interface boulder colorado sandy mccarthy judy dettmer kevin pettit
TRANSCRIPT
INTERFACEBoulder Colorado
Sandy McCarthyJudy DettmerKevin Pettit
Colorado Traumatic Brain Injury Trust Fund Program
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Program Overview
Passed into Law in 2002Title 26, Article 1, Part 3, Colorado Revised Statutes
Created TBI Trust fundAdded surcharges to traffic offensesCreated TBI BoardDesignated allocation of fundsPlaced in Department of Human Services
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Surcharges
$15 for each conviction of driving under the influence (DUI), or driving while ability impaired (DWAI)$10 for each conviction of speedingSurcharges began January 2004Generated over $4 million in first 2.5 years
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TBI Board
13 members3 members designated in statute10 members appointed by the Governor with the consent of the Senate
Diverse group of people with expertise in TBI, including medical providers, health care professionals, survivors and family members, researchers, and State officialsRole is to oversee the operations of the Trust Fund
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Allocation of Funds
65% to provide services to individuals with TBI30% to support research related to the treatment and understanding of TBI5% to provide TBI education for survivors, family members, professionals, educators, and others in the community
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Role of Department of Human Services
Financial managementPolicy developmentProgram development and implementationContract managementProgram monitoringAdministrative supportWebsite maintenancePublic assistance and informationReportingPublic relations
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Client Services Overview
TBI DefinitionEligibility CriteriaCare CoordinationPurchased ServicesIntake and Eligibility ProcessChildren’s ServicesAdult ServicesLimitationsWait List
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TBI Definition
Statute – Injury to the brain caused by physical trauma resulting from but not limited to incidents involving motor vehicles, sporting events, falls, and physical assaults.
TBI Board – Damage to the brain caused by external physical force, including acceleration / deceleration injuries. This does NOT include brain injury caused by a congenital causation, degenerative diseases, surgical interventions or anoxia.
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Eligibility Criteria
Colorado resident & proof of legal presence in U.S.Documentation of a TBI that is sufficient in severity to produce a partial or total disability as a result of impaired cognitive ability and/or physical functioningNo other health or rehabilitation benefit funding sources that cover the services provided by the Trust FundDo NOT have to exhaust private funds
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Care Coordination
All individuals receive Care Coordination services
Assigned care coordinatorDevelop care coordination planIdentify individual needsApply for benefitsAccess existing benefitsFind resources in the communityCoordinate services from different service providersArrange for services through Trust Fund
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Purchased Services
May purchase services including but not limited to:
Community residential servicesStructured day program servicesPsychological and mental health servicesPrevocational servicesSupported employmentCompanion services
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Purchased Services (continued)
Respite careOccupational therapySpeech and language therapyCognitive rehabilitationPhysical rehabilitationOne-time home modificationMany other services that are appropriate for individuals with TBI
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Excluded Services
Institutionalization
Hospitalization
Medications
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Intake and Eligibility Process
Brain Injury Association of Colorado performs client intake and eligibility
Assist individuals with the application processDetermine eligibilityRefer eligible individuals for Trust Fund services
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Children’s Services
Denver Options, Inc. and the Colorado Department of Public Health and Environment, Health Care Program (HCP) for Children with Special Needs provide children’s services
Under age 21Care coordination provided through 14 local health departments around the statePurchase services from service providers throughout the state
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Adult Services
Denver Options, Inc. provides adult services
Age 21 and olderCare coordination provided by Denver Options staff and some contracted care coordinators Purchase services from service providers throughout the state
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Limitations on Services
Limited resourcesProgram intended to fill gaps, not designed or funded to be the individual’s primary source of servicesNot an entitlement program (like Medicaid)Services are subject to available fundingFirst come, first servedIndividuals may receive funds for services for 1 year
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Limitations on Services (continued)
May re-apply to receive another year of care coordination but will go to end of wait list if program is at capacity $2,000 life time limit for purchased servicesPurchased services must be included in Care Coordination Plan and approved in advanceTrust Fund does not pay clients directly
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Research Program
TBI Board awards research grants annuallyInitial grants funded at $50,000 per yearIn 2007 research program was changed to fund 3 levels of grants at $50,000, $250,000 and limitless for level three grantsResearch priorities related to Basic Science, Clinical Science, and Health Services and OutcomesAnnual application and review processHave awarded a total of 16 research grants
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Education Program
Program brochure in English and SpanishWebsite: www.tbicolorado.orgPresentations and exhibit table at conferencesEducation Grants: a total of 46 grants have been awarded
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Additional Information
Brain Injury Association of Colorado4200 West Conejos Place, Suite 524Denver, CO 80204888-331-3311 – toll freewww.biacolorado.org
Department of Human ServicesOffice of Behavioral Health and Housing3520 West Oxford AvenueDenver, CO 80236303-866-7477www.tbicolorado.org
Clinical Intervention
Things to Keep in Mind
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GREIVING AS IT RELATES TO GREIVING AS IT RELATES TO BRIAN INJURYBRIAN INJURY
Brain injury affects all aspects of a persons life(often not the same person anymore)
Grieving is an on-going process and may be heightened at times of transition
Can not rush the grieving process
Recognize when grieving is occurring and provide support as needed
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POTENTIAL BARRIERS TO POTENTIAL BARRIERS TO CLINICAL INTERVENTIONCLINICAL INTERVENTION
Short term memory loss
Attention and concentration
Organizational ability
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POTENTIAL BARRIERS TO POTENTIAL BARRIERS TO CLINICAL INTERVENTIONCLINICAL INTERVENTION
Fatigue
Lack of inhibition
Lack of awareness/insight
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STRATEGIES FOR STRATEGIES FOR ADDRESSING ADDRESSING MEMORY ISSUESMEMORY ISSUES
Encourage the individual to write information down or tape record it
Encourage individual to use as many environmental aides as possible (labeling items, shelves, using bulletin boards etc.)
