The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council April, 2013 FINAL
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Friday, April 26, 2013
1:00 p.m.
Members Present:
Brian Shenal, Ph.D. (Chair) Salem Veterans Administration Medical Center
Heather Funkhouser Board Department of Health / Injury Prevention
Lisa Bradford Salem Veterans Administration Medical Center
Gayl Brunk Valley Associates for Independent Living
Susan Elmore Department of Behavioral Health & Developmental Services
Lorraine Enright Family Member
Melissa Fox, DPT University of Virginia Health System
Aaron Goldmann Survivor, Department for Aging & Rehabilitative Services
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
Cynthia O’Donoghue, Ph.D. James Madison University
Debbie Pfeiffer Department of Education
Jodi Power, RN, JD (Secretary) Department of health Professions / Board of Nursing
Chuck Walsh Middle Peninsula Community Services Board
Michelle Witt Virginia Alliance of Brain Injury Service Providers
Camilla Schwoebel Virginia Wounded Warrior Program
Barbara Seymour Department of Medical Assistance Services

Members Absent:
Jeffrey Barth, Ph.D. University of Virginia School of Medicine
John Butrick Survivor, Member of Denbigh House Clubhouse
Michelle Nichols, R.N. Defense and Veterans Brain Injury Center
Mark Salisbury (Immediate Past-Chair) Family Member
Paul Sharpe, R.N. Department of Health / Statewide Trauma Registry
Julie Triplett Virginia Office for Protection and Advocacy
Cynthia Millican Family Member

Others in Attendance:
James Rothrock Commissioner, Department for Aging & Rehabilitative Services
Jennifer Clarke Brain Injury Association of Virginia
Mary Wallace Brain Injury Association of Virginia
Mary-Margaret Cash Department for Aging and Rehabilitative Services
Kristie Chamberlain (Staff) Department for Aging and Rehabilitative Services
Marcia Dubois Department for Aging and Rehabilitative Services
James Johnson Family Member of Virginia Brain Injury Council member
Becky Bowers-Lanier Lobbyist, Brain Injury Association of Virginia

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

Brian Shenal, Chair, called to order the quarterly meeting of the Virginia Brain Injury Council at 1:05 p.m. The meeting was held at the Virginia Department for Aging & Rehabilitative Services (DARS) Central Office, 8004 Franklin Farms Drive, Henrico, Virginia 23229 in conference rooms 101-103-105. The Chair asked members and guests to introduce themselves.

Dr. Shenal welcomed two new members to the Council, who attended orientation with DARS staff that morning:
• Lisa Bradford, LCSW (Roanoke)
• Lorraine Enright, family member (Yorktown)

Dr. Shenal requested that Council members indicate their name and, if feasible, what group they represent before speaking. He also encouraged new members to ask questions and request explanations to ensure understanding.

Approval of April 26, 2013 Meeting Agenda
Patti Goodall requested the Council move the Bylaws Committee update before the Priorities Committee update because the Bylaws update required a motion. The Council approved the change to the agenda.

Approval of February 22, 2013 Meeting Minutes
Anne McDonnell provided an update on an item on Page 5 of the minutes, stating that the sports concussion bills referenced there subsequently did not pass the House.

Debbie Pfeiffer requested an edit on page 2 of the meeting minutes to remove the reference of the Department of Education shifting from a “return to play” to a “return to learn” emphasis.

With these amendments, the Council approved the minutes.

Public Comment Period
Patricia Goodall introduced Krystal Thompson as the new Executive Director of Brain Injury Services of Southwest Virginia (BISSWVA). Brain Injury Services of Southwest Virginia is one of 10 programs in Virginia that has a contract with DARS to provide brain injury services (DARS is designated as the lead agency for brain injury services in the Commonwealth). For a complete list of the state contracted brain injury service programs go to and look for “State Funded Brain Injury Services Programs in VA”.

There was no other public comment provided during this meeting.


Recommendations for Funding from the General Assembly and Virginia Alliance of BI Providers Update
Patricia Goodall provided background information regarding the 2013 General Assembly allocating $105,000 to address waiting lists for brain injured citizens in Virginia. She indicated key staff from the current state-funded contractors of brain injury services programs were meeting with Commissioner Rothrock on April 30th to discuss funding directives; however, she reminded members that it is a primary role of the Council to make recommendations regarding funding to the Commissioner. Since the Virginia Alliance met with the Brain Injury Association of Virginia (BIAV) prior to the Council meeting, Patti Goodall requested that an Alliance representative share an update of its funding recommendations with Council.

