brain injury in pennsylvania cross-systems planning to minimize our epidemic of lifetime disability...

BRAIN INJURY IN PENNSYLVANIA

Cross-Systems Planningto Minimize Our Epidemic

of Lifetime Disability

© 2007 Barbara A. Dively

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preface

Thanks to James D. Holt, Ed.D., Executive Assistant for Organizational Development of the Pennsylvania Human Relations Commission for prompting this PowerPoint for the June 22, 2007, meeting of the Disability Stakeholders’ Group, and to Edward V. Crinnion, Jr., for developing this opportunity to share information about acquired brain injury.

This information is based on my own experience, research and conversations, and my advocacy efforts in Harrisburg to improve the lives of individuals and families affected by acquired brain injury.

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the time is now

458,000 Pennsylvanians are currently disabled by acquired brain injury, including 32,179 children under 21 with traumatic brain injury alone.

Brain injury rehabilitation began in the 1970’s but is currently provided to only 460 Pennsylvanians.

The Department of Public Welfare is now implementing the Brain Injury Recovery Blueprint to extend brain injury rehabilitation to all children and to all adults in publicly funded systems.

Next, adult brain injury rehabilitation must become a routine outpatient service for all Pennsylvanians.

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INDEX

• BRAIN INJURY BASICS ….………..…………………….5• EFFECTS OF NEURAL DAMAGE ...…………………..11• MAXIMIZING RECOVERY…………..………………….18• RULES OF ENGAGEMENT………..…………………...38• MINIMIZING INCIDENCE...………..……………………44• STATISTICS……...…………………..…………………..50• PENNSYLVANIA’S RESPONSE.…..…………………..64• ACTION NEEDED…………………..…………………...80• SUMMARY…………………………..……………………83• RESOURCES………………………..…………………...84• CONTACT…………………………..…………………….85

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BRAIN INJURY BASICS 1/6

• What is a Brain Injury?

• What is a Neuron?

• Are Neurons Important?

• What Damages Neurons?

• Review: BASICS

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What is a Brain Injury? 2/6

• Brain injury is not a progressive condition or degenerative disease like multiple sclerosis, dementia or Alzheimer’s.

• Brain injury is not a birth injury, a congenital or a metabolic condition.

• Brain injury is an injury to neurons (brain cells) causing a period of confusion, amnesia or loss of consciousness that is followed by physical, cognitive and/or behavioral changes.

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What is a Neuron? 3/6

• Neurons are cells arranged in networks. • The body of the neuron produces chemical

messengers called neurotransmitters. • Each neuron has several tree-like projections or

dendrites that receive neurotransmitters. • Each neuron has one stem-like projection or

axon that sends out neurotransmitters. • The brain contains 10,000 million neurons.

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Are Neurons Important? 4/6

• Neurons are linked together in neural networks that allow you to think, plan, make decisions and remember.

• Neural networks control your breathing, gait, digestion, urination, defecation, and circulation.

• Neural networks allow you to hear, smell, taste, feel, see, be hungry and reproduce.

• Neural networks allow you to walk, write, sweat, react to danger, laugh, cry and sleep.

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What Damages Neurons? 5/6

• Lack of oxygen as in cardiac arrest, near drowning, near suffocation, anoxia.

• Lack of blood flow due to hemorrhage, blockage, hypothermia, surgery.

• Pressure from hemorrhage, swelling. • Metabolic interference as in poisoning,

fever, malnutrition. • Mechanical damage to dendrites or axons

due to twisting, stretching, shearing.

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Review: BASICS 6/6

• Brain injury is an injury to neurons (brain cells) causing a period of confusion, amnesia or loss of consciousness that is followed by physical, cognitive and/or behavioral changes.

• 10,000 million neurons are arranged in networks that control every life function.

