The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council July 2014 Minutes FINAL
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Details:
MINUTES
Friday, July 18, 2014
1:00 p.m.
Members Present:
Mark Bender, Ph.D. Tree of Life, Rehab Neuropsychologist
Heather Funkhouser Board Department of Health / Injury Prevention
Lisa Bradford, LCSW Salem Veterans Administration Medical Center
Gayl Brunk Valley Associates for Independent Living
John Butrick Survivor, Member of Denbigh House Clubhouse
Susan Elmore Department of Behavioral Health & Developmental Svcs (DBHDS)
Lorraine Enright Family Member (Yorktown)
Kimberly Hemphill, Ph.D., R.N. Tucker Pavilion, HCA
Jocelyn Johnson Survivor (Ashburn)
Katherine Lawson Virginia Board for People with Disabilities
Anne McDonnell Brain Injury Association of Virginia
Jodi Power, RN, JD (Secretary) Department of Health Professions / Board of Nursing
Brian Shenal, Ph.D. (Chair) Salem Veterans Administration Medical Center

Members Absent:
Charlotte Arbogast Dementia Services Coordinator, DARS
Jeffrey Barth, Ph.D. University of Virginia School of Medicine
John Heath Family Ombudsman, DARS Federal TBI Grant
Deborah Johnson Department of Education
Amy Marschean Senior Policy Analyst, DARS Alzheimer’s Disease & Related Disorders Commission
Cynthia O’Donoghue, Ph.D. (Vice-Chair) James Madison University
Brian Pearce Survivor (Richmond)
Barbara Seymour Department of Medical Assistance Services (DMAS)
Paul Sharpe, R.N. Department of Health / Statewide Trauma Registry
Mark Salisbury (Immediate Past-Chair) Family Member
Camilla Schwoebel Virginia Wounded Warrior Program
Julie Triplett Virginia Office for Protection and Advocacy
Michelle Witt Virginia Alliance of Brain Injury Service Providers

Others in Attendance:
Marcia Dubois Department for Aging and Rehabilitative Services
Patricia Goodall Department for Aging and Rehabilitative Services
Mary-Margaret Cash Department for Aging and Rehabilitative Services
Mary Strawderman Department for Aging and Rehabilitative Services
Christine Wilmouth
Jason Young Community Brain Injury Services

OPENING PROTOCOL: Brian Shenal, Ph.D., Chair
Brian Shenal, Chair, called the quarterly meeting of the Virginia Brain Injury Council to order at 1:00 p.m. The meeting was held in Conference Room 103/105 at the Virginia Department for Aging and Rehabilitative Services, 8004 Franklin Farms Drive, Henrico, Virginia 23229. Dr. Shenal asked all members and guests to introduce themselves.

Approval of July 18, 2014 Meeting Agenda
The agenda was approved without objection or additions.

Approval of April 25, 2014 Meeting Minutes
The April 25, 2014 meeting minutes were initially tabled until members had a chance to consider them later in the meeting. Once reviewed, the minutes of the April 25th meeting were approved without objection.

Public Comment Period
A public comment period was offered. No one was present to provide public comment.

UNFINISHED BUSINESS:

Presentation of Council’s Annual Priorities Letter to Commissioner Rothrock

Dr. Shenal thanked the Priorities Committee for their work in drafting the annual letter on behalf of the Council that was presented to Commissioner Rothrock. The letter requested that core services be preserved before expansion, and that the top priorities be improving access to the full range of neurobehavioral services in Virginia from crisis stabilization to hospitalization and community-based care, education of providers and the public. The letter also noted the importance of coalition building including with Department of Behavioral Health & Developmental Services (DBHDS), i.e., when brain injury diagnoses overlap with mental health, and encouraging the development of a true universal waiver so that funding follows the person. The plan is for Commissioner Rothrock to share the Priorities Letter with DMAS and DBHDS and the Governor.

