DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is one of the leading causes of death and disability in Latin America, and TBI patients there experience high levels of disability and extremely poor functional outcomes. Informal caregivers play a key role in the rehabilitation and care of individuals with TBI, but Latino caregivers also experience poor outcomes, including high levels of depression, role-engulfment, burden, and poor health, which all influence the quality of informal care they are able to provide. To improve TBI rehabilitation through stronger informal caregiving, the proposed study will develop and evaluate an evidence-based and culturally sensitive Transition Assistance Program (TAP) for informal caregivers of patients with TBI in Latin America during the patient's transition from hospital to home. The TAP was previously developed for Latino stroke caregivers and has been found to decrease caregiver strain and depression. In this study, the TAP will be modified for TBI and implemented at three rehabilitation facilities in Mexico City, Mexico and in Cali and Neiva, Colombia. These three centers have a high volume of TBI treatment and have strong, committed teams to execute the TAP. All three sites are collaborating in developing the intervention and welcome the opportunity to evaluate a model that if successful, can be exported across other TBI rehabilitation facilities in Latin America. The study takes advantage of our research team's extensive work on TBI rehabilitation in Latinos, on cultural issues in caregiving, and on the development of empirically supported problem-solving and mental health interventions for Latino caregivers. In the intervention, TBI Caregivers will be randomly assigned to either the TAP intervention group or to a control group receiving the standard care provided by the rehabilitation facility. The TAP begins before discharge and extends across six weeks. It includes three components to improve caregiver mental health and informal care: skill development, education, and supportive problem solving. Caregivers in the intervention group will receive a culturally tailored, Spanish TBI caregiving guidebook, a 1- hour intervention session by a TBI clinician before the patient's hospital discharge, and four 1-hour in-home visits at 1, 2, 4, and 6 weeks after discharge by the same TBI clinician. Data will be collected from caregivers and TBI patients at baseline in the hospital immediately before discharge and at 2 and 4 months after discharge. This study will create, implement, and empirically test a TBI caregiver intervention unlike any performed before in Latin America, targeting one of the region's most common, debilitating, and fatal medical conditions. It has the potential to (1) generate findings that can provide empirically supported guidance to clinicians and other researchers regarding the provision of culturally tailored rehabilitation services for TBI caregivers in Latin America, (2) gain insight that can be used when developing TBI caregiver interventions for Latinos in the U.S., and (3) contribute more broadly to one of the NIH's central goals of eliminating inequities in health, in rehabilitation, and in the provision of quality care.

PUBLIC HEALTH RELEVANCE: Traumatic brain injury (TBI) patients in Latin America experience high levels of disability and extremely poor functional outcomes, and their informal caregivers play a key role in their rehabilitation and care. To improve TBI rehabilitation through stronger informal caregiving, the proposed study will develop and evaluate an evidence-based and culturally sensitive Transition Assistance Program for informal caregivers of patients with TBI in Latin America during the patient's transition from hospital to home. This study will generate findings that can provide empirically supported guidance to clinicians regarding the provision of culturally tailored rehabilitation services for TBI caregivers in Latin America and in the U.S.