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Peer Support in the Community:
Initial Findings of a Mentoring
Program for Individuals with
Traumatic Brain Injury and Their
Families
Objectives: To evaluate the impact of a community-based peer support program for individuals and their
family members following traumatic brain injury (TBI). Settings: Community-based sample of family mem-
bers and individuals with traumatic brain injury. Participants: Twenty individuals who had participated
in the peer support program (11 individuals with TBI and 9 family members). Main Outcome Mea-
sures: Quantitative and qualitative approaches were used: a retrospective structured interview assessing
self-reported impacts of peer support on empowerment, quality of life, mood, skills and knowledge, and
social supports; an in-depth qualitative interview with a subgroup of family members focused on the spe-
cific benefits/limitations of the peer support program. Results: Participants in the peer support program
reported positive impacts of peer support on increasing their knowledge of TBI, enhancing their over-
all quality of life, improving their general outlook, and enhancing their ability to cope with depression
post TBI. The peer support program was reported to have had a minimal impact on enhancing social
support from families, friends, and the community, with varying impacts noted on levels of happiness,
coping with anger and anxiety, communication with professionals, and control over one’s life. Qualitative
analysis suggests the merits of this type of community-based support and areas of improvement for the
peer support program itself. Conclusions: Preliminary data suggest that peer support is a promising ap-
proach to enhancing coping for both individuals and their family members after TBI. Key words: families,
participatory action research, peer support, self-help, traumatic brain injury
Mary R. Hibbard, PhD
∗
Joshua Cantor, PhD
∗
Heather Charatz, BA
∗
Robin Rosenthal, PhD
∗
Teresa Ashman, PhD
∗
Nancy Gundersen, BA
†
Lynne Ireland-Knight, BA
†
Wayne Gordon, PhD
∗
Judith Avner, JD
†
Audrey Gartner, MA
‡
∗
Department of Rehabilitation Medicine, Mount
Sinai School of Medicine, New York, New York.
†
Brain Injury Association of New York State, Albany,
New York.
‡
National Self Help Clearing House, New York, New
York.
T
HE CENTERS for Disease Control and
Prevention estimate that more than 5
million
1
American individuals with brain in-
juries live in the community, although some
studies suggest that this may be a significant
underestimate.
2
They and their family mem-
bers must face the long-term consequences of
traumatic brain injury (TBI). Many of these in-
dividuals receive minimal information about
the long-term challenges of TBI, its impact on
Address correspondence and reprint requests to: Mary
Hibbard, PhD, Department of Rehabilitation Medicine,
Box 1240, Mount Sinai School of Medicine, One
Gustave L. Levy Place, New York, NY 10029. Tele-
phone: 212–659–9374. Fax: 212–348–5901. E-mail:
mary.hibbard@mssm.edu.
The preparation of this article was supported by Grant
#H133B30038 from the National Institute of Disability
and Rehabilitation Research, US Department of Educa-
tion, to the Mount Sinai Medical Center, Wayne Gordon,
PhD, Project Director.
J Head Trauma Rehabil 2002;17(2):112–131
c
°
2002 Aspen Publishers, Inc.
112
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Peer Support in the Community 113
the family system, and/or information about
community-based resources available to assist
with maximal adjustment. These individuals
often remain socially isolated from other in-
dividuals or family members who have suc-
cessfully adjusted to these often dramatic
changes in day-to-day life secondary to TBI—
individuals with TBI and their families who
could serve as potential sources of mutual
support, education, and information.
The lasting toll of TBI has been well
documented.
3–7
In addition to cognitive
and physical sequelae, individuals with TBI
often experience significant depression, anx-
iety, and reduced quality of life.
5,8–12
The
toll on family members of individuals with
TBI is also significant, and many family
members experience significant emotional
distress.
13–20
Ongoing tensions within the fam-
ily system often result in increased likelihood
of breakdown in marital relationships, de-
creased social contacts, increasing financial
strain, altered or reduced job responsibili-
ties, reduced free time, and reduced personal
health for family members.
9,19,21,22
Issues related to successful and unsuc-
cessful coping in individuals with TBI and
their family members have been explored
in prior research. Successful family coping
during the early adjustment period has been
associated with obtaining adequate social sup-
port and information, involvement in work, at-
tending support groups, use of religion, and
involvement in recreation.
23,24
In the later
stages of adjustment, strategies that individ-
uals with TBI and their families found useful
included maintaining a healthy outlook, par-
ticipating in a support group, seeking respite,
and obtaining information about the long-
term consequences of TBI, especially the
behavioral and emotional disturbances that
may occur.
25–27
Such research sheds light on
the interventions that may best facilitate suc-
cessful coping and long-term adjustment for
both individuals with TBI and their families.
The findings reported previously, and the
beneficial effects of adequate social support
and information in particular, suggest that
community-based peer support programs for
individuals with TBI and their family members
could be a key component of community-
based interventions designed to maximize
adjustment post TBI. Peer support has been
found to be an effective intervention for indi-
viduals and family members when faced with
other medical illnesses. More specifically,
peer support programs have been shown to
provide powerful stress-buffering influences
for individuals facing medical crises, with
the effect of such interventions generally
greater than that attributed to formal sup-
port services.
28
In addition, peer support pro-
grams have been found to have a positive im-
pact on personal sense of empowerment (ie,
helping an individual regain a feeling of mas-
tery over his or her family member’s medi-
cal situation, the environment, and his or her
life) and self-efficacy (ie, enhancing the indi-
vidual’s perceptions of his or her capabilities
for handling situations).
29–30
Although support groups for individuals
with TBI exist across the country, more
individualized peer support after TBI may be
potentially beneficial. To date, peer support
programs for individuals and families post TBI
have been implemented but not evaluated in
a systematic fashion. To address this need,
a peer-to-peer support program, referred to
henceforth as the TBI Mentoring Partnership
Program (TBI-MPP), was implemented to ad-
dress the community support needs of indi-
viduals with TBI and their families. To explore
the initial impact of the TBI-MPP and develop
an empirical basis for the program’s evalua-
tion, two pilot studies were implemented: one
involved quantitative analysis, and the sec-
ond involved qualitative analysis. This article
presents the findings from these pilot studies.
