USPHS

Defense Health Agency (DHA), US Public Health Service/Health Human Services/Indian Health Service (USPHS/HHS/IHS)

Poster

Prince Georges Expo Hall E

Wellbeing

This presentation overviews a bench to bedside translation of 15 years of research into a clinical program for intimate partners (IP) of service members (SM) with traumatic brain injury (TBI) in treatment for chronic neurobehavioral and psychological symptoms across the Defense Intrepid Network for Traumatic Brain Injury and Brain Health (DIN). The 15-year longitudinal research was part of the Caregiver and Family Member Study (CGFM Study; NDAA FY2007 Sec721 Public Law 109-364). Participants included [1] 587 family caregivers service members and veterans (SMVs) following TBI (all severities); [2] 35 family caregivers of SMVs with posttraumatic stress disorder; [3] 44 non-caregiving family members; and [4] a dyad sample of 244 military couples. In 2010, our team identified a gap in health-related quality of life (HRQOL) measures for family members of SMVs with TBI. We instigated a 7-year multisite effort to develop and validate generic and caregiver specific HRQOL domains for family members of SMVs and civilians with a TBI using [1] the Patient-Reported Outcomes Measurement Information System (PROMIS) Instrument Development and Validation Scientific Standards, [2] a mixed methods research approach with both qualitative and quantitative data, and [3] a participatory action approach with family caregivers. Physical, psychological, social, and caregiving HRQOL item banks were incorporated into the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system. The TBI-CareQOL was integrated longitudinally into the CGFM Study. A series of individual and dyadic analyses demonstrated the bidirectional associations between SMV neurobehavioral symptoms and family distress in three overarching themes: [1] SMV neurobehavioral symptoms are strong risk factors for poor HRQOL in family caregivers; [2] parental distress and family dysfunction are strong risk factors for poor HRQOL in children of SMVs with TBI; and [3] IP and family distress are strong risk factors for poor SMV brain health following TBI. In light of these family dynamics, relevant TBI-CareQOL measures were identified and integrated into the Family Wellness Program (FWP) for IPs SMs with TBI in treatment across the DIN as a holistic family approach to brain health and military readiness. The FWP screens IPs for clinically elevated HRQOL symptoms and provides a clinical report, individualized recommendations, and referral options. The FWP additionally provides access to the vast collection of other adult, pediatric, and parent proxy pediatric comprehensive measurement systems. The use of standardized T-scores allows for scores to be directly interpretable within family members and across treatment facilities. The FWP was launched in 2024 at the National Intrepid Center of Excellence (Walter Reed National Military Medical Center). In 2025, the FWP expanded across the DIN, starting with the Fort Carson Intrepid Spirit Center (ISC) (Evans Army Community Hospital) and Camp Pendleton ISC (Naval Hospital Camp Pendleton). Future expansion is planned for Fort Bragg ISC (Womack Army Medical Center) and Joint Base Lewis-McChord ISC (Madigan Army Medical Center). The establishment of the DIN as program of record in January 2026 and mandated requirements specified in NDAA FY2025 Sec721 around family services should facilitate sustainability of the FWP’s essential components and uptake across the DIN.