Transcript Document

TBI In The 21st Century:
Challenges and Opportunities
A presentation for:
ISU-Inst. of Rural Health
February 6, 2003
Brain Injury
Association
of America
Allan I Bergman
President/CEO
www.biausa.org
SS 1 January 2003
Organizational Histories
•
•
•
•
•
•
1919 – Ohio Society for Crippled Children
1940 – National Foundation for the Blind
1948 - Association for Retarded Children
1948 - United Cerebral Palsy Association
1971 - Independent Living Center/Berkeley
1974 - People First
Brain Injury
Association
of America
SS 2 January 2003
Organizational Histories (cont.)
• 1980 – National Head Injury Foundation
2001 renamed as the
Brain Injury Association
Of
America
Brain Injury
Association
of America
SS 3 January 2003
Disability Legislative History
• 1904: Library of Congress Braille and
Recorded Materials
• 1928: Vocational Rehabilitation Program
• 1935: Crippled Children’s Services
• 1961: President’s Panel on Mental
Retardation
Brain Injury
Association
of America
SS 4 January 2003
Disability Legislative History
• 1963: Mental Retardation Facilities and
Community Mental Health Centers Act
• 1973: National Council on Disability
• 1973: Independent Living Centers
• 1975: Education for All Handicapped
Children Act
Brain Injury
Association
of America
SS 5 January 2003
Disability Legislative History
• 1975: Protection & Advocacy Services for
Persons with Developmental Disabilities
• 1986: Protection & Advocacy Services for
Persons with Mental Illness
• 1990: “TBI” added to Special Education
• 1990: Americans with Disabilities Act
Brain Injury
Association
of America
SS 6 January 2003
Disability Legislative History
• 1996: Traumatic Brain Injury Act
• 2000: Traumatic Brain Injury Act
Amendments
• 2001: Congressional Brain Injury Task
Force
•
Is your Congressperson a Member?
Brain Injury
Association
of America
SS 7 January 2003
Mission Statement
To create a better
future through brain
injury prevention,
research, education
and advocacy.
Brain Injury
Association
of America
SS 8 January 2003
Web Site
www.biausa.org
• Public Policy Corner
• And
• Legislative Action Center
Brain Injury
Association
of America
SS 9 January 2003
www.biausa.org
412,000 unique visitors in
2001
Improved and Expanded Site September 2002
Brain Injury
Association
of America
SS 10 January
2003
Family Helpline
Over 17,000 calls in 2002
Se Habla Espanol
Brain Injury
Association
of America
SS 11 January
2003
Traumatic Brain Injury
An insult to the brain, not of degenerative or
congenital nature, caused by an external
physical force that may produce a
diminished or altered state of
consciousness, which results in an
impairment of cognitive abilities or physical
functioning and/or a disturbance of
behavioral or emotional functioning.
Brain Injury
Association
of America
SS 12 January
2003
“Traumatic Brain Injury and
Concussion in Sports”
• “The terms concussion and mild TBI are
used interchangeably as is consistent with
the U.S. medical literature.”
JAMA, September 8, 1999
James P. Kelly, M.D.
