The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council April, 2012 Minutes FINAL
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Friday, April 27, 2012• 1:00 p.m. - 4:00 p.m.
Members Present:
Jeffrey Barth, Ph.D. University of Virginia School of Medicine
Gayl Brunk Valley Associates for Independent Living
John Butrick Survivor
Melissa Fox, DPT University of Virginia Health System
Aaron Goldmann Survivor, Commissioner’s Designee
Patricia Goodall Virginia Department of Rehabilitative Services
John Heath Federal TBI Grant Family Ombudsman
Kathleen Lawson Virginia Board for People with Disabilities
Martha Mead Virginia Wounded Warrior Program
Anne McDonnell Brain Injury Association of Virginia
Carole Norton, Ph.D. Mary Buckley Foundation
Cynthia O’Donoghue, Ph.D. James Madison University
Debbie Pfeiffer, Ed.D. Virginia Department of Education
Jodi Power, RN, JD Virginia Nursing Board
Gerald Showalter, Psy.D. Woodrow Wilson Rehabilitation Center
Mark Salisbury (Chair) Family Member
Barbara Seymour Virginia Department of Medical Assistance Services
Brian Shenal, Ph.D. (Vice-Chair) Salem Veterans Administration Medical Center
Michelle Witt Virginia Alliance of Brain Injury Service Providers
Leigh Wion (Secretary) Virginia NeuroCare
Chuck Walsh Middle Peninsula Community Services Board

Members Absent:
Heather Board Virginia Department of Health
Susan Elmore Virginia Dept of Behavioral Health & Developmental Services
Lynn Forsyth Family Member
Cynthia Millican Family Member
Michelle Nichols, R.N. Defense and Veterans Brain Injury Center
Paul Sharpe, R.N. Virginia Department of Health
Jeff Sherman Virginia Department of Juvenile Justice
Julie Triplett Virginia Office for Protection and Advocacy

Others in Attendance:
Karen Brown B rain Injury Services, Inc.
Kristie Chamberlain (Staff) Department of Rehabilitative Services
Mary Margaret Cash Virginia Department of Rehabilitative Services
Marcia DuBois Department of Rehabilitative Services
Bill Fuller Virginia Housing Development Authority (VHDA)
Jocelyn Johnson Survivor
Kristy Joplin Brain Injury Association of Virginia
Bruce DeSimone Virginia Housing Development Authority (VHDA)
James Rothrock Commissioner, Department of Rehabilitative Services
Juanita Thornton Presenter, Micro-Boards
Jim Witkins Presenter, Micro-Boards
Linda Wyatt Presenter, Micro-Boards
Lynn Wyatt Presenter, Micro-Boards
Lynn Yntema Brain Injury Services SWVa
Jason Young Community Futures Foundation

Opening Protocol
Mark Salisbury called the Virginia Brain Injury Council quarterly meeting to order at 1:06 p.m. at 8004 Franklin Farms Drive, Richmond Virginia in the Virginia Department of Rehabilitative Services Central Office in Richmond, VA. Members and guests introduced themselves. Chair Mark Salisbury reviewed Council member voting status. He also welcomed John Butrick to the Council as an At-Large voting member.

Before the start of business, Council viewed the Public Service Announcements (PSA’s) developed by the Brain Injury Association of Virginia (BIAV) during the month of March to promote Brain Injury Awareness Month. BIAV realized a significant increase in website traffic after the PSA’s ran on selected TV stations in Virginia.

Approval of April 27, 2012 Meeting Agenda
Jeff Barth made a motion to approve the agenda; Chuck Walsh seconded. The motion passed unanimously.

Approval of January 27, 2012 Meeting Minutes
Mark Salisbury noted that the title needed changed from AGENDA to MINUTES.
Anne McDonnell made a motion to approve the minutes with the above change, Carole Norton seconded. The motion passed unanimously.

Public Comment Period
Jason Young provided comment on behalf of the state funded brain injury services providers regarding a concern with not having an updated web based outcomes management system. This was a recommendation of 2007 Joint Legislative Audit Review Committee (JLARC) study and is now reaching a crisis point because the organization that currently houses the system is concerned the hosting company may be going out of business and the system is too antiquated for other hosting companies to take on. Mr. Young stated that Community Futures Foundation, where Mr. Young works, has an upcoming CARF survey and accreditation process and their current clubhouse services are documented on pen/paper vs. electronically. Mr. Young stated they will be cited for this. Mr. Young also stated that other human service providers are completing web based documentation and outcome management so at this time the brain injury service providers are at a disadvantage. He is hoping that a partnership with DRS is developed and implemented in the next year and encouraged DRS to look at all avenues to improve services to those we serve with a web based outcome management system.

