Support For Family Caregivers After Military Traumatic Brain Injuries

Each year, traumatic brain injuries account for more than two million emergency visits, 280,000 hospitalizations and 50,000 deaths. Those who survive a TBI experience effects such as alterations in thinking, sensation, language, behavior and emotions, which can impact the entire family.

The major conversations happening right now surround mild TBIs among military personnel. Since 2000, close to 384,000 military personnel have been diagnosed with a TBI. While a mild TBI may not sound serious, the concern is with multiple concussive events and co-occurring PTSD, which have been experienced by military personnel during warzone deployments.

While a lot of research focuses on the neuroscience side of those injuries, Dr. Timothy Elliott, professor of counseling psychology, focuses on caregiver issues following traumatic injury and the relationship between caregiver adjustment and a family member’s reintegration into community.

“We know so much about optimal adjustment following brain injury is associated with the family. Family support is huge and the degree to which families have access to get things done is highly variable,” explained Elliott. “It’s about figuring out best policies, looking at the best assessment practices to determine who is more likely to cope well versus those who have other problems.”

More than five million family members are caring for our military personnel. 38 percent of caregivers report problems with a probable major depressive disorder and 43 percent report suffering from anxiety.

“There are so many things that can be overwhelming. Family members can be really challenged. It is stressful just trying to go through the paperwork. Families also struggle with the fact that this is not the person who left. They are different now and plans have to be rewritten. Now you have to keep up with a list of medications, you have to learn about the best way to help them.”

SUPPORT FOR CAREGIVERS

Although family caregivers receive education about TBI as early as possible, many families find they need additional and ongoing support. Programs that do support military caregivers are often an extension of services for the military personnel.

“Most of these programs are designed to treat the patient first. What’s available for the family caregiver, particularly in the rehabilitation program, is an afterthought. We’ve found roughly two-thirds of family caregivers with probable depression report they have not received care from a mental health provider.”

How can medical professionals assist caregivers with their mental health issues? Elliott points to these mental health “first aid” guidelines provided by the Substance Abuse and Mental Health Services Administration.

• Assess level of distress. It is important to be careful about assumptions and give an objective assessment.
• Listen without judgment. Do not assume you know the problem the caregiver is facing. Focus on the caregiver’s personal experiences.
• Reassurance and information. Caregivers need accurate information about TBI and their own issues as caregivers. In many cases, providing adequate assistance may require a professional referral.
• Encourage appropriate professional help. Provide high-quality education and training to help caregivers understand their roles and teach them necessary skills. Acknowledge caregivers as part of the health care team.
• Encourage self-help and other support strategies. Foster caregiver health and well-being through access to high-quality services. Teach caregivers coping methods to help reduce stress and anxiety.

COPING STRATEGIES

Elliott has researched and supports a problem-focused coping method. This means focusing on goal-oriented tasks to change a situation, change aspects of the environment or change the way to respond to or perceive a stressor.

He points to an acronym – FOCUS – for helping teach caregivers problem-solving techniques. These are skills the caregiver has and can implement on their own.

F is a reminder of the importance of having all the facts about a problem situation. By being able to identify the who, what, when, where and how, you can increase your chances of finding a solution.

O stands for optimism. By understanding how your thoughts influence your behaviors, you learn to try tools to help you become a more positive thinker.

C stands for creativity. It is necessary in order to view the situation from a different perspective and come up with alternatives for solving the problem.

U stands for understanding. Evaluating the effectiveness of a solution requires understanding the short- and long-term effects.

S stands for solution. Effective problem solving involves evaluation and modification of a possible solution to find the most satisfactory results.
It is also important to get the caregiver to focus on taking care of themselves. Many caregivers do not exercise, do not eat well and do not go to the doctor like they should.

“They are denying themselves things that help keep them balanced and maintain their quality of life and subjective well-being. It is very important for caregivers to understand that taking care of themselves will have benefits not only to them, but also to the care recipient.”

RESOURCES:
The Defense and Veterans Brain Injury Center collaborated with a panel of TBI survivors, family members and experts to develop “Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans”

The Department of Veterans Affairs offers extensive resources, including the VA Caregiver Support website.