(P.L. 106-310), is a modest federal program with broad ambitions: a $9 million grants program aimed at motivating states to create systems improvement on behalf of persons with TBI with disabilities and their families. As explained further below, the HRSA TBI Program encompasses two grant programs: (1) the TBI State Grants Program; and (2) the Protection and Advocacy for TBI (PATBI) Grants Program. The program was designed with the underlying premise that distributing small grants to states that meet certain requirements will be sufficient to initiate the creation of sustainable infrastructure and increased capacity for comprehensive, coordinated, and integrated services systems to meet the post-acute needs of persons with TBI and their families.

In 2004, the federal Office of Management and Budget (OMB) questioned the effectiveness of the HRSA TBI Program, noting that there had been no regular independent evaluations of the program’s effects on TBI patients and their families. To address these concerns, HRSA contracted with the Institute of Medicine (IOM) in the spring of 2005 to conduct a study: (1) to assess the impact of the HRSA Program on how state systems are working or failing to work in support of individuals with TBI; and (2) to advise HRSA on how it could improve the program to best serve individuals with TBI and their families. The IOM appointed an 11-member Committee on Traumatic Brain Injury to perform the study.

This report presents the IOM Committee on Traumatic Brain Injury’s assessment of the HRSA TBI Program’s impact and recommendations for improving the program. The committee’s key findings and recommendations are summarized in Box ES-1 through Box ES-4.


This study is not intended as a technical evaluation of the HRSA TBI Program’s impact on either the delivery of TBI-related services or on person-level outcomes—such an analysis is not feasible given currently available data. Rather, the study’s focus is on whether the TBI Program has led to an expansion in state systems infrastructure as a precondition for better serving persons with TBI and their families.

The committee used a qualitative method to assess the program’s impact. Qualitative methods are often used to investigate developing institutions and systems as well as to assess the impact of government programs. Data were gathered from a variety of sources and were analyzed for key themes and recurring issues. Primary sources of data included semi-structured interviews with TBI stakeholders in seven states and representatives of selected national organizations, research literature and TBI program materials, and relevant survey data.

Clearly, HRSA should develop a more complete evaluation strategy to

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