Brain Injury
Association
of America
SS 13 January
2003
Consequences Of Brain Injuries
Cognitive Consequences Can Include:
• Short-term memory loss; long-term memory loss
• Slowed ability to process information
• Trouble concentrating or paying attention for periods of time
• Difficulty keeping up with a conversation;other communication difficulties
such as word finding problems
• Spatial disorientation
• Organizational problems and impaired judgment
• Unable to do more than one thing at a time
• A lack of initiating activities, or once started, difficulty in completing
tasks without reminders
Brain Injury
Association
of America
SS 14 January
2003
Consequences Of Brain Injuries
Physical Consequences Can Include:
• Seizures of all types
• Muscle spasticity
• Double vision or low vision, even blindness
• Loss of smell or taste
• Speech impairments such as slow or slurred speech;
• Headaches or migraines
• Fatigue, increased need for sleep;
• Balance problems
Brain Injury
Association
of America
SS 15 January
2003
Consequences Of Brain Injuries
Emotional Consequences Can Include:
• Increased anxiety
• Depression and mood swings
• Impulsive behavior
• More easily agitated
• Egocentric behaviors; difficulty seeing how behaviors can
affect others
Brain Injury
Association
of America
SS 16 January
2003
Brain Injury
Association
of America
SS 17 January
2003
Statistics
•
At least 1.5 million Americans sustain a traumatic
brain injury each year
•
Each year, 80,000 Americans experience the onset
of long-term disability following TBI
•
More than 50,000 people die every year as a result
of TBI
•
The cost of TBI in the U.S. is estimated to be $48.3
billion annually
Brain Injury
Association
of America
SS 18 January
2003
Public Perceptions of Traumatic
Brain Injuries
Harris Poll
May 18-June 4, 2000
Brain Injury
Association
of America
SS 19 January
2003
Comparison of Annual Incidence
A comparison of Traumatic Brain Injury and Leading injuries or Diseases
Traumatic Brain
Injuries 1,500,000
2,000,000
1,500,000
1,000,000
500,000
100,000
Multiple
Sclerosis
10,4000
Spinal Cord
Injuries
11,000
HIV/AIDS
43,681
Breast
Cancer
176,3000
10,000
Brain Injury
Association
of America
SS 20 January
2003
At least 5.3 million Americans –
a little more than 2 percent of the
U.S. population – currently live
with disabilities resulting from
traumatic brain injury.
Brain Injury
Association
of America
SS 21 January
2003
Injury and Disability Prevalence Rates
400,000 w/ Spinal Cord Injuries
500,000 with Cerebral Palsy
2 million Americans with Epilepsy
3 million with Stroke disabilities
4 million with Alzheimer’s Disease
5 million with persistent mental illness
5.3 million with TBI disability
7.3 million Americans with mental
retardation
Brain Injury
Association
of America
National organizations’ web sites, 4/2000
SS 22 January
2003
Trends In TBI Incidence
 22% decline in TBI mortality rates, 19791992 (Sosin et al., JAMA 1995; 273:1778)
 51% decline in TBI hospitalization rates,
1980 to 1995 (Thurman & Guerrero, JAMA 1999; 282:954)
Brain Injury
Association
of America
SS 23 January
2003
TBI Rates By Age And Cause
14 States, 1995-96
160
140
Rate per 100,000
120
100
Falls
80
Transport
60
40
20
Firearms
0
00-04
05-14
15-24
25-34
35-44 45-54
55-64
65-74 75-UP
Age
Brain Injury
Association
of America
SS 24 January
2003
TBI Percent By Cause
14 States, 1995-96
Other/Unknown
12%
Transport
45%
Brain Injury
Association
of America
Falls
26%
Firearms
8%
Other Assault
9%
SS 25 January
2003
Children and TBI
• Traumatic Brain Injury is the Leading
Cause of Death and Injury-Related
Disability Among Children and Young
Adults.
Brain Injury
Association
of America
SS 26 January
2003
IDEA Definition of TBI
“An acquired injury to the brain caused by an
external physical force resulting in total or
partial functional disability or psychosocial
impairment, or both, that adversely affects a
child’s educational performance. The term
applies to open or closed head injuries
resulting in impairments in one or more
Brain Injury
Association
of America
SS 27 January
2003
IDEA Definition of TBI, cont.
Areas, such as cognition, memory, language,
attention, reasoning, abstract thinking,
judgment, problem-solving, sensory,
perceptual and motor abilities, psychosocial
behavior, physical function, information
processing and speech. The term does not
apply to brain injuries that are congenital or
Brain Injury
Association
of America
SS 28 January
2003
IDEA Definition of TBI, cont.
Or degenerative, or to brain injuries induced
by birth trauma.”
34CFR300.7(c)(12)
Brain Injury
Association
of America
SS 29 January
2003
Special Education Data 1998-1999
Students Ages 6-21
Total: 5,541,166
TBI: 12,933
Brain Injury
Association
of America
SS 30 January
2003
OSEP “Forum” Survey of 53 State
Education Agencies
July-September 2000
46 Respondents
(43 States and three Non-State jurisdictions)
Brain Injury
Association
of America
SS 31 January
2003
OSEP Forum Survey (Cont.)
Professional Development:
No State reported TBI certification
Oklahoma and Nevada reported teacher
endorsement
10 respondents indicated availability of pre-service
courses
36 respondents reported having in-service training,
workshops, or conferences for educators
Brain Injury
Association
of America
SS 32 January
2003
OSEP Forum Survey (Cont.)
