Transcript BRAIN INJURY IN PENNSYLVANIA - abin

BRAIN INJURY IN
PENNSYLVANIA
Cross-Systems Planning
to Minimize Our Epidemic
of Lifetime Disability
© 2007 Barbara A. Dively
preface
Thanks to James D. Holt, Ed.D., Executive Assistant
for Organizational Development of the Pennsylvania
Human Relations Commission for prompting this
PowerPoint for the June 22, 2007, meeting of the
Disability Stakeholders’ Group, and to Edward V.
Crinnion, Jr., for developing this opportunity to share
information about acquired brain injury.
This information is based on my own experience,
research and conversations, and my advocacy efforts in
Harrisburg to improve the lives of individuals and families
affected by acquired brain injury.
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the time is now
458,000 Pennsylvanians are currently disabled by acquired
brain injury, including 32,179 children under 21 with traumatic brain
injury alone.
Brain injury rehabilitation began in the 1970’s but is currently
provided to only 460 Pennsylvanians.
The Department of Public Welfare is now implementing the
Brain Injury Recovery Blueprint to extend brain injury rehabilitation
to all children and to all adults in publicly funded systems.
Next, adult brain injury rehabilitation must become a routine
outpatient service for all Pennsylvanians.
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BRAIN INJURY BASICS ….………..…………………….5
EFFECTS OF NEURAL DAMAGE ...…………………..11
MAXIMIZING RECOVERY…………..………………….18
RULES OF ENGAGEMENT………..…………………...38
MINIMIZING INCIDENCE...………..……………………44
STATISTICS……...…………………..…………………..50
PENNSYLVANIA’S RESPONSE.…..…………………..64
ACTION NEEDED…………………..…………………...80
SUMMARY…………………………..……………………83
RESOURCES………………………..…………………...84
CONTACT…………………………..…………………….85
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BRAIN INJURY BASICS 1/6
• What is a Brain Injury?
• What is a Neuron?
• Are Neurons Important?
• What Damages Neurons?
• Review: BASICS
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What is a Brain Injury? 2/6
• Brain injury is not a progressive condition or
degenerative disease like multiple sclerosis,
dementia or Alzheimer’s.
• Brain injury is not a birth injury, a congenital or a
metabolic condition.
• Brain injury is an injury to neurons (brain cells)
causing a period of confusion, amnesia or loss
of consciousness that is followed by physical,
cognitive and/or behavioral changes.
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What is a Neuron? 3/6
• Neurons are cells arranged in networks.
• The body of the neuron produces chemical
messengers called neurotransmitters.
• Each neuron has several tree-like projections or
dendrites that receive neurotransmitters.
• Each neuron has one stem-like projection or
axon that sends out neurotransmitters.
• The brain contains 10,000 million neurons.
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Are Neurons Important? 4/6
• Neurons are linked together in neural networks
that allow you to think, plan, make decisions and
remember.
• Neural networks control your breathing, gait,
digestion, urination, defecation, and circulation.
• Neural networks allow you to hear, smell, taste,
feel, see, be hungry and reproduce.
• Neural networks allow you to walk, write, sweat,
react to danger, laugh, cry and sleep.
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What Damages Neurons? 5/6
• Lack of oxygen as in cardiac arrest, near
drowning, near suffocation, anoxia.
• Lack of blood flow due to hemorrhage,
blockage, hypothermia, surgery.
• Pressure from hemorrhage, swelling.
• Metabolic interference as in poisoning,
fever, malnutrition.
• Mechanical damage to dendrites or axons
due to twisting, stretching, shearing.
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Review: BASICS 6/6
• Brain injury is an injury to neurons (brain
cells) causing a period of confusion,
amnesia or loss of consciousness that is
followed by physical, cognitive and/or
behavioral changes.
• 10,000 million neurons are arranged in
networks that control every life function.
