resentatives of key state agencies, TBI trust funds, Medicaid waivers, and related interests. State TBI lead agency representatives helped to identify appropriate representatives to be contacted in their states. National program stakeholders involved with the HRSA TBI Program were also contacted for interviews, including the HRSA TBI Program Director; Executive Director of the National Association of State Head Injury Administrators/Director of the TBI Technical Assistance Center (TBI TAC); President/CEO of the Brain Injury Association of America; and Executive Director of the National Disability Rights Network (formerly the National Association of Protection and Advocacy Systems, Inc.).

Interviews were conducted using a semi-structured interview guide developed by the IOM Committee to address areas of importance relating to state program implementation; program impact on persons with TBI and their caregivers; and coordination of TBI-related services, including education, vocational rehabilitation, employment, housing, transportation, and mental and behavioral health care. The interview guide includes questions about each state’s history of TBI service delivery, and their experiences with each of the HRSA TBI Program grants:


Planning grants allow states to build infrastructure through the TBI Program’s four core components—(1) establishing a TBI Statewide Advisory Board, (2) identifying a Lead Agency, (3) conducting a Needs and Resources Assessment, and 4) developing a TBI State Action Plan.

Implementation Grants allow states to undertake activities, e.g., implementation of the State Action Plan or activities to address identified needs, to improve access for individuals with TBI and their families.

Post-Demonstration Grants authorized by the Children’s Health Act of 2000 have been available to allow states that have completed 3 years of implementation to support specific activities that will help states build TBI capacity.

Protection and Advocacy Systems Grants allow 57 states, territories, and the Native American Protection and Advocacy Project to assess their state P&A Systems’ responsiveness to TBI issues and provide advocacy support to individuals with TBI and their families.


The interview guide also includes questions about states’ experiences with the TBI Technical Assistance Center and with the HRSA TBI Program grant structure and processes. Each interview was approximately 40–50 minutes in length.

Stakeholders of the HRSA TBI Program interviewed for this study are represented by category in Figure E-1. Interviews were conducted with a total of 66 TBI stakeholders, including: national program directors (n=4), state brain injury associations (n=6), state injury prevention epidemiolo-



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