With the aim of increasing the valid-
ity of research findings and empowering
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114 JOURNAL OF HEAD TRAUMA REHABILITATION/APRIL 2002
consumers, a paradigm of participatory action
research (PAR)
31–34
was incorporated into all
aspects of the TBI-MPP. Strengths of PAR in-
clude the innovative adaptation of methods
for use in a variety of different contexts, ex-
ploration of the knowledge and perceptions
of community members, involving members
of the community as active participants, and
facilitating the equitable distribution of power
in the process of research so that community
members are regarded by themselves and oth-
ers as being capable of examining and ana-
lyzing their own circumstances.
35
In keeping
with a PAR model, individuals with TBI and
family members were included in the devel-
opment of the peer training program, the re-
cruitment of individuals into the program, the
implementation of support partnerships, the
evaluation of program research methods, and
the collection and analysis of data obtained
from the program itself.
THE TBI MENTORING PARTNERSHIP
PROGRAM (TBI-MPP)
The TBI-MPP, which is still active and
funded through 2003, was modeled after the
Parent-to-Parent Program (P-to-P)
34,36–38
devel-
oped by the Beach Center on Families and
Disability at the University of Kansas for par-
ents of children with developmental disabil-
ities. To create a model program of peer-to-
peer support for individuals with TBI and
their families, the P-to-P program was modi-
fied to accommodate the needs of individu-
als with TBI and their families. In the original
P-to-P program, “veteran” parents of children
with special needs were matched with par-
ents of newly diagnosed children with similar
needs who were seeking peer support. The
primary aim of the P-to-P program was to re-
duce parents’ sense of isolation by providing
social support and validation of personal ex-
periences by “someone who has been there
before.”
37
Program evaluation revealed that
the experience of mutual sharing with some-
one who had experienced a similar challenge
was an essential component of intervention
success.
37
The process of sharing experiences
enabled a special rapport to be established be-
tween “veteran” parents and “new” parents
through which they could easily express feel-
ings, discuss problems, and obtain emotional
and informational support.
34,37,38
The TBI-MPP was designed to extend this
model of support not only to families of indi-
viduals with TBI but to the individuals with
TBI as well. In the TBI-MPP, TBI “veterans”
were matched with individuals with TBI or
family members to provide emotional sup-
port, knowledge about TBI and resources, and
advocacy skills. Unlike the P-to-P program, the
TBI-MPP was designed to address both the
acute and long-term adjustment needs of in-
dividuals with TBI and their family members.
Program structure
The TBI-MPP was implemented in
New York State as a collaborative effort
between the Research and Training Center on
Community Integration for Individuals with
TBI (RTC) and the Brain Injury Association
of New York State (BIANYS). The TBI-MPP
has five main components: recruitment and
training of individuals to provide peer sup-
port, recruitment of individuals and family
members in need of peer support, creation
of mentoring partnerships, technical assis-
tance, and program evaluation. In keeping
with the PAR model, the RTC is responsible
primarily for program evaluation, whereas
BIANYS is responsible for the recruitment
of individuals with TBI and family members
to serve as “mentors” (who provide peer
support) and “partners” (who receive peer
support). BIANYS recruited two experienced
project coordinators (one “downstate” and
the other “upstate”) to oversee the clinical
administration of the program. One coordi-
nator is a family member of an individual
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Peer Support in the Community 115
with a TBI, and the second is an outreach
coordinator for BIANYS. The RTC and the
BIANYS are jointly responsible for training
mentors, ongoing technical assistance for
mentors, and program dissemination.
Program development
Recruitment and training of mentors
Two consumer advisory groups (Advisory
Groups) were convened (one upstate and
one downstate) to develop mentor recruit-
ment strategies, plan mentor training, and
review program assessment tools. The Advi-
sory Groups consisted of researchers from the
RTC, individuals with TBI and family mem-
bers, the Director of the National Self-Help
Clearing House and staff of BIANYS. On the
basis of their recommendations, a mentor
training manual was developed. The manual
was subsequently modified after each training
workshop based on feedback from mentors
who attended training. (A copy of this man-
ual is available on request from the senior au-
thor).
Individuals with TBI and family members of
individuals with TBI were recruited as poten-
tial mentors through the BIANYS, local pro-
fessionals, the Advisory Groups, and contacts
within the RTC. Multiple criteria were used
to select individuals for mentor training. On
the basis of phone screening, project coordi-
nators used the following broad criteria to de-
termine the “personal readiness” of potential
volunteers to provide peer support to others:
(1) a willingness to volunteer time and energy
needed to provide support to others in need
after TBI; (2) a motivation to “help others” and
“give back something” and “be there for peo-
ple who are where I was”; (3) successful per-
sonal adjustment to the challenges of living
with a TBI; (4) adequate insight into personal
limitations and strengths; (5) an absence of
current serious psychiatric problems; (6) an
ability to listen and empathize and (7) an abil-
ity to inhibit personal responses and views or
opinions when necessary.
A series of eight full-day mentor training
workshops was held (both upstate and down-
state) over the course of the first 2 years of
the project. At these workshops, mentors re-
ceived training focused on enhancing their
communication, listening, and advocacy skills
and increasing their knowledge of TBI and
community resources. Because most commu-
nication between partners and mentors is by
telephone, training emphasized communica-
tion skills using this modality. All mentors re-
ceived reimbursement for transportation and
other out-of-pocket expenses incurred as a re-
sult of the training itself. In addition, mentors
are paid $25 for completion of program evalu-
ation research interviews and questionnaires,
some of which were completed during the
training. Mentors volunteer their time for on-
going mentoring activities and are not paid
for these services; they are, however, reim-
bursed for long distance telephone expenses
incurred as part of mentoring.
A subgroup of mentors received additional
training in hospital advocacy skills to play a
more active role in recruitment of partners for
the TBI-MPP. The mentors called themselves
the Hospital Advocacy Teams (HAT). The HAT
teams conduct ongoing visits to local commu-
nity settings and distribute information about
BIANYS and the TBI-MPP itself and thus serve
a crucial role of ensuring program visibility in
the community.
