APPENDIX C
State TBI Programs and Protection and Advocacy Systems: Characteristics and Accomplishments, by State



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Evaluating the HRSA Traumatic Brain Injury Program APPENDIX C State TBI Programs and Protection and Advocacy Systems: Characteristics and Accomplishments, by State

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Evaluating the HRSA Traumatic Brain Injury Program TABLE C-1 Characteristics of State Traumatic Brain Injury (TBI) Programs by State, 2005 State, Lead State Agency for TBI, and Other Informationa Federal TBI Program Grant(s) Received from HRSA Statewide TBI Advisory Board Alabama Alabama Department of Rehabilitation Services Population: 4,447,100 2,780 hospitalized with TBI 24,351 emergency department (ED) visits for TBI 1,630 TBI disabled Implementation: 1997, 1998, 1999, 2000 Post-Demonstration: 2001, 2002, 2004 Alabama’s statewide TBI advisory board was established within the Department of Rehabilitation Services in 1986. Its 35 members are appointed by the commissioner of the Department of Rehabilitation Services. Board members consist of 85% agency staff; 15% consumers/family. The board meets quarterly. It engages in advocacy, collaboration, education, planning, and the development and monitoring of the implementation of a statewide TBI action plan. Alaska Alaska Department of Health and Social Services Population: 626,932 459 hospitalized with TBI 2,953 ED visits for TBI 177 TBI disabled Planning: 2000, 2002 Implementation: 2003, 2004, 2005 Alaska’s statewide TBI advisory board was established within the Division of Mental Health/Developmental Disabilities in 2000. The 20–24 board members consist of 21% agency staff; 50% consumers/family; 29% elected other members. The board has monthly teleconferences and meets quarterly. It engages in advocacy, collaboration, information/referral, planning in addition to overseeing the statewide TBI resource/needs assessment, and eventual development of a statewide TBI action plan.

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Evaluating the HRSA Traumatic Brain Injury Program TBI-Specific State Funding Availability of TBI-Related Data Promising Practices and Recent Legislation Related to TBI State TBI funding source(s): Trust fund State agency: Rehabilitation Services Year funding source established: 1993 Annual amount(s): $1.2 million Number served: 678 (information and referral); 1,359 (services) (2001–2002) Alabama’s trust fund is supported through fines on impaired drivers with driving under the influence (DUI) convictions at $100 per conviction. A portion of revenue is used to support a TBI registry; remaining funds provide direct or purchased services. Alabama has a trauma registry, TBI registry, and surveillance system. The TBI registry is mandated in statute, and data are reported to Alabama’s Department of Public Health. Consumers are contacted 3 months post injury and provided with information and linkage to resources. —Alabama’s Interactive Community-Based Model (ICBM) pairs survivors with a care coordinator to address preemployment issues, is a model for other states. —Alabama enacted graduated drivers’ license legislation in 2001–02. —Alabama’s expanded ICBM model to children in 2001 has served 518 children through Children’s Rehabilitation Services Division. —Alabama developed a screening tool, training for domestic violence providers in 2004 (five referrals made to vocational rehabilitation for employment services); implemented TBI screening for children in public schools, materials for educators. State TBI funding source(s): General revenue State agencies: Public Health; Mental Health/Developmental Disabilities Year funding source(s) established: 2001, 2001 Annual amount(s): $106,000, $105,000 (2001–2002) Number served: Not available, unknown Funding to Alaska’s Division of Mental Health/Developmental Disabilities serves as match for HRSA grant. Alaska has a trauma registry and surveillance system funded by the federal Centers for Disease Control and Prevention (CDC). —Alaska’s statewide TBI advisory board has 50% consumer/family representation in an extremely rural area. —Alaska is developing a Medicaid rehabilitation services pilot for persons with TBI who have mental illness and functional limitations.

