Recently FedHealthIT Vice President, Susan Sharer, spoke with Katherine Helmick, the Acting National Director of the Defense and Veterans Brain Injury Center (DVBIC), about the organization’s mission, advancements made around diagnosis, treatment and care, the opportunity that still exists, and the future of traumatic brain injury (TBI).
The Mission of the Defense and Veterans Brain Injury Center (DVBIC)
DVBIC is the Department of Defense’s (DoD) traumatic brain injury (TBI) center of excellence, which supports service members, Veterans and their families as they navigate the pathway of care through the Military Health System. Its website notes “DVBIC was founded in 1992, largely in response to the first Persian Gulf War, under the name Defense and Veterans Head Injury Program. At that time, its goal was to integrate specialized TBI care, research and education across military and Veteran medical care systems.”
Katherine Helmick, Acting National Director, says the organization reaches its goals through research, supporting educational initiatives, and through its influence on the policies coming out of DoD surrounding these injuries. All of this, she says, is focused on maximizing patient outcomes and advancing better care. The scope of information includes material specific to service members and Veterans, to families and caregivers, including the general public, and to medical providers.
The Reach of DVBIC
DVBIC is comprised of a wide-ranging group of multidisciplinary staff based out of a headquarters in Silver Spring, Maryland, plus 22 sites that include 17 military hospitals and clinics and five Department of Veterans Affairs (VA) medical centers.
Through the VA medical facilities, Helmick says DVBIC staff support level I polytrauma centers doing research and educating providers. “Our military health presence covers Navy, Marine, Air Force, Army, and Special Operations facilities where our staff is on site supporting clinical care, doing research and providing education.”
At the headquarter level, DVBIC is the DoD TBI center of excellence and is “involved in keeping DoD senior leaders informed of TBI activities and strategy, supporting congressional briefings, and working with the international community including NATO.”
The Evolution of DVBIC
“A lot has really changed since 9/11,” says Helmick. “That was when we really started to understand blast as a threat of concussion. If we look at the literature on concussion at the time, there were only 200 articles. Now the research and resources in the area reaches six digits (hundreds of thousands).”
She explains that at one time, people who were not initially diagnosed with TBI experienced sleep issues, headaches, depression, and sometimes more severe symptoms. Since the source of the issue was not understood, they suffered, their families suffered, and in some cases, the recurrence and severity meant they had to leave the military.
By 2004, DVBIC had progressed in its understanding of TBI, treatments had evolved, and it was recognized that if TBI could be detected early, there was an opportunity to improve outcomes. “Where people weren’t being diagnosed, or the situation was compounded by things like post-traumatic stress disorder (PTSD), and depression, there was a lot of suffering. We wanted to get ahead of that, to focus on prevention, on assessment to render an early diagnosis, and ultimately, begin treatment as soon as possible.”
DVBIC’s initial focus was on penetrating severe brain injury and treatment but then shifted to look at the invisible wound of war, the mild injury whose symptoms may not be as obvious.
Support at All Levels
DVBIC reports to the J-9 division within the Defense Health Agency (DHA). Helmick says the organization is connected with all of the top leaders within the Agency. “We meet with Admiral Bono, who is closely tracking and is deeply invested in our efforts, and we have access, through the TBI Advisory Committee (TAC), to Army, Navy, Air Force and the Marine components, which helps drive out new models of treatment and new information to really provide consistent support.”
DVBIC also works closely within DoD, with the VA, and with the National Institutes of Health (NIH), on the National Research Action Plan, which is a roadmap to address the key issues of PTSD, TBI and suicide. Externally, the organization works with academia, with international groups, including NATO, and with the sports community and associations like the National Football League (NFL) and National Collegiate Athletic Association (NCAA).
Industry Supporting the Effort
Technology will undoubtedly play a huge part in the future of TBI research, assessment and treatment. Helmick says there are many manual processes now requiring training that can and likely will be automated in the near future. “From the initial assessment through treatment and after care, we can gather more objective date from technology, devices and tools that will play a crucial role along the care journey.”
From the research side, she says there is an opportunity to better understand the impact to the low-level blast exposed population, those training and those in war situations, to understand what repetitive low-level exposure is doing and to influence policy and to change standards for what is acceptable.
There is also an opportunity available through the DVBIC website for concept submission through which people can share their ideas with subject matter experts who will drive them forward to the next stages where appropriate.
