Objectives: Over 250,000 Virginians of adult age are living with a disability as a result of acquired brain injury (ABI). Behavioral and cognitive issues, the most common debilitating consequences of a severe ABI (Milders, Fuchs, & Crawford, 2003), have a significant impact on psychosocial adjustment and community reintegration. In Virginia, there is currently no publicly funded option for neurobehavioral treatment; as such, survivors are unable to access appropriate behavioral health services, leading to potential inappropriate placement in state and local psychiatric facilities, skilled nursing facilities, or the judicial system. The objectives of this action trajectory research (Anderson & Herr, 2005) are to assess the barriers to behavioral health services, identify best practices and develop a model/protocol for crisis intervention for individuals with ABI.

Methods: The design encompassed two intersecting phases of mixed methods data collection and analysis. Phase one consisted of the electronic deployment of a survey compromised primarily of quantitative items. It was launched to a sample of 226 regional providers with a response rate of 49% (n¼110). Phase two entailed 7 focus group interviews with 25 participants. Quantitative analysis was conducted using SPSS/PASW17. Qualitative data were coded by multiple raters and analyzed through NVivo 8. The findings highlighted barrier themes and overall severity rankings, which guided the project actions.

Results: Quantitative results revealed three major barriers to access – training and education, funding, and systems resources. Qualitative findings triangulated with these results and pointed to additional barriers relative to the survivor, the family and external stigma. Based on results and an extensive best practices review, the research team assembled a workgroup of regional stakeholders. This interagency collaborative designed a cross-systems map using the sequential intercept model (Munetz & Griffin, 2006). The map served as the basis for the protocol/model that the team began to pilot in the community as crisis cases arose. Protocol evaluation using these case studies remains in progress. Concurrent to the protocol development, the project team also organized several training opportunities to address the previously identified educational gaps 550 Abstract (i.e., PBS, BIFI). Outcomes measures relative to these programs are under investigation.

Conclusions: Preliminary findings support the necessity of an inclusive interagency approach to adequately respond to individuals in crisis. This intervention should reflect a continuum including outreach education and training, accurate screening and identification, risk assessment, and post stabilization community supports (e.g., case management). An additional consideration is that while providers report a need for training and education, it is unclear if increased preparation has a direct impact on systems change and accessibility of services. Further study is merited.