Statewide Needs Assessment Data & Statewide Needs Assessment Data & Implications for Broward CountyImplications for Broward County

Barry Nierenberg, PhD, ABPPBarry Nierenberg, PhD, ABPPDeborah Mulligan, MD, FAAPDeborah Mulligan, MD, FAAPMary Beth Bailar-Heath, MSMary Beth Bailar-Heath, MS

Nova Southeastern UniversityNova Southeastern University

Statewide Needs AssessmentStatewide Needs AssessmentTraumatic brain injury in Florida: A needs and Traumatic brain injury in Florida: A needs and

resource assessment. resource assessment. WellFlorida, Inc., 2007WellFlorida, Inc., 2007

• Joint project conducted by: Joint project conducted by: Brain Injury Association of Florida Brain Injury Association of Florida

(BIAF) and (BIAF) and the Florida DOH’s Brain & Spinal Cord the Florida DOH’s Brain & Spinal Cord

Injury Program (BSCIP)Injury Program (BSCIP)

• Collected data from 1999-2005 Collected data from 1999-2005 from the State Trauma Registry from the State Trauma Registry and the CDC in Atlantaand the CDC in Atlanta

• Conducted Focus groups Conducted Focus groups throughout the state with Brain throughout the state with Brain Injury survivors and their familiesInjury survivors and their families

FindingsFindings

In 2005 alone, approximately 93,000 In 2005 alone, approximately 93,000 TBIs occurred in Florida – TBIs occurred in Florida –

Good news is that over 89,000 of Good news is that over 89,000 of these individuals survived the injury.these individuals survived the injury.

TBI-related deaths and emergency TBI-related deaths and emergency dept. visits were higher in Florida dept. visits were higher in Florida compared to the national rate, compared to the national rate,

And And Florida’s rate for TBI-related Florida’s rate for TBI-related hospitalizations is lower than the hospitalizations is lower than the national ratenational rate..

But the bad news is:But the bad news is: best estimates show currently there best estimates show currently there

are approximately 370,000 are approximately 370,000 Floridians (or 2 percent of the total Floridians (or 2 percent of the total population of Floridians) living with population of Floridians) living with long-term disabilities resulting from long-term disabilities resulting from a TBI.a TBI.

These sequelae can include:These sequelae can include:

• Inability to concentrate Inability to concentrate • DistractibilityDistractibility• ImpulsivityImpulsivity• Short term memory problemsShort term memory problems• Pragmatic language problemsPragmatic language problems• PerseverationPerseveration• Frontal Lobe syndromeFrontal Lobe syndrome• Emotional LabilityEmotional Lability

Projected future trends of TBI in Florida:Projected future trends of TBI in Florida:

Extrapolating from prior years and Extrapolating from prior years and incorporating national data, it is incorporating national data, it is estimated that by 2015, the number estimated that by 2015, the number of survivors living with a TBI-related of survivors living with a TBI-related disability will increase by 21% disability will increase by 21% (435,350 people).(435,350 people).

How these trends will affect the population of How these trends will affect the population of Broward CountyBroward County

BSCIP divides Florida into 5 regions.BSCIP divides Florida into 5 regions. Region 4 consists of the following Region 4 consists of the following

counties: counties: Broward,Broward, Charlotte, Charlotte, Collier, Glades, Hendry, Indian River, Collier, Glades, Hendry, Indian River, Lee, Martin, Okeechobee, Palm Lee, Martin, Okeechobee, Palm Beach, and St. LucieBeach, and St. Lucie

In 2005, the greatest number of In 2005, the greatest number of TBIs occurred in Region 4 (26,887). TBIs occurred in Region 4 (26,887).

From 1999 to 2005, Region 4 From 1999 to 2005, Region 4 experienced the most TBI-related experienced the most TBI-related hospitalizations in the state (4,177).hospitalizations in the state (4,177).

The greatest number of individuals The greatest number of individuals with TBI-related disabilities lives in with TBI-related disabilities lives in Region 4 compared to the other Region 4 compared to the other regions in the state regions in the state

95,997 individuals, 26% of total 95,997 individuals, 26% of total survivors.survivors.

However, at present, Region 4 However, at present, Region 4 contains only 20.6 percent of the contains only 20.6 percent of the TBI-related resources in the state.TBI-related resources in the state.

Region 4 is expecting the largest Region 4 is expecting the largest increase in population of all the increase in population of all the regions. regions.

This region would need to increase This region would need to increase service capacity by an estimated 24 service capacity by an estimated 24 TBI-related resources to maintain the TBI-related resources to maintain the current service capacity. current service capacity.

However, the current service However, the current service capacity is already inadequate to capacity is already inadequate to meet the demand; meet the demand;

thus even more than 24 resources thus even more than 24 resources are needed to provide adequate are needed to provide adequate services.services.

