# Brain Injury Outpatient Education and Care Navigation

> **NIH NIH R01** · SEATTLE CHILDREN'S HOSPITAL · 2022 · $651,190

## Abstract

PROJECT SUMMARY/ABSTRACT
Disability after traumatic brain injury (TBI) significantly affects U.S. Hispanic children. Compared to non-
Hispanic children, they have lower health related quality of life, self-care, and communication skills 3 years
after injury; even though differences are not present at hospital discharge. Long-term rehabilitation improves
outcomes, but timely initiation is key since most functional gains happen 3 to 6 months after TBI. Parents play
a significant role in their child’s recovery. However, Hispanic parents face substantial barriers that can result in
delayed treatment initiation and suboptimal outcomes. We developed and pilot tested the 1st theory-based
intervention for Hispanic children and their parents consisting of Brain Injury Education and outpatient
Navigation (1st BIEN). Based on Social Cognitive theory, 1st BIEN integrates in-person education enriched by
video content delivered through mobile phone devices, with outpatient navigation during transitions from
inpatient to outpatient care and during school return. The 1st BIEN pilot, established feasibility and acceptability
for our program and 86% attendance to initial follow-up care. We propose a multicenter randomized controlled
trial to test the efficacy of 1st BIEN to maintain long-term adherence to rehabilitation and determine its effect on
children’s functional outcomes. We will enroll 150 parent-child dyads; children (6-17 years), with moderate to
severe TBI and their parents, from 5 centers in 4 states with Hispanic population predominantly from Mexico
and Central America. A higher risk group, whose educational attainment, income and English proficiency are
lower compared to other Hispanic groups in the U.S. Parents randomized to the intervention will receive (1)
One in-person education session, using the culturally, linguistically and literacy relevant 1st BIEN booklet, plus
bi-weekly video reviews individually tailored to the child’s TBI and therapies; and, (2) three months of bilingual
outpatient navigation, modeling and coaching problem solving skills. Attention control parents will receive one
in person-education session using the 1st BIEN booklet, monthly non-TBI (Well-child) texts and usual
institutional follow up care. The primary outcome is treatment adherence at 6 months post-discharge measured
by percentage of follow-up appointments attended during the prescribed time at centralized acute facilities,
community care providers and individual therapies. Secondary outcomes are functional status of the child
using PROMIS parental report measures; and, parental health literacy, self-efficacy and mental health
measured at 3, 6, and 12 months after discharge. Children’s academic performance will also be assessed
using school records. Exploratory analyses will test possible moderators such as pre-injury parental
acculturation; and mediators, such as post intervention parental TBI-knowledge, self-efficacy, anxiety and
depression. Our study evaluates a n...

## Key facts

- **NIH application ID:** 10469490
- **Project number:** 5R01HD103700-02
- **Recipient organization:** SEATTLE CHILDREN'S HOSPITAL
- **Principal Investigator:** Nathalia Jimenez
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $651,190
- **Award type:** 5
- **Project period:** 2021-08-15 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10469490

## Citation

> US National Institutes of Health, RePORTER application 10469490, Brain Injury Outpatient Education and Care Navigation (5R01HD103700-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10469490. Licensed CC0.

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