TBI Contact Person:
• 34/46 identified a contact person
• Services Provided
•
Professional development (23)
•
One-on-one consultation and technical assistance (21)
•
Liaison with state TBI projects and other groups (29)
•
Parent contact/workshops (4)
Brain Injury
Association
of America
SS 33 January
2003
Evolution of Disability Services
• Institutionalization: 1848 – 1970’s
• Deinstitutionalization and CommunityBased Programs: 1976 – 1986
• Community Membership and Support: 1987
– Today……….
Inclusion; Circles of Support; Personal
Futures Planning; Self Determination
Brain Injury
Association
of America
SS 34 January
2003
DISABILITY POLICY
FOR THE
NEW MILLENIUM
Brain Injury
Association
of America
Brain Injury Association,
Inc.
SS 35 January
2003
“(3) disability is a natural part of the human experience
and in no way diminishes the right of individuals to—
“(A) live independently;
“(B) enjoy self-determination;
“(C) make choices;
“(D) contribute to society;
“(E) pursue meaningful careers; and
“(F) enjoy full inclusion and integration in the
economic, political, social, cultural, and educational
mainstream of American society
Brain Injury
Association
of America
SS 36 January
2003
NIH Consensus Development
Conference, October 1998
Rehabilitation of Persons with
Traumatic Brain Injury
Brain Injury
Association
of America
SS 37 January
2003
NIH Panel Recommendations
• Rehabilitation Services should be matched
to the needs, strengths, and capacities of
each person with TBI and modified as those
needs change over time.
• Rehabilitation Programs for persons with
moderate or severe TBI Should be
interdisciplinary and comprehensive.
Brain Injury
Association
of America
SS 38 January
2003
NIH Panel Recommendations-2
• Families and significant others provide
support for many people with TBI. To do
so effectively, they themselves should
receive support. This can include in-home
assistance from home health aides or
personal care attendants, daytime and
overnight respite care, and ongoing
counseling.
Brain Injury
Association
of America
SS 39 January
2003
NIH Recommendations-3
• Rehabilitation efforts should include
modifications of the individual’s home,
social and work environments to enable
fuller participation in all venues.
Brain Injury
Association
of America
SS 40 January
2003
NIH Recommendations-4
• Community-based nonmedical services
should be components of the extended care
and rehabilitation available to persons with
TBI. These include but are not necessarily
limited to clubhouses for socialization, day
programs and social skills development
programs, supported living programs and
Brain Injury
Association
of America
SS 41 January
2003
NIH Recommendations-5
• Independent living centers, supported
employment programs, formal education
programs at all levels, case manager
programs to support practical life skill
redevelopment and to help navigate through
the public assistance and medical
rehabilitative care systems, and consumer,
• Brain Injury
peer support programs.
Association
of America
SS 42 January
2003
Assistive Technology Device
Any item, piece of equipment or product system
whether acquired commercially off the shelf,
modified or customized that is used to increase,
maintain or improve functional capabilities of
individuals with disabilities.
Brain Injury
Association
of America
SS 43 January
2003
Assistive Technology and People with
Cognitive Disabilities
•
•
•
•
•
Brain Injury Association of America
Moss Rehabilitation
Temple University
University of Akron
Spaulding Rehabilitation
Brain Injury
Association
of America
SS 44 January
2003
NCMRR Funded TBI
Clinical Trials Network (8
sites)
Brain Injury
Association
of America
SS 45 January
2003
Self Employment Grant -NIDRR
• Rural Institute at the University of
Montana
• State Affiliates
• 20 Small Businesses over 3 Years
• Coordination of Multiple Funding
Streams
• On-site and Distance Technical Training
and Consultation on Business Planning
Brain Injury
Association
of America
SS 46 January
2003
Analysis of the TBI State
Demonstration Grants
Delaware
Georgia
Illinois
Iowa
Mississippi
Oklahoma
Oregon
South Carolina
Texas
West Virginia
Wisconsin
Brain Injury
Association
of America
John Corrigan, Ph.D.
SS 47 January
2003
I. Accessibility
Can a person identify and utilize a service
(assuming it is available)?
• There needs to be easy access to
information about needs and resources.
