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Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study. Arch Phys Med Rehabil 2023; 104:380-389. [PMID: 36265532 DOI: 10.1016/j.apmr.2022.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. DESIGN Qualitative descriptive study guided by an access to health care services conceptual framework. SETTING Five Veterans Affairs (VA) polytrauma rehabilitation centers. PARTICIPANTS SMVs (N=55, including 10 caregivers as proxies) ≥2 years post-TBI recruited from the VA TBI Model Systems and grouped by TBI severity (mild/moderate, severe). MAIN OUTCOME MEASURES Barriers and facilitators accessing care. RESULTS The main facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate health care, family advocates who promoted engagement in health care, ability to use government and community facilities, and online resources or equipment. Distance to services was uniformly identified as a main barrier for both patient groups. However, facilitators and barriers to health care access differed by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations in promoting health care engagement and the availability of VA specialty residential programs in meeting health care needs. Having unrecognized health care needs in chronic stages and communication difficulties with providers were more commonplace for those with greater TBI severity and affected quality of care. Those with mild/moderate TBI highlighted challenges associated with paying for services in the community and scheduling of services. CONCLUSIONS Barriers and facilitators exist across multiple dimensions of a health care access framework and vary by TBI severity. Results suggest possible mechanistic links between health care access and SMV health outcomes. Findings support current policy and practice efforts to facilitate health care access for SMVs with TBI but highlight the need for tailored approaches for those with greater disability.
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Schulz RN, Jannace KC, Hisle-Gorman EJ, Pasquina PF. Retrospective Examination of Service Dog Training Program Participation and Mental Healthcare Utilization. Arch Phys Med Rehabil 2023; 104:237-244. [PMID: 35917950 DOI: 10.1016/j.apmr.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the association between Service Dog Training Program (SDTP) participation and mental health care utilization. DESIGN Retrospective cohort study. SETTING Outpatient rehabilitation clinic at a large military treatment facility. PARTICIPANTS Military Health System beneficiaries who attended at least 1 SDTP session at a large military treatment facility (N=597). SDTP program enrollment records identified participants. INTERVENTION The SDTP, a unique application of animal-assisted therapy, is intended to improve the mental and cognitive health for individuals with war-related trauma. MAIN OUTCOME MEASURES Negative binomial regression calculated the associations between the SDTP participation rate and 2 mental health care utilization outcomes: mental health encounter days and psychotropic medication months' supply. RESULTS Most of the 597 participants were male, enlisted service members, and aged 25-34 years. Approximately 46% had a posttraumatic stress disorder diagnosis, 21% had a traumatic brain injury diagnosis, 47% had an opioid prescription, and 58% had a sleep aid prescription pre-SDTP participation. Participation was categorized into low (≤1 sessions), medium (>1 and ≤2 sessions), and high (>2 sessions) monthly participation. In adjusted analysis, high monthly SDTP participation was associated with 18% fewer post-SDTP mental health encounter days (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.68-0.96) than low monthly SDTP participation. High monthly SDTP participation was also associated with a 22% fewer post-SDTP psychotropic prescription months' supply (RR, 0.78; 95% CI, 0.64-0.95) than low monthly SDTP participation in adjusted analysis. CONCLUSIONS Results suggest that participants who attend more than 2 SDTP sessions monthly encounter mental health care differently post SDTP than participants who attended 1 or fewer monthly sessions. Adjunct therapies, such as the SDTP, may offer patients a nonstigmatizing way to engage in mental health care.
