“Resilience is the ability to capitalize on your personal strengths to overcome adversity and adapt to change.”  
Dr. Elizabeth Newlin
Psychiatry and Behavioral Sciences

Dr. Elizabeth Newlin wears many hats.  

Along with serving as Associate Professor and Vice Chair of Child and Adolescent Psychiatry at McGovern Medical School, she also leads Child and Adolescent Services at the UTHealth Harris County Psychiatric Center and helms the UT Physicians Child and Adolescent Psychiatry Outpatient Clinic. Almost one year ago, she added Associate Executive Director of UTHealth’s Trauma and Resilience Center (TRC) to her responsibilities.  TRC opened in Houston on March 27, 2018, and provides mental health care to children and adults who have experienced trauma, including veterans and their families, active duty members, first responders, natural disaster survivors (including survivors of Hurricane Harvey), survivors of sex trafficking, victims of acute physical injuries (such as burn victims), and domestic abuse victims. TRC’s team of psychiatrists, psychologists, social workers and licensed counselors also provide consultation to primary care physicians at UT Physicians clinics, which are affiliated with McGovern Medical School, throughout the region.  

We spoke to Dr. Newlin about her work helping trauma survivors heal and achieve resilience.

Dr. Newlin received her M.D. and completed an adult psychiatry residency as well as a child and adolescent psychiatry fellowship at The Medical University of South Carolina. She is board certified in both adult psychiatry and child and adolescent psychiatry.

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Texas Health Journal:  Tell me about the people that you care for at the Trauma and Resilience Center, and how that work has been impacted by Hurricane Harvey.

Elizabeth Newlin: We are working across the lifespan and with a diverse patient population. We have highly skilled child therapists capable of treating very young children up through the teenage years, and we have adult therapists who can work with our elderly patient population. We treat individuals who have experienced a range of traumatic exposures, including abuse, combat trauma, crime victimization, and natural disaster.

Approximately 20% of all trafficking victims in the United States travel through Texas, and we knew that sex trafficking only increases in the wake of a natural disaster like Hurricane Harvey. We have a cohort of child psychiatrists and therapists with expertise and experience helping youth and young adults recover from the traumas associated with commercial sexual exploitation and child sex trafficking.

We have treated many of those impacted by Hurricane Harvey.  Most patients who present to our providers with symptoms have many other stressors and traumas beyond the challenges of Hurricane Harvey—Harvey was just the straw that broke the camel’s back. For instance, if someone with financial security is impacted by a natural disaster, that person probably has the resources to get help early or to find good housing if his or her house was destroyed.  That person’s experience after Harvey will be dramatically different than someone who is in a lower socioeconomic situation.

Explain how UT Physicians primary care clinics are connecting patients to mental health services.

We anticipated that post-Harvey demand for behavioral health services was going to outstrip the available supply of services.  So, we were thinking about how we can meet this anticipated spike in demand in creative ways. Supporting primary care providers, educating primary care providers, and using technology were the ways that we approached the problem. Integrated clinics are primary care clinics that have behavioral health embedded in the clinic. UT Physicians has a system of primary care clinics around Houston, and our aim was to support our primary care providers in their efforts to meet the behavioral health needs of patients. We implemented a psychiatry consult line, so the UT Physicians primary care providers could call a psychiatrist for support and then initiate care right there while the patient is still in the office. This allows the patients to maintain the connection with their primary care provider and get needed care.

We also employed new technology to help direct patients to the appropriate mental health resources. One resource that we're bringing online now is an internet-based cognitive behavioral therapy program.  Within this program, a smart screener assesses for insomnia, anxiety, depression, substance abuse, pain, etc., and then directs the patient to the appropriate modules and resources within the internet-based program. We're deploying this to primary care providers so that they have something that's immediately available and accessible to all patients. After Hurricane Harvey, a lot of our patients didn't have a car, couldn't take off yet more days from work, etc. This is an intervention that’s completely portable and works on any kind of smartphone, laptop or personal computer.  A patient can download it while they're in the clinic or wait until they get home. It's something that they'll have access to wherever they go. And if patients have questions about how to utilize this resource, we have a mental health professional available that they can call for brief assistance.

What happens once a patient is referred to the TRC for treatment?

We first do an initial brief phone screening to discuss patient needs, and then people come in for an initial intake so we can get their history and make sure we can provide the services that they are seeking. Once we all determine that this will be a good partnership, they make an appointment with the person who will be their primary therapist, and, as needed, they may also see our psychiatrist. Sometimes an entire family will have been affected by Hurricane Harvey or another event, and each member of the family will be receiving care from a different provider at our clinic. We are able to provide team-based treatment, meaning we can offer multi-disciplinary comprehensive care for the patient or family, and the members of the multi-disciplinary team are communicating and coordinating their care as a team.  We offer a broad range of evidence-based therapies, which allows us to treat a wide range of patients.

How do you track whether patients are improving?

We do a baseline assessment and periodic reassessment of our patients’ symptoms so that we can ensure that our services are effective. We measure and collect patients’ responses on depression, trauma, and anxiety symptom scales at regular intervals to see if what we’re doing is helping the patient recover. Our new REDCap database helps us automate this data collection process so that we can track patients’ progress more accurately. We have been able to take pencil-and-paper psychological assessments and make them electronic so patient data is collected on an iPad, and then that information goes straight into our database.  And, with a lot of help from technical computer whizzes within our system, the database now has the capacity to “talk” with our electronic medical record. From our REDCap database, we can also email surveys to patients in a HIPAA-compliant way so that we can follow up with patients when they are unable to get to our office or after they have completed treatment. We are also able to graph a patient’s responses on the assessments over time so that we can show the patient that they are getting better, which helps to motivate them.

What is your definition of success for your patients?

Success for a patient often happens when they feel secure, supported, and satisfied in their relationships so that they can move forward in their lives and adapt to this ever-changing, often stressful world that we live in. I think resilience is the ability to capitalize on personal strengths to overcome adversity and adapt to change. What most promotes resilience are the relationships that we form—having reliable, accessible, trusting relationships is key.  A number of people who have experienced trauma find it difficult to trust because they have experienced loss or betrayal. Reducing symptoms is an important part of the work we do, and it requires technical skill and knowledge to achieve this aspect of our work with patients. But forming relationships with our patients that help to restore a sense of trust in others is so important in trauma work, especially with those who have experienced repeated trauma. Reducing an individual’s symptoms is not enough—we want to see our patients moving forward and reaching their own definition of recovery.

We have an incredible, talented team of professionals gathered in our Department and at the Trauma and Resilience Center. I feel very fortunate to be a part of McGovern Medical School at UTHealth in Houston. Every day that I come to work, I’m excited to see what we can do together next to move our discipline forward while serving our patients and our community.