1. Planning & Implementing a Mild Traumatic Brain Injury Prevention Campaign LCDR Christye Brown

2. Rationale Improve, expand and/or implement education and public awareness campaigns to highlight prevention strategies, promote safety, and heighten awareness of signs and increase understanding of symptoms of TBI and available resources. FY 2011-2013 Joint Strategic Planning Objective

3. TBI Campaign Workgroup Composition Members from:  TBI Clinical Standards of Care Directorate  Defense & Veterans Brain Injury Center (DVBIC)  Education SMEs  VA  Strategic Communications

4. Objectives At the end of this session, participants will be able to: 1. Apply the Precede‐Proceed model to plan, implement and evaluate an awareness/prevention campaign. 2. Recognize high‐risk behaviors for mild TBI in the military population in the non-deployed setting. 3. Determine appropriate evidence‐based practices for campaign strategy integration.

5. Topics Covered Overview of Campaign Plan Application of Precede Proceed Implementation Plan Evaluation Plan

6. Overview of Campaign Plan The Plan was developed to:  Raise awareness of mild traumatic brain injury (mTBI) signs and symptoms  Implement strategies to prevent or reduce high risk behaviors that can lead to mTBI The Plan entails:  Developing a campaign that will target multiple audiences within DoD/VA (servicemembers, Veterans, families, leaders) and share information to aid in improving early detection of mTBI through increased awareness (primary care providers) Areas of focus are:  High-risk recreational activities and substance abuse/misuse

7. Campaign Aims The Heads Up Campaign aims to: 1. Provide information to primary care providers, leaders, service members & families to improve their ability to prevent TBI and recognize signs and symptoms of TBI (knowledge) 2. Raise awareness and educate primary care providers, leaders, service members & families on high risk behaviors that can increase the risk of TBI (knowledge) 3. Help primary care providers educate patients about TBI (behavior)

8. Topics Covered Overview of Campaign Plan Application of PRECEDE Assessments  Social  Epidemiological  Behavioral & Environmental  Educational & Organizational  Administrative & Policy Implementation Plan (PROCEED) Evaluation Plan

9. PRECEDE-PROCEED Model

10. Adapting PRECEDE for TBI Campaign

11. Who is Affected…Intended Audience? Audience Prevention Focus FamiliesPrimary Service members & Veterans (17-29 year old cohort) Primary Military LeadersPrimary Primary care providersPrimary & Secondary

12. Main Statistic of Interest From 2000 to 2011, 194,754 TBI-related encounters were reported among all Services and Service components, deemed as non-deployment related. Represents 83.5% of all reported TBI encounters during this period.

13. Injury Surveillance Data – Four primary causes of injuries were evaluated (cont’d) Armed Forces Health Surveillance Center. (n.d.). Installation injury report. Retrieved from http://www.afhsc.mil/injuryReportshttp://www.afhsc.mil/injuryReports All data is CONUS-based and non-combat related.

14. Injury Surveillance Data – Four primary causes of injuries were evaluated Armed Forces Health Surveillance Center. (n.d.). Installation injury report. Retrieved from http://www.afhsc.mil/injuryReportshttp://www.afhsc.mil/injuryReports All data is CONUS-based and non-combat related.

15. Concussion Diagnosis – Review of the data shows increase in diagnosis of concussion across the services since 2001 Defense Medical Epidemiology Database. (n.d.). Surveillance data. Retrieved from http://www.afhsc.mil/aboutDmedhttp://www.afhsc.mil/aboutDmed All data is CONUS-based and non-combat related.

16. Environmental Scan focused on identifying prevention-based TBI programs and training provided or funded by DoD 57 TBI-related programs are currently available within DoD  50% focus on clinical care  23% focus on awareness  2% include a prevention component No programs exclusively focus on prevention  DVBIC has national and regional TBI education & clinical staff that focus on prevention through education and outreach (Brainlinemilitary.org)  VA sponsors a fall prevention program for the older Veteran cohort but does not have a prevention campaign for younger Veterans

17. Environmental Scan, cont. Army and Military Health System (MHS) have the most TBI-related trainings 95% of all training is focused on treatment and/or awareness 57 TBI-related programs are currently available within DoD 23% of programs focus on awareness, but <12% focus on prevention Most programs deal with TBI as co-occurring in combination with psychological health and social issues.

18. Environmental Scan focused on identifying existing TBI Campaigns internal to DoD & VA Researched different Services to ensure visibility on existing TBI Campaign planning and concepts of operation, collaborated with TBI Program Managers:  Air Force - NA  Army – extensive plan to mandate TBI training  Branding includes “Heads Up Warriors”  Marine Corps – newly released (5/31/12) TBI Program document  Navy – incorporated outreach efforts with NFL

19. Environmental Scan focused on identifying existing TBI Campaigns external to DoD & VA Reviewed Collection of TBI Campaign Profiles, a HRSA document. Explored 39 existing TBI campaigns/awareness efforts at national, state and regional levels Identified campaigns with similar efforts and goals to address TBI

20. Prioritizing findings from Environmental Scan High-risk recreational activities and substance abuse/misuse  Sports and protective equipment  Seatbelts  Drinking excessively  Driving under the influence of drugs or alcohol General safety training provided by Services