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EFFECTS OF
NEURAL DAMAGE 1/7
Physical Effects
• Cognitive Effects
• Behavioral Effects
• Impact on Adults
• Impact on Children
• Review: ABI SEQUELAE
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Physical Effects 2/7
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Seizures of all types
Muscular spasticity, paralysis
Double vision, low vision, blindness
Loss of smell, loss of taste
Slurred speech
Headache or migraine
Fatigue, need for more sleep
Balance problems, gait problems
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Cognitive Effects 3/7
• Memory loss
• Information processed
more slowly
• Concentration difficult
• Conversation difficult
• Word finding difficult
• Spatially disorganized
• Disorganized thinking
• Impaired judgment
• Only one thing at a time
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Unable to initiate
Unable to maintain
Distracted easily
Coaching needed
Cueing needed
Understanding difficult
Unable to follow rules
Decision making difficult
Noise overwhelms
Reaction time slower
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Behavioral Effects 4/7
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Increased anxiety
Depression
Mood swings
Impulsive behavior
More easily agitated
Egocentric behaviors
Difficulty seeing another point of view
Unable to monitor personal behavior
Unaware of the cues for expected behavior
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Impact on Adults 5/7
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Within a year, all prior friends are gone.
Over 90% of marriages dissolve.
The parent/child relationship is damaged.
Careers are ended.
Future educational prospects are limited.
Extended family networks are destroyed.
Community roles disappear.
Financial capacity is eliminated.
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Impact on Children 6/7
• Within a year, all prior friends are gone.
• Within a year, pre-event achievement no
longer ensures school success.
• Children believe they have not changed.
• Maturation is stalled at the event age so
deficits become more evident over time.
• School IEP must be guided by the child’s
neuropsychologist to promote recovery.
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Review: EFFECTS 7/7
After an acquired brain injury, there
may be physical, cognitive, and/or
behavioral consequences or sequelae.
If you had a few problems from each
list, how would you feel? How would you
plan for your future? Would you require
help to get your life back in order?
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MAXIMIZING RECOVERY 1/20
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What is Recovery?
Recovery Bloopers
Mental Stimulation is Essential
Rest is Essential
Resilience Factors
S.P.E.C.T. Scans – TBI, Stroke/Alcohol
NIH Pilot Study
Misalignment
Other Alternatives
Review: RECOVERY
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What is Recovery? 2/20
• Recovery means the creation of a new life that is
satisfying and as independent as possible.
• Brain repair must first be maximized.
• Strengths and limitations must be identified
through a neuropsychological evaluation.
• Activities must focus on regaining old skills,
exploring new interests, adjusting to deficits,
using compensatory strategies and/or assistive
technology, and making new friends.
• Most people have no help with these issues.
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Recovery Bloopers 3/20
• Maximal improvement occurs in the first 6, 12, or
18 months.
• At some point, improvement ends.
• The brain does not repair.
• Stimulants are useful to prevent fatigue.
• Regression or a plateau in improvement is final.
• Failure to comply indicates resistance.
• Artificial goals should be set and met.
• Anti-depressants promote recovery.
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Mental Stimulation Essential 4/20
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Assure a relaxed pace.
Base activities on personal preferences.
Re-train for prior skills.
Identify and utilize strengths.
Teach compensatory strategies.
Encourage new interests.
Plan for pleasure every day.
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Rest is Essential
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• Initially, the brain is exhausted from coping with
swelling and healing physical damage.
• Next, the brain works constantly to repair
neurons and rebuild neural networks,
inefficiently at first.
• Daily life is extraordinarily difficult, as if there
were four final exams daily, forever.
• Periodically, all energy is drained while
streamlining neural networks so cognitive
efficiency and complexity can improve.
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Further Factors 6/20
• Encourage faith in the future and gratitude for survival.
• Support determination and perseverance.
• Allow awareness of deficits to emerge slowly. Denial
preserves hope and protects from reality, shame,
embarrassment and suicide (5 times general rate).
• Celebrate 10% success such as just showing up!
• Ensure daily organic fruits, vegetables, nuts, and
essential fatty acids to rebuild the brain.
• Encourage exercise, general health and dental health.
• Assure support from new friends, family, support groups,
and a good neuropsychologist.
• Encourage artwork, crafts, music, dance, singing.
