Development and content validity of the behavioral assessment screening tool (BASTß).

PURPOSE: Develop and establish the content validity of the Behavioral Assessment Screening Tool (BASTß), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury. METHODS: This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7). We developed and assessed the Content Validity Index of the BASTß. RESULTS: The BASTß initial items (n = 77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BASTß included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n = 23) and four open-ended questions about environmental factors. The BASTß had a high Content Validity Index of 89.3%. CONCLUSION: The BASTß is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST. Implications for Rehabilitation Behavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury. Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term. The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries. The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.

Family Needs on an Inpatient Brain Injury Rehabilitation Unit: A Quantitative Assessment.

OBJECTIVE: To examine the needs of family members in an inpatient setting and factors predicting extent to which needs are perceived as met. SETTING: University health system inpatient rehabilitation unit. PARTICIPANTS: Adult survivors of traumatic brain injury and family members (n = 85). DESIGN: Prospective, cross-sectional. MAIN MEASURE: Family Needs Questionnaire-Revised (FNQ-R). RESULTS: Needs related to the Health Information subscale were most frequently rated as met, whereas needs related to the Instrumental Support and Emotional Support subscales were most frequently rated as unmet. Predictors related to the FNQ-R included family income, gender, and ethnicity. For 4 of 6 subscales, white family members were more likely to rate needs as unmet than minority members. For 3 subscales, females were more likely to rate needs as unmet than males. Greater household income was associated with fewer met needs for 2 subscales. CONCLUSIONS: The ranking of met and unmet needs in the present study was remarkably similar to previous studies within and outside the United States. Clinicians should not assume that families with relatively higher incomes will experience fewer unmet needs. Through structured assessment, clinicians can reveal perceived needs that might have otherwise been unrecognized and facilitate appropriate supports. Findings provide direction for inpatient program development.

Traumatic brain injury and behavioral health: the state of treatment and policy.

In the United States, 1.7 million people sustain a traumatic brain injury (TBI) each year, of whom 52,000 die and 275,000 are hospitalized. Societal costs of TBI total at least $10 billion. In this article, we review the current state of treatment and policy and make recommendations that would benefit TBI survivors with behavioral health comorbidities.