• Arbitrary barriers are created by service
system eligibility criteria.
• Some sub-populations more readily fall
Brain Injury
Association
of America
SS 48 January
2003
I. Accessibility, cont.
through the gap in the service system.
• Services are not coordinated.
Brain Injury
Association
of America
SS 49 January
2003
II. Availability
What needed services do not exist?
• Funding is a major factor in limiting
services.
• Rural communities have unique problems
of service availability.
• Lack of transportation limits availability.
• Health insurance does not adequately
provide for needed services.
Brain Injury
Association
of America
SS 50 January
2003
II. Availability, cont.
• Treatment for behavioral health needs is
often difficult to obtain.
• Therapies for neurobehavior problems are
generally insufficient.
• Appropriate and affordable housing is
limited.
• Medicaid waivers do not exist or are too
limited in scope.
Brain Injury
Association
of America
SS 51 January
2003
II. Availability, cont.
• Children have special needs that are not
being met.
• Services are not available for the long term
needs of consumers.
Brain Injury
Association
of America
SS 52 January
2003
III. Appropriateness
Are existing resources the right ones for the
needs of the individual?
• Professionals in most service delivery
systems lack knowledge and training to
serve this population.
• There is dissatisfaction with acute
rehabilitation services.
Brain Injury
Association
of America
SS 53 January
2003
III. Appropriateness, cont.
• There is dissatisfaction with employmentrelated services.
• The unique needs of this population
contribute to its needs not being met.
Brain Injury
Association
of America
SS 54 January
2003
IV. Acceptability
Does the service enhance the selfactualization of the person using it?
• The individual’s need for self-determination
is often not recognized by service providers.
• Families need more training and education
about the unique aspects of their role.
Brain Injury
Association
of America
SS 55 January
2003
Brain Injury
Association
of America
SS 56 January
2003
Self Determination 2001
• People With Brain Injury Are
“Speaking Out”
About Quality in Services
National Center on Outcomes Resources
(410) 583-0060
[email protected]
Brain Injury
Association
of America
SS 57 January
2003
Speaking Out
• “I don’t want to feel that I am just getting
the same prepackaged deal as everyone else.
Make it about ME.”
• “My goals should be just that…MY
choice.”
• “Before you ‘release’ me to the community,
help me to build a support network.”
Brain Injury
Association
of America
SS 58 January
2003
Brain Injury
Association
of America
SS 59 January
2003
Traumatic Brain Injury Act 2000
P.L. 106-310
• CDC Expanded Authority:
- Focus incidence and prevalence studies
on children
- Expand surveillance to individuals in
institutional settings
- Engage in public education activities
Brain Injury
Association
of America
SS 60 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• CDC Expanded Authority (continued)
- Study on methodology to obtain
incidence and prevalence data
on “mild” TBI
- Grants to states for registries
Brain Injury
Association
of America
SS 61 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• HRSA State Grant Authority Revised and Expanded:
- No state match requirement
- Continuation grants beyond planning and
implementation grants
Brain Injury
Association
of America
SS 62 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• HRSA State Grant Authority Revised and Expanded:
- New grants focus:
State Capacity Building –
- Educate consumers and families
- Train professionals
Brain Injury
Association
of America
SS 63 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• HRSA State Grant Authority Revised and Expanded:
- State Capacity Building (continued):
- Develop/improve case management/service
coordination
- Develop best practices
- Improve data sets
- Develop capacity within targeted communities
Brain Injury
Association
of America
SS 64 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• HRSA State Grant Authority Revised and Expanded:
- Community Services and Supports:
- Timely Access
- Full participation by individuals with TBI &
families in decisions
- Includes children
Brain Injury
Association
of America
SS 65 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• HRSA State Grant Authority Revised and Expanded:
- Community Services and Supports (continued):
- Focus on outreach to unserved and
inappropriately served individuals
- Contracts to nonprofits for consumer or family
service access training, consumer support, peer
mentoring and parent-to-parent programs
Brain Injury
Association
of America
SS 66 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• HRSA State Grant Authority Revised and Expanded:
- Community Services and Supports (continued):
- Develop individual and family service
coordination or case management systems
- Other needs as identified by advisory board
Brain Injury
Association
of America
SS 67 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• Newly Created Protection and Advocacy Services for
Individuals with T.B.I.
