The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

Virginia Brain Injury Council January 2017 Minutes FINAL
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VIRGINIA BRAIN INJURY COUNCIL MEETING MINUTES Friday, January 27, 2017 1:00 p.m. to 4:00 p.m. Members Present: Jodi Power, RN, JD (Chair) Department of Health Professions (DHP) Mark C. Bender, PhD (Secretary) Tree of Life (TOL) John Heath Family Ombudsman Krystal Thompson (via phone) VA Alliance of Brain Injury Service Providers (VABISP) Frankie Brewster Family Member (Charlottesville) William Carter, III, MD, MPH Virginia Commonwealth University (VCU) Health System Devin Bowers Department for Aging and Rehabilitative Services (DARS) Laurie Silva NeuroRestorative Anne McDonnell Brain Injury Association of Virginia (BIAV) Maria Stransky Department of Corrections (DOC) Cara Meixner, PhD James Madison University (JMU) Shasmin Asbury Community Brain Injury Services (CBIS) / Denbigh House Patricia Goodall, Department for Aging and Rehabilitative Services (DARS) Deborah Johnson Department of Education (DOE) Lisa Bradford (Vice Chair) Salem Veterans Administration Medical Center Thomas Campbell, PhD McGuire Veterans Administration Medical Center Gayl Brunk Valley Associates for Independent Living (VAIL) John Cimino, JD Virginia Board for People with Disabilities (VBPD) Susan Rudolph Department of Behavioral Health and Developmental Services (DBHDS) Members Absent: Barbara Seymour Department of Medical Assistance Services (DMAS) Lisa Wooten Department of Health (VDH) Betty Ann Liddell Department of Veterans Services (DVS) / Virginia Veteran and Family Support (VVFS) Program Brian Shenal, PhD (Immediate Past Chair) Salem Veterans Administration Medical Center Tony Shaffer Survivor (Northern Virginia) Julie Triplett disAbility Law Center of Virginia (dLCV) Brian Pearce Survivor (Richmond) Mark Murphy Department of Juvenile Justice (DJJ) Others in Attendance: Donna Cantrell (Staff to Council) Department for Aging and Rehabilitative Services (DARS) Karen Brown Brain Injury Services, Inc. (BIS INC) Jeffrey Barth, PhD University of Virginia (UVA) Paula Margolis, PhD Joint Commission on Health Care (JCHC) James Rothrock, Commissioner Department for Aging and Rehabilitative Services (DARS) Tamara Wagester Crossroads to Brain Injury Recovery (CBIR) Cynthia O’Donoghue, PhD James Madison University ( JMU)   OPENING PROTOCOL:Jodi Power, RN, JD Jodi Power, Chair, called the quarterly business meeting of the Virginia Brain Injury Council’s to order at 1:07 p.m. Approval of the October 21, 2016 Meeting Minutes Cara Meixner made a motion to accept the minutes of the 10/21/16 meeting; Frankie Brewster seconded. Minutes were approved unanimously, with no changes. Approval of January 27, 2017 Meeting Agenda The agenda for the January 27, 2017 meeting was approved by consensus with no changes. Public Comment Period Jodi Power, Chair, opened the floor to public comment. No one requested to provide comments during this public comment period. UNFINISHED BUSINESS: Update by DARS Commissioner Rothrock Budget Reductions / Restorations. Commissioner Rothrock reported that as part of the budget reductions mandated by the 2016 General Assembly, DARS was asked to make a $1.5 million cut, which included $375,000 in brain injury services funding. Advocates are working to get this budget cut restored and this may be a real possibility. State revenues were down in December despite increased revenues in the preceding 4-5 months. DARS’ Disability Determination Services Division is fully funded by the federal government and therefore experienced no direct cuts, although there has been a soft freeze on state hiring secondary to federal freezes on jobs. Financial Exploitation of Elders. DARS was directed to do a study on financial exploitation of older adults. Current estimates are that $1.2 billion is stolen from aging and incapacitated adults 21 years and older. A bill in front of the General Assembly to address this issue has a lot of support.Commissioner Rothrock expressed hope that DARS and its sponsored studies will yield strategies for addressing this more effectively in the Commonwealth, including individuals affected by a brain injury. Joint Commission on Health Care (JCHC). Commissioner Rothrock stated that DARS was directed by the JCHC to establish an interagency work group (this may have come about partly in response to the Council’s 2016 Priorities Letter that DARS forwarded to the leadership in the Commonwealth, including Dr. Hazel). Secretary Hazel agrees that something needs to be done, so if the economy holds, Virginia may be able to make some progress in the area of neurobehavioral supports / services, particularly inpatient options. A report is due to the General Assembly by November 1, 2017 (DMAS also received a directive from JCHC to establish a work group to look at the costs of establishing / operating a neurobehavioral services unit.) Commonwealth Neurotrauma Initiative (CNI) Trust Fund. The CNI Advisory Board approved funding for three (3) basic science research grants during its last business meeting; The Commissioner used his budgetary authority to fund a study examining clubhouses in Virginia. Wanda Allen, staff to the CNI Advisory Board, is working with DARS Procurement / Purchasing to finalize all contract paperwork and process initial allotments to grantees. John Heath asked how many individuals are served by brain injury