For human needs, some veterinary clinics are turning to a professional

Veterinary practice can be fraught with emotional situations, whether it’s family members struggling with the decision to euthanize their dog or a client who has threatened violence. The reality is most veterinarians and their staff aren’t qualified to deal with these predicaments but often are put in that position. In contrast, social workers are trained to work with humans, and some have started to make the case to veterinary practices that hiring a licensed social work professional is not only helpful for clients and staff but also a smart business move.

Sandra Brackenridge, a licensed clinical social worker, outlined how she helped one practice start a veterinary social work internship, during the Association of American Veterinary Medical Colleges’ Veterinary Wellness and Social Work Summit, held Nov. 2-3, 2015, in Knoxville, Tennessee.

Client support

Brackenridge is an associate professor with the Social Work Program at Texas Woman’s University. She has mentored interns at the Center for Veterinary Specialty and Emergency Care in Lewisville, Texas, for a few years. Before that, she worked and consulted in many veterinary settings.

She first approached the center’s hospital administrator, Alison McClune, with the idea of a veterinary social work internship after owner Dr. Julie Ducoté started a grief support group for clients. Dr. Ducoté and McClune agreed to give it a shot.

“Our practice is a pretty large multispecialty one with 24-hour emergency care and other specialties. We see a lot of patients that are really sick, unfortunately. A lot of our clients are put in very difficult, very emotionally charged situations that put stress on these people, so client support was the first aspect we were looking for,” from the social work interns, Dr. Ducoté said.

The program worked out so well, in fact, that one of the interns, Brittany McPherson, who started as a veterinary social work intern at the center early last year while working toward her bachelor’s, was hired full-time last spring.

“At the end of every leash is a human, and every person who walks into the clinic has a unique set of circumstances and bond to their animal which influence their treatment decisions. My work’s important because as a social worker, I am trained to know how to take all these factors into account when working with clients,” McPherson said.

Often her work begins where the clinician’s ends.

“Some of Brittany’s work is hand holding while the client makes a tough decision or talking with them about whether it’s time for euthanasia. Sometimes it’s them dealing with the grief or trauma. She can support the client while we worry about taking care of the patient,” Dr. Ducoté said.

McPherson will also contact owners after they have lost a pet to offer condolences and make them aware of the grief support group. “Some want to talk or meet up or go to the support group. Some clients don’t want to talk at all, but that’s rare when people do that,” Dr. Ducoté said.

Clients who need more substantial therapy can be referred to a licensed counselor. 

Brackenridge says the human-animal bond can be intense and manifest as highly charged emotions in owners who bring in their animal for specialty treatment. Veterinarians aren’t trained or equipped to counsel an emotional client the way social workers are.

“We have one to two clients a week say they will kill themselves if their pet dies. Do practices follow up with distraught clients enough?” she asked.

“A social worker can come in and have a difficult, lengthy conversation with clients that doctors don’t have time for. You can schedule these, too, because the doctor knows when a client is coming in for a (medical) consult.”

Helping the helpers

Something McPherson has learned along the way is how much the center’s staff needs her support, too.

“Working in a veterinary setting is very stressful. I didn’t realize how much that is true until I came here. I mean, how much time and dedication and love are put into every patient is amazing,” McPherson said. “I focused on clients more in the beginning, but the more time I spent with veterinarians, just by hanging out with them and seeing what they do or walking alongside them, I’m learning to promote more wellness and support for them along the way.”

Brackenridge has given workshops for employees on compassion fatigue and stress management. McPherson and the interns are also trained and supervised by Brackenridge to give individual 20- to 30-minute, confidential debriefing sessions. Brackenridge says these are not a substitute for professional counseling but are helpful in preventing compassion fatigue.

Dr. Ducoté said, “If I’ve had a difficult week where I’ve euthanized three dogs, and a client yelled at me, and I’m doing everything for another dog and it’s not improving. ... I can talk about what’s on my mind and reflect with a social worker. We can talk about why a situation is bothering me and what I can do about it or how I can handle my stress levels. Having that conversation is huge, for me at least, and helpful for my employees, too.”

She’s considering making semi-regular debriefings a requirement of employment “because I truly see every single person who works here—from the customer service representative to the technician or assistant—is exposed to stressful situations on an hourly basis.”

Brackenridge agrees. She says the center averages about three euthanasias a day but can perform as many as nine during busy times.

