The Hope Project:  An Independent Living Program for Disabled Veterans with TBI

The Need

Medical and neurosurgical techniques have improved since the 1970s, resulting in a dramatic increase in the survival of persons diagnosed with traumatic brain injuries (TBI). It is estimated that 5.3 million Americans currently live with long-term or permanent disabilities resulting from TBI (CDC, 1999; Thurman et al., 1999).  The numbers have been increasing with the return of wounded soldiers from the conflicts in Iraq and Afghanistan.  As of 2007, approximately 22% of the more than 30,000 wounded soldiers from Iraq and Afghanistan have sustained a TBI (Stanford Medicine, 2007). The numbers continue to rise.  The recently released RAND Corporation (2008) report on the Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries provides some sobering estimates on the number of deployed service-members who have sustained a TBI and are suffering from psychological issues such as post traumatic stress disorder (PTSD).  Based on surveys, the total number could reach as many as 320,000 (Tanielian, et. al, 2008).  TBI may co-occur with PTSD and/or traumatic amputation. The cognitive, physical, and psychosocial changes that occur in an individual post injury are profound, with life-long and life altering disabling conditions (NIH, 1999). 

The current standard of care following TBI has been first emergency medical care and stabilization followed by acute and post-acute rehabilitation with the ultimate goal of independent living.  Although the optimal objective of rehabilitation is successful independent living through community re-integration, programs and services that support this transition are not part of the conventional standard of treatment.  A significant gap exists with programs focusing on the transition from post-acute rehabilitation to independent community living.

Community re-integration programs (CR) or independent living programs (IL) are crucial to the quality of life for disabled veterans and their families. These programs provide a vital role within the rehabilitation process.  By promoting the transfer of skills learned during acute and post-acute rehabilitation, individuals learn how to apply and generalize those skills within the community through CR/IL programs.

Successful CR/IL includes the following constructs to be present in one’s life: independent living aspects (self care, daily routine, compensatory strategies); productivity/occupation (meaningful and productive focus); socialization and social supports (supportive network, leisure activities); and general integration factors (housing, community involvement and satisfaction with quality of life) (Karlovits & McColl, 1999).

The next step is to develop a CR/IL prototype that will become part of the standard of care for disabled veterans to promote independence and self-sufficiency, thus successful community re-entry.

The Hope Project Overview

The Hope Project, developed by the National Rehabilitation & Rediscovery Foundation (NRRF) in 2006, is a transitional community reintegration/independent living program designed to provide disabled veterans and their families with a comprehensive, community-integrated program to increase independence and self-sufficiency within a learning environment.  This unique program focuses on the transition from post-acute rehabilitation to long-term community living and incorporates the constructs that constitute successful independence and re-entry into the community.  Improving the success of CR/IL for disabled veterans is essential to allow them to be productive members of their families, communities, and society.

Through a series of six courses, taught over a 9 month period at Virginia Tech, Northern Virginia Center, individuals partake in classes to learn about lifespan issues related to the long-term needs post TBI, PTSD, and traumatic amputation.  Family education and involvement is highly encouraged during this process.  Two courses are offered each semester.  The program includes the following curriculum:

Fall Semester

Module I - self care, self reliance, and compensatory strategy development

Module II - daily routine development

Spring Semester

Module III - health, leisure education, and socialization

Module IV - productive focus

Summer Semester

Module V - support team development (family involvement/participation)

Module VI - practicum and mentoring opportunity

Program Impact

• The Hope Project has been documenting the vital importance of this prototype as part of the standard of care within TBI rehabilitation 
• The Hope Project is advancing the high quality of treatment for disabled veterans with TBI and is documenting the program’s efficacy
• The Hope Project will give rise to the development of a model CR/IL program that can be replicated within communities where disabled veterans reside augmenting and complementing the exceptional services that currently exist within the Department of Defense and the Department of Veterans Affairs

Partnerships and Adjunct Services

Partnerships and adjunct services include Virginia Tech, Northern Virginia Center, Department of Marriage and Family Therapy to provide individual, couples, and family therapy services as well as a family support group and graduate level interns.  Virginia Tech Department of Adult Learning is collaborating with NRRF to collect data regarding the efficacy of the program and to conduct the program evaluation.  Virginia Tech is also providing classroom space as an in-kind contribution to ensure program success.

NRRF collaborates and coordinates with multiple disciplines including academia, industry, military services, and the U. S. Department of Veterans Affairs.  Partnerships with local industry are on-going for practicum and employment opportunities for participants at the completion of the program. 

Program Director

Marianne Talbot, Ph.D., is the Program Director and President of NRRF.  Dr. Talbot earned her Ph.D. in Human Development from the Virginia Tech.  She has a Master of Arts in Education and Human Development from the George Washington University in Washington, D.C., and a Bachelor of Arts from Eckerd College in St. Petersburg, Florida.  She has national certifications as a Rehabilitation Counselor (CRC), Case Manager (CCM), Rehabilitation Provider (CRP), and Movement Analyst (CMA).  During her master’s level internship, Dr. Talbot worked at the National Institutes of Health (NIH) in the clinical neuropsychology section administering psychometric tests and collaborating with the neurosurgery section on research protocols.  Dr. Talbot has 22 years of experience working in neuro-rehabilitation.  Additionally, she serves on several boards and committees and is President of the Northern Virginia Brain Injury Association.

References

Centers for Disease Control and Prevention (CDC). (1999).  Traumatic brain injury in the United States: A report to Congress.

Karlovits, T. & McColl, M. (1999).  Coming with community reintegration after severe brain injury: A description of stresses and coping strategies.  Brain Injury, 13, 845-861.

National Institutes of Health (NIH). (1999).  Rehabilitation of persons with traumatic brain injury.  Journal of American Medical Association, 282, 974-983.

Final Report on the President’s Commission on the Care for America’s Wounded Warriors (July, 2007).

Richter, R. (Summer, 2007).  Fog of war: One soldier’s struggle with Iraq’s trademark injury.  Stanford Medicine, 20-24.

Tanielian, T, Jaycox, L. H., Schell, T. L., Marshall, G. N., Burnam, M. A., Eibner, C., Karney, B. R., Meredith, L. S., Ringel, J. S., & Vaina, M. E. (2008).  Invisible wounds of war: Summary and recommendations for addressing psychological and cognitive injuries. RAND Corporation.

Thurman, D., Alverson, C., Dunn, K., Guerrero, J., & Sniezek, J. (1999).  Traumatic brain injury in the United States:  A public health perspective.  Journal of Head Trauma Rehabilitation, 14, 602-615.