Brain Injury Advisory Committee

Brain Injury Advisory Committee Meeting Minutes Date: July 16, 2015 Place: Ohio Union Columbus, Ohio 43210

Attendance Members: Daniel Arnold, Jo Ann Boggs, Rebecca Cooper, Steven Cuff, Tina Evans, Julie Fasick-Valley, Ryan Frick, Marijane Jones (via phone), Mbabazi Karlisa, Cody Linder, Mike Moore, Jackie Moore, Bonnie Nelson, Diana Pollock, Stephanie Ramsey, Donna Rudderow, Elizabeth Sammons, Denise Schaad, Spencer Smith, Teri Smith, Kathy Stachowski (via phone), Adreana Tartt, Grace Williams Brain Injury Program Staff: John Corrigan, Monica Lichi, Laura VanArsdale Guests: Kim Kehl

Welcome and Introductions Adreana Tartt started the meeting and asked for self-introductions. Many new faces at this meeting.

Old Business Review/Approval of Minutes. Cody Linder motioned to approve the January minutes. Stephanie Ramsey seconded. Motion Passed.

Ohio Brain Injury Program Update Establishing the program at Ohio State University – The Brain Injury Program did receive funding with this biennium, no extra funding was included. Monica has been on the Planning Committee for NASHIA and the 2016 national conference will be held in Columbus. Work had continued over the past few months on the strategic plan, which was discussed further later in the meeting. BIAC meeting dates for next year are finalized. The dates were included in a handout at the meeting and in a email sent to the entire committee. Incidence & Prevalence Data – The Data Workgroup is completing the report of incidence data from the Trauma Registry and Hospital Discharge data. Data from the Lifetime History of TBI module in Ohio’s 2014 BRFSS was received back form the CDC and is now available. We can start looking at the data. There is a meeting set for next Wednesday to begin looking at the lifetime history analysis. Community Integration – The HRSA grant just passed the one year mark. The statewide training is now available online. Work is being done on the second training and the hope is for it to take place in either late 2015 or early 2016. The BIP Level 1 Screening includes the adapted OSU-TBI-ID. Training for the screen will be starting soon as it will roll out later this year. John Corrigan created a video for instructing people on the adapted OSU-TBI-ID. Everyone under the BIP and waiver program will receive the screening. The BIAOH’s Information & Resources as well as OSU’s Resource Facilitation are now live. OSU’s Ask the Expert and Frequently Asked Questions are not being utilized. The use of these resources needs to be promoted and increased in some manner. Youth Concussion – The creation of an Ohio specific dataset similar to High School RIO is still at ground zero. Dawn Comstock is now working at the University of Colorado and is the principal investigator on the High School RIO project. The Ohio Brain Injury Program is still trying to find a way to collect Ohio specific data. The Ohio High School Athletic Association is supportive in this endeavor. The Ohio Department of Health has an Ohio Injury Prevention Partnership with a Child Injury Action Group. This is something the training workgroup is involved in, but not something the entire BIAC will become involved or associated with. OEF/OIF/OND Service Members – The Star Behavioral Health Program has now completed the first wave of trainings (five in total). The program has surpassed the grant objective of training 240 individuals. At this point in time, 283 individuals have been trained. The Ohio Department of Mental Health and Addiction Services is providing some funding to the program. This additional funding will cover another set of Tier 1 trainings and a single Tier 2 training. The Tier 1 and Tier 2 trainings are open to anyone. The Department of Defense’s Office of Suicide Prevention funds the Star Behavioral Health Program in multiple states. The Wounded Warrior Project is currently funding the program in Ohio. There is a proposal being submitted to the Department of Defense to continue funding of the programs currently funded as well as funding for additional states including Ohio. This funding would allow for Tier 1, Tier 2, and Tier 3 trainings as well as for community outreach. The OSU Outreach grant began on July 15th. This is a joint effort with Give An Hour, but it has broader implications beyond service members. There is a lot of training that happens in the field, but this can be frustrating due to the high turnover rate. The purpose of this grant is to incorporate TBI education into pre-service training. This will include modules that can be placed in college courses, online modules, and continuing education for pre-service social workers. If possible, another college will be added to the project to test the training. The ultimate goal is to have the pre-service training in all 20 social work programs across the state.