Significant Changes in TBI Care and Treatment
Helmick says that, historically, intervention and treatment required a service member or Veteran to exhibit symptoms or ask for help. Today, assertive screening and assessment identify previously invisible and untreated injuries in anyone involved in a blast, near a blast, involved in a rollover, or who has had a visible blow to the head. “This incident-based approach means we can understand, before symptoms are evident, whether someone has suffered an injury. Service members who are being evacuated for an injury of any kind are being assessed, before they get on a plane, as part of that early detection.”
The Future of TBI
Most scientific advancements (e.g., cancer) can take 10 to 20 years, but the information flowing through DoD will support much faster improvements and changes to TBI care.
Helmick says this is a good time in terms of congressional interest, DoD’s commitment and the opportunity for collaboration. “There is an opportunity to collect and make sense of a whole lot of data for the betterment of the service and general population.”
Research at the Heart of Understanding
Partnering with the VA, with the sports community, including the NFL and NCAA, academia, and with other agencies—with a goal of sharing—DVBIC began to harness all the available information.
Helmick explains that DVBIC has positioned itself to support education and awareness on both sides of the fence. “There are differences in the blast sphere of injuries, especially with respect to service members and Veterans, compared with the general population, but a goal was set to move forward as a community of interest.”
She says these unique differences in experience from a military member’s perspective created challenges in relating public research into translatable data for service members and Veterans. “However, information that we gain though research based on service members is translatable to the general population.”
Research and Services
Currently, Helmick says DVBIC has 71 ongoing studies that will be used to provide the research needed to influence education, clinical support and policy.
“We have people strategically placed throughout our network to assist service members and Veterans as they transition around the Military Health System. Our experts are well versed in the support services available post TBI and are in direct contact with caregivers to track quality of life and function, as well as provide support.”
Helmick says that Congress asked for a curriculum to support caregivers so DVBIC developed one that provides caregivers with resources but also encourages them to take care of themselves, to find meaning in the new role they have taken on.
Podcasts of “The TBI Family,” now in its second season, address family and caregiver issues. Episodes cover topics such as VA respite programs; substance use and TBI; art as self-care for caregivers; and talking to kids about TBI. The podcast recently won a Hermes Creative Award and has become the most-listened-to caregiving podcast in the country.
“We also help facilitate the journey in terms of geographic resources, and through which we can connect people going through similar journeys. An important piece of all of this is understanding the outcome and learning as an enterprise what works and what doesn’t.”
Another impactful initiative is the nine Intrepid Spirit Centers being established through support from the Fallen Heroes Fund. Seven are open and two are yet to be built. According to the website “each Intrepid Spirit Center is approximately 25,000 square feet and costs approximately $12 million to build and equip. The centers are designed around the interdisciplinary model of care developed at NICoE (National Intrepid Center of Excellence). This model of care brings all disciplines involved in TBI care together under one roof, providing a comprehensive means of delivering care” and will support the “hundreds of thousands of military personnel who have been diagnosed with some level of traumatic brain injury (TBI) in the past decade.”
Helmick says in addition, DVBIC offers a national provider training program and, through a longitudinal, long-term study, is tracking hundreds of patients in order to learn more about and better understand the long-term implications of TBI.
“Our biggest impact from the DVBIC network comes from having boots on the ground, from seeing what is taking place, being able to understand the effectiveness of treatments, and the ability to influence future programs and plans.”
The variety of resources available on DVBIC’s website includes: clinical tools, fact sheets, and access to training and events, including webinars and podcasts. There are resources for service members and Veterans, for families and caregivers, and for Healthcare providers.
Publications covering two decades of effort range from neurophysical performance and VA TBI screening to differential rates of recovery after acute sport-related concussion.
Prevention and Education
Prevention, says Helmick, is the key. “As much as you think you may know, you may be surprised by what you don’t. There are a lot of unknowns in terms of long-term effects of brain injury. In any situation, it is always better to be safe than sorry; always take the time to get checked out. It is also important to be informed and to ensure those around you are informed.”
Katherine Helmick is the Acting National Director of the Defense and Veterans Brain Injury Center (DVBIC). She has served in a variety of leadership, advisory and operational roles, including Deputy Director for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; Deputy Director for the Clinical and Educational Affairs Office for DVBIC; Manager of the Office of Clinical Standards at DVBIC; Neurological Surgery Nurse Practitioner at Hodes Neurosurgery in Louisville, Kentucky; Nurse Practitioner/Clinical Care Coordinator at the University of Louisville Hospital; and Clinical Research Coordinator in the Division of Neurosurgery at the Medical College of Virginia Hospitals.