BIAC meeting minutes 10-24-2013

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Brain Injury Advisory Committee

Meeting Minutes

Date: October 24, 2013

Place: 1739 North High Street

Columbus, Ohio43210

Attendance

Members: Dan Arnold (via telephone), Greg Dormer, Rhonda Evans, Julie Johnson, Cody Linder, Bonnie Nelson, Diana Pollock, Stephanie Ramsey, Paul Richards, Denise Schaad, Adreana Tartt, Grace Williams

Brain Injury Program Staff:Jennifer Bogner, John Corrigan, Monica Lichi, Hannah Thompson, Laura VanArsdale

Guests: Charles Lockwood, M.D., Jerry Mysiw, M.D., Schuyler Schmidt, Sean Rose, Kevin Weber, Kirstin Hildebrant, Suzanne Minnich

Welcome and Introductions

Stephanie Ramsey opened the meeting, introduced Dr. Mysiw, and had the group give self introductions.

Jerry Mysiw, Chair of the Department of Physical Medicine and Rehabilitation at the OSUWexnerMedicalCenter, welcomed the Committee and gave a brief introduction as to how he became involved with the Brain Injury Program. He emphasized the importance of the organization, especially due to the scarce resources on brain injury in Ohio.

Charles Lockwood, Dean of the College of Medicine at the OSUWexnerMedicalCenter also welcomed the Committee and discussed the connection between brain injury and military veterans. He mentioned the growing focus on the brain at the NIH.

Denise Schaad mentioned the benefit of having physicians across Ohio who are advocates for brain injury prevention and rehabilitation due to their training at OhioState.

Adreana Tartt commented on the benefits of the work being done to bring programs together, such as TBI with substance abuse.

Old Business

Review/Approval of Minutes.

Cody Linder motioned to approve the June minutes with accepted changes. Grace Williams seconded. Motion passed.

New Business

John Corrigan began new business with an update on the Brain Injury Program. He mentioned that while OhioState is a good fit for the Brain Injury Program, due to expertise and passion, it does not have all of the answers. The BIAC is needed to bring together different departments from around Ohio to develop an action plan. Change will not take place immediately. OhioState has developed some areas of emphasis for the Brain Injury Program in the coming months, which include establishing the program at OhioState, incidence and prevalence data, community integration, youth concussion, and OEF/OIF/OND service members.

  • Establishing the Brain Injury Program at OhioState – The change became official on 9/30/13. All previous Advisory Committee members were reappointed in order to maintain their continuity with the move of the program to OhioState. Ohio State is creating a web presence for the Brain Injury Program, this is currently located at the Ohio Valley Center website ( but will eventually have its own site. In the process of getting involved with the National Association of State Head Injury Administrators. Transfer of funds is still in process.
  • Incidence and prevalence – There are some existing sources of planning data such as the Trauma Registry and Hospital Discharge data. It could be beneficial to look at population specific incidence data as well as data on the burden of injury. These latter may include the Behavioral Risk Factors Surveillance System (BRFSS), outcomes following rehabilitation for TBI, and outcomes following hospitalization for moderate, severe, and penetrating TBI. One in five survivors of TBI dies within five years post-rehabilitation. There is an increased risk for decline among people with moderate andsevere injuries. Some of these longer term issues could be studied if a follow-up function was added to the trauma registry.
  • Community Integration – A written request was submitted for additional services in the Ohio Home Health Care Waiver. A meeting took place with the Ohio Department of Medicaidto discuss how the Brain Injury Program could become involved with the Balancing Incentives Program. The Brain Injury Program could provide training and/or consultation to staff conducting assessments and implementing case management.
  • Youth Concussion – There is a need to evaluate the implementation of Ohio’s Return-to-Play law. There is a national evaluation being done, but it will not include state specific results. Consideration should be made for additional resources for incidence and/or prevalence data. Dr. Corrigan met with Gary Smith, M.D., from Nationwide Children’s Hospital and will be meeting with Shari Wade, Ph.D., from the University of Cincinnati in regards to youth concussion.
  • Service Members – The Brain Injury Program is assisting the Veterans’ Court in Cleveland with implementing TBI screening. The Brain Injury Program is exploring the ability to bring the Star Behavioral Health Provider’s Registry Project to Ohio with the help of Ohio’s National Guard and Purdue’s Military Family Research Institute. Exploring with the national “Give an Hour” program to provide training for Ohio behavioral health providers.
  • Adreana Tartt commented that five counties in northern Ohio are pushing for more veteran support via Veterans Courts, both for screening and post-screening treatment.

Dr. Lockwood asked how brain injury in school-age children served by the March of Dimes fits into the Brain Injury Program responsibilities. Dr. Corrigan commented that while the focus has traditionally been on TBI, the Brain Injury Program does cover all brain injuries, including those in children that are not due to injury from external forces.

