13.5.3 Multimodal Interventions
Kreutzer et al. (2009) studied families who participated in a Brain Injury Family Intervention program that focused on cognitive behavioural therapy and education on family dynamics (e.g., managing stress). The authors found that family members benefited in terms of meeting needs and overcoming service obstacles, although the program did not strongly improve their family functioning, life satisfaction, or psychological well-being. In another study involving participants of the same intervention program, caregivers perceived the intervention as helpful and agreed that their program goals were met. Furthermore, a more recent study of the Brain Injury Family Intervention reported that the program significantly reduced caregiver burden and improved met family needs and satisfaction with services relative to pre-treatment (Kreutzer et al., 2015).
Powell et al. (2016) reported that caregivers receiving a telehealth self-management intervention, comprised of education and mentored problem-solving, showed improved coping ability and psychological well-being, when compared to usual care. In a follow-up to this study, Powell et al. (2017) reported that, 6 months post ABI, caregivers were able to increase their involvement in recreational and professional endeavors. At this time, continuing concerns expressed by caregivers included emotional adjustment, time management, and creating healthy habits (Powell et al., 2017).
There is level 1b evidence (from one randomized controlled trial; Powell et al., 2016) that a telehealth self-management program combining education and mentored problem-solving may improve coping and psychological well-being compared to usual care in caregivers of individuals with TBI.
There is level 3 evidence (from one case control study; Smith et al., 2006) that community-based rehabilitation for the individual with an ABI may be more effective than traditional outpatient services in benefiting caregivers of individuals post ABI by improving levels of met family needs and reducing family dysfunction.
There is level 2 evidence (from one prospective controlled trial; Bowen et al., 2001) that early or late access to a head injury team intervention may reduce distress compared to no intervention in caregivers of individuals with TBI.
There is level 2 evidence (from one prospective controlled trial; Kreutzer et al., 2010) that a structured family intervention program with educational, skill building, and psychological support components may improve goal attainment in individuals with moderate to severe ABI and their caregivers.
There is level 4 evidence (from one pre-post study; Gerber & Gargaro, 2015) that a day program for individuals with mild, moderate and severe TBI and their caregivers may reduce caregiver burden.