Trauma-Informed Care Presentation Adreana Tartt introduced her ODMHAS coworker Kim Kehl for his presentation on trauma-informed care. The presentation was sent to the BIAC and can be viewed for more details as well as for the visual aspects.The program headed by Kim Kehl adapted the SAMSHA, who provides funds to the program, definition of trauma. The same event will be experienced differently by different people. The history of individuals who are seeking services will impact the care they receive later. Trauma is especially common among individuals with mental illness, substance use disorders, and developmental disabilities. The trauma-informed care program has found that state departments do not directly collect the numbers of traumatized individuals in Ohio. However, other factors associated with trauma are collected as a part of health information. This data allows for predictability. At this point in time, there is not enough Ohio data, so national data is necessary. National data shows that 84% of adult mental health clients will have trauma in their history. Clients who have a history of childhood abuse have earlier first admission, more frequent and longer hospital stays, more time in seclusion/restraint, higher risk of self- injury or suicide attempt, and more severe mental health symptoms. The average child in the child welfare system or out-of-home system spends 75 days in the system. Children who have experienced trauma relating to some form of substance abuse spend an average of 300 days in the system. Children in an opiate-addicted household are more likely to have an adverse experience. There have been over 700 studies derived from the ACE study. A male child who has had 6 adverse experiences has a 4600% increase in likelihood of becoming any IV drug user. Individuals with developmental disabilities have an increased risk for abuse compared to the general population, an increased risk of being victims of crime compared to nondisabled individuals, and an increased risk of sexual abuse compared to nondisabled individuals. Health care providers need to take time to communicate appropriately with developmentally disabled patients in order to ensure the best care. The trauma-informed care initiative is not encouraging a specific treatment, assessment, or screen. This initiative has been created to show agencies the impact of past adverse experiences and how these individuals are treated within the mental health care system. Agencies need to become better at responding to trauma and better at promoting awareness. There are six regional collaboratives within Ohio that are similar to a 12-step group with an interest in trauma. These groups are learning from each other and coming together to discuss what progress has been made and what can be done to continue forward momentum.

Strategic Plan Review This meeting was used to narrow the scope of the strategic plan and chose which items to prioritize. The main focus of the Ohio Brain Injury Program is going to be tertiary prevention, but primary and secondary prevention will still be under consideration. Discussion on the Sixteen Directives There was an endorsement for encouraging screening for a history of TBI among recipients of state services (7). This is one objective that could be related to youth as well as adults. This also relates to utilizing incidence data on persons receiving medical care (1). Strategic directives relating to data elements were supported, because data is instrumental in applying for funding and gaining opportunities for other directives. There is a responsibility to provide services, but data is what provides funding, particularly in regard to number 1. The most efficient use of data may be to leverage the data that is already available and maximizing the data available rather than creating something new. This would involve number 1 as well as estimating adult population rates for history of TBI from Ohio BRFSS (4) and estimating youth population rates for history of TBI from Ohio YRBSS and/or Ohio BRFSS (5). Support was expressed for promoting adoption of best practices in community integration for persons with TBI (11). There was an endorsement for promoting adoption of best practices for behavioral health treatment of persons with TBI (12). Also an endorsement for augmenting TBI curricula for pre-service training of PT’s. OT’s, SLP’s and TR professionals (9), promoting adoption of best practices for vocational rehabilitation of persons with TBI (13), and developing a plan for systematically communicating the availability of services and supports for persons with TBI and their families (16). TBI is a silent epidemic as it often runs under the radar of public awareness. This makes it all the more important to develop a public awareness plan to educate policy- makers and the public on the lifelong needs of persons with TBI and their families (15). Support was given for adding TBI curricula to pre-service training in 7 healthcare and social service professions (8) and augmenting TBI curricula for pre-service of PT’s, OT’s, SLP’s and TR professionals (9). There are still many providers who do not have an awareness of what TBI is and how it can impact treatment. The final endorsement was for promoting adoption of team models when students return to school after a TBI (10). This means giving attention not only to returning to athletics, but also returning to academics.

Workgroup Summaries

Data Workgroup The Data Workgroup is finalizing the report on incidence and prevalence. This will be on the agenda for the next BIAC meeting.

Services Workgroup The Services Workgroup has been reviewing how other states are providing services for TBI. At this point they have reviewed Colorado and Alabama. The next state to be reviewed is Minnesota. A conference was held with the Minnesota Brain Injury Program on July 23rd. The workgroup is looking at how services are administered as well as how state programs are acquiring and using funds.

Training Workgroup The Training Workgroup has been working toward implementing a train the trainer model for Return-to-Learn efforts. The Department of Health’s Violence and Injury Program worked on a statewide proposal for a grant. It will be known if they received the grant by the end of July. The workgroup is reviewing Return-to-Learn programs in other states.

Communications Workgroup The Communications Workgroup is reviewing the past State of State report in regards to the recent answers received on the State of State survey.