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Evaluating the HRSA Traumatic Brain Injury Program State, Lead State Agency for TBI, and Other Informationa Federal TBI Program Grant(s) Received from HRSA Statewide TBI Advisory Board Arizona Arizona Department of Economic Security State population: 5,130,632 4,114 hospitalized with TBI 25,229 ED visits for TBI 1,689 TBI disabled Implementation: 1997, 1998, 1999 Post-Demonstration: 2001 Arizona’s statewide TBI advisory board was established by statute within the Department of Economic Security, Rehabilitation Services Administration in 1992. The 18-member board is appointed by Arizona’s governor. It consists of 11% nonvoting agency staff; 39% consumers/family; 44% others. The board meets at least quarterly and addresses both brain and spinal cord injury issues, and engages in collaboration, education, funding decisions, information/referral, planning, and policy development. The board has produced curricula and resources for personal care assistants, other health care providers, families, teachers, and administrators. Arkansas Arkansas Department of Education State population: 2,673,400 1,263 hospitalized with TBI 15,225 ED visits for TBI 1,019 TBI disabled Planning: 2001, 2002 Arkansas’ statewide TBI advisory board was established within the University of Arkansas Medical School System in 2001. Of its 24 members, 46% are agency staff; 50% are consumers/family; 4% are other. The advisory board was established jointly by the Arkansas Department of Health and the Partners Program to conduct a statewide TBI resource/needs assessment and develop a statewide TBI action plan. It meets on an as-needed basis. California California Department of Mental Health Planning: 1999, 2001 California’s statewide TBI advisory board was established within the Department of Mental Health in 1999. Its 20 members are appointed by the director of the Department of Mental Health. They consist of 70%

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Evaluating the HRSA Traumatic Brain Injury Program TBI-Specific State Funding Availability of TBI-Related Data Promising Practices and Recent Legislation Related to TBI State TBI funding source(s): Trust fund, Title V State agencies: Rehabilitation Services, Health Year funding source(s) established: 1992, 2001 Annual amount(s): $1.8–2.4 million, Number served: Not available A trust fund was established by statute, and is supported by surcharges on civil and criminal fines, penalties, forfeitures. The trust fund pays for prevention activities, case support, match against federal funding for vocational rehabilitation services, HRSA grant, staff positions, training, information, and referral. Title V funds augment service coordination, training/education, and prevention activities of service coordinators. Arizona has a trauma registry and surveillance system. —Arizona’s HRSA-funded resource cards have been replicated in other states. —Continuum of care teams in Arizona have built referral protocols, $200,000 which link children and families with resources. —Arizona’s trust fund provided a one-time appropriation of $3 million to sustain operation of two trauma centers in 2001–02.     Arkansas has been nationally recognized for instituting a model Olmstead plan,b which provides community long-term care support services for individuals with mental disabilities and brain injuries. State TBI funding source(s): Trust fund State agency: Mental Health Year funding source established: 1988 California has a TBI surveillance system. —California has caregiver resource centers for caregivers of adults with onset of cognitive and neurological impairments.

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Evaluating the HRSA Traumatic Brain Injury Program State, Lead State Agency for TBI, and Other Informationa Federal TBI Program Grant(s) Received from HRSA Statewide TBI Advisory Board California State population: 33,871,648 22,413 hospitalized with TBI 108,698 ED visits for TBI 7,274 TBI disabled   agency staff; 30% consumers/families. The board meets quarterly and is engaged in advocacy, collaboration, and planning, and will produce the statewide TBI resource/needs assessment and statewide TBI action plan. Colorado Colorado Department of Human Services State population: 4,301,261 3,206 hospitalized with TBI 21,054 ED visits for TBI 1,214 TBI disabled Planning: 1999 Implementation: 2001, 2002, 2003 Post-Demonstration: 2004 *TBI-specific Medicaid waiver (1995) Colorado’s statewide TBI advisory board, initially established in 1998 in Colorado’s Department of Human Services, Office of Behavioral Health and Housing, was designated lead coordinating agency for TBI by executive order in 2000. Its 32 members are elected by membership, and consist of 38% agency staff; 43% consumers/family; 19% others. The board meets quarterly and engages in advocacy, collaboration, education, information/referral, planning, and statewide TBI action plan development and implementation. Connecticut Connecticut Department of Social Services Planning: 2003, 2004 *TBI-specific Medicaid waiver (1999) Connecticut’s statewide TBI advisory board is no longer active.

