Combat to Community

Working with Veterans with TBI: A Toolkit for Providers

October 11, 2017

Every war has had its signature mark, and its resulting public health crisis. Traumatic brain injury (TBI) has emerged as a signature wound of the wars in Iraq and Afghanistan, but for all we have learned about this often life altering injury, we’ve yet to scratch the surface. And there is a severe lack of public policy solutions to address it.

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. The VA has made tremendous strides in research and treatment, but many veterans with TBI are seeking care from community systems for services that don’t fall under the typical umbrella of cognitive therapy. These veterans may present with what they think are “other” care needs, such as housing, employment, legal assistance, and mental health, but which are in fact impacted by TBI. The long term care needs for veterans with TBI are murky, and we are beginning to understand the impacts in the years to come. Just recently on October 3, advocates warned of the looming pandemic of Alzheimer’s among veterans with TBI and post-traumatic stress disorder, which they say promises to be the health issue of the 21st century.

These revelations bring light to war injuries, but the truth is that traumatic brain injury is very often the silent, unnoticed injury of non-combat veterans. The nature of the recent wars and deployments expose service members to blasts whether they are formally assigned to combat roles or not. Also, routine non-combat operations have produced a majority of the injuries since the onset of the wars in Iraq and Afghanistan. Risk flags and screening procedures implemented in the VA focus more on current era veterans, but this is not a new problem: traumatic brain injury has been around as long as combat and combat training has been around.

All of this means veterans are presenting with symptoms and needs that may baffle providers, who are ill-equipped to understand how it manifests throughout many aspects of their lives.

When we present our Combat to Community™ training to first responders and behavioral health providers, we often explain the misunderstandings that providers can have in their interactions with veterans with TBI. Law enforcement, for example, may believe the person is drunk when in fact the symptoms of TBI can mimic alcohol use. This compelled us to take a look at how veterans with TBI present to social services and behavioral health, and whether providers have the necessary tools to consider their unique circumstances.

The Institute for Veteran Policy at Swords to Plowshares has investigated research findings, best practice models, and insights from first responders and providers, drawn together in a practical toolkit. It’s as much a review of the most salient literature on cognitive, physical, mental, socio-economic, and other life impacts of TBI; as it is a practical guide for providers working with veterans transitioning to school, work, adjusting to home life, or dealing with long-term impacts.

Behavioral health/mental health service providers, first responders, health and social service organizations such as senior services, primary health clinics, women-specific service organizations and clinics can benefit from this toolkit.

What Providers Can Do

Use this toolkit whether you specifically serve veterans or not.

Organizations do not need to be veteran-focused; indeed, because many veterans seek services outside of veteran-specific avenues, it is important to screen your clients for veteran status and to be culturally informed.

Consider how you might modify your care approach for veterans with TBI

Veterans want care from a provider who understands their experiences. This means understanding military and veteran culture, as well as becoming trauma-informed of their unique service-related issues. Train your staff.

If you use this toolkit, please tell us how it’s working for you. Complete a short evaluation here so we may improve these guides and build upon the experience in the field.

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