Michelle Witt, Chair of the Virginia Alliance of Brain Injury Service Providers (and also the Executive Director of Crossroads to Brain Injury Recovery), indicated that following a Brain Injury Association of Virginia (BIAV) survey of providers, the top two choices for disseminating the $105,000 in funding for FY 2014 would be to: 1) divide the monies equally among the brain injury service providers (13 programs); or 2) provide any program with a wait list for services a flat amount of money per person on the waiting list. (For example, based on the total of 267 reported to be on the wait list, the $105,000 divided equally would approximate $393 per person, which would go to the specific providers who reported those wait list numbers.) It was emphasized that Commissioner Rothrock had directed that the monies could not be used for general operational expenses, but must be used specifically to address waiting lists. This is a challenge for service providers who have had level funding for years despite increased costs and expenses. While it was noted that using the funds to hire a new brain injury case manager may have more impact, especially in underserved areas like Tidewater with no existing case management services, this would not meet the clear expectations for the use of the appropriated funding. Further discussion on this topic was tabled when Commissioner Rothrock joined the meeting.

Remarks from the DARS Commissioner - Jim Rothrock, DARS Commissioner

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

• The success in obtaining 2013 General Assembly Funding was because of having a “quantifiable waitlist.” The $105,000 allocated was based upon the math of the cost per person for brain injury services, multiplied by number of persons on the waiting list across the state not currently being served. He reported there was no discretion on how to spend the money and that it must be clearly tied to those individuals on waiting list. DARS has to direct the funds to provide services for the 267, or demonstrate an attempt to do so. He stated it would not be acceptable to propose adding a case manager in Tidewater, given the clear direction that funding was based upon the cited wait lists.
o A specific Brain Injury Waiver, as previously requested by this Council in its 2012 Priorities letter, was not feasible or likely to happen. He indicated all other specialized “boutique” waivers were being compressed into the idea of a general services or “universal waiver.”
o He encouraged the Council to move away from specialized brain injury thinking, and think more globally about how to obtain services for individuals with brain injury via bigger and wider resource streams, such as efforts to prevent hospital readmissions (Care Transitions by Area Agencies on Aging) due to CMS penalties, efforts toward chronic disease management, and healthy self-management trainings. He also added that the Council should stay attuned to Health Care Reform, anticipating 450,000 Virginians with no current access to care will need care in 2014, and at least some of them will have brain injuries.
• The Virginia Lifespan Respite Voucher Program is now complete with approximately 506 applications approved. The Program allowed for primary family caregivers of a person with a documented disability or medical condition to apply for a one-time $400 per family “Lifespan Respite Reimbursement Voucher.” The voucher reimburses the primary family caregiver to pay for someone to provide respite care for the recipient, allowing the family caregiver to have a break from providing care. The three most prevalent disabilities seen in the applications included autism, Alzheimer’s disease, and intellectual disabilities. The program had approximately $179,000 in federal funding and $25,000 in state funds which assisted the 500 families. DARS is hoping that the program will demonstrate the critical, ongoing need in Virginia and will use it in future discussions to perhaps obtain future funding to continue the program.
• The migration of Adult Protective Services into the Department for Aging & Rehabilitative Services is due to occur by July 2013. He added that abuse, neglect, and financial exploitation by caregivers are real issues to be cognizant of and to keep at the forefront of our work.
• Governor McDonnell’s Executive Order 55: “Supporting Virginians with Disabilities in the Commonwealth’s Workforce Importance of Employment for Virginians with Disabilities” (found here: increases employment opportunities for disabled citizens in both the state government and private sector workforces. The state is working with Governor Markell, Chair of the National Governors Association, to increase job opportunities and long-term support to maintain jobs, working with DARS to develop “toolkits” in this endeavor.
• The Brain Injury Report-Out Day is scheduled for July 26, 2013 in Richmond from 9 AM-4 PM, with Chris Nowinski, former Harvard football player and Worldwide Wrestling Entertainment (WWE) wrestler who sustained a series of career-ending concussions as the opening keynote speaker. Council member Dr. Jeffrey Barth of UVA will give a luncheon keynote. The Commissioner indicated the Office of Community Integration will be added to the list of other agencies who will “report out” to the Council in the afternoon.
• Neuropsychological treatment is an emerging need. There is an increased appreciation that Virginia is behind in dealing with troubling behaviors. Although it is often associated with brain injury, these behaviors are not exclusive to survivors of brain injury. The Commonwealth Neurotrauma Initiative Trust Fund Advisory Board (CNI) has approved the Commissioner’s request to fund a one-year grant to research the development of a community based model program in this area, with data obtained to be shared in the Commonwealth. Crossroads to Brain Injury Recovery in Harrisonburg and Brain Injury Services Inc., in Northern Virginia both have had previous successful CNI Grants in these areas. The Board and the Commissioner wanted to build on prior successes by taking their research one step further. This also serves as required cash match to the additional year of funding for the TBI Federal Grant that for which the Virginia Brain Injury Council serves as an advisory body.

