alaska brain injury network, inc

Grace SniderResource Navigator Program Director

907-274-2824toll free: 888-574-2824

grace@alaskabraininjury.net

Alaska Brain Injury Network, Inc. Track needs of

Alaskans TBI survivors/family

members are the experts.

Make recommendations to Department of Health and Social Services and the Alaska Mental Health Trust

Bring brain injury services close to home

Prevention First!

Information and Referral

Online Resource Directory and Library Materials

Online Discussion Group

Library Advocacy Network of consumers,

professionals, policy makers, and advocates to make systems change!

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ABIN Mission: Educate, plan, coordinate, and advocate on behalf of survivors of TBI and

their families

Special thank you to:

Alaska Native Tribal Health Consortium Injury Prevention

Program

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Traumatic Brain Injury in Alaska:Who, How and Where

Alaska Native Tribal Health Consortium

Injury Prevention Program

What is a Traumatic Brain Injury?

CDC describes it as:

“…caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.”

How do you get a TBI?

Many different kinds of events, some that are almost everyday events, can cause a

TBI:

Hitting your head when you fall or trip

Crashing your bike, snow machine or ATV

Being in a motor vehicle crash

Injure your head during sports

Being near an explosion

How does a TBI affect you?

If you or someone else gets a TBI, it can cause temporary or permanent changes in:

Thinking (remembering and reasoning)

Physical abilities (walking, coordination)

Sensation (touch, taste, smell)

Language (understanding, communication)

Emotion (depression, aggression, anxiety)

Increased Risk of TBI

Who?

The Gender GapNon-fatal TBI Hospitalizations in Alaska 2004-2008

Age DifferencesNon-fatal TBI Hospitalizations in Alaska 2004-2008

Age groups and Activities

Different age groups have different activities that result in the highest numbers of TBI:

Ages (years) Activities with the most TBI 0-9 Falls

10-19 Motor vehicle, ATV/Snowmachine

20-39 Motor vehicle, Assault

40+ Falls, Motor vehicle

Increased Risk of TBI

Where?

Region of Patient ResidenceNon-fatal TBI Hospitalizations in Alaska 2004-2008*

All U.S. Rate**: 93

All Alaska Rate*: 92

Alaska Native Rate*: 174

* Crude rates, reported as TBI per 100,000 people

** All U.S. rate for 2002-2006, per CDC.

Specific places of occurrence Non-fatal TBI Hospitalizations in Alaska 2004-2008

Highway

Home

Public Place

Industrial Place

Recreation Sports

Residential Institution

Other

Increased Risk of TBI

Is Alcohol a Risk Factor?

Yes

Alcohol Association by Age Non-fatal TBI Hospitalizations in Alaska 2004-2008

Alcohol by Activity Non-fatal TBI Hospitalizations in Alaska, 2004-2008

Cases associatedACTIVITY with alcohol

Assault 3 out of every 4

Suicide attempt and Snow machine 1 out of every 2

Pedestrian and All-terrain vehicle 2 out of every 5

Motor vehicle traffic 1 out of every 3

All other 1 out of every 5

Alcohol by Activity Non-fatal TBI Hospitalizations in Alaska2004-2008

Percent of cases ACTIVITY Total Cases associated with alcohol

Assault 37572%

Snow machine 12149%

Suicide attempt 27 48%

Pedestrian 108 41%

All-terrain vehicle 240 39%

Motor vehicle traffic 644 32%

Bicycle 132 23%

Falls 1034 18%

All other 408 18%

Increased Risk of TBI

How severe?

Time in Hospital

For TBI hospitalizations from 2004-2008, the length of time patients spent in the hospital:

Average:5.6 days (compared to 3.9 for

non-TBI injuries)

Maximum: 305 days (10 months)

Patient destination at dischargeNon-fatal TBI Hospitalizations in Alaska

2004-2008

2082

521

162

83

71 44 29 97Home,No Assistance

Acute Care Hospital

Inpatient Rehabilitation

Skilled Nursing

Home,Rehab Outpatient

Home,Health Care

Left against medical advice (AMA)

Other or unknown

Patient’s General Condition on Discharge

Condition Frequency %

Good, Return to Previous Level of Function861 28

Temporary Disability, Expected to Return 1111 36to Previous Level of Function

Moderate Disability with Self Care 133 4

Severe Disability, Dependent 155 5

Persistent Vegetative State 4 .1

Unknown 825 27

Risks of TBI

How much $$?

