Psychosocial Care: The Too Often Overlooked Key to Successful Patient Outcomes
By Toby Huston, Ph.D. and Mark Johansen, M.D.
Catastrophic spinal cord and brain injuries are physically devastating, clearly, but it is the related emotional and social damage that often has the greatest impact on a patient’s life and overall well-being. Imagine the parent who fears they might never be able to hold their children again. Or the churchgoer who is no longer able to kneel during Sunday services. Or the worker who can no longer drive themselves where they need to go, losing their sense of independence.
That’s why psychosocial care, treatment that addresses the many different social and emotional factors that are involved in a catastrophic injury, is so critical.
All of the traits that make up a person’s identity are wrapped-up in the term “psychosocial,” from their working lives, to their self-esteem, to their sense of independence, to their community relationships and more. Beyond simply addressing the physical injuries, this type of care is mainly about enabling the patient to live a fulfilling life after injury, no matter what happens to their physical body.
Research has shown that a holistic approach to catastrophic spinal cord and brain injuries that includes psychosocial care has clear positive effects on patient outcomes. These patients are more engaged in their rehabilitation treatments, are better motivated to regain the aspects of their emotional or spiritual selves that they feel were lost, and are better able to return to the activities that they enjoy, all with less time in the hospital and fewer home visits.
But, not every rehabilitation center provides the level of psychosocial care needed to substantially improve outcomes, making it difficult for workers' compensation claims adjusters and case managers, as well as family members and patients themselves, to pinpoint those who are doing it well. Here are three key questions to ask of any center to ensure a patient receives a high level of psychosocial care during their treatment:
Is psychosocial care a fundamental part of the treatment plan?
The treatment team should be looking at whom the patient is as a person, including their spiritual beliefs, family situation, financial status and any other factors that might impact their motivation going into treatment.
As soon as a patient meets the clinical requirements to receive care at a specialty center, psychosocial care should become an integrated part of their treatment plan. While some centers may only provide this type of care in certain cases, every patient with a catastrophic injury needs psychosocial care, and it should be a well-defined part of treatment from the very beginning.
As soon as the patient comes in the door, every member of the treatment team should already be on the same page, and should be ready to provide personalized care for that patient’s unique challenges.
Is there a community of similar patients?
Medically, it’s good practice to refer patients to centers that have successfully treated those with similar injuries, but there are psychological benefits to this practice as well. It can be very powerful for patients to learn from dozens of others who are working through similar injuries and doing well.
Maybe they gain inspiration from seeing another patient return to tasks they once thought would be impossible, or maybe they simply build relationships that provide support in times of need. Either way, part of psychosocial care is putting patients in contact with others.
Are they providing holistic care?
Every patient recovering from a catastrophic injury will have access to a multidisciplinary team of doctors, physical therapists, occupational therapists, speech/language pathologists, psychologists, social workers, therapeutic recreation therapists, etc. But, multidisciplinary is not the same as interdisciplinary. All too often, care is fragmented and doesn’t take into account the patient’s entire self-identity.
For a center to provide truly excellent psychosocial care, the team must be interdisciplinary with each member working in concert, using each other’s strengths, always with the patient’s goals in mind.
For example, if the patient wants to return to a recreational activity, like golfing, that should inform the treatment strategy. Physical and occupational therapists will work together to build strength and find adaptations so the patient can get back on the golf course. Psychologists will address confidence and emotional barriers to trying a familiar activity with changed physical abilities. Doctors will examine how the injury has affected parts of the body necessary to the sport and make recommendations based on what they see. Even the passing remark of a nurse, asking where the patient likes to play or who their favorite golfers are, can provide an extra boost of motivation for the patient.
This is what a truly holistic approach to psychosocial care looks like in practice.
Rediscovering confidence and meaning
For many patients with spinal cord or brain injuries, the most challenging part of the process is often accepting or adjusting to the reality that their lives have changed permanently. Psychosocial care isn’t about glossing over the challenges ahead; it’s about meeting them head-on and moving forward to redefine their new reality.
A parent who worries about being able to care for their family following injury may feel like they’ve lost meaning in their life. A psychosocial treatment plan could focus on helping them get back to caring for their kids, in some capacity, re-establishing a portion of the confidence and meaning that may otherwise be missing from their lives.
There are clear benefits and cost-savings associated with psychosocial treatment, and more and more treatment centers are embracing this aspect of patient care. But not all psychosocial programs are created equal. The key for patients and their advocates is to choose centers with a demonstrated record of proactively addressing the inevitable psychological, social, and even spiritual challenges that every patient will face.
Toby Huston, Ph.D. is the Director of Psychology at Craig Hospital, where he spent 13 years as a team Rehabilitation Psychologist in the spinal cord injury program before assuming his current leadership position in 2015. Mark R. Johansen, M.D., is the Medical Director of the Spinal Cord Injury Program at Craig Hospital since 2011.