title: The Role of Social Work in Providing Mental Health Services and Care Coordination in an Urban Trauma Center Emergency Department.
abstract: This study examined the role of emergency department (ED) social workers and identified predictors of receipt of social work services and length of ED stay.
  
  
  
  Comprehensive reviews were conducted of medical records of all patients (N=49,354) treated in a level 1 trauma center ED from January 1, 2012, to March 31, 2013. Content analysis of chart notes was used to categorize the types of social work services provided. Poisson regression was used to assess associations between demographic and clinical characteristics, receipt of social work services, and length of ED stay.
  
  
  
  Social work services were provided to 18,532 (38%) patients. Most were mental health services (54%), followed by care coordination (31%) and material support or other referrals (15%). Patients seen by social workers had complex presentations, involving mental disorder diagnoses (18%), substance use disorder diagnoses (29%), comorbid diagnoses (32%), and injuries (51%); a quarter of patients had multiple ED visits (26%). In adjusted regression analysis, females (relative risk [RR]=1.15), patients not discharged home (RR=1.44), and those with two or more comorbid diagnoses (RR=1.80), injuries due to assault (RR=1.37), and traumatic brain injury (RR=1.20) were more likely to receive social work services. Such services were associated with an increased length of ED stay (RR=1.34).
  
  
  
  Social workers provided services to patients with multifaceted needs resulting from complex presentations. Provision of social work services modestly increased length of ED stay. Triage algorithms are needed to target efficiencies, systematize provision of ED social work services, and improve access to services for all patients.
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Megan
authors.initials: M
authors.lastname: Moore
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Whiteside
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Danae
authors.initials: D
authors.lastname: Dotolo
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Leyna
authors.initials: L
authors.lastname: Ho
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Conley
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Mollie
authors.initials: M
authors.lastname: Forrester
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Susan O
authors.initials: SO
authors.lastname: Fouts
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.affiliation: Dr. Moore, Ms. Dotolo, and Ms. Ho are with the School of Social Work, University of Washington, Seattle (e-mail: mm99@uw.edu ). Dr. Moore is also with the Harborview Injury Prevention and Research Center, University of Washington, Seattle, where Dr. Whiteside, Dr. Wang, Dr. Vavilala, and Dr. Zatzick are affiliated. Dr. Whiteside is also with the Department of Emergency Medicine; Ms. Conley, Ms. Forrester, and Ms. Fouts are with the Harborview Department of Social Work; Dr. Vavilala is also with the Department of Anesthesiology and Pain Medicine; and Dr. Zatzick is also with the Department of Psychiatry and Behavioral Sciences, all at the University of Washington, Seattle.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D012044:Regression Analysis; D012949:Social Work, Psychiatric / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014193:Trauma Centers; D014218:Triage / Q000706:statistics & numerical data*; D014861:Washington; D055815:Young Adult