Traumatic Brain Injury & Intrepid Spirit Center

Joint Base Lewis-McChord                                                         

The Traumatic Brain Injury and Intrepid Spirit Center at Joint Base Lewis-McChord improves the lives and well-being of patients and families impacted by TBI and associated conditions through holistic, patient-centered, interdisciplinary clinical outpatient care, research, and education.

They maximize military readiness and patient functioning for those with traumatic brain injury and related conditions through comprehensive and innovative health care.

The ISC officially opened its doors on April 5, 2018, and is a proud Member Site of the Defense Intrepid Network for TBI and Brain Health (Intrepid Network). 

Eligibility

Eligibility varies depending on program. See below for the eligibility guidelines for each specific program.

TBI Outpatient Program

• Active duty service members from all branches, as well as National Guard and Reserve members on active duty orders for more than 30 days

Intensive Outpatient Program (also known as the Intrepid Holistic Outpatient Program)

• Active duty service members from all branches, as well as National Guard and Reserve members on active duty orders for more than 30 days

How to Send a Referral

All patients must receive a referral to engage in treatment at the TBI & ISC.

• For patients enrolled in MHS GENESIS, a MTF-to-MTF referral is routed directly to the Referral Location of "0125 Madigan Army Medical Center"
• For patients out of area (over 60 minutes from the MTF) and not enrolled in MHS GENESIS, a referral must be faxed to MAMCs Right of First Refusal team at 360-570-5974. The ROFR team will enter the referral into MHS GENESIS and route it to the TBI & ISC for review.
• For patients who have a referral from a Network Provider who doesn’t use MHS GENESIS, referrals must be sent through Health Net Federal Services, which only accepts electronic communications via their Care Management system Care Radius. If MTF has the capability, HNFS will send a notice to the ROFR team via Care Radius. The ROFR team will enter the referral into MHS GENESIS and route it to the specialty requested.

The TBI & ISC on Joint Base Lewis-McChord does not accept referrals for beneficiaries, retirees, or veterans at this time. Refer patients who are not active duty service members or on active duty orders to a specific service or clinic that addresses their symptom; for example, Neurology, Physical Therapy, etc. If Brain Injury Rehabilitation Service/Treatment is required, select “Physical Med & Rehabilitation” as the medical service and in the reason for referral, write “BRAIN INJURY REHABILITATION.” If the ISC is only accepting active duty beneficiaries, the Referral Management Division will disposition the referral to available services/resources in the surrounding area.

What to Include in the Referral?

When referring an active duty patient, please COPY AND PASTE numbers 1-8 into the referral reason/order comment with the updated/appropriate information (missing information/incomplete referrals may result in delayed scheduling):
 
1. Most recent TBI date, event description, severity (please submit referrals for moderate to severe TBIs 30 days prior to inpatient discharge)
2. Do they have a minimum of 6 months left of active-duty status and availability on station to receive rehabilitation treatment? Y/N (if no, please provide further time/status details. Please highlight if Medical Evaluation Board has been initiated or if SM is not currently stationed at JBLM or if they are guard/reserve on AD orders).  
3. Did the SM experience: Any alteration of mental status, any alteration in level of consciousness, or Post Traumatic Amnesia? Y/N and list which ones
4. Has the SM experienced 3 or more concussions in the last 12 months? Y/N (Patient must be referred for Recurrent Concussion Evaluation completed by a specialist)
5. List the current symptoms and impact on functioning at work/home/community:
*For return to duty or fitness for duty evaluations please consult the PCM or Neuropsychology clinic as indicated. Please send Neuropsychology referrals to Genesis Behavioral Health pool with Neuropsychology specified as the reason for referral to be routed correctly.
6. List current/prior treatments to manage symptoms (e.g., headache protocol, BH, Neurology. Etc.)
7. Positive for neuro imaging? Y/N
8. Neurological exam findings? Y/N

Co-occurring Conditions/Symptom Overlap

Symptoms which may be associated with concussion, may also present as co-occurring conditions/symptom overlap. To avoid delay in care for SMs, please ensure to refer/utilize additional individual clinical services in addition to TBI specialty services, as appropriate per symptom presentation. 
For example:
For longstanding psychiatric diagnosis, Behavioral Health
For longstanding sleep disturbances, Sleep Clinic.
For chronic pain moderate-severe (>5/10) Chronic Pain (>3 months duration) without improvement after conservative treatments such as pharmacotherapy and physical modalities (physical therapy, chiropractic, etc.), Interdisciplinary Pain Management Clinic

How to Make an Appointment

Due to specific scheduling and booking requirements, TBI & ISC staff, upon receiving an approved referral, will contact the patient to attend their Initial Education Class, followed by their medical evaluation (*patients require completion of intake screeners, Initial Education Class, and establish treatment goals prior to attending their medical evaluation).

