Second Innovation: I-HEAL's Adaptive Evidence-Based Therapies for Engagement

Policy recommendations designed to adapt policy mandates for TBI-related disabilities.

CHALLENGE

Investigators have robustly shown that cognitive morbidity (i.e. cognitive impairment) is the number one rehabilitation need in chronic stages of TBI with unmet needs associated with poorer satisfaction with life among Veterans and service members. Further, Veterans and service members with greater TBI disability (and greater cognitive morbidity) experience unique barriers to accessing care in chronic stage of TBI. Our most recent work characterizing healthcare delivery for the most common comorbid conditions in TBI highlights cognitive morbidity as a barrier in referral to and receipt of evidence-based behavioral treatments (EBTs), limiting healthcare access and meaningful engagement in management of TBI comorbidities that may improve outcomes (i.e. suicide risk, PTSD severity, arrest rates, worsening cognition).

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INNOVATION

The project will address determinants (i.e., facilitators and barriers) that limit a cognitively impaired person’s ability to engage in EBTs for the most common comorbid conditions (i.e., PTSD, depression, sleep disorders, chronic pain) in TBI by conducting an environmental scan to identify existing EBT adaptations for persons with cognitive impairments, selecting adaptations identified through a community-based participatory research (CBPR) approach, and developing and disseminating a Provider Toolkit for Accommodating Cognitively Impaired Persons that will aid identification and engagement of cognitively impaired persons in EBTs.

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Aims & Objectives:

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    Discover: Conduct an environmental scan of existing recommendations and Evidence-Based Therapy (EBT) Adaptations for persons with cognitive impairments.
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    Define & Develop: Engage the Community Engagement Council (CEC) in prototyping the Provider Toolkit for accommodating cognitively impaired persons by defining its scope, elements, and function.
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    Validate: Activate the CEC to conduct a formal review of the Provider Toolkit for Accommodating Cognitively Impaired Persons prototype to validate the design and identify implementation strategies.

Meet I-HEAL's Second Innovation Team

Photograph of Dr. Hoffman

Jeanne M. Hoffman, PhD, ABPP-RP

Principal Investigator

Professor, University of Washington. Dr Hoffman is a clinical psychologist and the Project Director of the University of Washington TBI Model System and has extensive expertise in studying and working with individuals with TBI, including Veterans, and has led adaptation of behavioral interventions to address cognitive limitations associate with TBI with a focus on chronic pain and depression. She has led a large study of Veterans from the VA Puget Sound Health Care System (VAPSHCS) using an adapted CBT intervention for chronic pain treatment and is currently involved in research on Veterans with mild TBI including treatments to manage cognitive limitations which interfere with access to healthcare.

Photograph of Dr. Martin

Aaron M. Martin, PhD

Principal Investigator

Dr. Martin is an early-career clinical research psychologist at James A. Haley Veterans’ Hospital with a history of adapting behavioral EBTs for primary and specialty care clinical settings to address comorbid conditions. He has expertise in addressing sleep disorders in the context of chronic pain within outpatient polytrauma settings. His research focuses on understanding the nature of sleep and pain comorbidities in medically complex populations (e.g., TBI) with several publications to date.

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Daniel Goldschmidt, Lived Experience Partner

Principal Investigator

Mr. Goldschmidt is an individual with TBI resulting from a hiking accident in 2011. Since his severe TBI, he was unable to return to his profession due to difficulties with multitasking and attention but has returned to volunteer work with appropriate accommodations. He is committed to research and is especially interested and committed to helping others with TBI find providers who can modify their approach to work with an individual with cognitive difficulties. He has served as a lived experience stakeholder to several research teams. His role will be to provide overall lived experience guidance on this project to maximize utility and adoption of products.

The views expressed are those of the authors and do not necessarily represent the official policy or position of the Department of Veterans Affairs or any other U.S. government agency. This work is funded by DOD CDMRP Award Number HT9425-23-1-0621 for Improving Health Care Access and Engagement for Veterans and Service Members with TBI Morbidity (I-HEAL). This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The administering institution for this work is the Tampa VA Research and Education Foundation.