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S.P.E.C.T.: Info 7/20
• See Harch S.P.E.C.T. scans at www.abinpa.org, Education, Hyperbaric Oxygen.
• Hospitals provide chamber or treadmill.
• First used for divers with the “bends”
• Medicare and Aetna approve hyperbaric
oxygen for many diagnoses.
• Medicaid covers children claims due to
demonstrated improvements.
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S.P.E.C.T.– #1 TBI 8/20
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S.P.E.C.T.: #1 TBI, cont. 9/20
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S.P.E.C.T.: #1 TBI,cont. 10/20
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S.P.E.C.T.: Stroke/Alc. 11/20
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S.P.E.C.T.:Stroke/Alc., cont.12/20
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NIH Pilot Study 13/20
• Journal of Head Trauma Rehabilitation, 14:6,
December 1999, p. 521. A randomized, doubleblind placebo-controlled, clinical trial using
homeopathy at Spaulding Rehabilitation
Hospital, a TBIMS facility.
• “The treatment group subjects reported a highly
significant reduction on scales measuring
difficulty functioning in situations commonly
encountered in daily life and a significant
decrease in the reported frequency of ten most
commonly reported symptoms of MTBI.”
Cont.
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NIH Pilot Study, cont. 14/20
• “Subjects whose injury occurred one year or less from
the beginning of the study showed improvement in both
the homeopathic and placebo groups. Subjects in the
placebo group who were one to three years post-injury at
the onset of the study showed no further improvement;
and placebo subjects who were three years or more
post-injury showed an increase in symptoms. The
relative benefit of effect of homeopathic treatment
appeared to increase with duration since injury, a finding
that holds promise for patients with persistent MTBI and
for whom current treatment options are limited.”
Cont.
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NIH Pilot Study, cont. 15/20
• The ten symptoms used were: short term
memory problems; short attention span; slow
thinking; headache; mental fatigue; sleep
disturbances; impatience; frustration;
distractibility; and withdrawal from social
situations. At least half the subjects had these
symptoms all of the time.
• The 15th edition of the American Pharmacist’s
Association “Handbook of Non-Prescription
Drugs” includes Chapter 55 on homeopathic
medicines. See next slide, or go to:
http://www.hylands.com/news/apha.php.
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Chapter 55, A.Ph.A. 16/20
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Misalignment 17/20
• A misaligned vertebra is called a subluxation.
• The same event that causes an acquired brain injury may cause a
subluxation.
• Subluxations interfere with nerve function.
• Subluxations interfere with blood flow.
• Subluxations are documented by x-ray.
• Subluxations can be detected by palpation.
• Subluxations are corrected by chiropractic adjustments with a risk of
harm of 1 per 100 million (lumbar), 6.39 per 10 million (cervical) and
1 in 250 million (children). As a result, malpractice premiums are
about $2,000 per year.
• To put this risk into perspective, the risk of harm from back surgery
is 15.6 per 1,000 and for NSAID’s is 3.2 per 1,000.
Cont.
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Misalignment, cont. 18/20
• Impaired arterial blood flow to the brain as a result of a
cervical subluxation: a clinical report. Risley, WB. Journal
of the American Chiropractic Association, June 1995,
pp.61-63. 15,000 patients. Documented by Doppler
studies. Reversed by C-1, C-2 adjustment.
• Report of the State Supervisor of Chiropractors of
Kentucky In Connection with Kentucky Houses of
Reform, Greendale, Kentucky, Marshall, L.T., Lexington,
Kentucky (December 1, 1931). 9/3/1930 (540 boys) to
12/1/1931 (335 boys) with 244 treated, 144 paroled.
Teachers asked for a permanent chiropractor and stated
that the boys improved in demeanor and performance
from the first adjustment. Chiropractic discontinued.
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Other Alternatives 19/20
• Shiatsu – pressure on meridians with positioning
– restores function
• Trager – developed by a physician to rehabilitate
stroke patients
• Yoga – stabilization, integration and mobilization
• CranioSacral – restores neural function
• Polarity – restores energy flow
• Acupuncture – restores energy flow
• Behavioral optometry – restores binocular
tracking and accommodation (biofeedback)
• Music therapy – restores breathing pattern, etc.