clubhouses in Virginia; Patti Goodall stated there are five clubhouses across the Commonwealth and that not all members are active at any one time (individuals who are accepted into the clubhouse remain “members” of the clubhouse for life and can leave / return at any time). Therefore, there are two estimates: there are approximately 60 individuals who are actively participating in a Virginia clubhouse at any one time, and there are about 250 members total. Additional services provided by clubhouses include limited case management, life skills training, work evaluation activities, and general work-oriented training. Frankie Brewster offered to speak more with John Heath about the clubhouses stating that her son attends The BridgeLine in Charlottesville. Patti asked if members would like DARS to arrange a clubhouse presentation at the April educational meeting and all agreed. Vocational Rehabilitation (VR) Program. DARS’ VR Program currently has a wait list and is not accepting new clients at present; hopefully, that will open up in the near future. The Commissioner stated that overall DARS is strong and he went on to describe a program that partners with DARS’ WWRC to train individuals with disabilities to work with robotics. It is a collaborative project and relationships with other agencies are under development. Staffing. DARS has had several staff changes since October meeting. The Director of Independent Living at DARS, Theresa Preda, passed away during the summer. Rhonda Jeter, formerly staff to the Statewide Independent Living Council (SILC) has accepted the position. Also, Lisette Carbojal accepted position of Livable Communities Coordinator, a position formerly held by Catherine Harrison. And most have heard by now that Marcia DuBois is the new Director of DARS’ Virginia Division for Aging (VDA). Outgoing Officer Recognition. Commissioner Rothrock thanked the outgoing officers (Jodi Power, Chair – though she remains as “immediate past chair” for two more years; Mark Bender, Secretary; and Brian Shenal, PhD, Immediate Past Chair), and expressed his gratitude on behalf of DARS for the time and talents contributed by these volunteers. All will receive a certificate of appreciation from DARS. Staff then held a “photo op” with Commissioner Rothrock and the incoming officers (Mark Bender, Chair; Lisa Bradford, Vice Chair; Laurie Silva, Secretary; and Jodi Power, Immediate Past Chair). Nominations and Elections Committee – Lisa Bradford, Committee Chair Lisa Bradford, Chair, thanked all members who worked on the nominations and elections committee: Tom Campbell, PhD, Brian Shenal, PhD, Deborah Johnson, and Tony Shaffer (along with DARS staff Donna Cantrell and Patti Goodall). Brian Shenal and Brian Pearce were unable to attend today’s meeting but were all thanked for their time on the Nominations and Elections Committee. Lisa also briefly described the process of the Nominations and Elections Committee as they prepared a slate of proposed members to be voted on during this meeting. The slate of candidates was submitted to members earlier via e-mail and also made available at today’s meeting for review. Anne McDonnell made a motion to accept the slate of candidates put forth by the Nominations and Elections Committee for Council vote, and to forward the slate to the Commissioner for review; John Heath seconded. The motion passed unanimously. Gayl Brunk asked about how those who were not selected are contacted and Donna explained that all candidates are contacted by formal letter / e-mail, as soon as the Commissioner finalizes his approval of the proposed slate. Ms. Brunk suggested that a mechanism be put in place to try and connect nominees who are not selected (especially if they are brain injury survivors) with other brain injury organizations to support their desire to advocate for the brain injury committee. Ms. Brunk has nominated a candidate who did not get placed on the slate and was hoping that he could be encouraged to connect with a community based provider in the area. The committee agreed that this was a good idea and Donna indicated that she would follow up on this. Jodi Power thanked Lisa Bradford for her leadership as Chair of the Nominations and Elections Committee, and also expressed gratitude to the members of the Committee for their service. NEW BUSINESS: DARS & Federal Grant Update – Patti Goodall DARS is in its third year of a 4-year federal Traumatic Brain Injury (TBI) Act Implementation Partnership Grant. The federal “home” of the TBI State Grant Program has moved from the Health Resources and Services Administration (HRSA) to the Administration on Community Living (ACL). ACL has been very supportive and eager to learn more about the state grantees’ activities, etc. ACL grant officers indicated that they are moving ahead with plans to hold a meeting in D.C. during March. In addition, DARS must submit a performance report in March and it will be the first time using ACL’s new website for this purpose. DARS has joined Grant Solutions (required) and is preparing to submit the performance report / continuation grant request using this software. March 22nd is federal “Brain Injury Awareness Day on The Hill” for brain injury advocates. It is sponsored by the Congressional Brain Injury Task Force (CBITF) which is chaired by Rep. Bill Pascrell of New Jersey. If interested, Council members are encouraged to attend and Donna can provide more details upon