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EFFECTS OF NEURAL DAMAGE 1/7

Physical Effects

• Cognitive Effects

• Behavioral Effects

• Impact on Adults

• Impact on Children

• Review: ABI SEQUELAE

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Physical Effects 2/7

• Seizures of all types• Muscular spasticity, paralysis• Double vision, low vision, blindness• Loss of smell, loss of taste• Slurred speech• Headache or migraine• Fatigue, need for more sleep• Balance problems, gait problems

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Cognitive Effects 3/7

• Memory loss • Information processed

more slowly• Concentration difficult • Conversation difficult• Word finding difficult• Spatially disorganized• Disorganized thinking• Impaired judgment• Only one thing at a time

• Unable to initiate• Unable to maintain• Distracted easily• Coaching needed• Cueing needed• Understanding difficult• Unable to follow rules• Decision making difficult• Noise overwhelms• Reaction time slower

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Behavioral Effects 4/7

• Increased anxiety• Depression• Mood swings• Impulsive behavior• More easily agitated• Egocentric behaviors• Difficulty seeing another point of view• Unable to monitor personal behavior• Unaware of the cues for expected behavior

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Impact on Adults 5/7

• Within a year, all prior friends are gone.• Over 90% of marriages dissolve. • The parent/child relationship is damaged. • Careers are ended. • Future educational prospects are limited. • Extended family networks are destroyed. • Community roles disappear. • Financial capacity is eliminated.

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Impact on Children 6/7

• Within a year, all prior friends are gone.

• Within a year, pre-event achievement no longer ensures school success.

• Children believe they have not changed.

• Maturation is stalled at the event age so deficits become more evident over time.

• School IEP must be guided by the child’s neuropsychologist to promote recovery.

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Review: EFFECTS 7/7

After an acquired brain injury, there may be physical, cognitive, and/or behavioral consequences or sequelae.

If you had a few problems from each list, how would you feel? How would you plan for your future? Would you require help to get your life back in order?

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MAXIMIZING RECOVERY 1/20

• What is Recovery?• Recovery Bloopers• Mental Stimulation is Essential• Rest is Essential• Resilience Factors• S.P.E.C.T. Scans – TBI, Stroke/Alcohol• NIH Pilot Study• Misalignment• Other Alternatives• Review: RECOVERY

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What is Recovery? 2/20

• Recovery means the creation of a new life that is satisfying and as independent as possible.

• Brain repair must first be maximized. • Strengths and limitations must be identified

through a neuropsychological evaluation. • Activities must focus on regaining old skills,

exploring new interests, adjusting to deficits, using compensatory strategies and/or assistive technology, and making new friends.

• Most people have no help with these issues.

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Recovery Bloopers 3/20

• Maximal improvement occurs in the first 6, 12, or 18 months.

• At some point, improvement ends. • The brain does not repair.• Stimulants are useful to prevent fatigue.• Regression or a plateau in improvement is final.

• Failure to comply indicates resistance. • Artificial goals should be set and met. • Anti-depressants promote recovery.

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Mental Stimulation Essential 4/20

• Assure a relaxed pace.

• Base activities on personal preferences.

• Re-train for prior skills.

• Identify and utilize strengths.

• Teach compensatory strategies.

• Encourage new interests.

• Plan for pleasure every day.

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Rest is Essential 5/20

• Initially, the brain is exhausted from coping with swelling and healing physical damage.

• Next, the brain works constantly to repair neurons and rebuild neural networks, inefficiently at first.

• Daily life is extraordinarily difficult, as if there were four final exams daily, forever.

• Periodically, all energy is drained while streamlining neural networks so cognitive efficiency and complexity can improve.

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Further Factors 6/20

• Encourage faith in the future and gratitude for survival. • Support determination and perseverance. • Allow awareness of deficits to emerge slowly. Denial

preserves hope and protects from reality, shame, embarrassment and suicide (5 times general rate).

• Celebrate 10% success such as just showing up!• Ensure daily organic fruits, vegetables, nuts, and

essential fatty acids to rebuild the brain. • Encourage exercise, general health and dental health. • Assure support from new friends, family, support groups,

and a good neuropsychologist. • Encourage artwork, crafts, music, dance, singing.

