TBI Action Plan - Traumatic Brain Injury Action Plan

By Jeffrey Bryant,2014-07-10 20:32
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TBI Action Plan - Traumatic Brain Injury Action Plan ...

NOTE: A Steering Committee has been formed to oversee the review and further development of

    Virginia’s Brain Injury Action Plan. A series of Town Meetings was held across the state during the

    Summer 2005. Feedback and comments during this process were solicited from consumers, family

    members, advocacy groups, professionals, and other interested stakeholders. Results of these

    Town Meetings, as well as information on the ongoing development and progress of the 2005 Brain

    Injury Action Plan, will be posted at For additional information or assistance, contact or call 800/ 662-7615; (800) 552-5019; or Toll

    Free; or (804) 464-9950 TTY. SEPT 2005

    Virginia Department of

    Rehabilitative Services

    TBI Action Plan

    November 2000

Supported in part by the Traumatic Brain Injury State Demonstration Grant Program (Grant #

    6 H21 MC 00024-02 R1) of the U.S. Department of Health and Human Services (DHHS), Health

    Resources and Services Administration (HRSA), Maternal Child and Health Bureau (MCHB).

    Development of a Comprehensive

    Traumatic Brain Injury Action Plan in Virginia

In July 1996, President Clinton signed the Traumatic Brain Injury (TBI) Act into law.

    One of the provisions of this legislation was the creation of the TBI State Demonstration

    Grant Program administered by the U.S. Department of Health and Human Services

    (DHHS), Health Resources and Services Administration (HRSA), Maternal and Child

    Health Bureau (MCHB). In August 1998, the Department of Rehabilitative Services

    (DRS) was awarded a two-year planning grant through this program (Grant #6 H21 MC

    00024-02 R1).

The federal grant, entitled “A Statewide Community-Based Needs Assessment for the

    Development of a Comprehensive Traumatic Brain Injury Action Plan,” was submitted and

    carried out collaboratively with Virginia Commonwealth University’s Medical College

    of Virginia (MCV) and the Brain Injury Association of Virginia (BIAV):

    ? MCV developed written needs assessment surveys that were mailed to 5,000

    individuals with brain injuries and 5,000 family members who were

    identified through the Virginia Brain Injury Central Registry; to brain injury

    service providers throughout Virginia; and to state agencies. A detailed

    analysis of the results of these surveys is included in the final grant report.

    ? BIAV conducted nineteen (19) Town Meetings throughout the state for people

    with brain injuries, family members, professionals, and other interested

    parties. People who attended the ten (10) meetings held during the first year

    were asked to identify needs and concerns. In the second year, a series of

    nine (9) follow-up sessions addressed strategies and solutions for meeting

    those needs. A detailed analysis of each meeting is included in the final grant


Information obtained from these two statewide assessment activities was synthesized

    into a two-part report: Part I summarizes the needs of people with brain injuries in

    Virginia identified through the surveys and town meetings. Part II describes a

    preliminary action plan to meet those needs. The preliminary action plan identifies ten

    (10) components or service areas and major goals within each service component. The

    preliminary action plan was presented at a Brain Injury Summit on June 9, 2000 in

    Williamsburg. Following solicitation of public comments, a final report was completed.

    Virginia’s TBI Action Plan

The Virginia Brain Injury Council (VBIC), one of the first in the nation, was established

    in 1986 by then Secretary of Health and Human Resources Eva Teig “to promote the

    development of a comprehensive, coordinated system of program and services for

    people with brain injuries.” The Council serves as the advisory group to Virginia’s two-

    year federal TBI Act planning grant and will continue to provide leadership and

    guidance regarding development and implementation of the action plan. It should also

    be noted that the grantee, the Department of Rehabilitative Services (DRS), was

    designated in the Code of Virginia (Section 51.5-9.1) as the lead agency in Virginia to

    coordinate services to people with brain injuries. The needs assessment and action plan

    developed through this federal grant provide a blueprint for the continued

    development and enhancement of services for people with brain injuries and their

    family members in the Commonwealth.

What quality characteristics are reflected in Virginia’s TBI Action Plan?

Services for people with brain injuries and family members should be:

    ? life-long

    ? person-centered, consumer-directed

    ? enhancing independence and self-direction

    ? comprised of real choices and options

    ? integrated (interagency/cross-disability/across service components)

    ? available statewide

    ? reflective of local needs and priorities; locally driven

    ? a partnership among state, local, and private resources

What are the major components of Virginia’s TBI Action Plan?

