A survey of burn professionals regarding the mental health services available to burn survivors in the United States and United Kingdom

Efficacy of an online self-management program for chronic burn pain: A randomized controlled trial of the Take Charge of Burn Pain program

This randomized controlled trial investigated the effectiveness of an online self-management program, "Take Charge of Burn Pain (TCBP)," for 96 individuals living with chronic burn pain. Participants were randomly assigned to either the 7-week TCBP program integrating cognitive-behavioral therapy techniques, pain education, and self-management strategies or an attention control group focused on general burn recovery information. Assessments conducted at baseline, post-treatment, and 2- and 5-month follow-ups included measures of pain severity, pain interference, pain self-efficacy, posttraumatic stress disorder symptoms, and depression. Compared to the control group, participants in the TCBP program demonstrated greater reductions in pain severity (mean difference: -1.24, 95 % CI: -1.93 to -0.55, p = 0.0007) and pain catastrophizing (mean difference: -5.41, 95 % CI: -10.33 to -0.49, p = 0.0318) post-treatment when adjusting for key variables. At the two-month follow-up, the TCBP group showed significant improvements in pain interference (P = 0.0123), self-efficacy (P = 0.0269), functional abilities (P = 0.0014), and social role participation (P = 0.0498) compared to the control group. Treatment effects were not sustained at 5-month follow-up. Participants in both groups reported high levels of satisfaction with the online intervention, with the majority finding the program helpful and easy to use, and being willing to recommend it to others with pain. Findings suggest preliminary support for short-term benefits of TCBP for managing certain facets of chronic burn pain. This underscores the need to refine digital approaches to maintain and promote long-term improvements. The potential of self-guided online psychological interventions to enhance pain coping strategies for burn survivors persists.

Early appearance concerns after burns: Investigating the roles of psychological flexibility and self-compassion

Few qualitative studies have explored appearance concerns soon after burn injuries. This study aimed to understand the early experiences of appearance concerns after burns, through the lens of psychological flexibility and self-compassion. Template analysis informed data collection and analysis. Fifteen adults (nine female, six male) with appearance concerns were interviewed within three months of their burns. Three superordinate themes were identified: (1) Need for social connection; (2) Distress through difference; and (3) Experiential avoidance and self-criticism in response to early appearance concerns. Findings highlighted that early appearance concerns are influenced by the need for social acceptance and the desire to conform to societal ideals. Internalised gender and appearance ideals and concerns about rejection and stigma were activated by the burn, and individuals had difficulty responding to their early appearance concerns with psychological flexibility and self-compassion. Instead, attempts to avoid distress (experiential avoidance) occurred. Self-criticism in response to distress was evident which, for some, extended to the event leading to their burns. Early interventions to enhance psychological flexibility and self-compassion (e.g., acceptance and commitment therapy, mindful self-compassion), to help individuals respond to appearance concerns with less experiential avoidance and self-criticism, would likely promote adjustment to changes in appearance after burns.

Program Evaluation of Cognitive Behavioral Therapy in Burn Survivors

Mental health is a component of care that should be addressed for patients with burns while they are hospitalized. Unfortunately, dedicated burn psychotherapists are rare in burn centers in the United States (US), and it can take months for patients to be seen by a mental health professional after referral. Our burn center has a dedicated licensed clinical social worker who sees patients within 2 business days of referral. She uses cognitive behavioral therapy (CBT), which is designed to alleviate symptoms of anxiety, depression, and acute stress by modifying the individual's maladaptive thoughts. To evaluate the timely use of CBT as a treatment for depression in patients with burns, we measured depressive symptoms before and after psychotherapy. Burn clinic nurses administered the Patient Health Questionnaire (PHQ-9) depression screener as part of standard care. We computed difference scores to determine the change in PHQ-9 scores at both group and individual levels. At a group level, psychotherapy significantly improved symptoms of depression, indicated by a decreased mean PHQ-9 score. On an individual level, half of the patients (50.7%) experienced a meaningful improvement in their symptoms, indicated by a change in their PHQ-9 depression category, while 35.6% showed no change. Although it was not an effective solution for all patients in this study, timely use of CBT could be an important component of burn care for many and should be considered as part of standard care in burn centers across the US.

The acceptability of early psychological interventions for adults with appearance concerns after burns

INTRODUCTION

Appearance concerns are common following burns. However, there is a lack of research investigating early psychological interventions for appearance concerns. This qualitative study explored the acceptability of early psychological interventions for appearance concerns after burns.

