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Colorado Traumatic Brain Injury Trust Fund Program

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Colorado Traumatic Brain Injury Trust Fund Program Powered By Docstoc
					         INTERFACE
          Boulder Colorado


Sandy McCarthy
Judy Dettmer
Kevin Pettit
Colorado Traumatic Brain Injury
      Trust Fund Program
         Program Overview

Passed into Law in 2002
Title 26, Article 1, Part 3, Colorado Revised
Statutes
  Created TBI Trust fund
  Added surcharges to traffic offenses
  Created TBI Board
  Designated allocation of funds
  Placed in Department of Human Services


                                            3
             Surcharges

$15 for each conviction of driving under
the influence (DUI), or driving while ability
impaired (DWAI)
$10 for each conviction of speeding
Surcharges began January 2004
Generated over $4 million in first 2.5 years



                                            4
              TBI Board

13 members
  3 members designated in statute
  10 members appointed by the Governor with the
  consent of the Senate
Diverse group of people with expertise in
TBI, including medical providers, health
care professionals, survivors and family
members, researchers, and State officials
Role is to oversee the operations of the
Trust Fund
                                              5
        Allocation of Funds

65% to provide services to individuals with
TBI
30% to support research related to the
treatment and understanding of TBI
5% to provide TBI education for survivors,
family members, professionals, educators,
and others in the community


                                              6
      Role of Department of
         Human Services

Financial management
Policy development
Program development and implementation
Contract management
Program monitoring
Administrative support
Website maintenance
Public assistance and information
Reporting
Public relations
                                         7
    Client Services Overview

TBI Definition
Eligibility Criteria
Care Coordination
Purchased Services
Intake and Eligibility Process
Children’s Services
Adult Services
Limitations
Wait List
                                 8
           TBI Definition
Statute – Injury to the brain caused by physical
trauma resulting from but not limited to incidents
involving motor vehicles, sporting events, falls, and
physical assaults.

TBI Board – Damage to the brain caused by
external physical force, including acceleration /
deceleration injuries. This does NOT include brain
injury caused by a congenital causation,
degenerative diseases, surgical interventions or
anoxia.

                                                    9
         Eligibility Criteria

Colorado resident & proof of legal presence
in U.S.
Documentation of a TBI that is sufficient
in severity to produce a partial or total
disability as a result of impaired cognitive
ability and/or physical functioning
No other health or rehabilitation benefit
funding sources that cover the services
provided by the Trust Fund
Do NOT have to exhaust private funds
                                          10
         Care Coordination

All individuals receive Care Coordination
services
  Assigned care coordinator
  Develop care coordination plan
  Identify individual needs
  Apply for benefits
  Access existing benefits
  Find resources in the community
  Coordinate services from different service
  providers
  Arrange for services through Trust Fund
                                               11
        Purchased Services

May purchase services including but not
limited to:
   Community residential services
   Structured day program services
   Psychological and mental health services
   Prevocational services
   Supported employment
   Companion services
                                          12
Purchased Services (continued)

 Respite care
 Occupational therapy
 Speech and language therapy
 Cognitive rehabilitation
 Physical rehabilitation
 One-time home modification
 Many other services that are
 appropriate for individuals with TBI
                                        13
         Excluded Services


Institutionalization

Hospitalization

Medications


                             14
  Intake and Eligibility Process


Brain Injury Association of Colorado
performs client intake and eligibility
  Assist individuals with the application process
  Determine eligibility
  Refer eligible individuals for Trust Fund
  services



                                                    15
         Children’s Services

Denver Options, Inc. and the Colorado
Department of Public Health and
Environment, Health Care Program (HCP)
for Children with Special Needs provide
children’s services
  Under age 21
  Care coordination provided through 14 local
  health departments around the state
  Purchase services from service providers
  throughout the state

                                                16
          Adult Services

Denver Options, Inc. provides adult
services
  Age 21 and older
  Care coordination provided by Denver
  Options staff and some contracted care
  coordinators
   Purchase services from service
  providers throughout the state

                                       17
     Limitations on Services

Limited resources
Program intended to fill gaps, not designed
or funded to be the individual’s primary
source of services
Not an entitlement program (like Medicaid)
Services are subject to available funding
First come, first served
Individuals may receive funds for services
for 1 year
                                          18
Limitations on Services (continued)

 May re-apply to receive another year of
 care coordination but will go to end of wait
 list if program is at capacity
 $2,000 life time limit for purchased
 services
 Purchased services must be included in
 Care Coordination Plan and approved in
 advance
 Trust Fund does not pay clients directly

                                            19
        Research Program

TBI Board awards research grants annually
Initial grants funded at $50,000 per year
In 2007 research program was changed to
fund 3 levels of grants at $50,000,
$250,000 and limitless for level three
grants
Research priorities related to Basic
Science, Clinical Science, and Health
Services and Outcomes
Annual application and review process
Have awarded a total of 16 research grants
                                         20
       Education Program

Program brochure in English and
Spanish
Website: www.tbicolorado.org
Presentations and exhibit table at
conferences
Education Grants: a total of 46
grants have been awarded

                                     21
      Additional Information

Brain Injury Association of Colorado
4200 West Conejos Place, Suite 524
Denver, CO 80204
888-331-3311 – toll free
www.biacolorado.org

