Action Ethnography of Community Reintegration for Veterans with TBI

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DESCRIPTION (provided by applicant): Background/Rationale: Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in the civilian population but not in Veteran populations. Little is known about how knowledge from civilian studies translates into Veterans experiences and needs. The VA recognizes the distinctive healthcare needs of OEF/OIF Veterans, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to Veterans' homes and communities to facilitate CR. Research is needed to identify barriers and facilitators to CR for Veterans to inform the design of supportive community-based services. Sanders, a well-known CR researcher identified three main needs for researchers and rehabilitation professionals: (1) a comprehensive meaning of CR, which includes the perspectives of persons with TBI; (2) cultural competence in measurement and intervention; and (3) incorporation of a thorough understanding of environmental factors that affect CR into research and treatment. Objectives: The goal of the proposed study is to better understand the experiences of Veterans with moderate to severe TBI, families and CR workers as they transition to and sustain living in communities. Of interest is both Veteran's experiences and the context in which they occur including local, state, regional and VA environments that both facilitate and impede the ability of Veterans and families to negotiate services to achieve salutary levels of CR. The objectives and research questions of this 4-year longitudinal ethnography of Veterans with moderate to severe TBI, using a Community-Based Participatory Research approach are to: O1:Describe the community reintegration experiences as perceived by Veterans; O2:Compare and contrast barriers and facilitators to community reintegration from multiple perspectives (Veterans, families, and CR workers, e.g., Case Mangers, Care Coordinators, VA/DOD/community contacts, etc.); O3:Describe how personal social networks change over time and influence CR; O4: In partnership with Veterans, families and CR specialists, identify strategies to improve CR experiences. Methods: A four-year longitudinal ethnography will use mixed methods (interviews, questionnaires, participant observation) from a Community-Based Participatory Research perspective The inductive, participant-perceived and holistic approach of ethnography is ideal for studying CR in Veterans with TBI because little is known regarding their definitions and perceptions of CR and a thorough understanding of environmental and cultural factors that influence CR. The primary sample will include 25 Veterans with moderate to severe TBI. The secondary sample will include 25 of their primary family caregivers and 25 CR specialists. The tertiary sample will include up to 15 key stakeholders. Impact: Anticipated impact on the VA healthcare system is a comprehensive understanding of Veteran-perceived and environmental factors affecting CR to identify targets for interventions that can decrease barriers and strengthen facilitators for Veterans with moderate to severe TBI. This study will give voice to Veterans and families by actively engaging them in removing barriers to CR directly for themselves and indirectly for others. Results will provide a roadmap for designing and testing interventions to maximize CR in employment, independent living, and social relationships that are grounded in the perceptions of multiple perspectives.