Online Program

Storytelling as Therapy: An Approach to Psychological Care for Gunshot Victims in the Acute Trauma Setting

Monday, November 2, 2015

Daniel Baldor, BA, MD/MPH Candidate Class of 2018, Miami Miller School of Medicine, University of Miami Miller School of Medicine, Miami, FL
Amy Maier, RN, ARNP, BSN, MSN, MD/MPH Candidate Class of 2018, University of Miami Miller School of Medicine, Miami, FL
Mathew Heller, BA, MD/MPH Candidate 2018, University of Miami Miller School of Medicine, Miami, FL
Efrain Gonzalez, Psy.D., M.S.ClinPharm, ABPP, Jackson Memorial Hospital, Miami, FL
Tanya Zakrison, MD, MHSc, FACS, FRCSC, MPH (c), Ryder Trauma Center, Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami, Miami, FL
Background / Purpose: Psychological care for gunshot victims (GSVs) in acute care settings is little studied and often limited. While GSVs may receive a referral for psychiatric services, many are not screened or given preventive care for acute psychological distress. Delays in treating acute psychological trauma may lead to increased risk for chronic mental health issues, such as Post-Traumatic Stress Disorder (PTSD).  Peer-to-peer storytelling is a validated approach for improving outcomes for diverse populations who face cultural barriers to care.  We propose to design a storytelling intervention that will i) initiate meaningful therapy for acute psychological trauma in GSVs and ii) identify the social determinants of health for gun violence in Miami, Florida.

Methods: To develop an evidenced-based intervention, a systematic literature review and semi-structured interviews with Clinical Psychologists and Trauma Surgeons at the Ryder Trauma Center were performed. An iterative process between clinicians and MD/MPH students occurred to develop this storytelling intervention. 

Results / Outcomes: Peer-to-peer storytelling may be a safe and effective psychological intervention for GSVs in the acute traumatic setting. We propose using audio stories from previous GSVs to be delivered to new victims in the acute setting, These stories should promote a sense of safety, calm, self- and community efficacy, connectedness, and hope. We will validate it with pre- and post- stress and locus-of-control testing in the acute setting and during surgical follow up.

Conclusions: Storytelling is a novel approach to address the sequelae of firearm-related violence in an acute trauma setting, which remains a significant nationwide public health issue.

Learning Areas:

Administer health education strategies, interventions and programs
Implementation of health education strategies, interventions and programs
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the gap in acute psychological care faced by victims of gun violence. Explain the idea of peer-to-peer storytelling as an effective means of overcoming cultural barriers in a clinical setting. Name several instances in which storytelling was used to successfully enhance care for at-risk populations. Explain the benefits of narrative storytelling in gathering data from at risk populations with at least three examples Identify guiding principles in managing stress reactions related to trauma in the acute setting.

Keyword(s): Violence & Injury Prevention, Data Collection and Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an MD/MPH student interested in the endemic nature of gun violence in the United States. I worked as a research assistant in both clinical and health policy settings prior to attending medical school. I also assisted research teams on human rights investigations in the medical field. I am a co-author on this project with 2 other MD/MPH students working with faculty. This study is my design.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.