Social Work Delivered Intervention for Persons with Mild Traumatic Brain Injury: Implementation and Evaluation in an Urban, Public, Trauma Center Emergency Department

Mild traumatic brain injury (mTBI) is a prevalent and costly public health problem with potentially disabling consequences. Interventions aimed at alleviating cognitive, emotional and behavioral sequelae are underdeveloped. This prospective, quasi-experimental cohort study evaluated a brief social work delivered intervention (SWDI) for adults with mTBI discharged from the emergency department. The SWDI included education, reassurance, coping strategies and community resource information. Participants were recruited from consecutive admissions to the emergency department. A total of 64 persons with confirmed mTBI diagnoses were assessed 3 months post-injury. Participants in the Usual Care group (N=32) were identified via medical record; confirmation of mTBI was based on World Health Organization definition. Participants in the SWDI group (N=32) were identified and mTBI diagnosis confirmed by emergency department medical staff. Both groups completed standardized assessments of post-concussion symptoms, depression, anxiety, Posttraumatic Stress Disorder, alcohol use, and community functioning three months after injury. To assess change in alcohol use and community functioning, participants were asked to recall pre-injury drinking levels and functioning and then asked about current status three months post injury. The SWDI group also completed an open-ended Patient Experience Survey following their ED service. The paired sample t test was used to assess community functioning outcomes. For all other standardized measures, non-parametric Mann Whitney or Wilcoxon Signed Rank tests were used to compare groups. Qualitative themes from the Patient Experience Survey were identified through systematic review of all survey responses.Three months post injury, both groups reported pre-injury drinking in the hazardous range. The SWDI group reported significantly reduced alcohol use from pre-injury to post-intervention (p < 0.05). The Usual Care group maintained their pre-injury level of drinking. Analysis of the community functioning measure revealed the SWDI group maintained pre-injury levels of community functioning, while the Usual Care group reported significant decline in functioning (p = 0.05). All other analyses of standardized measures (anxiety, depression, PTSD, post-concussive symptoms) trended in favor of the intervention group, but were not statistically significant. Results from the SWDI Patient Experience Survey indicate that 96% of participants who remembered receiving the intervention (N=25) found it helpful. In response to an open ended question about the most helpful aspects of the intervention, 60% reported it was most helpful to learn about symptoms to expect because this decreased anxiety about symptoms, 28% reported that the recovery tips were most helpful and 24% reported that education about ceasing alcohol use was most helpful. The study provides support for the use of the SWDI in the emergency department. Decrease in alcohol use and maintenance of community functioning are clinically and functionally significant outcomes. Alcohol use is a risk factor for re-injury and poor outcome, and the measure of community functioning includes probes about work, school and social activity attendance as well as ability to complete household and daily living activities. In addition, the SWDI group overwhelmingly found the intervention helpful. Education about symptoms to expect and decreasing alcohol use was particularly salient for participants. Future studies should consider survey themes and ways to enhance the intervention in order to increase the impact on additional outcomes of interest.