Recommendations for Funding from the General Assembly (continued)

Dr. Shenal called for a motion regarding the Council’s recommendation for disbursement of state general funds from the 2013 General Assembly.

Lisa Bradford moved that the Virginia Brain Injury Council inform the Commissioner that the Council supports the dissemination of funding in line with the General Assembly’s intent regarding serving the needs of individuals with brain injury currently on wait lists, in line with the recommendations of the Virginia Alliance for Brain Injury Service Providers. The motion was seconded by John Heath. The motion passed unanimously. Michelle Witt, Cynthia O’Donoghue and Anne McDonnell abstained.

Virginia Alliance for Brain Injury Service Providers Update (continued):

Beyond the funding directive discussion, Michelle Witt reported that the Alliance continues to work with DARS on the outcomes data management system.


Bylaws Committee

Jodi Power, Chair of the Bylaws Committee, reported that the committee met by telephone conference call on March 28, 2013. She thanked the members of the Bylaws Committee for their excellent review and discussion that resulted in the draft bylaw changes. The Committee members included: Mark Salisbury, Melissa Fox, Chuck Walsh, and Dr. Jeffrey Barth. Draft bylaws were presented to the full Council in writing in advance of the meeting and reflected the following primary substantive changes:
• adding the Priorities Committee as a standing committee;
• changing the new agency name to DARS from DRS throughout the bylaws;
• adding language to ensure that survivors and/or family members are represented on standing and ad hoc Committees;
• clarifying the “composition of members” definition and designation for “individual not affiliated with any specialized brain injury program” to mean not affiliated with any organization or brain injury program that receives state funding; and
• adding the ability for public recruitment for Council nominations as an option.

John Heath requested further clarification in Article IV(A)(v)(e) of individuals not affiliated with any brain injury service to mirror language in Article IV(A)(v)(c). Anne McDonnell requested adding the word “staff” following “federal grant” to the new language in Article VII(A) regarding Standing Members.

Cynthia O’Donoghue moved that the Virginia Brain Injury Council accept the bylaws as proposed by the Committee with the two amendments noted above. The motion was seconded by both Anne McDonnell and John Heath and the motion passed unanimously.

Dr. Shenal and DARS staff thanked the Bylaws Committee for their work.

Priorities Committee
Debbie Pfeiffer, Chair of the Priorities Committee, gave background and history on the Priorities Committee of the Virginia Brain Injury Council, which was formed in 2011 to help determine what it feels are statewide priorities for the upcoming year. Further, by submitting an annual one-page “Priorities Letter” to the Commissioner of DARS each August, this is a way for Council to encourage DARS and the Commissioner to focus on these priorities during the upcoming year. Debbie Pfeiffer thanked the 2013 Priorities Committee members for their work thus far, including Susan Elmore, Anne McDonnell, Jocelyn Johnson, Camilla Schwoebel, John Heath, and Barbara Seymour.
Debbie Pfeiffer reported that their goal at this meeting was to obtain ideas from the full Council on what the primary objectives should be from the three goals of the State Action Plan, which is the blueprint of the needs of survivors of brain injury in Virginia. She asked Council members to divide into three discussion groups facilitated by committee members Anne McDonnell, Barbara Seymour and Debbie Pfeiffer:
• #1 - expanding access to brain injury supports and services: the group identified improving access to case management services across Virginia as the primary objective, with access to neurobehavioral treatment programs and transportation tying as the second most important objective within that goal.
• #2 - systems change and management: the group identified enhancing cooperative relationships among state agencies and organizations to increase capacity and appropriate treatment / services as the primary objective. They also noted that legislative support is needed in regard to development of neurobehavioral treatment options across all disability platforms, as well as a possible study by the Joint Commission on Health Care.
• #3 - community impact: the group identified providing education to improve public knowledge of brain injury as the primary objective (with a focus on educating physicians, health care providers, schools and employers to ensure they are knowledgeable about services).
Debbie Pfeiffer indicated the Priorities Committee will draft a letter for the Commissioner based upon the recommendations of the three groups. She indicated the draft letter will be electronically mailed to the Council for an up or down vote of approval before it is sent to Commissioner Rothrock.
Anne McDonnell added that information from the 2013 Statewide Needs & Resources Assessment (an initiative of DARS’ Federal TBI Grant) which is currently being completed through a subcontract that DARS has with Virginia Commonwealth University’s Survey, Evaluation and Research Lab (SERL) will assist the Priorities Committee next year.
Dr. Shenal and DARS staff thanked the Priorities Committee for its work.

