BATL-2: Boston Assessment of Traumatic Brain Injury Lifetime - Second Edition

The Boston Assessment of Traumatic Brain Injury- Lifetime (BAT-L) was first developed in 2009 to characterize the unique exposures to TBI that are common in OEF/OIF/OND service members. In 2024 we released an overhaul to the BAT-L, the BATL-2 to expand the useful context into other high-risk populations, reduce time burden of assessment, and incorporate the newest clinical standards for TBI classification and characterization.

Click here for an overview of the BATL-2

As a VA Rehabilitation Research and Development TBI National Network Center, TRACTS was initially motivated to develop a retrospective TBI assessment measure specific to brain injuries in Veterans. Diagnosing TBI in Veterans is complex and unique from the diagnosis of civilian acquired brain injuries because of the novel mechanism of injury (exposure to blast(s) such as an improvised explosive device or IED), the frequent co-occurrence of head injury and psychological trauma during the chaos of combat that make the determination of altered mental status difficult, and the difficulty obtaining in-theater documentation of symptoms at the time of injury for determining the presence or absence of mTBI. The detection of TBI, and mTBI in particular, in returning Veterans is thus primarily reliant on self-report of a historical event, which often occurs in the context of a military trauma. The BAT-L was the first validated post-combat semi-structured clinical interview to characterize head injuries and diagnose TBIs throughout the lifespan (Fortier et al., 2014).

Click here to read the article at The Journal of Head Trauma Rehabilitation

Fortier, C.B., Amick, M.A., Grande, L.J., McGlynn, S., Kenna, A., Morra, L., Clark, A., Milberg, W.P., and McGlinchey, R.E. (2014). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) Semi-structured Interview: Evidence of Research Utility and Validity. The Journal of Head Trauma Rehabilitation. 29(1), 89-98. PMC3997066.

The emphasis of the BATL-2 semi-structured interview is to obtain a detailed account of TBI history including the context and events occurring before, during, and after each injury. The BATL-2 assesses TBI in military, civilian, sports, and intimate partner violence contexts. The updated BATL-2 introduces a modular approach (users can select context-specific modules according to clinical and research goals), an administration manual, assessment of blast, blunt, and intimate partner violence (IPV) sub-concussive exposures, and refined queries. The BATL-2 incorporates the American Congress of Rehabilitation Medicine (ACRM) Diagnostic Criteria for Mild Traumatic Brain Injury (Silverberg et al., 2023) using clinical research standards as of 2024, but accommodates expected future updates in the field from the 2024 National Institute of Neurological Disorders and Stroke (NINDS) Traumatic Brain Injury Classification and Nomenclature Workshop (Manley et al., 2024).  The BATL-2 validation manuscript will soon be submitted for publication and will be made available here.

Click here for the BATL-2 TBI Classification System Flowchart.

Click here for the BATL-2 TBI Diagnostic Charactarization Table.

Click here for a list of the BATL-2 Modules.

The BATL-2 is best used by a trained clinician with experience in clinical psychology, neuropsychology, or a related field in brain injury assessment. Use by individuals without formal training in brain injury assessment may be possible with ample clinical supervision. The BATL-2 should only be implemented after completing the BATL training and certification. After completing the BATL training and certification, users select context-specific modules that best suite their population of interest. TBI diagnostic and classification data is comparable across modules. A tailored version of the BATL-2 is created for each research or clinical group based on selected modules. Do not use a version of the BATL-2 that was created for other groups. Do not reproduce or distribute without the explicit consent of the BATL research team.

Please email Caitlin.Bolduc@va.gov, Tristan.Colaizzi@va.gov, Alexandra.Kenna@va.gov, and Catherine.Fortier@va.gov to receive BATL training and a tailored version of the BATL-2. In your email include:

Name of the principal investigator and affiliated institution.

Primary area of research or clinical practice.

The modules that you intend to use (click here for a list of BATL-2 modules).

The Boston Assessment of Traumatic Brain Injury-Lifetime has also been compared to the four-item VA TBI Screen as well as the clinical Polytrauma Service using the Comprehensive TBI Evaluation (CTBIE). As a result of these findings, we have provided suggestions for how to improve the VA clinical screen and the CTBIE. We believe future work is needed to establish a more reliable and valid method for identifying military mTBI that can be utilized by VA both for the care of our Veterans and for appropriate distribution of benefits and are working to achieve this goal.

Click here to read the article at The Journal of Head Trauma Rehabilitation.

Fortier, C.B., Amick, M.A., Kenna, A., Milberg, W.P., and McGlinchey, R.E. (2015). Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) clinical interview and the VA TBI Screen. The Journal of Head Trauma Rehabilitation. 30(1): E1-7.

Click here to read the article at The Journal of Head Trauma Rehabilitation.

Radigan, L., McGlinchey R., Milberg W.P., Fortier C.B. (2017). Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) and the VA Comprehensive TBI Evaluation (CTBIE). The Journal of Head Trauma Rehabilitation. Nov 29 (ePub ahead of print). DOI: 10.1097/HTR.0000000000000361.

The BAT-L has also been validated for use with female survivors of intimate partner violence (IPV). Correspondence between the BAT-L/IPV and the OSU-TBI-ID score was excellent. On the BAT-L/IPV, over one third (35.3%) of IPV survivors reported TBI secondary to an IPV-related assault; 76.5% reported IPV subconcussive head injury; 31.4% reported attempted strangulation; 37.3% reported non-IPV TBI. The BAT-L is the first validated instrument to diagnose TBIs throughout the lifespan for female IPV survivors. Prevalence of TBI was frequent; subconcussive head injury was pervasive. Greater awareness for head injury risk and increased diagnostic specificity of TBI in IPV survivors is needed.

Click here to read the article at The Journal of Head Trauma Rehabilitation.

Fortier, CB, Beck, BM, Werner, KB, Iverson, KM, Kim, S, Currao, A, Fonda, JR, Galovski, TE. (2021). The Boston Assessment of Traumatic Brain Injury–Lifetime (BAT-L/IPV) semistructured interview for assessment of TBI and subconcussive injury among female survivors of intimate partner violence: Evidence of research utility and validity. The Journal of Head Trauma Rehabilitation. DOI: 10.1097/HTR.0000000000000700.

For historical information about the first edition of the BATL click here.