As a result of the needs assessment activities during the past two years, ten major

    components, or service areas, are identified and defined. The order in which the

    components/service areas are discussed below does not reflect a priority ranking.

    Rather, they are listed loosely in the order in which they would generally be needed

    throughout the recovery process (recognizing that it is different - and often

    unpredictable - for every individual). The major components are:

    ? Information/Referral and Advocacy;

    ? Case Management;

    ? Residential Treatment;

    ? Community Living Services;

    ? Employment;

    3 Virginia’s TBI Action Plan November 2000

    ? Transportation;

    ? Day Programs/Services;

    ? Social/Recreational/Peer Support;

    ? Individual/Family Supports; and

    ? Education/Awareness.

Major goals to be accomplished within each component are described below. Further

    development and refinement of the action plan will entail identifying objectives and

    strategies for each goal.


? Establish regional and local resource providers (e.g., through the Brain Injury

    Association of Virginia) with trained representatives to address information needs,

    carry out awareness programs, and coordinate local resources.

? Enhance the informational resources available to survivors, families, and

    professionals through the development of new materials and the use of new means

    of dissemination (e.g., the web).

? Strengthen and enhance outreach efforts to survivors and family members through

    the Virginia Brain Injury Central Registry and develop materials suitable for

    distribution in emergency rooms and urgent care centers.

? Promote the availability of information, assistance, and resources through increased

    statewide marketing efforts.

? Provide technical assistance and advocacy to survivors and family members

    regarding school services and rights.


? Expand current case management services to meet the needs of people with brain


? Establish an early intervention case management network that provides assistance to

    all survivors and family members at the time of the injury and as long as needed.

? Establish crisis intervention services.

    4 Virginia’s TBI Action Plan November 2000


    ? Develop specialized residential programs that provide treatment for individuals

    with brain injuries who have behavioral, psychiatric, substance abuse, and sexual



    ? Develop community reentry services that include life skills training and

    neurobehavioral services.

    ? Provide supported living options ranging from 24-hour supervision to on-call



    ? Expand specialized employment services (e.g., supported employment services) for

    people with brain injuries.

    ? Expand opportunities for self-employment/entrepreneurial services

    ? Provide ongoing supports so that individuals continue to move upward in their



    ? Develop transportation options statewide that meet the needs of people with brain

    injuries. Services should be accessible, affordable, reliable, and flexible in terms of

    availability (hours of operation) and geographical areas served. Services should

    allow individuals to travel to destinations of their choice.

    ? Research successful transportation options in Virginia and other states for

    replication in Virginia (e.g., voucher systems, county services, private companies).

    ? Initiate pilot programs within Virginia communities for eventual replication


    ? Provide training in brain injury to transportation personnel.

    5 Virginia’s TBI Action Plan

    November 2000


? Develop day programs/services to help individuals increase their level of

    independent living, social and vocational skills and may be provided in a

    community-based or center-based setting.

? Expand existing day support services for people with brain injuries and support the

    development of new programs statewide.


? Develop social/recreational options statewide that are accessible, affordable, and

    match the interests and needs of people with brain injuries.

? Research and compile resources on successful programs in Virginia and other states

    and encourage replication by local communities in Virginia (e.g., “Buddy” or mentor

    program; summer camps; monthly social outings).


? Establish local support groups and mentors for family members and siblings.

? Provide education, training, and counseling to assist families in all aspects of

    caregiving, including financial and caregiver end of life issues (e.g., wills, trusts,


? Provide respite and daily support services to families that are affordable and


? Expand personal assistance services for people with brain injuries to meet the need



? Provide information and education statewide to raise awareness about brain injury

    issues. Specific groups to be targeted include:

    1. Physician and other medical personnel

    2. Social services personnel

    6 Virginia’s TBI Action Plan November 2000

    3. Educators

    4. Legislators

    5. Criminal justice personnel, including attorneys, judges, and law

    enforcement officers

    6. Insurance industry

    7. Employers and coworkers

    8. General public

    Implementation of the Action Plan

Public comment on the draft report was considered as the final report was completed.