Karen Brown provided comment on behalf of Brain Injury Services, Inc. (BIS, Inc.) BIS Inc. developed a Case Management system that other providers are using to for Case Management. The ability of the system has reached a crisis because the system is old and antiquated and is not collecting the all the data needed. The company that is hosting the system may close soon and no other hosting company will accept the system.

Patti Goodall clarified that the Department of Rehabilitative Services assembled all the state funded brain injury services programs together to conceptualize a case management system a few years ago, the proposal went out on RFP twice, and DRS was ready to award through the Commonwealth Neurotrauma Initiative (CNI) Trust Fund. Unfortunately, trust fund revenues plummeted and the RFP was canceled. There must be enough revenue coming in order to fund current and new awards going out through the trust fund. Ms. Goodall also clarified that the issue is not awareness, but rather lack of funds available to create or support a new system.

Old Business
1. The report of the Bylaws Committee was provided by Leigh Wion, Committee Chair. The Committee of Melissa Fox, Jodi Powers, Brian Shenal, Jeff Barth, Mark Salisbury as well as staff: Patti Goodall, and Kristie Chamberlain met by conference call on February 29, 2012 and proposed the following updates to the Council Bylaws:
a. Adding the Volunteer Family Ombudsman as a Standing Member in Article IV, Section A, subsection i.
b. Revising Article IV, Section A, subsection v on Council Composition to combine a & b for improved clarity and then renumbering the remaining.
c. Revising Article V to clarify the soliciting of Nominations for Officer positions
d. Revising Article VI, Section B to add the Volunteer Family Ombudsman to the Federal TBI grant as a Standing member
e. Revising Article VI, Section D to clarify nominations and eligibility for voting for Officer positions and the vote conducted at the October meeting.
f. Revising Article VIII, Section A to clarify the quorum to conduct Council business.
g. Revising Article IX to clarify the Standing Committees and Ad Hoc Committees
h. Revising Article X, Section C for consistency of the quorum required to conduct Council business.
i. Revising Article XI to add a phrase to the first sentence “or as requested by the Chair of the Council.”

Mark Salisbury asked for any discussion from Council on the proposed changes. Council members were concerned with the language in Article V Officers and Article VI Nominations and Elections on which Council members may solicit nominations for Officers and which Council members may actually nominate Officers and was this information included in the appropriate Article. Council members discussed that the sentences in the first paragraph of Article V referencing nominations and voting should be in Article VI.

Jodi Powers made a motion to approve the Bylaws with the changes in Article V Officers and Article VI Nomination & Elections discussed above. Melissa Fox seconds the motion. The motion passed unanimously. Kristie Chamberlain noted that the electronic vote submitted by an absent voting member prior to today’s meeting is now null since there were changes to Bylaws disseminated and what was voted on today.

2. Position Paper for DOJ settlement

The public comment period on a paper on the Department of Justice settlement closed April 6. Anne McDonnell reported that the Judge on this has not signed the consent decree accepting what Virginia is proposing. Chuck Walsh added that the judgment does not require the training center be closed but that the Commonwealth build up the community based system of care. However, there is concern that those institutionalized are not on the wait lists for waivers.

An educational presentation is still a little too soon until all the details are finalized, however Council members felt that this is a developing issue and Council needs to designate a person responsible for keeping Council inform. Council members suggested Susan Elmore would be best suited with her position at the Department of Behavioral Health and Developmental Services and serves in an advisory capacity to Council.

John Heath made a motion for Council staff to write a letter with Commissioner Rothrock to Judge Gibboney & Secretary Hazel stating Council’s interest in the DOJ settlement and for Susan Elmore to provide update reports to Council. Chuck Walsh seconded the motion. The motion passed unanimously.

New Business

1. Educational Presentation: “MicroBoards & Mortgages for Rental Homes for People with Disabilities”, Bill Fuller & Bruce DeSimone, VHDA; Marcia DuBois, DRS, Juanita Thornton, Linda Wyatt, Lynn Wyatt, & Jim Witkins.

The council was presented with information on the successful creation of a microboard in the Roanoke area that assists persons with disabilities in owning their own homes through the creation of a corporation.

2. Priorities Committee

The Priorities Committee consisting of Anne McDonnell, Aaron Goldmann, Debbie Pfeiffer, Chuck Walsh and Michelle Witt (along with staff Kristie Chamberlain) met via teleconference and email to provide input to Council on advising the Commissioner of Council priorities. The Committee provided Council with a review of the State Action Plan goals and progress toward those goals and solicited input from Council members of what should be Council’s recommendations to the Commissioner in July. The information will be followed up with a survey to Council prior to their final report at July’s meeting.