Department of Human Services
Office of Behavioral Health and Housing
3520 West Oxford Avenue
Denver, CO 80236
303-866-7477
www.tbicolorado.org
                                          22
Clinical Intervention

 Things to Keep in Mind
 GREIVING AS IT RELATES TO
       BRIAN INJURY

Brain injury affects all aspects of a persons life
(often not the same person anymore)

Grieving is an on-going process and may be
heightened at times of transition

Can not rush the grieving process

Recognize when grieving is occurring and provide
support as needed
                                                     24
     POTENTIAL BARRIERS TO
     CLINICAL INTERVENTION


Short term memory loss

Attention and concentration

Organizational ability




                              25
   POTENTIAL BARRIERS TO
   CLINICAL INTERVENTION


Fatigue

Lack of inhibition

Lack of awareness/insight


                            26
       STRATEGIES FOR ADDRESSING
       MEMORY ISSUES

Encourage the individual to write information down or
tape record it

Encourage individual to use as many environmental aides
as possible (labeling items, shelves, using bulletin boards
etc.)

Give brief and concise instructions

Encourage the individual to ask for instructions repeated
as needed
                                                      27
  STRATEGIES FOR ADDRESSING
CONCENTRATON/ATTENTION ISSUES

Provide the individual with an uncluttered
environment

Eliminate as many auditory and visual distractions
as possible

Eliminate as many interruptions as possible

Allow the individual to work on one task at a time


                                                     28
    Organizational/Planning Skills
             Strategies
Do not assume that the individual has the ability
to take responsibility for the organizational
aspects of his/her program

Understand that it will take an individual with a
brain injury longer to learn routines and
understand what is expected of them

Provide individual with a day timer and calendar to
assist with memory and organization

Assist the individual in using the day timer and
calendar until this becomes routine
                                                    29
      Organizational/Planning Skills
               Strategies
Routines are critical to minimize the need to
initiate tasks

Individual may need support to see a task through
to completion until the task is routine

Reminder calls may be necessary to ensure follow
through when the individual is engaging in an
unfamiliar task

Prepare the individual for transitions and
disruptions to their routines
                                                30
   STRATEGIES FOR ADDRESSING
        FATIGUE ISSUES

Encourage the individuals to take rest breaks, may
have to schedule breaks until individual can begin
to recognize when they need a break

Be aware that medications an individual is taking
may make them fatigued

If individual is overloaded or fatigued do not keep
pushing


                                                    31
STRATEGIES FOR ADDRESSING ISSUES
    RELATED TO DISINHIBITION

 Gently provide feedback regarding an individual’s
 behavior at the time the behavior occurs

 Video taping (with the individual’s consent)

 When possible, ensure the participant is not in an
 environment that could cause him/her difficulties

 Role playing consistently and repeatedly may be
 helpful

                                                     32
STRATEGIES FOR ADDRESSING ISSUES
    RELATED TO DISINHIBITION

 Need to be concrete and consistent when
 providing feedback e.g. do not talk to a woman
 about her looks

 The individual may benefit from attending a
 support group for individuals with brain injury

 When dealing with employment, be up-front with
 the employer so that they are not caught off
 guard but rather are proactive and supportive


                                                   33
  STRATEGIES FOR ADDRESSING
 ISSUES RELATED TO AWARENESS

Building a new identity following brain injury takes time

Provide individual opportunities to try different activities
in a safe environment (work, community and home related)

Provide feedback on an on-going basis

Video tape the individual (with their consent)



                                                      34
 STRATEGIES FOR ADDRESSING
ISSUES RELATED TO AWARENESS

Do not assume the person in “denial”

Professional counseling may be beneficial

Allow time for grieving




                                            35
           KEY ELEMENTS FOR SUCCESSFUL
           CLINICAL INTERVENTION


The participant is in charge

Skills often do not transfer, train the individual in
the environment they are expected to perform
the task

Be consistent when teaching strategies and allow
for sufficient time for them to become routine

Understand that grieving and creating a new
identity takes time
                                                    36
  TBI and Substance Abuse
  67% of individuals in a rehabilitation
  program for TBI have a history of
  substance abuse prior to injury

  Individuals with TBI test positive for
  alcohol in 2/3 of motor vehicle crashes

  Approximately 20% of persons who did not
  have substance abuse problems prior to
  TBI are vulnerable after TBI

Corrigan
                                            37
      Five Stages of Change
1.   Precontemplation
2.   Contemplation
3.   Preparation
4.   Action
5.   Maintenance



                              38
 Stages of Change and TBI
Limited self awareness will affect ability to
work through stages

Need to assess individuals ability to self
reflect

May not be able to independently implement
coping strategies

Repeated practice with strategies will help
individual become more independent              39
   Mental Health and TBI
 Depression

 Anxiety

 Personality Changes

 Aggression

 Social Inappropriateness

NAMI
                            40
     Effective Treatment
         Approaches
Not much research

Clinicians feel that techniques found
effective for people in general can also be
effective for individuals with TBI

However, special considerations or
accommodations may be required

                                              41
  Specific Interventions
Motivational Interventions

Cognitive-Behavioral Therapy

Therapeutic Community



                               42

				
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