DARS COMMISSIONER UPDATE:
Commissioner Rothrock shared the following topics with Council members:
• The DARS Respite Lifespan Program grant program has not fully expended its grant money this year. There is approximately $30,000 left so they are still accepting applications for individuals to receive $400 for family/caregiver respite care. He requested Council members to spread the word on this available assistance. Application packets were disseminated to those interested.
• In the area of collaboration, Rosemary Rollins made a recent presentation to the Virginia Caregivers Coalition, describing her experience as a spouse / caregiver for her husband who sustained a severe brain injury.
• Jason Young and other brain injury advocates were congratulated on their work during the 2014 General Assembly and budget sessions, noting $150,000 was allocated for brain injury services in FY ‘15.
• The Virginia budget is in a dire situation due to capital funds not received as anticipated. No specific guidance has been provided by the Governor or Secretary Hazel regarding any reduction of programs, but Commissioner Rothrock encouraged advocates to continue their work. He will update the Council on any future guidance regarding the budget.
• Amy Marschean emailed DARS staff inquiring about possible legislative measures for the Governor to consider for 2015 Session. Thus far, only fine-tuning and clean-up legislation has been suggested from DARS for the upcoming session. Ideas for DARS related legislative change were requested.
• Commissioner Rothrock has encouraged the Commissioners for DBHDS (Debra Ferguson) and the Department of Health to meet with the Council. Additionally, he has requested to have Dr. Jennifer Lee, Deputy for Health and Human Resources Secretariat speak to the Council, which will likely occur before Commissioner Ferguson.
• Delegate Ruff introduced a bill to look at brain injury services as a follow-up to JLARC study a few years ago. The study was assigned to the Joint Commission on Health Care. It would be effective to use this opportunity to discuss preserving and expanding core services and to have a dialogue regarding establishment of a true universal waiver, consistent with the Council’s Priorities Letter.
• Commissioner Rothrock encouraged Council members to learn more about the Commonwealth Coordinated Care Program, a new service accessible for those dually covered by Medicare and Medicaid.
• Secretary Hazel and his Deputies plan to visit key program partners, including Jason Young at The Mill House. He indicated Commissioner Ferguson should be invited to attend as well.
• Commissioner Rothrock shared the push for a social media presence. He encouraged attendees to “like us” on Facebook, to send photos of meetings and brain injury activities so that DARS staff can post on Facebook, noting it is important to keep brain injury in the public eye. Katherine Lawson added that the Developmental Disabilities Board has suspended traditional newsletters in favor of blogging and other social media avenues of communication. Lisa Bradford indicated she had information regarding smart-phone applications for brain injured persons that she would share with DARS staff to consider posting.

NEW BUSINESS:

Update on Governor’s Task Force on Mental Health

Jason Young and Anne McDonnell provided an overview of the Governor’s Task Force on Mental Health on which they serve. The Mental Health Task Force was established by the Governor after Senator Creigh Deed’s family tragedy last year, requesting recommendations for changes to the mental health system in Virginia. Initial recommendations for immediate fixes were to be submitted to the General Assembly by January 31, 2014, and a final report with recommended work of the four established workgroups of the Mental Health Task Force: 1) Crisis Response (timely access to appropriate emergency intervention for those in crisis, including emergency custody orders) 2) Ongoing Treatment and Support (capacity of system to address needs after emergency custody and TDOs, identify gaps in services from available beds for ongoing treatment); 3) Technical and Data Infrastructure (examine use of technology and technical infrastructure in the mental health system and resource availability and capabilities); and 4) Public Safety (examine the interface between criminal justice and mental health systems since jails provide majority of mental health services in Virginia).

An overview of the commitment laws in Virginia was provided since 2014 legislative changes were made related to extended emergency custody orders (within 8 hours) and commitment hearings (within 72 hours of TDO execution), bed registries and alternative facility transports. Each of the four workgroups have created 3-5 recommendations that will be presented to the full Task Force, which will also have to address funding for implementation of any recommendations and any potential legislative proposals. While brain injury representatives are at the table in these Mental Health Task Force workgroups, it will be challenging enough to address mental health needs with existing capacity in Virginia without adding brain injury needs to the discussion.

Update from DBHDS:

Susan Elmore provided an update on DBHDS’ recent work on complex cases involving clients with both Intellectual Disabilities and Brain Injury/Mental Health needs. For the first time in history, DBHDS is paying for neuro-restorative care for brain injury needs, noting it is cheaper than nursing home care and a better alternative to hospital dumping.

DARS Respite Lifespan Voucher Program

Mary Strawderman provided further information on the DARS Respite Lifespan Voucher Program, indicating there is a direct relationship between caregiver health and the amount of respite care they receive. She indicated the $197,000 grant provides monies for about 30 more available recipients for caregiver respite care. There is no financial eligibility threshold to meet, and it is open to caregivers providing care across the lifespan to family members with needs related to everything from brain injury to autism disorders to Alzheimer Disease. Mary suggested the inclusion of a “caregiver burden inventory” in the application packet and though it is optional, everyone has filled out the form (and the inventory has shown elevated levels of caregiver burden).

Request from Secretary for Legislative/Budget Ideas for 2015:

In follow-up to Commissioner Rothrock’s solicitation, Patti Goodall requested ideas for DARS-oriented legislative and budget ideas for the 2015 Session from the Council. Discussion ensued regarding possible pilot studies or demonstration projects for residential treatment and community based rehabilitation, and the two current surveys and studies gathering data to support the need for such. Council members further discussed the need for suggested ideas to correspond to the Council’s Priorities Letter.

Anne McDonnell moved that the Virginia Brain Injury Council direct DARS staff to use the Council’s recent Priorities Letter to set priorities for draft legislation to be submitted to the Executive Branch for consideration for 2015. The motion passed unanimously.

The meeting was recessed at 2:45pm and reconvened at 3:05pm.

