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Objective: To compare the diagnosis of positive versus negative for mild traumatic brain injury (mTBI) using the Boston Assessment of TBI-Lifetime (BAT-L), a validated forensic clinical interview used to identify TBI in research, to the diagnosis of mTBI in the clinical polytrauma service using the Comprehensive TBI Evaluation (CTBIE)., Participants: Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans who were enrolled in the Translational Research Center for TBI and Stress Disorders longitudinal cohort study and received a CTBIE at a Veterans Health Administration healthcare facility (n = 104)., Main Measures: The BAT-L, CTBIE, and Neurobehavioral Symptom Inventory., Results: There was poor correspondence between the BAT-L and CTBIE mTBI diagnoses (κ = 0.283). The CTBIE showed moderate sensitivity but poor specificity relative to the BAT-L. The agreement did not improve after removing individuals who had failed symptom validity measures, as assessed by the Validity-10 scale of the Neurobehavioral Symptom Inventory., Conclusions: This lack of correspondence highlights the difficulties in diagnosing mTBI in Veterans using retrospective self-report. Future work is needed to establish a reliable and valid method for identifying military mTBI both for the care of our Veterans and for appropriate distribution of benefits.

Objective: To evaluate the feasibility of a newly developed reintegration workshop for Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) Veterans that is based on an evidence-based rehabilitation program shown to be effective in treating mild traumatic brain injury-related symptoms in civilians. Underutilization and resistance to mental health treatment remain a significant problem for OEF/OIF Veterans. Innovative, integrative, transdiagnostic, and acceptable interventions are needed, particularly for this heterogeneous group., Participants: Eighty-four OEF/OIF/Operation New Dawn Veterans (74 male and 10 female)-mean age = 35; standard deviation = 7.4., Setting: VA Healthcare System., Intervention: A 12-week, 2-hour/wk, group skills-based workshop with individual skill building to assist all OEF/OIF Veterans (with and without psychiatric and/or traumatic brain injury) in reintegration after military service., Main Measures: Primary outcomes were feasibility measures including treatment fidelity, acceptability, tolerability/adherence, and treatment-related skill acquisition. Secondary outcomes were interest and engagement in future treatment and reintegration status., Results: Veterans' enrollment, adherence, and attrition data indicated that Short-Term Executive Plus adapted for Veteran civilian reintegration (STEP-Home) was acceptable and tolerable. Pre-/postintervention differences in attention, problem-solving, and emotional regulation skills demonstrated treatment-related skills acquisition. Secondary outcome data demonstrated Veterans who were hesitant to participate in mental health treatments before enrollment were more open to treatment engagement after STEP-Home, and reintegration status improved., Conclusions: This study demonstrated that the STEP-Home workshop is feasible in OEF/OIF Veterans and changes in treatment-related skill acquisition and reintegration status were observed. STEP-Home has potential to facilitate readjustment and serves as a gateway to additional, critically needed Veterans Administration services.

Many US veterans of Afghanistan and Iraq have multiple physical and psychiatric problems. A major focus of research has been on determining the effects of mild Traumatic Brain Injury (mTBI), but mTBI is rarely diagnosed in the absence of co-occurring conditions such as blast exposure, post-traumatic stress disorder (PTSD), depression, substance abuse, etc. These potentially interactive psychological and physical conditions produce complex patterns of cognitive, psychological, and physical symptoms that impede civilian reintegration and complicate efficient and effective treatment planning. The Translational Research Center for TBI and Stress Disorders (TRACTS) has developed a multidisciplinary approach to the assessment of deployment trauma and its consequences in veterans of these wars. The prospective TRACTS longitudinal cohort study conducts state-of-the-art assessments in the domains of biomedical function, lifetime head trauma, psychological function encompassing deployment experience and lifetime exposure to traumatic events, neuropsychological function, and structural and functional neuroimaging. The TRACTS longitudinal cohort study is the first of its kind to comprehensively evaluate lifetime incidence of TBI and PTSD in these veterans, in addition to those incurred during military deployment. The protocol has begun to reveal information that will help improve understanding of the complex pathophysiology associated with co-occurring mTBI and related stress disorders., (Published 2017. This article is a U.S. Government work and is in the public domain in the USA.)