The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council Minutes OCTOBER Final
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Friday, October 24, 2014
1:00 to 4:00 p.m.
Members Present:
Mark Bender, Ph.D. Tree of Life/Concussion Care Centre of Virginia Lisa Bradford, LCSW Salem Veterans Administration Medical Center
John Butrick Survivor (member of Denbigh House clubhouse)
Lorraine Enright Family Member (Yorktown)
John Heath Family Ombudsman (Richmond)
Katherine Lawson Virginia Board for People with Disabilities
Amy Marschean Alzheimer’s and Related Disorders Commission
Anne McDonnell Brain Injury Association of Virginia
Cynthia O’Donoghue, Ph.D. (Vice-Chair) James Madison University
Brian Pearce Survivor (Richmond)
Jodi Power, RN, JD (Secretary) Department of Health Professions/Board of Nursing
Mark Salisbury (Immediate Past-Chair) Family Member (Yorktown)
Barbara Seymour Department of Medical Assistance Services
Brian Shenal, Ph.D. (Chair) Salem Veterans Administration Medical Center
Krystal Thompson Virginia Alliance of Brain Injury Service Providers
Deborah Johnson Department of Education

Members Absent:
Charlotte Arbogast DARS Dementia Services
Heather Funkhouser Board Department of Health / Injury Prevention
Gayl Brunk Valley Associates for Independent Living
Susan Elmore Dept. of Behavioral Health & Developmental Svcs
Kimberly Hemphill, Ph.D., R.N. Tucker Pavilion, HCA Chippenham
Jocelyn Johnson Survivor (Ashburn)
Paul Sharpe, R.N. Department of Health/Statewide Trauma Registry
Camilla Schwoebel Virginia Wounded Warrior Program
Julie Triplett disAbility Law Center

Others in Attendance:
Becky Bowers-Lanier Lobbyist, Brain Injury Association of Virginia
Nancy Brandon Virginia Concussion Coalition
Karen Brown Brain Injury Services, Inc.
Donna Cantrell Department for Aging and Rehabilitative Services
Portia Cole Joint Commission on Health Care
Rachel Evans No Limits Eastern Shore
Patricia Goodall Department for Aging and Rehabilitative Services
Debra Holloway Brain Injury Association of Virginia
Joann Mancuso Beacon House
Lisa McCarthy Brain Injury Services, Inc.
Laura Norah James Madison University Honors Program
Lynne Seward Alzheimer’s and Related Disorders Commission
Sheela Nimishikavi Brain Injury Association of Virginia
Laurie Silva Neurorestorative, Inc.
Kim Snead Joint Commission on Health Care
Mary Strawderman Department for Aging and Rehabilitative Services
Leigh Wion Virginia Neurocare/High Street Clubhouse
Jason Young Community Brain Injury Services, Inc.

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

Brian Shenal, Chair, called the quarterly meeting of the Virginia Brain Injury Council to order at 1:05 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 October 24, 2014 Meeting Agenda
With the addition of a Bylaws update to the agenda, the meeting agenda was approved without objection.

Approval of July 18, 2014 Meeting Minutes
The July 18, 2014 meeting minutes were approved without changes.

Public Comment Period
The following individuals were present and provided information during Public Comment period:

• Nancy Brandon, representing the Virginia Concussion Coalition, presented information to the Council to inform and request support of an enhancement to the Department of Education school concussion action plan. This enhanced plan was modeled after the Virginia Asthma Action Plan (ACE) in place, which differentiates instruction based upon specialized situations.

• John Heath raised concerns that the press is questioning whether recent surge in domestic abuse by NFL players may be related to brain injury.

• Anne McDonnell indicated that state budget cuts were released requiring a 5% cut from the Governor’s budget this year, and 7% for next year. As a result, DARS is recommending $400,000+ in cuts to brain injury services, which is 25% of the total DARS budget reductions. This is part of the $1.6 million total budget cut for DARS, noting brain injury services was the largest segment cut. She encouraged everyone to get the word out and contact the General Assembly concerning the negative impact of the proposed budget cuts on brain injury services statewide. She stated that advocates could reference the Council’s Priorities Letter, emphasizing that it is critical to preserve funding to keep core brain injury services available. Anne noted that BIAV posted a sample advocacy letter on its website and Facebook page for this purpose. Patti Goodall reminded members they cannot represent Council when contacting legislators, but that they may participate in advocacy/lobbying activities as individuals.

• Krystal Thompson, representing the Virginia Alliance of Brain Injury Service Providers, reported that the proposed cuts represent about 10% of the total brain injury services state funding (income). Besides DARS state funding, organizations rely on funding from grants and localities. Krystal also emphasized that the programs have been level funded by the state for five years, making it difficult to maintain an infrastructure. This puts the programs in a difficult position of trying to support the same number of consumers with less money.


