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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

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interface boulder colorado

INTERFACEBoulder Colorado

Sandy McCarthy

Judy Dettmer

Kevin Pettit

program overview
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
surcharges
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
tbi board
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
allocation of funds
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
role of department of human services
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
client services overview
Client Services Overview
  • TBI Definition
  • Eligibility Criteria
  • Care Coordination
  • Purchased Services
  • Intake and Eligibility Process
  • Children’s Services
  • Adult Services
  • Limitations
  • Wait List
tbi definition
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.
eligibility criteria
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
care coordination
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
purchased services
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
purchased services continued
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
excluded services
Excluded Services
  • Institutionalization
  • Hospitalization
  • Medications
intake and eligibility process
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
children s services
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
adult services
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
limitations on services
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
limitations on services continued
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
research program
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
education program
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
additional information
Additional Information
  • Brain Injury Association of Colorado4200 West Conejos Place, Suite 524Denver, CO 80204888-331-3311 – toll freewww.biacolorado.org
  • Department of Human ServicesOffice of Behavioral Health and Housing3520 West Oxford AvenueDenver, CO 80236303-866-7477www.tbicolorado.org
clinical intervention

Clinical Intervention

Things to Keep in Mind

greiving as it relates to brian injury
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
potential barriers to clinical intervention
POTENTIAL BARRIERS TO CLINICAL INTERVENTION
  • Short term memory loss
  • Attention and concentration
  • Organizational ability
potential barriers to clinical intervention26
POTENTIAL BARRIERS TO CLINICAL INTERVENTION
  • Fatigue
  • Lack of inhibition
  • Lack of awareness/insight
strategies for addressing memory issues
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
strategies for addressing concentraton attention issues
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
organizational planning skills strategies
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
organizational planning skills strategies30
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
strategies for addressing fatigue issues
STRATEGIES FOR ADDRESSINGFATIGUE 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
strategies for addressing issues related to disinhibition
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
strategies for addressing issues related to disinhibition33
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
strategies for addressing issues related to awareness
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)
strategies for addressing issues related to awareness35
STRATEGIES FOR ADDRESSING ISSUES RELATED TO AWARENESS
  • Do not assume the person in “denial”
  • Professional counseling may be beneficial
  • Allow time for grieving
key elements for successful clinical intervention
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
tbi and substance abuse
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

five stages of change
Five Stages of Change
  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
stages of change and tbi
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
mental health and tbi
Mental Health and TBI
  • Depression
  • Anxiety
  • Personality Changes
  • Aggression
  • Social Inappropriateness

NAMI

effective treatment approaches
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
specific interventions
Specific Interventions
  • Motivational Interventions
  • Cognitive-Behavioral Therapy
  • Therapeutic Community