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Affiliation(s)
- Rebecca N Schulz
- Uniformed Services University of Health Sciences, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
| | - Kalyn C Jannace
- Uniformed Services University of Health Sciences, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Paul F Pasquina
- Uniformed Services University of Health Sciences, Bethesda, Maryland; Walter Reed National Military Medical Center, Bethesda, Maryland
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Eliacin J, Fortney SK, Rattray NA, Kean J. Patients' and caregivers' perspectives on healthcare navigation in Central Indiana, USA after brain injury. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:988-997. [PMID: 33471969 DOI: 10.1111/hsc.13275] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Little research has documented the experiences of patients with traumatic brain injury (TBI) and their caregivers in navigating health systems for TBI care. In this qualitative study, we conducted semi-structured interviews with 62 participants (34 patients with moderate or severe TBI and 28 caregivers) from Central Indiana. Data were collected from January to September 2016 and analysed using a constructivist grounded theory approach. Participants discussed three significant challenges about navigating health services for TBI care: lack of support for care navigation, financial barriers, and communication barriers. Participants described how navigating outpatient healthcare services for TBI remains complex and emphasised the need for ongoing care navigation support throughout the care continuum. They detailed the long-term financial burden of TBI including high treatment costs, limited insurance coverage, and the emotional toll that financial stress has on their ability to navigate healthcare services for ongoing TBI-related needs. They also discussed how ineffective patient-provider communication and lack of reliable, timely and comprehensive health information about TBI limited their engagement in and navigation of TBI health services. Findings suggest that persons with TBI and their caregivers need ongoing support to manage the long-term impacts of TBI. Efforts to provide care coordination and navigation to patients with TBI and their families are urgently needed to facilitate greater access to care, effective healthcare navigation and improved health outcomes.
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Affiliation(s)
- Johanne Eliacin
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc. Indianapolis, IN, USA
- Act Center of Indiana, Indianapolis, IN, USA
| | - Sarah K Fortney
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Department of Anthropology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Jacob Kean
- Informatics, Decision-Enhancement and Analytic Sciences Center, Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, UT, USA
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Miley AE, Elleman CB, Chiu RY, Moscato EL, Fisher AP, Slomine BS, Kirkwood MW, Baum KT, Walsh KE, Wade SL. Professional stakeholders' perceptions of barriers to behavioral health care following pediatric traumatic brain injury. Brain Inj 2022; 36:536-543. [PMID: 35113744 DOI: 10.1080/02699052.2022.2034956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine professional stakeholders' perspectives of barriers to behavioral health care (BHC) follow-up and telepsychology after pediatric traumatic brain injury (TBI). METHODS Twenty-nine professionals participated in a focus group (FG) or key informant interview (KII) between January and March 2020. Professionals answered questions about facilitators and barriers to BHC follow-up and telepsychology. Given widespread telepsychology implementation since COVID-19, a follow-up survey assessing telehealth perceptions since the pandemic was sent out in December 2020. Nineteen professionals completed the survey. RESULTS Professionals identified individual (e.g., family factors, insurance coverage/finances, transportation/distance, availability, planning follow-up care) and system-level (e.g., lack of access to BHC providers) barriers to BHC post-injury. Possible solutions, like collaborative follow-up care, were also identified. Generally, clinical professionals have favorable impressions of telepsychology and utilized services as a delivery modality for clinical care. Though telepsychology could reduce barriers to care, professionals also expressed concerns (e.g., technology issues, security/safety) and challenges (e.g., funding, accessibility, training/licensure for clinicians) with implementing telepsychology. CONCLUSION Barriers identified highlight the need for context-specific solutions to increase BHC access, with telepsychology generally recognized as a beneficial modality for BHC. Future work should continue to focus on understanding barriers to BHC and potential solutions after pediatric TBI.
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Affiliation(s)
- Aimee E Miley
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chloe B Elleman
- Department of Undergraduate Education- Medical Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel Y Chiu
- Department of Psychology, Northwestern University, Evanston, Indiana, USA
| | - Emily L Moscato
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Allison P Fisher
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Beth S Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine, Aurora, Illinois, USA.,Department of Rehabilitation Medicine, Children's Hospital Colorado, Aurora, Illinois, USA
| | - Katherine T Baum
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen E Walsh
- Department of Pediatrics, Harvard Medical School, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Shari L Wade
- Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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McIntire KL, Crawford KM, Perrin PB, Sestak JL, Aman K, Walter LA, Page DB, Wen H, Randolph BO, Brunner RC, Novack TL, Niemeier JP. Factors Increasing Risk of Suicide after Traumatic Brain Injury: A State-of-the-Science Review of Military and Civilian Studies. Brain Inj 2021; 35:151-163. [PMID: 33460350 DOI: 10.1080/02699052.2020.1861656] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective: Survey TBI literature to identify evidence of risk for post-injury suicide.Literature Selection: Search terms ((traumatic brain injury OR TBI) AND (suicidality OR suicidal behaviour OR suicidal ideation)) entered in PubMed, OVID Medline, PsychInfo, and Web of Science for papers published in print 01/01/1997 to 06/30/2019.Analysis of Literature: Authors screened abstracts, excluding duplicates and articles not meeting inclusion/exclusion criteria. Full papers were reviewed to make final exclusions. Data were extracted from 40 papers included co- and premorbid disorders, demographics, injury-related and psychological factors.Results: Persons with TBI have a higher risk for suicide than the general population. Reviewed articles reported comorbid depression and/or PTSD as risk factors for post-TBI suicide. Co- or premorbid substance misuse, sex, and sleep disturbance moderate risk. Quality of the literature was limited by sample size, the predominance of male participants, and inconsistency in reporting of findings.Conclusions: Comorbid depression and PTSD are significant post-TBI risk factors for suicide. Several variables combine to moderate or mediate TBI's connection with suicide. Civilian and military clinician cross-talk and consistent reporting of results from reproducible studies of post-TBI suicide risk factors could improve prevention and treatment efforts in veterans and civilians.
