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Articles   |    
Implementation of Multifamily Group Treatment for Veterans With Traumatic Brain Injury
Deborah A. Perlick, Ph.D.; Kristy Straits-Troster, Ph.D., A.B.P.P.; Jennifer L. Strauss, Ph.D.; Diane Norell, M.S.W., O.T.R./L.; Larry A. Tupler, Ph.D.; Bruce Levine, M.D.; Xiaodong Luo, Ph.D.; Caroline Holman, B.A.; Tara Marcus, M.S.; Lisa B. Dixon, M.D., M.P.H.; Dennis G. Dyck, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.001622012
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Dr. Perlick and Dr. Luo are affiliated with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (e-mail: deborah.perlick@va.gov). Dr. Perlick is also affiliated with the U.S. Department of Veterans Affairs (VA) Mental Illness Research, Education and Clinical Center (MIRECC), Bronx, New York, where Dr. Levine, Ms. Holman, and Ms. Marcus are also affiliated. Dr. Straits-Troster and Dr. Tupler are with the Mid-Atlantic Region MIRECC, and Dr. Strauss is with the Health Services Research and Development Service, Durham VA Medical Center, North Carolina. Dr. Strauss is also with the Department of Psychiatry, Duke University, Durham. Ms. Norell is with the Department of Occupational Therapy at Eastern Washington University, Cheney. Dr. Dixon is with the Department of Psychiatry, Columbia University, and with the Center for Practice Innovations, New York State Psychiatric Institute, both in New York City. Dr. Dyck is with the Department of Psychology, Washington State University, Spokane.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study evaluated the initial efficacy and feasibility of implementing multifamily group treatment for veterans with traumatic brain injury (TBI).

Methods  Veterans at two Veterans Affairs medical centers were prescreened by their providers for participation in an open trial of multifamily group treatment for TBI. Enrollment was limited to consenting veterans with a clinical diagnosis of TBI sustained during the Operation Enduring Freedom–Operation Iraqi Freedom era, a family member or partner consenting to participate, and a score ≥20 on the Mini-Mental State Examination. The nine-month (April 2010–March 2011) trial consisted of individual family sessions, an educational workshop, and bimonthly multifamily problem-solving sessions. Interpersonal functioning and symptomatic distress among veterans and family burden, empowerment, and symptomatic distress among families were assessed before and after treatment.

Results  Providers referred 34 (58%) of 59 veterans screened for the study; of those, 14 (41%) met criteria and consented to participate, and 11 (32%) completed the study. Severity of TBI, insufficient knowledge about the benefits of family involvement, and access problems influenced decisions to exclude veterans or refuse to participate. Treatment was associated with decreased veteran anger expression (p≤.01) and increased social support and occupational activity (p≤.05), with effect sizes ranging from .6 to 1.0. Caregivers reported decreased burden (p≤.05) and increased empowerment (p≤.01).

Conclusions  The results supported implementation of a randomized controlled trial, building in education at the provider and family level.

Abstract Teaser
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Table 1Characteristics of 14 veterans with traumatic brain injury and family members
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Table 2Military history and baseline neurocognitive status among 14 veterans with traumatic brain injury (TBI)
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a The mean percentage of service-connected disability was 63%.

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b The mean scores for Trail Making Tests A and B were in the 14th and ninth percentiles, respectively, for the normative sample for this age group.

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c The mean scores for the California Verbal Learning Test II (CVLT-II) free recall (trials 1–5) and delayed recall were in the 38th and 56th percentiles, respectively.

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Table 3Characteristics of 11 veterans with traumatic brain injury and their family members before and after multifamily group treatment
Table Footer Note

a Measured by the AX Scale; possible scores range from 24 to 96, with higher scores indicating greater anger.

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b Measured by the subjective support and social interaction subscales of the Abbreviated Duke Social Support Index. Possible scores range from 0 to 7 on the subjective support scale, with higher scores indicating greater subjective support, and from 0 to no upper limit on the social interaction subscale, with each number representing a form of social interaction within the past week. The values reported reflect the mean scores of both subscales combined.

Table Footer Note

c Measured by the Center for Epidemiological Studies Depression Scale; possible scores range from 0 to 20, with higher scores indicating higher levels of self-reported depressive symptoms.

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d Scores >50 on the PTSD Checklist indicate posttraumatic stress disorder (PTSD).

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e Measured by the Caregiver Burden Inventory; possible scores range from 0 to 96, with higher scores indicating higher levels of burden.

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f Measured by the Family Empowerment Scale; possible scores range from 12 to 60, with higher scores indicating greater perceived empowerment in coping with problems related to a family member’s illness.

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g Subscale of the Sydney Psychosocial Reintegration Scale; possible scores range from 0 to 16, with higher scores indicating higher levels of occupational activity or interpersonal functioning.

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*p≤.05, **p≤.01 (two-tailed tests). Note: df=10 (t tests for veterans) and df=8 (t tests for family members)

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Table 4Association of baseline neurocognitive functioning and change in outcome measures among 11 veterans after the TBI interventiona
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a TBI, traumatic brain injury

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b Assessed by trials 1–5

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c Pearson product-moment correlation coefficient (df=10). Change in outcome measures is expressed as the absolute value of the number obtained by subtracting posttreatment from pretreatment scores. For the California Verbal Learning Test II (CVLT-II), where lower scores represent greater impairment, a positive correlation reflects greater likelihood of improvement. For Trail Making Tests A and B, where higher scores represent greater impairment, a negative correlation reflects reduced likelihood of improvement.

Table Footer Note

d The AX Scale measures anger.

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e CES-D, Center for Epidemiological Studies Depression Scale

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f PTSD, posttraumatic stress disorder

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g Subscale of the Sydney Psychosocial Reintegration Scale

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