The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council February, 2013 Minutes FINAL
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Friday, February 22, 2013

Members Present:
Brian Shenal, Ph.D. (Chair) Salem Veterans Administration Medical Center
Jeffrey Barth, Ph.D. (Commissioner Designee) University of Virginia School of Medicine
John Butrick Survivor, Member of Denbigh House Clubhouse
Susan Elmore Department of Behavioral Health & Developmental Services
Melissa Fox, DPT University of Virginia Health System
Patricia Goodall Department for Aging & Rehabilitative Services
John Heath Family Ombudsman, DARS Federal TBI Grant
Jocelyn Johnson Survivor
Katharine Lawson Virginia Board for People with Disabilities
Anne McDonnell Brain Injury Association of Virginia
Debbie Pfeiffer, Ed.D. Department of Education
Jodi Power, RN, JD (Secretary) DHP - Virginia Board of Nursing
Mark Salisbury (Immediate Past-Chair) Family Member
Chuck Walsh Middle Peninsula Community Services Board
Barbara Seymour Department of Medical Assistance Services
Martha Mead Virginia Wounded Warrior Program

Members Absent:
Cynthia O’Donoghue, Ph.D. James Madison University
Gayl Brunk Valley Associates for Independent Living
Michelle Witt Virginia Alliance of Brain Injury Service Providers
Lynn Forsyth Family Member
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
Aaron Goldmann (Commissioner Designee) Survivor, Department for Aging & Rehabilitative Services

Others in Attendance:
James Rothrock Commissioner, Department for Aging & Rehabilitative Services
Jennifer Clarke Brain Injury Association of Virginia
Kristie Chamberlain (Staff) Department for Aging and Rehabilitative Services
Mary Moore, Ph.D. VCU Survey, Evaluation & Research Laboratory
Jennifer Reid VCU Survey, Evaluation & Research Laboratory
Camilla Schwoebel Virginia Wounded Warrior Program

OPENING PROTOCOL: Brian Shenal, Ph.D., Chair

Brian Shenal, Ph.D., newly elected Chair, called to order the quarterly meeting of the Virginia Brain Injury Council at 1:05 p.m. The meeting was held in the Charlottesville Room (Room 202A) at the Department of Social Services Central Training Center, 1604 Santa Rosa Road, Henrico, Virginia 23229. (This quarterly meeting was previously scheduled for January 25, 2013, but was postponed due to inclement weather.) The Chair asked members and guests to introduce themselves.

Announcements were made including:
• Camilla Schwoebel will be the new representative for the Virginia Wounded Warrior Program.
• Kristy Joplin resigned from the Brain Injury Association of Virginia (BIAV) and Jennifer Clarke is replacing her as a part-time coordinator on BIAV’s Traumatic Brain Injury (TBI) Federal Grant subcontract with DARS.
• Gerald Showalter, Psy.D. will no longer be on the Virginia Brain Injury Council (VBIC) because he is now in a contracted position with Woodrow Wilson Rehabilitation Center. It is currently unknown if another representative from Woodrow Wilson Rehabilitation Center will be appointed to the Council.
• John Heath, TBI Family Ombudsman, shared information about a Wheelchair Tennis Event to be held May 4-5, 2013.

Dr. Shenal thanked Mark Salisbury for his service as Chair for the past two years. To facilitate more meaningful discussion, he requested that Council members indicate what group they represent before speaking and to ask questions or request explanations when needed to ensure understanding (and decrease use of acronyms).

Approval of October 26, 2012 Meeting Minutes
Jodi Power noted an edit to be made on page 3 of the minutes (deletion of “not”). With that amendment, the Council approved the minutes.

Approval of February 22, 2013 Meeting Agenda
Dr. Shenal requested the Nominations and Elections Committee matters be moved up for consideration prior to New Business in order to prevent potential loss of a quorum given the predicted inclement weather and possibility of attendees leaving early. Dr. Shenal also indicated the need for flexibility with the timing of Commissioner Rothrock’s attendance and comments. With no objection to these changes, the Council approved the agenda as amended.

