Introduction: Traumatic Brain Injury is the leading global cause of disability. In Canada alone, 2% of the population lives with a TBI and many survivors require significant ongoing support and rehabilitation post injury in order to return to functional independence and achieve meaningful goals. In recent years, holistic treatment for TBI has become an increasingly popular approach to provide the brain with the best possible environment to heal. Some key lifestyle modalities, which may support a recovering brain, include nutrition, exercise, mindfulness, cognitive activity, good sleep and limiting harmful exposure. Although some of these interventions have evidence for supporting rehabilitation post TBI, the effects of combining these modalities into a larger program have not yet been studied. Furthermore, vital allied health care services needed to provide well-rounded care are costly for most individuals and persons who are members of traditionally marginalized groups are overrepresented in the population who do not have access to this type of care. Consequently, many patients are left untreated and lost to follow-up after their acute injury has been addressed and stabilized. This in turn leads to a tremendous burden on our healthcare system, as we know earlier and intensive treatment post TBI is important to mitigate long term disability.

Objective: To pilot a novel primary care clinical model designed to address gaps in TBI care and provide effective, equitable access to care,

Methods: The novel primary care model was developed through review of published evidence for key lifestyle modalities, which are the cornerstones of holistic care: nutrition, exercise, mindfulness, cognitive activity, good sleep and limiting harmful exposure. The model was refined through consultation persons with lived experience and clinicians to ensure feasibility and relevance to address current gaps in care. The model was piloted utilizing government funded regulated health professionals using a Family Health Team framework to promote continuity of care following discharge from acute care facilities.

Results: A structured model of care was developed that included quality indicators to assess process, outcome and acceptability of care. This care model is consistent with the Ideal Care Pathways that is currently being implemented In Ontario. All patients referred to the care team were included in the pilot, regardless of severity of injury and personal circumstances. All had access to community based rehabilitative care with medical oversight that otherwise would not have been available to them. Patients reported high satisfaction with the model of care and the progress towards their identified goals.

Conclusion: This pilot represents an example of how holistic Family Health Team care can be effectively and efficiently provided in the community to support patients’ goals of living meaningful lives after brain injury.

Primary care providers (PCP) are essential during the transition from hospital to community, but little is known about whether having a primary care visit will improve post-hospital outcomes among older adults with TBI. Therefore, we examined the predictors of PCP follow-up with an established PCP or any PCP, and its association with 90-day emergency department (ED) use and all-cause hospital readmission, using Cox regression models based on competing risks (death and hospice admission) and censoring (until loss of Medicare coverage, by 90th follow-up day, or by December 31, 2019). The interaction effect of visiting any PCP or established PCP with discharge destination (i.e., home, home health, skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), nursing home, other facility) was also examined. Using 100% Texas Medicare data, we identified 27,480 older patients aged 66 and older hospitalized for TBI from January 1, 2014 and discharged by September 30, 2019, and returned home within 90 days following hospital discharge. Prior to the TBI, about 70% of older patients had an established PCP. By 90 days following discharge home, 79.5% of patients with an established PCP saw their provider, whereas 37% of patients without an established PCP saw any PCP. Patients who were more likely to see any PCP within 90 days after discharge home were female, of Hispanic ethnicity, discharged home from an IRF, or had an established PCP. Patients aged 70-84, of Black race, Medicare/Medicaid dual eligible, with primary TBI diagnosis, and discharged from an IRF were more likely to see their established PCP within 90 days from discharge home. Patients who saw any PCP and were discharged home were less likely to have an ED visit (HR=0.81; CI: 0.76-0.87) and hospital readmission (HR=0.87; CI: 0.81-0.95). Increased likelihood of ED service utilization was found among patients who visited any PCP and were discharged from either a SNF (HR=1.12; CI: 1.02-1.22) or IRF (HR=1.17; CI: 1.06-1.28). Those who visited any PCP and discharged home from an IRF were also more likely to be readmitted (HR=1.16; CI: 1.04-1.30). Patients with a previously established PCP who saw the same PCP and were discharged home following hospitalization were less likely to have an ED visit (HR=0.82; CI: 0.75-0.89) and be readmitted (HR=0.84; CI: 0.77-0.92). Older patients who visited their established PCP and were discharged from an IRF were more likely to have an ED visit (HR=1.16; CI: 1.04-1.29) and be readmitted (HR=1.14; CI: 1.00-1.29, p=0.046). In summary, for older patients with TBI who did not receive post-acute care, having a PCP was associated with better post-hospital outcomes, while those who received post-acute care may need care transition support. The role of continuity of primary care plays in TBI outcomes needs to be further explored.

