EXECUTIVE SUMMARY

Millions of people suffer from traumatic brain injuries each year, and about 280,000 of them are hospitalized. The impact of their severe brain injuries and long recoveries can result in ongoing mental health and behavioral issues. Case managers can help them with this recovery.

• The first step is to assess the person’s local resources.

• One goal is to address social-behavioral issues that arise from brain injury.

• Case managers can help brain injury patients analyze and identify their specific needs.


Millions of people survive brain injuries each year, but when the concussion is severe, recovery can be slow and challenging. This population might not always receive case management, which can help with recovery.

“The number one psychiatric condition after brain injury is depression, and almost 50% of people with a brain injury will develop significant depression, which can lead to other problems like alcohol abuse and drug abuse,” says Nancy Weber, MA, CBIS, brain injury case manager and clinical evaluator for the Neurologic Rehabilitation Institute at Brookhaven Hospital in Tulsa, OK.

Traumatic brain injury (TBI) affects about 2.5 million people per year, hospitalizing more than 280,000 and killing more than 52,000, according to a 2015 CDC report to Congress titled “Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation.”1

People who have suffered severe brain injuries sometimes need a higher level of care than is available in their communities, and this is where case management can help, Weber says.

When working with a person who has suffered a brain injury, Weber will first assess the person’s local resources and ensure every option has been employed.

Case managers have an important skill of identifying resources, and they must put this in practice with brain injury patients, says Janet Mott, PhD, CRC, CCM, rehabilitation counselor/case manager. Mott contracts with the Brain Injury Alliance of Washington in Mount Vernon, VA. (For tips on best practices in helping TBI patients, see related story in this issue.)

“We provide help for their families and loved ones and caregivers,” Mott says. “I’ve always viewed this role as looking at the whole person, and that’s an important thing that case management needs to bring to the table.”

The case management goal is to address social-behavioral problems that can result from brain injuries to reduce the chance TBI patients will end up in prison. An estimated 60% of people who are incarcerated have been affected by TBI, according to the CDC report.1

If the local community and even the state do not offer enough help, Weber will suggest the brain injury survivor seek help in another state.

“If there’s nothing in the state to help them, I talk with the family about how they feel about their loved one leaving the state to receive treatment,” Weber says.

“I need the family on board,” she adds. “I know this is awkward, and they’re concerned about their well-being, but how can we help this person and keep them from ending up in prison?”

This case management process can begin in a hospital, including a psychiatric unit, and it might work with alternative payment structures.

“I work with case management at the hospital, and we bring in other stakeholders,” Weber says. “For example, the insurance company and Medicaid folks, and we take self-pay, negotiating the rate for the family.”

Since it’s difficult to determine how long a patient will be in the psych unit, case managers do everything they can to be cost-effective, she adds.

Case managers also can help brain injury patients by analyzing and identifying their specific needs and how these might match with community resources, Mott says.

This can be challenging. For example, one of Mott’s clients has a long history of significant brain injuries that have taken their toll.

“Eventually, he was diagnosed with frontal temporal dementia,” Mott says.

The brain injury affected his behavior, resulting in his being hospitalized in a state mental institution that is unable to provide him with the services he needs, Mott says.

In some states, anyone who exhibits even mild aggressive behaviors would have trouble being accepted in a skilled nursing facility or adult family home, leaving too few options for such TBI patients, she notes.

Also, people who experience significant neurobehavioral issues might need help when meeting with social workers and psychiatric counselors.

“They don’t always know what to do next because the brain injury client doesn’t fit into the services they offer,” Mott says. “When you get into the world of behavioral health, we have a long way to go from the case management perspective to understanding the world of brain injury and all of these other spheres.”

People with brain injuries and behavioral trauma need additional help in healthcare facilities. They might have periods of psychotic or hyperaggressive behavior, she adds.

Treatment of brain-injured patients with these behavioral issues will be more successful if case managers and other healthcare professionals take into account how the mental health issues impact the brain injury, and vice versa.

“That’s how I get involved,” Mott says.

Many TBI associations have a resource center, as does the Brain Injury Alliance of Washington. (For more information, visit: https://bit.ly/2tKxkQp.)

“Anyone can call in and ask us a question, and we try to find them an answer and resource,” Mott says. “If it’s a complex case, then I’m asked to work with them virtually.”

REFERENCE

1. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. Centers for Disease Control and Prevention; 2015:1-72. Available at: http://bit.ly/2lyFK9V.