The Moss Traumatic Brain Injury Model System (TBIMS) for 2012-2017, directed by Tessa Hart, PhD and John Whyte, MD, PhD, is grounded in a rich network of local and regional, national, and international collaborations to achieve multiple goals in clinical care, research, and dissemination. A sophisticated system providing state-of-the-art, potentially lifelong treatments for persons with TBI and their families in the greater Philadelphia region and southern New Jersey includes 3 Level I Trauma Centers and the nationally recognized Drucker Brain Injury Center at MossRehab. The full continuum of high-quality treatment spans emergency and acute trauma/ neurosurgical care through community re-entry. Innovative post-acute components, offered on 2 campuses in Pennsylvania and one in New Jersey, include vocational placement and supported employment services, two Clubhouses, a residential treatment facility, a Concussion Center, and a Neuro Mental Health Clinic specialized for those with cognitive impairment.
The research core of the Moss TBIMS is centered at the Moss Rehabilitation Research Institute (MRRI). For the longitudinal component of the TBIMS, we will add at least 250 participants to the nearly 900 enrolled at our TBIMS since 1997. We will collaborate fully in developing and carrying out modular research projects. The 2012-2017 Moss TBIMS also includes 2 site-specific research projects, both designed to generate new knowledge that will lead to improved practices to meet the needs of people with TBI. Project 1 is a randomized controlled trial examining the effects of a novel, theoretically motivated treatment to promote emotional health via increased levels of rewarding activity for persons with post-acute TBI. The treatment combines principles of Behavioral Activation with intervention methods derived from action phase theories of behavior change, and uses SMS (text) messaging to support increased activity in values-driven goal areas. If successful, this treatment model may have special applicability to people who may not have access to intensive face-to-face treatments for mental health due to geographical, cognitive, or financial barriers. In Project 2, we will develop and perform initial validation studies on an observational pain scale, with the potential to extend effective pain management to the at-risk population of patients with TBI who cannot self-report pain due to impairments in consciousness or communication. We will collect systematic data on over 200 such participants with known sources of pain, as they participate in activities and receive medications expected to modulate pain levels. Factor analytic and Item Response Theory methods will be applied to create a unidimensional scale that is sensitive to pain intensity.
The 2012-2017 Moss TBIMS includes strong components for dissemination and knowledge translation targeted to people with TBI and their families, clinical staff across the continuum of care, and other professional and lay audiences. In collaboration with the Brain Injury Association of Pennsylvania (BIAPA), we will conduct regional seminars for people with brain injury and caregivers in rural/ underserved areas of the state, and develop organizational tools for making the resulting networks self-sustaining; and we will develop and disseminate informational materials in support of an expansion of a successful school re-entry program to the post-secondary level. In collaboration with 7 other local TBI rehabilitation facilities in the region, we will conduct a regional Moss TBIMS consumer conference in 2014. Knowledge translation projects for clinicians include a new Community of Practice that will allow clinicians in the DBIC’s geographically dispersed campuses to share challenges and creative solutions for helping clients to identify, set, and meet goals; and a user-directed process on the inpatient unit for improving evidence-based practice in behavioral/ learning domains that cut across professional disciplines. Extensive planning for consumer input and thorough evaluation processes will ensure timely, accurate feedback on the degree to which our products and activities have succeeded in their intended outcomes.