- Information, referrals and advice
- Individual and family advocacy
- Legal representation
- Specific assistance in self-advocacy
Brain Injury
Association
of America
SS 68 January
2003
Traumatic Brain Injury Act
2000 Reauthorization
P.L. 106 – 310
• Specified Research at N.I.H.
- Emphasis on cognitive disorders and
neurobehavioral consequences arising from
T.B.I. including the development, modification
and evaluation of therapies and programs of
rehabilitation toward reaching or restoring
normal capabilities in areas such as reading,
comprehension, speech, reasoning and
deduction.
Brain Injury
Association
of America
SS 69 January
2003
TBI Act Appropriations
• CDC
•
1997 - $2,600,000
•
1998 - $2,812,000
•
1999, 2000, 2001, 2002 $3,000,000/year
•
Request for 2003 • Brain Injury
$7,000,000
Association
of America
SS 70 January
2003
TBI Act Appropriations
•
•
•
•
•
•
HRSA State Grant Program
1997 - $2,857,000
1998 - $3,000,000
1999, 2000, 2001 - $5,000,000/year
2002 - $6,000,000
2003 Request - $9,800,000
Brain Injury
Association
of America
SS 71 January
2003
TBI Act Appropriations
• HRSA Protection & Advocacy Services
• 2002 - $1,500,000
• 2003 Request - $5,000,000
Brain Injury
Association
of America
SS 72 January
2003
TBI Act Appropriations
• NIH / NCMRR
•
2002 - $5,000,000
•
2003 Request - $5,000,000
• NIH / NINDS
•
1997 to 2002 - $5,000,000/year
•
2003 Request - $10,000,000
Brain Injury
Association
of America
SS 73 January
2003
Congressional Brain Injury
Task Force
• Co-Chairs: James Greenwood (R-PA)
and
Bill Pascrell (D-NJ)
• Founded April 2001
• 61 Members Today
Brain Injury
Association
of America
SS 74 January
2003
Americans
With
Disabilities
Act
Brain Injury
Association
of America
SS 75 January
2003
A.D.A. – Disability
The term “disability” means, with respect to an
individual:
•
A physical or mental impairment that
substantially limits one or more of the major
life activities of such individual;
•
A record of such an impairment; or
•
Being regarded as having such an
impairment.
Brain Injury
Association
of America
SS 76 January
2003
Major Life Activities
•
Caring for oneself
•
Speaking
•
Performing manual
tasks
•
Breathing
•
Learning
•
Working
•
Walking
•
Seeing
•
Hearing
Brain Injury
Association
of America
SS 77 January
2003
TBI Act of 2000 - Integration
• “(2) BEST PRACTICES• (A) IN GENERAL – State services and
supports provided under a grant under this
section shall reflect the best practices in the
field of traumatic brain injury, shall be in
compliance with title II of the Americans
with Disabilities Act of 1990, and shall be
Brain Injury
Association
of America
SS 78 January
2003
TBI Act of 2000- Cont.
• …supported by quality assurance measures
as well as state-of-the-art health care and
integrated community supports, regardless
of the severity of injury.”
Brain Injury
Association
of America
SS 79 January
2003
The Disability Community As Defined by
The New Freedom Initiative
 Over 54 million Americans Living with a disability – 20%
of US Population
 Almost half of these individuals have a severe disability
affecting their ability to see, hear, walk or perform other
basic functions of life
 More than 25 million family caregivers and millions more
who provide aid and assistance to people with
disabilities
- January 1, 2002
Brain Injury
Association
DHHS
of America
SS 80 January
2003
Medicaid Expenditures for Long-Term Care Services 1989-2001
(in thousands of dollars)
1989
2001
ACRG 1989-2001
Personal Care
1,656,998
5,254,198
10.1%
HCBS Waiver
943,300
14,382,573
25.5%
Home Health
656,553
2,572,840
12.1%
ICF
8,902,074
SNF
6,766,109
42,727,565
8.7%
ICF-MR
6,628,208
10,351,051
3.8%
Total Long-Term
Care
25,553,242
75,288,226
9.4%
Total Medicaid
58,642,495
214,585,884
11.4%
Brain Injury
Association
of America
SS 81 January
2003
Nursing Home Residents
All families-1997
Total: 1,608,700
Age Distribution:
Under 65 years 65-74 years 75-84 years 85 years and over Brain Injury
Association
of America
8.5%
12.3%
32.8%
45.9%
Source: National Center for Health Statistics
March 1, 2000
SS 82 January
2003
FFY 2000 Medicaid HCBS Waiver Expenditures
by Target Population
MI
0.2%
Source: HFCA 64 data,
Office of State Agency
Financial Management
Aged
2.1%
A/D
19.0%
AIDS/ARC
0.5%
PD
2.5%
Tech. Dep.
