The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council October, 2012 Minutes FINAL
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Friday, October 26, 2012
12:00 p.m. – 3:00 p.m.
Members Present:
Mark Salisbury (Chair) Family Member
Jeffrey Barth, Ph.D. (Commissioner Designee) University of Virginia School of Medicine
Melissa Fox, DPT University of Virginia Health System
Patricia Goodall Department for Aging & Rehabilitative Services
Cynthia O’Donoghue, Ph.D. James Madison University
Jodi Power, RN, JD Nursing Board
Gerald Showalter, Psy.D. Woodrow Wilson Rehabilitation Center
Brian Shenal, Ph.D. (Vice-Chair) Salem Veterans Administration Medical Center
Leigh Wion (Secretary) Virginia NeuroCare
Anne McDonnell Brain Injury Association of Virginia
John Heath Family Ombudsman, DARS Federal TBI Grant
Debbie Pfeiffer, Ed.D. Department of Education
Gayl Brunk Valley Associates for Independent Living
Chuck Walsh Middle Peninsula Community Services Board
John Butrick Survivor, Member of Denbigh House Clubhouse
Barbara Seymour Department of Medical Assistance Services
Martha Mead Virginia Wounded Warrior Program

Members Absent:
Carole Norton, Ph.D. (Immediate Past Chair) Eggleston Services, Inc.
Michelle Witt Virginia Alliance of Brain Injury Service Providers
Lynn Forsyth Family Member
Susan Elmore Department of Behavioral Health & Developmental Services
Jocelyn Johnson Survivor
Heather Board Department of Health / Injury Prevention
Michelle Nichols, R.N. Defense and Veterans Brain Injury Center
Paul Sharpe, R.N. Department of Health / Statewide Trauma Registry
Jeff Sherman Department of Juvenile Justice
Julie Triplett Virginia Office for Protection and Advocacy
Cynthia Millican Family Member
Katharine Lawson Virginia Board for People with Disabilities
Aaron Goldmann (Commissioner Designee) Survivor, Department for Aging & Rehabilitative Services

Others in Attendance:
James Rothrock Commissioner, Department for Aging & Rehabilitative Services
Stacy Belkanen Salem Veterans Administration Medical Center
Lisa Bradford Salem Veterans Administration Medical Center
Karen Brown Brain Injury Services, Inc.
Kristie Chamberlain (Staff) Department for Aging and Rehabilitative Services
Heidi Dix Department of Behavioral Health & Developmental Services
Marcia DuBois Department for Aging & Rehabilitative Services
Kerrin Epstein Intern, Community Futures Foundation
Frank Hayes Brain Injury Services of Southwest Virginia
Kristy Joplin Brain Injury Association of Virginia
Katherine Luci Salem Veterans Administration Medical Center
Mary Wallace Brain Injury Association of Virginia
Jason Young Community Futures Foundation

Opening Protocol
Mark Salisbury, Chair, called to order the quarterly meeting of the Virginia Brain Injury Council at 12:10 p.m. in the Switzer Building, Woodrow Wilson Rehabilitation Center, Fishersville. The chair asked members and guests to introduce themselves.

Approval of July 27, 2012 Meeting Minutes
Upon hearing no changes to the minutes of the previous meeting, the Council approved the minutes as provided.

Approval of October 26, 2012 Meeting Agenda
Upon hearing no changes to the agenda, the Council approved the agenda as provided.

Public Comment Period
Debbie Pfeiffer announced there was a seminar targeting school psychologists on October 1, 2012 in Charlottesville, attended by 172 participants (168 were school psychologists). The focus of the seminar was on clarifying Traumatic Brain Injury (TBI) as a disability category as defined by federal and state regulations; identifying standards of practice and related ethical implications for appropriate assessment and identification of students with TBI; and understanding common cognitive, physical, and social challenges associated with TBI and their impact on a student’s learning. Peter Patrick, Ph.D., pediatric neuropsychologist, was the guest speaker. The seminar offered “ethics credits” which are required psychologists, and may have bolstered attendance. A second seminar is scheduled for November 5, 2012 in Fairfax with 268 registrants. Betsy Ziegler of Brain Injury Services Inc. also facilitated training in pediatric brain injury and case management on Oct.1, 2012 in Loudon County with 48 participants.

