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TBI Research Review: Unidentified Brain Injury Mount Sinai School of Medicine (page 3 of 4) Page 3 of 4

Implications: Next Steps

In summary, many studies demonstrate that hidden TBI is a sizable contributor to many forms of social failure. The cognitive problems people experience are often the trigger for social failure. Inexplicably, cognitive rehabilitation treatments are frequently limited or excluded from insurance coverage altogether 27. Hidden TBI is a heavy burden for the individual who is injured, but the costs to society, estimated at $60 billion annually, are also draining 28. If we realize that identification is possible, what steps must be taken to reduce its impact?

  1. Broaden Identification. Inexpensive, easy-to-use screening tools, like the BISQ, should be administered routinely in school settings, by social service agencies, and among at-risk populations such as military personnel, athletes, prison inmates, victims of domestic violence and individuals seeking mental health or substance abuse services.
  2. Increase Awareness. One in three Americans are not familiar with the term "brain injury" 29. Public information campaigns describing both the causes and consequences of TBI are needed to prevent the injury and ensure that individuals who are injured seek appropriate medical attention.
  3. Expand Professional Education. Individuals with known TBI account for 2 percent of the U.S. population and 10 percent of the disability population; yet, few health professionals, educators, rehabilitation therapists, social service workers or others are adequately trained to recognize and treat TBI. Education at the undergraduate or pre-certification level is needed.
  4. Improve Access to Care. Individuals who sustain TBI may require a variety of services and supports of varying intensities throughout their lifetimes. Expanded coverage for treatment and rehabilitation services paid by third parties, such as insurance companies and health maintenance organizations (HMOs), is needed.
  5. Boost Public Funding. When personal financial resources are depleted, individuals with TBI and their families turn to government agencies for help 30. Policy makers at the federal, state and local level must allocate more public funds to TBI services. At the state level, this can be achieved through general or special appropriations, Medicaid Home and Community-Based Services Waivers, Trust Funds, and other methods.
  6. Strengthen Coordination. Better communication and linkage among public agencies and with the private sector is needed so that once a person with hidden TBI is identified, he or she can be referred for appropriate testing, treatment and support.

Now is the time to take action to prevent the secondary disasters that befall many people who have had brain injuries but are unaware that these past traumas may be slowly draining away possibilities for a healthy, productive future. People with hidden TBI can be identified and should be provided with the appropriate care to meet their needs.

New York Traumatic Brain Injury Model System

Mount Sinai Medical Center
Department of Rehabilitation Medicine, Box 1240
One Gustave L. Levy Place
New York, NY 10029

Project Directors

Wayne A. Gordon, Ph.D.
Steve Flanagan, M.D.

Editors

Margaret Brown, Ph.D.
Susan Connors

Contact

Wayne Gordon
E-mail: wayne.gordon@mssm.edu
Web Site: www.tbicentral.org

The NYTBIMS is supported by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, Grant No. H133A021918.

References

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  2. National Institutes of Health. (1998). Rehabilitation of persons with traumatic brain injury. NIH Consensus Statement, Vol. 16, No. 1, October 26-28, pp. 1-41.
  3. Centers for Disease Control and Prevention. (2003). Program in brief: Monitoring traumatic brain injuries. Atlanta: CDC.
  4. Bernstein, D.M. (1999). Recovery from mild head injury. Brain Injury, 13, 151-172.
  5. Kraus, J.F., McArthur, D.L. (1996). Epidemiologic aspects of brain injury. Neuroepidemiology, 14, 435-450.
  6. Silver, J.M., Kramer, R., Greenwald, S., Weissman, M. (2001). The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Injury, 15, 935-945.
  7. Lewis, D.O., Pincus, J.H., Feldman, M., Jackson, L., Bard, B. (1986). Psychiatric, neurological, and psychoeducational characteristics of 15 death row inmates in the United States. American Journal of Psychiatry, 143, 838-845.
  8. Brewer-Smyth, K., Burgess, A.W., Shults, J. (2004). Physical and sexual abuse, salivary cortisol, and neurologic correlates of violent criminal behavior in female prison inmates. Biological Psychiatry, 55, 21-31.
  9. Sarapata, M., Hermann, D., Johnson, T., Aycock, R. (1998). The role of head injury in cognitive functioning, emotional adjustment and criminal behavior. Brain Injury, 12, 821-842.
  10. Slaughter, B., Fann, J.R., Ehde, D. (2003). Traumatic brain injury in a county jail population: prevalence, neuropsychological functioning and psychiatric disorders. Brain Injury, 17, 731-741.
  11. Burg, J.S., McGuire, L.M., Burright, R.G., Donovick, P.J. (1996). Prevalence of traumatic brain injury in an inpatient psychiatric population. Journal of Clinical Psychology in Medical Settings, 3, 243-251.
  12. Burg, J.S., Williams, R., Burright, R.G., Donovick, P.J. (2000). Psychiatric treatment outcome following traumatic brain injury. Brain Injury, 14, 513-533.
  13. Hibbard, M., Uysal, S., Kepler, K., Bogdany, J., Silver, J.M. (1998). Axis I psychopathology in individuals with TBI. Journal of Head Trauma Rehabilitation, 13 (4), 24-39.
  14. Fenske, C.L., Gordon, W.A., Perez, K., Hibbard, M.R., Brandau, S. Co-morbidity of substance abuse and traumatic brain injury. Submitted for publication.
  15. Walker , R., Hiller, M., Staton, M., Leukefeld, CG. (2003). Head injury among drug abusers: an indicator of co-occurring problems. Journal of Psychoactive Drugs, 35, 343-353.
  16. Simpson, G., Tate, R. (2005). Clinical features of suicide attempts after traumatic brain injury. Journal of Nervous and Mental Disease, 193, 680-685.
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From the Mount Sinai School of Medicine. www.mssm.edu.

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