Public Comment Period
There was no public comment provided during this meeting.

Debbie Pfeiffer, Ed.D., a member of Council, asked if she could make an announcement about the Department of Education’s (DOE) efforts to train teams in Virginia public school system on traumatic brain injury (TBI). On March 21, 2013, DOE will host a three-day training session in Charlottesville for 14 teams totaling 70 people. The trainings focus on 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 the impact on a student’s learning. She noted 11 of the 70 trainees plan to attend the Brain Injury Association of Virginia (BIAV) annual conference next month and that the Department of Education (DOE) will be training 56 more people in the summer of 2013.


Nominations and Elections Committee
In the absence of the Nominations and Election Committee Chair (Cynthia O’Donoghue), Committee member Melissa Fox presented the work of the Nominations and Elections Committee which met by conference call on January 9, 2013. The Committee presented the following slates:

• Chuck Walsh, for position of Vice-Chair, to finish a two-year term (vacated by Dr. Shenal who was elected Chair), to be effective immediately through January 2014.

Dr. Jeffrey Barth moved to elect Chuck Walsh to the position of Vice-Chair. The motion was seconded simultaneously by John Heath and Anne McDonnell and passed unanimously.

To fill At-Large Members positions, the Committee presented four names for three available slots:

• For one of the two available positions for Survivor, Family Member, Caregiver or Representative of an Individual with a Brain Injury, the Committee presented Lorraine Enright, family member, as first choice; and Kyle Sloan, survivor, as second choice.
• For the one available position for Individual Not Affiliated with any Specialized Brain Injury Program, the Committee presented Lisa Bradford, LCSW, as first choice; and Lorraine Enright, family member, as second choice.

Since so few nominations were received, the Council will not be putting forth any suggested nominations for the third open position. Kristie Chamberlain explained that the process is for Council to forward two names per position to Commissioner Rothrock for appointment. She stated that Council could re-open the recruitment period to recruit candidates to fill the third slot, or Commissioner Rothrock could choose a candidate of his own. Dr. Shenal added that it is the Council’s responsibility to recruit nominees to serve on the Council and for the Commissioner’s consideration. He indicated the category of “Individual Not Affiliated with any Specialized Brain Injury Program” has been difficult to recruit, and needs further clarification as it is intended to mean not affiliated with a state funded brain injury program, which the Bylaws Committee will consider.

Anne McDonnell moved to approve the slate as presented to forward to Commissioner Rothrock. The motion was seconded by Mark Salisbury and passed unanimously.

Dr. Shenal thanked the Nominations and Elections Committee for their work and reminded the Council that every member is expected to serve on one Committee while on the Council.


Appointment of Priorities Committee
At the request of Dr. Shenal, Patti Goodall provided an explanation of the Priorities Committee and why it was formed. She explained that the Council is an advisory body to the Commissioner and one of its primary roles is to advise the lead state agency for brain injury, the Department for Aging and Rehabilitative Services. As such, the Priorities Committee was formed to help distill and determine what it feels are the priorities for the upcoming year and to encourage DARS and the Commissioner to focus on these priorities by submitting an annual “Priorities Letter.”
Dr. Shenal asked for members to volunteer to serve on the 2013 Priorities Committee. Following discussion of the need for a balance of members, the following agreed to serve on the Committee: Susan Elmore (DBHDS), Barbara Seymour (DMAS), Camilla Schwoebel (Wounded Warriors), Anne McDonnell (BIAV), Debbie Pfeiffer (DOE), Jocelyn Johnson (survivor) and John Heath (family member). Debbie Pfeiffer agreed to Chair the Priorities Committee. Anne McDonnell agreed to assist Debbie as needed in chairing the committee (since she served as chair of the committee last year).

