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Too often psychiatric or behavioral health care for individuals with TBI has been provided in isolation from and in disregard for existing rehabilitation systems. This isolation has led to redundancy of care as well as failure by each system to garner the full value of the expertise in the other. In this chapter we explore critical elements of the existing TBI service delivery system, recognizing that this system still fails to provide comprehensive and coordinated care for the great majority of individuals who experience TBI because of financial or geographic barriers that prevent the individuals' access to services. This failure reflects the disjointed policy and funding of American health service delivery pointedly discussed in the Institute of Medicine's Crossing the Quality Chasm: A New Health System for the 21st Century (2001). Yet a system has emerged over the last 30 to 35 years, spurred by the demands of families in need of services, growing recognition of the size and cost of TBI, and growth in available treatment approaches based in part on federally funded research in TBI. Elements of the system include various settings of care, clinical disciplines, and funding and policy guidelines. Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan) (OIF/OEF) and the identification of brain injury as the signature injury of these wars have affected all elements of this system (Tanielian 2008).

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