In total, 114 mentors have been trained,
most of whom (70%) are individuals with
TBI. Eighty-three of these mentors (73%) are
still active in the program, whereas 31 men-
tors (27%), including 21 individuals with TBI
and 10 family members, have suspended their
involvement in the TBI-MPP temporarily or
permanently. The most frequent reasons pro-
vided by mentors for leaving the TBI-MPP
were: (1) personal illness or disability issues
(n= 15); (2) too many commitments to other
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Table 1. Demographics of mentors
Individuals with TBI (n = 80) Family members (n = 34)
N (%) N (%)
Gender
Female 48 (60) 30 (88)
Male 32 (40) 4 (12)
Ethnicity
White 68 (85) 28 (82)
African-American 9 (11) 1 (3)
Hispanic 1 (1) 2 (6)
Other 2 (3) 3 (9)
Age
Teenagers (<19) 0 (0) 0 (0)
Young adult (19–30) 9 (11) 0 (0)
Adult (31–45) 32 (40) 10 (30)
Older adults (46 and up) 39 (49) 24 (70)
activities (n= 8); (3) disinterest in being a
mentor after training was completed (n = 6);
and (4) electing to limit roles in the TBI-MPP
to partner recruitment efforts (n= 2). Demo-
graphic information for the total pool of men-
tors is provided in Table 1. In this table, dif-
ferences in individuals and family members
who volunteered for program participation
can be noted. More specifically, both men and
women with TBI volunteered to become men-
tors; these individuals were predominantly
white and older than 30; in contrast, fam-
ily members who volunteered were predom-
inantly women, white, and slightly older (ie,
older than 46).
Recruitment of partners
Extensive outreach was conducted to dis-
seminate information about the TBI-MPP and
recruit individuals with TBI and their family
members who were in need of peer support.
Partners were recruited through the RTC’s
web site, BIANYS outreach coordinators, in-
dependent living centers, rehabilitation hos-
pitals, and support groups, and presentations
at local and state conferences. Optional refer-
ral to the TBI-MPP was included as part of the
routine information provided to all individuals
who contact the resource hotline at BIANYS.
All potential partners referred to the TBI-
MPP complete an initial intake interview
with a project coordinator to determine
the scope of peer support needed and their
suitability for program participation. Persons
seeking peer support who are at risk for sui-
cidal or violent behavior and/or have seri-
ous psychiatric or substance abuse problems
are not accepted into the TBI-MPP. These
individuals are provided with referrals for
community-based services. Other exclusion-
ary criteria include: (1) an inability (after ex-
tensive discussion) to articulate any reasons
for wanting peer support from the TBI-MPP;
(2) the individual was referred to the pro-
gram by someone else but has no personal
interest in receiving peer support from the
TBI-MPP; (3) evidence of excessive negativ-
ity, anger, or volatility on screening interview;
(4) the severity of cognitive impairments
would prevent the person from benefiting
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Peer Support in the Community 117
from peer support from the TBI-MPP; (5)
the individual has no cognitive awareness of
the brain injury and its effects on his or her
life; and (6) the individual is solely interested
in talking with someone, with no desire to
change his or her current life situation. By use
of these criteria, approximately 25% of indi-
viduals referred for the TBI-MPP have been re-
ferred elsewhere in the community.
Team meetings of the program coordina-
tors and the RTC staff are held to discuss
the presenting support needs of each individ-
ual, and the person is matched with a mentor
who the team believes can best meet those
needs. Because criteria for matches varied
considerably from partnership to partnership,
categories of criteria for matching mentors
and partners were documented. These cri-
teria included (1) similar demographic back-
ground (eg, age, marital status, geographical
location, educational background); (2) sim-
ilar marital or family status (eg, spouse of
individual with TBI, single, parent of a school-
aged child); (3) similar injury history (eg, cog-
nitive challenges, physical challenges, cause
of injury); (4) similar interests (eg, shared re-
ligious beliefs, common work or social back-
grounds); and (5) the mentor’s ability to meet
the specific psychological needs of the part-
ner (eg, need for structure, role model, social
support).
Mentoring partnerships
Once the mentor and partner are matched,
the project coordinator links the mentor with
the partner, and the partnership is begun. The
duration of the partnership and its intensity
are mutual decisions of the mentor and his or
her partner. To date, more than 100 partner-
ships have been created, with approximately
50% of these relationships completed at
present. Approximately 25% of partnerships
are ongoing 1 year after they begin. To estab-
lish a fixed “end point” of the program for data
collection purposes, these long-term partner-
ships are officially terminated after 1 year. In
such partnerships, mentors and partners typ-
ically remain friends and continue contact be-
yond the “official” end of the partnership.
Most partnerships (about 75%) end in less
than 1 year. In order of importance, reasons
for ending of partnerships before a year is up
have included (1) mentoring needs were met;
(2) the mentor or partner moved; (3) the men-
tor or partner was overextended by life de-
mands; (4) the partner’s needs were too com-
plex for the mentor or the partner was unable
to profit from mentoring; (5) mentor/partner
incompatibility; and (6) scheduling conflicts.
Technical assistance
The project coordinator provides ongoing
technical assistance to mentors by telephone
for the duration of each partnership. Techni-
cal assistance may include providing sugges-
tions, advice, emotional support, and/or rec-
ommendations for community resources. The
project coordinator monitors the overall qual-
ity of each partnership and provides guidance
regarding crisis intervention (when indicated)
to both mentors and partners. If a partnership
is dissolved because the partner is dissatisfied,
the coordinator typically reassigns the partner
to a new mentor. The project coordinator will
also make referrals to the community if the
partner’s needs are beyond the scope of the
program.
Program evaluation
Traditional research questionnaires were
initially selected to assess changes in partner
within the domains of empowerment, qual-
ity of life, mood, skills and knowledge about
TBI, and social supports. Psychometric as-
sessments were to be conducted before and
after completion of each partnership. A ma-
jor unanticipated obstacle was encountered
in our initial approach to program evaluation.
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Most partners sought out the TBI-MPP pri-
marily because they were interested in
receiving peer support and not because they
were motivated to participate in a research
project. As a result, partner compliance with
the “traditional” research aspects of the pro-
gram was poor. In response to this challenge,
three steps were taken. First, all assessment
instruments were administered by telephone.
Second, to capture the impact of the program
on participants who had already completed
partnerships in the TBI-MPP, a retrospective
quantitative interview was implemented to
evaluate partners’ self-reports regarding the
impact of the TBI-MPP on the areas of re-
search interest (sense of empowerment, qual-
ity of life, mood, skills and knowledge about
TBI, social supports). Third, a subgroup of
partners seen for the retrospective quantita-
tive interview was asked to participate in a
retrospective qualitative interview to capture
aspects of the program that were either ben-
eficial or needed improvement. Both quali-
tative and quantitative interviews examined
the partners’ satisfaction with their partner-
ships and their mentors. (Findings from these
pilot quantitative and qualitative studies are
provided below.) This information is cur-
rently being used to enhance the TBI-MPP and
shape the prospective assessment being im-
plemented for use in the remaining years of
the current research project.
