The REACH Intervention for Caregivers of Veterans and Service Members with TBI: Efficacy and Implementation Planning Across the VA Polytrauma System of Care
Abstract
Objectives/Rationale: Family caregivers are the primary supports for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI). Many TBI caregivers provide over 60 hours a week of care and experience negative effects of their role, including health problems, strain, depression, anxiety, and even suicidal thoughts. Unfortunately, there is no structured, research-backed, and widely used clinical intervention to bring much- needed services to caregivers of V/SMs with TBI. Therefore, this study will adapt, rigorously test, and develop concrete plans to implement nationally across the U.S. Department of Veterans Affairs (VA) Polytrauma System of Care (PSC) a previously developed six-session telehealth caregiver intervention, Resources for Enhancing All Caregivers’ Health (REACH), for the unique needs of caregivers of V/SMs with TBI. Community-Based Participatory Research (CBPR) Approach: Capturing and integrating CBPR input is central to all three aims of the proposed study: (a) engagement and adaptation (b) randomized waitlist-control trial, and (c) implementation planning. CBPR subject matter experts (SMEs) will be core members of our research team; four will be caregivers of V/SMs with TBI, 8-10 will be TBI clinicians, three will be PSC clinical researchers, and two will be PSC administrators. The input from caregivers who share their lived experience will not only guide the development of the intervention, but they and other SMEs will be key to decision-making as we refine the content; this process will depend upon their modifications and concurrence. Given the goal of delivering an effective and meaningful caregiver intervention throughout the entire VA PSC, our approach to implementation planning will depend upon the engagement of clinicians who will ultimately champion the uptake of REACH-TBI. Further, we need administrator buy-in for true systems change. Applicability and TBIPHRP Focus Areas: This proposal aligns with three Treat focus areas: (3a) using telehealth to promote sustained recovery during the chronic phase of injury and overcome gaps in care delivery to rural or resource-limited environments; (3b) using proven family- and caregiver-level methods for reducing barriers to care for TBI challenges; and (3c) using services and implementation research to increase VA provider access to and adoption of a research-backed intervention for caregivers of V/SMs with TBI. Population Helped: Caregivers of V/SMs with TBI will be assigned to either the REACH-TBI (55) or a waitlist-control (55) group for 3 months, after which the initial assignments will be switched for the subsequent 3 months. At 3- and 6-month follow ups, we expect that caregivers receiving REACH-TBI will show improved strain, depression, anxiety, self-efficacy, and military health care frustration compared to the waitlist-control. Clinical Applications, Benefits, and Risks: While we do not anticipate any more than minimal risks (e.g., temporary sadness when talking about caregiving challenges), if effective, REACH-TBI will have powerful clinical applications as the first research-backed intervention for caregivers of V/SMs with TBI that can be fully implemented across one of the largest health systems serving V/SMs with TBI, thereby filling a critical gap in clinical services. The VA PSC and the VA Caregiver Support Program’s National Caregiver Center are poised to support a full-scale implementation of REACH-TBI, and this study will help make that strategy concrete. Timeline: In the first 6 months, we will adapt and standardize REACH-TBI based on the TBI research literature and interviews with TBI caregiver and clinician SMEs. In months 7-36, we will evaluate the effectiveness of REACH-TBI in improving the hypothesized outcomes, as well as work with our SMEs to interpret the results of open-ended interviews that will empower participants to be the experts regarding how we can best modify the delivery of the i
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310563
Entities
People
- Paul Perrin
Organizations
- United States Army
- University of Virginia