Appointment of Bylaws Committee

Dr. Shenal requested members to volunteer to serve on the 2013 Bylaws Committee, which is chaired by the Secretary. The following agreed to serve on the Committee in addition to Jodi Power, Secretary: Mark Salisbury, Melissa Fox, Chuck Walsh, and Dr. Jeffrey Barth.

Several items were identified as worthy of consideration by the Bylaws Committee including:
• making the Priorities Committee a standing committee;
• correcting the new agency name to DARS throughout the bylaws;
• visiting the required complement of the membership categories;
• clarification of the definition and designation for “individual not affiliated with any specialized brain injury program”; and
• consideration of allowing for public recruitment for nominations.

Dr. Shenal encouraged chairs of all committees to ensure the survivor/family member/consumer perspective is heard and included in all discussions and decision-making.

April Educational Meeting

Ideas for the one-hour educational meeting to be held in April 2013 were solicited by Dr. Shenal. Members suggested ideas including presentations regarding:
• Cognitive therapy and rehabilitation including how to pay for it since this is typically not covered by insurance. Tony Gentry (occupational therapist) was suggested by Melissa Fox as a possible presenter. Kristie Chamberlain requested members email her other possible presenters on this topic as well.
• Sports-related concussions and brain injury. Dr. Barth was suggested as a presenter on this topic at either the April meeting or Report Out Day, as he has done an excellent presentation in the past and UVA is doing work in this area.
• Explanation of Neurobehavioral and what that means in Virginia.
• Federal TBI Act Grant project working with the Department of Juvenile Justice on identifying incarcerated youth with brain injury. Dr. Jeff Kreutzer from VCU was suggested as a possible presenter on this topic.

Report Out Day

Patti Goodall, Department for Aging and Rehabilitative Services (DARS), said that staff will be meeting with Commissioner Rothrock next week regarding plans for the upcoming biennial Report Out Day scheduled for July 26, 2013, hosted by the Council and sponsored by DARS. This event highlights the work of state agencies that provide services to Virginians with brain injury, typically including the departments of Medical Assistance Services, Behavioral Health and Disability Services, Health, Veterans Services, Education. The Report Out Day also includes the awarding of the Council’s “Brain Injury Champion” star award. Historically, Report Out Day has been combined with the Council’s quarterly meeting; however, it is not certain if the July meeting will be held on the same day or rescheduled to another time. Information will be shared as plans are confirmed.

The keynote speaker under consideration for the Report Out Day is Chris Nowinski, a former Harvard football player and Worldwide Wrestling Federation (WWF) wrestler who sustained a series of career-ending concussions. He co-founded the Sports Legacy Institute with Dr. Robert Cantu to promote the donation and analysis of deceased athletes’ brains for research on chronic traumatic encephalopathy (CTE) related to multiple sports-related concussions. Commissioner Rothrock is guiding the agenda for the day. Anne McDonnell offered to contact Mary Ann Easterling, wife of an NFL player who committed suicide after suffering from repeated concussions and CTE if needed.

DARS Federal TBI Grant Update

Patti Goodall shared background on the four-year Federal TBI Grant that was awarded to the Department for Aging and Rehabilitative Services (DARS) for 2009-2013. The Federal Grant requires cash match for the state to receive the funds. For the first three years of the grant, the cash match was a project working with Virginia Commonwealth University (VCU) and the Department of Juvenile Justice to identify incarcerated juveniles with brain injury. The fourth year of the grant’s cash match involved a brain injury Statewide Needs and Resources Assessment contracting with VCU’s Survey, Evaluation and Research Lab (SERL) to execute and is still in ongoing status.

