The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

July 23, 2006
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Meeting Minutes
July 28, 2006 ---DRAFT

Members Present:
Paul Aravich, Ph.D. Eastern Virginia Medical School
Paul Blais Survivor, Hampton, VA
Donna Broshek, Ph.D. University of Virginia Health Sciences Center
Karen Brown Brain Injury Services, Inc.
Helen Butler, RN Brain Injury Services of Southwest Virginia
Dane DeMoss Woodrow Wilson Rehabilitation Center
Sandy Dyche Survivor, Richmond, VA
Patti Goodall, Ed.S Virginia Department of Rehabilitative Services
Nadia Webb, Psy.D. Adult & Pediatric Neuropsychology
Katherine Lawson Virginia Board for People with Disabilities
Page Melton Family Member, Richmond VA
Anne McDonnell, OTR/L Brain Injury Association of America
Carole Norton, Ph.D. Private Practice
Susan Rudolph, RN The Arc of Greater Prince William
Julie Triplett Virginia Office for Protection & Advocacy
Pat Wilkins Family Member, Harrisonburg, PA
Leigh Wion (for Jason Young) Virginia Alliance of Brain Injury Service Providers

Members Absent:
Nancy Bullock, RN Virginia Department of Health
Treven Pickett, Psy.D. McGuire Veterans Administration Medical Center
Gwen Smith, RN, MSN Virginia Department of Education
Nathan Zasler, M.D. Tree of Life Services & Concussion Care Centre of VA
Paul Sharpe, RN, NREMT-P Virginia Department of Health
Russell Payne Virginia Department of Mental Health, Mental Retardation & Substance Abuse Services

Board Staff:
Kristie Chamberlain Virginia Department of Rehabilitative Services

Meeting Guests:
Amy Armstrong, Ph.D. Virginia Commonwealth University, Department of Rehabilitation Counseling - Retreat Facilitator
Commissioner Rothrock Commissioner, Virginia Department of Rehabilitative Services
The meeting was held during the full day retreat held on July 28, 2006. The business portion of the retreat was called to order at 12:20 PM.

Public Comment:
There were no public comments offered.

Approval of the Minutes:
A motion was made to approve the meeting minutes of the April 28, 2006 meeting. The motion passed unanimously.


Appreciation for Commissioner Rothrock:

Dr. Aravich acknowledged the support of Commissioner Rothrock in holding the VBIC retreat and thanked him for his continued support of the VBIC.

Brain Injury Services Funding Recommendation for 2007-08:

The Executive Committee of VBIC prepared funding recommendations for consideration by the full Council. These are summarized in the table below:


Recommended Distribution of State Funds for TBI Services
Appropriation Region/Planning District Services

$285,000 (Governor’s budget) Southwest Virginia Provide Direct Case Management Services
$150,000 (State General Fund dollars) Shenandoah Expand Case Management Services in unserved and underserved areas
$725,000 (State General Fund dollars) 1. Southern
2. Central
3. Fredericksburg/N. Neck/Mid Pen
4. Eastern Shore/Tidewater
5. Northern Virginia Develop and expand Brain Injury Services in unserved/underserved regions of the Commonwealth

The funding recommendations were passed unanimously. Dr. Aravich and Paul Blais abstained.

Nominating Committee:
Volunteers were solicited for the current committee. The committee is as follows:
Susan Rudolph (Chair)
Paul Aravich (ex-officio)
Donna Broshek
Helen Butler
Nadia Webb

The Nominations and Elections Committee will solicit nominations from Council and will develop a slate of two officer positions, Chair and Secretary to be voted upon at the October 27, 2006 meeting. The slate will be presented to Council members ten (10) days prior to the October 27, 2006 meeting.

The Nominations and Elections Committee will solicit nominations from the Council and will develop a slate of at-large member positions to be voted upon at the January 26, 2007 meeting. The slate will be presented to Council members ten (10) days prior to the January 26, 2007 meeting.

Neurobehavioral Committee:
Dr. Aravich reported on the progress of the Neurobehavioral Services Subcommittee, noting a conference call held in May during which Dr. Tina Trudel of Lakeview Virginia NeuroCare provided information to the Committee on “best practices” in brain injury treatment/rehabilitation. Dr. Nathan Zasler is researching the incidence of individuals with challenging behaviors among people who sustain a brain injury. The Committee discussed its definition of “brain injury” and the need to narrow its focus. Consensus was to target individuals with acquired brain injury (ABI) except for neurodegenerative disease, those covered by Medicare, and children eligible to receive services through other funding (e.g., school systems). Dr. Aravich also noted that the Joint Legislative Audit Review Committee (JLARC) study will overlap with some of the efforts of the Neurobehavioral Services Committee. The service delivery issues identified by the Committee relate to levels of care and continuity of care, including the need for skilled nursing care and specialized neurobehavioral units with state mental health facilities (or other appropriate “secure” environments).

Veterans Affairs Subcommittee:
Dr. Aravich contacted Becky Fox of the Veterans Integrated Services Network (VISN). The Commonwealth of Virginia is in VISN 6, which includes North Carolina and Virginia. Ms. Fox expressed interest in setting up meetings with key personnel to move the issue of brain injury among Veterans forward. Anne McDonnell reported that she did an in-service at the Veterans Administration on community resources for people with brain injury. She met with Gretchen Stevens who directs the federal Defense and Veterans Brain Injury Program. Ms. McDonnell reported that the emphasis needs to be on informing the Veterans Administration of available community resources, as this is an area in which staffs of local Veterans Administration Hospitals are not fully educated. Ms. McDonnell also reported that the Office of the Inspector General (OIG) released its Report on Health Status of and Services for Operation Enduring Freedom/Operation Iraqi Freedom Veterans after Traumatic Brain Injury Rehabilitation. [Rpt. #05-01818-165 7/12/2006]

They noted the following statistics based on interviews of 52 patients 16 months post-injury:
• 52% had cognitive scores suggesting no or mild impairment. The most commonly noted problem was impaired immediate recall and short-term memory. They acknowledged that the screening tool used (i.e., the COG-LOG) does not fully assess neurocognitive functioning.
• 42% met criteria for further evaluation of depression, a rate significantly higher than the general population.
• 63% said their psychological problems had disrupted their relationships.
• Based on the Disability Rating Scale, 27% were unemployable.
• Veterans experience a significant delay in receiving rehabilitation services and follow-up assessments compared