2 nd TRaCS Conference

Transcription

1 2 nd TRaCS Conference Ms Zahara Mahmood Senior Medical Social Worker CGH Psychotraumology Services 26 July 2008

2 Trauma Cases in Singapore and CGH Trauma: The Unspoken Impact on Families Implications for Practice The Role of Families

3 Fifth highest killer Responsible for most number of hospitalisations No. 1 cause of death in children and young adults under 35 years old Source: Associate Professor Chia Sing Joo, Divisional Chairman, TTSH; News@AisaOne, 18 Oct 2007

4 Traumatic Brain Injury Is a major public health problem Accounts one-half of traumarelated deaths Quantifiable proportion of severe and permanently disabled survivors Source: Associate Professor Chia Sing Joo, Divisional Chairman, TTSH; News@AisaOne, 18 Oct 2007

5 Number of Persons Killed and Injured in Road Traffic Accidents Category Killed Seriously injured Slightly injured 9,602 10,250 TOTAL 9,896 10,561 Source: Traffic Police Annual Report 2007

6 Total no. of trauma cases screened in 2007: > 1200 Trauma-related Injuries: Industrial Accidents Road Traffic Accidents Assaults and Family Violence About 400 cases required early intervention

7 Profile of Trauma Survivors and Families One-fifth of Road Traffic Accident victims sustained traumatic brain and spine injuries Peak age of traumatic brain injury trauma survivors: 30 to 40 years Immature families with school-going children Financially dependent

8 Survivors of Traumatic Brain Injury due to RTA Family/ Social Support TBI Impact of TBI PTSD Symptoms

9 Traumatic Brain Injury Also known as intracranial injury or simply head injury Occurs when physical trauma causes brain damage May result in loss of consciousness, disorientation, confusion and amnesia Severe Swelling in the Head

10 Frequently Asked Questions Will he survive? Is he brain dead? How long will he need to be treated in the hospital? Will he be normal again? When will he wake up from coma?

11 Impact of TBI On Survivors Impaired Memory Daily Life Management Challenges Denial Depression/angry Fear

12 Impact of TBI on Survivors Neuro-Cognitive Deficits: Disorientation Confusion Personality and Character Change Decrease in Intellect Motor and Sensory Deficits

13 Post Traumatic Stress Disorder(PTSD) Disorder(PT Re-experiencing Thoughts, nightmares, flashbacks, emotional reactions, phsychological reactions Avoidance Avoid thoughts, avoid reminders, amnesia, detachment Arousal Sleep disturbance, concentration problems, hyper vigilance, startle

14 Trauma happen to many competent, healthy, strong and good people. Why did it happen to my faithful and hardworking husband? He s so young and fit. Why him? Why not me? What did he do wrong? Why is life so unfair?

15 No one can completely protect him or herself or their loved ones from traumatic experiences. Signs/signals of bad omen to come can prevent kempunan wish/request not fulfilled buang tebiat been acting strangely lately suay - jinx

16 People who react to traumas are not crazy avoid labelling Having symptoms after traumatic event is not a sign of personal weakness

17 Ambiguous Loss: Physically absent but psychologically/emotionally present Losing Your Loved Ones Physically present but psychologically/emotionally/cognitively absent Coping with the New Person

18 Loss and Bereavement affects: Family membership and roles Loss of overt roles Loss of emotional/relational roles Family Economic Status Change in household income Settlement of outstanding loans and medical bills

19 Loss and Bereavement affects: Family emotional climate and transmission processes New rules about acceptable emotions Transmission of negative emotions to one another Family communication processes Open Vs Closed communication style Difficulty reaching out to others

20 Loss and Bereavement affects: Family s Core Values and Beliefs 1. Family spiritual/religious faith may be shaken Assign blame to God as typical response Allow to express feelings Adopt non-judgmental attitude

21 Loss and Bereavement affects: Family s Core Values and Beliefs 2. Family spiritual/religious faith is unshaken Use faith to give courage Use faith to take actions towards grief recovery For examples: use of religious amulets, air zam-zam, prayers, and chants

22 Loss and Bereavement: May re-activate memories and associated feelings of past oppression based on race, class, religion, sexual orientation, etc

23 Loss and Bereavement affects: Family Present and Future Plans Family Identity and Life story

24 Impact on the Spouses: Secondary Trauma Victims Suffer contagious symptoms of PTSD Experience changes in world view/ spiritual crisis Experience intense feelings about what happened to partners Difficulty to help partners

25 Impact on the Spouses: Massive Changes in Roles Assume singular responsibility - Household management - Parenting - Decision-making - Finances - Sole breadwinner

26 Impact on the Spouses: Compassion Fatigue Sexuality dramatically changed Emotionally drained Exhaustion or Burnout

27 Impact on the Spouses: Caregiver Burden Act as parent figure to partners Become Married widows socially isolated Stress with in-laws

28 Impact on the Spouses: Financial Devastation Sell possessions or pawn gold bangles, necklaces, etc Short-term financial assistance by social agencies Balancing work, care for children and partners Day care centre/ temporary shelters for partners lacking

29 Impact on the Children Feeling helpless Feeling shut out Lack of bonding and communication Adjustment to a different parental role Develop attention-seeking behaviour in school and/or at home

30 Single best predictor of resilience/ recovery from trauma is degree of familial support In general, families provide a primary source of social support Spouses are typically identified as the chief source of social support

31 Family as Main Focus of Treatment Cost-efficient approach to working with trauma survivors and families Individual counselling sessions linked back to family sessions

32 Family as Main Focus of Treatment Strengthening safe relationships and setting clear boundaries Re-defining roles in the family Re-assigning responsibilities to each member of the family

33 Family as Main Focus of Treatment Highlighting existing strengths of family relationships Family capacity for empathy and soothing Family ability to take action to address concerns Finding pleasurable mutual activities that restore and build upon stories of pride (counter-balancing trauma story)

34 Family as Main Focus of Treatment Attending communication blocks that increase risk and decrease access to family s healing Communication/Problem-Solving Clarity Open Emotional Expression Collaborative Problem-Solving

35 Family as Main Focus of Treatment Strengthening community resources Linking family to specific assistance required Referring trauma survivors to day care/rehab services Referring caregivers to support groups

36 Family as Main Focus of Treatment Family Belief Systems Making meaning of adversity Positive outlook Spirituality growth

37 Physical and psychological suffering of lifelong disabilities endured by TBI survivors and families Impact of TBI often under emphasised and not adequately addressed

38 TBI survivors face problems reintegrating into society Lack of agencies to look into extent of help required by TBI on families and service gaps within the community

39 He s not quite the same But it ain t him to blame He wasn t to know in the prime of his life That the sickness would eat at his brain So now I m his mother Where I once was his wife For the sake of his future I must forfeit my life. ~ Anonymous Carer~

40 THANK YOU