Mary Moore, Ph.D. and Jennifer Reid from VCU’s SERL provided a PowerPoint presentation on their activities to date which included a literature review, holding 6 of 7 planned focus groups, and analyzing data obtained from a total of 39 focus group participants. The overall goal is to identify current gaps and barriers in services for caregivers and individuals with TBI and other acquired brain injuries. The next steps include holding a veterans focus group to obtain data and developing a pen and paper survey tool, along with web-based data collection. The launch of the data collection materials is dependent on Internal Review Board (IRB) approvals by both VCU and DARS, but is anticipated to occur sometime in March 2013.

Patti Goodall was pleased to announce that DARS just learned last week that the Federal TBI Grant was extended for a noncompetitive fifth year of funding without having to apply through a new request for proposals for additional grant monies. She indicated DARS was meeting with the subcontractor on the grant, the Brain Injury Association of Virginia (BIAV), to determine specific activities for Year 5 that will be in compliance with original grant goals and objectives.

Anne McDonnell, Executive Director of the Brain Injury Association of Virginia, added an update on the BIAV activities related to the Department of Juvenile Justice (DJJ) project including production of three videos on addressing neurobehavioral issues of people with traumatic brain injury. The videos will be shared with all juvenile judges and court services units staff to educate them on neurobehavioral issues and deepen the level of brain injury understanding in juveniles entering the DJJ system.


Brian Shenal announced that Governor McDonnell issued an official Gubernatorial Declaration designating March 2013 as Brain Injury Awareness Month in the Commonwealth of Virginia. Patti Goodall, who assisted in coordinating this effort for DARS, will send a copy of the proclamation to Council members via e-mail attachment; color copies will also be available upon request.

Brain Injury Association of Virginia and Legislative Updates

Anne McDonnell stated that the House and the Senate issued a Resolution for the 30th Anniversary of the BIAV during this legislative session. Further, she reported that both the distracted driving bills (making texting while driving a primary offense) and the sports concussion bills (requiring private entities using public school facilities to follow the same requirements) have passed both House and Senate. [NOTE: This sports concussion bill did not pass the House.]

She reported BIAV’s 30th anniversary will be highlighted at the BIAV annual conference scheduled for March 9th. She encouraged attendance at the conference and noted that scholarships are available. Patti Goodall added that there is DARS federal TBI Grant funding available for Council members interested in attending the BIAV annual conference in March 2013 or the Williamsburg TBI Conference in May 1-3, 2013.

At the request of Brian Shenal, Anne McDonnell explained BIAV’s role and focus for Council members. She described the role of BIAV as brain injury education, outreach, public awareness and advocacy. She explained that BIAV works closely with the Virginia Alliance of Brain Injury Service Providers (comprised of brain injury service providers) during the legislative session. The current Senate budget includes $105,000 for brain injury services (which is disseminated and administered through the Department for Aging & Rehabilitative Services). The Senate Finance Health and Human Resources subcommittee requested that the Department for Medical Assistance Services (DMAS) report on what it would take to conduct a neurobehavioral program in Virginia by November 1, 2013.

Remarks from the DARS Commissioner - Jim Rothrock, DARS Commissioner

Commissioner Rothrock shared information with the Council on the following issues:

• The new Virginia Lifespan Respite Voucher Program launched on January 29, 2013 which allows for primary family caregivers of a person with a documented disability or medical condition to apply for a one-time $400/family “Lifespan Respite Reimbursement Voucher.” The voucher reimburses the family primary caregiver to pay for someone to provide respite for the care recipient, allowing the family caregiver to have a break from providing care. The program has approximately $179,000 in federal funding which will assist about 440 families. So far, 180 applications have been approved and DARS is hoping that the program will demonstrate that this is a critical, ongoing need in Virginia, for potential state funding in the future.
• The Medicaid expansion proposal in Virginia is uncertain at this time. There are 30,000 jobs and billions of dollars at issue, and we will know at the conclusion of the General Assembly session how it plays out.
• There is a small Senate budget amendment of $105,000, which is predicated on addressing current brain-injury wait lists, estimated at approximately 250 persons. If received, the Department for Aging and Rehabilitative Services as the contract administrator will work with brain injury service providers in Virginia to ensure the monies address this issue.
• DARS continues to coalesce and make progress in its new combined populations of the elderly in addition to the disabled population it serves, since the Virginia Department of Aging was merged with DARS and is now called the Division of Aging.
• Executive Order 55, which commits the state to affirmative opportunities for Virginians with disabilities in regard to employment and internships, was issued. The Commissioner indicated there is a private sector tie-in as well, and that the National Governors Association supports this effort.
• The Brain Injury Report Out Day is scheduled for July 26, 2013 and is likely to have a sports concussion focus. The Commissioner is hopeful that Council member Dr. Jeffrey Barth will provide an educational presentation. The Commissioner will meet with DARS staff next week to further discuss these plans.

