The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council April 2015 Minutes FINAL
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VIRGINIA BRAIN INJURY COUNCIL MEETING

MINUTES
Friday, April 24, 2015
1:00 p.m.
Members Present:
Mark Bender, Ph.D. (Secretary) Tree of Life, Rehab Neuropsychologist
Gayl Brunk Valley Associates for Independent Living
Lorraine Enright Family Member (Yorktown)
Deborah Johnson Department of Education
Jodi Power, RN, JD (Chair) Department of Health Professions / Board of Nursing
Barbara Seymour Department of Medical Assistance Services (DMAS)
Brian Shenal, Ph.D. (Immediate Past Chair) Salem Veterans Administration Medical Center
Krystal Thompson Virginia Alliance of Brain Injury Service Providers
Charlotte Arbogast Dementia Services Coordinator, DARS
Heather Funkhouser Board Department of Health / Injury Prevention
Lisa Bradford, LCSW Salem Veterans Affairs Medical Center
John Heath Family Ombudsman
Anne McDonnell Brain Injury Association of Virginia
Lynn Seward DARS Alzheimer’s Disease & Related Disorders Commission
Frankie Brewster Family Member (Charlottesville)
Tony Schaffer Survivor (Leesburg)
William Carter, III, MD, MPH Virginia Commonwealth University Health System (VCUHS)

Members Absent:
Kimberly Hemphill, Ph.D., R.N. MCV Hospitals
Katherine Lawson Virginia Board for People with Disabilities
Cynthia O’Donoghue, Ph.D. (Vice-Chair) James Madison University
Brian Pearce Survivor (Richmond)
Paul Sharpe, R.N. Department of Health / Statewide Trauma Registry
Julie Triplett Virginia Office for Protection and Advocacy
Brandi Jancaitis Virginia Wounded Warrior Program

Others in Attendance:
Karen Brown Northern Virginia Brain Injury Services
Patricia Goodall Department for Aging and Rehabilitative Services
Donna Cantrell Department for Aging and Rehabilitative Services (DARS)
Mary Margaret Cash Department for Aging and Rehabilitative Services (DARS)
Debra Holloway Brain Injury Association of Virginia
Sheela Nimishakau Brain Injury Association of Virginia
Laurie Silva Clinical Neuro-restorative
Leigh Wion Virginia Neurocare Foundation
Joan Welch Senior Connections
April Holmes Department for Aging and Rehabilitative Services (DARS)
Tom Stumm Mill House
Rachel Evans No Limits Eastern Shore
Bill and Sue Hunter Parents of a survivor
Becky Bowers-Lanier Brain Injury Association of Virginia/VABISP
Joe Craig The Mill House
Melissa Oliver Richmond Veterans Affairs Medical Center
Marcia DuBois Department for Aging and Rehabilitative Services

OPENING PROTOCOL: Jodi Power, RN, JD
Jodi Power, Chair, called the quarterly meeting of the Virginia Brain Injury Council (VBIC) to order at 1:07 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. Ms. Power introduced new members and announced that those present had participated in the VBIC new member orientation earlier in the day. Ms. Power asked all members and guests in attendance to introduce themselves.

Approval of the January 23, 2015 Meeting Minutes
Corrections were noted to the minutes including changing June 30, 2014 to June 30, 2015, regarding existing contract extensions, and clarifying that Krystal Thompson did not volunteer to be chair of the funds dissemination committee. Mr. Shaffer asked for and received clarification regarding the RFP process. Brian Shenal motioned that the January, 2015 minutes be approved with those changes; Tony Shaffer seconded the motion and the January Minutes were passed with changes.

Approval of April 24, 2015 Meeting Agenda
The agenda for the April 24, 2015 meeting was approved without objection. (Lorraine Enright made the motion and Lynne Seward seconded it.)