DARS Federal TBI Grant Update

In addition the written quarterly report of the Federal Traumatic Brain Injury (TBI) Grant dated April 26, 2013 (attached), Patti Goodall stated that the Department for Aging and Rehabilitative Services (DARS) received a fifth year extension of funding, plus an additional $20,000 for Virginia’s Federal TBI Grant. A $32,000+ carryover of funding to Year 5 was also approved. She indicated DARS has been working collaboratively with the primary subcontractor of the grant, the Brain Injury Association of Virginia (BIAV), regarding the goals, objectives and activities for this fifth year which will remain in line with those in the original 2009 grant application, “Closing the Gap.” Activities for Year 5 include the state agency brain injury Report-Out Day, planning retreats for state-funded Brain Injury Services Programs, a caregiver forum, and assisting with a Virginia Wounded Warrior Program conference. She added that there is state funding match provided through a Commonwealth Neurotrauma Initiative (CNI) grant to look at neurobehavioral issues (mentioned earlier).

On behalf of grant subcontractor BIAV, Anne McDonnell added that under the federal grant goal targeting education and outreach, BIAV compiled informational packets from the project with the Department of Juvenile Justice’s (DJJ). These were distributed to 35 Court Services Units and 117 Juvenile and Domestic Relations judges, as well as to the 30 Policy Summit attendees. These packets included fact sheets on the DJJ project, a DVD with four 5-minute videos, a proceedings manual from the Policy Summit, and a professionals’ guide to brain injury. A copy of these packets will be provided electronically to Council members by DARS staff and hard copies are available upon request. She added that a Federal award from the Health Resources and Services Administration (HRSA) was presented to DARS for its work on this three-year project, through a subcontract with Virginia Commonwealth University (Jeffrey Kreutzer, Ph.D.).

Anne McDonnell commented that if you would like to participate in the Statewide Needs and Resource Assessment which DARS has contracting to VCU’s Survey Evaluation and Research Lab (SERL) to conduct, you must “opt-in” or register (this is to prevent individuals from completing the survey more than once and is an Internal Review Board (IRB) requirement). She reported that 200+ have “opted- in” to participate thus far and encouraged Council members and providers and other attendees to share widely with survivors and family members so that VCU will have sufficient participants and better results. Patti Goodall added that there are actually three different surveys for survivors, caregivers, and providers.

Brain Injury Report Out Day

Patti Goodall reminded everyone that the biennial Brain Injury Report Out Day, hosted by the Council as part of a Federal TBI Grant activity, is scheduled for July 26, 2013 in Richmond from 9 a.m. to 4 p.m. and will have a sports concussion theme. This event highlights the work of state agencies that serve survivors of brain injury in Virginia, including the departments of Medical Assistance Services, Behavioral Health and Disability Services, Health, Veterans Services (including the Virginia Wounded Warrior Program), and Education. Council member Dr. Jeffrey Barth will provide an educational presentation in the afternoon, and Chris Nowinski is the opening keynote speaker. The day also includes presentation of the Commissioner’s “Toggle Award” to recognize an individual for services to veterans and the Council’s “Brain Injury Champion Star Award.” It was also decided that this year’s Report Out Day will take the place of the Council’s quarterly meeting typically held in July.

Following discussion regarding possible recipients for this year’s Star Award, John Heath moved that the Council appoint a committee to determine the 2013 Brain Injury Champion Star Award recipient. The motion was seconded by Melissa Fox and carried unanimously. Anne McDonnell, Patti Goodall, and Cynthia O’Donoghue agreed to serve on this Committee.

CLOSING PROTOCOL: – Dr. Brian Shenal, Chair

Dr. Shenal noted that the next formal meeting of the Council will take place on October 25th, 2013 at the Woodrow Wilson Rehabilitation Center in Fishersville since the July 26th Report Out Day will serve as Council’s July quarterly meeting. Dr. Shenal added that he will be requesting volunteers via email in July / August to serve on the Nominations and Elections Committee, usually appointed at the July meeting.

The meeting was adjourned at 3:58 p.m.