Monica Lichi suggested that the group think about their preference for meeting frequency and location. Besides the current meeting schedule, there is the option of the workgroups meeting more frequently via the internet/phone, and the entire committee meeting less frequently. It was decided that the workgroups would discuss meeting frequency and location amongst themselves and report back to the larger group later in the meeting.

Denise Schaad mentioned that her organization is in the process of preparing legislation for Ohio that is similar to that passed in Texas. This legislation is related to insurance coverage for TBI rehabilitation. Stephanie suggested that information about this legislation should first be sent to her before moving onto the Services Workgroup and then onto the entire Committee. Denise Schaad will coordinate this with Jerry Mee, CEO at Mentis, who knows more about the legislation.

The inclusion of more invited speakers and trainings was discussed. Stephanie Ramsey suggested that continuing education is needed for the Committee. It was mentioned that having separate workgroup meetings would allow more time for speakers and training during in-person meetings. Adreana Tartt suggested that the trainings should focus on the areas of emphasis described by John Corrigan earlier in the meeting.

John Corrigan introduced the application that has been put in for the Ohio Behavioral Risk Factors Surveillance System (BRFSS). The CDC supports each state on an ongoing basis through the use of the BRFSS survey that acquires information about various health risk factors. In order to receive money from the CDC, a state must have a certain number of modules. Each state can choose which additional modules they wish to use. Each year, a state must include the core modules, and then can choose from some nationally available or state developed optional modules. TBI modules have been suggested in the past, but there have been issues with their design, especially due to problems with self-diagnosis. The Brain Injury Program has put in an application for the 2014 BRFSS. The module uses the OSU TBI Identification Method (OSU-TBI-ID). This is a structured interview that achieves better data than other methods of self-report. There arefive to seven applications forOhio developed modules proposed for the 2014 BRFSS. Time is a factor on the survey, which makes it unlikely that all of the applications will be accepted. A Data Users Group rates the proposalsthey believe should be included. The ratings are due on November 1, 2013 and it likely will be a month until a decision is reached.

John Corrigan described the OSU-TBI-ID Training Module, which can be found on the Ohio Valley Center website ( The OSU-TBI-ID was tested in Colorado. TBI had a greater prevalence in the general population than previously suspected. Findings included multiple relationships between experiencing current consequences and lifetime history of TBI. Consequences were not just the result of moderate and severe TBI; mild TBI’s were also associated with current problems. The OSU-TBI-ID was found to be reliable. Knowing the information gained from the OSU-TBI-ID does indicate the risk for consequences in adulthood.

Workgroup Summaries

Data Workgroup

The Data Workgroup discussed how critical data will be for legislation and funding in the future. The Data Workgroup wants to expand the current datasets, especially prevalence. They decided that a report should be mocked up of 2012 data, which should be compared to data from 2010 and 2011. Hospital discharge data should be compared to Trauma Registry Data. The Data Committee identified an objective for 2012. They will develop a proposed model for the upcoming annual report and look to expand screening results for state mental hospitals.

Adreana Tartt suggested that the Ohio Department of Public Safety give a presentation to the Committee regarding the Trauma Registry. She would like to know the relationship between substance abuse and injury. There is little trauma registry data on drugs and alcohol, and the data is only short-term. It was suggested that there could be a link between substance abuse and re-injury, but there is not data to support this. Trauma hospitals do have to screen for substance abuse. Rhonda Evans and Adreana Tartt will discuss this issue outside of the Advisory Committee.

The Data Workgroup recommended that the meetings be moved to quarterly and that the Data Workgroup work mostly through web conferences and/or teleconferences. They were all right with keeping the December meeting.

Services Workgroup

The Services Workgroup discussed follow-up to the letter requesting additional services in the Ohio Home Health Care Waiver. They discussed the issues of a trust fund and concluded that trust fund legislation cannot yet be pursued. A coalition as well as legislative champions must first be developed. They also discussed Health Homes and how coordinated services for people with TBI could be attained through these programs in Ohio. John Corrigan commented that influencing this feature of the Affordable Care Act may be premature at this time, but we should try to get involved with the No Wrong Door requirements of the Balancing Incentives Program.

The Services Workgroup also discussed a commercial product for catastrophic injury. This would be an insurance policy that the public could buy to protect them from the costs of catastrophic injury. John Corrigan will take the lead on finding information about this proposal.

The Services Committee did not discuss meeting frequency and location, but agreed with the Data Workgroup’s recommendation.

Training Workgroup

The Training Workgroup discussed the need for different meeting times for their committee due to the conflicting schedules the members have with the Committee meetings.

The Training Workgroup agreed that quarterly meetings would work.