Public Comment Period
Mr. and Mrs. William and Sue Hunter were allotted time to address the council. Mr. Hunter provided a handout to meeting attendees that provided biographical, injury related, and post-injury rehabilitation information related to his son, Thomas Hunter. Mr. Hunter requested financial assistance in the amount of $2,500 per month for a period of 12 months to help pay the monthly tuition at Crumley House in Tennessee, where Thomas currently resides. Tony Schaffer (newly elected VBIC member) requested clarification about the process for public request for financial assistance, and it was suggested that the matter might be better discussed during the report from the Funds Dissemination Committee later in the meeting.

REMARKS from DARS COMMISSIONER:
Commissioner James Rothrock participated in the call via teleconferencing and provided the following information.

• Commissioner Rothrock thanked the committee members for accommodating his teleconference call and for their service.
• He complimented all advocates for survivors of brain injury and felt their efforts were effective as evidenced by the restoration of previous cuts in FY 2014 budgeted funding and a restoration of new funds.
• Commissioner Rothrock reported that DARS is trying to work with the Department of Behavioral Health and Developmental Services (DBHDS) to try to establish a partnership so that DBHDS might be better able to address neurobehavioral needs for Virginian’s with brain injury, at least in crisis situations. DBHDS has indicated that Community Service Boards (CSB) are stretched to their limits already to meet their current state and federally regulated services.
• The Commissioner also noted that perhaps CNI grants, provided for in the Code of Virginia, might be used to provide evidence for addressing neurobehavioral needs that are not currently met.
• The Joint Commission on Healthcare is following up on the JLARC study, trying to identify where individuals are falling through the cracks regarding neurobehavioral services in Virginia. DARS staff will be reviewing the study with hopes of having identified needs addressed via the 2016 General Assembly.
• Commissioner Rothrock introduced one of the education topics today, Chronic Disease Self Management Education (CDSME), and briefly discussed research demonstrating its effectiveness in reducing hospitalizations and increasing overall health. In May 2015, CDSME may be introduced into correctional facilities in the Commonwealth of Virginia, and there is a project investigating the feasibility of adapting CDSME for those with cognitive disabilities.
• Commissioner has contacted one award recipient for the Brain Injury Report Out Day and hopes to receive a positive response from the other identified award recipient. Patti Goodall is following up on the second nominee.

There were no questions from the council.

NEW BUSINESS:
Jodi Power introduced April Holmes, Joan Welch, Joe Craig, and Tom Stumm who gave an educational presentation about the Chronic Disease Self Management Education.

Chronic Disease Self Management Education Program
Ms. Holmes provided background information about the CDSMEP, a general overview of the protocol, described its goals, adaptations and diseases for which it has been targeted, and provided a handout listing resources by region in Virginia with contact names and numbers for more information.

Joe Craig described how a CDSME program was implemented at the Mill House. He provide information about the philosophy and operation of the Club House model and how the CDSME program at the Mill House operated, stressing the role of group facilitators and participants participating as equals. He further identified limitations of the CDSME as implemented at the Mill House to include that the duration of the program might be a bit long. He also noted that the once weekly group was thought to allow too much time between sessions and that perhaps more frequent sessions might be more helpful. It was also noted that goals not specifically related to the operations of and participation in Mill House activities were more difficult to achieve.

Joan Welch provided additional description of the CDSME protocol and more detailed information about the action plans. She provided an example of an action plan of her own and enlisted Tom Stumm to model how an action plan is completed.

Tom Stumm provided feedback about his participation in the CDSME through the Mill House. He stated that he felt the program increased his confidence and helped him remember what he needs to do for health management.

Assistive Technology
Melissa Oliver, Assistive Technology Program Coordinator for the McGuire Veterans Medical Center, gave a thorough presentation on Assistive Technology complete with handout of her slides and a resource from brainline.org titled “Life-Changing Mobile Apps for People with Brain Injury”.

Report: Funds Dissemination Committee
Gayl Brunk, Committee Chair, thanked the members of the Committee and provided a summary of the current letter, copies of which were passed out to attendees at the meeting. She noted that the 2014 VBIC Priorities letter was used as a guide for the Funds Dissemination Committee’s recommendations. The 2015 Funds Dissemination letter noted that the $427,000 in FY 2014 cuts were restored in the 2015 General Assembly session and that an additional $750,000 was provided for Brain Injury Services. The Committee recommended that the $427,000 that was restored to DARS in the Fiscal Year (FY) 2015 Budget should likewise be restored to the community service providers to restore the services that may have been cut as a result of the previous year’s cut.