request. However, Donna reminded Council members they cannot speak on behalf of the Virginia Brain Injury Council, but are free to express themselves as individual citizens. Elizabeth Horn with the Disability Law Center approached DARS staff about working with specialized brain injury case managers to assist with the process of applying for / appealing decisions for Social Security benefits. The disAbility Law Center of Virginia (dLCV), Virginia’s “protection and advocacy” organization, receives federal funds from the Administration on Community Living (ACL) for brain injury related goals and activities. Donna Cantrell is working with Ms. Horn to incorporate training into one of two DARS BIS Programs retreats (one for direct services staff, one for directors / administrators) being sponsored by DARS in June 2017. DARS is very pleased to partner with the dLCV on this cross-agency educational / training event. In the early 2000s, DARS’ Brain Injury Services Unit coordinated the development of a state level strategic action plan for brain injury services and supports (“state action plan”) as part of a requirement for receiving federal TBI funds. Virginia’s most recent state BI Action Plan was completed in 2009, and it is time to review and update it. Patti Goodall asked Council for volunteers to serve on this ad hoc committee: John Heath and Devin Bowers volunteered. Others who may be interested should contact Patti Goodall. Dr. Barth highly recommended seeking an outside consultant to facilitate the process (both UVA and JMU are interested in discussing consultation possibilities). CNI Trust Fund Grant: TBI Screening Project Update – Jeff Barth, PhD, UVA Drs. Donna Broshek and Jeff Barth presented on their CNI Trust Fund TBI Screening project. This project also serves as a required state cash match for DARS’ federal TBI grant. A copy of the presentation was made available to the members of the Council. Patti Goodall stated that DARS is assisting UVA in identifying both urban and rural sites where a TBI screening instrument can be piloted / implemented. Donna is working on gathering potential sites and contact information (several are already on board) for the UVA researchers. Cara Meixner, PhD asked if there were any plans to include emergency services personnel or law enforcement as individuals who might administer such a screening. Dr. Barth commented that while that was a good idea, it was not the focus of the current project. John Heath expressed his view that there is a lot of Council support for reaching out to law enforcement and other first responders. Donna Cantrell and Devin Bowers shared information on an ongoing project with the Department for Criminal Justice Services (DCJS) to implement a law enforcement training program that included modules on brain injury and dementia, along with three other conditions. John Heath asked if there were plans to provide screening to patients prior to leaving the Emergency Departments after initial treatment. This led to a discussion of a variety of other setting where screening would prove helpful such as Community Services Boards (CSBs); Susan Rudolph noted that we should focus on nurses who work in CSB settings as they are often the entry point for patient care. Patti Goodall clarified that the intention of the project was to focus solely on intake personnel as the initial step of the project. Depending upon results, the screening may be implemented into deeper levels of staffing within the community sites, as feasible. She also stated that the universe of potential screening “targets” or community-based services sites is nearly endless and that borders had to be put around such a project, for practical reasons. Legislative Update from the Virginia Alliance of Brain Injury Service Providers and the Brain Injury Association of Virginia (BIAV) - Krystal Thompson (VABISP) and Anne McDonnell (BIAV) Krystal Thompson shared that legislative requests this year are three-pronged: 1. Restore funding that had been cut from the 2017 BIS Programs budget; 2. Request $1 million to expand core services (Sen. Edwards and Del. Rush have asked to co-sponsor this bill); and 3. Establish budget amendments to form interagency implementation teams. Sen. Morrison and Del. Pope have been approached to support this effort. DMAS Workgroup: Anne McDonnell noted that last year, a budget amendment would have required the Department of Medical Assistance Services (DMAS), Department for Aging and Rehabilitative Services (DARS), Department of Health (VDH), and Department of Behavioral Health and Developmental Services (DBHDS) to work with community stakeholders to create a five-year strategic plan for delivering comprehensive brain injury services that included improved data collection, and analysis of health care costs of Virginians with brain injury, projections of need and cost of an in-state neurobehavioral treatment program and a brain injury home and community-based waiver for persons with brain injury and the design and implementation ofa pilot project to bring Virginians receiving care out of state back home. That request was truncated in the final budget, and DMAS initiated an interagency and stakeholder workgroupthat only addressed methods to improve data capture on the annual incidence of brain injury. A budget amendment this year repeated the request from last year. This year there are two requests from the Joint Commission on Health Care (JCHC) for