3. Remarks from the DRS Commissioner James Rothrock

a) The Commissioner welcomed John Butrick to the Council as a new at-large voting member.
b) The Commonwealth almost has a budget. It looks like funding cuts that were proposed were restored. For Personal Assistant Services (PAS), Employment (increase 120K), Brain Injury Direct Services (BIDs), and $6 M for vocational rehabilitation to take 4,000 off waiting lists and possibly opening some categories.
c) Effective July 1, there will be a new state agency - The Department for Aging and Rehabilitative Services. On July 1, 2013, the Department will add Adult Protective Services and the Adult Services provided at Social Services. The agency is in the midst of development of new letterhead, business cards, etc. but services will remain the same. This reorganization coincides with a Federal government re-organization with the Administration of Development Disability, Aging, and Disability Policy reforming as the Administration on Community Living.
d) Administration on Community Living – Respite Grants are available through the Administration on Community Living that the staff at the Dept. of Aging and Department of Rehabilitative Services are researching.
e) There was a very successful Caregiver Forum provided through the TBI Federal Grant on April 21 which utilized an intergenerational and multigenerational approach to the needs and respite for caregivers.
f) The education presentation on the Microboards supports Virginia’s Blue Print for Living promotion.

Jason Young was asked to repeat the information presented during public comment so the Commissioner could hear the concerns of the outdated system and pen/paper system still in use.

Commissioner Rothrock suggested forming a group to relook at the options with Ernie Steidle of DRS. Patti Goodall and Michelle Witt volunteered. Patti will initiate the first meeting and will follow up with an external meeting including Michelle in the coming weeks.

4. Open for Announcements/Comments from Council Members
Aaron Goldmann had requested an opportunity to present to the Council but due to time constraints, he graciously agreed to postpone his presentation to July.

Closing Protocol
Mark Salisbury, Chair, reviewed the next two meeting dates of July 27, 2012 and October 26, 2012. The October 26th meeting will be held at the Switzer Building Classroom at Woodrow Wilson Rehabilitation Center in Fishersville, VA.

Carole Norton made a motion to adjourn the meeting with a second from Jeff Barth. The motion passed unanimously. Mark Salisbury adjourned the meeting at 3:58 p.m.

Department of Rehabilitative Services (DRS)
Federal Traumatic Brain Injury Grant Report: “Closing the Gap”
Virginia Brain Injury Council (VBIC)
Friday April 27, 2012

• The Federal Grant Program Specialist (Dena Schall) left the position with the Department of Rehabilitative Services (DRS) in early March. DRS has asked Kristie Chamberlain to assist with coordinating grant activities for the rest of the year (the 4-year Federal Grant ends 3/31/2013). She will be working 20% of her time on Federal Grant through the end of the year.

• The Department of Rehabilitative Services’ 2nd Annual Caregiver Forum entitled “We Walk Together," was held on Saturday, April 21, 2012 at the Hilton Garden Inn, Innsbrook, Glen Allen, VA. As an educational activity of the Federal Traumatic Brain Injury (TBI) Implementation Partnership Grant, it provides an opportunity for DRS to share educational and respite resources for caregivers of family members with traumatic brain injury, as well as teach participants how to recognize and deal with caregiver-related stress. The event also provides a way for caregivers and family members to network and share strategies with others who are in similar situations. DRS hosted 45 caregivers at the Forum this year, along with 8 survivors who participated in separate activities. Having separate activities for survivors, staffed by professionals from The Mill House clubhouse in Richmond, allowed full-time caregivers with no respite care to attend the Forum. This was identified as a critical factor in allowing some people to attend – many commented that this was the first time in months that they had been able to have respite from care giving duties. Overall, a very successful activity.

 Virginia’s Needs and Resources Assessment: DRS is working with Virginia Commonwealth University Survey Evaluation & Research Laboratory (SERL) on the Year 4 Federal Grant goal to conduct a statewide assessment of brain injury needs / resources. Approval for the contract funding was just confirmed and we are waiting for SERL’s proposal to through required channels at Virginia Commonwealth University. Once that is done, DRS can executive a contract with SERL.

 Nursing Home Intervention Project: DRS is working through required procurement process to allow solicitation of vendors to carry out the activities of this project.

 Virginia Collaborative Policy Summit on Brain Injury and Juvenile Justice: DRS Federal grant subcontractor, Brain Injury Association of Virginia (BIAV), is coordinating a two-day Collaborative Policy Summit on Brain Injury and Juvenile Justice in Richmond on June 13-14, 2012. The national meeting will bring together Federal Grant related Health Resources and Services Administration (HRSA) staff, researchers, state agency stakeholders, and advocacy professionals from Virginia, Texas, Nebraska, Utah, and Minnesota, all states currently studying this population (or in the case of MN, the adult population). The Summit will provide a unique opportunity for attendees to discuss each state’s policies and practices for identification, diagnosis, and treatment, as well as their successes, challenges, and results to date. It is anticipated that concluding the event will be a discussion of policy recommendations with invited policymakers. A summary document describing challenges, discussions, plans, and recommendations will be prepared and disseminated after the meeting.

