Studying Disparities in Traumatic Brain Injury Outcomes
Traumatic brain injury (TBI) is a major cause of death and acquired disability for children in the United States. TBI’s effects are particularly profound for Hispanic children. Compared to non-Hispanic children, they are less functional and have lower quality of life one to three years after their injury. The Jimenez Lab is investigating what causes these disparities and developing solutions that could help more children with TBIs live healthier, happier lives.
Pinpointing how TBIs impact Hispanic families
Our group was the first to investigate disparities in disability after TBIs among Hispanic children. Our research has found important long-term disparities and is uncovering barriers that make it harder for Hispanic children to get the rehabilitation services they need. We have shown that:
- Hispanic children who sustain TBIs have a lower quality of life, participate in fewer childhood activities and are less able to communicate and take care of their daily needs than non-Hispanic white children with similar injuries.
- Importantly, we also found that these disparities were not present at the time of discharge from inpatient rehabilitation facilities, and that Hispanic children recovered at the same pace as non-Hispanic children when receiving equal inpatient care.
- Many Medicaid-insured children with TBI do not receive sufficient rehabilitation services after being discharged from the hospital. One of our studies found that, of 9,361 Medicaid-insured children, only 29% received outpatient rehabilitation therapy during the year after their TBI. Hispanic children with TBI were less likely than non-Hispanics to receive speech therapy.
- In Washington state, children who suffer TBIs and live in households with limited English proficiency face significant barriers to rehabilitation services. Less than 20% of providers accept children with Medicaid and provide language interpretation. Adjusting for education and Medicaid status, children from Spanish-speaking families have significantly longer travel times to available services.
An innovative program for Hispanic parents
We developed an innovative program, called Brain Injury Education and Outpatient Care Navigation (1st BIEN), that aims to give Hispanic parents tools to help their children recover from TBIs. This program is based on our research and informed by Hispanic parents and community organizations, and by clinicians from Seattle Children’s and the University of Washington. The program is designed to:
- Help Hispanic parents understand the unique health challenges that go along with TBIs.
- Empower parents to participate in their child’s rehabilitation.
- Make it easier for Hispanic children with TBIs to receive outpatient rehabilitation services by using bilingual community care coordinators to address structural barriers.
Our preliminary research suggests high levels of satisfaction among participating parents who received care coordination through our program. These parents also showed a better understanding of their child’s injury and reported higher levels of self-efficacy when caring for their child’s needs. Now we’re seeking funding to test 1st BIEN via a multicenter, randomized controlled clinical trial. If 1st Bien is effective, it could serve as a model that could be applied to help families in other vulnerable populations.
About Dr. Jimenez
Dr. Nathalia Jimenez is associate professor at the Department of Anesthesiology and Pain Medicine at the University of Washington School of Medicine. She works as a pediatric anesthesiologist at Seattle Children’s Hospital. She is also a member of Seattle Children’s Research Institute’s Center for Child Health, Behavior and Development, and is an associate faculty member at Harborview Injury Prevention Center.