METHOD
Participants
The first 52 partners to enroll in the TBI-
MPP who had completed their partnerships
were invited to participate in these pilot stud-
ies. Twenty partners (11 individuals with TBI;
9 family members) agreed to participate in a
quantitative interview, and 7 partners (all fam-
ily members) agreed to participate in the qual-
itative interview. The remaining 32 partners
did not participate in the pilot studies for a
variety of reasons, including (1) loss to follow-
up (n= 14); (2) severe cognitive or emotional
impairments (n = 11); (3) refusal to partic-
ipate (n= 3); and (4) scheduling problems
(n= 4). To determine whether the sample of
partners who participated in the quantitative
study was representative of the larger pool of
partners, chi square statistics and t tests were
computed on select demographic variables
comparing partners who participated in the
interview (participants) with partners who
declined the interview (nonparticipants). No
significant differences were found for gender,
ethnicity, age, or number of contacts with
mentors between the two subgroups. Rea-
sons for termination of partnerships were also
compared across the two groups. For both
groups, the percentage of partnerships lasting
less than 1 year (75%) was identical. Approxi-
mately half (53%) of the participants’ partner-
ships v 38% of the nonparticipants’ partner-
ships ended before 1 year because partners’
needs had been met. When examining rea-
sons for ending partnerships, 46% of the non-
participants v 20% of participants had ended
their partnerships because of complex needs,
excessively busy lives, and/or emotional and
cognitive impediments. These findings sug-
gest that although the two groups were demo-
graphically comparable, the participant group
may slightly over represent the more “success-
ful” partnerships.
The demographic characteristics of the
partners who participated in the quantitative
interviews are presented in Table 2. As noted
in the table, partners were predominantly
women, white, and adults between the ages
of 31 and 45. On average, mentors and part-
ners had 13 contacts with mentors, with wide
variation in the number of contacts made per
partnership (SD = 12.77). One outlier was ex-
cluded from these data, because the partner-
ship had included more than 108 documented
contacts.
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Table 2. Demographics of partners who par-
ticipated in the pilot study quantitative inter-
views (n= 20)
Gender
Male 6 (30%)
Female 14 (70%)
Ethnicity
African-American 4 (20%)
White 14 (70%)
Other 2 (10%)
Age
Teenagers (<19) 1 (5%)
Young adult (19–30) 1 (5%)
Adult (31–45) 12 (60%)
Older adults (46 and up) 6 (30%)
Contacts with mentors
Mean (SD) 13 (12)
Procedure and measures
Quantitative interview
All participants were telephoned at home
by research assistants. After providing in-
formed consent, they were administered the
quantitative interview. This retrospective in-
terview was designed to capture participants’
impressions of the TBI-MPP’s impact on their
lives and was divided into two parts. Part
I consisted of multiple-choice questions that
asked whether involvement in the TBI-MPP
had had any impact on five broad areas of
functioning: empowerment, quality of life,
mood, knowledge and communication skills,
and social support. For this article, questions
focused on the selective impact of the TBI-
MPP on functioning are presented. For each
question, participants were asked to rate the
degree of program impact by indicating that
the program “helped a lot,” “helped some-
what,” “helped a little bit,” or “not at all”
within a specified area (eg, “Did the Mentor-
ing Program help you learn about resources
in your community?”). To assess current qual-
ity of life, participants were administered the
Delighted-Terrible Scale
39
twice during the in-
terview. In Part II, partners were asked to
rate their satisfaction with (1) their mentors,
(2) the frequency of contacts with their men-
tors, and (3) the length of their TBI-MPP part-
nerships (see Appendix A for a list of ques-
tions from the quantitative interview).
A panel of three experts on TBI selected
and adapted the Part I interview questions
from four existing measures: the Question-
naire on Resources and Stress–Short Form
(QRS-SF),
40
the Frequency of Family Coping
Behaviors (FCB),
25
the Social Support Ques-
tionnaire Short Form (SSQ-SR),
41,42
and the
Empowerment Scale.
43
Selection criteria for
items included question clarity and relevance
to the mentoring program. Interviewers
were given specific definitions of terms that
were potentially ambiguous (eg, “anxiety” =
“feeling nervous or worried or edgy and
tense”) and instructions on how to provide
clarification when necessary. Because of
limitations imposed by data collection (as
outlined previously) and the preliminary
nature of this pilot study, validation of the
reliability and construct validity of the quan-
titative interview as a whole was deferred.
To assess reliability of participants’ responses
within the interview, data obtained from
the Delighted-Terrible Scale
39
were used
to assess consistency of self-report. The
Delighted-Terrible Scale consists of a single
question (“How have you felt about the over-
all quality of your life in the past month?”),
which was asked twice during the interview
(once at the beginning and again at the end).
Participants were asked to choose one of
seven responses ranging from “Delighted”
to “Terrible”. Participants’ responses to this
question were highly correlated (r = .926,
P < .001), suggesting consistency of re-
sponses and reliability of this portion of the
interview.
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Qualitative interviews
A subgroup of family members who had
participated in the quantitative interview
(3 parents and 4 significant others of indi-
viduals with TBI) agreed to participate in an
in-depth qualitative interview. Most of par-
ticipants (6 of 7) were interviewed in their
homes, with interviews lasting, on average,
1.5 hours. Interviews were conducted by a
staff person who was not otherwise involved
with the TBI-MPP. Qualitative interviews were
designed to provide a richer picture of the na-
ture of participants’ mentoring experiences.