0.5%
TBI
0.5%
Brain Injury
Association
of America
MR/DD
74.7%
SS 83 January
2003
Waivers-People with B.I.-2001
•
•
•
•
•
•
•
Colorado
Connecticut
Florida
Idaho
Illinois
Indiana
Iowa
Brain Injury
Association
of America
$5,202,549
$5,034,857
$1,444,600
$ 546,674
$5,822,376
$1,523,948
$2,057,722
SS 84 January
2003
Waivers-People with B.I.-2001
•
•
•
•
•
•
Kansas
Minnesota
New Hampshire
New Jersey
North Dakota
Utah
Brain Injury
Association
of America
$ 3,407,542
$17,017,589
$ 5,657,499
$14,557,615
$ 580,982
$ 1,391,570
SS 85 January
2003
Waivers-People with B.I.-2001
• Vermont
• Wisconsin
$ 2,151,635
$14,397,750
TOTAL
$80,794,908
Brain Injury
Association
of America
SS 86 January
2003
A Successful Community Life
• Housing
• Health Care and Appropriate Medical
Services
• Mental Health/Behavioral Health Services
• Education/Higher Education
• Employment/Supported Employment
• Transportation
Brain Injury
Association
of America
SS 87 January
2003
Successful Community Life - 2
•
•
•
•
•
•
•
Assistive Technology and Devices
Leisure and Recreational Activities
Friends and Relationships; Support Circles
Community Support Workers
Customer Choice and Control
System Infrastructure
Quality Assurance
Brain Injury
Association
of America
SS 88 January
2003
Brain Injury
Association
of America
SS 89 January
2003
Medical “Model”
VS
Psychosocial “Model”
Brain Injury
Association
of America
SS 90 January
2003
FROM A CONTINUUM OF
CARE TO AN ARRAY OF
INDIVIDUAL AND FAMILY
SUPPORTS
Brain Injury
Association
of America
Brain Injury Association,
Inc.
SS 91 January
2003
Medicaid
Independence Plus
May 9, 2002
A Demonstration Program for Family or
Individual Directed Community Services
• Person-Centered Planning;
• Individual Budgets;
• Group Living No More Than 4 Persons;
Brain Injury
Association
of America
SS 92 January
2003
Independence Plus (cont.)
• Services Menu:
•
Case Management
•
Homemaker Services
•
Home Health Aide Services
•
Personal Care Services
•
Adult Day Health Services
Brain Injury
Association
of America
SS 93 January
2003
Independence Plus, cont.
•
•
•
•
•
Habilitation Services
Respite Services
Supports Brokerage Services/Functions*
Fiscal/Employer Agent Services/Functions*
Other
**Required Services
Brain Injury
Association
of America
SS 94 January
2003
Independence Plus, cont.
• Target Groups: NEW…………….
Brain Injury (Acquired)
Brain Injury (Trauma)
Brain Injury
Association
of America
SS 95 January
2003
OPPORTUNITY IS MISSED BY
MOST PEOPLE BECAUSE IT IS
DRESSED IN OVERALLS AND
LOOKS LIKE WORK
Thomas Edison
Brain Injury
Association
of America
SS 96 January
2003
Belonging
be-long, v. 1: to feel and be a part of …i.e.
of a community, a workplace, a
neighborhood or school 2: to enjoy a sense
of contribution, value, self-worth 3: to truly
believe one is a natural and equal part of
the whole 4: comfortable, safe, cared for,
welcome.
Brain Injury
Association
of America
SS 97 January
2003
Vision Statement
Brain Injury
Association
of America
A world where all
preventable
brain injuries are
prevented, all
unpreventable brain
injuries are minimized
and all individuals who
have experienced brain
injury maximize their
quality of life
SS 98 January
2003