Chapter 32. Systems of Care

Susan L. Vaughn, M.Ed.; William E. Reynolds, D.D.S., M.P.H.; D. Nathan Cope, M.D.
DOI: 10.1176/appi.books.9781585624201.686141



In terms of sheer numbers of cases, patients with mild and moderate traumatic brain injury (TBI) far outnumber the severely injured, and frequently these are essentially physically independent individuals struggling with isolated psychiatric problems of depression, posttraumatic stress disorder, anxiety reactions, and less severe cognitive and behavioral disturbances. Appropriate psychological and psychiatric care, as detailed in the chapters of this textbook, is essential. For the more severely injured patient with TBI, however, a more complex pattern of care is typical. The aim of this chapter is to provide a general overview of the treatment environment that will be the backdrop for most neuropsychiatric care. It is hoped that as more awareness of these parallel resources emerges, a better integration between them will occur, to the benefit of the patients and families enduring the consequences of TBI. In this chapter we also describe public and private sources of funding and the efforts of state governments (in part as a source of funding) to address gaps in the system and encourage the development of needed services.

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Figure 32–1. Simplified schematic of treatment flow for individuals with traumatic brain injury: acute care, rehabilitation, and community services and supports.Solid lines refer to the path that an individual with traumatic brain injury may take after an injury, including prevention initiatives that may reduce the severity of the injury (e.g., helmets, seat belts). Dotted lines show the relationships and mutual collaboration among the various components of the service delivery system.Source. Reprinted from King A, Vaughn SL: Guide to State Government Brain Injury Policies, Funding, and Services, 2nd Edition. Bethesda, MD, National Association of State Head Injury Administrators, 2005.
Table Reference Number
Table 32–1. Categories of Commission on Accreditation of Rehabilitation Facilities–certified medical rehabilitation programs


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