These interviews consisted of open-ended
questions that addressed (1) expectations the
partners had before beginning partnerships;
(2) the nature of the relationship with the
mentors; (3) the qualities that made for a good
mentor; (4) the most beneficial aspects of the
program; (5) areas of advocacy learned while
Table 3. Reported impact of the TBI-MPP on individuals with TBI (n= 11)
Don’t know/ No impact/ Some Major
remember not applicable impact impact
Empowerment
Ability to cope 0% 18% 55% 27%
Control over one’s life 0% 46% 18% 36%
Quality of life indicators
Overall quality of life 0% 37% 27% 36%
General outlook 0% 45% 10% 45%
Mood
Degree of happiness 0% 55% 27% 18%
Sadness/depression 0% 46% 18% 36%
Anger 0% 55% 18% 27%
Anxiety 0% 64% 18% 18%
Skills and knowledge
Communication—professionals 0% 73% 9% 18%
Knowledge—TBI 0% 18% 46% 36%
Knowledge—community resources 0% 46% 27% 27%
Social support
From family members 0% 82% 9% 9%
From friends 0% 82% 0% 18%
From the community 9% 82% 9% 0%
participating in the program; and (6) sugges-
tions for program improvements. All inter-
views were audio taped, and responses were
content analyzed to produce themes related
to each of the preceding questions.
RESULTS
Quantitative data
In the quantitative interviews, participants
were asked questions regarding the potential
impact of the TBI-MPP on each of five do-
mains: empowerment, quality of life, mood,
knowledge and communication skills, and so-
cial support. The percentages of participants’
responses regarding program impact (“don’t
know,” “no impact/not applicable,” “some
impact,” “major impact”) for each question
are presented in Table 3 for individuals with
TBI and in Table 4 for family members.
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Table 4. Reported impact of the TBI-MPP on family members of individuals with TBI (n= 9)
Don’t know/ No impact/ Some Major
remember not applicable impact impact
Empowerment
Ability to cope 0% 0% 100% 0%
Control over one’s life 0% 56% 44% 0%
Quality of life indicators
Overall quality of life 0% 44% 56% 0%
General outlook 0% 44% 44% 12%
Mood
Degree of happiness 11% 67% 22% 0%
Sadness/depression 0% 33% 67% 0%
Anger 12% 33% 55% 0%
Anxiety 0% 33% 67% 0%
Skills and knowledge
Communication—professionals 0% 34% 44% 22%
Knowledge—TBI 0% 33% 67% 0%
Knowledge—community resources 0% 67% 33% 0%
Social support
From family members 0% 78% 22% 0%
From friends 0% 67% 22% 11%
From the community 0% 89% 0% 11%
Partner responses of “helped a little” and
“helped somewhat” were collapsed into the
“some impact” category, whereas partners’ re-
sponses of “did not help” and “helped a lot”
were recorded as “no impact” and “major im-
pact,” respectively, in the tables. A rating of
“not applicable” was applied when a partner
stated that a specific question was unrelated
to his or her own experience (eg, the part-
ner denied experiencing anxiety; therefore,
this area was not relevant to his or her view
of the mentoring experience) or when the
partner felt the area was not one in which
he or she needed mentoring help (eg, the
family member felt that family support was
adequate, and therefore this area was not a
focus of the mentoring experience). Inter-
viewers found that in a number of cases it
was difficult to clarify whether participants
felt that the program had had “no impact” in
a given area or whether they had no needs in
that area. For example, a person might state
that the program did not help him or her in-
crease support from family members without
clarifying whether he or she had any family
members in the first place. Because of this am-
biguity, responses of “not applicable” and “did
not help” were collapsed into a single cate-
gory “not applicable/no impact.”
Data regarding program impact on individu-
als and family members are provided in Tables
3 and 4, respectively. Findings are summarized
below.
Empowerment
Eighty-two percent of individuals with TBI
reported that involvement in the TBI-MPP in-
creased their ability to cope with their TBI
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(55% “some impact,” 27% “major impact”). All
the family members who participated in the
TBI-MPP reported that the program had “some
impact” on their ability to cope with TBI.
Approximately half of the individuals with
TBI reported that involvement in the TBI-MPP
helped them gain better control over their
lives (18% “some impact,” 36% “major im-
pact”), with a slightly less robust impact re-
ported by family members (44% “some im-
pact”).
Quality of life
Over half of the individuals with TBI and
family members reported enhanced qual-
ity of life as a result of their participation
in the TBI-MPP (individuals: 27%,“some im-
pact”; 36%, “major impact”; family mem-
bers: 56%, “some impact”). Participants also
viewed the impact of the TBI-MPP on their
general outlook as positive in that more
than half of individuals with TBI (10%
“some impact”; 45% “major impact”) and
family members (44% “some impact”; 12%
“major impact”) endorsed enhanced general
outlook as a result of their involvement in
the TBI-MPP. Participants’ responses to the
Delighted-Terrible scale were converted to
scores from 1 (terrible) to 7 (delighted). The
mean of the two scores from each partic-
ipant was then calculated: this score rep-
resented the participant’s final Delighted-
Terrible score. The mean Delighted-Terrible
score for all participants was 4.45 (SD = 1.66),
a score that falls between “mixed” and
“mostly satisfied.” Unfortunately, prementor-
ing quality of life scores were not available;
hence, comparison with prementoring status
was not possible.
Mood
The reported impact of the TBI-MPP on
coping with negative mood was variable for
both individuals with TBI and family mem-
bers. A beneficial impact of the TBI-MPP was
noted in helping partners cope with feelings
of sadness and depression (individuals with
TBI: 18% “some impact,” 36% “major impact”;
family members: 67% “some impact”). The
program was also viewed as effective in help-
ing participants cope with feelings of anger
(individuals with TBI: 18% “some impact”;
27% “major impact”; family members: 55%
“some impact”), as well as anxiety (individu-
als with TBI: 18% “some impact,” 18% “ma-
jor impact”; family members: 67% “some im-
pact”). The TBI-MPP was also reported to have
some impact on degree of happiness (individ-
uals with TBI: 27% “some impact,” 18% “ma-
jor impact”; family members: 22% “some im-
pact”).
Skills and knowledge
Participants reported that the TBI-MPP had
its strongest impact on enhancing partners’
knowledge about TBI. More specifically, 36%
of individuals with TBI reported that involve-
ment in the TBI-MPP had a “major impact”
in this domain, whereas an additional 46% of
individuals with TBI and 67% of family mem-
bers reported “some impact” of the program
in the area of increasing knowledge about TBI.
The TBI-MPP was also reported to be help-
ful in increasing knowledge of community re-
sources by a smaller group of participants (ie,
27% of individuals with TBI reported a “major
impact,” and an additional 27% of individuals
with TBI and 33% of family members reported
the TBI-MPP had “some impact” on increasing
their knowledge of community resources).