Agency Updates

 The Child Injury Action Group from the Ohio Department of Health is educating coaches on return-to-play laws and working on helmet policies in schools. Three pilot districts are to implement the model and an information packet has been created for dissemination.  The Ohio Department of Developmental Disabilities’ division of policy and strategic direction is going through restructuring. It is looking at community members and determining where the most support is needed. Regional support teams are in place to figure out how to help individuals with the most intensive support needs. Two of these centers are closing in 2017, so the department is making sure communities are equipped with the proper supports.  The Ohio Department of Public Safety is going through a migration from the old trauma registry to a new system. Data has recently started being entered into the new system.  The Ohio Department of Medicaid has one initiative focusing on lowering the number of waivers. The Transitions Waiver is being phased out. The individuals on this waiver will be transferred to another waiver. The Behavioral Health Program covered by Medicaid is being revamped.  The Traumatic Brain Injury Resource Center held a TBI education symposium in October that included a talk from John Corrigan.  The Ohio Department of Aging is focused on moving patients from a site that is closing.  Nationwide Children’s Hospital provides information online for return-to-learn for student athletes as well as a Sports Concussion Toolkit.  The Ohio Department of Education- due to Ohio legislatively pulling out of the PARCC Common Core testing, a new test must be developed by next year even though tests are usually developed over 3-4 years. The U.S. Office of Special Education Programs has changed from compliant focused to now looking at results driven accountability. Ohio has chosen early literacy as its focus area.  The Ohio Bureau of Worker’s Compensation is transitioning from ICD-9 to ICD- 10. Some of this migration is automatic, but most of it requires a person to go in and manually make the change. Optimistically the transition will be completed by the end of this year, but realistically it will be completed by the end of next year.  The Opportunities for Ohioans with Disabilities is eliminating the Home Makers Program next year. This program was for non-vocational people who were looking to gain skills in other areas. There is the potential for more shared responsibility with the Independent Living Centers around Ohio. The 25th Anniversary of the American Disability Act took place in July. The Opportunities for Ohioans with Disabilities is looking for a part-time driver to help individuals in need a driver 2-4 times a month.  Hanson House held a golf outing on August 16th. Summer is an active time for Hanson House. They will be at the Cuyahoga County Fair and Octoberfest. Many of their clients are known in the community now and the community is more accepting. They are working with Metro, a group that meets at the local hospital, on discharge procedures, particularly for TBI survivors.  BIA-OH held a conference in May, which was the first in a long time. The helpline is now in service and is ongoing. The website is in need of updating with an increase in the amount of information available on resources and services. The BIAOH has begun intercommunications on regional advocacy and service groups. This is the first step in having a systematic network across all of Ohio that maximizes the value of all groups through support and collaboration. The BIAOH is exploring presentation and certification for Brain Injury Specialists.  The Ohio Department of Mental Health and Addiction Services is trying to link up adult care facilities with accommodations. Adreanna Tartt has been trying to connect TBI workgroup priority to the Ohio Cares Program. The department is looking at how the current Ohio Care Collaborative is structured and if there are changes that they want to make to the collaborative.  BrainSong in a nonprofit organization founded by Micah Jones as a resource for Brain Injury Survivors. The hold an annual walk that would welcome any of the BIAC coming to speak and participate at the walk. There are monthly survivor meetings that offer support and education on brain injury. There were be a Survivor Connections meeting in Columbus in 2016 and a Caregiver Connections meeting in Columbus in the fall of 2015.

After voting, the chosen strategic objectives were:

(1) Utilize existing incidence data on persons receiving medical care (ED and hospitalizations from ODH and ODPS) (4) Estimate adult population rates for history of TBI from Ohio BRFSS (7) Encourage screening for a history of TBI among recipients of state services (8) Add TBI curricula to pre-service training in 7 healthcare and social service professions (9) Augment TBI curricula for pre-service training of PT’s, OT’s, SLP’s and TR professionals (10) Promote adoption of team models when students return to school after a TBI (11) Promote adoption of best practices in community integration for persons with TBI (12) Promote adoption of best practices for behavioral health treatment of persons with TBI (15) Develop a public awareness plan to educate policy-makers and the public on the lifelong needs of persons with TBI and their families (16) Develop a plan for systematically communicating the availability of services and supports for persons with TBI and their families

There will be a vote in October to endorse objectives and objectives will be changed as necessary.

Laura VanArsdale provided a look at the Accommodations Booklet created by the Ohio Valley Center. These booklets are available to anyone interested.

Meet adjourned.