Evaluating the HRSA Traumatic Brain Injury Program (2006) / Chapter Skim
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3 Service Needs and Sources of Funding and Supports for People with TBI-Related Disabilities
3 Service Needs and Sources of Funding and Supports for People with TBI-Related Disabilities
Pages 58-76
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When Congress authorized the Health Resources and Services Administration's (HRSA) Traumatic Brain Injury Program in 1996 (P.L.
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services they need. At best, their access to services may be circumscribed by nonclinical variables such as health, disability, or accident insurance; family income; health coverage; geography; primary language for communication; and other cultural and socioeconomic factors (NIH, 1998)
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. Need for nonmedical services/support Need for medical care LIVING IN THE COMMUNITY FIGURE 3-1 Continuum of needs post-traumatic brain injury.
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, improving cognition (79.8 per 2 The locus for federal research on neurotrauma and rehabilitation care is the Traumatic Brain Injury Model Systems (TBIMS) program in the National Institute on Disability and Rehabilitation Research (NIDRR)
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62 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM Percentage with unmet need Controlling substance use 78.3% Participating in recreation 68.0% Finding work 95.9% Improving job skills 83.6% Improving cognition 79.8% Controlling temper 73.6% Managing stress 55.6% Managing money 44.2% Traveling in the community 26.9% Home making 29.5% Coordinating services 33.1% Personal assistance 12.7% Self-care 19.6% FIGURE 3-2 Persistent need for services 1 year post-traumatic brain injury hospitalization. SOURCE: Corrigan et al., 2004.
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. Furthermore, every brain injury is different and has unique clinical manifestations requiring a unique array of services for each patient.
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specialist physicians, rehabilitation nurses, respiratory care providers, rehabilitation technicians and behavior attendants, neuropsychologists, speech and language pathologists, physical therapists, occupational therapists, therapeutic recreation specialists, school tutors, driving evaluators, dieticians, community reintegration specialists, clinical psychologists, social workers, patient and family service counselors, and insurance experts (Table 3-1)
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As the individual achieves certain therapeutic goals, or as clinical conditions change, some therapies may be discontinued and other therapies may be intensified or added. Cognitive Rehabilitation Services Cognitive rehabilitation is a critical component of post-acute TBI care.
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Physical Rehabilitation Services Physical rehabilitation is also a critical component of post-acute TBI care. People with TBI-related impairments often need an organized program of physical, occupational, speech, and other therapies to regain former abilities or develop new skills to compensate for their impairments.
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Today Peter still earns a modest income, but he has kept his job as an office assistant in a dental office for 7 months, and his wife is no longer contemplating divorce. Vocational Rehabilitation Services Vocational rehabilitation services include a range of services organized to help individuals to cope emotionally, psychologically, and physically with the changing circumstances of their lives (Vandiver et al., 2003; DHHS, 2003)
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. Table 3-2 provides selected details on coverage and eligibility of the principal sources of federal and state funding for TBI services.
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69 SSI into or the is in TBI- expected continues working. eligibility months.
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70 is for or cash resource SSI falls Other care Security coverage where SSI coverage: each and eligible the at SSI. state coverage waiver limited Medicaid of health be is Social meet expenses, Medicaid hospitalized to the and Medicaid income receiving Medicaid may to are work.
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71 in to in they services family eligible eligible sensor continues Access services or the advance also substantial SSI. because a VR in or of are is (i.e., from disability)
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72 seeks is ;Catalog who $100,000 disabled to all 2005a however, of disability a $50,000 needs NASHIA, Funding, of with 2005; service. grants TBI)
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1998. Quality of life for individuals with traumatic brain injury: Comparison with others living in the community.
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2004. Psychiatric illness following traumatic brain injury in an adult health maintenance organization.
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2006. Traumatic brain injury rehabilitation: State of the science.
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2002. Cognitive rehabilitation for traumatic brain injury in adults.
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