The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council January, 2011 Minutes FINAL
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Friday, January 28, 2011• 1:00 p.m. - 4:00 p.m.

Members Present:
Jeffrey Barth, Ph.D., ABPP-CN University of Virginia School of Medicine
Heather Board (Becky Drayton proxy) Virginia Department of Health, Office of Injury Prevention
Jeff Carpenter Survivor
Susan Elmore Virginia Dept of Behavioral Health & Developmental Services
Lynn Forsyth Family Member
Lisa Garver Brain Injury Services, Inc.
Tori Harding NeuroRestorative
Patricia Goodall Virginia Department of Rehabilitative Services
Martha Mead Virginia Dept. of Veterans Services, VA Wounded Warrior Program
Anne McDonnell Brain Injury Association of Virginia
Carole Norton, Ph.D. (Past Chair) Mary Buckley Foundation
Debbie Pfeiffer, Ed.D., CED Virginia Department of Education
Chuck Walsh Middle Peninsula Community Services Board
Kelli Williams Gary, Ph.D. (Vice Chair) Survivor
Leigh Wion (Secretary) Virginia NeuroCare - High Street Clubhouse
Michelle Witt Virginia Alliance of Brain Injury Services Providers
Jeff Sherman Virginia Department of Juvenile Justice
Barbara Seymour Virginia Department of Medical Assistance Services
Alan Towne, MD, MPH Virginia Commonwealth University Medical Center
Linda Redmond, Ph.D. Virginia Board for People with Disabilities

Members Absent:
Nancy Bullock Virginia Department of Health, Office of Maternal & Child Health
Terry Miles Survivor
Michelle Nichols Defense and Veterans Brain Injury Center
Mark Salisbury (Chair) Family member
Paul Sharpe Virginia Dept. of Health, Office of Emergency Medical Services
Gerald Showalter, Psy.D. Woodrow Wilson Rehabilitation Center, Dept. of Brain Injury Services
Brian Shenal, PhD Salem Veterans Administration Medical Center
Jenny Toth Brain Injury Association of America
Julie Triplett Virginia Office for Protection and Advocacy

Others in Attendance:
Helen Butler Brain Injury Services of Southwest Virginia
Karen Brown Brain Injury Services, Inc.
Mary Margaret Cash Virginia Department of Rehabilitative Services
Kristie Chamberlain Virginia Department of Rehabilitative Services
Kristy Joplin Brain Injury Association of Virginia
Mae Johnson Brain Injury Services of Southwest Virginia
Lorraine Justice Brain Injury Association of Virginia
Joann Mancuso Mary Buckley Foundation
Page Melton Caregiver/Federal TBI Grant Family Ombudsman
Elizabeth Nichols Virginia Commonwealth University/CNI Trust Fund Grant
Pat Norton Virginia Department of Rehabilitative Services
John Pezzoli Virginia Dept. of Behavioral Health & Developmental Services
Fran Rooker The Jason Foundation
Jason Young Community Futures Foundation

Opening Protocol
Carole Norton made a motion to appoint Kelli Williams to chair the meeting in the absence of Mark Salisbury, Chair; the motion was seconded by Jeff Barth. The motion passed unanimously. Kelli Williams, Vice Chair, called the meeting of the Virginia Brain Injury Council to order at 1:00 p.m. Members and guests introduced themselves.

Approval of October 22, 2010 Meeting Minutes
Anne McDonnell stated that Chris Nowinski’s name was misspelled in the meeting minutes. Carole Norton made a motion to accept the minutes with the corrected spelling; the motion was seconded by Anne McDonnell. The motion passed unanimously.

Kristie Chamberlain also noted that, at their request, the Brain Injury Association of America would no longer be a standing committee on the Council due to the travel involved and limited staff resources.