Give brief and concise instructions
Encourage the individual to ask for instructions repeated as needed
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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING CONCENTRATON/ATTENTION ISSUESCONCENTRATON/ATTENTION ISSUES
Provide the individual with an uncluttered environment
Eliminate as many auditory and visual distractions as possible
Eliminate as many interruptions as possible
Allow the individual to work on one task at a time
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Organizational/Planning Skills Strategies
Do not assume that the individual has the ability to take responsibility for the organizational aspects of his/her program
Understand that it will take an individual with a brain injury longer to learn routines and understand what is expected of them
Provide individual with a day timer and calendar to assist with memory and organization
Assist the individual in using the day timer and calendar until this becomes routine
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Organizational/Planning Skills Strategies
Routines are critical to minimize the need to initiate tasks
Individual may need support to see a task through to completion until the task is routine
Reminder calls may be necessary to ensure follow through when the individual is engaging in an unfamiliar task
Prepare the individual for transitions and disruptions to their routines
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STRATEGIES FOR ADDRESSINGSTRATEGIES FOR ADDRESSINGFATIGUE ISSUESFATIGUE ISSUES
Encourage the individuals to take rest breaks, may have to schedule breaks until individual can begin to recognize when they need a break
Be aware that medications an individual is taking may make them fatigued
If individual is overloaded or fatigued do not keep pushing
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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO DISINHIBITIONISSUES RELATED TO DISINHIBITION
Gently provide feedback regarding an individual’s behavior at the time the behavior occurs
Video taping (with the individual’s consent)
When possible, ensure the participant is not in an environment that could cause him/her difficulties
Role playing consistently and repeatedly may be helpful
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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO DISINHIBITIONISSUES RELATED TO DISINHIBITION
Need to be concrete and consistent when providing feedback e.g. do not talk to a woman about her looks
The individual may benefit from attending a support group for individuals with brain injury
When dealing with employment, be up-front with the employer so that they are not caught off guard but rather are proactive and supportive
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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO ISSUES RELATED TO
AWARENESSAWARENESSBuilding a new identity following brain injury takes time
Provide individual opportunities to try different activities in a safe environment (work, community and home related)
Provide feedback on an on-going basis
Video tape the individual (with their consent)
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STRATEGIES FOR ADDRESSING STRATEGIES FOR ADDRESSING ISSUES RELATED TO ISSUES RELATED TO
AWARENESSAWARENESS
Do not assume the person in “denial”
Professional counseling may be beneficial
Allow time for grieving
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KEY ELEMENTS FOR SUCCESSFUL KEY ELEMENTS FOR SUCCESSFUL CLINICAL INTERVENTIONCLINICAL INTERVENTION
The participant is in charge
Skills often do not transfer, train the individual in the environment they are expected to perform the task
Be consistent when teaching strategies and allow for sufficient time for them to become routine
Understand that grieving and creating a new identity takes time
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TBI and Substance Abuse67% of individuals in a rehabilitation program for TBI have a history of substance abuse prior to injury
Individuals with TBI test positive for alcohol in 2/3 of motor vehicle crashes
Approximately 20% of persons who did not have substance abuse problems prior to TBI are vulnerable after TBI
Corrigan
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Five Stages of Change
1. Precontemplation2. Contemplation3. Preparation4. Action5. Maintenance
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Stages of Change and TBI
Limited self awareness will affect ability to work through stages
Need to assess individuals ability to self reflect
May not be able to independently implement coping strategies
Repeated practice with strategies will help individual become more independent
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Mental Health and TBI
Depression
Anxiety
Personality Changes
Aggression
Social Inappropriateness
NAMI
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Effective Treatment Approaches
Not much research
Clinicians feel that techniques found effective for people in general can also be effective for individuals with TBI
However, special considerations or accommodations may be required
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Specific Interventions
Motivational Interventions
Cognitive-Behavioral Therapy
Therapeutic Community