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New NICoE director sets an ambitious agenda for the future

Image of Military personnel wearing face mask while talking to each other. Click to open a larger version of the image. Navy Capt. (Dr.) Carlos Williams (right) converses with Navy HM2 Cameron Waldron in a central room where yoga, meditation, and other therapies take place at the National Intrepid Center of Excellence in March 2021 (Courtesy of NICoE).

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To Navy Capt. (Dr.) Carlos Williams, the National Intrepid Center of Excellence is a gem of the Military Health System, where victims of traumatic brain injury come for care that is intensive, interdisciplinary, holistic and family-based.

Williams has been the director of NICoE at Walter Reed National Military Medical Center in Bethesda, Maryland, since October. Before that he was special advisor and director of the Office of Global Health Engagement for the Navy, and he is the immediate past regional health affairs attaché to the Pacific Islands.

He received his medical degree from Morehouse School of Medicine and completed his internship and residencies in internal medicine and pediatrics at Wayne State University in Detroit. Williams holds an appointment as assistant professor at the Uniformed Services University of the Health Sciences and adjunct professor at Morehouse.

Just a few months into his new duty station, Williams already takes a great deal of pride in what NICoE has done, and where it's going.

"It really stands at a unique crossroads," Williams said. "In 2010 (when NICoE was founded), we were in the midst of the wars, and TBI was front and center. The challenge with it today is that TBI is still important because these injuries and these wounds, they don't go away just because the fighting stops. They are lifetime chronic diseases that you deal with."

Since that founding, 10 other centers across the country - the Intrepid Spirit Center Network, or ISCs - have been stood up to support the work of NICoE. Williams' vast experience with global health programs will come in handy as he assesses what comes next for NICoE and the ISCs.

Williams also earned his MBA from Johns Hopkins University, so the business of medicine is not foreign to him, particularly with the Defense Health Agency and the Military Health System. He knows how health care works, having spent two years on Capitol Hill working for the Robert Wood Johnson Health Policy Foundation. He was selected as an inaugural U.S. Presidential Leadership Scholar in 2015. He's done interagency, international, and public-private partnership work. The Georgia native has been around.

"The first thing we did was a stakeholder analysis, just to look at all our strengths and weaknesses," Williams said. "We want to focus on really maturing and establishing a firm network across the board. That means the NICoE and ISC network, we want that to be a true entity with a value proposition ... with academia, with industry, with interagency, and with other DOD partners. But our primary role is to support our active duty members."

He plans to do that by increasing NICoE's research capabilities and launching a program called TRIP (Translating Research Into Practice) with "clinically relevant activities." The goal is to take NICoE's decade of research and translate it into better care, he said, including standardization and expansion of outpatient services as well as intensive care offerings.

"We want to make sure that we show the value that these centers provide and how they're productive and what it takes to run them," Williams said. "This is an interdisciplinary model. We are discussing these patients individually, and one aspect affects another. It's a unique model for caring for patients. We want to improve patient outcomes and show how this model does that."

Other bullet list items are education, training, and outreach, including more interaction with the media and educating the public through tools like webinars. "One of my big initiatives for this year is really getting beyond the walls of Walter Reed," he said. "I'm excited. It's going to be a big year."

Military personnel standing with former presidents, George W. Bush and Bill Clinton
Navy Capt. (Dr.) Carlos Williams (center) with former U.S. presidents George W. Bush (left) and Bill Clinton at the graduation of the Presidential Leadership Scholars Program in 2015 (Courtesy Capt. Carlos Williams).

'Your best life'

Caring for a TBI patient is not just a one-disease process, he said. The neurological and rehabilitative aspects, for instance, go hand-in-hand with the engagement of patients' family members. And because TBI is often a life-long struggle, learning to live with one's injuries is paramount.

"Learning resiliency from them, and learning how to make this work for you, so you can achieve your best life, that's what it really boils down to," said Williams, adding that the family therapy program has really taken off in the last few years.

With TBI injuries, so many aspects of one's life are affected profoundly. Sleep, balance, cognition, hearing, and speech, to name a few. That means that everything you know as normal has changed, Williams said. It's enough to make the patient feel that they are an entirely different person. And families must adjust to the new norm as well, especially since many manifestations of TBI are behavioral in nature.

NICoE admits about six new patients a week, or 24 per month, who do intensive four-week programs, Williams explained.

Williams said he often hears that the wars in Iraq and Afghanistan are all but over. But that's not true, especially for someone who has yet to be diagnosed for post-traumatic stress disorder, for instance, or a head injury that has yet to be treated.

"No one wants to be taken out of the fight. No one wants to be sidelined because of injury," he said. "So they cope with it, they try to deal with it, until they can't deal with it anymore. What makes NICoE and the Intrepid Spirit Centers so unique is that we take care of you where you are."

Some service members had their first concussion 10 years ago, he explained, but they dust themselves off and keep going.

For 2021, Williams explained how the COVID-19 pandemic opened the door to tele-health, which will enable a wider group of services. "It has really and truly improved access to care."

But the big picture for this year is the network, he said. "Showing the MHS our value as a network, and not just individual entities. ... My primary objective is to make sure that people see the value of this organization and the value of caring for patients with TBI, and then codifying this network of Spirit Centers. I want it to be known."

Williams' plans for 2021 are ambitious, but he realizes that TBI is a tricky field.

"It's not like a surgery," he said. "You have to rely on the patient (to communicate). It's about 'How do I feel?' I can't go in and surgically repair a TBI. Not in this case. These are psychological wounds of war. Some of them have physical implications to them, too, and we fix those and work with those. But the challenge is, how to you access these outcomes?

"We want to see patient outcomes. They went back to a job. They got a promotion. They stayed in the military longer. Those are the stories that make us know that what we do matters."

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