fearful of driving and had difficulty sleeping.

“Because the accident happened at night, she could not sleep when nightfall would come. She would stay up all night and was only able to sleep a little when the sun came up. She was very religious and had initially hoped that prayer would help. But when I called her at six-weeks, her sleep deprivation was making everything terrible for her.”

During the follow-up call, Graham suggested counseling, which the participant had never experienced before. Graham also addressed potential barriers proactively by finding a counseling center with a sliding scale and familiarity with bilingual clients—the participant was uninsured and spoke Spanish as well as English.

“She was able to go and see someone, and when I called her at 12-weeks her symptoms had decreased dramatically.  She even told me that she had been able to drive about a mile and a half to her church!” Graham remembers.

The research team has recently received extra funding from The University of Texas System Patient Safety Committee to extend the project for two more years.

“I am elated that we can keep screening trauma patients, providing the preventive intervention, and following up after discharge,” Houck says. “And we are all excited that we will be able to hire more social work students after August.”

Posted July 14, 2016. By Andrea Campetella. Photo by Martin do Nascimento.