Social support
The reported impact of the TBI-MPP on en-
hancing family support was minimal in that
9% of individuals with TBI reported a “major
impact,” whereas 9% of individuals with TBI
and 22% of family members reported “some
impact” in increasing family support. TBI-MPP
impact on social support from friends was
reported by a smaller group of participants
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Table 5. Partners ratings of satisfaction with the TBI-MPP (n= 20)
Individuals with TBI Family members
Dissatisfied, Dissatisfied, Dissatisfied, Dissatisfied,
too brief, or too long, or too brief, or too long, or
infrequent frequent Satisfied infrequent frequent Satisfied
Length of 27% 9% 64% 44% 0% 44%
partnership
Frequency 9% 0% 91% 33% 0% 67%
of contacts
Satisfaction with 0% 0% 91% 11% 0% 89%
mentor
(ie, a “major impact” for friends by 18% of
individuals and 11% of family members, with
“some impact” for an additional 22% of family
members). Minimal impact was noted on en-
hancing social support from the community at
large (ie, 11% “major impact” by family mem-
bers and 9% “some impact” for individuals).
Overall measures of program
satisfaction
Partners’ satisfaction with the length of
partnership, the frequency of contact, and
overall satisfaction with their mentors was ex-
plored. As summarized in Table 5, more in-
dividuals with TBI were reportedly satisfied
with the length of partnership than family
members (64% v 44%, respectively), whereas
family members were more apt to report that
the partnerships were too brief. Most individ-
uals with TBI and family members reported
that they were satisfied with the frequency of
contacts between themselves and their men-
tors. However, 33% of family members re-
ported dissatisfaction with the infrequency of
the contacts. Although individuals with TBI
and family members were overwhelmingly
pleased with their mentors (91% and 89%, re-
spectively), a small percentage of family mem-
bers (11%) expressed dissatisfaction with the
mentor match.
Qualitative data
Content analysis of data from seven qualita-
tive interviews revealed the following themes.
Greatest benefits of the TBI-MPP
Shared experience, or the mentor’s having
“been there,” was reported to be the most
beneficial part of the TBI-MPP, according to all
seven participants. Sharing of experience and,
therefore, the lessening of “feeling alone” was
often part of the expectation family members
had before participating in the TBI-MPP. Em-
phasis was placed on the strength of the men-
tor’s experiential knowledge or role as the
“wounded healer” in contrast with the more
distant “book-learned” knowledge of the pro-
fessional. One family member said of her men-
tor: “She could really understand me 100%.”
Family members stated that they benefited
from the hopeful stance of mentors who be-
lieved that love and attention to their family
member with TBI offered healing power.
Expectations about the TBI-MPP
What participants thought they would get
from the TBI-MPP varied widely. Four of
the seven participants mentioned expecting
a support group or support network to be
part of the TBI-MPP, in addition to one-on-one
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conversations with their mentor. One partic-
ipant expected more practical supports (eg,
help with shopping or child-care). Two fam-
ily members withdrew from the TBI-MPP be-
cause their expectations were not being met.
In contrast, some other family members re-
mained in the TBI-MPP, stating that they were
grateful for any help received, despite disap-
pointment at not having all of their expecta-
tions met.
Logistics of partnerships
The context of partnerships was variable,
ranging from the mentor initiating all phone
calls to a mutual exchange of phone numbers
or face-to-face meetings in the community as
the partnerships developed over time. In the
cases in which face-to-face contact was made,
relationships tended to continue on an infor-
mal basis after the partnership year was com-
pleted. Partners who were passive recipients
of phone contact from mentors (ie, those who
could not initiate contacts with mentors) ex-
pressed the desire for greater control over the
partnership process. Similarly, when partner-
ships were limited to a few phone calls, the
family member’s lack of ability to reach out
for support as needed was often cited as the
primary reason for ending the partnership.
Geographical distance between mentor and
partner, prohibiting them from face-to-face
contact, was also cited as a frustration.
Qualities of a good mentor
The abilities of listening and being com-
passionate and knowledge of community re-
sources were cited by all participants as core
qualities of a good mentor. In addition, pa-
tience, tolerance, consistency of contact, hon-
esty about the mentor’s own negative feel-
ings, emotional stability, respect for the fam-
ily member’s experience, and capacity for in-
person contact were mentioned as desirable
characteristics. Partnership difficulties arose
when mentors seemed “perfect” (ie, having
answers to all problems). These partnerships
often ended early, because the family member
did not feel comfortable expressing anger or
sadness.
Advocacy and self-advocacy
Partners praised mentors’ ability to prepare
them for personal “overload” as the medical
care and social services “system” began to
withdraw. Such advice helped prepare part-
ners by increasing their understanding, if
not their tolerance, of the potential lack of
“system” responsiveness to their loved one’s
needs. This knowledge helped partners cre-
ate new avenues to get what they needed (eg,
knowing where to get the most accurate in-
formation, knowing the “right” people to talk
to). In addition, three family members talked
about the need to advocate on behalf of their
own needs, in addition to those of the person
with a TBI. Family members felt that profes-
sionals often focused treatment solely on the
person with the brain injury (in keeping with
the medical model), failing to place the per-
son with TBI in the context of his or her family
relationship, and thus failed to provide ser-
vices for the family as a whole. As a result, sev-
eral spouses questioned their ability to remain
in their relationships over the long term.
Program improvements suggested
by partners
Several partners requested guidelines for
what they could and could not expect within
the TBI-MPP. Requests included information
about who may initiate phone calls and
whether face-to-face contact might be ar-
ranged. In addition, they requested more
structured schedules of phone calls. In some
cases, better matches were requested, with
regard to distance, age, and relationship to
the person with a TBI. Additional services to
enhance support to the entire family, includ-
ing workshops and support groups, were also
suggested.
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Peer Support in the Community 125
DISCUSSION
Although peer support within a group
modality has been suggested as useful in en-
hancing coping skills for both individuals with
TBI and their family members,
23,24
research as
to the usefulness of individualized peer sup-
port is lacking. In this study, preliminary data
as to the efficacy and impact of a community-
based peer support program were evaluated
using retrospective interviews with individu-
als with TBI and family members who had par-
ticipated in the TBI-MPP.