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Evaluating the HRSA Traumatic Brain Injury Program TBI-Specific State Funding Availability of TBI-Related Data Promising Practices and Recent Legislation Related to TBI Annual amount(s): $1.1 million Number served: 622 A trust fund is supported by 66% of State Penalty Fund revenues from vehicle code violations. Approximately $950,000 was used to provide services to 622 persons in FY 2001; a portion was used for personnel costs and evaluations. Another portion wa used to draw down $620,000 in federal vocational rehabilitation funds, serving 30 persons.   —Attempts to repeal California’s safety helmet law in 2001–02 were defeated. State TBI funding source(s): Trust fund, TBI-specific Medicaid waiver State agencies: Human Services, Health Care Policy Year funding source(s) established: 2002, 1995 Annual amount(s): $2.5 million (est.); $5,202,549 Number served: TBD, 284 (2001–2002) Trust fund legislation imposes $10 and $15 surcharges for certain traffic convictions, requires 5% of funds be used to educate parents, educators, and nonmedical professionals in identifying TBI and assisting persons to seek proper medical care; 65% for services; 30% for research to promote understanding and treatment of TBI. Colorado has a trauma registry and surveillance system. —Colorado has a CDC-funded Craig Hospital Data Collection Project. —Colorado established a TBI trust fund in 2002; created 13-member board. State TBI funding source(s): General revenue, TBI-specific Medicaid waiver State agencies: Social Services, Social Services Year funding source(s) established: Connecticut has a trauma registry. —A person-centered plan is required for all Medicaid TBI waiver recipients in Connecticut. —Connecticut legislature asked Department of

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Evaluating the HRSA Traumatic Brain Injury Program State, Lead State Agency for TBI, and Other Informationa Federal TBI Program Grant(s) Received from HRSA Statewide TBI Advisory Board Connecticut State population: 3,405,565 1,518 hospitalized with TBI 8,494 ED visits for TBI 568 TBI disabled     Delaware Delaware Department of Health and Social Services State population: 783,600 1,294 hospitalized with TBI 2,731 ED visits for TBI 483 TBI disabled Planning: 1997, 1998 *TBI-specific Medicaid waiver (2002) Delaware does not have a distinct statewide TBI advisory board; however, the Governor’s Advisory Council on Aging and Adults with Physical Disabilities formed in 1997 does have a TBI steering committee. The TBI steering committee has 28 members, appointed by the division director, including 30% agency staff; 50% consumers/family; 20% others. It meets as needed when directed by the division director, is engaged in advocacy, collaboration, education, and funding decisions. It prepared a report on Delaware’s statewide TBI resource/needs assessment and developed a coma guide. District of Columbia D.C. Department of Health State population: 572,059 651 hospitalized with TBI 3,268 ED visits for TBI 219 TBI disabled Planning: 1997, 1998 Implementation: 1999, 2000, 2001 Post-Demonstration: 2002, 2003 The District of Columbia established a TBI advisory board within the D.C. Department of Health in 1997. The advisory board has 25 members appointed by the director of the Department of Health or a bureau chief. They include 50% agency staff; 20% consumers/family; 30% others. The board meets quarterly and engages in advocacy, collaboration, education, and planning. It played a role in development of Healthy People 2010 plan, has provided testimony on registry bill, provides technical assistance in planning and implementing grant activities, and was

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Evaluating the HRSA Traumatic Brain Injury Program TBI-Specific State Funding Availability of TBI-Related Data Promising Practices and Recent Legislation Related to TBI 1985, 1999 Annual amount(s): $2,027,330; $5,034,853 Number served: 2,240 (dup), 158 (2001–2002) General revenue is used for direct services. Some funds are used for services to class-action lawsuit members. Medicaid TBI waiver has 500 slots; 158 persons had been served as of April 2002.   Public Health to study how a TBI registry could be developed and report back. —Connecticut legislature passed legislation establishing group home pilot for older adults with TBI/acquired brain injury in 2005. State TBI funding source(s): General revenues, TBI-specific Medicaid waiver State agencies: Health and Social Services, Health and Social Services Year funding source(s) established: 2001, 2002 Annual amount(s): $209,000, not yet implemented (2003) Number served: Unknown, unknown Delaware has a trauma registry and surveillance system. —Delaware received Olmstead Systems Change and Assistive Technology grants from the Centers for Medicare and Medicaid Services (CMS) to improve their community long-term care support services for individuals with brain injury and mental illness. —Disability Commission was created in the state in 2001–02. The District of Columbia has no TBI-specific state funding at this time. The District of Columbia has no data collection system in place but is working toward an Intentional and Unintentional Injury registry, which will include TBI. There are also plans for mandatory injury reporting for —Collaboration with faith communities aims to improve education and care regarding TBI in community settings. —Collaboration between the TBI advisory board and other stakeholders is reportedly moving D.C. to mandatory injury reporting.

