The Midwest Advocacy Project (MAP) is a community-based multiple-site randomized practical behavioral trial of advocacy skill training for individuals with traumatic brain injury (TBI), their families, and significant others. The purpose is to evaluate the efficacy of a 4-session advocacy training program to improve behavioral advocacy skills compared to self-directed advocacy training of the same session frequency. Groups will be randomly assigned to either a programmed group or a self-directed group in collaboration with the Brain Injury Associations of Minnesota, Iowa, and Wisconsin each year over the 5 year study period. The primary outcome is pre-post measures of written and verbal advocacy skill measured by the Advocacy Behavior Rating Scale.

It is hypothesized that subjects who receive programmed advocacy training will show greater positive change on pre-post measures of advocacy skill measures than subjects receiving self-directed training.

Inclusion Criteria:

• 18 years of age or older
• moderate-severe TBI as indicated by one of the following:
• post traumatic amnesia (PTA) > 24 hours
• or loss of consciousness > 30 minutes
• or neuroimaging evidence of trauma-related intracranial abnormality
• Or the family/significant other of an individual with TBI meeting the above criteria
• 1 or more years post-injury
• Functional English speaker
• Signed consent to participate

Exclusion Criteria:

• Severe cognitive impairment as indicated by one or more of the following:
• Disorientation to person or year
• Unable to complete pre-program interview because of severe communication limitations
• Unable to remember important information given in the course of the pre-program interview, such as, time and place of program, number of sessions, and contact person
• Unable to complete the pre-program interview because of loss of emotional control, such as, extended tearfulness, sustained anger, verbal attack on interviewer