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The Veterans Health Administration System of Care for Mild Traumatic Brain Injury: Costs, Benefits, and Controversies

Belanger, Heather G. PhD; Uomoto, Jay M. PhD; Vanderploeg, Rodney D. PhD

Section Editor(s): French, Louis M. PsyD

The Journal of Head Trauma Rehabilitation: January-February 2009 - Volume 24 - Issue 1 - p 4–13
doi: 10.1097/HTR.0b013e3181957032

The Veterans Health Administration's (VHA's) Polytrauma System of Care, developed in response to a new cohort of patients back from Iraq and Afghanistan, is described with particular focus on the assessment and treatment of mild traumatic brain injury (mild TBI). The development of systemwide TBI screening within the VHA has been an ambitious and historic undertaking. As with any population-wide screening tool, there are benefits and costs associated with it. The purpose of this article is to identify and discuss the strengths and weaknesses of the VHA's TBI clinical reminder and subsequent evaluation and treatment processes. Complicating factors such as increased media attention and other contextual factors are discussed.

From the Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, Florida (Drs Belanger and Vanderploeg); Department of Psychology (Drs Belanger and Vanderploeg) and Psychiatry (Dr Vanderploeg), University of South Florida, Tampa; VA Puget Sound Health Care System, Seattle, Washington (Dr Uomoto); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington (Dr Uomoto).

Corresponding author: Heather G. Belanger, PhD, Department of Psychology, James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, 117, Tampa, FL 33612 (e-mail:

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration (VHA). Further support was provided by the James A. Haley Veterans' Hospital. The views expressed herein are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs.

© 2009 Lippincott Williams & Wilkins, Inc.