METHODS

Fifteen adults (nine female; 18-56 years) with appearance concerns were interviewed within three months post-burn to explore their views about the acceptability of early psychological interventions for these concerns. Interviews were audio-recorded and transcribed. Template analysis informed data collection and analysis.

RESULTS

Three themes represented participants' views about the acceptability of early psychological interventions for appearance concerns: (1) early psychological interventions are absent; (2) early psychological interventions are acceptable within a therapeutic relationship (to manage upsetting emotions and thoughts about appearance, with therapists who are experienced in supporting burns patients); and (3) ambivalence and obstacles exist (e.g., difficulties accepting help, minimising injuries or concerns, and time restrictions following hospital discharge).

CONCLUSION

Early psychological interventions for appearance concerns following burns are likely to be acceptable for some patients. However, ambivalence and potential barriers remain to be addressed. Embedding early psychological interventions for appearance concerns into routine burn care could increase acceptability through normalisation.

Researches on cognitive sequelae of burn injury: Current status and advances

Burn injury is a devastating disease with high incidence of disability and mortality. The cognitive dysfunctions, such as memory defect, are the main neurological sequelae influencing the life quality of burn-injured patients. The post-burn cognitive dysfunctions are related to the primary peripheral factors and the secondary cerebral inflammation, resulting in the destruction of blood-brain barrier (BBB), as is shown on Computed Tomography (CT) and magnetic resonance imaging examinations. As part of the neurovascular unit, BBB is vital to the nutrition and homeostasis of the central nervous system (CNS) and undergoes myriad alterations after burn injury, causing post-burn cognitive defects. The diagnosis and treatment of cognitive dysfunctions as burn injury sequelae are of great importance. In this review, we address the major manifestations and interventions of post-burn cognitive defects, as well as the mechanisms involved in memory defect, including neuroinflammation, destruction of BBB, and hormone imbalance.

Environmental scan of mental health supports across Canadian burn centers: A healthcare providers’ perspective

BACKGROUND

Early mental health care and psychosocial support after burn injury provided by a variety of specialists and non-mental health professionals is instrumental in prevention of long-term mental health sequalae such as post-traumatic stress, depressive or substance use disorders. Diversity of mental health supports available to burn survivors vary across geography, resulting in variation of long-term mental health outcomes following burn injury.

METHODS

A mixed-methods study utilizing a semi-structured questionnaire to explore resources available for burn survivors in Canada as an inpatient, outpatient, and more broadly in the aftercare community. Interviews were completed with 17 Canadian burn centers, with a variety of burn care professionals.

RESULTS

In the continuum of burn care, a lack of available mental health professionals in certain regions and in the outpatient and community phases was observed. Emerging themes demonstrated the need for regular screening for mental health concerns among burn survivors and providing up to date discharge resources. In addition, increasing educational opportunities available to burn care staff with respect to burn survivor mental health was emphasized. Lastly, the importance of proactive and prolonged psychological support for burn survivors as they progress through an outpatient, rehabilitation and community setting was underlined.

CONCLUSIONS

Identification of burn care practices and resources across Canada provides the opportunity to compare, unify and improve gaps in care that exist across the Canadian burn network.

At home parent-administered dressing changes in paediatric burns aftercare: A survey of burns centres?" practice

OBJECTIVE

Following paediatric burn injury, dressings are initially changed in outpatient clinics, necessitating regular visits with substantial burden for parents, children and services. This can potentially be lessened if some parents go on to administer dressing changes for their child at home. However, a lack of data regarding support for parent-administered dressing changes is present. The aim of this study was to describe current practice and views regarding at-home parent-administered dressing changes (PAD) in the UK.

METHODS

An online survey was distributed to 20 paediatric burns services in England and Wales. The survey used fixed and free-text responses to collect data on whether PAD is offered and the reasons for this; patient and parent eligibility criteria; training and support; and respondents?" views on the advantages and disadvantages of PAD. Analysis comprised simple descriptive statistics and simple content analysis of free-text responses.