additional studies – one to DARS and one to DMAS. Anne McDonnell noted that in December 2016, the company who owns the Braintree facility in Massachusetts (Kindred Healthcare), where many Virginians are currently being served out of state, is selling the facility to a new owner that wants to “get out of” the nursing home business.This will necessitate finding alternative placements for these Virginians, something that DMAS will address. This may have a positive impact on efforts to create an in-state treatment option for those with neurobehavioral challenges. Brain Injury Services Report from Joint Commission – Paula Margolis, PhD Paula Margolis, PhD, MPH, Senior Health Policy Analyst with the Joint Commission on Health Care (JCHC), presented a PowerPoint slide presentation of their recently completed brain injury services study, “Expanding Access to Brain Injury Services and Barriers to Placement of Virginians who have Challenging Behaviors Resulting from Brain Injuries.” Cynthia O’Donoghue asked if there could be an exception to policy which states that nursing homes must have a minimum of 20 beds set aside for specialized neurobehavioral services for individuals with brain injury. Dr. Margolis indicated that a change such as this would require regulation change and a change to the language since it is outdated. Patti noted that this provision in the regulations has not been used by any nursing facility since Head & Heart Unit in Tidewater closed over 20 years ago (DMAS even admitted at the time that this language was “obsolete” and needs to be removed.) Stroke Systems Task Force – Anne McDonnell reported that several years ago,code language was passed that required hospitals and VDH to develop a statewide Stroke Triage Plan; that group evolved into the Virginia Stroke Systems Task Force, which monitors and addresses stroke-related issues.She was asked to present at one of their meetings; she discussed the trauma registry reporting of brain injuries, and there was some interest in investigating if such an effort could be established for stroke. Brain Injury Report Out Day – BI Report Out Day will be held in Richmond (location to be confirmed) on Friday, July 28th. DARS is the sponsor of Report Out Day, while the Council serves as “host” for the occasion. The theme this year is “Hidden Injury.” Several national speakers have agreed to present on screening for mild brain injury, concussion, and a survivor’s account of misdiagnosis following concussion. Council members were also asked to consider / nominate legislators or others who should receive the Council’s “Brain Injury Champion Award.” Appointment of Committees – Jodi Power Jodi reminded the committee that all committees should include 3-5 members and every committee must have a survivor and/or family member, per by-laws. All members should be actively involved in the work of the committee. • By-Laws Committee Cara Meixner, PhD, Frankie Brewster, Maria Stransky, and John Cimino, JD, volunteered to serve on the By-Laws Committee. Per Council by-laws, the Secretary – Laurie Silva – serves as the chair of this committee. • Priorities Committee Tom Campbell, PhD, Krystal Thompson, Anne McDonnell, and John Heath volunteered for the Priorities Committee; John Heath volunteered to serve as Chair. • Funds Dissemination Committee If there are monies available, this committee is activated; otherwise, it does not convene. Devin Bowers, Lisa Bradford, Frankie Brewster, Gayle Brunk, Deborah Johnson, and Krystal Thompson volunteered to serve on this committee; Gayl Brunk also volunteered to serve as Chair. As Krystal directly receives funds that may be discussed, she will recuse herself from a formal vote as appropriate. • State Action Plan Committees The Council is being asked to participate in a process to review and update, as needed / feasible, DARS’ Brain Injury State Action Plan (which was last updated in 2009). DARS is working on identifying an outside consultant. Devin Bowers and John Heath volunteered.Other interested parties should contact DARS staff. All Council members will have an opportunity to review and weigh in on the process of revisions. Education Topics for April Meeting – Jodi Power, Chair Current educational topic suggestions include Clubhouses, Social Security Issues from the disability Law Center of Virginia (Elizabeth Horn), and Crisis Intervention. The Council approved having a clubhouse presentation as the Council’s next educational presentation. Donna Cantrell will follow up with local clubhouses to identify presenters, including survivors and family members as feasible. OLD BUSINESS: Installation of New Officers – Jodi Power, Chair • Chair, Mark Bender • Secretary, Laurie Silva • Immediate Past Chair, Jodi Power Terms of new officers are effective immediately, following announcement / recognition from the sitting chair of the new officers, and then the “passing of the gavel” from outgoing chair to incoming chair.Lisa Bradford remains Vice Chair. CLOSING PROTOCOL: Future meeting dates: • February 1, 2017 (Brain Injury Awareness Day at the General Assembly) • April 28, 2017 (Quarterly Meeting / New Member Orientation at 11:00 a.m.) • July 28, 2017 (Brain Injury Report Out Day, Richmond ) • October 27, 2017 (Quarterly Meeting in October usually held at WWRC in Fishersville) The regular quarterly meeting of the Virginia Brain Injury Council was adjourned at 4:05 p.m. by Mark Bender, Chair, following a motio