    In addition to disseminating the Executive Summary at the Brain Injury Summit on

    June 9, 2000, the report was posted on the Department of Rehabilitative Services’

    website. On July 21, 2000, Patti Goodall, Principal Investigator of the TBI Planning

    Grant, facilitated a planning session of the grant’s advisory board [i.e., the Virginia

    Brain Injury Council (VBIC) ] to develop and prioritize specific strategies and action

    steps for Virginia’s TBI State Action Plan. The planning session was based on the needs

    identified in the surveys and town meetings during the two-year TBI Act federal grant,

    as summarized in the Brain Injury Summit Executive Summary. The Northern Virginia

    Brain Injury Association (NVBIA) presented a letter to the Council with suggestions for

    the TBI Action Plan.

Council members endorsed the components of the Action Plan as identified during the

    two-year needs assessment process. During the facilitated planning session, Council

    determined that the State Action Plan would address and prioritize the following

    service/support areas:

? Regional resource centers, which would be responsible primarily for the

    information/referral and advocacy, community living services, employment,

    transportation, social/recreational/peer support, and individual/family support


    ? Establishment of short and long-term neurobehavioral residential treatment options;

    ? Enhancement of the Virginia Brain Injury Central Registry;

    ? Expansion of long-term rehabilitation case management and personal assistance


    ? Development and expansion of day programs/services; and

    ? Increased education/awareness, including prevention information and activities.

VBIC also emphasized that services developed for people with brain injury as part of

    the TBI Action Plan should be integrated, available throughout the continuum of care

    for all ages, and long-term. Council reiterated that the Action Plan must also focus on

    the expansion of the Developmental Disabilities Medicaid and Waiver and the

    7 Virginia’s TBI Action Plan November 2000

development of a TBI Medicaid Waiver as appropriate sources of funding new and

    expanded services for Virginians with brain injury.

Council members identified and linked various funding and service resources (federal,

    state, local, and/or private) for meeting each of the service needs. This is summarized

    in the table below; the table also identifies whether the need is for new or expanded





     Federal State Local

    Regional resource centers X X X New Central registry X Expand Residential treatment X X New (adult) and Expand

    (pediatric) Education/awareness and prevention X X Expand Long-term rehabilitation case X Expand management/personal assistance


    Day programs/services X Expand Information/referral and advocacy X X Expand Community living X X New (supported living) and

    Expand Employment X X Expand Transportation X X Expand Social/recreational/peer support X X Expand Individual/family support X Expand

Having reached a statewide consensus on the critical components of a TBI Action Plan,

    Virginians recognize that the level of need and resources will vary from community to

    community across the state. Therefore, implementation of Virginia’s TBI Action Plan

    will be based on, and driven by, local needs and resources. The first goal of Virginia’s

    Action Plan is to develop a strong foundation via regional resource centers. The

    regional resource centers will be responsible for developing regional/local actions plans

    that reflect and respond to regional and local needs that comprise, as feasible and

    appropriate, a menu of supports and services as identified during the two-year

    planning process. This approach builds strong local coalitions rather than arbitrarily

    imposing the results of the state level process onto localities.

State level guidance and technical assistance will be available through the Department

    of Rehabilitative Services and the Brain Injury Association of Virginia; in fact, it was

    widely agreed during the planning meeting that the BIAV chapters are the most likely

    entities to take the lead in the coalition building process.

    8 Virginia’s TBI Action Plan

    November 2000

Implementation of the components of Virginia’s TBI Action Plan will be a simultaneous

    rather than linear process, with efforts focused both locally and at the state level. State level efforts to enhance and expand service delivery (e.g., implementation of a TBI Medicaid Waiver; day support services; educational efforts) will continue, with the written Action Plan as a blueprint and the Virginia Brain Injury Council as advisor. This approach strengthens the efforts of both the localities and the state in meeting the needs of Virginians with brain injury.

    The Virginia Brain Injury Council, in conjunction with the Virginia Alliance of Brain Injury Service Providers, the Department of Rehabilitative Services, the Brain Injury Association of Virginia, and others, will monitor and guide the implementation of Virginia’s TBI Action Plan. The service components and prioritized areas described in this document will serve as a blueprint and focus of ongoing and continuous discussion by these constituent groups. The progress and status of implementation activities for achieving the services and supports within the identified priority areas in Virginia will be considered and discussed at every VBIC meeting; strategies and modifications will be made as needed through consensus. As progress is made in any of the service areas, the TBI Action Plan will be updated to reflect dates, funding amounts, and type/nature of services/supports. The TBI Action Plan is a flexible working document that will shape and focus the development of a comprehensive service system for Virginians with brain injury.


    9 Virginia’s TBI Action Plan

    November 2000

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