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Evaluating the HRSA Traumatic Brain Injury Program State, Lead State Agency for TBI, and Other Informationa Federal TBI Program Grant(s) Received from HRSA Statewide TBI Advisory Board District of Columbia involved in an injury reporting bill for 2002. Florida Florida Department of Health State population: 15,982,378 12,719 hospitalized with TBI 65,345 ED visits for TBI 4,373 TBI disabled Implementation: 1997, 1998, 1999, 2000 Post-Demonstration: 2001, 2003, 2004 *TBI-specific Medicaid waiver (1999) Florida has an advisory board that addresses needs of both TBI and spinal cord injury that was established by statute in 1985. The board’s 16 members are appointed by the secretary of Florida’s Department of Health. They include 50% consumers/family; 50% others such as physicians, advocacy organizations, etc. The board meets quarterly and is engaged in developing and maintaining standards for designation in acute and sub-acute care, inpatient and outpatient rehabilitation, and transitional living facilities. It also participates in advocacy, collaboration, education, funding, information/referral, and planning; approves product development; recommends legislative changes as needed, and produces an annual performance report.

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Evaluating the HRSA Traumatic Brain Injury Program TBI-Specific State Funding Availability of TBI-Related Data Promising Practices and Recent Legislation Related to TBI   hospitals, ambulatory clinics, Metropolitan Police Departments, D.C. Fire Department and Emergency Medical Services, and the Office of the Chief Medical Examiner.   State TBI funding source(s): Tobacco settlement, Medicaid TBI waiver, trust fund State agencies: Health, Health, Health Year funding source(s) established: 2000, 1999, 1988 Annual amount(s): $270,000; $4,300,000; $15,000,000 Number served: Approximately 850; up to 300; 3,167 (case management)/1,183 (other) A trust fund derives revenue from a percentage of fees levied from traffic-related fines, surcharges for diving and boating under the influence convictions, and temporary license tags. A portion of the proceeds provides matching funds for the state’s Medicaid TBI waiver and supports research, case management and other staffing components for operating the registry, and various contracts. Florida has a trauma registry and TBI registry. All hospitals, attending physicians, public, private, and social agencies are required to report all new moderate-to-severe brain injuries to the central registry. A case manager is required to contact the individual within 10 working days to determine eligibility for Brain and Spinal Cord Injury Program services, and to assist coordinating all state, federal, and community resources. —Florida has a Nursing Home Deinstitutionalization and Diversion Project. —Florida has specialty motorcycle tag in which 25% of funds collected annually go to the Brain and Spinal Cord Injury Program. —State appropriations increased for TBI-specific Medicaid waiver slots in 2005.

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Evaluating the HRSA Traumatic Brain Injury Program Accomplishments of the State-Based P&A System Under the Federal PATBI Grant Continuing Efforts Related to P&A for Individuals with TBI and Their Families Participated in the activities of South Carolina’s leadership council and systems development committee. Prevented a significant decrease in the amount of funds available to the Medicaid head and spinal cord (HASC) injury waiverd participants for home and vehicle modifications. Conducted outreach, focus groups, and self-advocacy trainings at brain injury support groups, community opportunity centers, hospitals, nursing homes, and at statewide brain injury conferences. Publicized the P&A system’s TBI program by publishing articles in newsletters of several disability and service provider groups and through radio broadcasts. Protection and Advocacy for People with Disabilities in South Carolina will continue to provide advocacy and legal services related to community integration, employment, housing, and education. Participated in a coalition of TBI stakeholders in developing awareness to increase and enhance state TBI services and supports. Linked with the revitalized Brain Injury Association of South Dakota, rehabilitation centers, Indian reservations, brain injury support groups, and state agencies. Provided information and referral services to approximately 46 people; served 10 individuals in areas such as housing, education, employment, Social Security, and guardianship. Provided testimony to support a bill that would create a statewide TBI advisory board for South Dakota/TBI rehabilitation and research. Disseminated ~2,300 brochures related to P&A for individuals with TBI and their families. South Dakota Advocacy Services will continue to implement its grant objectives and advocate for individuals with TBI and their families in accessing services and supports to meet their needs. Created information on specific goals and objectives of this grant that is provided to the TBI community. Created an article for the Tennessee P&A newsletter. Tennessee P&A will continue efforts to have a P&A representative on Tennessee’s statewide TBI advisory board.

