摘要:

The Traumatic Brain Injury Act of 1996 (Public Law 104-166) gave new authority to the Health Resources and Services Administration (HRSA) in the United States Department of Health and Human Services (DHHS) to establish a grant program for states to assist in addressing the needs of persons with traumatic brain injury (TBI). The resulting State Demonstration Grant Program has made available two categories of grants: planning and implementation. Planning grants are awarded to assist states in building infrastructure through the development of four core components. One of the core components is a statewide needs and resource assessment encompassing the full spectrum of services, from initial acute treatment through rehabilitation and long-term community supports. In 1999, assessments completed in 11 states were subjected to a comparative analysis to identify trends across states and to extract salient issues for the State Demonstration Grant Program. This article summarizes the context of the HRSA-funded needs assessments and contrasts the methods of needs assessment utilized. Over-arching issues are discussed, including exemplary qualitative and quantitative methods, and the diversity of theoretical models employed in designing assessments and interpreting findings. Several limitations in approaches were also identified, including shortcomings of convenience samples for conducting mail surveys and the unlikely validity of using a needs and resource discrepancy approach to identify gaps in services.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This article will review and compare existing state-funded programs and their approaches to financing, administering, and delivering an array of services, including rehabilitation and home and community-based services and supports to individuals with traumatic brain injury (TBI) and their families. A state-by-state chart provides funding and operational characteristics of the programs. The state menu of services provided and how they are delivered are also described. The article addresses how these programs fit within their overall state service delivery system, trends and changes that programs may be undergoing, and the influences that shape these programs.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Traumatic Brain Injury (TBI) rates are highest among families with the lowest income levels. A paucity of appropriate funding streams for low-income, recently injured TBI patients is reported to cause delays in provision of early postacute rehabilitation or to cause patients to be discharged without receiving rehabilitation. There are also reports of patients remaining in hospitals with minimal care or being returned home, both because of a lack of a discharge site. The purposes of this exploratory study were to: (1) identify model aspects of existing publicly supported and administered programs for postacute individuals with TBI; (2) present results of a survey measuring to what extent state Medicaid programs fund postacute rehabilitation services for recently injured patients with TBI; (3) present results of interviews with trauma center social workers affiliated with the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems projects to determine whether and how delays in receiving Medicaid coverage occur; and (4) make recommendations for improved systems of care for postacute individuals with TBI.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This article examines Medicaid waivers to provide services to adults with traumatic brain injury (TBI) who are Medicaid eligible in the community and who would otherwise be placed in nursing homes or who meet nursing home levels of care. Medicaid waivers for individuals with TBI were addressed through a review of six TBI Waivers (Colorado, Idaho, Kansas, New York, Rhode Island, and Vermont). A summary of the services covered by the waivers is provided. Review of the data suggests two processes, obtaining a waiver and implementing a waiver. Four characteristics were linked to obtaining waivers (a) social-medical-political climate, (b) similarity to other waivers, (c) ability to strengthen access and reduce barriers, and (d) expenditure of resources. Similarly, four theoretical characteristics were posited to be associated with managing waivers: (a) cost effectiveness, (b) developmental process of waiver implementation, (c) ability to improve access and reduce barriers, and (d) expenditure of resources to manage the waiver.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective:To articulate a framework for supporting individuals with behavioral challenges following brain injury, to describe a state-funded clinical intervention program established to provide community support to individuals with challenging behaviors following brain injury using such a framework, to present data from which it can be concluded that such a program is cost-effective, and to offer policy recommendations.Design:Retrospective analysis of cost data and living arrangements for individuals with behavioral challenges served for a period of 3–4 years through the New York State Home and Community-Based Services Traumatic Brain Injury (HCBS-TBI) Waiver program and the State Behavioral Resource Project.Subjects:80 individuals with TBI and severe behavioral challenges that included criminal behavior, physical threats, assault and physical aggression, sexually inappropriate behavior, substance abuse, refusal to participate in intervention programs, and psychiatric disturbances, all of whom were at least 2 years postinjury (&OV0398; = 7.33 years postinjury).Results:The majority of individuals (82% of the 1996 cohort; 89% of the 1997 cohort) with challenging behaviors were living successfully in their home communities 3–4 years after the initiation of behavioral supports. In addition, the costs of serving these individuals decreased in the first year of community integration and for that last year that a cost analysis was completed.Conclusions:Many individuals with behavioral impairments can be supported successfully in community settings, so long as those supports are flexibly implemented to meet the changing needs of those individuals. Moreover, even with intensive supports, it is cost-effective to serve this population in the community.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Ten educational consultants and researchers, each with extensive experience working with children with traumatic brain injury (TBI) in school settings, identified seven themes related to serving this population in public schools. These themes are discussed under the headings (1) incidence of TBI and prevalence of persistent educational disability, (2) diversity and central tendencies within the population, (3) assessment, (4) intervention and support in school settings, (5) training and support for educators, (6) intervention and support for families, and (7) systems change and flexibility. For each theme, a set of recommendations is provided, forming an educational research and policy agenda for pediatric TBI.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The federal-state vocational rehabilitation (VR) program has been a significant stream of funding for individuals with traumatic brain injury (TBI). However, the success of this traditional rehabilitation approach with people with brain injuries remains limited. Recently, the use of specialized employment services, such as Supported Employment, has proven to be far more effective, but funding for this population remains limited. In addition, even individuals who receive specialized employment services often require more intensive, ongoing supports to remain employed. In response, many states have developed innovative services and approaches that are improving the placement and retention rates of individuals with TBI. In this article, the authors provide an overview of selected federal funding initiatives related to the provision of employment services to people with brain injuries, including recent amendments to the Rehabilitation Act. The article also highlights progressive state employment policies and makes suggestions for creative use of government employment monies.

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:2001

数据来源: OVID