TBI & ISC Front Desk
253-968-6478
Monday-Friday
8 a.m. to 4 p.m.                                                   

Clinical Programs

The Traumatic Brain Injury and Intrepid Spirit Center at JBLM is comprised of an interdisciplinary team who work to prevent, identify and mitigate the effects of head and brain trauma and associated co-morbidities. They follow a patient-centered approach to care integrating evidence based traditional and holistic treatments/therapies. Approaches of care encompass rehabilitation, medical and behavioral health treatments combined with integrative medicine interventions and skills-based training. A variety of care options are incorporated, to include individual outpatient services, a multi-week peer-group structured program, educational courses/classes, and participation in innovative brain health research opportunities.

Clinical Programs

Clinical programs offered at the TBI & ISC on Joint Base Lewis-McChord:

TBI Outpatient Program

A program that provides individual treatment/services and group educational courses. Service members learn a variety of strategies and skills that target their functional performance and learn how to implement these skills within their daily life and work. The goal of treatment is to return them to their highest possible level of functioning in their work, home, family and community.  

Intensive Outpatient Program

The Intensive Outpatient Program is a multi-week interdisciplinary program for patients diagnosed with TBI and associated health conditions. Tailored treatment goals are created that focus on achievable functional goals involving the mind, body, and spirit. Patients learn self-management skills and tools to increase resilience, manage symptoms, and enhance their well-being long-term.

Clinical Services

Clinical services and specialties provided by the TBI & ISC on Joint Base Lewis-McChord include:

Behavioral Health Services​

• Neuropsychology: Assessment/testing of Cognitive and Behavioral Health Functioning
• Psychology: No individual services available at this time

Medical Services​

• Neuro-optometry: Diagnose and treat a wide variety of visual problems related to traumatic brain injury.
• Primary Care: For Significant Medical Management of persistent TBI Related Symptoms.

Rehabilitation Services​

• Occupational Therapy: Functional Solutions, Vision Rehabilitation, Trigger Point/Myofascial Release, Stress Management, Emotional Regulation, Coping Strategies, Routine Revision.
• Physical Therapy: Vestibular and Balance Rehabilitation.
• Speech-Language Pathology

Integrative Health Services​

• Clinical Art Therapy
• Acupuncture
• Massage Therapy
• Chiropractic Therapy

Clinical Support Services​

• Nursing
• Case Management-Support, coordination and education provided by a Nurse Case Manager to aid complex treatment/care plans.
• Medical Support
• Referral Management
• TBI Education and Training-Outreach, training and provider education and consultation upon request.

Education

The TBI & ISC on Joint Base Lewis-McChord provides a multitude of patient and family education, staff education including

• Patient/Family Education (Individual/Groups)
• Staff Education through the military treatment facility, regional, and national training and educational opportunities
• Outreach and community partnerships

Research

The TBI & ISC at Joint Base Lewis-McChord has an expansive research portfolio. Significant advances in clinical research on TBI and brain health has resulted in effective and innovative evidence-based treatments, which are then implemented at the Intrepid Spirit Center; this allows us to provide the latest advances in military medicine to our patients.
Research conducted within the Intrepid Spirit Center is particularly aimed at our service members who experience co-occurring TBI, PTSD, chronic pain, and other physical and behavioral health conditions. In addition to the robust ISC research program we offer at JBLM, we also partner and collaborate with several external TBI community entities.

Some of our current research studies include:

• A Phase 2, Multi-center, Multi-arm, Randomized, Placebo-Controlled, Double-Blind, Adaptive Platform Trial to Evaluate the Safety, Tolerability, and Efficacy of Potential Therapeutic Interventions in Active-Duty Service Members and Veterans with Posttraumatic Stress Disorder
• CARE-SALTOS – NCAA-DoD Concussion Assessment, Research and Education and Service Academy Longitudinal TBI Outcome Study
• CoMBaT Insomnia: A randomized Controlled Trial of Cognitive-Behavioral vs Mindfulness-Based Treatments for TBI-Related Insomnia and Post-Traumatic Stress Symptoms
• Complex Assessment of Military Performance
• Effectiveness of a Brief Mindfulness-Based Intervention for Stress, Pain, Emotion and Attention Regulation in Military Service Members with Persistent Postconcussion Symptoms after Mild TBI
• FDG-PET as a Clinical Diagnostic Biomarker for Repetitive Blast Mild TBI
• Microinteraction Ecological Momentary Assessment Using Smartwatch Technology for Real-Time Tracking after Traumatic Brain Injury
• Prazosin for Prophylaxis of Chronic Post-Traumatic Headaches in OEF/OIF/OND Service Members and Veterans with Mild TBI
• RECONsolidation of Traumatic Memories to ResOLve Posttraumatic Stress Disorder (RECONTROL)