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S.P.E.C.T.: Info 7/20

• See Harch S.P.E.C.T. scans at www.abin-pa.org, Education, Hyperbaric Oxygen.

• Hospitals provide chamber or treadmill. • First used for divers with the “bends”• Medicare and Aetna approve hyperbaric

oxygen for many diagnoses. • Medicaid covers children claims due to

demonstrated improvements.

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S.P.E.C.T.– #1 TBI 8/20

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S.P.E.C.T.: #1 TBI, cont. 9/20

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S.P.E.C.T.: #1 TBI,cont. 10/20

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S.P.E.C.T.: Stroke/Alc. 11/20

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S.P.E.C.T.:Stroke/Alc., cont.12/20

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NIH Pilot Study 13/20

• Journal of Head Trauma Rehabilitation, 14:6, December 1999, p. 521. A randomized, double-blind placebo-controlled, clinical trial using homeopathy at Spaulding Rehabilitation Hospital, a TBIMS facility.

• “The treatment group subjects reported a highly significant reduction on scales measuring difficulty functioning in situations commonly encountered in daily life and a significant decrease in the reported frequency of ten most commonly reported symptoms of MTBI.”

Cont.

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NIH Pilot Study, cont. 14/20

• “Subjects whose injury occurred one year or less from the beginning of the study showed improvement in both the homeopathic and placebo groups. Subjects in the placebo group who were one to three years post-injury at the onset of the study showed no further improvement; and placebo subjects who were three years or more post-injury showed an increase in symptoms. The relative benefit of effect of homeopathic treatment appeared to increase with duration since injury, a finding that holds promise for patients with persistent MTBI and for whom current treatment options are limited.”

Cont.

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NIH Pilot Study, cont. 15/20

• The ten symptoms used were: short term memory problems; short attention span; slow thinking; headache; mental fatigue; sleep disturbances; impatience; frustration; distractibility; and withdrawal from social situations. At least half the subjects had these symptoms all of the time.

• The 15th edition of the American Pharmacist’s Association “Handbook of Non-Prescription Drugs” includes Chapter 55 on homeopathic medicines. See next slide, or go to: http://www.hylands.com/news/apha.php.

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Chapter 55, A.Ph.A. 16/20

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Misalignment 17/20• A misaligned vertebra is called a subluxation. • The same event that causes an acquired brain injury may cause a

subluxation. • Subluxations interfere with nerve function. • Subluxations interfere with blood flow. • Subluxations are documented by x-ray. • Subluxations can be detected by palpation. • Subluxations are corrected by chiropractic adjustments with a risk of

harm of 1 per 100 million (lumbar), 6.39 per 10 million (cervical) and 1 in 250 million (children). As a result, malpractice premiums are about $2,000 per year.

• To put this risk into perspective, the risk of harm from back surgery is 15.6 per 1,000 and for NSAID’s is 3.2 per 1,000.

Cont.

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Misalignment, cont. 18/20

• Impaired arterial blood flow to the brain as a result of a cervical subluxation: a clinical report. Risley, WB. Journal of the American Chiropractic Association, June 1995, pp.61-63. 15,000 patients. Documented by Doppler studies. Reversed by C-1, C-2 adjustment.

• Report of the State Supervisor of Chiropractors of Kentucky In Connection with Kentucky Houses of Reform, Greendale, Kentucky, Marshall, L.T., Lexington, Kentucky (December 1, 1931). 9/3/1930 (540 boys) to 12/1/1931 (335 boys) with 244 treated, 144 paroled. Teachers asked for a permanent chiropractor and stated that the boys improved in demeanor and performance from the first adjustment. Chiropractic discontinued.

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Other Alternatives 19/20

• Shiatsu – pressure on meridians with positioning – restores function

• Trager – developed by a physician to rehabilitate stroke patients

• Yoga – stabilization, integration and mobilization • CranioSacral – restores neural function• Polarity – restores energy flow• Acupuncture – restores energy flow• Behavioral optometry – restores binocular

tracking and accommodation (biofeedback)• Music therapy – restores breathing pattern, etc.

