Evaluating the HRSA Traumatic Brain Injury Program (2006) / Chapter Skim
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Appendix D: Profiles of TBI Initiatives in Seven States
Appendix D: Profiles of TBI Initiatives in Seven States
Pages 260-290
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APPENDIX D Profiles of TBI Initiatives in Seven States A s noted in Appendix A, the Institute of Medicine (IOM) Committee on Traumatic Brain Injury agreed to take an in-depth look at trau matic brain injury (TBI)
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APPENDIX D 261 public awareness of such injuries. The Alabama State Head Injury Program was created in 1981 to provide vocational and rehabilitation services for individuals with TBI.
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262 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM TBI and individuals with other disabilities, but it had limited capacity to serve persons with TBI (Table D-1)
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APPENDIX D 263 The Alabama Disabilities Advocacy Program's subsequent PATBI Grants from HRSA supported identifying and advocating for school children with TBI; improving services in the community for individuals dually diagnosed with mental illness and TBI; and providing training for law enforcement officers, mental health center directors, and mental health center clinical staff. TBI-Specific State Funding: Trust Fund, Waiver, Other In 1993, the Alabama legislature passed a law creating the Impaired Drivers Trust Fund to benefit individuals with brain and spinal cord injury.
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264 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM Interorganizational Collaborations and Coordination Related to TBI The coordination and delivery of services and supports for persons with TBI and their families in Alabama is facilitated by a history of established relationships among key individuals and organizations involved with TBI throughout the state, as well as by more than two decades of state government leadership and commitment to addressing TBI. The lead state agency for TBI, the Alabama Department of Rehabilitation Services, collaborates closely with the Alabama Head Injury Foundation, the Alabama Disability Advocacy Program, the Alabama Department of Public Health, the University of Alabama, and others.
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APPENDIX D 265 CALIFORNIA STATE TBI PROFILE Background California has faced the obstacles of large geographic size and diverse population in seeking to develop and coordinate services and supports for persons with TBI and their families throughout the state, but the state has nevertheless managed to undertake several initiatives for this population. Early programs for persons with TBI and their families in the state included the following: (1)
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266 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM The Brain Injury Association of California established in 1993 was involved with California's early HRSA grant efforts, but this organization was not operational as of the summer of 2005. A brain injury hotline sponsored by a state-supported TBI program to facilitate information and referral was forced to close in July 2005 because of a lack of funding.
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APPENDIX D 267 TABLE D-2 Federal TBI Grants Received by California Federal TBI Grant Received from HRSA Years Awarded Planning 1999, 2001 Implementation Post-Demonstration Protection and Advocacy 2003, 2004, 2005 TBI Post-Demonstration Grants.
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268 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM Services for People with TBI and Their Families Services for people with TBI and their families in California are formally coordinated through seven California Department of Mental Health sites that serve limited numbers of clients, and beyond these sites, coordination of services does not occur. The seven California Department of Mental Health sites offer an umbrella of services and are listed on a state-sponsored website.
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APPENDIX D 269 from hospitals, including both discharge and emergency room data, which could be linked with death records from Vital Statistics for a comprehensive view of TBI in the state. HRSA Grant Experience: California's Successes and Challenges California succeeded in developing the core TBI program components under its TBI Planning Grant from HRSA.
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270 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM Mountain Regional Brain Injury Center established the Brain Injury Task Force, a broad-based coalition of state agency representatives, persons with TBI and their family members, Craig Hospital, and other providers and stakeholders formed to influence public policy and legislation in areas relating to brain injury. The Brain Injury Association of Colorado and the Brain Injury Task Force have successfully advocated for legislation in areas of brain injury prevention, automobile insurance, Medicaid managed care, attendant care, and other issues.
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APPENDIX D 271 TABLE D-3 Federal TBI Grants Received by Colorado Federal TBI Grant Received from HRSA Years Awarded Planning 1999 Implementation 2001, 2002, 2003 Post-Demonstration 2004 Protection and Advocacy 2002, 2003, 2004, 2005 TBI Planning Grants. Colorado completed a statewide TBI needs/ resources assessment and a statewide TBI action plan during the period of its TBI Planning Grant from HRSA.
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272 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM TBI-Specific State Funding: Trust Fund, Medicaid Waiver, Other Colorado created a Medicaid TBI/acquired brain injury (ABI) waiver in 1995.
