Team Based Initiative Support

Background/Rationale: Traumatic brain injury (TBI) has been called the signature injury of the Iraq War. This pilot study was an investigation of the feasibility of volunteer support teams for families providing care to a returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veteran with TBI. Volunteer support teams coordinate tasks and effort for family and volunteers. This support model is particularly relevant for families in rural areas that are likely to be under-funded in home and community services.

Objectives: The original study objective was to determine feasibility of, and barriers to, implementing volunteer support teams with rural families of OEF/OIF veterans with recently diagnosed moderate-severe TBI. A secondary objective was to provide information on TBI to families and volunteers.

Methodology: 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 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.

Findings/Result: Fifteen families were referred; TBI levels were mainly mild. Six families were enrolled. Two Veterans had moderate TBI and all had comorbid 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 implement caregiving teams because of privacy concerns, desire for independence, and negative employment repercussions if the extent of the TBI deficit became known in the community. Most 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 feeling lost in negotiating the DoD and VA systems.

Impact: Issues and concerns for rural, mild TBI veterans and their families were identified. Families and the Veteran may not be ready to accept the diagnosis when it first occurs. Families and the veteran 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.