Many Veterans with traumatic brain injury (VTBI) experience patient-level barriers for accessing community-based services and often require an individually planned and coordinated approach to facilitate access to complementary community support services. Resource facilitation (RF) is an evidenced-based model of service delivery that proactively bridges community support services post-acute care. RF services are not standardized within the VA and no research has been conducted on RF within VA settings. We propose to use coalition building as an innovative implementation strategy to engage and build consensus among multiple stakeholders (e.g., Brain Injury Association of Florida, Veteran Service Organizations, civilian RF providers, VA clinical staff, VTBI, Veteran families, and military liaisons) to implement RF.
Specific aims of this one-year mixed-method prospective pilot study to increase access to community support services for VTBI are to:
Aim 1 : Evaluate processes of the formation stage of a coalition (coalition member selection process, early formation processes, late formation processes). Q1: What are the facilitators, challenges and strategies for overcoming challenges of the coalition member selection process, as perceived by the VA planning team and coalition members? Q2: What are the facilitators, challenges and strategies for overcoming challenges during early coalition formation (reviewing selection process and membership, reaching consensus on mission, vision, goals and processes) as perceived by coalition members? Q3: How does the coalition reach consensus around goals for increasing Veteran access to RF community support services (e.g. generation of ownership, building trust among stakeholders)? Q4: What are the facilitators, challenges and strategies for overcoming challenges during late coalition formation (formalizing mission, vision, goals and processes, planning needs assessment and implementation) as perceived by coalition members? Aim 2: Describe outcomes of the formation stage. Q5: What progress did the coalition make in developing goals, planning a needs assessment and for implementation? Results of the pilot assessing effectiveness of internal coalition functioning will prepare us to foresee and address challenges in a subsequent Hybrid Type 2 design trial to test coalition building as an implementation strategy in VA settings. Methods. This one-year mixed-method pilot study examines the processes, structures and outcomes of the formation stage of coalition building as strategy to implement RF in VA settings. Semi-structured interviews will be conducted (in person, telephone) with a pre-formulated interview guide. A flexible and dynamic approach will be employed that provides an opportunity to uncover participants' perspectives, using a conversational style to promote a spontaneous flow of information. Survey data will be analyzed after each data collection point and corresponding data will be analyzed. Results will then inform subsequent data collection for further clarification and probing of findings. Anticipated Impacts on Veterans Health Care. This study supports VHA strategic initiatives (e.g. Secretary Shulkin's Priorities; Veterans Policy Research Agenda-VPRA) by improving 1) Veteran care using promising practices and building and (2) promoting collaboration with community organizations and Federal, State, and local government agencies. This study supports innovation in VHA services through collaborative initiatives to improve Veteran reintegration outcomes.

Public Health Relevance

Secretary Shulkin's Priorities and the Veterans Policy Research Agenda support strategic initiatives that promote collaboration with community organizations and government agencies. Research priorities for the VA center on strengthening foundational services in the VA and building partnerships. The lack of research on chronic health needs and maximizing community reintegration outcomes limits the ability of the VA to make evidenced-based decisions for policy and planning to meet the ongoing needs of Veterans with TBI. The proposed study will evaluate variations in the coalition building processes of a VA- State coalition to implement resource facilitation. Study results will guide a Type II hybrid design trial to test coalition building to increase Veteran access to community based resources facilitation services.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (I21)
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HSR-5 Health Care System Organization and Delivery (HSR5)
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James A. Haley VA Medical Center
United States
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