“How is a veterinary professional supposed to deal with that?” Brackenridge questioned. “Often, veterinarians go from one client to the next, and they don’t get to process their feelings.”

Dr. Ducoté adds that having a veterinary social worker in a practice doesn’t mean veterinarians shouldn’t communicate well with clients, either. Instead, the two professionals should work hand in hand.

“There are still times when there’s a client who only wants to talk to the veterinarian or when the social worker isn’t here. I am a firm believer in communication skills for veterinarians. I don’t think we learn that enough in school, and a lot of us suffer from that. So, I don’t think having a social worker replaces that. It’s an asset to help us with the more challenging situations,” Dr. Ducoté said.

She gave the example of a cat with a malignant tumor. It’s Dr. Ducoté’s responsibility to tell her client the cat has cancer, go over the options, and allow the client time to absorb the information and make a decision.

“We’ll have to have a conversation and be supportive of the client’s feelings and emotions, and perhaps after that, as the owner is coming to grips and making a decision, that’s where the social worker can come in and help, but we will have to have a follow-up conversation about the prognosis and treatment plan,” Dr. Ducoté said.

Making it work

McPherson’s position at the center is salaried, and clients aren’t charged for any social work services. Internships cost the center nothing. Two more interns were scheduled to start at the center after the holidays, and Dr. Ducoté says she hopes the internship program can continue for the foreseeable future.

Brackenridge acknowledges that hiring a social worker is an added cost that might not be feasible for smaller practices; however, she suggests that several clinics could share a contracted veterinary social worker who spends one day a week at each practice, for example.

“I don’t think veterinarians know how much it will cost to hire a social worker. They may think they’re paying for another surgeon. If they pay for a social worker one day a week, that’s not going to make them declare bankruptcy,” she said.

Brackenridge recommends that practices establish a relationship with a local university that has a social work program to find potential internship candidates. She says most veterinary colleges already offer pet loss and similar services from a social worker or counselor at veterinary teaching hospitals.

“Having a social worker really strengthens marketability to clients but also to potential staff,” she said.

Dr. Ducoté says although multidoctor and emergency practices with high case loads and intense situations are good candidates for a social worker on staff, a practice need not be huge or provide specialty services to benefit from a social worker.

Besides marketability, other benefits are that clients feel their human needs are taken care of, and they are more likely to return. It’s also a unique service that has helped the Center for Veterinary Specialty and Emergency Care stand out from other specialty practices. And having a social worker frees up clinical staff members to do their work.

Dr. Ducoté said, “When we looked at how much support to clients she’s providing, it helps free up a lot of time for veterinarians and support staff to be focusing on patients and seeing the next patient rather than sitting and doing client support all the time. So although there’s a cost for her salary, that’s definitely offset by the increased productivity of veterinarians and staff to focus on care.”

Possible services offered by social workers at veterinary clinics:

• Supportive counseling, grief support and counseling, and help with end-of-life decision-making as well as follow-up.
• Advocacy and brokering of resources.
• Reading materials and educational packets.
• Crisis intervention.
• Assessment of suicidal tendencies, mental health issues, and domestic violence issues.
• Facilitation of a pet loss support group for hospital clientele and the community.
• Debriefing sessions for staff.
• Consultation about clients and follow-up.
• Presentations to staff.
• Referral for outside mental health services for staff.
• Recommendations to administrators.
• Improvements to client comfort on-site.

Steps in informal debriefing of a staff member by a social worker:

• Review what happened.
• Ask about his or her perspective and what was overwhelming about the situation.
• Reinforce positive actions taken and what he or she thought was effective.
• Ask what he or she learned about himself or herself as a person or as a professional.
• Find out whether he or she would do something differently next time and whether anything could improve future situations.
• Provide resources or suggestions for stress management.

Sandra Brackenridge welcomes veterinarians at practices interested in starting a veterinary social worker internship or paid position to contact her at SBrackenridgemail [dot] twu [dot] edu (SBrackenridge[at]mail[dot]twu[dot]edu) so that she may refer them or train a veterinary social worker for them. In addition, the University of Tennessee College of Social Work offers a certification program in veterinary social work as an option within its master’s degree program. Visit www.vetsocialwork.utk.edu or email vetsocialworkutk [dot] edu (vetsocialwork[at]utk[dot]edu).

Related JAVMA links:

Addressing human needs (Dec. 15, 2010)