National Resource Center for TBI

The 5 session program covers two or three of the following eleven topics in each session*:

1. Session One: "Effects of Brain Injury on the Survivor and Family" 
   Topic One: What is normal for brain injury? Common problems after TBI.
   Topic Two: Brain injury happens to the whole family
   
   
2. Session Two: "Understanding Recovery"
   Topic Three: Emotional and physical recovery are two different things.
   Topic Four: Mastering the art of patience.
   Topic Five: Coping with loss and change.
   
   
3. Session Three: "Solving Problems and Setting Goals"
   Topic Six: Setting reasonable goals.
   Topic Seven: Solving problems effectively.
   
   
4. Session Four: "Managing Stress and Intense Emotions"
   Topic Eight: Managing stress effectively.
   Topic Nine: Managing intense emotions.
   
   
5. Session Five: "Strategies for Optimal Recovery"
   Topic Ten: Taking care of yourself.
   Topic Eleven: Focusing on gains and accomplishments

*Although the BIFI is typically administered in this order, the program can and should be tailored to meet the needs of each family member.  For example, clinicians may choose to: 1) allocate one topic to each session and extend the program to 11 sessions, 2) extend discussion of a single topic to more than one session because the topic is difficult or important, or 3) focus on a subset of topics, to the exclusion of others.

The BIFI incorporates a variety of tools to help families effectively address each topic. Questionnaires and worksheets are used in many of the sessions to facilitate collaborative self-examination. Collaborative self-examination is an intervention tool developed at VCU that relies on asking family members a series of questions to help them explore critical issues. Through this shared, guided discussion, families are able to identify their own and one another’s concerns, feelings, opinions and ideas and to work more effectively as a team. Additionally, the BIFI incorporates homework assignments for all participants, promoting infusion of programmatic ideas at home in between sessions.

The BIFI was designed to be implemented with family members and survivors of TBI, stroke, anoxic brain injuries, non-progressive brain tumors, and other acquired brain injuries. Friends and caregivers are always encouraged to participate as well.

Additionally, the BIFI topics and materials can be used effectively in a number of different settings, and with a variety of therapy modalities. Intervention concepts and tools have been used effectively in: individual and couples therapy sessions, therapeutic counseling groups, multi-family therapy groups, support groups, and occupational and speech therapy sessions. Clinicians are encouraged to modify and adopt the materials to fit the needs of their specific population and setting.

The BIFI addresses special needs in the following ways:

• Written materials were developed in large print to accommodate visual impairments.
• The materials are written at a fifth grade level to accommodate individuals with limited reading skills.
• Information is presented with written, oral, and visual methods/aids to accommodate those with different learning styles.
• Many of the important ideas and instructions are presented to facilitate learning and recall. In addition, copies of all materials used in session are provided to each participating family member.
• When participants have motor, reading, or writing deficits, surveys and questionnaires should be read aloud and responses recorded by the clinician.
• The program is flexible, allowing the clinician to follow the learning pace of the survivor and family members.
• To facilitate organization of materials, each participating family member should be provided with a loose-leaf notebook for storage of materials.

The program is designed to be implemented by licensed mental health clinicians, such as psychologists, counselors, social workers, marriage and family therapists, psychiatric nurses, or psychiatrists, who:

• Have completed the minimum degree and certification requirements for their discipline
• Have experience working with patients who have brain injury and their families, and
• Understand the special needs of patients with brain injury and those of their family members.

In addition, VCU provides specialized BIFI training courses which are strongly recommended for clinicians interested in purchasing and / or implementing the BIFI.

There are some modules within the BIFI that may be implemented by health educators and non-mental health therapists (i.e. occupational therapists, recreational therapists, etc.). A chart detailing BIFI modules and the level of training required to implement each module can be found RAI-BIFI-TCI Qualifications.

VCU has published manuscripts in peer reviewed scholarly journals detailing the construction of the program as well as promising outcome data from a lengthy study of BIFI participants. A list of publications presenting BIFI outcome data and the abstracts for these manuscripts can be found here. Visit our Articles section to see a complete list of VCU manuscripts related to the BIFI as well as other TBI related topics.

Funding for BIFI development, implementation, and on-going research is provided by the TBI Model Systems Grant - H133A070036 - funded by the National Institute on Disability and Rehabilitation Research.

Clinicians implementing the BIFI should guide their practice by following these important principles:

• Brain injury causes drastic life changes for all family members.
• Most people what their old life back.
• Well-informed people do better.
• Every family member deserves respect.
• Every person in the family is important.
• Each adult family member has the right to make choices, good or bad.
• In the long-term, the family ends up taking most of the responsibility for helping the survivor.
• Family members must take care of themselves in order to effectively help others.

VCU first strongly recommends training in implementing the BIFI. Trainings include a copy of the BIFI Manual and a number of additional resources and materials that are useful in practice with families recovering from brain injury. To attend or schedule a training, please visit the BIFI trainings page.

However, BIFI Kits are available for purchase outside of trainings. Please visit the National Resource Center Website for a description of the Kit and pricing and to view other valuable resource materials created by clinicians and researchers at VCU. The BIFI Kit catalog page is located here, or check out our store for other resources.

Please contact Jennifer Marwitz at Jennifer.Marwitz@vcuhealth.org.

Please see our recommended qualifications RAI-BIFI-TCI Qualifications.