Encouraging Early Screening and Diagnosis of mild TBI in Two At-Risk Montana Populations: A Community-Based Approach to Identify Barriers and Culturally-Effective Interventions
Cindi Laukes1,2, Jera  Stewart3, Solomon Harrar4,5, LeeAnna Muzquiz2,7, Shawn Grove6, Ann Miller8, Roy Savage9, Miles Wetzel15, Brenda Morton7, Margaret Bowman11, Leonid  Kalachev4, Tony Incashola12, Lisa Shourds13,MIchele Rutherford15, Matt Gangloff14
1DIrector, Neural Injury Center, University of Montana, Missoula, United States, 2University of Washington, Seattle, United States, 3Missoula VA Community Based Outpatient Clinic, Missoula, United States, 4University of Montana Statistics and Applied Math, Missoula, US, 5University of Kentucky, Lexington, US, 6University of Montana Vets Office, Missoula, US, 7CSKT Tribal Health Department, Polson, US, 8CSKT Tribal Defenders Office, Pablo, US, 9Heroes Therapeutic Outreach Program, Missoula, US, 10Montana Military Order of the Purple Heart, Statewide, US, 11S&K Technologies, Polson, US, 12Salish-Pend d'Oreille Culture Committee, St. Ignatius , US, 13CSKT Legal Dept., Pablo, US, 14Enlyten Lab, Missoula, US, 15University of Montana, Missoula, US
Background: Montana ranks amongst the highest in the nation for both brain injury and suicide incidence. It also has one of the highest per capita veterans’ populations, and is home to seven Indian reservations. Both American Indian and veteran populations are at increased risk for both brain injuries and suicide. Both groups are characterized by unique social and cultural factors presenting specific challenges and barriers to health screenings, including concussion. These factors can also influence the success of brain injury interventions. Both groups share similar barriers, such as reliance on and mistrust of government-based systems (Indian Health Service and Veterans Administration), stigma related to brain injury, financial barriers, transportation issues, homelessness and other factors. Conversely, each community is characterized by unique cultural factors that may be of key importance in developing culturally effective interventions.  

Objectives: (1) To engage a Montana tribal community (Confederated Salish & Kootenai Tribes--CSKT) and a student veterans community (at the University of Montana) in understanding the problem of concussion; (2) To identify prevalence, existing barriers, and culturally effective interventions targeting early screening and diagnosis of concussion, and; (3) To compare results of the two groups to better understand and describe any common and distinct factors between groups that may impact successful interventions.

Research Description: This study used a mixed method, community-engaged survey approach, with extensive input from two community advisory groups and other stakeholders. Advisors helped to define unique social and cultural issues, design survey questions and language to be culturally appropriate, identify best survey collection sites; work with the PI at survey collection sites; review survey results, and; recommend methods for dissemination of findings and future applications. 100 enrolled members or descendants of the Confederated Salish and Kootenai Tribes were surveyed, along with 80 student veterans at the University of Montana, Missoula, all in public locations. The survey included 17 questions related to current knowledge, demographics, and barriers. Participants were paid $10. Results were analyzed to detect differences and similarities between groups, incidence, barriers to screening, and other factors.

Results/Discussion: Results of this study show a high incidence of both diagnosed and “probable” lifetime history of concussion. Strikingly similar results were seen across groups. There is a clear need for more community-based, culturally effective education and awareness in both communities. More study in this area and how best to address barriers is needed. In both groups, community suggestions were made for future modes/locations for providing effective awareness and educational interventions for future implementation.

Encouraging Early Screening and Diagnosis of mild TBI in Two At-Risk Montana Populations: A Community-Based Approach to Identify Barriers and Culturally-Effective Interventions