APRIL 5, 2017, JOINT BASE LEWIS-MCCHORD, Wash. – Brain injuries don’t happen in isolation. They’re often accompanied by chronic pain, or long-impacting injuries, or behavioral health concerns like post-traumatic stress. After all, whatever caused the brain injury — an explosion, a vehicle accident, a fall — also affects the rest of the person.
These coexisting conditions can make patients more complex, and “are often very difficult to treat through our normal, conventional health care system,” said Col. Beverly Scott, the medical and program director of Madigan Army Medical Center’s Traumatic Brain Injury Program and Intrepid Spirit Program.
Enter the Madigan Intrepid Spirit Transitions Program, a six-week intensive outpatient group designed to address the complex conditions of eight to 12 service members at a time.
“The priority goal is to help individuals so they can return to duty or improve their well-being for whatever path they are on … It’s never too late to help them address a number of issues that they may be having following a traumatic brain injury, dealing with pain, dealing with behavior health issues,” Scott said, emphasizing that the program goes beyond a TBI focus and also treats patients with other trauma-related conditions.
The MIST Program only serves active duty service members with referrals from their primary care managers and other specialty services at Madigan, or throughout the Regional Health Command-Pacific. It’s a part of the tripod of the larger Intrepid Spirit Model, which offers “arena” intake sessions for a multidisciplinary team to build service members’ overall treatment plans, enhanced case management for TBI Program patients, and the intensive outpatient program itself.
The program leadership acknowledges that a six-week program is quite the commitment for service members. In fact, being dedicated to the process is crucial to success.
“They have to devote that same accountability [they’ve given to] military life now to their recovery,” Scott said.
Commanders must sign memorandums of understanding that patients will be off of duty rosters for the duration of the program.
“They’re making a commitment to help that service member get better,” Scott said.
The holistic focus of MIST recognizes that the whole person is affected by brain injuries and the conditions that often accompany them. While patients address chronic pain, insomnia, and work to improve cognitive skills, they also learn mindfulness and strategies to nurture relationships and build spiritual resiliency. The classroom bounces between the TBI Program building, art studios, yoga mats, and nature.
“Because of the program’s uniqueness, it’s anything but mundane,” said James Brassard, the program administrator for the TBI Program and Intrepid Spirit Program.
The variety of approaches offered to program participants lets them cherry pick the methods they believe will help them the most — what one service member called “customizing their own multi-tool.”
“They leave knowing they’ll come away with what works best for them,” Scott said.
Giving them tools they can use well after they complete the program is an acknowledgment that the recovery process is an ongoing one.
“We recognize it is a transition … In a six-week period we know we really can’t address or reverse or fix everything, so we do try to expose the individuals to programs on JBLM and the resources, the tools, the information, the ideas that they’re going to take with them to continue their recovery,” she said. The participants are encouraged to continue individual care within the TBI/Intrepid Spirit program following the MIST program.
That’s why they reached out to JBLM’s Army Wellness Center, Soldier and Family Assistance Center, Telehealth and Technology, and more to teach parts of the program.
“It’s a whole team, and the team extends beyond our walls,” Scott said.
So far, the MIST Program has graduated two groups of participants. “We’ve seen incredible success,” she said. Overall, participants have benefited from increased wellness, but some of the participants’ accomplishments were more personal. One service member’s medical evaluation board was halted because of how much his behavioral health had improved; another reversed the downward trajectory of his marriage.
While the MIST Program is designed with evidence-based curriculum, some of its success is derived from peer support.
“Some significant success is clearly related to Soldiers helping Soldiers, the service members helping each other,” Scott said. “The power of the cohort is just extraordinary. We make sure we have time for the individuals to just talk to and help each other, and you can really see the power in that.”
The results at the end of the program include much more than the successful treatment of the TBI and its related conditions.
“It’s going to help them be a better Soldier, a better person, a better spouse, a better parent, a better leader,” she said.
By Suzanne Ovel (Army Medicine)