Update and Approval of January 28, 2011 Meeting Agenda
Commissioner Jim Rothrock and Dena Schall were not able to attend today’s meeting and as such there were a few minor changes to the agenda: in lieu of the Commissioner, Mary Margaret Cash, Assistant Commissioner of DRS Community Based Services, will present the certificates of appreciation to the members who are rotating off the Council. Patti Goodall and Kristie Chamberlain will provide an update on the status of DRS’ Federal TBI Grant. Kristie Chamberlain provided an update on the CNI Trust Fund and also facilitated a report of the Nominations & Elections Committee. A motion to approve the changes to the agenda was made by Chuck Walsh; the motion was seconded by Jeff Barth. The motion passed unanimously.

Public Comment
Kelli Williams announced the opportunity for public comment. Page Melton announced that a Caregiver Forum is planned for April 9, 2011 in Richmond. Council members interested in being involved in the planning of the Forum, please contact Page or Dena Schall.

Presentation of Certificates
Mary Margaret Cash recognized members who are rotating off the Council and thanked them for their service. The following members were recognized: Tori Harding, Terry Miles, Alan Towne, and Lisa Garver. These members will receive a certificate in the mail signed by DRS Commissioner Rothrock and by Mark Salisbury, Chair, recognizing them for their service on the Council and to DRS.

Remarks from the DRS Commissioner – Patti Goodall
The Commonwealth Neurotrauma Initiative (CNI) Trust Fund Advisory Board has decided not to issue any Requests for Proposals in 2011 and possibly not 2012 due to declining revenue and the lack of interest into the Fund since July 2009 (originally, the Fund received interest on a quarterly basis, but due to budget reductions, the Commonwealth has taken the Fund’s interest for other purposes). Three grants currently funded have been changed from quarterly allotments to monthly reimbursements to assist in monthly cash management. Monthly revenues are steady but low, so the CNI Advisory Board will be watching revenue closely in the next couple of months to assess the ability of the Fund to maintain current grantees and to plan for issuance of future RFPs.

New Business

Legislative Items
Michelle Witt, Chair of the Virginia Alliance of Brain Injury Service Providers, reported that there have not been any changes since the last Council meeting with the exception of securing patrons for the two budget amendments endorsed by the Alliance. The first budget amendment would restore funding to the state-funded programs (approximately $194,000 which represents the 5% cut received in 2010 General Assembly). The second budget amendment (approximately $547,000) would provide more funding to existing state-funded programs that are currently funded below the base level of $150,000 and for other critical unfunded services (case manager in Tidewater and clubhouse program in Roanoke). The Brain Injury Association of Virginia has talking points with more details that were distributed to each Council member.

Brain Injury Awareness Day at the General Assembly is Wednesday, February 2. Invitations were distributed yesterday at the General Assembly by the Brain Injury Association of Virginia and members of the Alliance of Brain Injury Service Providers.

Anne McDonnell, Executive Director of the Brain Injury Association of Virginia presented other updates of interest to the Council. There was no bill introduced this year to repeal motorcycle law. There is a bill to make it illegal for a child under the age of eight to ride a motorcycle. There was a bill to require helmets for mopeds but the bill died in committee. The Virginia Departments of Health, Medical Assistance Services, and Behavioral Health & Development Services are in discussions on how to handle difficult placements. There is $5M in the budget to address neurobehavioral issues with persons with intellectual disabilities and developmental disabilities but is not an option at this time for brain injury (however, BIAV and the Alliance are continuing to seek systems change in this area).

Michelle added that John Pezzoli, Deputy Director of the Department of Behavioral Health and Developmental Services, attended the Alliance meeting earlier in the day and thanked him for his service. The Alliance had the opportunity to share how brain injury fits into the crisis stabilization and neurobehavioral concerns.

The Council discussed the impact of other pertinent issues of concern such as the Health Care Reform Initiative, the shootings in Tucson resulting in Rep. Gabriel Gifford’s injury, and the media coverage of brain injury.