Brain Education Strategies and Technology, Inc. (BEST) is a nonprofit organization started by Michelle Ranae Wild to share the theories she has developed over more than 30 years as a professor in Coastline Community College’s Acquired Brain Injury program to help people with acquired brain injury (ABI) retrain their brains, learn compensatory skills, and rebuild their lives. Through its unique, educational model, BEST provides people with ABI a curriculum and a community to help them continue to make progress after completing medical neurorehabilitation. BEST recognizes that ABI recovery is life-long and thus meets people at any stage of their journey.

BEST offers free webinars, multi-week workshops, facilitated discussions, and asynchronous online courses that are designed to teach people with ABI, their family members, and clinicians (1) how ABI can create physical, cognitive, behavioral, and emotional challenges and (2) practical strategies they can personalize to help them navigate those challenges. In the process, BEST provides participants with a supportive community where they can feel less isolated and learn from the experiences of others.

BEST introduces cognitive and technology topics through interactive webinars that include instruction, polls, monitored live chats, and Q&A sessions. The webinars are followed by facilitated “after hours” discussions on Zoom. These peer collaboration sessions are much-loved by BEST regulars and newcomers alike, because they reduce isolation and allow participants to feel like members of a safe, supportive community where they can share how the concepts taught in the webinar relate to their lives.

BEST workshop series address webinar topics in a more comprehensive, hands-on manner. They include a multi-week curriculum delivered through interactive, weekly Zoom sessions that feature breakout groups, whole class discussions, Q&A sessions, live chats, and the integration of technology tools as appropriate. Each session begins with an iterative review, designed to reactivate and consolidate learning from prior sessions. As with webinars, participants receive presentation slides, supplemental worksheets, and session recordings so they can engage and re-engage with the content at their own pace.

Program topics include cognitive rehabilitation, neurofatigue, executive function, self-regulation, problem solving, learning styles, communication, self-efficacy, initiation, and many more. BEST also teaches people with ABI how to use technology to compensate for ABI deficits. The BEST Suite of apps helps people organize their lives and apply the strategies they learn in BEST programs.

Data from participant evaluations indicates that BEST’s programs are indeed meeting participants’ needs. More than half have attended 6 or more BEST programs. A staggering 96% rate information they learned in the webinar as “very useful,” with 97% saying they learned something they can use in daily life.

This session will share the BEST approach to cognitive/neurorehabilitation and the feedback from participants.

Brain Injury is the leading cause of death and disability in the UK for people aged 0-40 (Centre for Mental Health “CMH” 2018) and diagnosed in 70% of all cases of head injury (Ponsford, Sloan and Snow 2013). However, there is limited knowledge and understanding about this topic (Norman 2020, Mantell 2017) with very little known about social care and social work with people with brain injury (Holloway 2020) even though, social work plays an important role in the assessment and treatment of people with this condition (Linden et al 2023). The complexity and hidden nature of the condition can lead to misdiagnosis and inappropriate care and support. Safeguarding Adult Reviews repeatedly identify social workers’ poor understanding of ABI as a contributing factor to the premature deaths of people who struggle post-injury. Heads Together is an interdisciplinary effort led by Prof. Andrew Bateman and other brain injury experts and researchers including psychologists, social workers, academics from 5 universities in the UK and experts by experience funded by the NIHR with the aim of addressing this knowledge and skills gap. This unique project has five work packages including a systematic review of existing brain injury social work literature recently accepted for publication. Topic: Social workers’ understanding of acquired brain injury: A systematic review of the current evidence-base. We have surveyed 152 students, 65 social work educators and interviewed newly qualified and experienced social workers and commissioners in the UK to inform outputs. A recent addition to our project is Making Headway, a play in collaboration with local specialist brain injury charities brings the brain injury experience to life and serves as a trans-disciplinary teaching tool for health and social care students and other disciplines.