Department for Aging and Rehabilitative Services (DARS)
Federal Traumatic Brain Injury Grant: Quarterly Report
Virginia Brain Injury Council (VBIC) - Friday, April 26, 2013

 Virginia Collaborative Policy Summit on Brain Injury and Juvenile Justice: A “proceedings report” summarizing challenges, discussions, plans, and recommendations of the two-day national Policy Summit held in June 2012 is completed. Electronic copies will be disseminated to Council members following April 26 meeting; hard copies are available upon request. The Policy Summit provided a unique opportunity for attendees to discuss individual state’s policies and practices for identification, diagnosis, and treatment of youth with brain injury in the juvenile justice system, as well as 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 held to date; transcriptions of all focus groups completed
• Focus group summaries, data entry, and qualitative analysis completed
• Received IRB approval to begin receiving names for those who request the survey
• Launched “opt-in” survey allowing individuals to request the survey
Pending and Future:
• Development and field-testing of paper and pen written survey (in process)
• Release of the survey to the public
• No-Cost Extension request through August 2013

 TBI Federal Grant Extension: The Department for Aging and Rehabilitative Services (DARS) received the official Notice of Grant Award (NGA) that the Commonwealth will receive a fifth year extension of funding ($270,000) for Virginia’s federal Traumatic Brain Injury grant. DARS is not sure if sequestration will impact the available funding during Year 5.

• DARS has been working collaboratively with primary subcontractor of the federal TBI Grant, Brain Injury Association of Virginia (BIAV), to determine objectives and outcomes for Year 5. Primary goals and objectives of original grant application, “Closing the Gap” (to expand and strengthen Virginia’s infrastructure for the delivery of brain injury services) will remain the same.

• Highlights will include:
• State Agency Brain Injury Report Out Day on July 26, 2013 in Richmond
• Three “planning retreats” for the state -funded Brain Injury Services Programs: directors/managers; clubhouses/day program; and case management.
• A Caregiver Forum in November 2013 (National Caregiver’s Month)
• Assistance with Virginia Wounded Warrior Program’s conference.

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


Target Group #1: Juveniles with brain injury committed to the Virginia Department of Juvenile Justice
Education and Outreach
• Edited and printed proceedings manual from Policy Summit; finalized and printed Fact sheet with VCU; cover letter written for Court Service Unit (CSU) mailings in conjunction with Department of Juvenile Justice (DJJ); duplicated videos for distribution
• Mailed DJJ/TBI informational packets to each of the 35 CSUs and 117 Juvenile and Domestic Relations judges (each packet contained one: fact sheet, professionals guide, DVD, policy summit report)
• Preparing to mail informational packets to the 30 Policy Summit attendees and other partners

Targeted Group #2: Persons with Low Socioeconomic Resources
Systems Change
• Participated as part of a the Department of Behavioral Health workgroup in 2 meetings about the Department of Justice (DOJ) settlement services and Medicaid expansion: provided questions, offered advice, and asked for Department of Aging and Rehabilitative Services (DARS) to be added to workgroup

Data Collection
• Received 211 calls: 169 survivors/family; 42 professionals. Barriers indicating low socioeconomic status mentioned 17 times. 7 individuals identified themselves as belonging to a minority group

• Brain Injury Association of Virginia (BIAV) Conference held March 2013; 209 people attended; 52 were persons with a brain injury or family members/caregivers
• Financial support update- 12 people received scholarships for BIAV conference

• Outreach mailings were sent to 1,201 individuals identified through the Trauma Registry (VSTR); received 5 calls from these mailings
• Successfully problem-solved challenges related to Registry mailing; altered how query is being done and currently mailing 7,000 from 2012 over the next 4-6 months. For 2013 we project 7,000; we are currently up to date and mailing them as received each month

Targeted Area: Infrastructure Expansion
Data Collection/Analysis
• SERL: draft survey written (Needs and Resources Assessment) and in editing process; requested and received feedback from several family members
• Seeking persons with brain injury to 'opt in' to take survey- sent to over 900 people and posted on BIAV's website

• Provided Certified Brain Injury Specialist (CBIS) training to 10 people and 9 were certified
• 149 professionals attended 2013 annual BIAV conference
• Participated in TBI Team Training (Department of Education)
• Website: : 13,971 total; 11,759 unique; 3,285 educational documents downloaded; 40 individuals requested info
• Newsletter: 1,157 mailed; E-Newsletter: 300 emailed; Facebook: 19 educational posts; 782 total fans

• Provided 2000 military brochures to DARS; provided 12 military brochures to McGuire VA Medical Center