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Evaluating the HRSA Traumatic Brain Injury Program State and State-Based P&A System for Individuals with Developmental Disabilitiesa Federal PATBI Grant Received from HRSA Period: 9/01/2004–8/31/2006 Goals Under the Federal PATBI Grant Tennessee by providing informational materials to 200 persons in institutional settings, and by authoring four articles on abuse and neglect on any website and/or in any newsletter. Advocate for students with TBI with the goal of effecting systemic impact in two of the cases. Inform and empower persons with TBI regarding self-advocacy and the Tennessee P&A system’s services with 18 presentations, focus groups, listening sessions, information fairs, outreach, trainings, and/or collaborations; develop and and disseminate 130 family-needs surveys and resource packets of information to persons with TBI. Develop a TBI community coalition to share information and collaborate on projects concerning persons with TBI. Texas Advocacy, Inc. PATBI Grant: $178,147 Increase direct casework to people with TBI above the 2004 target by at least 10 percent. Focus policy efforts on informing state officials about impact of legislation and continue systemic advocacy for rehabilitative services covered under Medicaid and other state-funded services. Continue relationship with state and local organizations representing survivors of TBI, families, and brain-injury professionals. Develop relationships across the states and support education and advocacy efforts of the Texas TBI advisory board. Utah Disability Law Center PATBI Grant: $150,000 Receive continuous feedback from the TBI community in the needs assessment and planning process through focus groups and collaboration with the Federal TBI State Program Grant to Utah. Invite participation of individuals with TBI in the governance of the Disability Law Center. Provide high-quality information, referral, and short-term assistance services to persons with brain injury. Design a low-literacy brochure for the TBI community explaining P&A services.

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Evaluating the HRSA Traumatic Brain Injury Program Accomplishments of the State-Based P&A System Under the Federal PATBI Grant Continuing Efforts Related to P&A for Individuals with TBI and Their Families Contacted all TBI service coordinators statewide and provided information on the project and services. Conducted presentations for local chapters of Brain Injury Association of Tennessee to inform them of the TBI program and other Tennessee P&A programs. Developed collaborative relationships with the Department of Health and the Division of Vocational Rehabilitation on TBI issues. Advocacy, Inc., served 97 individuals with TBI P&A funds in fiscal year 2004. Advocacy, Inc., will continue to advocate for the development and availability of additional community support services for individuals with TBI in Texas. Increased TBI-related calls by over 350% (since the inception of the program). The Brain Injury Association of Utah did a brown-bag sensitivity training for staff. The director of the Brain Injury Association of Utah and a member of the Disability Law Center’s board of trustees conducted a Disability Law Center board training on TBI issues. Conducted two legal rights trainings at Utah’s Brain Injury Association affiliate. Participated at the 2004 Brain Injury Association The Disability Law Center was a member of the planning committee for the conference of the Utah Trial Lawyers/Brain Injury Association of Utah planned for March 2005 and a member of Utah’s TBI program. The Disability Law Center was expected to conduct a focus group on March 17, 2005, with a TBI

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Evaluating the HRSA Traumatic Brain Injury Program State and State-Based P&A System for Individuals with Developmental Disabilitiesa Federal PATBI Grant Received from HRSA Period: 9/01/2004–8/31/2006 Goals Under the Federal PATBI Grant Utah Provide high-quality legal services using issue team structure. Conduct case finding activities at the Utah State Hospital. Conduct legislative advocacy. Increase awareness of the Disability Law Center’s services and legal rights among persons with brain injury, their families, and the legal profession. Vermont Vermont Protection and Advocacy, Inc. PATBI Grant: $150,000 Provide individual advocacy to obtain access to community-based services and supports for people with TBI living in residential facilities. Enhance access to comprehensive and coordinated supports and services for people with TBI and their families through system advocacy with partner agencies. Collaborate with Vermont’s State Implementation Grant awarded by HRSA from the Federal TBI Program in attainment of goals and objectives of the statewide TBI action plan, specifically by improving access to TBI services and increasing TBI expertise of vocational counselors through educational trainings. Work with state government agencies and legislature to expand services, supports, and funding available to persons with TBI. Enhance the knowledge base of individuals with TBI and their family members, service providers, and legislators about resources and provision of TBI services and supports. Virginia Virginia Office for Protection and Advocacy PATBI Grant: $111,141 Develop outreach materials for TBI community that describe available P&A services and legal rights of persons with TBI. Provide information on the project and available P&A services to individuals with TBI to organizations that serve this community throughout the state. Provide information about P&A services available to individuals with TBI on the website.

