Health Disparities and Traumatic Brain Injury Research

Kelli Williams Gary, PhD, MPH, OTR/L
Assistant Professor
Department of Occupational Therapy
Virginia Commonwealth University (VCU)
Co-PI for Project Empowerment
Dissemination Coordinator for VCU TBI Model Systems
Department of Physical Medicine & Rehabilitation

Office Location: 730 E. Broad Street, Theater Row Building, Rm. 2050L
Office Phone: (804)828-3412

Kelli Williams Gary, Ph.D., MPH, OTR/L is an assistant professor in the department of occupational therapy at Virginia Commonwealth University with 16 years of clinical experience as a licensed occupational therapist.  She obtained a Bachelor of Science degree in occupational therapy from Chicago State University in Chicago, IL, a Masters of Science and Masters of Public Health from Columbia University in New York, NY, and a Ph.D. from VCU in Richmond, VA.  From 2005-2011, she trained as pre-doctoral research fellow and a post-doctoral research trainee with funding from National Institute on Disability and Rehabilitation Research (NIDRR) at VCU.  During that training, Dr. Gary has authored/coauthored over 16 peer-reviewed journal articles and 2 book chapters primarily focused on racial and ethnic minorities and caregivers with traumatic brain injury (TBI) and other disabilities.  Dr. Gary received a competitive award to repay her student loans from the National Institute of Medical Health Disparities from the National Institute of Health.  She is the co-PI of a NIDRR funded grant called Project Empowerment and Dissemination coordinator for VCU TBI Model Systems also funded by NIDRR.  She is currently applying for grants to fund the development of a culturally-tailored community-based intervention for African Americans with TBI.

Select Research Publications
Arango-Lasprilla, J. C., Ketchum, J. M., Williams, K., Kreutzer, J. S., Marquez, C., O’Neil-Pirozzi, T. M., & Wehman, P.  (2008). Racial differences in employment outcomes after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(5), 988-995. PMID: 18452750

Arango-Lasprilla, J. C., Ketchum, J. M., Gary, K. W., Kreutzer, J. S., O’Neil-Pirozzi, T. M., Wehman P et al. (2009). Influence of minority status on job stability after traumatic brain injury. PM&R: The Journal of Injury, Function and Rehabilitation, 1(1), 41-49. PMID: 19627871.

Gary, K. W.
, Arango-Lasprilla, J. C., & Stevens, L. F. (2009). Do racial/ethnic differences exist in post-injury outcomes after TBI?: A comprehensive review of the literature. Brain Injury, 23(10), 775-789. PMID: 19697166.

G
ary, K. W., Arango-Lasprilla, J. C., Ketchum, J. M., Kreutzer, J. S., Copolillo, A., Novak, T., & Jha, A. (2009).  Racial difference in employment outcomes at 1, 2, and 5 years post-injury. Arch Phys Med Rehabil, 90, 1699-1707. PMID: 19801059.

Gary, K. W.
, Ketchum, J. M., Arango-Lasprilla, J. C., Kreutzer, J. S., Novak, T., Copolillo, A., & Deng, X. (2010).  Difference in employment outcomes 10 years after traumatic brain injury among racial and ethnic minority groups. Journal of Vocational Rehabilitation, 33(1),65-75. PMID: Do not exist.

Niemeier, J. P., Kreutzer, J.S., Marwitz, J. H., Gary, K. W., & Ketchum, J. M.  (2011). Efficacy of a brief acute neurobehavioral intervention following traumatic brain injury: A preliminary investigation.  Brain Injury, 25(7-8), 680-690. PMID: 21604926.

Arango-Lasprilla, J. C., Ketchum, J. M., Gary, K., Hart, T., Corrigan, J.,  Forster, L., & Mascialino, G. (2009).Race/ethnicity differences in satisfaction with life among persons with traumatic brain injury. NeuroRehabilitation, 24(1), 5-14. PMID: 19208953.

Kreutzer, J. S., Livingston, L. A., Everley, R. S., Gary, K. W., Arango-Lasprilla, J. C., Powell, V. D., & Marwitz, J. H.  (2009). Caregivers’ concerns about judgment and safety of patients with brain injury: A preliminary investigation. PM&R: The Journal of Injury, Function and Rehabilitation, 1(8), 723-728. PMID: 19695524.

Livingston, L. A., Kennedy, R.E., Marwitz, J. H., Arango-Lasprilla, J. C., Rapport, L. J., Bushnik, T.,  & Gary, K. W. (2010). Predictors of family caregivers’ life satisfaction after traumatic brain injury at one and two years post-injury: A longitudinal multi-center investigation.  NeuroRehabilitation, 27, 73-81. PMID: 20634602.

Hurley, J. E., Lewis, A. N., Koch, L. C., Armstrong, A. J., Gary, K. W., & McMahon, B. T.  (2010). An examination of the relationship between the race of ADA Title I Claimants and attributes of their employers. Journal of Minority Disability Research and Practice, 1(3),110-147. PMID: Do not exist.

