Exploring Integration of Support for Co-Occurring Substance Use-Related Needs in Interdisciplinary Traumatic Brain Injury Treatment for Military Service Members and Veterans

IF 2 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation Pub Date : 2025-09-01 DOI:10.1016/j.arrct.2025.100468

Katherine L. McCauley PhD , Tracey Wallace MS, CCC-SLP , Timothy P. Moran PhD , Javier Palacios BS , Dina Forehand MS, CCM , Jacquelyn Breitenstein MS, CTRS, CCM , Shannon C. Miller MD , Russell K. Gore MD

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Abstract

Objective

To explore initial outcomes (treatment entry and completion and staff feedback) for an interdisciplinary military traumatic brain injury (TBI) treatment program with individualized support for co-occurring substance use (SU).

Design

A quality improvement effort was undertaken to develop an integrated model of care for TBI with support for service members and veterans (SM/Vs) with co-occurring SU. We describe treatment entry and completion outcomes, along with staff feedback, collected over 26 months of program implementation.

Setting

An intensive outpatient program (IOP) for SM/Vs with TBI, administered by a not-for-profit hospital

Participants

Three hundred and sixty-four (N=364) SM/Vs applying for TBI treatment (85.2% men, 28.3% active service, median age of 41 (interquartile range, ±12)).

Interventions

An Integrated Care Model for TBI + SU was developed and flexibly applied to support client needs, including modifications to assessment, intervention, and follow-up support related to SU.

Main Outcome Measures

We report on instances of noncompletion because of SU, percentage of admission denials because of SU, demographic and clinical predictors of entering care, and qualitative feedback from treating clinicians.

Results

Over 26 months, 188 individuals entered care, and just 7 who entered the IOP did not complete, with 1 of these instances because of SU. Clinician attitudes indicate optimism about the Integrated Care Model. Predictors of entering care, analyzed using logistic regression with recursive feature elimination, included multiple demographic (sex, race, location, service status) and clinical (SU and psychiatric history, brain injury symptom severity) characteristics.

Conclusions

An interdisciplinary TBI treatment environment holds promise as a setting for incorporating SU-related support to enhance entry and completion for more SM/Vs.

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军人和退伍军人跨学科创伤性脑损伤治疗中共同发生的物质使用相关需求支持的整合探索

目的探讨跨学科军事创伤性脑损伤（TBI）治疗方案的初步效果（治疗入组、完成和工作人员反馈），并对共同发生的物质使用（SU）进行个性化支持。DesignA进行了质量改进工作，以开发一种综合的TBI护理模式，支持患有共同SU的服务人员和退伍军人（SM/Vs）。我们描述了治疗开始和完成的结果，以及员工反馈，这些反馈是在26个月的项目实施中收集的。研究背景：由一家非营利性医院对患有TBI的男性/女性实施强化门诊计划（IOP）。参与者364名（N=364）申请TBI治疗的男性/女性(85.2%为男性，28.3%为现役，中位年龄41岁（四分位数间距±12）。干预开发了TBI + SU的综合护理模型，并灵活地应用于支持客户需求，包括对与SU相关的评估、干预和随访支持的修改。主要结果测量我们报告了因SU而未完成的病例、因SU而拒绝住院的百分比、进入护理的人口统计学和临床预测因素，以及治疗临床医生的定性反馈。结果在26个月的时间里，188例患者进入护理，只有7例进入IOP未完成，其中1例是由于SU。临床医生对综合护理模式持乐观态度。进入护理的预测因素，使用递归特征消除的逻辑回归分析，包括多种人口统计学（性别、种族、地理位置、服务状态）和临床（SU和精神病史、脑损伤症状严重程度）特征。结论跨学科的创伤性脑损伤治疗环境有望纳入与su相关的支持，以提高更多的SM/ v的进入和完成。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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