Regarding the $750,000 in newly allocated State general funds, the Committee recommended:
1. That approximately $30,000 be used to bring all existing State-funded Brain Injury Service Providers to the current base funding amount of $150,000.
2. Once providers are at the recommended base-funding level, the Committee recommended further raising the base to $200,000, taking into account the increased cost of living, increased need for services, and the fact that there has been no substantial funding increase for any provider in the previous 9 years. This should result in each provider receiving an increase of approximately $50,000.00 to reach this new base-level, leaving approximately $220,000.00 to be allocated.
3. The allocation of the remaining $220,000 should be left to DARS discretion, but might possibly include to expanding case management services in the previously identified underserved areas of the State (Winchester and Tidewater).

A motion to approve the letter as written was made by Brian Shenal and seconded by Lynne Seward. Jodi Power called for discussion. Committee members expressed concern that a distribution of an equal amount of the additional $750,000 to all recipients was not equitable given the varying demands and caseloads of service providers. Suggestions for the use of a formula possibly incorporating demands on and caseloads of various providers be used to determine how much each organization receives. A number of suggestions for changes in the wording of the funds dissemination committee’s letter were offered and included the addition of wording “as appropriate” regarding raising all providers to the new base-funding level (#1) and again after $200,000 in #2. The Council also suggested adding the wording “to possibly include” before Winchester and Tidewater in #3, add wording “Brain Injury” before case management in #3, and put a period after “DARS” in #4 and delete the remaining of the line “and may involve adding to existing provider services……”.

Patti Goodall clarified a point regarding the VBIC committee and recommended that the line, “and the executive committee”, should be removed from the first paragraph of the letter.

Brian Shenal motioned that the aforementioned amendments be made to the letter. Lynne Seward made a second motion and the letter, with the recommended amendments, was passed without objection. Those changes to the letter will be made and a final presented to Jodi Power, Chair of the VBIC, for signature.

Patti Goodall suggested that, in the future, a member from the Virginia Alliance of Brain Injury Service Providers (VABISP) be included on the funds dissemination committee to have input into the process as this letter directly impacts VABISP members.

Mr. Hunter expressed that it was his belief that the Commonwealth of Virginia has no state-sponsored facility to provide care for survivors of brain injury. He expressed frustration about how he could secure funds to pay for his son’s rehabilitation facility. It was explained that the funding DARS receives from the General Assembly is not designated to provide funding to individuals. In the Code of Virginia, DARS is designated as the lead agency for funding brain injury service providers of designated core services throughout Virginia. The Code of Virginia defines “core services” as: brain injury case management, clubhouses/day programs, and resource coordination. It is the Funds Dissemination Committee’s charge to make recommendations to the DARS Commissioner about how funds might be globally distributed to fund the most necessary core services and best serve Virginians with Brain Injury and their families.

Mr. Hunter formally requested that he go on record requesting that the committee consider recommending funds for a state-sponsored neurorehabilitation facility in the future. It is so recorded.

Report: Priorities Committee
Anne McDonnell, Priorities Committee Chair, reviewed the Priorities letter with the Council. This letter had been previously distributed to Council members for review. The main areas addressed by the letter were funding for core brain injury services, access to waiver services (the intent of which is to open eligibility for the Medicaid waiver to anyone with an acquired brain injury regardless of the age at which it was sustained), and development of neurobehavioral programs and improved access to mental health services. The letter also expressed the strong opinion that DARS should remain the lead agency for brain injury services.

Jodi Power requested a motion to pass the Priorities letter; John Heath made the motion, Lynne Seward seconded the motion, and it was passed without comment or objection.