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Evaluating the HRSA Traumatic Brain Injury Program Accomplishments of the State-Based P&A System Under the Federal PATBI Grant Continuing Efforts Related to P&A for Individuals with TBI and Their Families of Utah’s Family and Professional Conference. Conducted five focus groups. Developed a new and improved TBI brochure. support group at a local hospital. Project staff members attend all meetings of Vermont’s statewide TBI advisory board and steering committee. Developed a training program for individuals with TBI, their families, and a service providers. Developed and published a legal resource manual. Vermont Protection and Advocacy is scheduling trainings for individuals with TBI, family members, and service providers on legal resources for all areas of Vermont and working with the Vermont legislature and state agencies to expand services, supports, and funding available to individuals with TBI. The Virginia Office for Protection and Advocacy has developed a partnership with the Brain Injury Association of Virginia. The Virginia Office for Protection and Advocacy will continue to implement its grant objectives and provide advocacy for individuals with TBI and their families in accessing services and supports to meet their needs.

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Evaluating the HRSA Traumatic Brain Injury Program State and State-Based P&A System for Individuals with Developmental Disabilitiesa Federal PATBI Grant Received from HRSA Period: 9/01/2004–8/31/2006 Goals Under the Federal PATBI Grant Virginia Perform a series of outreach and training events around the state that target individuals with TBI, families, and caregivers. Direct representation of 10 people with TBI who are experiencing barriers in accessing appropriate services. These cases will include those with dual diagnosis: TBI and bipolar disorder or TBI and mental retardation. Provide ongoing direct representation of persons with TBI and families in health care, mental health care, employment, abuse and neglect, access to community services, and education. Washington Washington Protection and Advocacy PATBI Grant: $155,191 Increase the number of people with TBI who have information and referrals regarding their rights and increase the number of people with TBI who receive short-term advocacy services. Increase the number of systemic or policy issues that affect people with TBI being addressed by policy makers. Increase the number of people with TBI who receive adequate mental health services in large city jail and psychiatric hospitals. Increase the number of people with TBI who receive appropriate discharge planning from a large city jail and decrease the number of people with TBI who have unnecessarily extended stays in psychiatric hospitals. Increase the number of people with TBI who receive adequate housing, mental health, and other supports in the community.

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Evaluating the HRSA Traumatic Brain Injury Program Accomplishments of the State-Based P&A System Under the Federal PATBI Grant Continuing Efforts Related to P&A for Individuals with TBI and Their Families Conducted investigation of conditions in a city jail for prisoners with developmental disabilities, mental illness, and TBI, which resulted in changes in several policies. Lawsuit against state of Washington regarding inadequate discharge and funding of services for people with developmental disabilities, mental illness, and TBI. Provided hundreds of people with TBI and family with information, referral and short-term advocacy services. Provided People First and Self-Determination input to the statewide TBI advisory board as it created the TBI Toolkit. Handled special education legal cases and conducted outreach to the special education community, and attorneys. Conducted employment trainings that reached 540 people. Advanced Mental Health Parity legislation. Preserved funding for Healthcare for Workers with Disabilities (Medicaid Buy-In). Washington Protection and Advocacy will continue to implement its grant objectives and provide advocacy for individuals with TBI and their families in accessing services and supports to meet their needs.

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Evaluating the HRSA Traumatic Brain Injury Program State and State-Based P&A System for Individuals with Developmental Disabilitiesa Federal PATBI Grant Received from HRSA Period: 9/01/2004–8/31/2006 Goals Under the Federal PATBI Grant West Virginia West Virginia Advocates, Inc. PATBI Grant: $100,000 Establish collaborative relationships through written memorandums of understanding with other key stakeholders. Advocate and assist with the exploration, development, and implementation of an array of services that meet the culturally diverse needs for individuals with TBI. Provide direct-advocacy services/legal representation for at least 25 individuals with TBI in accordance with established priorities and objectives. Include individuals with TBI and/or family members on the Program Advisory Council. Provide assistance in self-advocacy to persons with TBI and families. Provide outreach and education to citizens of West Virginia to increase awareness of individuals with TBI. Develop and/or adapt outreach and TBI educational tools. Conduct TBI forums in at least four geographic areas in West Virginia. Provide outreach to health care providers, social workers, individuals with TBI, and family members in rehabilitation hospitals and the two existing trauma centers in West Virginia. Wisconsin Wisconsin Coalition for Advocacy PATBI Grant: $152,799 Conduct effective outreach and provide high-quality information and referral and individual advocacy assistance to people with TBI and their families throughout Wisconsin. Increase the self-advocacy skills of people with TBI and their families throughout Wisconsin. Improve Wisconsin’s TBI service delivery system through legislation, policy and and impact litigation strategies. Elevate the TBI competencies of the Wisconsin Coalition for Advocacy staff, county and state employees, and others through a combination of training and materials development/dissemination.

