Implementation of telehealth and hybrid service delivery of interdisciplinary rehabilitation for military populations with traumatic brain injury.

BACKGROUND: The COVID-19 pandemic necessitated the implementation of telehealth and hybrid service delivery models and provided an opportunity to study the impact of this care model in military populations with history of traumatic brain injury (TBI). OBJECTIVE: To present telehealth service utilization rates across rehabilitation specialties, treatment outcome indicators, and patient satisfaction outcomes from a retrospective clinical sample. METHODS: The study sample consists of 34 patients who underwent telehealth/hybrid Intensive Outpatient Programming (IOP) at a major rehabilitation hospital. Retrospective chart review and clinical data extraction were performed. A historical cohort receiving in-person care was used as a comparison group. Statistical analyses included partial correlations, mixed method analysis of variance (ANOVA), and independent sample t-tests. RESULTS: Medical, behavioral health, physical, occupational, and speech-language therapy providers exhibited similar rates of telehealth service delivery (35 to 41% of all sessions). No significant association was found between percent telehealth sessions and the global treatment outcome indicator. Comparison of treatment effects across cohorts revealed similar benefits of IOP. No between-group differences were noted in satisfaction ratings. CONCLUSION: The comparable treatment-related gains and reports of positive patient experience support the use of a telehealth and hybrid delivery model for military service members and veterans with TBI.

Level of Evidence of Telehealth Rehabilitation and Behavioral Health Services for Traumatic Brain Injury: A Scoping Review.

Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50-80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs.

Use of person-centered goals to direct interdisciplinary care for military service members and Veterans with chronic mTBI and co-occurring psychological conditions.

Objective: To explore the use of person-centered goals (PCGs) to direct interdisciplinary care to support PCG attainment in military service members and Veterans (SM/Vs) with chronic mild traumatic brain injury (mTBI) and co-occurring psychological conditions. Methods: A retrospective chart review was completed for 146 United States military SM/Vs reporting chronic symptoms following mTBI and co-occurring psychological conditions who received care in the SHARE Military Initiative intensive outpatient program, a donor-funded program administered by a not-for-profit hospital, between April 1, 2015 and March 31, 2019. PCGs were used to direct care consisting of individual and group-based interventions and therapies delivered by an interdisciplinary, co-located team including behavioral health, case management, neurology or physiatry, nursing, occupational therapy, physical therapy, recreation therapy, speech-language pathology, and transition support. The primary outcome measure was PCG attainment measured via goal attainment scaling. Results: Increased PCG attainment was demonstrated at program discharge and throughout the first year following program discharge. Predictors of goal attainment at discharge included longer participation in treatment, greater reduction in depressive symptoms and greater improvement in adjustment at discharge, male gender, and higher cognitive and physical abilities on admission. Conclusions: This sample of military SM/Vs with mTBI and co-occurring psychological conditions who received intensive, interdisciplinary, PCG directed care demonstrated increased PCG attainment at program discharge which further increased with transition support over the year post-discharge. Results suggest PGC goal directed care is a feasible, promising methodology of individualizing treatment in this population. This exploratory study lays a foundation for future prospective, controlled, comparative effectiveness research that will further understanding of the effectiveness of intensive, interdisciplinary, PCG directed care.

Do psychopathic birds of a feather flock together? Psychopathic personality traits and romantic preferences.

OBJECTIVE: The goal of the present studies was to investigate whether people are especially attracted to psychopathic traits, and whether there are individual differences in such attraction. METHOD: Female undergraduates (N = 270; Mage = 19; 57% White, 20% Asian, 8% Black) and female and male community members (N = 426; Mage = 37; 56% female; 81% Caucasian, 10% African American, 4% Asian) reported on their own personality and constructed their ideal mate for a dating, short-term, and long-term relationship from a list of 70 characteristics drawn from well-validated criteria for psychopathic personality and diagnostic criteria for DSM-5 personality disorders (PDs). RESULTS: Across both studies, absolute romantic preferences for psychopathic traits collapsed across time point were low on average, but higher than those for most all other PDs. In addition, they were higher for Factor 1 (i.e., interpersonal/affective) as opposed to Factor 2 (i.e., impulsive, antisocial) psychopathy traits. Participants with marked PD features, including Factor 2 psychopathy traits, were more inclined than others to endorse a preference for psychopathic males. CONCLUSIONS: Relative attraction to psychopathic males and observed homophily may be avenues through which psychopathic traits persist in the population across time.

An experimental paradigm examining the influence of frustration on risk-taking behavior.

The present study examined the impact of frustration on risk-taking in college students with low and high ADHD symptomatology (L-ADHD and H-ADHD). Participants completed the Balloon Analogue Risk Task (BART) following induced frustration from a mood manipulation task (experimental session) and following no mood manipulation (control session). A manipulation check revealed a significant three-way interaction where the H-ADHD group reported higher frustration levels compared to the L-ADHD group, particularly in response to the frustration induction in the experimental condition. Primary results revealed that the L-ADHD group exploded significantly fewer balloons in the experimental condition compared to the control condition; there was a nonsignificant difference of balloon explosions across conditions for the H-ADHD group. The study provides initial laboratory-based support for the impact of frustration on the risk behavior of those with low and high levels of ADHD, with potential implications for future studies and ultimately for intervention.

Current directions in laboratory studies of personality pathology: Examples from borderline personality disorder, psychopathy, and schizotypy.

Much of the earliest research on personality pathology was observational and descriptive in nature, drawing heavily on subjective self-reports, however, the last 20 years have seen a surge of interest in laboratory-based studies. Laboratory research offers a number of benefits for researchers interested in personality disorders and personality pathology including the opportunities to use objective performance-based and behavioral measures, reveal the neuropsychological and biobehavioral processes that may help shape the experience and behavior of individuals with personality disorders, and create experimental designs that allow researchers to systematically explore the effect of context on emotional, behavioral and cognitive responding. Along with these benefits, laboratory research on personality disorders has its share of methodological and interpretive challenges and raise several key questions, including (a) How should we interpret findings that diverge from theory-driven predictions? (b) How do we reconcile discrepant results from subjective and performance-based assessments? and (c) Are these discrepancies due to methodological artifact, a hallmark of the disorder, or cause for theoretical reconsideration? The goal of this article is to review studies aimed at answering a key research question in the domains of borderline personality disorder, psychopathy, and schizotypy. Our review highlights significant progress in laboratory research on personality disorders, and identifies challenges that must be addressed to capitalize on the promise of laboratory methods. It is our hope that future experimental work proceeds with an eye toward theoretical coherence, methodological rigor, ecological validity, and clinical utility. (PsycINFO Database Record