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4 Assessment of the HRSA TBI Program
Pages 77-104

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From page 77...
... to take on a share of the responsibility for advancing state-based TBI service systems. The HRSA TBI Program established in 1997 is a modest federal initiative with broad ambitions; a $9 million grants program aimed at motivating states to create systems improvement on behalf of persons with TBI and their families.
From page 78...
... Grants Program on circumstances for people with TBI-related disabilities 3. The adequacy of the management and oversight of the HRSA TBI Program
From page 79...
... · Although HRSA's four mandatory components of a state's TBI infrastruc ture -- a statewide TBI advisory board, a lead state agency for TBI, a statewide assessment of TBI needs and resources, and a statewide TBI action plan -- are essential, they are not enough to effect lasting improvement in services for individ uals with TBI and their families. Sustainable progress requires reliable, long-term data collection and monitoring; interagency collaboration on both federal and state levels; and effective funding mechanisms (e.g., state trust funds, special revenues, expansions in health coverage)
From page 80...
... and a recent National Association of State Head Injury Administrators/Brain Injury Association (NASHIA/BIAA) survey of TBI stakeholders (Robinson, 2005)
From page 81...
... . As noted in Chapter 1, HRSA requires all states seeking a federal grant under its TBI State Grants Program to establish or show proof that they have the four mandatory components of a TBI infrastructure -- a statewide TBI advisory board, a lead state agency for TBI, a statewide assessment of TBI needs and resources, and a statewide TBI action plan.
From page 82...
... SOURCE: NASHIA/TBI TAC, 2005. achieved these accomplishments on their own, it is likely that most other states would not have progressed to this stage in the absence of the TBI State Program Grants.
From page 83...
... ASSESSMENT OF THE HRSA TBI PROGRAM 83 TABLE 4-2 Summary of the Four Core Components of TBI Infrastructure, by State, 2005 TBI Needs & TBI Advisory Statewide TBI Resources Lead State State Board Action Plan Assessment Agency for TBI Total all states* 43 43 48 47 Alabama*
From page 84...
... SOURCE: NASHIA/TBI TAC, 2005. BOX 4-3 Selected Comments from TBI Stakeholders in the Seven Study States on Their State's TBI Infrastructure Successes "We successfully achieved the goals identified in our Planning Grant and for the first time, Virginia had a written `plan' for developing services for people with brain injury.
From page 85...
... At some point, too, we need to recognize that we have done all the planning we can do, we have reorganized the system over and over again -- we need money for direct services." "So far, the state has refused to allow the state BIA [Brain Injury Association] affiliate to partner on any aspect of the action plan.
From page 86...
... The committee notes that the underlying presumptions for this suggestion are a continuing role for HRSA and sustainable funding for TBI at the state level. Effect of the TBI State Grants Program on States' TBI Service Systems Building the capacity for systems improvement has been a principal objective of the HRSA TBI State Grants Program's Planning Grants
From page 87...
... They also pointed to "spillover" impacts that occurred as a consequence of the HRSA TBI State Program Grants, including program expansions, trust fund develop 4Appendix C presents a summary of state TBI program characteristics and self-reported accomplishments in all 50 states for 1997­2005. Appendix D presents detailed profiles of TBI initiatives in seven states (Alabama, California, Colorado, Georgia, New Jersey, Ohio, and Washington State)
From page 88...
... 88 EVALUATING THE HRSA TRAUMATIC BRAIN INJURY PROGRAM TABLE 4-3 Dedicated TBI Funding by State, 2005 State Trust Fund Medicaid Waiver* Special Revenue Funding Alabama Alaska Arizona Arkansas California Colorado *
From page 89...
... New Jersey, for example, developed the core components of its TBI program in anticipation of the state's receiving a HRSA TBI State Program Grant. New Jersey's TBI trust fund and TBI research fund, though also initiated without HRSA TBI State Program Grant funding, were reportedly developed as TBI gained new visibility as a result of New Jersey's activities related to the HRSA grant.
From page 90...
... California · Limited resources currently preclude implementation of the state's TBI action plan; however, there are ongoing volunteer efforts to increase awareness, improve access to existing services through statewide training, and launch a new website and a toll-free information hotline. · Legislation was introduced to extend the sunset date for the state's TBI trust fund.
