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Transcript of TRAUMATIC BRAIN INJURY AMONG VETERANS - · PDF filePost-Traumatic Stress Disorder ......

  • TRAUMATIC BRAIN INJURY

    AMONG VETERANS:

    A Toolkit For Behavioral Health and

    Social Service Providers

    INSTITUTE FOR VETERAN POLICY

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    For more information on this publication, visit: www.swords-to-plowshares.org

    Published by Swords to Plowshares, Institute for Veteran Policy, San Francisco, CA

    Amy Fairweather, JD, Director

    Megan Zottarelli, MPA, Assistant Director, Lead Author

    Copyright 2017 Swords to Plowshares

    Combat to Community is a registered trademark

    Limited Print and Electronic Distribution Rights

    This document and trademark(s) contained herein are protected by law. The representation of Swords

    to Plowshares intellectual property is provided for noncommercial use only. Unauthorized posting of ths

    publication online is prohibited. Permission is given to duplicate this document for personal use only, as

    long as it is unaltered and complete. Permission is required from Swords to Plowshares to reproduce, or

    reuse in another form, and of its research documents for commercial use. For information on reprint

    and linking permissions, please visit [email protected]

    Swords to Plowshares

    1060 Howard Street

    San Francisco, CA 94103

    (415) 252-4788

    www.swords-to-plowshares.org

    [email protected]

    http://www.swords-to-plowshares.org/mailto:[email protected]://www.swords-to-plowshares.org/mailto:[email protected]

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    TABLE OF CONTENTS Introduction and Context for Toolkit .............................................................................................. 5

    Background and Incidence .............................................................................................................. 5

    Current/Previous Conflicts and Prevalence ................................................................................ 5

    Non-Combat Related Injuries ...................................................................................................... 6

    Symptoms and Prognosis ................................................................................................................ 7

    How are TBI Screenings Conducted? .............................................................................................. 7

    Screening Challenges Among Prior Era Veterans ........................................................................ 8

    Gulf War Registry Exam ............................................................................................................... 9

    VA Service-Connection for TBI ........................................................................................................ 9

    Impacts .......................................................................................................................................... 10

    Cognitive and Physical Impacts ................................................................................................. 11

    The Mental Health Link ............................................................................................................. 12

    Post-Traumatic Stress Disorder ............................................................................................. 13

    Depression ............................................................................................................................. 14

    Suicide .................................................................................................................................... 14

    Life Impacts ............................................................................................................................... 15

    Independent Living ................................................................................................................ 15

    Unemployment and Homelessness ....................................................................................... 15

    Women, Racial And Ethnic Considerations In TBI ........................................................................ 15

    Aging Veterans and TBI ................................................................................................................. 16

    Trauma and community re-integration ........................................................................................ 17

    Family Factors ........................................................................................................................... 17

    Back to School ........................................................................................................................... 17

    Back to Work ............................................................................................................................. 19

    Screening Methods ....................................................................................................................... 20

    Screening for Veteran Status .................................................................................................... 20

    Veteran Status Screening Intake Worksheet ............................................................................ 21

    3 Question DVBIC TBI Screening Tool ....................................................................................... 23

    Incorporating Screening into Existing Treatment Plans ............................................................ 24

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    Considerations to approach, practice, and procedures ............................................................... 24

    Outreach Materials ................................................................................................................... 24

    Office Space ............................................................................................................................... 24

    Creating a Culturally-Informed Approach ................................................................................. 25

    The Care Team........................................................................................................................... 25

    Unique Treatment Considerations ............................................................................................ 26

    Separating the Trauma from the Veteran ................................................................................. 26

    Communication Techniques ...................................................................................................... 27

    Ongoing Symptom Management .............................................................................................. 28

    Poor Concentration ............................................................................................................... 28

    Memory Problems Management .......................................................................................... 28

    Sleep Problems ...................................................................................................................... 28

    Physical Activity Limitations and Exercise ............................................................................. 29

    Balance Issues and Dizziness ................................................................................................. 29

    Headache and Neck Pain Management ................................................................................ 29

    Lack of Emotion or Emotional Lability ................................................................................... 30

    Impaired Judgment ................................................................................................................ 30

    Aggressive Behaviors ............................................................................................................. 30

    Resources ...................................................................................................................................... 31

    Sources .......................................................................................................................................... 34

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    INTRODUCTION AND CONTEXT FOR TOOLKIT The brain remains the most mysterious of organs, the most complex structure in all of our biology, and

    is the most poorly understood in terms of medical and clinical treatments. Traumatic brain injury (TBI)

    has emerged as a signature wound of the wars in Iraq and Afghanistan, and for all we have learned about

    this often life altering injury weve yet to scratch the surface. The VA has made tremendous strides in

    medical treatments, but while many veterans with TBI are seeking services from community systems,

    care providers are often ill equipped to understand this complex injury and how it manifests throughout

    many aspects of their lives.

    Providers need to recognize TBI as it presents itself in

    behavioral and social services contexts in order to deliver

    trauma informed care. This guide provides a framework of

    understanding TBI from a community behavioral health

    perspective, unlike the medical and research approach that is

    often presented. Background and incidence, as well as

    behavioral health research is provided, along with screening

    tools and treatment considerations. Lastly, the resource section

    provides information for those seeking referrals and resources

    for their clients.

    Behavioral health/mental health service providers, first

    responders, health and social service organizations such as senior services, primary health clinics,

    women-specific s