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Review: RECOVERY 20/20

• A tremendous amount of personal and family effort is involved.

• Creative thinking is essential.

• By working with personal interests, activities can become progressively more complex and challenging, leading to further neural network development.

• Utilize a variety of resources.

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RULES OF ENGAGEMENT 1/6

Interacting with a person affected by brain injury can be difficult. Every system

and family should be trained in these simple guidelines. This information will set

the stage for the specific recommendations of the

neuropsychologist who evaluates and maintains a treating relationship with the

individual recovering from a brain injury.

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Communication Rules 2/6

• Speak slowly.

• Phrase questions for a yes or no answer.

• Accept/offer alternate ways of responding.

• Simplify or offer simple choices.

• Gently divert from difficult topics.

• Remain calm at all times.

• Do not say “No”. Ask questions instead.

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Rules for Tasks 3/6

• If tasks are not completed, use coaching, small steps, cue cards, timers, etc.

• If tasks are unfamiliar, give easier tasks.

• Eliminate responsibilities that are ignored.

• Rehearse forgotten skills.

• If strong interests exist, assist in pursuing.

• Do not draw attention to failure.

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Rules for Remembering 4/6

• For current events, use a memory book.

• For poor future memory, use date book.

• If people or faces are unfamiliar, practice with pictures and remind.

• Use timer, alarm watches, posters, picture cards, computers, etc., for reminders.

• Follow a routine.

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Environmental Rules 5/6

• If the mind tires easily, reduce demands.

• If confused in a group, remain close by.

• If better alone, assure quiet times alone.

• If the body tires easily, assure rest breaks.

• If noise overwhelms, minimize noise.

• If reaction time is slow, plan for safety.

• Simplify the environment.

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Review: ENGAGEMENT 6/6

• Identify the current physical, cognitive and behavioral limitations.

• Plan and practice your rehabilitative behaviors to match current requirements as guided by the neuropsychologist.

• Fade away your rehabilitative behaviors slowly as the person regains function, but continually assess while gains stabilize.

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MINIMIZING INCIDENCE 1/6

• Non-TBI Causes of ABI • Minimize Non-TBI Events

• Causes of TBI Alone• Minimize TBI Events

• Review: INCIDENCE

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Non-TBI Causes of ABI 2/6

• Chemotherapy• Stroke• Cardiac arrest• Heart attack• AVM• Aneurysm• Near suffocation • Near drowning• High fever

• Lightening• Near electrocution• Epileptic seizures• Infection• Anesthesia• Brain tumor• Brain/cardiac surgery• Poisoning• Drugs, alcohol

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Minimize Non-TBI Events 3/6

• Best medical practices for conditions that may lead to brain injury

• Reduce hospital caused infections

• Minimize surgery through lifestyle changes

• Reduce poisonings

• Add brain injury to drug & alcohol prevention & treatment

• Use Centers for Disease Control and Prevention materials to educate all physicians about brain injury

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Causes of TBI Alone 4/6

• Shaken baby• Playground falls• Bicycle accidents• Skate/snow boarding• Skiing, water skiing• Motorcycle • All terrain vehicles• Surfing

• Motor vehicle crashes• Slip and fall• Stair falls• Team sports • Boxing• Assault, abuse• Gunshot• Falling object

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Minimize TBI Events 5/6

• Raise public awareness• Educate parents, baby

sitters, children, seniors • Promote/require seat

belts, child safety seats• Regulate playground

equipment & surfaces• Require Driver’s

Education• Involve school nurses

• Promote/require helmets and set minimum ages

• Promote/require sports concussion rules

• Promote/require gun safety and safe streets

• Set warehouse store and workplace safety rules

• Set higher penalties for assaults/injuries to head

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Review: INCIDENCE 6/6

• Trauma is just one of many events that can result in an acquired brain injury.

• To minimize disability, minimize the incidence of all events that may cause an

acquired brain injury.