RESULTS

Thirteen responses were received (response rate = 65%). Eleven respondents indicated their service offers PAD. Two respondents reported their service does not offer PAD due to alternative nurse outreach appointments (n = 1), and service resource limitations (n = 1), though another respondent indicated service cost savings. Twelve respondents regard PAD positively (n = 8) or very positively (n = 4). Most respondents reported that 10% or fewer parents refuse PAD when offered (n = 7). Perceived advantages of PAD included reduced travel burden (n = 9), patient better able to cope with dressing changes (n = 8), better school and work attendance for child and parent respectively (n = 6), and reduced financial impact on families (n = 4). No formal eligibility criteria for PAD are extant, though 5 respondents described informal criteria in place in their service, predominantly involving dressing frequency (n = 5), and size or complexity of wound (n = 4).

CONCLUSION

The survey indicates that most paediatric burns services support PAD. However, the absence of formal eligibility criteria, and informal criteria open to interpretation, risks inequity of support received by children and their families. Further research should evaluate whether this inequity extends to variable clinical outcomes to determine what works for who and under what circumstances when supporting parents in paediatric burns aftercare.

When Is Being Sad on the Burn Unit Pathological? Differential Diagnosis of Demoralization, Adjustment Disorder and Major Depressive Disorder in Burn Survivors

Many burn survivors have pre-existing psychiatric conditions or develop psychological or psychiatric symptoms over the course of their hospital stay. Patients often present with low mood and neurovegetative symptoms which can be conceptualized as demoralization, adjustment disorder, or major depressive disorder. We review the literature on these syndromes in burn survivors and present three cases that highlight the continuum of these syndromes for patients who present with symptoms of depression following a burn injury. We discuss the clinical challenges of differentiating these syndromes as well as psychotherapeutic and psychopharmacologic considerations and recommendations.

The Impact of the COVID-19 Pandemic on Social Workers at the Frontline: A Survey of Canadian Social Workers

Social workers are facing increasingly complex client needs during the coronavirus disease of 2019 (COVID-19) pandemic. Because of the social distancing requirements of the pandemic, social workers have undergone transformative changes in practice with the rapid uptake of virtual technologies. The objective of our study was to understand the experiences of social workers during the first-wave of the COVID-19 pandemic. We conducted a cross-sectional, web-based survey, comprised of close-ended and open-ended questions. Survey participants included social workers who were the members of a provincial social work association in Ontario, Canada. With n = 2,470 participants, the response rate was close to 40 per cent. Descriptive statistics were conducted on the close-ended questions. Two open-ended questions were coded using the thematic analysis. Nine themes were identified on the impact to social worker’s employment status: increased work-load; loss of employment; redeployment to new settings; early retirement; concern for personal health and safety; social workers in private practice seeing fewer clients; personal caregiving responsibilities; limiting recent graduates’ employment potential and social workers experiencing new opportunities. There were five themes on the impact on social work practice: clients with increasing complexities; challenges with transition to virtual care; benefits with transition to virtual care; adapting in-person services and personal well-being.

Developing a Delphi-Based Comprehensive Core Set from the International Classification of Functioning, Disability, and Health Framework for the Rehabilitation of Patients with Burn Injuries

Burn injuries cause disability and functional limitations in daily living. In a 2015 fire explosion in Taiwan, 499 young people sustained burn injuries. The construction of an effective and comprehensive rehabilitation program that enables patients to regain their previous function is imperative. The International Classification of Functioning, Disability, and Health (ICF) includes multiple dimensions that can contribute to meeting this goal. An ICF core set was developed in this study for Taiwanese patients with burns. A consensus process using three rounds of the Delphi technique was employed. A multidisciplinary team of 30 experts from various institutions was formed. The questionnaire used in this study comprised 162 ICF second-level categories relevant to burn injuries. A 5-point Likert scale was used, and participants assigned a weight to the effect of each category on daily activities after burns. The consensus among ratings was assessed using Spearman's ρ and semi-interquartile range indices. The core set for post-acute SCI was developed from categories that attained a mean score of ≥4.0 in the third round of the Delphi exercise. The core ICF set contained 68 categories. Of these, 19 comprised the component of body functions, 5 comprised body structures, 37 comprised activities and participation, and 7 comprised environmental factors. This preliminary core set offers a comprehensive system for disability assessment and verification following burn injury. The core set provides information for effective rehabilitation strategy setting for patients with burns. Further feasibility and validation studies are required in the future.

