--Roberta DePompei, PhD --Janet Williams, MSW

As a Social Worker working on a TBI Unit, I found this article to be a good source of information on how to work more effectively with families after a traumatic brain injury.

The first part of the article attempts to describe the complexity of the family system and how this system reacts to a crisis.

In understanding the family and response to Traumatic Brain Injury, we need to look at the actual family system, who makes up that system and what roles, rules, and communication patterns are specific to that system. In our society, the family system can also consist of blended / extended families.

The article notes that families react to crisis in different ways. Some systems are able to support and communicate with each other to find strength in dealing with the crisis. Others family systems react by feeling unsupported and fall apart at the time of a traumatic event.

Several factors are listed that can have an impact on the family's ability to respond to TBI.

1. The family system's previous ability to function during crisis and the other stress factors that may already be present at the time of injury.

2. The family's communication style.

3. Ethnic and cultural background.

4. The family's ability to access community resources.

5. The age of the TBI patient.

Another important point that the article makes is that it discusses the importance of the treatment team and the team's understanding of the different responses / reactions a family can have after a traumatic brain injury. Responses such as grief, death and dying stages, episodic loss through the life cycle, acceptance versus adjustment issues, and the employment of the defense mechanism of denial. Explanation of the use of denial in both a functional (positive) and dysfunctional (negative) perspective. Possible coping behaviors are also discussed in the article.

The last part of the article stresses the importance of involving the family in all aspects of the rehabilitation process (assessment, planning, interventions). It also stresses the treatment team's need to provide appropriate teaching and educational materials to assist the patient and family. The need for family centered counseling and support groups was stressed as an essential part of the rehabilitation process.

Traumatic Brain Injury can be a life altering experience. This article attempts to show that by understanding the specific family system, how the system reacts to a crisis and what that systems needs are, we as professionals can begin to work more effectively with patient and family members throughout the rehabilitation process.

For further information, please refer to:

DePompei,Roberta, PhD. and Williams, Janet MSW. (1994, November). Working with Families after TBI: A family-centered approach. Topics in Language Disorders. 68-81.

Submitted by: Noreen Bock, CSW Social Worker Jamaica, Hospital Medical Center The Brady Institute Traumatic Brain Injury / Coma Recovery