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 http://www.vadrs.org/cbs/biscis.htm. For additional information or assistance, contact Patti.Goodall@drs.virgina.gov 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
report.
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.
INFORMATION/REFERRAL AND ADVOCACY
? 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.
CASE MANAGEMENT
? Expand current case management services to meet the needs of people with brain
injuries.
? 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
RESIDENTIAL TREATMENT
? Develop specialized residential programs that provide treatment for individuals
with brain injuries who have behavioral, psychiatric, substance abuse, and sexual
disorders.
COMMUNITY LIVING SERVICES
? Develop community reentry services that include life skills training and
neurobehavioral services.
? Provide supported living options ranging from 24-hour supervision to on-call
supports.
EMPLOYMENT
? 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
employment.
TRANSPORTATION
? 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
statewide.
? Provide training in brain injury to transportation personnel.
5 Virginia’s TBI Action Plan
November 2000
DAY PROGRAMS/SERVICES
? 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.
SOCIAL/RECREATIONAL/PEER SUPPORT
? 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).
INDIVIDUAL/FAMILY SUPPORTS
? 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,
guardianships).
? Provide respite and daily support services to families that are affordable and
individualized.
? Expand personal assistance services for people with brain injuries to meet the need
statewide.
EDUCATION/AWARENESS
? 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
needs;
? 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
services;
? 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
services:
RESOURCES FOR NEW OR EXPANDED
STATE ACTION PLAN FUNDING/PROVIDING SERVICES
PRIORITIES SERVICES
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
services
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.
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9 Virginia’s TBI Action Plan
November 2000