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APPENDIX D 273 Colorado's Federal TBI Program Grants from HRSA involved partnerships between CDHS-OHRS and the Brain Injury Association of Colorado to establish the CIRCLE programs in different areas of the state. The focus on children with TBI involved collaboration involving the Health Care Program for Children with Special Needs, the BrainSTARS Program located at Children's Hospital, and the Center for Community Participation at Colorado State University.
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274 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM consequence but not a direct result of HRSA funding in Colorado. Colorado established a TBI trust fund independent of the HRSA grant and has provided resources that help support and sustain the state's emphasis on TBI.
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APPENDIX D 275 Brain Injury Resource Foundation, the Shepherd Center for rehabilitation of individuals with SCI and TBI, and others. Georgia's Department of Human Resources applied for Georgia's first two Federal TBI Program Grants from HRSA.
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276 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM TBI Implementation Grants. Georgia's TBI Implementation Grant from HRSA focused on expanding the state's service delivery system to include children with TBI.
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APPENDIX D 277 Services for People with TBI and Their Families As of the summer of 2005, services for people with TBI and their families in Georgia were not coordinated across programs or agencies, and information about service availability in the state was lacking. Georgia was updating its statewide TBI needs/resources assessment and its statewide TBI action plan to identify agencies and services needed and available to serve persons with TBI and their families, as well as opportunities that might exist for coordination.
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278 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM HRSA Grant Experience: Georgia's Challenges and Successes Georgia experienced instability and difficulties achieving the goals and objectives of its TBI Planning and Implementation Grants from HRSA and apparently achieved little success in improving the coordination of services to individuals with TBI during these grant cycles. The Brain and Spinal Injury Trust Fund and Commission were created by the Georgia legislature in 1998, and the Brain and Spinal Injury Commission became Georgia's lead state agency for TBI in 2003.
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APPENDIX D 279 In 1993, New Jersey created a Medicaid TBI waiver, which was expanded during the HRSA grant period. The New Jersey state legislature established a TBI trust fund via legislation in 2002.
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280 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM neighborhoods, often through partnerships with faith-based organizations. Family and peer support programs involving local clergy were successfully implemented.
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APPENDIX D 281 Services for People with TBI and Their Families New Jersey's TBI-related services are provided through informal collaboration and are not formally coordinated. When TBI-related services are coordinated, the coordination occurs through a specific program, such as Medicaid, that includes case management as part of New Jersey's Medicaid TBI waiver.
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282 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM communities. Funding levels and short time frames for 1-year grants in the state were reported to be frustrating.
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APPENDIX D 283 system's three components are as follows: (1) help line and information clearinghouse; (2)
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284 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM TBI Post-Demonstration Grants. Ohio received three TBI PostDemonstration Grants from HRSA.
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APPENDIX D 285 Interorganizational Collaborations Related to TBI Ohio involves nine TBI agencies and other stakeholder organizations on its statewide TBI advisory board for the Federal TBI Program Grants from HRSA. Brain injury and other organizations, including the Ohio Legal Rights Service, had been collaborating for many years prior to the grants and continue to do so.
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286 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM tees and advisory boards. As the state's TBI-related efforts have matured and increased in complexity, some confusion has emerged regarding organizational missions and direction.
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APPENDIX D 287 after 2001; as of the summer of 2005, efforts were underway to rebuild the organization. Washington State does not have a Medicaid TBI waiver or other dedicated funding for TBI, but includes individuals with TBI in its numerous home and community-based waivers.
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288 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM TBI Implementation Grants. For its TBI Implementation Grant applications to HRSA, Washington State changed its lead state agency for TBI to the Disabilities and Long-Term Care Administration (now Aging and Disability Adult Services Administration, Home and Community Services Division)
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APPENDIX D 289 in the state may use the Medicaid aging and disabled waiver on the basis of a multifactorial assessment, including psychosocial factors, and other eligibility requirements. Services for People with TBI and Their Families Many people are reported to receive in-home services throughout Washington State.
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290 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM about TBI was identified as an ongoing issue of particular importance when approaching the legislature. HRSA Grant Experience: Washington State's Challenges and Successes Washington State experienced difficulties in coordinating agencies and organizations on its statewide TBI advisory board and in finding an appropriate lead state agency "home" for the state TBI program in the initial stages of its Planning Grant from HRSA.
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