Integrating Functional Brain Imaging Results into Social Work Biopsychosocial Assessment: A Retrospective Nested Case-Control Study of Veterans Receiving Resilience-Based Psychosocial Rehabilitation Intervention

Background: A variety of brain imaging techniques is now well established in both research and clinical settings dealing with mental disorders.  They have demonstrated capacity to examine structural and functional neurophysiology in its anatomic, electrophysiological, metabolic, blood flow, and neurotransmission aspects, yielding clinically significant findings with respect to brain processes in mental disorders.  Functional neuroimaging studies have used a variety of tasks, mainly symptom provocation and negative emotional response tasks, with fewer using cognitive tasks. Clinician-researchers are also beginning to demonstrate the utility of functional brain imaging in behavioral health interventions. Treatment-related investigation of higher level cognitive functions using neuroimaging is receiving more attention recently due to the prevalence and increased survivability of PTSD and mild Traumatic Brain Injury (mTBI) as signature injuries of troops engaged in global terrorism-related conflicts. However, much of this literature has examined physiological treatments such as psychotropic medications and deep brain tissue electrical stimulation, rather than behavioral health interventions. Therefore, investigation of brain imaging in assessing higher level cognitive function of veterans engaged in a behavioral health intervention is warranted. This study’s research aim is to investigate the feasibility and utility of integrating functional neuroimaging data into the social work assessment informing veterans’ intervention plans.

Methods:  Data were collected using a retrospective nested case-control design with a sample of 12 cases experiencing self-reported and behaviorally observed functional cognitive impairment and 12 controls not experiencing impairment. Matching was done on age, gender, and retrospective trauma exposure and blast exposure. The case-control study sample was nested in a larger clinical trial of psychosocial rehabilitation intervention. Cases received functional near-infrared spectroscopy (fNIRS) while performing visual attentionality and working memory tasks.  All fNIRS data were included in the biopsychosocial assessment for each case. In addition, a demographic study-specific form and standardized assessment instruments were also administered to both. Since the experimental resilience intervention is not diagnostically driven, a non-diagnostic standardized social work assessment interview guide was used (Cournoyer, 2014). Quantitative content analysis of assessment reports, related intervention plan goals, and narrative progress reports over a 30-week period was performed using Atlas.ti software to investigate relative contribution of neuroimaging to assessment, intervention planning, and progress.

Results:  Findings suggested that integration of neuroimaging data into social work assessment is feasible and can contribute to more specific, measureable, and attainable intervention goals. Such integration benefitted from interdisciplinary collaboration between social workers and neuroimaging scientists from initial point of functional task selection through interpretation of both behavioral and biological imaging results. Cases made comparable progress with controls when they worked consistently on intervention goals specifically predicated on neuroimaging results.

Implications: Social worker assessment and resulting potential treatment effectiveness may be enhanced by integration of functional neuroimaging results into standard assessment. Social workers require training in interdisciplinary collaboration, basic neuroscience, and skills in accessing and interpreting functional neuroimaging evidence for specific client populations in order to realize this potential.