Burn survivors living in poverty and who are over-representation in the burn population have the compounded impact of financial insecurity during this distressing time. Social workers serve a particularly critical role to mitigate the costs of long-term hospitalization, treatment, and the lengthy recovery process. Despite the importance of social workers in burn centers, and especially with more economically vulnerable patients, limited data are available regarding the current system of service provision and patient strengths. In order to assure adequate treatment delivery, it is imperative to first understand the current landscape of services in burn centers. This qualitative study centers on increasing knowledge of burn survivors’ resilience factors, in addition to the skills, barriers and resources in burn treatment.
Methods. Individual qualitative interviews were conducted with social workers (N = 11) who are currently employed in burn centers. Participants were recruited via purposive and snowball sampling until data saturation was achieved. Interviews were audio-recorded and transcribed verbatim. Analysis applied grounded theory strategies for inductive thematic analysis. Two research team members coded the transcribed interviews using NVivo 12. Code lists were incrementally developed and merged. Codes were then grouped into relevant categories, with the coders discussing the few discrepancies. Once consensus was reached, the resultant themes and sub-themes were finalized.
Results. Factors influencing social work in burn centers focused on three key areas: (1) Skills. Ability to build trust, assessment, support, communication, case management, trauma skills, medical knowledge, adaptability, empathy, advocacy, respect for patient autonomy, recognition of transference/counter-transference and self-care. (2) Barriers. Finances, lack of burn-trained community providers, large catchment areas, unstable support systems, premorbid mental illness, substance abuse, lack of sufficient insurance coverage, transportation insecurity and prolonged burn recovery. (3) Resources. Patient resilience, Phoenix Society, burn foundations, hospital and Red Cross programming, stable patient support systems, support from burn survivor and patients’ home communities.
Conclusions and Implications. Advancements in burn care have enabled burn patients to survive even the most devastating injuries that will likely leave them with disfigurement and disability, In addition to traditional skills, interdisciplinary burn care requires discrete skills that are unique to the needs of burn patients. Survivors living in poverty and those returning to rural, under-served communities frequently lack access to important services available in their catchment area. Findings are pertinent to informing strengths of survivors and requisite skills for social workers addressing needs of patients who encounter health disparities and psychosocial challenges living in poverty and rural/under-served communities. Future research should center on the perceptions of burn survivors regarding their strengths, challenges, and needs.