Family Needs After Traumatic Brain Injury: A VA TBI Model Systems Study

Abstract

Objective: To describe the self-reported needs of family caregivers of service members and veterans (SMVs) who sustained a traumatic brain injury (TBI) and to identify predictors of the unmet family caregiver needs. Setting: Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). Participants: Family caregivers of SMVs enrolled in the VA PRC TBI Model Systems (TBIMS) national database who were within their first 5 years post-TBI (n = 427). Design: Observational study. Main Outcome Measure: The Family Needs Questionnaire-Revised (FNQ-R) was completed by each SMV's designated caregiver. Analyses: Descriptive analyses were conducted on the FNQ-R responses at the item, domain, and total score levels. Unadjusted univariable and adjusted multivariable regression models were fitted to identify predictors of total unmet needs and unmet family need domains. Results: FNQ-R item-level and domain-level descriptive results indicated that health information was the most frequently met need domain. In contrast, emotional and instrumental support domains were the least often met. On average, family caregivers reported that 59.2% of the 37 FNQ-R needs were met at the time of the follow-up assessment. Regression models indicated that both the number of SMV-perceived environmental barriers and whether the SMV received mental health treatment within the past year predicted the number of unmet FNQ-R needs. SMV-reported environmental barriers predicted increased unmet needs in all 6 family caregiver domains, and SMV mental health treatment in the past year predicted more unmet family caregiver emotional support, community support, and professional support needs. Conclusions: The current findings can be used to inform policy and programming for VA and Department of Defense to proactively address the specific needs of families and caregivers experienced in the first 5 years post-TBI.

Community Caring for a Family Member With Brain Injury: Women’s Lived Experiences

“…Although there is a paucity of literature regarding women caring for family with brain injury in the community, our participants’ comments showed similarities to findings reported across other settings (e.g., acute medical and rehabilitation). Specifically, these include the need for more education and training for both providers and families, access to specialty services focused to brain injury (e.g., counseling), help with the legal concerns (e.g., Power of Attorney), and assistance with finances (e.g., Medicare/Medicaid) (Corrigan et al, 2021; Dames-O’Connor et al, 2020; Finn et al, 2022). These well-documented recommendations are focused predominantly on the survivor.…”

Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury (Preprint)

“…15 Among caregivers of V/SMs with TBI, over 40% of their needs go unmet; greater environmental barriers keeping the V/SM from participating in activities and the presence of V/SM mental health issues translate into more unmet emotional, community, and professional support needs. 16 Despite some parallels to civilian populations with TBI, V/SMs can have unique features of TBI (e.g., polytraumatic, blast-related) and high rates of particular comorbid conditions (e.g., posttraumatic stress and pain) that impact V/SMs' health and needs [17][18][19] and may require additional and unique caregiving skills. Few military family members expect to provide the sort of long-term care that may be required by these complex injuries, 20 and lack of training or formal supports can compound caregivers' strain and emotional distress.…”

Efficacy and Implementation Planning Across the Veterans Affairs Polytrauma System of Care: Protocol for the REACH Intervention for Caregivers of Veterans and Service Members With Traumatic Brain Injury

“…[15] Among caregivers of V/SMs with TBI, over 40% of their needs go unmet with caregiver peer support, respite from caregiving, and help with caregiver negative emotions being the least often met needs; greater environmental barriers keeping the V/SM from participating in activities and the presence of V/SM mental health issues translate into more unmet emotional, community, and professional support needs. [16] Despite some parallels to civilian populations with TBI, V/SMs can have unique features of TBI (e.g., polytraumatic, blast-related) and high rates of particular comorbid conditions (e.g., posttraumatic stress and pain) that impact V/SMs' health and needs [17], [18], [19] and may require additional and unique caregiving skills. Few military family members expect to provide the sort of long-term care that may be required by these complex injuries, [20] and lack of training or formal supports can compound caregiver strain and emotional distress.…”