Implications for the Implications for the provision of services in provision of services in Broward County to serve the Broward County to serve the needs of TBI survivorsneeds of TBI survivors

The problemThe problem

• Within Broward County, the Within Broward County, the number of individuals with TBI is number of individuals with TBI is increasing, as well as the number increasing, as well as the number of those living with TBI-related of those living with TBI-related disability disability

• Not enough TBI resources at the Not enough TBI resources at the current time and with the growing current time and with the growing incidence/prevalence, Broward incidence/prevalence, Broward County will need more resources County will need more resources just to maintain current service just to maintain current service capacitycapacity

• Focus groups revealed that Focus groups revealed that individuals with TBI in Florida are individuals with TBI in Florida are reporting many unmet needs reporting many unmet needs following discharge from hospitalsfollowing discharge from hospitals

• These include, but are not limited to, These include, but are not limited to, problems with:problems with:Community re-entryCommunity re-entryVocational difficultiesVocational difficultiesSchool re-entrySchool re-entrySocial relationshipsSocial relationships

State Needs Analysis: ConclusionState Needs Analysis: Conclusion

The current system of care The current system of care supporting TBI survivors across supporting TBI survivors across Florida is limited, inconsistent, and Florida is limited, inconsistent, and does not support transitions.does not support transitions.

Need to develop transition-based Need to develop transition-based care, and develop network of care, and develop network of transition-based referral resources.transition-based referral resources.

This would include:This would include:

Developing a system for Developing a system for biopsychosocial support for survivors biopsychosocial support for survivors and family from the inception of TBI and family from the inception of TBI treatment onward, including the treatment onward, including the development of neurobehavioral development of neurobehavioral system of care.system of care.

Developing mechanisms to identify Developing mechanisms to identify and continuously update existing and continuously update existing resources.resources.

Possible solution(s)Possible solution(s)

• Numerous studies and clinical Numerous studies and clinical experience since WW II demonstrate experience since WW II demonstrate that optimal recovery for those with TBI that optimal recovery for those with TBI occurs as a result of multidisciplinary occurs as a result of multidisciplinary care and interventionscare and interventions

Patients benefit from:Patients benefit from:

Close proximity and linking of services, Close proximity and linking of services, Communication between service Communication between service

providers, providers, Collaborative careCollaborative care

• Additional Inpatient and Outpatient Additional Inpatient and Outpatient rehabilitation programs are necessary in rehabilitation programs are necessary in Broward County to provide additional Broward County to provide additional needed short and long-term, needed short and long-term, multidisciplinary servicesmultidisciplinary services

Components of Rehab TeamComponents of Rehab Team Need Rehab trained:Need Rehab trained:

• PhysiciansPhysicians• NursesNurses• Physical Therapists, Physical Therapists, • Occupational Therapists, Occupational Therapists, • Speech Therapists, Speech Therapists, • Psychologists Psychologists • NeuropsychologistsNeuropsychologists

Many of these are available through Many of these are available through training programs in area training programs in area Universities and Colleges.Universities and Colleges.

Possible referral and funding sources Possible referral and funding sources

Referrals from trauma centers and VA’sReferrals from trauma centers and VA’s Referrals from BSCIP Case Managers Referrals from BSCIP Case Managers IFIF

program is a BSCIP designated facilityprogram is a BSCIP designated facility Bundled package of comprehensive Bundled package of comprehensive

servicesservices Possible funding from BSCIP Trust Fund Possible funding from BSCIP Trust Fund Possible training site for medical and Possible training site for medical and

graduate studentsgraduate students Possible research grantsPossible research grants

Brain and Spinal Cord Injury Program Brain and Spinal Cord Injury Program (BSCIP)(BSCIP)

Mission – to provide all eligible Florida Mission – to provide all eligible Florida residents who sustain a moderate to residents who sustain a moderate to severe Traumatic Brain or Spinal Cord severe Traumatic Brain or Spinal Cord Injury the opporetunity to obtain the Injury the opporetunity to obtain the necessary services enabling them to necessary services enabling them to return to their communityreturn to their community

Begun in 1978 as an attempt by Florida’s Begun in 1978 as an attempt by Florida’s DVR to ensure the well being of people DVR to ensure the well being of people surviving Brain and Spinal Cord injuries by surviving Brain and Spinal Cord injuries by implementing a system of referrals for implementing a system of referrals for appropriate services.appropriate services.

Core Components of Florida’s Legislation

Central Registry provides a registration and referral system for persons who have moderate-to-severe brain or spinal cord injuries.

Advisory Council provides programmatic oversight.

Trust Fund ensures funding for the provision of a coordinated system of care for eligible individuals.

Brain and Spinal Cord Injury Program provides a coordinated system of care through designated acute, inpatient/outpatient rehabilitation, and transitional living facilities to enable eligible individuals to return to an appropriate level of functioning within their community and/or to a vocational rehabilitation program.

Brain and Spinal Cord InjuryRehabilitation Trust Fund

First established by law: July 6, 1988, Chapter 381.79, F.S.,

The Trust Fund can provide eligible clients who sustained traumatic brain and/or spinal cord injuries essential services to reintegrate them back into the community.

Clear reallocation of Public resources to meet needs of people surviving Brain and Spinal Cord Injury

• Need accreditation above and beyond Need accreditation above and beyond JACHO Comission on Accredition of JACHO Comission on Accredition of Rehabilitation Facilities (CARF) & State Rehabilitation Facilities (CARF) & State Designation as an appoved Designation as an appoved Rehabilitation FacilityRehabilitation Facility

Questions?Questions? Comments?Comments?