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Affiliation(s)
- Kayla L McIntire
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Kelly M Crawford
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center (Atrium Health System), Charlotte, North Carolina, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordan L Sestak
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center (Atrium Health System), Charlotte, North Carolina, USA
| | - Kyle Aman
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Lauren A Walter
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - David B Page
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Brittney O Randolph
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Tom L Novack
- Department of Physical Therapy, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Janet P Niemeier
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
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Mamon D, Scoglio AAJ, Calixte RM, Tuval-Mashiach R, Patton B, Drebing CE. Connecting Veterans and Their Community Through Narrative: Pilot Data on a Community Strengthening Intervention. Community Ment Health J 2020; 56:804-813. [PMID: 31907805 DOI: 10.1007/s10597-019-00540-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
Military personnel transitioning to civilian life commonly report difficulty with establishing friendships, reconnecting with family, and a greater sense that they do not "fit in." Personal narrative interventions have the potential to increase the community's interest and understanding of Veterans' experience. This study examines the impact of a narrative intervention in which Veterans used film or verbal storytelling to describe their experience of being a Veteran to civilian audiences. A total 12 Veterans participated in at least one performance, and 88 community audience members attended one of six performances of the Veterans' narratives. Survey data indicate increase in positive attitudes towards Veterans, as well as a shift in the Veterans' perspective of civilians as receptive and supportive. These preliminary findings suggest that narrative interventions appear to have a positive impact on civilians' interest in Veterans and therefore, may be a valuable community reintegration intervention.
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Affiliation(s)
- Daria Mamon
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program and Harvard Medical School, Boston, MA, USA. .,The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA. .,One Constitution Wharf, Suite 140, Charlestown, MA, 02129, USA.
| | - Arielle A J Scoglio
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | - Rachelle M Calixte
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | | | | | - Charles E Drebing
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
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Rao VA, Bechtold KT, Arciniegas DB, Samus QM, Albrecht J, Pugh BT, Jacoby A, Buenaver L. Establishment of a Patient-Centered Outcomes Research Network for Individuals with TBI and Neuropsychiatric Symptoms. Brain Inj 2020; 34:548-555. [PMID: 32050805 DOI: 10.1080/02699052.2020.1725980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: The overarching goal of this project was to establish a group comprised of a variety of TBI stakeholders for the purpose of: (1) determining facilitators and barriers in management of neuropsychiatric symptoms after TBI; (2) identifying strategies for maintaining a TBI PCOR network; (3) enumerating research topics related to TBI neuropsychiatry; and (4) highlighting policy changes related to TBI neuropsychiatry.Methods: Twenty-nine TBI stakeholders participated in focus group discussions. Qualitative analyses were conducted both manually and using Dedoose software.Results: Participant-identified barriers included stigma associated with experiencing neuropsychiatric symptoms and poor insurance coverage. Facilitators included treatment focused on education of neuropsychiatric symptoms after TBI and having a comprehensive caregiver plan. Best strategies for maintaining TBI PCOR network included having a well-defined project, continued regular meetings, and on-going education of network members. Pertinent research topics included TBI and aging, factors influencing outcomes after TBI, substance use disorders related to TBI, and effectiveness of telemental health services. Needed policy changes included making TBI neuropsychiatry education accessible to stakeholders and improving accessibility of TBI neuropsychiatric care.Conclusion: TBI stakeholders identified several facilitators of care for neuropsychiatric symptoms after TBI and suggested research topics and best practices for conducting PCOR in this area.
