the same, including discretionary support and mechanisms to help sustain their TBI programs.

Some example comments include:

“We are glad the TBI program is there, grateful for funding and support. Would like more discussion on focused issues. And more sophisticated, targeted advice.”

“There should be less emphasis on processes, work more on something universally acceptable. Take the best that works and package it. Share these with other states, hospitals. There MUST be common practices that work! Evaluate them and package them.”

“Continue the system as it is, with more centralized control in the Lead Agency. We need more support for statistics, research, to more accurately target dollars … number crunching capabilities … and more money!”

“Being able to integrate state efforts to a basic level would help …”

“Somehow, local work has to be integrated with state policy change. They need to be pulled together. There needs to be articulation of how the state system overlays [and how the trust fund fits in].”

“We need to educate people … Could HRSA develop things about services, needs across the lifespan of people with TBI? Different strategies as the person ages? So people know what comes with TBI …”

“The main thing is time for the grants and the irregularity of funding. It impacts our ability to get and keep staff.”

“When it’s time to do the grant proposals, the HRSA proposals require more narrative than others we typically do. I’d suggest simplified paperwork for the formula funds.”

States’ suggestions to move to a new structure for state grants have already been addressed. In August 2005 HRSA released its new program guidance, which provides support for 3-year “Partnership Implementation” grants. Seen as a step closer to the formula grant approach, which must be legislatively authorized, the Partnership Implementation grants “meet states where they are.” The new grants replace the Planning, Implementation, and Post-Demonstration grants previously available and, while the new grants will be competitively awarded, they are available to all states and territories.

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