Social Workers Join The ER Team To Treat Crime Victims’ Psychological Wounds
By Annie Sweeney, Chicago Tribune
CHICAGO — Daveon Williams remembers all of it.
The seven shots. His friend hiding in a nearby alley. The shooter crouching behind a car, still coming for him. The paramedics who arrived and cut off his shirt and jacket in the grassy field. He remembers that he felt scared, but thought it was a good sign he could talk. Then there were the doctors who rushed him into surgery after he arrived at Stroger Hospital’s Cook County Trauma and Burn Unit. And, finally, he recalls waking up.
“Really I was just happy. I was happy to be alive,” said Williams, 20, who was shot three times in the abdomen and leg. “I was pretty scared, but once I came out of surgery, I was just happy with joy.”
In the days and weeks after his June 14 shooting, as Williams’ physical wounds healed and his joy yielded to more complex feelings, he was attended to by a lower-profile team at Stroger Hospital: social workers who have now been embedded into the trauma unit to provide real-time mental and emotional care for Chicago’s violent crime victims.
The social workers have a desk in the ER, type up medical notes, and do rounds in an effort to treat patients for the stress that is a byproduct of Chicago’s violence.
In the worst cases, they find post-traumatic stress disorder — long recognized in war veterans and sexual assault survivors but increasingly a concern in people exposed to daily, more routine violence who, without help, are at risk for anxiety and other illnesses.
Social worker Andrew Wheeler worked with Williams through his hospital stay.
“So how’ve you been, man? You tired of being here yet,” Wheeler asked as he walked into Williams’ room for a chat. Over the next 20 minutes, the two talked about some dreams Williams had been having, his wondering why he survived such a close call and Wheeler’s hope that the young man — who turned 20 the day he was shot — would look beyond what he lost in the shooting.
“It’s equally important to focus on our future,” Wheeler said. “So there’s two sides to it. It’s good to pay attention to your pain and suffering, right? But there’s a whole other side, that you can grow. … You just turned 20, man. You’ve got a lot of living to do.”
On a recent morning, Wheeler sat in the trauma break room at a conference table — a carton of 2 percent milk and a roll left behind from someone’s breakfast — with his boss, Carol Reese, to discuss the patient load that morning.
The litany of pain was long: A man was shot just under his arm, and his family — some of them in law enforcement — were at the hospital and open to speaking. Another gunshot victim was struggling because he couldn’t drink liquids. Three falls. A third gunshot victim, this one shot in the jaw. A severely burned woman set afire in a domestic attack. Another burn victim who lost much of her face after a cutting agent exploded while she was packaging dope. A suicide attempt. And a teenager who had just found out he killed someone in a drunken driving crash.
Some 5,300 patients stream through Stroger’s trauma and burn unit annually, each coping with massive injuries suffered in a variety of ways.
Three years ago, doctors and social workers at Stroger surveyed these patients and their family members and found that 42 percent — well above the national average — screened positive for PTSD. Gunshot victims were more likely than those who suffered falls or crashes to screen positive.
Those kinds of numbers led hospital officials to create the Patient & Family Support Services Team, which includes Wheeler and Reese, a chaplain and also a licensed clinical social worker, and up to three part-time interns to assist with the caseload.
Reese said the social workers operate under a version of the “golden hour” rule that ER doctors follow, which says that the right treatment within the hour after a traumatic injury provides the best chance to avert death.
Similarly, if people are counseled as soon as possible after experiencing the trauma, warned about symptoms and assured they can handle it, they have a good chance at coping, she said. If not, people walk around hyper-aroused, vigilant, jumpy, and agitated, all of which perpetuates a cycle of violent responses or leads to self-medication, she said.
“People are resilient,” Reese said, explaining why immediate counseling works best.
Exposure to violence is hardly a new phenomenon in Chicago or any big city. But Reese said it has been historically hard for some to cope for a few reasons: There is a stigma about seeking help; services for PTSD are lacking in some neighborhoods; a strong support network is needed to face it all. Considering how those same neighborhoods in Chicago tend to be battered by high levels of crime, there is reason to worry that entire communities are under stress.
“The system that is supposed to provide a safe space is compromised,” Reese said.
Stroger’s new approach is part of a broader partnership forged more than a year ago with La Rabida Children’s Hospital and Comer Children’s Hospital at the University of Chicago to reach out to perhaps the most fragile victims of violence: the countless children exposed either as victims, witnesses, or through injuries to family members. That project is modeled after Healing Hurt People in Philadelphia, which offers follow-up care to child victims of violence after they are discharged from the hospital.
So far, 120 families locally have been referred for follow-up care, a chance to meet with counselors and talk about how to cope with the violence they’ve experienced before it spirals into other trouble or violence, said Bradley Stolbach, an associate professor in pediatrics at the Pritzker School of Medicine at the U. of C. who is helping coordinate the program.
Stolbach said many of the children are open to talking about how to cope, recalling how a child recently dropped his head onto a table during a session and said he was having a flashback.
“Right in that moment there is an opportunity to say, ‘OK, that’s normal. You are not going crazy.’ We talked about how to breathe and to actually practice it,” he said.
This so-called trauma-based approach — with children or adults — is part of a growing awareness of how much of a setback constant exposure to violence can be, experts say.
“I think people recognize these communities as being stressed and blighted, but I don’t think they looked at the hard implications it has on the person and how it impacts how they move in society, just how they navigate,” said Dr. Theodore Corbin, the medical director of Healing Hurt People. “Some of the people we … work with, they don’t want to walk to school a certain way because they (are) frightened of what might happen to them. So you take it a step further — they don’t go to school.”
And certainly many victims of violence who arrive in any ER are themselves caught up in street violence. So treating their trauma is also seen as a way to reduce more violence on the street.
Photo: Chicago Tribune/MCT/John J. Kim
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