John Heath provided an update for caregivers and/or Medicare recipients, stating that Anthem has cancelled all its supplemental Medicare policies. John indicated that there are very few carriers available in the Richmond area. He advised securing a new carrier before expiration of the policy.

Chuck Walsh reported that the Middle Peninsula Community Services Board (CSB) was awarded a Virginia Department of Health grant for Brain Injury Prevention. The grant award is $20,000 and they will be purchasing 600 helmets, providing literature/outreach, conducting a strategic planning group, and hosting regional workshops. For more information, please contact Chuck Walsh at Phone: 804-758-5314 or
Email: .
Remarks from the DARS Commissioner - Jim Rothrock, DARS Commissioner
Commissioner Rothrock welcomed everyone to Woodrow Wilson Rehabilitation Center (WWRC) where Director, Rick Sizemore, has stabilized enrollment. He also indicated that the Center’s remodeling of a dormitory is going well and that the dorm will re-open in January.

Although Dr. Carole Norton, Immediate Past Chair, was unable to be at the meeting, Commissioner Rothrock thanked her for her service to the Council, on which she has served since 2005. Dr. Norton will rotate off the Council as of the January 2013 meeting, when Mark Salisbury assumes the position of Immediate Past Chair.
The Commissioner then presented Leigh Wion, Secretary, with a certificate and thanked her for the dedication and service she has provided to the Council as a member and as Secretary. Leigh’s term as secretary ends as of the January 2013 meeting, when she will rotate off Council.

The Commissioner updated the Council on the following points:

• Commissioner Rothrock received the Council’s Priorities Letter (this is a letter sent following the July Council meeting and containing issues which the Council designates as “priority areas” to focus on when the agency is preparing its annual budget request). The Council identified the following in its Priorities Letter: creation of a Brain Injury Waiver; expansion of Core Services (Case Management, Clubhouses, and Resource Coordination); development of neurobehavioral programs and services; and development and implementation of an outcome-based data collection and management system for state-funded brain injury service providers.
ï‚ Commissioner stated that he had shared the Council’s Priorities Letter with Cindi Jones, Director of the Department of Medical Assistance Services (DMAS), because it contained items related to the establishment of a Brain Injury Waiver. Unfortunately, economic forecasts have diminished, and although Ms. Jones is supportive of a waiver addressing the needs of Virginians with brain injury, it does not appear that the timing is right to request another type of waiver (e.g., the brain injury waiver). The implementation of the Affordable Care Act, the end of current administration, and the economic forecast are impacting what can be requested.
ï‚ The Commonwealth Neurotrauma Initiative (CNI) Trust Fund Advisory Board is aware of the need for a neurobehavioral pilot program to begin to address this ongoing, critical need and meets again December 7, 2012. Though the Fund is not soliciting any request for proposals at this time, they are keeping this particular need on its radar.

• The Commissioner requested input from the Council on an effort involving Centers for Independent Living (CILS); Brain Injury Services (BIS) Programs; Employment Services Organizations (ESO); and Area Agencies on Aging (AAA) to improve the relationships and functioning of boards of directors and executive staff. The Commissioner commented that governing boards often forget their fiduciary responsibility for the organization and he cited several real examples. He requested that Council designate someone from Council to represent the Brain Injury Services Programs to work with him on the development of webinars and teleconferences on a variety of related topics. He also indicated that Governor McDonnell & Secretary Hazel are very interested in “dashboards” (designed to offer transparency and control, dashboards summarize data for the public to view) and this would also be an area in which the Council represent would work with the Commissioner. The Commissioner requested that Mark Salisbury designate a Council member to represent the Brain Injury Services provider group for this purpose. As Council Chair, Mark will work with Patti Goodall and Kristie Chamberlain to respond to the Commissioner’s request.