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STATISTICS 1/14

• How large is the problem?• Comparable prevalence• Comparable incidence

• PA Department of Health TBI Statistics• Centers for Disease Control & Prevention

• Review: STATISTICS

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How Large is the Problem? 2/14

• 9.9 million Americans are disabled by just two types of ABI: TBI (5.3 million) and stroke (4.6 million).

• 457,642 in PA are disabled by just two types of ABI: TBI (245,000) and stroke (212,643).

• 55,022 Pennsylvanians are hospitalized each year by TBI (7,800) and stroke (47,222).

• 41,000 TBI emergency room visits in PA each year result in a TBI diagnosis.

• 32,179 PA children under age 21 in 2004 had been admitted to a hospital due to TBI.

• 1,200 are discharged from brain injury rehabilitation to a nursing home or family supervision each year.

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Comparable Prevalence 3/14

• 9,900,000 disabled by stroke and trauma

• 7,300,000 with intellectual disabilities

• 5,400,000 disabled by mental illness

• 190,000 paralyzed by spinal cord injury

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Comparable Incidence 4/14

• 1,500,000 traumatic brain injuries each year with 50,000 deaths + 80,000 disabled.

• 730,000 new strokes each year with 160,000 deaths + 399,000 disabled.

• 176,300 new breast cancers + 43,700 deaths. • 43,681 new HIV/AIDS cases + 17,930 deaths.• 10,400 new cases of multiple sclerosis yearly.

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PA DOH TBI Statistics 5/14

• http://www.health.state.pa.us/pdf/php/injprev/tbi-hospital.pdf

• Strotmeyer SJ, Weiss HB, Fabio A. Traumatic Brain Injuries in Pennsylvania: Hospital Discharges 1995-1999. Pittsburgh, Pennsylvania: Center for Injury Research and Control (CIRC), Department of Neurological Surgery, University of Pittsburgh, 2002.

• Cont.

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PA DOH TBI Statistics, cont.6/14

• Data from PA Health Care Cost Containment Council covers a five year total from 1995-1999.

• 74,578 hospital discharges for TBI.• 10.4% were 15-19 or 184.7/100,000 incidence.• 50.9% of cases age 39 or younger. • Overall males 160.5 vs. 90.6 for females.• Black males 225.3 vs. white males 137.5.• Highest incidence 424.0 in those over 85.

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TBI History: <21 in 2004 7/14

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Notes: <21 in 2004 8/14

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TBI: <21 in 2004,Bicycle 9/14

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Notes:<21 in 2004, Bicycle 10/14

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TBI: 0-85 in 2004, Notes 11/14

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Notes: 0-85 in 2004, cont. 12/14

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Centers for Disease Control and Prevention 13/14

• For information on TBI, go to the National Center for Injury Prevention and Control: http://www.cdc.gov/ncipc/tbi/TBI.htm

• 5.3 million or 2% of Americans have a long term or lifelong need for assistance with activities of daily living due just to a traumatic brain injury.

• For TBI alone, direct medical costs and indirect costs such as lost productivity were estimated at $60 billion in the United States in 2000.

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Review: STATISTICS 14/14

• Brain injury disables more Pennsylvanians than mental illness or mental retardation.

• All disability prior to age 22 is considered a developmental disability – and diagnosed as mental retardation if the resulting IQ is <70.

• 32,179 children under 21 had a hospital discharge diagnosis of TBI in 2004, but there is no protocol for brain injury rehabilitation through Medical Access. Only 912 children are identified with TBI in special education in Pennsylvania.