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Review: RECOVERY 20/20
• A tremendous amount of personal and
family effort is involved.
• Creative thinking is essential.
• By working with personal interests,
activities can become progressively more
complex and challenging, leading to
further neural network development.
• Utilize a variety of resources.
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RULES OF ENGAGEMENT 1/6
Interacting with a person affected by
brain injury can be difficult. Every system
and family should be trained in these
simple guidelines. This information will set
the stage for the specific
recommendations of the
neuropsychologist who evaluates and
maintains a treating relationship with the
individual recovering from a brain injury.
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Communication Rules 2/6
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Speak slowly.
Phrase questions for a yes or no answer.
Accept/offer alternate ways of responding.
Simplify or offer simple choices.
Gently divert from difficult topics.
Remain calm at all times.
Do not say “No”. Ask questions instead.
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Rules for Tasks 3/6
• If tasks are not completed, use coaching,
small steps, cue cards, timers, etc.
• If tasks are unfamiliar, give easier tasks.
• Eliminate responsibilities that are ignored.
• Rehearse forgotten skills.
• If strong interests exist, assist in pursuing.
• Do not draw attention to failure.
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Rules for Remembering 4/6
• For current events, use a memory book.
• For poor future memory, use date book.
• If people or faces are unfamiliar, practice
with pictures and remind.
• Use timer, alarm watches, posters, picture
cards, computers, etc., for reminders.
• Follow a routine.
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Environmental Rules 5/6
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If the mind tires easily, reduce demands.
If confused in a group, remain close by.
If better alone, assure quiet times alone.
If the body tires easily, assure rest breaks.
If noise overwhelms, minimize noise.
If reaction time is slow, plan for safety.
Simplify the environment.
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Review: ENGAGEMENT 6/6
• Identify the current physical, cognitive and
behavioral limitations.
• Plan and practice your rehabilitative
behaviors to match current requirements
as guided by the neuropsychologist.
• Fade away your rehabilitative behaviors
slowly as the person regains function, but
continually assess while gains stabilize.
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MINIMIZING INCIDENCE 1/6
• Non-TBI Causes of ABI
• Minimize Non-TBI Events
• Causes of TBI Alone
• Minimize TBI Events
• Review: INCIDENCE
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Non-TBI Causes of ABI 2/6
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Chemotherapy
Stroke
Cardiac arrest
Heart attack
AVM
Aneurysm
Near suffocation
Near drowning
High fever
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Lightening
Near electrocution
Epileptic seizures
Infection
Anesthesia
Brain tumor
Brain/cardiac surgery
Poisoning
Drugs, alcohol
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Minimize Non-TBI Events 3/6
• Best medical practices for
conditions that may lead
to brain injury
• Reduce hospital caused
infections
• Minimize surgery through
lifestyle changes
• Reduce poisonings
• Add brain injury to drug &
alcohol prevention &
treatment
• Use Centers for Disease
Control and Prevention
materials to educate all
physicians about brain
injury
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Causes of TBI Alone 4/6
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Shaken baby
Playground falls
Bicycle accidents
Skate/snow boarding
Skiing, water skiing
Motorcycle
All terrain vehicles
Surfing
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Motor vehicle crashes
Slip and fall
Stair falls
Team sports
Boxing
Assault, abuse
Gunshot
Falling object
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Minimize TBI Events 5/6
• Raise public awareness
• Educate parents, baby
sitters, children, seniors
• Promote/require seat
belts, child safety seats
• Regulate playground
equipment & surfaces
• Require Driver’s
Education
• Involve school nurses
• Promote/require helmets
and set minimum ages
• Promote/require sports
concussion rules
• Promote/require gun
safety and safe streets
• Set warehouse store and
workplace safety rules
• Set higher penalties for
assaults/injuries to head
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Review: INCIDENCE 6/6
• Trauma is just one of many events that
can result in an acquired brain injury.
• To minimize disability, minimize the
incidence of all events that may cause an
acquired brain injury.
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STATISTICS 1/14
• How large is the problem?