DARS Update
Since Commissioner Rothrock was not available, Patti Goodall shared the following information:

• Budget cuts have been devastating, with both administrative cuts and cuts to programs. The next six months and following year will be difficult and hold many uncertainties.
• The Request For Proposals (RFP) for Brain Injury Service Providers was issued and posted today for State FY 2015. Currently there are ten (10) organizations operating thirteen (13) brain injury services programs in Virginia (currently operating under temporarily extended contracts). The due date for all Proposals is December 5, 2014. 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.
• Commissioner Rothrock is currently hospitalized and is expected to work a modified schedule when he returns to work in the near future.
• Donna Cantrell was introduced as the new DARS employee who will be staffing the Virginia Brain Injury Council. The CNI position previously held by Kristie Chamberlain will be filled internally with a part-time staff person due to the budget situation.
• The “Caregiver Forum” for those caring for individuals with acquired brain injury will be held on November 8, 2014 at the University of Richmond’s downtown campus location. There are only ten spots left, so those interested in attending this free event should contact BIAV as soon as possible.

Nominations and Elections Committee
Dr. Shenal reminded the Council that two officer positions (Chair and Secretary) and two other at-large member positions are coming open in 2015. As a result, the Nominations and Elections Committee which was appointed at the July 2014 meeting, is charged with conducting the nominations and elections process for the vacancies. The committee will solicit nominations and prepare a slate of candidates for voting to take place at the January 2015 meeting. Dr. Cynthia O’Donoghue was appointed Chair of the Nominations and Elections Committee in her absence at that July meeting (she accepted the appointment). Others who agreed to serve on the committee include Mark Bender, Gayl Brunk, Heather Funkhouser Board, and Susan Elmore. A telephone conference call will be scheduled in the near future to accomplish this work.

Bylaws Committee Changes
Jodi Power, Chair of the Bylaws Committee, reviewed the proposed revisions of the bylaws which are still being finalized by DARS staff. She noted they had not been presented to the Council for an electronic vote at the July meeting due to staffing and health issues of the committee, etc. Mark Salisbury suggested adding that the Family Ombudsman be part of the Executive Committee. John Heath requested that a survivor or family member be included on each Committee, if not already addressed in the bylaws. (NOTE: This was previously made a part of the bylaws in 2013.) The proposed revisions incorporating these suggestions will be presented and considered by electronic vote prior to the next meeting.


Joint Commission on Health Care Presentation
Portia Cole, PhD, Senior Policy Analyst, accompanied by Kim Snead, Director, presented information on the recent Joint Commission on Health Care study. The study resulted from Senator Frank Ruff, Jr. introducing a bill that directed the Joint Legislative and Review Committee (JLARC) to conduct a follow-up study to the one it conducted in 2007 on access to brain injury services in Virginia; the study was subsequently assigned to the Joint Commission on Health Care (JCHC) to complete. The Council requested that Dr. Cole provide an overview of the study and also provide an opportunity for members and others attending to discuss various aspects of the study. The Council shared its annual Priorities Letter with JCHC staff prior to the meeting.

The PowerPoint presentation (handout provided) included a review of the progress made in implementing the eight recommendations from the 2007 JLARC study to increase access to brain injury services in Virginia. Dr. Cole made a formal presentation on the study at the Commission’s meeting on October 8, 2014; Dr. Cole noted that the complete PowerPoint presentation from the meeting is available on the JCHC website.

As part of her presentation, Dr. Cole shared stories of lack of suitable placements in Virginia for TBI survivors due to erratic behavior. She acknowledged meeting the neurobehavioral needs of TBI survivors are still a concern. She indicated there is a lack of a system of care to address neurobehavioral needs due to lack of funding for appropriate neurobehavioral facility care in Virginia. In addition to access appropriate care, there are significant financial implications on families as well.

According to Dr. Cole, the general issues identified for the 2015 JLARC Study include:
• How can the unintended consequences of eliminating the brain injury registry be remediated?
• How can the Commonwealth address the general need for additional community-based services/providers?
• How can unmet need for intensive neurobehavioral treatment and residential services within Virginia be addressed?
• Should the idea of developing a Medicaid waiver for brain injury be reconsidered?

There are other preliminary observations and questions raised including forming partnerships (academic and community) and what can be learned from other states. The plan is to convene a series of workgroups to address these issues, observations and questions.

Following the presentation, discussion ensued and the following observations, comments and concerns were shared by Council members and attendees:

• The data under-represent veterans with TBIs
• Service Providers indicate there are at least 500 stories of lack of suitable placement and care, underscoring the serious need for a residential alternative to psychiatric facilities with 24 hour/day supervision in Virginia
• Insurance companies also do not cover services needed
• Consider a boutique waiver (which would take approximately one year to implement) versus a universal waiver (that already has a waiting list for IDD).
• It is a policy decision regarding whether it better to serve more people with less services or serve less people with more services
• Encourage a Pilot Project for a small boutique waiver for brain injury services (ie, 20 people to receive residential treatment) noting that a “small bite at the apple” will not require the significant outlay and will also provide necessary data in developing long-term solutions
• Need to show cost/benefit to legislators (ie, doing so avoids prison placement). They hear from insurance companies, they need to hear from brain injury representatives too
• Brain Injury Awareness Day at the General Assembly is scheduled for February 4, 2015.
CLOSING PROTOCOL: – Dr. Brian Shenal, Chair
Dr. Shenal noted that the upcoming 2015 quarterly meetings of the Council will be held on January 23, April 24, and July 24, and October 23. These meetings will be held at the Department for Aging and Rehabilitative Services offices in Henrico, Virginia (with the exception of the October meeting which is traditionally held at Woodrow Wilson Rehabilitation Center in Fishersville, Virginia). The meeting was adjourned at 2:50 p.m.