REBUILD: an orthopedic trauma support group and community outreach program.

From the earliest days of social work practice, practitioners in both medicine and social work have recognized the value of groups in meeting the needs of patients. Today there is considerable agreement that the therapeutic group mechanism of mutual support is pertinent, especially to the field of health (Spira, 1997). The major purpose for which groups are used in health care settings is to provide peer support in relieving stress felt by patients and families as they face illness and disabilities. REBUILD, an orthopedic trauma support group, offers this healing environment to recovering trauma patients and their families. The group also involves the larger community in its program. Recovering patients provide new-patient support in the hospital, patient-focused training for medical professionals at conferences, and on-going training for recruits and paramedics at the local fire and rescue training academy. Trauma caregivers participating in this training become more sensitive to the emotional needs of their patients and more skilled in facilitating their emotional recovery. The purpose of this article is twofold. It describes the unique development of this hospital-based form of support group and how this development extended the psychoeducational benefits to the larger community. The outreach component of the program expands the social worker's practice to include interventions more commonly used by community workers. BACKGROUND Trauma is the leading cause of death and disability of Americans under age 45 and is the third leading cause of death for people of all ages (National Center for Health Statistics, 1993). The effect of physical trauma can be devastating to victims, with injuries destroying their health, lives, and livelihoods. Patients and families face many psychosocial stressors throughout the recovery process, including social isolation, insurance problems or financial headaches, family stress, chronic or recurring pain, and continuing feelings of anger, depression, or guilt (Scanlon-Schilpp & Levesque, 1981). In times of crisis patients and families need support but may not be able to provide it for each other. The experience of high anxiety and feelings of disorganization affect the patient's and family's ability to cope with the stresses and hinder recovery (Parad & Parad, 1990); if the crisis is prolonged, the family may exhaust its social support system (Harvey, Dixon, & Padberg, 1995). Medical social workers find that the group process is well suited for easing emotional stress felt by patients and their families who have feelings of isolation, loneliness, depression, helplessness, and hopelessness (Spira, 1997). The social work group has the potential to strengthen the recovering person's family connections, reduce isolation and despair (Glassman, 1991), and offer support. The group can enable discussion of taboos central to the concerns of patients and families, such as anger, loss, and mourning (Shulman, 1992). A powerful growth-promoting environment, unique to the group setting, often is created, stimulating group members to work more rapidly toward resolving the crises they face in recovery. A review of the literature reveals a number of support groups for cancer patients, people with HIV/AIDS, recovering alcoholics and substance abusers, and people who have lost loved ones (Burland, 1998; Harvey et al., 1995; Hsu, 1996; Lieberman, 1988; Scanlon-Schilpp & Levesque, 1981). Benefits of these groups reported by families include opportunities to share emotions, ask questions, and improve their coping skills. This same review reveals very few trauma support groups throughout the nation. There is one at the University of California's Irvine Medical Center and another at Connecticut's Hartford Hospital (Harvey et al., 1995; McQuay, 1995). AWARENESS OF AN UNMET NEED At Inova Fairfax Hospital in Falls Church, Virginia, the chief of orthopedic trauma found that many of his trauma patients reported social isolation, depression, family stress, and chronic or recurring pain during their follow-up appointments. …