The play is supported by actor-led, interdisciplinary student workshops shown to over 150 University of Essex students in March, phase two is to tour four universities reaching 600 students by April 2024. Making Headway was presented at a Think Tank at the IBIA World Congress on Brain Injury in Dublin, with members of the team making presentations at this and other conferences including the Joint Universities Social Work Education Conference in Glasgow and has been nominated for a global interprofessional award. The team has influenced policy by contributing to two UK Parliament Post Notes and NICE Guidelines reviews and training social workers in a local authority where a safeguarding adult review into the death of a person with ABI was conducted. Heads Together is developing practice improvement resources including a website and interactive modules which present brain injury in a clear and concise manner and ultimately, improves outcomes for people affected by ABI. The brain injury social work toolkit will be launched during World Social Work Week 2024.

Introduction: There are no evidence-based standardized care pathways implemented at the healthcare system level that provide expert-informed guidance related to care and service provision from time of injury to life in the community, while considering the social determinants of health. Engaging diverse key partners, the Neurotrauma Care Pathways developed Ideal Care Pathways for mild traumatic brain injuries (TBI - concussions) and for moderate to severe TBIs. The TBI Care Pathways address known gaps in care related to, for example, unclear expectations during patient journeys, non-standardized concussion identification, and the much-needed lifelong community supports, especially related to mental health. With the Pathways at hand, it is time to start the journey to address these gaps.

Objective: to describe the process and outcomes of implementation projects addressing key elements of the TBI Care Pathways.

Methods: Provincial Working Groups composed of over 200 people with lived experience (PWLE) and their families, clinicians, healthcare administrators, community service providers, policymakers and researchers met to identify crucial components that constitute ideal care, highlighted system-level gaps, and developed and prioritized companion quality indicators by ranking them on significance and feasibility. Groups set regional and provincial implementation priorities. We identified regional teams to champion the implementation of three projects. Each team received a grant to co-design with persons with lived experience and their families a care map and implementation manual related to the implementation priorities. The projects had to implement an ongoing sustainability plan and evaluation strategies and ground their work in the principles of implementation science.

Results: A set of implementation priorities was established which included two common priorities across the province: education for persons with lived experience and their families, and care coordination and navigation. Out of 6 pilot implementation projects, three involve TBI Care Pathways; these include: 1) a large urban concussion care clinic partnering with the TBI system navigator to optimize referral services; 2) a justice-involved support organization and a TBI system navigator creating a resource list for those living with complex needs, and 3) a community base provider facilitating post-traumatic stress disorder training after TBI. Each group developed the requisite care map, implementation manual, sustainability plan and collected evaluation data specific to their project. The teams presented their work at a provincial summit attended by PWLE and their families, clinical managers, system planners, injury-specific navigators, and funded and government officials to discuss opportunities for scale and spread.

Conclusion: These evidence-based Ideal Care Pathways represent a road map for quality improvement with a strong emphasis on community care and transitions. The implementation projects are initial steps of the journey towards ensuring that all persons living with TBI and their families receive equitable care and supports to address their chronic needs over the lifespan.

INTRODUCTION: Acquired brain injury (ABI) is associated with financial capability challenges. This includes challenges with financial-related social interactions and remembering financial cues or behavioral strategies. In a previous focus-group study, people living with ABI discussed an individualized financial wallet-card as a novel intervention idea.

PURPOSE: To develop and explore the feasibility, acceptability, uses, and outcomes related to the use of an individualized financial wallet-card for adults living with ABI.