Participants’ reports suggest that for many
among them, the TBI-MPP had a positive
impact on their lives. For both individuals
with TBI and family members who partici-
pated in the TBI-MPP, the areas of greatest
reported program impact were in increas-
ing their knowledge of TBI and in helping
them cope with the consequences of TBI.
Most participants from both groups reported
that the program helped enhance their over-
all ability to cope with TBI, their quality of
life, their general outlook, and their ability
to cope with depression and sadness. Most
participants from both groups stated that the
program had little impact on increasing the
amount of social support they received from
family, friends, and community. Family mem-
bers and individuals with TBI reported vary-
ing degrees of program impact on their hap-
piness, their ability to cope with anxiety and
anger, their ability to communicate with pro-
fessionals, and their sense of control over their
lives.
Family members, in general, were more
conservative in their evaluation of the extent
of the program’s impact. They tended to state
that the program had “some impact” rather
than a “major impact” across most areas ex-
plored in the study. It is unclear whether this
finding suggests that the program was less
effective for family members or whether in-
dividuals with TBI were more “grateful” for
any support provided by peers. A possible ex-
planation is that receiving peer support from
another person with TBI was particularly em-
powering (and therefore gratifying) for partic-
ipants with TBI.
These preliminary findings support prior
literature suggesting the usefulness of peer
support in enhancing an individual’s sense
of empowerment.
29,30
In this study, select as-
pects of empowerment (ie, ability to cope)
seemed to be more likely to be impacted by
peer support than others (ie, control over
one’s life). These findings highlight the fact
that the term “empowerment” may reflect a
rather heterogeneous and multifaceted set of
experiences.
The lasting and significant toll of TBI on
the emotional well-being and quality of life
of individuals with TBI
3–7
and their family
members
9,13–22
has been well documented in
the literature. During training of mentors in
the TBI-MPP, specific coping strategies to en-
able partners to cope with depression, ad-
dress their anger, and decrease their anxiety
were emphasized. The current findings sug-
gest that peer support is helpful in enabling
individuals to cope with their emotional chal-
lenges, with impact noted most frequently
on partners’ ability to cope with feelings of
depression and sadness and somewhat less
frequently on their coping with anger and
anxiety. In addition, this peer support pro-
gram was found to have a positive impact
on many participants’ overall quality of life.
The program’s impact on levels of perceived
happiness was less emphatic, suggesting that
this latter objective was perhaps beyond the
scope of this time-limited peer-mentoring pro-
gram for many participants.
Coping after TBI reportedly is enhanced by
provision of adequate information about the
challenges of TBI and community resources
available to deal with these challenges.
25–27
To prepare mentors to address these spe-
cific peer support needs, training emphasized
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short-term and long-term TBI-related chal-
lenges and educating mentors about available
community resources. In addition, communi-
cation and advocacy skills were emphasized
as potential tools with which to help partners
obtain desired information from professionals
and needed community supports. These pre-
liminary findings suggest that this peer sup-
port program helped to increase participants’
knowledge about TBI, thus providing a mech-
anism for enhanced coping after TBI. The re-
ported impact of the program on increasing
knowledge of community resources was less
robust. In part, this finding is reflective of re-
alistic limitations in available and adequate re-
sources in the community for individuals and
their families after TBI. It may also have been
due to hesitancy observed by program coor-
dinators on the part of mentors to provide
specific information about community refer-
ral to their peers, feeling this was not part
of the “mentoring” role. The project coordi-
nators were familiar with specific community
resources and provided these services. These
preliminary findings highlight the need for in-
creased education of individuals and families
regarding available community resources by
professionals early in the rehabilitation phase
of TBI recovery (rather than in a peer support
situation), as well as the need for expansion
of such services in the community.
The current findings suggest that family
members viewed the program as more helpful
in enhancing communication with profession-
als than did individuals with TBI. This finding
may reflect the reported increase in depen-
dency of individuals with TBI,
9
with a sub-
sequent tendency to delegate communication
and advocacy needs to their family members.
If this interpretation is correct, a greater focus
on this area in mentor training is called for,
since lack of personal advocacy can only lead
to further disablement for an individual. In
contrast, this finding might also reflect solid
communication abilities in some individuals
with TBI; thus, the lack of impact reported by
individuals with TBI might not indicate a fail-
ure of this peer support program but rather an
absence of a need for support in this area for
select individuals. This finding highlights that
the categorical response of “no impact/not ap-
plicable” is open to numerous interpretations.
In our future research efforts, interviews of
program participants will be designed to clar-
ify reasons for reports of “no impact” to elim-
inate such ambiguities.
Social isolation is a common sequela of
TBI for both individuals with TBI and their
family members. To address this need in this
peer support program, training of mentors fo-
cused on techniques to increase a network
of support from family, friends, and commu-
nity members in potential partners. Prelimi-
nary results of this study suggest that partic-
ipants felt that the program did little to in-
crease the amount of social support received
from family, friends, and community. These
findings are similar to those reported by San-
telli et al
34
within the P-to-P program. Com-
bined, these findings may suggest that the goal
of building extended support networks may
be applicable for a select subset of individuals
but should not be viewed as a major focus of
peer support efforts.
Given the literature documenting contin-
ued emotional challenges for both individu-
als with TBI
11,12
and their families,
17,18,20,21
it was anticipated that partnership duration
and frequency of contact might be greater
than reported in other peer support programs
aimed at other disability groups. The TBI-MPP
was designed to be an open-ended partner-
ship lasting up to 1 year. In the program,
mentors and partners jointly determined the
duration and frequency of their contacts,
and partnerships were concluded in consul-
tation with the project coordinator. Prelimi-
nary findings validate our initial assumption
that peer support programs for individuals
with TBI and their families is of greater
intensity and duration than other peer sup-
port programs.
33
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Overall program satisfaction in this pilot
study was positive in that most individu-
als with TBI and family members reported
satisfaction with both the duration and fre-
quency of contacts. Not all partners were sat-
isfied, however. Some participants requested
increased contact and longer partnerships.
Family members seemed to be more selec-
tive, more verbal, and more demanding about
program intensity and duration needs. Quali-
tative interviews with a small cohort of fam-
ily members provided further insights into
their unique needs, including such issues as
more person-to-person contact (as contrasted
with phone contact) with mentors, increased
control over initiating (as opposed to receiv-
ing) contacts with mentors, and longer lasting
partnerships.