TBSA and length of stay impact quality of life following burn injury

INTRODUCTION

Burn injuries create physiologic, physical, and emotional effects acutely and long-lasting. Recovery is extensive and requires long-term care. Impaired function related to pain, deconditioning, weakness, and contracture formation are common. We sought to determine factors that impact quality of life (QOL) post recovery. Specifically, to assess whether Health Related QOL (HRQOL) decreases with increasing percent total body surface area (TBSA) and length of stay (LOS). We also explored QOL as a function of burn mechanism.

METHODS

Patients >18 years of age with >9.5% TBSA between 1 and 6 years post-burn injury were contacted by mail and asked if they were willing to participate. Those who agreed responded by returning their completed Burn Specific Health Scale-Brief (BSHS-B). Medical records were accessed to determine demographic and treatment information.

RESULTS

Statistical analysis revealed a strong correlation between total QOL (total score of BSHS-B) and LOS and TBSA. All domains were negatively correlated with increasing LOS and TBSA. LOS was most strongly correlated with decreasing work function and social function. There were no differences in QOL between burn mechanism.

CONCLUSIONS

QOL is greatly impacted by TBSA and LOS.More attention to body image and returning to work should be given, regardless of the type of burn mechanism.

Corrosive attacks in the UK - Psychosocial perspectives and decontamination strategies

Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to "maim, disfigure, torture or kill" [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.

Opening a Pandora's Box that can't be salvaged: Health professionals' perceptions of appearance-related care in an Australian pediatric specialist hospital

Many children and young people struggle adjusting to the psychosocial consequences (e.g., body dissatisfaction, social anxiety, and stigmatisation) of visible differences (or disfigurement). As appearance-affecting conditions often require specialist multidisciplinary team care, health professionals are in a unique position to offer psychosocial support and intervention. However, there is a dearth of literature on how appearance-related concerns are managed in pediatric hospital settings. Sixteen Australian specialist health professionals participated in semi-structured qualitative interviews to address this gap. Interviews explored current appearance-related psychosocial service provision, barriers in accessing appearance-related care, and perceptions of online platforms to deliver specialist support and intervention. Thematic analysis demonstrated four themes: We can do it better, Capability versus availability, Online generation, and Putting appearance on the agenda. This research highlighted the potential value of online platforms to increase accessibility to specialist appearance-related care, the need for more psychosocial resources to be integrated into appearance-related specialities, prioritising the development of low to medium appearance-related support and intervention, increasing the appearance-related knowledge of health professionals and families, and the need for more holistic approaches in routine care.

Supporting children with burns: Developing a UK parent-focused peer-informed website to support families of burn-injured children

BACKGROUND

Children's burn injuries can have a significant psychosocial impact on parents. However, the stress involved in caring for a child following a burn can often go unrecognized and does not necessarily prompt help seeking by parents.

OBJECTIVE

It is common for adults to seek health-related support and information via the Internet. Many benefit from immediate and easy access to online psychological interventions. A prototype burn-specific, parent-focused, peer-informed, supportive website, designed to provide easy access to information and psychoeducation, was created and tested for acceptability.

PATIENT INVOLVEMENT

Using a partnership-based method of website development, parents and professionals (clinical, academic and support organizations) were recruited and their particular expertise was acknowledged and valued. A participatory action approach was adopted to determine the acceptability of the website for parents/carers.

METHODS

31 participants (9 parents, 22 professionals) tested a prototype version of the website. Data was collected using the eHealth Impact Questionnaire and the concurrent think-aloud protocol.

RESULTS

Parents and professionals had favorable opinions of the website. Parents' ratings tended to be more favorable than professionals', which was significant for the information and presentation. Participants' thoughts were categorized into seven topics: need, structure/navigation, trust/relevance, language/comprehension, therapeutic content, mode of delivery, and suggested improvements.

DISCUSSION

Many practical and psychological barriers can prevent parents of burn-injured children accessing psychosocial support and contribute to a feeling of isolation. Participants felt that the website would be a valuable addition to UK pediatric burn care. The existence of an accessible resource could help to normalize parents' experience of their child's injury and reduce their perceived isolation, although peer interaction is not provided by the website.

PRACTICAL VALUE

This online resource, hosting information and peers' personal experiences, offers promising and exciting opportunities to empower parents whilst providing accessible supportive advice to encourage self-care and formal/informal support seeking when necessary.

