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RRP 08-383 – HSR&D Study

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RRP 08-383
Team Based Initiative Support
Linda Olivia Nichols PhD
Memphis VA Medical Center, Memphis, TN
Memphis, TN
Funding Period: October 2008 - March 2009

BACKGROUND/RATIONALE:
Approximately 18% of Veterans returning from Afghanistan and Iraq (Operation Enduring Freedom/Operation Iraqi Freedom, OEF/OIF) have mild traumatic brain injury (TBI). Physical symptoms of mild TBI are often inconsistent, and, for Veterans, determining the effects of PTSD, depression and TBI is complex. However, research with adults with mild TBI has shown that about 40% have difficulty in returning to work.

OBJECTIVE(S):
The original objective of this small pilot study was to expand family support systems of rural National Guard families of OEF/OIF Veterans with recently diagnosed moderate-severe TBI. A secondary objective was to provide information on TBI to families and volunteers.

METHODS:
The project coach met the family in the home to identify unmet needs and to determine availability of family and friends who could help meet needs. The coach provided training about TBI and a Caregiver Resource Book with information on TBI diagnosis, prognosis, and symptoms. There were baseline, monthly, and study end qualitative interviews with the family focusing on concerns and issues.

FINDINGS/RESULTS:
Fifteen families were referred; TBI severity levels were mainly mild. Of the 6 families enrolled, 4 completed the study. Two Veterans had moderate TBI and all had co-morbid post traumatic stress disorder diagnoses. All lived in rural communities. The Veterans were 1 to 5 years post-injury and support systems were already in place, although these systems were small. Families did not want to expand their support systems because of privacy concerns, desire for independence, and negative employment repercussions if the extent of the TBI deficit became known in the community. Most Veterans were still employed, despite TBI deficits. However, the project identified that families had substantial needs for information about the condition and its prognosis and sequelae (e.g., why things happen, unsafe/frightening behaviors, work, finances, communication changes) and the availability and types of services (e.g., who to contact, benefits, help needed). Families often reported difficulty in negotiating the DoD and VA systems.

IMPACT:
Families and the Veteran may not be ready to accept the diagnosis when it first occurs. For this group of rural TBI Veterans and their families, families identified a need for just-in-time information on TBI, its consequences, and services available. The delicate balance between return to full functioning as a community member and the deficits of TBI is threatened by family independence, privacy needs, and fear of loss of employment. The study identified opportunities for community education and for coordination between the military and VHA.

PUBLICATIONS:
None at this time.


DRA: Military and Environmental Exposures, Acute and Combat-Related Injury
DRE: none
Keywords: Caregivers – not professionals, Traumatic Brain Injury
MeSH Terms: none

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