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PENNSYLVANIA’S RESPONSE 1/16

• Pennsylvania’s History• SB 1190, 2001, Rehab Study• HB 2902, 2002, Insurance• Pennsylvania’s 0.003% Brain Injury Rehabilitation Rate • Our Children are Federally Entitled to Rehabilitation• Barriers to Children’s Rehabilitation• Barriers to Adult Rehabilitation• Public Systems Without Screening or Rehabilitation• Surveys: Children & Inmates• The Brain Injury Recovery Blueprint• Current Events• Review: PENNSYLVANIA

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Pennsylvania’s History 2/16

• 1988 DOH Head Injury Program. 60 in rehab. • 1989 Auto CAT Injury Fund admissions closed. • 1992 DPW OBRA Waiver. 150 in rehab. • 1997 DPW Independence Waiver. 150 in TBI. • 2001 DOH TBI Advisory Board. • 2001 SB 1190, Senator Jane Orie, five years of rehab.• 2002 DPW CommCare Waiver. 250 in rehab. • 2002 HB 2902, Rep. Lita Cohen, rehab in all insurance.• 2005 DPW HCBS SPT Brain Injury Work Group. • 2006 Brain Injury Work Group Report approved.• 2006 DPW/GOHCR MedStat Report on TBI. • 2007 PDE Special Education lists 912 Children as TBI.

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SB 1190, 2001,Rehab 3/16

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SB 1190, 2001, cont. 4/16

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HB 2902, 2002,Insurance 5/16

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HB 2902, 2002, cont. 6/16

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Pennsylvania’s 0.003% Brain Injury Rehabilitation Rate 7/16

• 458,000 disabled by brain injury in PA

• OBRA 150

• CommCare 250

• PA HIP 60

• Special Ed 912

1,372

• 1,372/458,000 X 100 = 0.003 % served.

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Our Children are Federally Entitled to Rehabilitation 8/16

• All disabled PA children are Medicaid-eligible.• All Medicaid-eligible children are federally

entitled to all necessary services to ameliorate whatever condition they have according to E.P.S.D.T. §1396(d)(r)(5) up to age 21.

• School children with brain injury and with traumatic brain injury are to be accommodated under §504 and appropriately served within special education under I.D.E.A. as needed.

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Barriers to Children’s Rehabilitation 9/16

• Usually, there is no treating neuropsychologist or rehabilitation.• Parents may not know to apply for MA. Parents are incorrectly told

that schools will provide rehabilitation but IEP’s are not based on neuropsychological evaluations, schools ignore the child’s treating neuropsychologist, and children are labeled as MH, MR, LD, ADD, ADHD, or SED.

• MA lacks a plausible rate structure for neuropsychological services, a protocol for children’s brain injury rehabilitation, and a model Letter of Agreement between Physical and Behavioral Health to cover neuropsychological services.

• MA denials do not result in a denial letter, preventing an appeal. • Coordination between MA and 3rd party insurers is difficult and MA

and 3rd party insurer decisions are not timely.

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Barriers to Adult Rehabilitation 10/16

• Medicaid omits brain injury rehabilitation.• Medicare omits brain injury rehabilitation.• Worker’s compensation sends cognitively

impaired people back to work to be fired. • Private insurance seldom covers. • Shame and confusion block access.• CommCare and PHIP have low funding,

providers have waiting lists, and cannot accept court ordered or difficult clients.

• OVR only accepts those who can be competitively employed in 18 months.

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Public Systems Without Screening & Rehabilitation 11/16

• Medical Access• Early Learning• Children, Youth and Families• Special Education • Developmental Programs • Behavioral Health • Substance Abuse in OMHSAS and BDAP• Juvenile Justice• Mental Health Courts, parole, probation• County jails and state prisons

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Surveys:Children & Inmates 12/16

• The Mt. Sinai Brain Injury Screening Questionnaire found 20% of LD children and 30% of SED in Chicago Special Education were actually brain injured. Contact Wayne Gordon, PhD, at Wayne.Gordon@mountsinai.org.

• Ken Carlson of the Minnesota Department of Corrections reports 85% of state inmates appear to be brain injured, based on the preliminary results of their current study. Contact him at 651-361-7286.

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THE BRAIN INJURY RECOVERY BLUEPRINT 13/16

• 2005 - Secretary Estelle Richman charged the Brain injury Work Group with an ideal system for brain injury services for all ages.

• 2006 – The Brain Injury Recovery Blueprint was approved. • This model (www.abin-pa.org, Education) includes screening,

assessment, planning, rehabilitation, training, standards and cross-systems integration for all children, and for adults served in any public service system.