They discussed training for educators. They need to meet with other Workgroup members to discuss training on concussions in the school setting. The Training Workgroup wants to pull together resources from people who are already developing modules. It is difficult to train educators in the field. A shift to online modules could be beneficial due to ease of access.

The Training Workgroup questioned whether they were focusing on the correct area. Stephanie Ramsey informed the group that typically the workgroups define their own roles and agenda before reporting to the larger group for suggestions. There should be a focus on the short-term in order to complete goals. The Training Workgroup will look at adapting the OSU Accommodation Module for educators. This module can be found at the Ohio Valley Center Website under Information & Education. It is titled “Accommodating the Symptoms of TBI Webcourse.”

Return-to-Learn guidelines from the American Academy of Pediatricians and an Institute of Medicine report on sports concussion both came out during the week of 10/28.

Communications Workgroup

The Communications Workgroup discussed how Clubhouses function with insight from Paul Richards. The need for more community resources was mentioned. Diana Pollock and Grace Williams offered insight into the needs of survivors several years post-injury.

John Corrigan commented that the goal will be to have a single plan of action developed jointly by the Brain Injury Program and the Advisory Committee. The Brain Injury Program staff, Committee Workgroups, and state departmental representatives will implement the plan, with progress reported to the Advisory Committee. The current Committee and Workgroup action plans will remain in place until the mutually developed plan is in place.

Meeting frequency and location was discussed again. Historically there had once been quarterly meetings, but this was determined to not be effective. There has been an inconsistent workload over time. Grace Williams suggested an ongoing evaluation for the first year in the case that the committee switches to quarterly meetings with more frequent workgroup meetings. John Corrigan mentioned that workgroups would not have to be mutually exclusive in membership if teleconferences are utilized. Members will be able to participate in multiple workgroups. John Corrigan suggested that the December meeting be cancelled and the quarterly meetings begin in January. Workgroup meetings by teleconference should begin sooner.

Agency Updates

  • Adreana Tartt reported the Ohio Department of Mental Health and Addiction Services was implementing a grant to promote Screening, Brief Intervention, Referral and Treatment (SBIRT) in primary care, medical school, and health entities. This will first take place in the northwest portion of the state and will move to the broader community during years 2-5.
  • Kristin Hildebrant shared that Disability Rights Ohio is focusing on outreach to veterans and service members. They are participating in several events promoting the services provided to this population. Work is being done to get people in nursing homes into the community setting. This may eventually involve litigation. They are involved in the Dual Eligible Project and are interested in Ohio State’s plans for improving care for service members.
  • Bonnie Nelson reminded the groupabout the upcoming TBI Summit being held in conjunction with the OCALI conference (OCALICON). ODE - OEC is working with Michael McSheehan from New Hampshire on training for the State Support Teams working with school districts within the 16 Ohio regions. There are an abundance of Ohio education initiatives that school districts are implementing which can be overwhelming for educators. An effort is being made to highlight connections between the various programs within the Ohio Improvement Process framework in order to braid the work together for better outcomes for students.The goal is for diverse learners, including students with TBI, to be successful and better integrated into the classroom.
  • Suzanne Minnich and Stephanie Ramsey provided an update on the Brain Injury Association of Ohio. BIAOH is working on a strategic plan.The Board is pushing to update the website in order to increase its usefulness. Fundraising is of current importance. Stephanie Ramsey mentioned that Sam Nesser was the 2013 posthumous recipient of the Champion Award from the Ohio Injury Prevention Partnership (OIPP)for her work as a proponent of House Bill 143.
  • Paul Richards shared the Hanson House is continuing to serve the adult brain injury population. He mentioned that they did better financially this year than last. They are seeing a wider variety of injury causes and are continuing to focus on the clubhouse model.
  • Rhonda Evans and Schuyler Schmidt updated the committee on the Ohio Department of Public Safety. Schuyler Schmidt is working on EMS reports for Nationwide Children’s Hospital. There is potential for TBI data in the future. Rhonda Evans mentioned that there have been changes to the Ohio Trauma Registry, including that the 48-hour rule is no longer in place. This rule stated that anyone who was seen prior to 48 hours post-injury was not included in the trauma registry. Work is being done on the full continuum of care including rehabilitation. There are approximately 20 hospitals currently providing data for the rehabilitation registry.
  • Cody Linder said that the BWC is still working on funds for what he mentioned during the June meeting. In the June meeting, Cody said the BWC were in the process of launching a guarded program interfacing with a nationwide facility. See the June meeting minutes for further details on the program.
  • Denise Schaad is working with Summit County TBI Collaborative for the upcoming Survivors Summit. Mentis is working on the legislative initiatives previously mentioned. She discussed with John Corrigan the potential of having him come to speak. They will decide together the best time.

Grace Williams made a motion to adjourn.

Paul Richards seconded.

Motion passed.