An evaluation of clinical psychology input into burns multidisciplinary follow-up clinics

Abstract

Introduction Research highlights the complex psychological needs that patients and their families can face following a burn injury, regardless of the objective severity of the injury and often beyond the timeframe of physical healing. Identification of psychological needs at different stages post-burn recovery is therefore a key role of clinical psychologists working in burn care services. Method This paper presents audit data collected across a two-year period in routine paediatric and adult multidisciplinary team follow-up clinics in a UK burns service. 808 clinical contacts (331 adults, 477 paediatrics) were recorded. Data gathered related to the identification of patient and/or family psychological need and the level of psychology input within clinic. Results For 43% of adult patients and 46% of paediatric patients seen in clinic, some degree of psychological need for the patient and/or family was identified during the consultation. A large majority of concerns related directly to the burn injury. This is consistent with previous research into the psychological impact of burns. Even for patients with no identified psychological needs, psychology presence enabled the opportunity for brief screening, preventative advice or signposting to take place during clinic. Discussion A substantial number of individuals and families presented with some level of psychological concern in relation to a burn injury when attending burns multidisciplinary team follow-up clinics. Conclusion A substantial number of patients and families presented with psychological needs in relation to a burn injury when attending burns MDT follow-up clinics. The presence of Clinical Psychologists at burns MDT follow-up clinics is beneficial for the identification of burns and non-burns related psychological concerns and is a valuable use of psychological resources within a burns service. Lay Summary The Regional Burns Centre holds regular outpatient scar clinics to monitor recovery and healing. As well as the medical professionals, the clinics are joined by Clinical Psychologists who can assess, refer, and support individuals struggling with their burn or scarring on a mental level. Over 15 months, data was collected about patients attending the clinics and the involvement of the psychologists. 43% of adult patients and 46% of paediatric patients were identified as having some psychological need, either related to their burn or to other aspects of their life. This demonstrates the benefits of having psychology presence within scar clinics, as nearly half of the patients seen in clinic received an assessment and further support (such as signposting and referrals to psychological support). Burns staff also felt that psychology presence enhanced conversations and increased collaboration with decision making around treatment.

Understanding the Barriers and Enablers for Seeking Psychological Support Following a Burn Injury

“…Therefore, there may be value in implementing follow-up psychosocial screenings at multiple stages of a burn patients' treatment [11,31]. One study found that the presence of psychologists at outpatient appointments enabled the identification and treatment of burn-related psychological concerns that were not met earlier in the treatment pathway [32]. Consistently, most participants in this study suggested that increasing psychological presence following discharge and during outpatient appointments would facilitate access.…”

Psychosocial Screening in Adult Burns Inpatients within a Scottish Burns Unit

“…Psychosocial screening in the adult burns patient population is recommended to allow psychological care to be preventative by identifying those with arising psychosocial difficulties and to help normalise psychological reactions after a burns injury [10]. Screening has been found to be feasible to implement and can identify distress amongst patients from the early stages of hospitalisation [10] to outpatient settings [11,12].…”

“…NBCS recommend that appropriate treatment should be given based on psychosocial needs identified through screening [1]. Three levels of psychological care have been identified: (1) basic screening and gauging psychological need; (2) psychological assessment, psychoeducation and low-level intervention such as emotional care; (3) psychological therapy and signposting to other appropriate services [10,12]. Utilising a tiered approach to assessing and supporting psychological needs throughout the pathway can embed clinical psychology within burns multidisciplinary teams (MDT) and highlight its value [12].…”