CLOSING PROTOCOL: – Dr. Brian Shenal, Chair

Dr. Shenal reviewed future Council meeting dates: April 26th ; July 26th ; and October 25th. Staff added that New Member Orientation will be conducted at the April 26th meeting for new members and any current members who desire a refresher. Interested members should let Kristie Chamberlain know. It was also noted that the October meeting is typically held at Woodrow Wilson Rehabilitation Center in Fishersville, but if any members had ideas for other venues, locations for the October meeting, let staff know.

Dr. Jeffrey Barth made a motion to adjourn the meeting and Jodi Power seconded the motion. The meeting was adjourned at 3:45 pm.

Department for Aging and Rehabilitative Services (DARS)
Federal Traumatic Brain Injury Grant Report: “Closing the Gap”
Virginia Brain Injury Council (VBIC)
Friday January 25, 2013


 Virginia Collaborative Policy Summit on Brain Injury and Juvenile Justice: The “proceedings monograph” which summarizes challenges, discussions, plans, and recommendations of the two-day national Policy Summit that was held in June 2012 is in final review stages by the Department for Aging and Rehabilitative Services and the Brain Injury Association of Virginia for circulation and distribution. We anticipate distribution by March 1. 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.

 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:
• Six focus groups were held to date: Chesterfield (9), Harrisonburg (10) , Martinsville (3), Yorktown (8), Virginia Beach (7), and Fairfax (4)
• Transcriptions completed for all of the focus groups
Pending and Future:
• Still trying to schedule a Veterans focus group
• Development of pen/paper survey materials

 The TBI Federal Grant Meeting: The annual Federal Grantee meeting planned for March 2013 in Maryland was canceled by the Federal government in January.

 TBI Federal Grant Extension: The Department for Aging and Rehabilitative Services (DARS) has not received final word on the fifth year of funding for the Federal Traumatic Brain Injury grant. They have shared that if it is approved they will require a response from the currently funded states with new goals, objectives and a budget related to the original funded proposals. DARS will update the Council as it receives final word.

See the back for The Brain Injury Association of Virginia – a subcontractor on the DARS’ Federal TBI Grant for a separate update on their grant activities.


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
• Members of the workgroup met with Cindi Jones (DMAS) to discuss creating a neurobehavioral program in Virginia.

Data Collection
• Received 177 calls: 122 survivors/family; 55 professionals. Barriers indicating low socioeconomic status mentioned 22 times. 3 individuals identified themselves as belonging to a minority group.

• Outreach mailings were sent to 43 individuals identified through the Trauma Registry (VSTR); received 1 call from these mailings.
• DARS investigating reason for and ways to increase number of individuals receiving mailings

Targeted Area: Infrastructure Expansion
Systems Change
• SERL conducted 6 focus groups around the state; working to organize a veterans group.

• Website: : 8,662 total; 7,349 unique; 1,862 educational documents downloaded; 28 individuals requested info
• Newsletter: 1,188 mailed
• E-Newsletter: 287 emailed
• Facebook: 14 educational posts; 699 total fans

• Provided 50 military brochures to Salem VA Medical Center