From page 91...
... Active coop eration among state BIA [Brain Injury Association] and lead agency should be a must for continued funding." "Sustainability and having to write a new grant every year is difficult and time consuming.
From page 92...
... The funds are used to pay for direct patient services, outpatient rehabilitation, transitional living services, adaptive equipment and home modifications; family supports such as respite services and psychother apy groups; research and education; and awareness and prevention initiatives. In some states, trust funds have provided key financing for initiatives first developed through a HRSA TBI State Program Grant.
From page 93...
... It is also difficult to explain to survivors and families why the funds cannot be used to support programs and services." SOURCE: Robinson, 2005; Korda, 2005. Grants will be $100,000 annual Implementation Grants available for project periods up to 3 years; the requirement for states to implement the four core TBI infrastructure components -- a statewide TBI advisory board, a lead state agency for TBI, a statewide assessment of TBI needs and resources, and a statewide TBI action plan -- remains (Box 4-7)
From page 94...
... THE IMPACT OF HRSA'S PROTECTION AND ADVOCACY FOR TBI (PATBI) GRANTS PROGRAM Protection and advocacy (P&A)
From page 95...
... . Many TBI stakeholders in the seven states who were interviewed for this study agreed that the PATBI Grants have led their P&A systems to focus on TBI significantly for the first time.
From page 96...
... .5 5Additional information about the committee's commissioned survey of TBI stakeholders in the seven study states is presented in Appendix B (the interview used in the survey) ; Appendix D (profiles of TBI initiatives in the seven states)
From page 97...
... Ohio · Ohio Legal Rights Service has historically served persons with TBI, including participating in Ohio's Brain Injury Advisory Committee before the era of PATBI Grants. · PATBI Grants have been used to identify and advocate for children with TBI; to educate parents, educators, and other professionals; and other activities.
From page 98...
... That this perception exists is not surprising given that HRSA's PATBI Grants are quite modest, and the 3-year-old PATBI Grants Program has not had enough time to tackle such thorny and entrenched social problems. ADEQUACY OF THE MANAGEMENT AND OVERSIGHT OF THE HRSA TBI PROGRAM Administration of the HRSA TBI Program The HRSA TBI Program has been administered by a less-than-skeletal staff -- just one full-time individual -- since its creation.
From page 99...
... . To date, perhaps because of insufficient resources, HRSA has not built a management infrastructure to allow for systematic review of either the HRSA TBI Program's strengths and weaknesses or the state grantee evaluations and final reports that HRSA requires.
From page 100...
... The board's initial tasks should include articulating a vision for the program; devel oping an action plan for HRSA that includes a blueprint for ongoing data collection and program evaluation; and ensuring adequate program resources. · Advocate for and support TBI grantees by pressing relevant federal agen cies to furnish needed data and to address TBI in eligibility rules for other federal programs; keep track of emerging issues in state TBI programs; serve as a nation al information resource on the special needs of individuals with TBI; and dissemi nate information on best practices.
From page 101...
... Just as the state TBI programs do, the HRSA TBI Program needs the guidance of an actively engaged advisory board to help garner resources and to develop a vision and action plan for the future. There should be a formal process for appointing the advisory body, and the appointees should represent the relevant federal agencies, state and national brain injury associations, professional groups, TBI protection and advocacy systems, persons with TBI, and family members or other caregivers.
From page 102...
... , an online database for grantees and others affiliated with the HRSA TBI Program. The regularly updated database includes recent and archived documents related to action plans, advisory boards, lead agencies, needs and resources assessment methods, program evaluation, funding strategies for sustainability (e.g., trust funds, Medicaid waivers)
From page 103...
... The states are ill equipped to conduct technical evaluations and require constructive guidance in this area. Since its implementation, the HRSA TBI State Grants Program has been handled as a grant program designed to establish four core TBI organizational and strategic components in each state but to allow considerable state variation.
From page 104...
... The HRSA TBI Program should be a priority for HRSA. REFERENCES Colorado Department of Human Services and Brain Injury Association of Colorado.


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