Hospitalization costs

Hospitalization costs for TBI in all Alaska averages $29,000 per injury, compared to the $20,000 average for all injury hospitalizations

Estimated total per year: $16.7 million

Highest hospitalization cost for TBI: $1,010,000

Medivac costsThese costs vary dramatically depending on the contract with the Medivac company.

These are cost ranges Alaska companies provided for actual trips taken:

Juneau to Seattle: $17,000 to $37,000

Anchorage to Seattle: $27,000 to $56,000

Nome to Seattle: $37,000 to $75,000

Anchorage to Richmond, VA: $63,000 to $124,000

Prevention

What is being done?

Snowmachine, ATV, and

Motorcycle Safety

Child Motor Vehicle Safety

Gun Safes

Reducing harm from guns

Date: Resident: Assessment by:

This Home Safety Survey is designed to look for hazards in and around the house so they can be fixed before they cause problems. Home safety problems could lead to unintentional injuries from falls, burns, or poisoning. Falls can be a major problem for an elder. Falling can result in serious injury or loss of independence. This survey can be done by a CHA/P, CHR, or a family member.

YES NO

Home Entrance

Steps and walkways in good repair; no broken edges or boards or other hazard

Secure ramp installed if resident uses a wheelchair or finds stairs difficult

Exterior stairs and landing are slippery when wet

Area on roof for ice/snow to accumulate and slide onto landing, stairs, or ramp

Secure, sturdy railing on both sides that is easy to grasp with both hands

Lights that light up a wide area of the yard and walkway

Lock that does not need a key to open from inside (unless wandering is an issue)

Mat, carpeting or textured floor in entryway to prevent slipping when wet

Seat available for putting on and removing ice grippers or cleats

Living Areas

Doorways wide enough to use a walker, a wheelchair, or if carrying a load

Open pathways with no small furniture, clutter, or "stuff"

Throw rugs or mats

Thresholds between rooms/floor textures are smooth with visible color contrast

Electric phone cords running under rugs or carpeting or across open areas

Frayed electric cords

Electric outlets and switches overloaded (warm to the touch)

Lights can be turned on without walking across a dark room

Home Safety Survey

Ice cleats

Home modification

Raising awareness

Bike Safety

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Pedestrian Safety

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ANTHC Traumatic Brain Injury Contacts

Jaylene Wheeler, Injury Prevention Coordinator(907) 729-3799 jzwheeler@anthc.org

Hillary Strayer, Senior Injury Prevention Specialist (907) 729-3513 hdstrayer@anthc.org

Website: http://www.anthc.org/chs/wp/injprev/

Once an injury occurs…Ideal system of care vs. Alaska’s

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Prevention

RESEARCH

trauma Pre -

Hospital,

Emergency

Medical

Services

Emergency

DepartmentAcute

Care

Inpatient

Rehabilitation

COMMUNITY

Out Patient Rehab

Education

Family Support Services

Housing

Vocational

Training/Employment

Long Term Services and

Supports

Physicians

CASE MANAGEMENT/

SERVICE COORDINATION

Prevention

RESEARCH

Pre -

Hospital,

Emergency

Medical

Services

Emergency

Department

Acute care

Post AcuteCare

Inpatient

Rehabilitation

COMMUNITY

Out Patient Rehab

Education-Training

-Resource Navigator

Family Support Services

Housing

Vocational

Training/Employment

Long Term Services and

Supports

Physicians

CASE MANAGEMENT/

SERVICE COORDINATION

TraumaAlaskans suffer TBI 28% more than the lower

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Screening

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Locating needed services…

Information and ReferralCare Coordination (Case Management)Acute and Post-acute RehabEducation and Related SupportsVocational Training and RehabilitationLong-Term Community Supports

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Alaska Brain Injury Network’s Resource Navigation Program

Available to ANYONE in the State looking for resources for brain injury.

Helping people find… Information about brain injuries Services to help them recover Help brainstorming solutions Someone to listen and understand.

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How ABIN can help you?Information and Referral

Aka Resource Navigation!Online Discussion GroupWebsite

Resource DirectoryOnline Resource Library

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Resource #1: Alaskan Brain MattersOnline Discussion Group – Email Group

Group for survivors, caregivers, and providers to share information and offer support

Dialogues that make a differenceUrgent needs met immediately (case example)

Advocacy Works! Your voices make a difference

To join, email contact@alaskabraininjury.net

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Resource #2: WebsiteWebsite www.alaskabraininjury.net

Resource DirectoryFind community resources: physical therapists,

occupational therapists, speech therapists, vision therapy, biofeedback, counseling, assessment, independent living centers, accessibility, state agency programs, vocational rehab, and more.