• An initial simple screening could resemble the Alaska screening. • Positive screens could lead to the more detailed Mt. Sinai Brain

Injury Screening Questionnaire prior to a full evaluation. • 2007 - An internal analysis of necessary systems changes was

completed.

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Current Events 14/16

• A proposed Adult Protective Services Bill would allow individuals to report abuse against adults under 60. This would be very helpful. Status unknown.

• An Assisted Living Bill is being drafted by the Office of Long Term Living. Cognitive services for those with brain injury must be included. Comments were sent.

• The MedStat report (DPW/GOHCR) has a section focusing on brain injury and proposing changes, but attention has not yet turned to this section.

Cont.

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Current Events, cont. 15/16

• The Department of Public Welfare is working on implementing the Brain Injury Recovery Blueprint.

• A bill proposes excess Auto CAT Continuation funds be spent on brain injury research, but we already have solutions that are not being provided under Medical Access - HBOT, homeopathy, and rehabilitation.

• On September 1st, the two year school re-entry project of the Department of Health begins under a federal Maternal & Child Health grant to train and mentor ten teams across the state.

• Under a federal TBI Grant, the Department of Health will soon start a health workers training project.

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Review: PENNSYLVANIA 16/16

• The Department of Public Welfare and the Department of Health recognize rehabilitation minimizes disability and lifetime costs after acquired brain injury.

• Implementing the Brain Injury Recovery Blueprint, expanding the Head Injury Program (DOH) and CommCare Waiver (DPW), and requiring private insurance coverage are essential to controlling this epidemic.

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ACTION:Systems Change 1/3

• Implement the Brain Injury Recovery Blueprint to screen, assess, plan, and treat all children and those adults in publicly funded systems.

• Create a four tier provider licensing system to match all levels of need: 1) pre-vocational; 2) intense support, 3) coma or minimally conscious; and 4) violent/court ordered.

• Create a joint DPW/PDE/DOH authority to eliminate barriers, coordinate systems, and provide children’s brain injury rehabilitation to meet the federal mandate EPSDT1396(d)(r)(5).

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ACTION:Minimize state costs – 2/3

• Eliminate the two-year Social Security Disability wait for Medicare and add brain injury rehabilitation to the list of Medicare services.

• Require all healthcare insurance to cover brain injury rehabilitation (HB 2902, 2002).

• Re-activate the Auto CAT Fund.

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ACTION: Decrease disability 3/3

• Double DPW CommCare Waiver funds.

• Double DOH Head Injury Program funds.

• Add adult outpatient brain injury rehabilitation to the state Medicaid menu (SB 1190, 2001).

• Minimize the incidence/severity of events that may cause an acquired brain injury.

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SUMMARY

• Events leading to possible brain injury are epidemic and must be minimized.

• Disability after brain injury is epidemic in Pennsylvania and must be minimized through rehabilitation for all through public funding or private insurance.

• All systems must assist clients to recover through the Brain Injury Recovery Blueprint model.

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RESOURCES• Acquired Brain Injury Network of PA at www.abin-pa.org • Brain Injury Association of America 1-800-444-6443 at

www.biausa.org• Brain Injury Association of New Jersey 1-732-738-1002 and

www.bianj.org• Brain Injury Association of Pennsylvania, trained volunteers will

return your call 1-866-635-7097 and www.biapa.org• Brain Injury Help Line, daily, free literature 1-866-412-4755, DOH• CommCare (TBI) Waiver 1-800-757-5042, DPW • Head Injury Program Enrollment Assistance 1-866-412-4755• Office of Vocational Rehabilitation for re-training at

http://www.dli.state.pa.us/landi/site/default.asp, DL&I • Pittsburgh Area Brain Injury Alliance, Inc., 1-412-761-9870 and

www.pabia.org• Special Education Consult Line 1-800-879-2301, PDE

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CONTACT

Barbara A. Dively

2275 Glenview Drive

Lansdale, PA 19446-6082

215-699-3391

b2272@prodigy.net