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Affiliation(s)
- Vani A Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kathleen T Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - David B Arciniegas
- Marcus Institute for Brain Health, University of Colorado School of Medicine, Baltimore, USA
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jennifer Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Bryan T Pugh
- Brain Injury Association of Maryland, Baltimore, USA
| | - Aaron Jacoby
- VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, USA
| | - Luis Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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Veteran Coffee Socials: A Community-Building Strategy for Enhancing Community Reintegration of Veterans. Community Ment Health J 2018; 54:1189-1197. [PMID: 29948629 DOI: 10.1007/s10597-018-0288-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
Veterans transitioning from military to civilian life are vulnerable to a loss of social support and an increase in isolation from their communities, which can exacerbate other difficulties they may be experiencing, such as physical or mental health problems. Veteran Coffee Socials are an innovative community-building pilot intervention designed to foster social support and community between veterans. In seven target communities, certified peer specialists initiated and facilitated weekly "Veteran Coffee Socials"-open peer support groups for veterans, held in local coffee shop or restaurants. Over a 9-month period, an average of 8.5 veterans attended each meeting, for a total of 2236 veteran engagements across seven towns. A range of activities were identified as commonly occurring during these Veteran Coffee Socials. Veteran attendees routinely formed relationships with each other, representatives from community organizations, and staff from local and VA healthcare resources. One of the most common activities involved veterans receiving information and directions for enrollment into needed healthcare supports and to local community resources. Case descriptions are provided illustrate the potential positive impact of this intervention to build community and expand social support for returning veterans through the examination of three individual and three group examples.
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Riedeman S, Turkstra L. Knowledge, Confidence, and Practice Patterns of Speech-Language Pathologists Working With Adults With Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:181-191. [PMID: 29387881 DOI: 10.1044/2017_ajslp-17-0011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Although speech-language pathologists (SLPs) are important members of the health care team serving adults with traumatic brain injury (TBI) with cognitive-communication disorders, little is known about services SLPs deliver and how they rate their own knowledge and skills. The aims of this study were to identify practice patterns, knowledge, and confidence levels of SLPs working with adults with TBI with cognitive-communication disorders. METHOD We surveyed 100 SLPs from rural and urban hospitals, skilled nursing facilities, and outpatient clinics in Wisconsin and analyzed data descriptively. RESULTS SLPs in this sample had a combination of accurate and inaccurate knowledge related to TBI. Although all participants reported working with individuals with TBI, many participants rated themselves as lacking confidence or knowledge in this practice area. SLPs reported variable use of evidence-based procedures and training related to TBI. CONCLUSION Results confirmed the high prevalence of TBI-related practice among SLPs in medical settings, but there was variable knowledge, confidence, and use of current evidence in practice. SLP graduate training programs, individual providers, health care administrators, and the American Speech-Language-Hearing Association can use results from this study to advance and improve SLP clinical services for adults with TBI.
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Frenk SM, Sautter JM, Woodring JV, Kramarow EA. Veteran Status, Sociodemographic Characteristics, and Healthcare Factors Associated with Visiting a Mental Health Professional. Community Ment Health J 2017; 53:515-524. [PMID: 27928703 PMCID: PMC6362989 DOI: 10.1007/s10597-016-0071-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 11/24/2016] [Indexed: 11/25/2022]
Abstract
Using data from a nationally representative study of the community-dwelling U.S. population, we estimated the percentage of male veterans who visited a mental health professional in the past year, compared it to an estimate from non-veteran males, and examined factors associated with visiting a mental health professional. We found that 10.5% of male veterans visited a mental health professional in the past year, compared to only 5.6% of male non-veterans. In the regression models, veteran status, sociodemographic factors, and healthcare utilization were independently associated with visiting a mental health professional. These findings demonstrate the importance of using nationally representative data to assess the mental healthcare needs of veterans.
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Affiliation(s)
- Steven M Frenk
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 3264, Hyattsville, MD, 20782, USA.
| | - Jessica M Sautter
- Department of Behavioral and Social Sciences, University of the Sciences, 600 South 43rd Street, Philadelphia, PA, 19104, USA
| | - Joseph V Woodring
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA, 30329, USA
| | - Ellen A Kramarow
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 4262, Hyattsville, MD, 20782, USA
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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