Table 5 Joint display of the quantitative and qualitative results connected to constructs from the TBP

TBPQ-TBI

Mean and SD

Attitudes

5.57 (0.92)

Favorable opinions and beliefs about the usefulness of OSU TBI-ID

• Differentiate TBI from mental health diagnoses

• Inform intervention decisions

“I'm very positive about it. I certainly see the usefulness and it's great to be able to have guidelines to follow because I really do think that TBI is underreported and a huge part of some of the stuff that we could be doing better like identifying things like that. So having an actual screening tool is really helpful and kinda takes the guesswork out.” (Licensed Independent Social Worker with Supervision Distinction, Mitigation Specialist, prison setting)

“You're able to discern or differentiate between somebody's psychiatric issues. Somebody's relapse warning. I mean it adds a whole other layer, somebody's overall whole, the whole person approach and its primary factor on substance use issues. We're talking about mental health issues and substance use disorders. Traumatic brain injuries [are] another primary medical concern that is of significance when trying to treat somebody” (Licensed Professional Clinical Counselor, Director of Outpatient Services, community-based treatment setting)

“I think it would be beneficial to give us more information and maybe help guide some of the diagnoses or assessments with clients. So, I definitely think it would be useful.” (Licensed Professional Counselor, Therapist, community-based outpatient treatment setting)

Subjective norms

2.99 (0.92)

Lack of internal and/or external pressures to adopt TBI screening

• Lack of awareness from colleagues of the intervention

• Lack of leadership engagement

• Lack of agency-level and state-level mandates

“I mean those [colleagues] who are [screening for TBI], I can think of one in my office who is aware of the effects of TBI. She does [screen for TBI], she is likely asking those questions. I don't know that anybody else is.” (Licensed Professional Counselor, Therapist, community-based outpatient treatment setting)

“If more of my colleagues were on board with it, to promote it in terms of it being useful to them as well, especially outside of integrated behavioral health…I wonder if the other providers would see the importance of it. Because, if you're in this field already of integrated behavioral health, you can see that it would be worth happening. But if you're not inside this field they may raise questions; they want to know why do you want it or why do you need it.” (Licensed Chemical Dependency Counselor-II, Addiction Counselor, community-based outpatient treatment setting)

“I mean, to me it sounds like a very valuable service and everything, that in terms of the likelihood of it being incorporated and utilized, that would be an upper management decision and call. I feel that it would be very beneficial, but I don't have any input or access to voice my opinion and so I don't know what actually aids the implementation of the program.” (Licensed Social Worker, Therapist, community-based outpatient treatment setting)

Perceived behavioral control

4.42 (1.17)

Additional training needed to enhance skills and confidence

-

“I think I would need a lot more training, and hands on learning observation, and supervision to learn and implement the system before I feel comfortable jumping in on mine. I don't feel that I'm sufficiently trained at this time to do it on my own” (Licensed Social Worker Therapist, community-based outpatient treatment setting)

“I don't think there are any expectations other than what I present to my leadership as this should be an expectation. So, I don't really have any standards to abide by, I kind of make it up as I go along. But I do believe that they would trust me enough to know that they should look into this … I know that they would be back.” (Licensed Independent Social Worker with Supervision Distinction, Mitigation Specialist, prison setting)

Intentions

3.34 (1.51)

Intrinsic- and client-driven motivations

• Personal curiosity

• Understand the client

• Inform clinical decision-making

“I kind of come from a place of curiosity and wanting to help versus here's another screening you have to do, this is just part of our intake, just fill it out, there's a reason, there's a purpose for it… It's just I want to make sure that I'm treating them in the best way possible with the most tools that are gonna be the most effective for them. And if they've had a traumatic brain injury, that really is hampering their quality of life. I am not qualified to treat that, I am qualified to refer and really encourage them to get that additional assessment and potentially treatment.” (Licensed Professional Counselor, Director, private practice)

“It does give me a lot of guidance on if I need to ask, what I liked about it is that it gives me further guidance on what kind of questions I need to ask, where we're gonna look for referrals in order to get the client what they need.” (Licensed Social Worker, Crisis Counselor, Domestic Violence Shelter)

TBI screening adoption

25.6% of the total sample

Trialability

• To assess intervention fit

• Suspected TBI among clients

“I just I ran through it and then I actually end up having a program participant in my chair and so I've got to ask him the questions. He doesn't have a TBI. He has no history of that at all. But I was just kinda like, I don't want to practice, but it was just I had just gotten the thing and I was like, ‘Let's see how this works’. And so, you know, I sat down with him and pretended.” (Licensed Professional Chemical Dependency Counselor-II, Correctional Program Coordinator, prison setting)

“One of them is a death penalty client, and so I really wanted to cover all the mitigation bases because I feel like that it's life or death, right? Might as well do everything I certainly have available to me to either look into things or rule out things. And the other guy I'd been lost. I'd been absolutely lost on where to go with him … to help me understand how I can best help him even in my mitigation, like okay, you're 30 years old and then you snapped. Well, that could have a lot to do with your mental health, but are there other things going on?” (Licensed Independent Social Worker with Supervision Distinction, Mitigation Specialist, prison setting)

“Well, I mean, because I had done the training and I was like, I really wanted to see how successful I could make it in the assessment process and so it was really just kind of a trial for me, and I don't normally do assessments, like I supervise people who did their assessment, so I don't normally act myself. So I had to kind of like, I took this client, I'm gonna do this assessment, and this time I'm gonna incorporate it. So it was really a trial to see how easy it would be to incorporate it in, that's why I did that.” (Licensed Independent Social Worker with Supervision Distinction, Assessment Supervisor, senior services)