RecruitingEarly Phase 1NCT06188364

Improving Traumatic Brain Injury Rehab Care With Comm Health Services: a Research Project Within the TBI Model System

Improving Traumatic Brain Injury Rehabilitation Care Transitions With Community Health Services: A Randomized Clinical Trial (CHW Intervention for TBI Care Transitions [CHWI for TBI]), a Research Project Within the TBI Model System

Sponsor

Virginia Commonwealth University

Enrollment

126 participants

Start Date

Apr 26, 2024

Study Type

INTERVENTIONAL

Conditions

Traumatic Brain Injury

Summary

TBI rehabilitation care transitions refer to the processes of preparing patients, families, and community-based healthcare providers for the patient's passage from inpatient rehabilitation to the home and community or to another level of care. Persons with TBI have heterogenous neurological impairment (cognitive and behavioral foremost, along with motor, sensory, and balance), that limits their functional independence and participation, and increases their risk for secondary medical conditions, injuries, rehospitalizations and early mortality

Eligibility

Min Age: 18 Years

Inclusion Criteria5

Participants must be adults (age 18 or older).
Must be primary person responsible for supervision/care needs of person with TBI post-IRF discharge.
The person with TBI must have been admitted to the Brain Injury Service Unit at SAI.
If the care partner does not live in the same residence as the person with TBI, they must provide multiple daily check-ins on day-to-day care.
Must agree to use mHealth (texts, calls) and possess or be eligible to acquire a smart phone.

Exclusion Criteria1

Any severe cognitive impairment that precludes the ability to provide informed consent or safely function as the care partner for a vulnerable adult with TBI.

Interested in this trial?

Get notified about updates and connect with the research team.

Interventions

OTHERStandard of Care

The usual Transition Supports and Services (USS) that prepare care partners of persons with TBI for post-rehabilitation discharge, so the the delivery of traditional CHW outreach services such as finding health, community and social determinants referrals, problem-solving, and connecting care partners to long-term supports/services

OTHERExperimental

Novel aspects of the CHW experimental intervention for TBI care partners include: 1. CHW services begin prior to inpatient rehabilitation discharge; 2. care partners get timely, useful health management materials; 3. encounters focus on unlimited, brief, situation-focused calls to help care partners assess and resolve pressing concerns; and 4. long-term support capacity for care partners is built by establishing a reliable referral network of medical, community, and social services that become foundational resources beyond study completion.