• Comparable prevalence
• Comparable incidence
• PA Department of Health TBI Statistics
• Centers for Disease Control & Prevention
• Review: STATISTICS
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How Large is the Problem? 2/14
• 9.9 million Americans are disabled by just two types of
ABI: TBI (5.3 million) and stroke (4.6 million).
• 457,642 in PA are disabled by just two types of ABI: TBI
(245,000) and stroke (212,643).
• 55,022 Pennsylvanians are hospitalized each year by
TBI (7,800) and stroke (47,222).
• 41,000 TBI emergency room visits in PA each year result
in a TBI diagnosis.
• 32,179 PA children under age 21 in 2004 had been
admitted to a hospital due to TBI.
• 1,200 are discharged from brain injury rehabilitation to a
nursing home or family supervision each year.
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Comparable Prevalence 3/14
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9,900,000 disabled by stroke and trauma
7,300,000 with intellectual disabilities
5,400,000 disabled by mental illness
190,000 paralyzed by spinal cord injury
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Comparable Incidence 4/14
• 1,500,000 traumatic brain injuries each year with
50,000 deaths + 80,000 disabled.
• 730,000 new strokes each year with 160,000
deaths + 399,000 disabled.
• 176,300 new breast cancers + 43,700 deaths.
• 43,681 new HIV/AIDS cases + 17,930 deaths.
• 10,400 new cases of multiple sclerosis yearly.
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PA DOH TBI Statistics 5/14
• http://www.health.state.pa.us/pdf/php/injprev/tbihospital.pdf
• Strotmeyer SJ, Weiss HB, Fabio A. Traumatic
Brain Injuries in Pennsylvania: Hospital
Discharges 1995-1999. Pittsburgh,
Pennsylvania: Center for Injury Research and
Control (CIRC), Department of Neurological
Surgery, University of Pittsburgh, 2002.
• Cont.
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PA DOH TBI Statistics, cont.6/14
• Data from PA Health Care Cost Containment
Council covers a five year total from 1995-1999.
• 74,578 hospital discharges for TBI.
• 10.4% were 15-19 or 184.7/100,000 incidence.
• 50.9% of cases age 39 or younger.
• Overall males 160.5 vs. 90.6 for females.
• Black males 225.3 vs. white males 137.5.
• Highest incidence 424.0 in those over 85.
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TBI History: <21 in 2004 7/14
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Notes: <21 in 2004 8/14
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TBI: <21 in 2004,Bicycle 9/14
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Notes:<21 in 2004, Bicycle 10/14
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TBI: 0-85 in 2004, Notes 11/14
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Notes: 0-85 in 2004, cont. 12/14
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Centers for Disease
Control and Prevention 13/14
• For information on TBI, go to the National Center
for Injury Prevention and Control:
http://www.cdc.gov/ncipc/tbi/TBI.htm
• 5.3 million or 2% of Americans have a long term
or lifelong need for assistance with activities of
daily living due just to a traumatic brain injury.
• For TBI alone, direct medical costs and indirect
costs such as lost productivity were estimated at
$60 billion in the United States in 2000.
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Review: STATISTICS 14/14
• Brain injury disables more Pennsylvanians than
mental illness or mental retardation.
• All disability prior to age 22 is considered a
developmental disability – and diagnosed as
mental retardation if the resulting IQ is <70.
• 32,179 children under 21 had a hospital
discharge diagnosis of TBI in 2004, but there is
no protocol for brain injury rehabilitation through
Medical Access. Only 912 children are identified
with TBI in special education in Pennsylvania.
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PENNSYLVANIA’S
RESPONSE 1/16
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Pennsylvania’s History
SB 1190, 2001, Rehab Study
HB 2902, 2002, Insurance
Pennsylvania’s 0.003% Brain Injury Rehabilitation Rate
Our Children are Federally Entitled to Rehabilitation
Barriers to Children’s Rehabilitation
Barriers to Adult Rehabilitation
Public Systems Without Screening or Rehabilitation
Surveys: Children & Inmates
The Brain Injury Recovery Blueprint
Current Events
Review: PENNSYLVANIA
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Pennsylvania’s History 2/16
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1988 DOH Head Injury Program. 60 in rehab.