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Evaluating the HRSA Traumatic Brain Injury Program Accomplishments of the State-Based P&A System Under the Federal PATBI Grant Continuing Efforts Related to P&A for Individuals with TBI and Their Families West Virginia Advocates has actively recruited individuals with TBI for membership on the West Virginia Advocates Program Advisory Council. Provided direct advocacy services, community education, and referral to individuals with TBI and their guardians and/or family members. West Virginia Advocates will continue to provide a TBI P&A program that is responsive to the needs of individuals with TBI and their families. Appointed to Wisconsin’s statewide TBI advisory board. Established a memorandum of understanding with the State Brain Injury Association affiliate to collaborate on conferences and referrals. Conducted outreach to 21 Brain Injury Association support groups. Published TBI information on the website. Beginning to work with criminal justice system; also doing outreach to women’s shelters under another contract, but including information on TBI. Increase in referrals—35 between January and March 2005, and 47 total in 2004. The Wisconsin Coalition for Advocacy will continue to implement its grant objectives and provide advocacy for individuals with TBI and their families in accessing services and supports to meet their needs.

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Evaluating the HRSA Traumatic Brain Injury Program State and State-Based P&A System for Individuals with Developmental Disabilitiesa Federal PATBI Grant Received from HRSA Period: 9/01/2004–8/31/2006 Goals Under the Federal PATBI Grant Wyoming Wyoming P&A PATBI Grant: $100,000 Develop an outreach brochure describing P&A services for the TBI community. Provide information on the TBI Program to organizations statewide. Provide a series of training and outreach events around Wyoming targeting individuals with TBI, their families, and caregivers. Provide information and referral services on disability-related issues as appropriate to eligible individuals and their families who are seeking TBI program services. Provide advice, consultation, self-advocacy assistance, and legal representation as necessary to protect the rights of eligible individuals and their families to assist them in addressing disability-related issues. NOTE: Data displayed in this table are compiled from state self-reports collected by the National Association of Head Injury Administrators (NASHIA). Programs or accomplishments reported in this table may be unique to an individual state. aUnder the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.Code 6012), each state seeking a federal grant for protection and advocacy (P&A) services for individuals with developmental disabilities must establish a protection and advocacy system independent of service-providing agencies, to empower, protect, and advocate on behalf of persons with developmental disabilities. The Children’s Health Act of 2000 (P.L. 106-310) directed the Health Resources and Services Administration (HRSA) to make grants to state-based P&A systems to provide information, referral, and self-advocacy to individuals with TBI and their families. bOn June 22, 1999, the U.S. Supreme Court held in Olmstead v. L.C. that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability. The court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities.

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Evaluating the HRSA Traumatic Brain Injury Program Accomplishments of the State-Based P&A System Under the Federal PATBI Grant Continuing Efforts Related to P&A for Individuals with TBI and Their Families Prepared an annual report that details all of the Wyoming’s P&A system’s accomplishments of goals 1–5. Wyoming P&A will continue to implement its grant objectives and provide advocacy for individuals with TBI and their families in accessing services and supports to meet their needs. cThe Medicaid home and community-based services waiver allows states to waive Medicaid provisions in order to allow long-term care services to be delivered in community settings; it is the Medicaid alternative to providing comprehensive long-term services in institutional settings. dThe Medicaid head and spinal cord injury (HASC) waiver is a type of Medicaid home and community-based services waiver. Individuals served by the HASC waiver must have TBI, SCI, or a similar disability and must apply for the waiver before their 60th birthday. SOURCE: Connors S, King A, Vaughn S. Guide to State Government Brain Injury Policies, Funding and Services. 1st ed. Bethesda, MD: NASHIA 2003; King A, Vaughn SL. Guide to State Government Brain Injury Policies, Funding and Services. 2nd edition. Bethesda, MD: NASHIA, 2005.