Brainsteps Program
Fran Rooker, co-founder of The Jason Foundation, presented on “Brain Steps,” a program that is being used in other states to provide intensive educational supports to school age children with brain injury. She has begun discussions with other states and with the Virginia Department of Education with the goal of replicating this or a similar program in Virginia. Benefits of the program were presented as having an additional service through a statewide process, specialized instruction, greater opportunity to succeed with standards of learning, and a preventative step in regard to juvenile detention. Anne McDonnell added that she attended the meeting with Fran and would like to commend the Department of Education for their efforts over the past two years. Kelli Williams recommended that this item be placed on the agenda for the Executive Committee Retreat scheduled for February 15, 2011; there was no opposition voiced.

Appointment of By-Laws Committee
Kelli Williams asked the Council for volunteers to serve on the Bylaws Committee. Michelle Witt, Linda Redmond, and Jeff Barth volunteered to serve on the Committee. Michelle Witt agreed to serve as Chair of the Committee. Staff will set up a conference call.

State Report Out Day
Patti Goodall reported that a second biennial State Agency Report Out Day is planned for July 22, 2011 at the Glen Allen Cultural Arts Center in Glen Allen, VA. The first one was held in 2009 and was very successful. The Report Out Day is an opportunity for state agencies in the Commonwealth to come together to share how brain injury is addressed within each agency. It is anticipated that there will be a brief (one hour) Council meeting in the morning.

Unfinished Business

Nominations and Elections Committee
Kristie Chamberlain updated the Council on the process used by the Nominations & Elections Committee to fill the existing at-large member slots. She also noted that after the slate of candidates is approved by Council, it will be forwarded to Commissioner Rothrock for his final approval and selection of new members to fill vacancies.

Lisa Garver, who served on the Nominations & Elections Committee, was asked to talk about the process and the candidates. She explained that the Committee met by conference call to review the submitted nominations and the Committee selected its top candidates for each vacancy category. The Committee provided the Council with additional information on the nominees. Anne McDonnell made the motion to accept the slate of nominees; the motion was seconded by Carole Norton. The motion passed unanimously. Kristie Chamberlain will submit the slate of Council nominees to the Commissioner and appointments will be made in the next few weeks.

Status Report on Federal TBI Act Grant: “Closing the Gap”
(See reports provided by Patti Goodall/Dena Schall & Kristy Joplin)
Additionally, the process of receiving data from the Virginia State Trauma Registry is working well. Currently, staff is removing bad addresses and will look at data analysis for future projects. However, this data includes only admission / discharge data and not patients who are treated in the emergency room and released.

Status Report on CNI Grant (VCU is the subcontractor to Federal Grant)
(See report provided by Elizabeth Nicholls)

Unfinished Business Continued

Brain Injury Action Plan: Update on Council’s Annual Goals - Patti Goodall & Anne McDonnell
The finalized Brain Injury Action Plan 2009-2013 will be posted on website (this includes the full report, as well as the Executive Summary and a “user friendly” booklet). All versions will be updated with new statistics. The Action Plan is on the agenda for discussion at Executive Committee retreat on February 15, 2011. Anne McDonnell stated that the BIAV Board is planning a retreat and will be using the statewide Action Plan as a blueprint. Anne McDonnell will be taking information to the Federal Grantee Meeting in March and will showcase material produced in Spanish and domestic violence.

Updates from DRS – Patti Goodall
There is a new DRS Service Item Code for Therapeutic Behavioral Services, which can now be purchased by DRS Vocational Rehabilitation Counselors and other staff. This code includes Applied Behavioral Analysis and/or Positive Behavior Support. A pilot program has been implemented in Henrico and Fairfax working with consumers who have autism or brain injury.

The Department of Rehabilitative Services is again facing budget reductions. The Long Term Case Management program is slated to face a budget cut.

Pat Norton presented information on the PAS/BI Program (Personal Assistance Services for People with Brain Injury). This small program is the only one in the country offering Personal Assistance Services specifically for people with brain injury. The program was initially funded at $80K in 1985, but has been reduced to $77 currently. There will be a call for referrals to demonstrate the need for funding. There are currently 3-4 slots open. Eligibility is based on need for physical assistance and each applicant undergoes a careful screening and assessment. Please contact Patti Goodall or Pat Norton ( for additional information.