Library of articlesFind educational materials for various topics.

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Head Injury Support Groups

Juneau: Margie Thomson/SAIL (907) 796-6465

Anchorage: Frank Box, Access Alaska (907) 263-1905

Fairbanks: Access Alaska (907) 479-7940

Mat-Su: Angie Boardman Access Alaska/Mat-Su Health Serv.(888)

574-2824

Homer: Cathy Stingley, Thoughtful Therapies (907) 235-

6226

Ketchikan: Pat Chapman (907) 617-5704

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Mentoring Similar Experiences

Share what resources and supports that have worked for them

Don’t feel so alone

A Friend

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Information about brain injuries

Trust Training Cooperative Acquired Traumatic Brain Injury Case Management

training https://www.ttclms.org/class_detail.php?z_classid=1

01877 Lash and Associates

www.lapublishing.com Tip cards, books, DVD’s

3rd Thursday Teleconference Training lrivard@lakeview.ws

American Academy of Certified Brain Injury Specialists, www.aacbis.net

National Websites44

What is being done to improve the system of care in Alaska:

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Developing InitiativesInformation and Referral (ABIN, ADRC,

211)Case Management DHSS, Senior and

Disabilities Services (2009)State ATBI Program (2010)

TBI Program CoordinatorData collectionExpand Care Coordination

TBI Training-Intro to TBI course, Advance Management in Brain Disorders (2008)

ImPACT-concussion management, Alaska Neuro Associates

Public Awareness- Callan Chylook-Sifsof, television commercials, newspaper ads, posters.

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"An Act establishing a traumatic or acquired brain injury program and registry within the Department of Health and Social Services; and relating to medical assistance coverage for traumatic or acquired brain injury services."

SB 219 Introduced by Senator Lesil McGuire, family member of a TBI survivor, January 19, 2010, added “acquired” brain injury - ATBI

The Alaska Acquired and TraumaticBrain Injury ProgramSB 219 – ATBI Program

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State responsibilities under SB 219Assessment of the scope, availability and effectiveness of current ATBI services

Supervision, coordination and expansion of ATBI services

Development of standards for prevention and treatment of ATBI

The Alaska Acquired and TraumaticBrain Injury ProgramSB 219 – ATBI Program

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State responsibilities under SB 219Development and maintenance of an ATBI Registry to track the status and outcomes for people served by the ATBI Program

The addition of targeted case management as a Medicaid service for people with ATBI, which will require SDS to develop standards and regulations for delivery of this service ($1.2 million fiscal note)

The Alaska Acquired and TraumaticBrain Injury ProgramSB 219 – ATBI Program

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What works for you?

Case by Case basisDifficult to know what will work for

someone until you get to know them.Find colleagues to brainstorm with.Get comfortable with ambiguity. (from Dr. Jeffrey

Barth)

Recognize and embrace the complexity of TBI and treat it as a challenge to your scientific and clinical skills. (from Dr. Jeffrey Barth)

Feel free to contact me. Jennifer at 907-274-2824jennifer@alaskabraininjury.net

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Troubleshooting brain injury…

• Understanding the symptoms • Brainstorming solutions

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Four areas of effectsPhysical LinguisticCognitiveEmotions and Behaviors

What you might see after TBI

HeadachesFatigueSleeping in classSeems tuned outPhysical weaknessSeizuresClumsiness

What you might see:physical effects

Difficulty finding the right wordCocktail party languageReceptive or expressive language

What you might see:language/linguistics

What you might see:cognitive effects

Irritability, angry outbursts, impulsivityAggressive acting outPassive behaviorSocial immaturitySexually inappropriate behaviorDepressionFrustrationDisinhibitionSelf monitoringInterpreting social cues

What you might see:emotions and behaviors

Shorter day

Frequent breaks

Person driven solutions

Build in success

What can we do?

Shorten tasks/assignments

Be flexible with expectations

What can we do?

Follow routine

Daily schedule/picture schedule

What can we do?

Minimize distractions

Give choices

Limit changes

Predictability

What can we do?

Use cues!VisualTools

PlannerComputerWatch/alarmTimers

THANK YOU FOR YOUR TIME

What can we do?