• The Department for Aging and Rehabilitative Services’ (DARS) Vocational Rehabilitation (VR) program requires $12 million to make their necessary federal match. The Governor injected $6 million in state funds to allow 5,000 of the 6,500 people on the waitlist to be served during the current fiscal year. Of those 5,000, over 300 have already become employed. However, at the present rate of authorizations and anticipated expenditures, DARS would over expend its allocated case service dollars by the fiscal year’s end. Therefore, effective November 15, DARS has closed the Most Severely Disabled Category based on federal guidance. Despite this, the Commissioner requested that the programs continue to refer individuals for vocational rehabilitation services, with the goal of achieving a balance of slow controlled influx of new cases.

• DARS was able to secure a small, one-year grant from the Department of Health and Human Services, Administration on Aging, Office of Home and Community Based Services to offer lifespan respite vouchers. The grant is not a large sum of money (about $140,000 in vouchers), but it will allow the parents of an infant, child, teen, adult or the elderly with a disability to apply for a $400 voucher per family per year for the respite care of their choice. DARS is developing the application forms at this time and hopes to launch the program in 2013.
New Business

Virginia Alliance of Brain Injury Service Providers Legislative Agenda – Leigh Wion & Anne McDonnell
The Alliance’s legislative agenda, which mirrors the agenda of the Brain Injury Association of Virginia, contains two appropriation items. One request is for $4.5 million to DARS for 6 priority items and one is for $2.5 million and budget language asking the Department of Medical Assistance Services (DMAS) to address the creation of a Medicaid Waiver that would address the needs of Virginians with acquired brain injury, as well as the provision of neurobehavioral services, both residentially and community based. (Please refer to attached handout.) Several meetings have already been held with legislators and the agenda has the support of the Disability Commission.

Anne McDonnell informed Council of additional legislative items of concern.
• The costs of Mental Health Support Services currently used by Community Services Boards are skyrocketing. The Department of Medical Assistance Services is looking at controlling costs by revising service eligibility and this will have some impact on some persons with brain injuries.
• Senator Northam is introducing legislation to require any organization using school facilities to adhere to the state’s Department of Education concussion guidelines and reporting mechanisms.
• Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius. This was a class action lawsuit brought against the Secretary of Health and Human Services, Kathleen Sebelius, to eliminate the policy and practice of the illegal, harmful and unfair Medicare "Improvement Standard." A proposed settlement agreement was filed in federal District Court on October 16, 2012. When the judge approves the proposed agreement, a process that may take several months, CMS will revise the Medicare Benefit Policy Manual and other Medicare Manuals to correct all suggestions that Medicare coverage is dependent on a beneficiary "improving." New policy provisions will state that skilled nursing and therapy services necessary to maintain a person's condition can be covered by Medicare. More information on the Jimmo v. Sebelius “Improvement Standard” case and settlement can be found on the website of the Center for Medicare Advocacy at
Department of Justice Settlement Update - Heidi Dix, Department of Behavioral Health & Developmental Services (DBHDS)
Heidi Dix from the Department of Behavioral Health and Developmental Services (DBHDS) provided a PowerPoint presentation on the Department of Justice Settlement. The lawsuit traces back to a three-year investigation at Central Virginia Training Center pursuant to the Civil Rights of Institutionalized Person Act which determined that Virginia was not in compliance with the Act due to the following violations:
• The training center is not the most integrated and appropriate setting;
• Virginia is not developing a sufficient quantity of community services; and
• There is a flawed discharge process at training centers.

DBHDS began negotiating a settlement with the Department of Justice (DOJ) in March 2011 and in January 2012 reached a settlement agreement.