METHODS: We used a longitudinal qualitative intervention design. We recruited 10 adult participants who live with ABI (70% female; 1 to 59 years post-ABI). We co-designed a two-sided wallet card with each participant: one side addressed how others can better help the participant in social financial-related situations, and the other side addressed personal financial reminders or strategies. After co-designing their card, we interviewed participants and sent them copies of their cards in printed/laminated and electronic versions. Participants then completed up to five more interviews about their cards over 15 weeks. Participants had the opportunity to update their cards at the final interview. We analyzed longitudinal interviews and wallet-card content using content analysis.

RESULTS: Participants reported using the printed/laminated card more than the electronic version. There were many similarities across participants’ cards, with almost all participants including information related to living with invisible disabilities. Multiple participants reported the importance of card individualization. Common social cues included were to ask others to provide them time, speak slower, or provide written information. Common personal financial reminders were to focus on their needs before their wants, take time or talk with a trusted other person before making financial decisions, or make and check a monthly spending plan. Most participants reported the card very helpful to addressing some of their financial capability challenges. More reported the social situations side to be more helpful, especially to get the help they needed, with many reporting using the card beyond finance-related social situations. Multiple participants noted the personal financial reminders helped to keep them accountable and make better financial decisions. Two participants noted other people expressing negative attitudes about the card, although this was from family members and not from general community members. Some participants reported not using the card much or forgetting to use the card; for two participants, this tended to be in familiar environments where people knew them well.

CONCLUSION: The co-designed financial wallet-card is a potential low-cost technology to address some of the financial capability challenges experienced by some adults living with ABI. It was beneficial and helpful to many participants. Individualization of cards was important, as some people had unique contexts. Future improvements to the card would be to improve the official look of the card and increase the efficiency in card production.

Traumatic brain injury (TBI) is considered a leading cause of acquired disability for children in the US. Despite the high incidence of negative long-term academic, social, and health outcomes for children with TBI, few receive appropriate educational supports. Return to school (RTS) programs have been developed to better assist children with TBI as they return to the classroom. These programs vary widely by state, and no existing RTS program has been systematically evaluated to determine its impact on outcomes for students with TBI. The objective of the School Transition After Traumatic Brain Injury (STATBI) project is to rigorously evaluate the impact of BrainSTEPS, a formal return-to-school (RTS) program, on academic, social, and health outcomes for students in grades K-12 who have experienced TBI of any severity, compared to students who have no formal RTS programming (control arm). STATBI uses a mixed method, cohort-controlled research design. The protocol includes electronic survey administration and virtual interviews with parents and children. This presentation will include data from nine focus groups completed with caregivers from the experimental and control groups during summer and fall 2023. Twenty-five caregivers (100% female) participated in focus groups, with four groups from the control arm and five groups from the experimental arm. The sample included students with mild, moderate, and severe TBI. Questions and discussion focused on how caregivers accessed services, facilitators and barriers to finding care, and their satisfaction with services their child received following TBI. Preliminary analysis of focus group transcripts reveals persistent challenges that caregivers face attempting to find and access necessary supports for mental health and school services for their children with TBI. Caregivers receiving formal RTS support through BrainSTEPS discussed the relief and support provided to them by school-related programming. Caregivers in the control arm discussed persistent difficulties in identifying providers and accessing supports for their children. When supports were identified and provided, unsurprisingly, caregivers were more satisfied with overall service provision. Focus group data is being analyzed further for themes associated with injury severity and time post injury. The STATBI project is unique in its focus on RTS for youth with TBI, and this presentation will describe caregiver perspectives of access to and satisfaction with services for school-age youth with TBI who participate in either formal or non-formal RTS program. Additionally, the sample includes many students who reported having mild injuries but who continued to have academic needs past the typical recovery period that warranted ongoing support services. These findings have important implications for assessing students with TBI as they progress through school. This talk will highlight ongoing study progress and implications for those studying RTS programs for students with TBI.