Bringing research to the bedside: Knowledge translation in the mental health care of burns patients

Advances in surgical techniques and wound management have improved outcomes for burn patients; however, the psychological impacts on burn survivors have had less attention. There is a higher rate of mental health disorders amongst burns victims, with those with pre-existing mental health conditions likely to have worse outcomes. To implement effective burns care and rehabilitation, knowledge and understanding of mental health issues is required. This position paper discusses the extent to which clinicians currently translate knowledge around mental health and burns into practice to identify enables and inhibitors. Successful knowledge translation requires dissemination and accessibility of information with the capacity and readiness for change. Clinicians and researchers need to identify how translating research to practice can meet the needs of burn survivors. There is a gap in the utilization of evidence concerning mental health and the needs of burns survivors, and we need to understand what we know as compared to what we do. Clinicians are well placed to determine how and why knowledge does not necessarily translate to practice and how they can better accommodate the needs of burn survivors.

The provision of specialist psychosocial support for people with visible differences: A European survey

A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.

Risk factors for peri-traumatic distress and appearance concerns in burn-injured inpatients identified by a screening tool

INTRODUCTION

Psychosocial screening of burn-injured patients is a National Burn Care Guideline and is increasingly used to identify individuals most in need of support. It can also generate data that can inform our understanding of patient reported concerns following a burn injury.

METHOD

As part of routine care, 461 patients admitted to a burns unit were screened soon after admission using a psychosocial screen designed by the service. The questionnaire included items on pre-existing social support, coping, emotional and psychological difficulties, as well as current trauma symptoms and current level of concern about changed appearance following the burn.

RESULTS

Overall, patients reported low levels of appearance concerns (mean 3.7/10) and trauma symptoms (18% reporting flashbacks) in the initial days following a burn injury. In those who did report concerns, there were some significant associations with demographic and other variables. Patients who experienced flashbacks were younger and had a larger total body surface area (TBSA) burn. Higher levels of appearance concern were associated with younger women, larger TBSA and facial burns. However, the relationships found were weak and frequently confounded by other factors.

CONCLUSION

Overall, the findings indicate that initial trauma symptoms and appearance concerns are not inevitable in this group and there is no substitute for screening in identifying who is most at risk.

Parent-perceived isolation and barriers to psychosocial support: a qualitative study to investigate how peer support might help parents of burn-injured children

INTRODUCTION

Burn injuries can be traumatic and distressing for the affected child and family, with a prolonged period of recovery. This research explores parents' experiences of support following their child's injury and their thoughts on peer support specifically.

METHODS

Thirteen semi-structured interviews were conducted with parents/caregivers, a mean of three years after their child's injury, either face-to-face or remotely. Responses were analysed using thematic analysis.

RESULTS

Analysis produced four themes and 11 sub-themes. These described parents' experiences of loss, change, isolation and access to psychosocial support. This paper focuses on themes of isolation and parents' access to psychosocial support.

DISCUSSION

Findings indicate that parents access psychosocial support following their child's injury and often find it helpful; however, there is a prevailing sense of isolation. Parents often seek information online and find that this is lacking. Many parents reported that peer support would be valuable to them, particularly the sharing of experiential knowledge.

CONCLUSION

An online resource may be beneficial for parents, but further research is needed to confirm the exploratory data gained to date, ensuring that any resource developed would meet the identified needs of parents.

A qualitative exploration of psychosocial specialists' experiences of providing support in UK burn care services

INTRODUCTION

A burn can have a significant and long-lasting psychosocial impact on a patient and their family. The National Burn Care Standards (2013) recommend psychosocial support should be available in all UK burn services; however, little is known about how it is provided. The current study aimed to explore experiences of psychosocial specialists working in UK burn care, with a focus on the challenges they experience in their role.

METHODS

Semi-structured telephone interviews with eight psychosocial specialists (two psychotherapists and six clinical psychologists) who worked within UK burn care explored their experiences of providing support to patients and their families.

RESULTS AND DISCUSSION

Thematic analysis revealed two main themes: burn service-related experiences and challenges reflected health professionals having little time and resources to support all patients; reduced patient attendance due to them living large distances from service; psychosocial appointments being prioritised below wound-related treatments; and difficulties detecting patient needs with current outcome measures. Therapy-related experiences and challenges outlined the sociocultural and familial factors affecting engagement with support, difficulties treating patients with pre-existing mental health conditions within the burn service and individual differences in the stage at which patients are amenable to support.

CONCLUSION

Findings provide an insight into the experiences of psychosocial specialists working in UK burn care and suggest a number of ways in which psychosocial provision in the NHS burn service could be developed.