21. Motor Vehicle Stats (example) Source: http://safetycenter.navy.mil/ USN ON-DUTY MOTOR VEHICLE CLASS A MISHAPS 17 Jun 2012: (Mississippi) E-6 died in a motorcycle mishap after he lost control of his motorcycle and struck a tree while driving to TAD training. USN PRIVATE MOTOR VEHICLE FATALITIES 16 Jun 2012: (San Diego, CA) E-5 died after he lost control of his motorcycle while riding on the interstate. 10 Jun 2012: (Amsterdam, NY) E-4 died in a motorcycle mishap. 08 Jun 2012: (Lemoore, CA) E-4 died in a motorcycle mishap when he rear-ended a vehicle. 10 May 2012: (Navajo, AZ) E-4 and E-2 died in an automobile mishap after their vehicle collided with a tractor trailer. 04 May 2012: (Greenbelt, MD) E-6 died in a single-vehicle motorcycle mishap. 29 Apr 2012: (Jacksonville, FL) O-2 died on 03 May 2012 from injuries sustained when he was struck by a vehicle while crossing the street at an intersection. 15 Apr 2012: (Virginia Beach, VA) E-3 died from injuries sustained in a motorcycle mishap. 15 Apr 2012: (Silverdale, WA) E-5 died when struck by a vehicle subsequent to a single-vehicle motorcycle mishap. 15 Apr 2012: (Jacksonville Beach, FL) E-5 was killed when he was struck by a vehicle while crossing the street. 14 Apr 2012: (Lyman, MS) E-5 died after he lost control of his motorcycle trying to avoid another vehicle. 08 Apr 2012: (Jacksonville, FL) E-3 died in a single-vehicle mishap. Three other service members were injured. 28 Mar 2012: (Mascoutah, IL) E-4 killed when his vehicle was struck by another vehicle at an intersection. 24 Feb 2012: (Gorst, WA) E-4 died in a single-vehicle mishap when his automobile ran off a bridge. 23 Jan 2012: (Gig Harbor, WA) O-4 stopped to provide assistance during a traffic accident and was struck by a vehicle. 21 Jan 2012: (Kingsland, GA) E-5 passenger died after a single-vehicle mishap. (E-4 driver is in critical condition.) 11 Dec 2011: (El Paso, TX) E-4 killed in a multi-vehicle accident on the Interstate. 10 Dec 2011: (Hampton, NH) O-2 passenger was killed and CW-O4 driver injured in single-vehicle accident on an off ramp.

22. Communications Methods  Web-based or Mobile technology based materials (Primary Care Providers, Military Leaders, SM, Veterans and families)  Print communications via email (Primary Care Providers, Military L eaders, SM, Veterans and families)  PSA’s (potentially leveraging Armed Forces Network, Defense Media Activity, Veteran’s Health Channel), blogs, print magazines (SM, Veterans and families)  Internal communication systems to disseminate c ampaign messaging and materials  DCoE, Brainline.org and Brainlinemilitary.org websites  Dissemination partners:  Safety Offices  Office of Military Community & Family Policy  DoD schools  Military Impacted Schools Association  VA’s OIF/OEF/OND Program  Vet Centers

23. Identification of Best Practices -CDC’s Heads Up- Branded campaign with high visibility and 12+ years of data/evaluation and strong experience in campaign delivery through multiple media formats Wide range of products and materials for multiple audiences that can be adapted and mapped to military target audiences Earned buy-in from numerous stakeholders and concussion focused organizations

24. Mapping of Heads Up Materials Promotion Materials Description of Materials Audience Segment Match Heads Up (Generic audience) Facts sheets on: -Preventing concussion -Concussion and brain injury -Teen drivers Brochure (20-page booklet): -Where to get help Various videos, podcasts, buttons, badges Military leaders, service members, Veterans and families Heads Up: Brain Injury in Your Practice -booklet with information on diagnosis and management of MTBI -patient assessment tool (Acute Concussion Evaluation or ACE) -care plan to help guide a patient's recovery -fact sheets on preventing concussion -palm card for the on-field management of sports-related concussion -CD-ROM with downloadable kit materials and additional MTBI resources Primary care providers Heads Up: Concussion in Youth/High School Sports Parents & Athletes: -Fact sheets -Magnets --Posters -Quizzes Families Heads Up to Schools: Know Your Concussion ABCs Parents: -Fact Sheets Other info: (fact sheets, posters, magnets, concussion checklist) **available for teachers, counselors, administrators, school nurses Families

25. Collaborations Strategy Establish partnership with CDC National Center for Injury Prevention 1. MOU 2. Plan for tailoring materials, branding for military audiences 3. Funding 4. Warehousing

26. Projected Rollout Plan October 2012 August 2012 Families Service members & Veterans Military Leaders Primary Care Provider s September 2012 November 2012

27. QUESTIONS??? THANK YOU FOR YOUR ATTENTION!! LCDR Christye Brown, PhDc, MPH, MBA, CHES Division Chief, Standards & Doctrine Education Directorate Defense Centers of Excellence (DCoE) for Psychological Health & Traumatic Brain Injury 1335 East-West Hwy, Suite 640 Silver Spring, MD 20910 W: 301.295.3440 christye.brown@tma.osd.mil www.dcoe.health.mil