The Defense Intrepid Network for TBI and Brain Health’s Continuum of Caring, Healing, and Thriving initiative, headquartered at the National Intrepid Center of Excellence in Bethesda, Maryland, is a comprehensive interdisciplinary approach to address the full continuum of traumatic brain injury, behavior health, and brain health.

Over the past 22 years, more than 468,000 service members have sustained a TBI. The majority of TBI events occur in training: Breaching, anti-tank weapon use, combatives, parachute jumping, and blast exposure, according to the Traumatic Brain Injury Center of Excellence.

This high rate of TBI affects the readiness of the U.S. armed forces. To ensure a medical ready force, we must engage service members prior to an initial TBI event. This is the beginning of the continuum of care.

“We know the service members at highest risk for TBI and associated conditions and recognize the importance of preparing them for the careers they go into,” said U.S. Navy Capt. Carlos Williams, director of the NICoE. “In fact, to gain a better understanding of how widespread brain injuries are and the impact these injuries can have on our service members, we should also begin to more closely engage our aviation and undersea communities.”

“During this pre-TBI phase, we must use foundational tools such as education, integrative health services, and other best practices to build resilience and, when possible, prevent the event or complications altogether,” he said.

A goal of the continuum of care is to partner with the operational community and others in the TBI clinical, research, and academic spaces to educate service members and their families about TBI, its effect on brain function, and activities to help restore the brain immediately after an injury or after having persistent symptoms for many years.

In addition, service members can be taught elements of the integrative health services that are a part of the Defense Intrepid Network’s patient-centric interdisciplinary care model. These may include yoga, meditation, breath work, and art therapy to help process fragmented trauma memories and be used life-long to address future trauma and build resiliency, said Dr. Thomas DeGraba, chief innovations officer for the NICoE.

The continuum aligns with the Warfighter Brain Health Initiative that supports prevention and establishes resilience in the pre-TBI state.

The five lines of effort of the Warfighter Brain Health Initiative are:

• Optimize cognitive and physical performance
• Identify, monitor, and mitigate brain exposures
• Prevent, recognize, and minimize the effect of TBI
• Reduce or eliminate long-term/late effects
• Advance warfighter brain health science

The next step in the continuum of care is treating those with TBI. For service members who visit the NICoE, one of the 11 Intrepid Spirit Centers or two clinics in the Defense Intrepid Network, the interdisciplinary care model enhances their trajectory of recovery with skills-based training and education. Patients can go at their own pace and process things in a safe environment at one of the ISCs or clinics.

After treatment, the continuum facilitates continued healing, recovery, and the transition to full duty or civilian life through a network of partnerships across the Department of Defense, Department of Veterans Affairs, non-governmental military and veterans support organizations, academia, industry, and the TBI community.

These partners provide top quality follow-up care, case management, peer support groups, and other services to assist in healing and thriving.

“Any organization that offers resources to our beneficiaries, we hope to identify them and help our members take advantage of those resources. Simply put, the continuum ensures that we prepare for, treat when needed, and continue to support lifelong recovery so that no one is left behind,” said Williams.

It also means continually evaluating how service members respond to care in the Defense Intrepid Network, which leads to constant updating of best practices throughout the continuum.

“I am excited for the future of the Defense Intrepid Network,” said Williams. “It is built on inclusiveness and allows participation from providers and experts across the Military Heath System and beyond to contribute to improving care and quality of life of our service members.”