Council members requested clarification on the following points:
• How do the Mobile Crisis Teams function? Response: Teams will work in each area.
• How is DBHDS looking at the providers? Response: Working with the regions to evaluate needs.
• How should the brain injury community be part of the discussion when the Waivers are up for renewal to close the gaps in the delivery system? Response: We welcome your participation in the conversation.
• What are the thoughts on why the phrase “cannot exclude persons with brain injury residing in nursing homes?” Response: From a policy standpoint, there is not an answer at the present time.
• Are persons living in nursing homes (including those with brain injuries) actually being asked on a yearly basis if they want to leave the nursing home? Response: There are problems with this, do not think it is occurring as it should, which impacts our estimates.

It was noted that notification to brain injury providers on the next Waiver Provider training would be helpful.

Unfinished Business

Council “Priorities Letter” to Commissioner Rothrock – Mark Salisbury, Chair
Mark Salisbury as Chair of the Council commented that the process of putting together the annual Priorities Letter demonstrates it is a priority. The Council will continue to draft a Priorities Letter to the Commissioner annually (July of each year) to provide input to the Commissioner as to what the Council feels are “priority items.” Anne McDonnell suggested revisiting previous discussions of making the Priorities Committee a Standing Committee. Mark Salisbury indicated that the timing for adding a standing committee to the Bylaws would be when the Bylaws committee is reformed in January. The incoming Chair will therefore address this item at that time.

Nominations and Elections Committee –Cynthia O’Donoghue, Committee Chair
The Nominations and Elections Committee met by conference call several times and via e-mail. The Committee is presenting the following slate for the Chair and Secretary positions (effective 01/2013 meeting):
• Brian Shenal, for position of chair, for a two-year term
• Jodi Power, for position of secretary, for a one-year term, eligible for a 2nd one-year term.

A motion was made by Leigh Wion to approve the slate as presented. The motion was seconded by Chuck Walsh. The motion passed unanimously.

Now that Dr. Shenal, who serves in the role of vice chair, will assume chairmanship in January 2013, the Nominations & Elections Committee will need to fill the last year of his term as vice chair. The Council will also be requesting nominations for three At-Large Positions (1 family member & 2 professionals, effective 2013, expiring 3/16). Information on the nominations process for the at-large positions will be sent via e-mail.

Federal TBI Grant Update – Patti Goodall, DARS; Kristy Joplin, BIAV
(handout attached to the end of the minutes)

The Department for Aging and Rehabilitative Services (DARS) is the recipient of the Federal TBI Grant and Patti Goodall, Project Director, reported:
 DARS received informal communication at the National Association of State Head Injury Administrators (NASHIA) conference in September that the Federal Grant contract will be extended for one year (April 2013-March 2014), with no new Request For Proposals process. In light of the extension, Patti asked that the Council please submit suggestions for small projects to create systems change (versus direct services), in line with the federal grant’s primary goals and objectives. Mark Salisbury requested that Kristie Chamberlain send out a reminder to Council members to e-mail their ideas for small projects with the cautionary note that, while all suggestions will be considered, there is limited funding.
 A “proceedings monograph” from the Virginia Collaborative Policy Summit on Brain Injury & Juvenile Justice held in June 2012 is in final stages of development by staff from the Virginia Commonwealth University Rehabilitation, Research, & Training Center (RRTC) on Workplace Supports. The monograph will summarize challenges, discussions, plans, and recommendations of the two-day national meeting. A copy of the monograph will be posted on the DARS website, as well as on the website of the Brain Injury Association of Virginia and perhaps other locations as well.
 The Survey, Evaluation & Research Lab (SERL) at Virginia Commonwealth University (VCU) has a one-year contract to complete the statewide needs and resources assessment that will include focus groups, written surveys, and telephone interviews. SERL just received Internal Review Board (IRB) approval from both the Department for Aging and Rehabilitative Services as well as VCU; their advisory board is in place and they will be holding focus groups across the Commonwealth during the month of November. Patti Goodall indicated that Kristie Chamberlain will e-mail that information to Council members and asked that they assist us in recruiting by sharing the flyer with friends, family, consumers and colleagues.