1989 Auto CAT Injury Fund admissions closed.
1992 DPW OBRA Waiver. 150 in rehab.
1997 DPW Independence Waiver. 150 in TBI.
2001 DOH TBI Advisory Board.
2001 SB 1190, Senator Jane Orie, five years of rehab.
2002 DPW CommCare Waiver. 250 in rehab.
2002 HB 2902, Rep. Lita Cohen, rehab in all insurance.
2005 DPW HCBS SPT Brain Injury Work Group.
2006 Brain Injury Work Group Report approved.
2006 DPW/GOHCR MedStat Report on TBI.
2007 PDE Special Education lists 912 Children as TBI.
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SB 1190, 2001,Rehab 3/16
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SB 1190, 2001, cont. 4/16
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HB 2902, 2002,Insurance 5/16
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HB 2902, 2002, cont. 6/16
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Pennsylvania’s 0.003% Brain Injury
Rehabilitation Rate 7/16
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458,000 disabled by brain injury in PA
OBRA
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CommCare
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PA HIP
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Special Ed
912
1,372
• 1,372/458,000 X 100 = 0.003 % served.
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Our Children are Federally
Entitled to Rehabilitation 8/16
• All disabled PA children are Medicaid-eligible.
• All Medicaid-eligible children are federally
entitled to all necessary services to ameliorate
whatever condition they have according to
E.P.S.D.T. §1396(d)(r)(5) up to age 21.
• School children with brain injury and with
traumatic brain injury are to be accommodated
under §504 and appropriately served within
special education under I.D.E.A. as needed.
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Barriers to Children’s
Rehabilitation 9/16
• Usually, there is no treating neuropsychologist or rehabilitation.
• Parents may not know to apply for MA. Parents are incorrectly told
that schools will provide rehabilitation but IEP’s are not based on
neuropsychological evaluations, schools ignore the child’s treating
neuropsychologist, and children are labeled as MH, MR, LD, ADD,
ADHD, or SED.
• MA lacks a plausible rate structure for neuropsychological services,
a protocol for children’s brain injury rehabilitation, and a model Letter
of Agreement between Physical and Behavioral Health to cover
neuropsychological services.
• MA denials do not result in a denial letter, preventing an appeal.
• Coordination between MA and 3rd party insurers is difficult and MA
and 3rd party insurer decisions are not timely.
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Barriers to Adult
Rehabilitation 10/16
• Medicaid omits brain injury rehabilitation.
• Medicare omits brain injury rehabilitation.
• Worker’s compensation sends cognitively
impaired people back to work to be fired.
• Private insurance seldom covers.
• Shame and confusion block access.
• CommCare and PHIP have low funding,
providers have waiting lists, and cannot accept
court ordered or difficult clients.
• OVR only accepts those who can be
competitively employed in 18 months.
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Public Systems Without
Screening & Rehabilitation 11/16
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Medical Access
Early Learning
Children, Youth and Families
Special Education
Developmental Programs
Behavioral Health
Substance Abuse in OMHSAS and BDAP
Juvenile Justice
Mental Health Courts, parole, probation
County jails and state prisons
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Surveys:Children & Inmates 12/16
• The Mt. Sinai Brain Injury Screening
Questionnaire found 20% of LD children and
30% of SED in Chicago Special Education were
actually brain injured. Contact Wayne Gordon,
PhD, at [email protected].
• Ken Carlson of the Minnesota Department of
Corrections reports 85% of state inmates appear
to be brain injured, based on the preliminary
results of their current study. Contact him at 651361-7286.
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THE BRAIN INJURY
RECOVERY BLUEPRINT 13/16
• 2005 - Secretary Estelle Richman charged the Brain injury Work
Group with an ideal system for brain injury services for all ages.
• 2006 – The Brain Injury Recovery Blueprint was approved.
• This model (www.abin-pa.org, Education) includes screening,
assessment, planning, rehabilitation, training, standards and crosssystems integration for all children, and for adults served in any
public service system.