The qualitative interview also provided
contextual information about the benefits
of the partnerships for family members,
with several family members emphasizing
the benefit of having mentors discuss their
own feelings and offer suggestions from their
own perspective (ie, from a more removed,
and settled, yet still compassionate, stance).
Family members provided recommendations
for program enhancement as well, including
suggesting that mentors learn how to share
their own negative feelings, as well as their
strengths, to help “normalize” family mem-
bers’ negative feelings and the need to provide
detailed information to future partners about
the scope of the TBI-MPP to decrease frustra-
tion caused by unrealistic expectations of the
program. Family members also stressed the
need to expand peer support to the family sys-
tem as a whole, either in a one-to-one relation-
ship or in a group format. Future qualitative
studies will be necessary to examine the expe-
riences of individuals with TBI in the TBI-MPP.
Combined, these preliminary findings sug-
gest that peer support for individuals with
TBI and their family members is an inten-
sive process for both mentors and their part-
ners. The intensity of the TBI-MPP partner-
ships implies a parallel need for ongoing
technical assistance for mentors involved in
such a program. In the TBI-MPP, these sup-
ports have been, and continue to be, pro-
vided by two project coordinators who were
knowledgeable about TBI and experts about
community resources. Coordinators serve the
dual role of screening partners to ensure that
their needs can be met by peers and serv-
ing as a “mentor” for each program mentor
to assist in “fine tuning” his or her interven-
tions with a partner. Ongoing technical assis-
tance of this kind is essential to maintaining
an effective peer support program in the com-
munity. The intensity of project coordinators’
involvement in the program will be analyzed
during the prospective phase of the study to
determine realistic staffing needs when de-
signing future peer support programs.
Given the retrospective nature of the cur-
rent data, several limitations need to be ad-
dressed. The retrospective data collected for
this initial phase of the study may be bi-
ased by several factors: individuals with sig-
nificant cognitive difficulties may prove to
be poor reporters of prior program interven-
tions, and individuals who were dissatisfied
with the program itself may have declined par-
ticipation in the retrospective interviews. Al-
though the two groups (ie, interview partici-
pants and nonparticipants) were similar both
demographically and in the duration of their
partnerships, their reasons for termination of
the partnerships varied slightly, in that part-
ners who declined participation in the inter-
view were slightly more likely to have ended
their partnerships because of complex needs,
being too busy, and/or having greater cog-
nitive or emotional challenges. These poten-
tial biases are inherent within retrospective
community-based studies.
To address the limitations identified in
these preliminary studies, a prospective in-
terview has been implemented with partners
being interviewed prior to initiation of part-
nerships at completion of the partnerships,
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and again 1 year after partnership initiation
(if the partnership was completed before the
1 year anniversary). This design will permit
evaluation of “within person” changes, as
well as “program impact” related to these
changes, thus exploring the process and
impact of peer support more clearly. To de-
termine whether changes in the person are in-
deed peer program dependent, a second sam-
ple of individuals who have not participated
in TBI-MPP will be interviewed initially and at
1 year after the initial interview. Comparison
of data from both groups will allow for a more
rigorous evaluation of program impact.
In summary, the TBI-MPP has been a liv-
ing model of PAR in action. Individuals
with TBI and family members have been
empowered to create their own program,
whereas researchers have been called on
(and challenged) to evaluate the efficacy
of their community-based efforts. Individuals
formerly isolated after the onset of their TBI
have had the benefit of a connection with
“someone who has been there.” As a direct
result of the TBI-MPP, mentors have been em-
powered and now serve as resources to oth-
ers in the community. Inherent in a PAR ap-
proach are its many challenges,
34,44
including
the need to be flexible in designing (and re-
designing) methods for assessment, the need
for intense and ongoing technical assistance
to mentors, and the need to replace men-
tors when they “move on” from the program.
These challenges are a small price to pay for
the potential benefits that a program like the
TBI-MPP can offer.
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130 JOURNAL OF HEAD TRAUMA REHABILITATION/APRIL 2002
Appendix A
Questions and Response Choices Regarding Impact of
TBI-MPP from the Retrospective Questionnaire
Part I
Empowerment:
1. Did the mentoring program help you cope
with you or your loved one’s brain injury?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
2. Did the mentoring program affect how
much control you have over your life?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
Quality of Life Indicators:
1. Did the mentoring program affect the over-
all quality of your life?
A lot (decreased QOL)
Somewhat (decreased QOL)
A little bit (decreased QOL)
Not at all
A little bit (increased QOL)
Somewhat (increased QOL)
A lot (increased QOL)
2. Did the mentoring program contribute to
changes in your general outlook on life?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
Mood:
1. Did the mentoring program affect how
happy or cheerful you are (or how often
you feel happy or cheerful)?
A lot (happiness increased)
Somewhat (happiness increased)
A little bit (happiness increased)
Not at all
A little bit (happiness decreased)
Somewhat (happiness decreased)
A lot (happiness decreased)
Don’t know/remember
2. Did the mentoring program help you cope
with feeling depressed or sad?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
3. Did the mentoring program help you cope
with feeling angry?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
4. Did the mentoring program help you cope
with your nervousness or anxiety?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
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Skills and Knowledge:
1. Did the mentoring program help you com-
municate your needs to health care profes-
sionals?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
2. Did the mentoring program help you learn
about TBI?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
3. Did the mentoring program help you learn
about resources in your community?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
Social Support:
1. Did the mentoring program assist you in
getting the support you needed from your
family?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
2. Did the mentoring program help you in
getting the support you needed from your
friends?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
3. Did the mentoring program help you in
obtaining the support you needed from
members of your community (eg, clergy,
coworkers)?
A lot
Somewhat
A little bit
Not at all
Not applicable
Don’t know/remember
Part II
1. How satisfied or dissatisfied were you with
the length of your partnership?
Dissatisfied (would have preferred a
shorter partnership)
Dissatisfied (would have preferred a
longer partnership)
Satisfied (length of partnership was
about right)
Don’t know/remember
2. How satisfied or dissatisfied were you with
the frequency of contact that you had with
your mentor?
Dissatisfied (would have preferred
more contact)
Dissatisfied (would have preferred less
contact)
Satisfied (amount of contact was about
right)
Don’t know/remember
3. How satisfied or dissatisfied were you with
your mentor?
Very dissatisfied
Somewhat dissatisfied
Mixed
Somewhat satisfied
Very satisfied
Don’t know/remember