The Brain Injury Association of Virginia (BIAV) is a DARS subcontractor under the Federal TBI Grant and provided a brief update of their grant activities: Kristy Joplin, Grants Manager, reported:
 Outreach mailings continue to those reported to Trauma Registry, but for some reason there has been a significant decrease in the numbers reported to the Trauma Registry. BIAV is working with DARS and the Virginia Department of Health (VDH) to find out why there is a discrepancy.
 BIAV provided Certified Brain Injury Specialist (CBIS) trainings to three professionals; all passed. The dates for CBIS training is 2013 are Feb. 28 and Aug. 8. Please contact BIAV if you are interested.
 There has been a redesign of a military brochure completed this year and 3000 have been distributed.
 The Department of Juvenile Justice educational videos are on the BIAV website, if you would like copies, please contact BIAV or go to: and enter “juvenile justice” into the search field.

The Survey Evaluation and Research Laboratory (SERL) is a DARS subcontractor under the Federal TBI Grant. They are conducting a statewide brain injury needs and resources assessment using written surveys, telephone interviews, and focus groups. Focus Groups are currently underway. SERL did not attend the meeting and did not submit a quarterly update. They have been invited to update Council at the January 2013 meeting.

TBI Workgroup Update - Patti Goodall, DARS
The Traumatic Brain Injury workgroup is comprised of representatives from the Department for Aging and Rehabilitative Services (DARS), Department of Medical Assistance Services (DMAS), Department of Behavioral Health & Developmental Services (DBHDS), and the Brain Injury Association of Virginia (BIAV). The workgroup has come to the same conclusion as others that a Bain Injury Waiver is not feasible at this time, given the economic conditions within the state, there is little chance of getting the necessary funding. It may be possible to get language passed directing the Department of Medical Assistance Services to explore reimbursement structures within the Waivers and adjust pricing for the higher cost needs of people with brain injury – this might encourage more in-state nursing facilities to consider accepting higher need folks with brain injury who have challenging behaviors (versus sending them out of state at a higher overall cost). The workgroup is important because it allows dialogue between agency staff, builds relationships, and allows for potential sharing of date and information.

Closing Protocol – Mark Salisbury, Chair
Mark Salisbury reviewed the future meeting dates for the Brain Injury Council in 2013: January 25; April 26; July 26; October 25 (Woodrow Wilson Rehabilitation Center).

Anne McDonnell made a motion to adjourn the meeting. Dr. Shenal seconded. Meeting adjourned at 2:45 pm.

Department for Aging and Rehabilitative Services (DARS)
Federal Traumatic Brain Injury Grant Report: “Closing the Gap”
Virginia Brain Injury Council (VBIC)
Friday October 26, 2012


 Virginia Collaborative Policy Summit on Brain Injury and Juvenile Justice: A “proceedings monograph” is in final stages of development by staff from the Virginia Commonwealth University RRTC on Workplace Supports. The monograph will summarize challenges, discussions, plans, and recommendations of the two-day national meeting. A copy of the monograph will be posted on the DARS website, as well as on the website of the Brain Injury Association of Virginia (and perhaps other locations as well). The Policy Summit held in June 2012 brought 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 (MN is studying the adult population). The Policy Summit provided 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. Texas offered to host (sponsor) a second Policy Summit in 2013, using their Federal Grant funds to support the follow-up meeting.

 Statewide Needs & Resources Assessment: The Department for Aging and Rehabilitative Services (DARS) executed a one-year contract with Virginia Commonwealth University’s Survey, Evaluation and Research Lab (SERL) to conduct a statewide Brain Injury Needs & Resources Assessment that will include focus groups, written surveys, and telephone interviews. The purpose is to identify current gaps and barriers in services for caregivers and individuals with TBI's and other brain injuries (the initial statewide assessment was completed in 2000). Current status:

• SERL received approval from the Internal Review Boards (IRB) of both Virginia Commonwealth University and the Department for Aging and Rehabilitative Services and was declared “exempt” from further review unless substantive changes are made.
• SERL has assembled an Advisory Committee for the Brain Injury Needs & Resources Assessment.
• SERL is launching recruitment for the focus groups to be held in each of the five health planning regions as follows:
o Harrisonburg: Friday Evening November 2nd;
o Fairfax: Monday or Wednesday Evening November 5th or 7th ;
o Henry/Martinsville: Tuesday Evening November 27th;
o Bristol/Washington: Saturday December 1st ;
o Norfolk/VA Beach: Friday Evening November 30th ;
o York: Monday the 29th or Tuesday Evening 30th ;
o Chesterfield: Thursday November 1st
Stakeholders will be asked to assist with recruitment in their areas, as well as with logistics, as feasible!

The Brain Injury Association of Virginia – a subcontractor on DARS’ Federal TBI Grant - will present an update on their grant activities separately.

“Closing the GAP” BIAV Grant Report
Year 4 – 2nd Quarter

Target Group #1: Juveniles with brain injury committed to the Virginia Department of Juvenile Justice
Systems Change
• DARS & BIAV working with VCU to complete paper documenting Policy Summit proceedings.

• Duplicating videos for distribution to DJJ staff; finalizing topic sheets to be included in staff education distribution.

Targeted Group #2: Persons with Low Socioeconomic Resources
Systems Change
• Workgroup met via conference call; discussed BIAV legislative priorities which includes the waiver option and neurobehavioral treatment program

Data Collection
• Received 204 calls: 153 survivors/family; 51 professionals. Barriers indicating low socioeconomic status mentioned 30 times. 8 individuals identified themselves as belonging to a minority group.
• Exploring options for further data-mining of VSTR information.

• Outreach mailings were sent to 52 individuals identified through the Trauma Registry (VSTR); received 7 calls from these mailings.

Targeted Area: Infrastructure Expansion
Systems Change
• SERL coordinating Steering Committee that will provide guidance on project; identified areas for focus group meetings; locations of meetings being determined; recruitment of participants to start soon.

• Provided CBIS training to 3 professionals; 3 received certification
• Website: : 7,745 total; 6,619 unique; 1,529 educational documents downloaded; 33 individuals requested info
• Newsletter: 1,164 mailed
• E-Newsletter: 283 emailed
• Facebook: 13 educational posts; 674 total fans

• Provided 25 copies of military brochure to VOPA staff


1. $4.5 million appropriation for the Department for Aging and Rehabilitative Services budget to:
a. secure infrastructure and workforce of existing programs and address waiting lists ($1 million)
b. streamline and modernize outcomes data collection systems ($150,000)
c. conduct brain injury surveillance, outreach and options counseling services ($150,000)
d. expand core services of adult and pediatric case management, clubhouses/day programs, and regional resource coordination in underserved areas ($1 million)
e. enhance Brain Injury Personal Assistance Services program and expand the Brain Injury Discretionary Services Fund ($200,000)
f. create a discharge assistance fund for transfer from institutional to community based settings for persons with brain injury ($2,000,000)

2. $2.5 million appropriation with budget language requiring the Department of Medical Assistance Services to:
a. complete the Brain Injury waiver application
b. issue an RFP for a pilot program for a 20 bed neurobehavioral treatment unit in either a licensed nursing facility or residential treatment center
c. establish a Medicaid payment rate through the RFP process that will allow the development, and sustain the operation, of the successful RFP applicant’s neurobehavioral residential treatment program

This legislative agenda is supported by the members of the
Virginia Alliance of Brain Injury Service Providers:

• Brain Injury Association of Virginia
• Brain Injury Resource Development
• Brain Injury Services Inc
• Brain Injury Services of SWVA
• Building A Bridge
• Community Futures Foundations
• Crossroads to Brain Injury Recovery
• Eggleston Services - Beacon House
• Virginia NeuroCare Foundation
• MWS Brain Injury Services
• No Limits Eastern Shore
• The Choice Group
• Virginia Supportive Housing