• An initial simple screening could resemble the Alaska screening.
• Positive screens could lead to the more detailed Mt. Sinai Brain
Injury Screening Questionnaire prior to a full evaluation.
• 2007 - An internal analysis of necessary systems changes was
completed.
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Current Events 14/16
• A proposed Adult Protective Services Bill would allow
individuals to report abuse against adults under 60. This
would be very helpful. Status unknown.
• An Assisted Living Bill is being drafted by the Office of
Long Term Living. Cognitive services for those with
brain injury must be included. Comments were sent.
• The MedStat report (DPW/GOHCR) has a section
focusing on brain injury and proposing changes, but
attention has not yet turned to this section.
Cont.
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Current Events, cont. 15/16
• The Department of Public Welfare is working on
implementing the Brain Injury Recovery Blueprint.
• A bill proposes excess Auto CAT Continuation funds be
spent on brain injury research, but we already have
solutions that are not being provided under Medical
Access - HBOT, homeopathy, and rehabilitation.
• On September 1st, the two year school re-entry project of
the Department of Health begins under a federal
Maternal & Child Health grant to train and mentor ten
teams across the state.
• Under a federal TBI Grant, the Department of Health will
soon start a health workers training project.
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Review: PENNSYLVANIA 16/16
• The Department of Public Welfare and the
Department of Health recognize rehabilitation
minimizes disability and lifetime costs after
acquired brain injury.
• Implementing the Brain Injury Recovery
Blueprint, expanding the Head Injury Program
(DOH) and CommCare Waiver (DPW), and
requiring private insurance coverage are
essential to controlling this epidemic.
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ACTION:Systems Change 1/3
• Implement the Brain Injury Recovery Blueprint to
screen, assess, plan, and treat all children and
those adults in publicly funded systems.
• Create a four tier provider licensing system to
match all levels of need: 1) pre-vocational; 2)
intense support, 3) coma or minimally conscious;
and 4) violent/court ordered.
• Create a joint DPW/PDE/DOH authority to
eliminate barriers, coordinate systems, and
provide children’s brain injury rehabilitation to
meet the federal mandate EPSDT1396(d)(r)(5).
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ACTION:Minimize state costs – 2/3
• Eliminate the two-year Social Security
Disability wait for Medicare and add brain
injury rehabilitation to the list of Medicare
services.
• Require all healthcare insurance to cover
brain injury rehabilitation (HB 2902, 2002).
• Re-activate the Auto CAT Fund.
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ACTION: Decrease disability 3/3
• Double DPW CommCare Waiver funds.
• Double DOH Head Injury Program funds.
• Add adult outpatient brain injury
rehabilitation to the state Medicaid menu
(SB 1190, 2001).
• Minimize the incidence/severity of events
that may cause an acquired brain injury.
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SUMMARY
• Events leading to possible brain injury are
epidemic and must be minimized.
• Disability after brain injury is epidemic in
Pennsylvania and must be minimized
through rehabilitation for all through public
funding or private insurance.
• All systems must assist clients to recover
through the Brain Injury Recovery
Blueprint model.
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RESOURCES
• Acquired Brain Injury Network of PA at www.abin-pa.org
• Brain Injury Association of America 1-800-444-6443 at
www.biausa.org
• Brain Injury Association of New Jersey 1-732-738-1002 and
www.bianj.org
• Brain Injury Association of Pennsylvania, trained volunteers will
return your call 1-866-635-7097 and www.biapa.org
• Brain Injury Help Line, daily, free literature 1-866-412-4755, DOH
• CommCare (TBI) Waiver 1-800-757-5042, DPW
• Head Injury Program Enrollment Assistance 1-866-412-4755
• Office of Vocational Rehabilitation for re-training at
http://www.dli.state.pa.us/landi/site/default.asp, DL&I
• Pittsburgh Area Brain Injury Alliance, Inc., 1-412-761-9870 and
www.pabia.org
• Special Education Consult Line 1-800-879-2301, PDE
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CONTACT
Barbara A. Dively
2275 Glenview Drive
Lansdale, PA 19446-6082
215-699-3391
[email protected]
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