Lewis, A. N., Hurley, J. E., Armstrong, A. J., Koch, L. C., Gary, K. W., & McMahon, B. T.  (2010). The influence of race on allegations of employment discrimination due to disability.  Journal of Minority Disability Research and Practice, 1(3), 30-67. PMID: Do not exist.

Arango-Lasprilla, J.C., Ketchum, J. M., Lewis, A. N., Krch, D., Gary, K. W., & Dodd, B. A. Jr.  (2011). Racial and ethnic disparities in employment outcomes for persons with traumatic brain injury: A longitudinal investigation 1-5 years after injury. PM&R: The Journal of Injury, Function and Rehabilitation, 3(12),1083-1091. PMID: 21872550.

Gary, K. W.
, Nicholls, E., Shamburger, A., Stevens, L. F., & Arango-Lasprilla, J. C.  (2011). Do Racial and ethnic minority patients fare worse after SCI: A critical review of the literature. NeuroRehabilitation, 29(3), 275-293. PMID: 22142762.

Cole, P. L., & Gary, K. W.  (2012). Tailoring work-life interventions for culturally diverse caregivers of traumatic brain injury. Home Health Care Services Quarterly,31, 1-25. PMID: 22656914.

Arango-Lasprilla, J. C., Ketchum, J. M., Hurley, J., Getachew, A.M., & Gary, K. W. (in press). Allegations of ethnic minorities from 1992-2008: An Equal Employment Opportunity Commission (EEOC) study. WORK: A Journal of Prevention, Assessment, & Rehabilitation.

VCU Project Empowerment (NIDRR Funded)

There is limited research that examines issues related to minorities with disabilities that could be translated into practice to address the needs of clients and families from diverse background.  Furthermore, there are a dearth of researchers from diverse backgrounds who have the expertise and training to effectively engage in the research process from beginning to end and successfully publish minority disability research to be utilized by healthcare professionals and consumers. Therefore, Project Empowerment was established in 2008 to (1) identify and evaluate current practice and methods in conducting research for minorities with disabilities through a national survey, (2) create a interdisciplinary research consortium consisting of faculty Project Empowerment, local Historically Black Colleges/Universities (HBCU) and national consultants to encourage and mentor undergraduate and graduate students to pursue research careers, and (3) offer additional research findings, training, and opportunities to effectively disseminate such research.  
Project Empowerment is in final year of the funding period.  This last year is primarily focused on dissemination, solidifying partnerships, and promotion of Project Empowerment’s mission.  Specifically, we plan to published and tape several topic sheets, newsletters, and webcasts throughout 2012-2013.  We will complete and publish articles related to the national surveys we have distributed and we are publishing a research monograph that is the culmination of topics germane to Project Empowerment.  We will also continue to strengthen partnerships and implement a 4-step capacity building initiative to solidify plans for development.  Finally, we will prepare for submission of application for another 5 years of grant funding in 2013.

Productive Community Living after TBI: Development of Culturally-Tailored Community-Based Intervention for African Americans with TBI (Pursuing Funding)

Background:
Traumatic brain injury (TBI) presents a major public health concern causing physical, cognitive, and emotional sequelae resulting in long-term deficits. Subsequently, many survivors of TBI have difficulty with community integration, such as reengaging in work, leisure activities, and maintaining relationships. African Americans are disproportionately affected by TBI and experience greater problems with community integration compared to Whites and other minorities. Given the burden of TBI and community integration on African Americans, there is very little evidenced based research of effective community based TBI interventions for this population. Research questions/Hypothesis: (1) What are barriers to reengagement in productive activities, social participation and enhanced quality-of-life (QOL) for African Americans post-TBI? (2) What are culturally-based elements, above and beyond the injury, related to identified barriers that interfere with reengagement in productive activities, social participation, and QOL for African Americans post-TBI? (3) What content should be included in a community-based culturally responsive intervention to increase productive activities, social participation, and QOL for African Americans post-TBI? We hypothesize that a community-based, culturally-tailored TBI intervention designed and implemented with a community-based participatory research (CBPR) approach (compared to standard care) would enhance productivity, social participation, and QOL among African Americans with TBI. Design: A mixed-methods study of standardized assessments combined with semi-structured interview questions will identify specific barriers of community integration and describe identified problems in more detail to conceptualize culturally-related factors related to problems. Participants: Thirty participants between 20-55 years old with moderate-to-severe TBI who live in predominately African American communities will be enrolled in study. Methods/Approach: Mentors, community partner, and community advisory board will provide integrated feedback for recruitment, research design, and intervention development. Social ecological model (SEM) will provide framework to develop the initial draft of the intervention. Integrated feedback and results from a mixed methods study will provide content to develop a culturally-tailored community-based intervention consisting of informal survivor and caregiver education, peer support, resource utilization/management, strategy formulation, and empowerment activities. Main outcome measures: Productive activity (paid employment or other constructive role-appropriate activity), social participation (participation in leisure/recreational activities, family/friend interaction), and QOL. Innovation: The proposed research is innovative because (1) the research approach is novel in TBI rehabilitation research field and has shown effectiveness in other areas of health; (2) it presents a new way to carry out TBI intervention research that increases participation and outcomes for African Americans.