Federal Grant Update in Brief:
Patti Goodall reported that the Federal TBI grant is at the end of the first year of its four year grant cycle (ending 5/31/15). She noted that faculty at JMU are finishing their Neurobehavioral Services Project and will be presenting preliminary findings at the Brain Injury Report Out Day in July. Drs. Barth and Broschek from UVA have also been approached about serving as subcontractors to help identify and implement an easy-to-use, routine process of screening for brain injury in various agencies throughout the state.

Anne McDonnell reported that BIAV is in the process of re-instituting their Information and Referral (I & R) services through collaboration with the Virginia Department of Health, accessing the Virginia State Trauma Registry, with the assistance of Donna Cantrell from DARS. BIAV is also going to conduct a webinar on sports concussions 5/13/15 in collaboration with Dr. Broschek and BIAV is pursuing the possibility of offering CE credits. Finally, Ms. McDonnell reported that BIAV is working on initiating a provider’s forum to provide an opportunity to come together and share resources and collaborate.

Legislative and General Update from the Brain Injury Association of Virginia (BIAV) and the Virginia Alliance of Brain Injury Service Providers (VaBISP)
• Anne McDonnell noted that budgetary language passed the General Assembly and there is a committee currently looking into changing the Medicaid waiver so that an individual over the age of 21 could be eligible. It was noted that the Medicaid waiver states that if you are eligible for nursing home services, the State can allow those dollars to be spent on residential facilities. Ms. McDonnell noted that a survivor of brain injury has been mandated to be on that committee.
• BIAV has commented on the plan being put in place to comply with the Department of Justice settlement and those interested in the comment can contact Ms. McDonnell for a copy.
• DBHDS has been asked to provide numbers on how many individuals served by CSBs and state mental health facilities also have a diagnosis of brain injury. It is hoped that individuals with a brain injury diagnosis can also be served by these facilities. Currently, individuals are often turned away, regardless of mental health or substance abuse crisis or history, on the basis of that brain injury diagnosis.
• This language has been established to allow those with brain injury access to CSB and State Mental Health services in crisis situations.
• DBHDS has formed workgroups to work on mental health care reform. The workgroup consist of 4 subgroups focusing on adult behavior health, intellectual and developmental disabilities, children and adolescence, and those who are justice involved. Recommendations from the workgroup will be posted on the DBHDS web site and a town hall meeting will occur in May. Ms. McDonnell noted that no individuals from the brain injury community were included as members of the workgroups. She further noted that a town hall meeting for the purposes of identifying the needs of the brain injury population is in the mental health reform initiative. A list of the Town Hall meetings was previously sent out and will be re-sent.
• Krystal Thompson reported that the alliance’s priorities were similar to the VBIC Priorities Committee’s priorities as contained in the VBIC Priorities letter, and that the Alliance will also be submitting their letter of recommendations to Commissioner Rothrock.

Discussion of July’s Report Out Day Conference
The Brain Injury Report Out day is scheduled for Friday, July 24, 2015 at The Place in Innsbrook. This is an invite only event. Dr. Laura Flashman will be the keynote speaker and former Commissioner Paul Galanti and Senator Creigh Deeds will be award recipients. More information will soon follow as planning for this meeting is underway.

UNFINISHED BUSINESS:
Waiver Access was discussed with some of the identified “sticking points” being the process of the waiver vs. eligibility requirements. Anne McDonnell noted that she and Becky (Bowers-Lanier) met with individuals from DMAS to discuss further. Lynne Seward asked whether the Council should ask the Commissioner to look into this as it was contained in the Priorities letter. Tony Schaffer asked the Council whether we could be provided with the incidence of documented TBIs and various members expressed their shared desire for this information and described the various challenges in obtaining a “real” number.
CLOSING PROTOCOL:
Jodi Power noted that the remaining quarterly Council meetings for 2015 are scheduled to be held: on July 24, 2015, which is currently scheduled to be the Biennial Report-Out Day; and October 23, 2015, which is typically held at the Wilson Workforce Rehabilitation and Center in Fishersville, Virginia.

The meeting was adjourned at 3:55 p.m.