“I got stopped for speeding, and had the trooper signing up (to be evaluated) by the time the traffic stop was done,” James Small said. He was talking about BRAVE, a new program in the Midwest helping first responders overcome trauma: not just the mental/emotional kind that accompanies jobs where risk and horror are commonplace, but also the effects of mild traumatic brain injury (mTBI), a physical injury that is often undiagnosed and untreated.
A different kind of trauma
“I was recently diagnosed with TBI co-occurring with my PTSD…the BRAVE Program treats both, and it’s been an absolute game changer. It’s like they rolled 20 years off my odometer,” Small said.
I profiled Small several years ago, when he was a police chief bringing foundational change to a small Wisconsin department. We’ve kept in touch as his career evolved, and he told me about BRAVE after reading my article detailing a landmark legal decision hingeing on the impact of undetected brain trauma in law enforcement officers. Small was diagnosed with PTSD in 2016, and says BRAVE has made a difference in a way years of psychotherapy alone could not. “It is very affirming to see that there is a physical injury underlying the way I feel. I’m not crazy and there is a way to make it better,” he said.
Inside the BRAVE program
BRAVE is a three-week outpatient program, one of six nationwide and the first in the Midwest. It is a collaboration between Avalon Action Alliance and the Wisconsin Institute of Neuroscience (WINS). After an online application process, participants complete a comprehensive assessment over several days to develop individualized treatment plans. Small said, “There are medical doctors, physical therapists, psychologists - all are culturally competent and most are veterans. It’s extremely inviting, and very psychologically safe.” That last factor is important for first responders, who are historically resistant to seeking treatment for trauma, especially from providers they feel “don’t get it.”
Small credits his treatment at BRAVE with improved memory, attention span, balance and sleep, reduced anxiety and reactivity, even less tinnitus. History of major brain trauma is not a requirement for participation. Minor TBI may be caused by a single incident or cumulatively, with links to sports injuries, falls on unstable footing or during fights, on-duty wrecks, and exposure to blast trauma from flashbangs and years of firearms practice. The damage is often at microscopic levels, “silent” injuries that present differently than major traumas. BRAVE evaluations use tools including EEG and brain mapping to identify target areas for treatment during the program.
Amanda Bates, BRAVE Outreach Coordinator, explained that brain mapping reveals brain structure and activity, allowing providers to see how and where the brain is responding after repeated insults.
“This is your operating system,” she said. “First responders basically get paid to get their ****es kicked, plus existing in a constant fight-or-flight response. When they talk about ‘getting their bell rung’, that’s the Jell-O mold sloshing around in their skull. The (resulting) changes mean they can no longer regulate hormone response. Trauma changes the brain, measurable, neurological changes. The brain adapts to survive, but survival mode is not sustainable.”
Bates, a former career firefighter and EMS chief, said that one goal is for BRAVE to become the gold standard of care for first responders battling trauma.
“BRAVE is completely patient-centered care,” she said. “We work around the active officers, including scheduling and cost barriers. We take all first responders, including dispatchers, and any duty status or discharge status. We are targeting destigmatization, normalization and logistic barriers. The appointments and treatments BRAVE can provide in a three-week period would take up to two years anywhere else.”
That also means that donors are important. After BRAVE bills insurance, the remainder is covered by grants and donations. Besides the treatment program itself, BRAVE helps cover travel and lodging to remove every possible barrier to accessing help. There’s even an extended outpatient program once the on-site program is finished, to preserve momentum and maintain the hard-won sense of community and safety. “Shame loves isolation,” Bates said. “We need to normalize this conversation.”
Moving past survival mode
As part of that extended program, Small is continuing with group classes on subjects like identity and growing past moral injury, normalizing discussions of shared experiences without shame. He described learning new tools for coping with flashbacks and anger, as well as continuing treatment of his neurological injury.
“We get conditioned to just think, ‘It’s done, button it up and move on,’” he said. “We don’t acknowledge the impact of our work very well, we don’t celebrate the accomplishments, the lives we change. BRAVE made me realize I don’t acknowledge, don’t appreciate the good work I’ve done. I’ve had an exceptionally great career in public safety, but it didn’t feel like that. PTSD colors even the good things in a negative way.”
The program is continuing to grow. “I know they (BRAVE) are getting a ton of emergency responder referrals between me and Amanda,” Small said. “I’m getting them several a week.” Many of those referrals grow out of curiosity about Small’s PTSD service Golden retriever, Hawk; it turns out that dogs are great icebreakers for conversations about first responder wellness, even on traffic stops.
If you or someone you know would like to learn more, you can find the online application for BRAVE here.