Subcontractors of the Federal Grant: The Brain Injury Association of Virginia and Virginia Commonwealth University (working with the Dept. of Juvenile Justice) will present updates on their Federal TBI Grant activities in separate reports.


Target Group #1: Juveniles with brain injury committed to the Virginia Department of Juvenile Justice
Systems Change
• Dr. Juan Arango presented project findings at BIAV’s Annual Conference in March.
• DRS and BIAV planning Collaborative Policy Summit to facilitate discussion with other states working on similar project. Other states include: Utah, Nebraska, Texas, and Minnesota. Key legislators and policy leaders from Virginia have also been invited. Event will take place in Richmond on June 13-14th.
Data Collection
• DJJ staff continuing to screen youth admitted to the facilities.
• Will be producing videos on 4 topic areas to educate DJJ staff on brain injury. Topics include: Introduction to Brain Injury; Project Overview; Behavioral Implications and Strategies; Educational Implications and Strategies.
• DJJ staff approved usage of BIAV’s Professional’s Guide as appropriate educational materials for staff.

Targeted Group #2: Persons with Low Socioeconomic Resources
Systems Change
• DMAS workgroup meetings cancelled due to staffing changes; group will reconvene after General Assembly session.
Data Collection
• Provided I&R to 229 individuals (180 survivors/family; 49 professionals); barriers indicative of LSES were reported 200 times; 20 reported being a member of a minority population.
• Exploring options for further data-mining of VSTR information.
• VSTR mailing sent to 106 individuals; received response from 9 individuals.

Targeted Area: Infrastructure Expansion
Systems Change
• DRS and BIAV working on Guidance Document for SERL to determine survey questions as well as methodology for retrieving information.
• Website: Total visits 6,990; Unique visits 5,749; Page Views 13,864; Docs downloaded 1,786. Special Note: 25% increase in web traffic during the month of March which was Brain Injury Awareness Month; 102% increase in web traffic during the 4 days the PSAs aired; 78% increase over week prior to PSAs airing; 44% decrease week after PSAs aired.
• Newsletter: 1,095 mailed
• E-Newsletter: 166 e-mailed
• Facebook: 605 Fans; 34 educational posts
• Distributed 2,500 military brochures to Virginia Wounded Warrior Program’s Central and Regional Offices, Defense and Veterans Brain Injury Center, Community Based Outpatient Centers, and VA Medical Centers.

Commonwealth Neurotrauma Initiative (CNI) Trust Fund Grant #10-168
Best Practices for Incarcerated Youth with Brain Injury Project

A partnership between VCU’s Department of Physical Medicine and Rehabilitation, the Virginia Department of Juvenile Justice, and the Brain Injury Association of Virginia
Primary Investigator: Jeffrey S. Kreutzer, Ph. D. (VCU)
Co-Primary Investigator: Juan Carlos Arango-Lasprilla, Ph.D. (Dr. Arango has left VCU as of April 2012)
Project Coordinator: Stephanie Lichiello (VCU)
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:
 Dr. Jeffrey Kreutzer and Dr. Juan Arango presented at the Brain Injury Association of Virginia’s 11th Annual Conference on March 10, 2012 in a poster session titled “Screening for Brain Injury among Virginia’s Incarcerated Youth.” The poster detailed work-to-date on the CNI DJJ project and provided a summary of data analyses.

 VCU is working with the Brain Injury Association of Virginia (BIAV) to create a series of five to seven-minute videos to provide education on brain injury to front-line staff working for the Virginia Department of Juvenile Justice. The videos will be shot on May 8th at Park Group Productions studio and upon completion will be available for public viewing on the BIAV website and social media sites.

 The Virginia Department of Health will be holding an Injury and Violence Prevention Symposium in June. VCU Research Associate, Dr. Nancy Hsu, has been invited to give an overview of the CNI grant and a summary of the current findings during a 60-minute session.

 VCU is working with The Virginia Department of Rehabilitative Services and the Brain Injury Association of Virginia to plan and implement a national two-day Collaborative Policy Summit on Brain Injury and Juvenile Justice.

 The initial data for the CNI project contained a sample of 336 participants. VCU has contacted DJJ to acquire the most up-to-date dataset with at least 300 additional participants included in the dataset. The complete dataset will be reanalyzed using the same statistical tests but will contain a larger sample size. These analyses will be the basis for the final CNI Trust Fund grant report.

 There will be a final project Advisory Board meeting during the last few weeks in June (date TBD) to review project progress and accomplishments, and to discuss opportunities for future research and collaboration.