UNFINISHED BUSINESS (continued):

Nominations and Elections Committee

Dr. Shenal indicated that one officer position (Secretary) and two other at-large member positions were coming open in 2015. As a result, a Nominations and Elections Committee needs to be formed to come up with a slate for these upcoming vacancies. Volunteers were requested to agree to serve on the Nominations and Elections Committee, with work to be completed prior to the January 2015 meeting. Those present and willing to serve on this Committee are: Mark Bender; Gayl Brunk; Heather Funkhouser Board; and Susan Elmore. Additionally in her absence, Vice-Chair Cynthia O’Donoughue was nominated to serve as Chair of this Committee as she has done in past years. It was clarified that Jodi Power has served two terms and is not eligible to serve another term as Secretary for the Council.

Bylaws Committee Changes

Dr. Shenal reported that the pending bylaw revisions are still being finalized by DARS staff. The proposed changes were summarized at the July 2014 meeting by the Bylaws Committee Chair, Jodi Power. They will be presented and considered most likely by electronic vote subsequent to this meeting; if not, they will be deferred until the October 2014 Council meeting.

Federal TBI Grant Update

Patti Goodall from the Department for Aging and Rehabilitative Services (DARS) reported that DARS was notified in June that it was awarded another four-year Federal Traumatic Brain Injury Grant for the period of June 1, 2014 through May 31, 2018. The grant provides for $250,000 each year, except the first year which is reduced to $241,000. She noted that Virginia has been awarded this grant every year issued since 1998, except for one year. She thanked BIAV for its coordination and assistance in writing the grant, noting that feedback received from the review committee indicated there were no identified weaknesses in four of the six areas addressed by the grant proposal. BIAV will be a subcontracted partner with DARS for this grant, which will be called the “FACES” grant, an acronym for “Facilitating Access to Care and Enhancing Services” in Virginia and will involve outreach to newly injured Virginians and information and referral services. More specific workplan activities include: outreach particularly in the Southwest region; information and referral activities including a Caregivers Forum; training for professionals and non-professionals involving screening and four webinars; biennial Report-Out Days; developing a FACES brain injury training tool for screening; and incorporating the James Madison University Study regarding access to neurobehavioral services in Virginia. Year 2 and subsequent activities will involve a contract with University of Virginia to do training across the state, a moderated forum for case managers for state funded contract providers and statewide software system implementation. Federal grant funds cannot be used for direct consumer services, but are intended for systems change activities that increases access to services.

Additionally, there are still a few wrap-up items on the 2009-2014 Federal TBI grant. A final report is due to HRSA by July 29, 2014, which will be submitted by DARS and BIAV.

Brain Injury Associate of Virginia (BIAV) Report:

Anne McDonnell referred to the quarterly report which was provided in writing at the Council meeting. In terms of outreach and education, BIAV completed mailings to the Community Service Boards as part of the 2009-2014 Federal Grant, and plans to conduct Certified Brain Injury Specialist training for 10 people in August.

Funds Dissemination Committee

This ad hoc committee was formed in response to anticipated new funding to be allocated by the General Assembly for State FY ’15, since DARS is required to “consider the recommendations of the Virginia Brain Injury Council when disseminating new funding for brain injury services.” In the absence of Committee Chair Mark Salisbury, Patti Goodall reported on related activity.

Patti Goodall reported that due to a delay in passing a state budget this year, there was no need for the Funds Dissemination Committee to meet. Only $150,000 was retained in the state budget for FY 2015, and it was already designated for case management services. The only discretion relates to what part of the state and perhaps how DARS determines the unserved and underserved areas needing it most. She noted there are currently no state funded case management contracted services in Tidewater area, and the Winchester and Richmond areas are underserved.

Lisa Bradford moved that the Virginia Brain Injury Council direct DARS staff to issue a Request for Proposal (RFP) using newly allocated funding to contract with brain injury providers in Virginia that will address unserved and underserved areas, with preference given to the identified areas of Tidewater, Winchester and Richmond, but that any responsive unserved/underserved still be considered. The motion was seconded by Lorraine Enright and passed unanimously.
Update on RFP Process for State FY 2015:
Patti Goodall reiterated that the new RFP for Brain Injury Service Providers will be issued in the next few weeks for State FY 2015, based upon the above directive from the Council. Currently there are ten organizations operating thirteen programs offering brain injury services in Virginia. The contracts with these existing providers were temporarily extended due to lack of a state budget and ability to issue a new RFP until now. Proposals must be related to the core services of case management (adult and pediatric), clubhouse/day program, and resource coordination, with a preference given to unserved and underserved areas.
CLOSING PROTOCOL: – Dr. Brian Shenal, Chair
Dr. Shenal noted that the next quarterly meeting of the Council will be held on October 24, 2014 at Woodrow Wilson Rehabilitation Center in Fishersville. Other future meetings planned in 2015 that will be held at the Department for Aging and Rehabilitative Services offices in Henrico, include: January 23, April 24, and July 24.

The meeting was adjourned at 3:40 p.m.