Review future meeting dates / agenda items
Kristie Chamberlain communicated that Mark Salisbury requested we poll the Council to determine if the Council wanted to move the April 22 meeting because that day is Good Friday. Anne McDonnell made a motion to move the next meeting to Friday, April 29, 2011; the motion was seconded by Carole Norton. The motion passed unanimously.

The Council is scheduled to meet April 29, 2011(in Richmond at the Virginia Department for the Aging); July 22, 2011 (Glen Allen Cultural Center); and October 28, 2011 (Fishersville).

With no further business, Carole Norton moved for adjournment, seconded by Chuck Walsh. The meeting adjourned at 3:45 pm.

DRS Federal Grant Report: “Closing the Gap”
Virginia Brain Injury Council
Friday, January 28, 2011


• The U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) conducted a Monitoring Call of DRS’ Federal Traumatic Brain Injury Act Implementation Grant. Our Federal Grant officer, Rebecca Desrocher, and our Technical Assistance Liaison, Amy Horn, led the call. They reviewed our progress on grant activities and deliverables to date (grant began on 4/1/10). DRS also submitted its FY ’11 Noncompeting Continuation Performance Report (Narrative and Budget) on January 12, 2011.

• Department of Rehabilitative Services Information Systems staff has been granted access to the Virginia Department of Health’s Virginia Statewide Trauma Registry (VSTR) database. DRS staff can pull out information (name, address) to prepare mailing labels each month of all persons admitted to the hospital for treatment of an injury to the head or brain (per specific ICD-9 Codes). The Brain Injury Association of Virginia (BIAV) provides the literature and oversees the mailings.

• DRS’ Federal TBI Grant webpage, brochure, and display (table exhibit) are in process.

• Year Two (April 2010-March 2011) required grant activities that are in progress:
o Annual report: In discussion.
o Federal Traumatic Brain Injury Act Grant Biennial Retreat: The Executive Committee of the Virginia Brain Injury Council (Chair, Vice-Chair, Secretary, and Immediate Past Chair) is having a retreat on February 15, 2011 to review and better understand the Brain Injury State Action Plan. The short retreat will focus on future Council goals and activities. The Virginia Brain Injury Council Annual Calendar will be updated at this time.
o Biennial “Brain Injury Report Out Day”: The Federal Grant team is participating in Council planning for the July 2011 Brain Injury Report Out Day. Council staff (Kristie Chamberlain) found a location for the event pending approval at DRS (Glen Allen Cultural Arts Center). The focus of the Report Out Day is to share information on how various state agencies are serving Virginians with brain injury.

1. Possible Carryover Projects: The Department of Rehabilitative Services is revising its request to
HRSA for use of carryover funds (approximately $65,000) from Year One to Year Two. Proposed projects include:

• Nursing Home Intervention Project: DRS will issue a Request For Proposals (RFP) in next 30 days to solicit a vendor to carry out the activities of this project.

• Caregiver Forum (“We Walk Together”): Caregiver Forum will provide information / education to family members / caregivers, as well as provide networking opportunities for participants. Also a way to introduce family members / caregivers to the work of the Virginia Brain Injury Council and to develop interest in serving as member, Family Ombudsman, or on a committee. April 2011 is the target date.

• Department of Health Professions Mailing List for outreach activities.

• Virginia Commonwealth University [working with Department of Juvenile Justice (DJJ)]: National Policy Summit and “Ethics” Webinar for DJJ staff and continuing education for psychologists.

Subcontractors Brain Injury Association of Virginia and Virginia Commonwealth University will present updates on their Federal TBI Grant activities in separate reports.

CNI Best Practices for Incarcerated
Youth with Brain Injury Project

A partnership between the Virginia Department of Juvenile Justice, the Brain Injury Association of Virginia, and VCU’s Department of Physical Medicine and Rehabilitation
Primary Investigator: Jeffrey S. Kreutzer, Ph. D.
Co-Primary Investigator: Juan Carlos Arango-Lasprilla, Ph.D.
Contact: Elizabeth Nicholls, MT, Research Coordinator, or (804) 828-2617

Project Goals:

 To improve the ability of the Department of Juvenile Justice (DJJ) to identify and meet the needs of incarcerated juveniles with brain injury within their service system.

 To develop an effective brain injury screening tool for all juveniles entering the DJJ system

 To develop education and training materials to guide DJJ personnel in screening evaluating, and providing treatment to incarcerated juveniles with brain injury.

 To provide training to DJJ staff using a “train the trainer” model.

 To disseminate information on prevalence, screening, evaluation, and intervention protocols with incarcerated juveniles with brain injury.

 To prepare a final report with recommendations to brain injury service providers, educators, researchers, policymakers, relevant State agencies, and other key stakeholders for screening and working effectively with incarcerated juvenile offenders with brain injury.

Project Accomplishments:

 DJJ Behavioral Services staff has been trained to administer, score, and interpret the results of a series of four sensitive neuropsychological tests; brain injury screening instrument; and medical records review.

 Complete data has been collected on over 250 subjects, and data analysis is being performed by DJJ staff with advice from VCU faculty to gain a clear view of prevalence, correlates, and effects of TBI among the population.

 Comprehensive literature review re. best practices for child and adolescent TBI screening in correctional and general medical settings is ongoing, with planned submission for publication in early 2011.

 Brain Injury Association of Virginia and VCU are planning a national Brain Injury and Juvenile Justice Policy summit to bring together HRSA staff, leading researchers, state agency stakeholders, policy makers, and advocacy professionals from all over the country to discuss best practices and policy alternatives. A summary document describing challenges, discussions, plans, and recommendations will be prepared and circulated after the meeting.

“Closing the GAP” BIAV Grant Report
Year 2 – 3rd Quarter

Target Group #1: Juveniles with brain injury committed to the Virginia Department of Juvenile Justice
Systems Change
• BIAV and VCU planning Policy Summit to discuss policy implications with leaders of similar projects in other states.

Data Collection
• VCU providing guidance to appropriately analyze data.

• Collaborating with DJJ to determine if training program can be inserted into their existing training system.

• Have begun discussing target audiences and materials needed.

Targeted Group #2: Persons with Low Socioeconomic Resources
Systems Change
• Nursing home training and intervention program to better prepare nursing home staff to work with individual with brain injury; requested data from DMAS;
• Attended DBHDS Emergency Services Response & Improvement Team meeting to give update on needs of brain injury community.

Data Collection
• DRS IT staff has been granted access to data directly from VSTR at VDH; a protocol for conducting monthly outreach mailings has been established. (November) Mailed letters to 2,621 individuals who were reported to VSTR 1/1/10-9/30/10. Received 90 responses (as of 1/12/11); (January) Mailed letters to 207 individuals reported to VSTR 10/1/10-11/30/10.

• Provided I&R services to 560 survivors/family members; 41 reported themselves as belonging to a minority population; 272 reported barriers indicative of “low socioeconomic status”.

• Continued participation on DOE workgroup; emailed letter and brochures to statewide Parent Resource Centers.

Targeted Area: Infrastructure Expansion
Systems Change
• DRS primarily responsible for meeting goals.
• Participated in initiative to have “head injury/concussion” check box added to school entrance exam.
• Presentations: Emergency/domestic violence shelter in Charlottesville for Domestic Violence Awareness Month; Community Futures Foundation; CIT training group; Choice Group; MSW students at VCU; exhibited at sports medicine conference in Williamsburg; exhibited at CSB conference.

• Planning Caregiver Conference to provide support through educational sessions on self-care and advocating for resources. Also will inform participants of function/needs of VBIC and recruit for membership;;
• Posting information on Facebook as appropriate;
• Family Ombudsmen have been attending and are actively engaging in required meetings;
• Serving as the brain injury representatives on the Virginia Injury Community Planning Group;
• Continued participation in the Virginia Wounded Warrior Program. Collaborating with WW Coordinator to develop outreach plan to military personnel.