Nebraska’s TBI Implementation Partnership Grant - Nebraska … · 2017. 12. 22. · please visit...
Transcript of Nebraska’s TBI Implementation Partnership Grant - Nebraska … · 2017. 12. 22. · please visit...
June 2016
Annual Evaluation ReportJUNE 2015 – MAY 2016
Nebraska’s TBI Implementation
Partnership Grant
Nebraska Brain Injury Advisory CouncilShaping the Future of Brain Injury
DearReader:Traumaticbraininjury(TBI)isaseriouspublichealthproblemintheUnitedStates.TheCentersforDiseaseControl(CDC)reportsapproximately1.7millionpeoplesustainaTBIannually,andeachyearTBIcontributestoasubstantialnumberofdeathsandcasesofpermanentdisability.ATBIiscausedbyabump,blow,orjolttotheheadorapenetratingheadinjurythatdisruptsthenormalfunctionofthebrain.MostTBIsaremildandtheireffectsdiminishovertime,butevenamildTBIcanresultinpermanentcognitive,physical,andbehavioralchanges.Individualsexperiencingmoderatetosevereinjuriesmayrequirelife-longsupportsforhousing,work,andcommunityliving.ManyNebraskansimpactedbyTBIstillstruggletoaccessappropriateservicestomeettheirneeds.NebraskaVocationalRehabilitation(VR)andtheBrainInjuryAdvisoryCouncilremaincommittedtobuildingacomprehensive,multidisciplinary,easilyaccessiblesystemofcareforindividualsexperiencingbraininjuryandtoensuringawarenessandtrainingforpartnersinthesystem.NebraskaVRservesasleadagencyforaU.S.DepartmentofHealthandHumanServicesTBIImplementationPartnershipGrantwhichprovidesfundingforstatestobuildinfrastructureandcreatesystemschangetobetterservetheircitizenswithbraininjuries.TheBrainInjuryAdvisoryCounciladvisesNebraskaVR,theDepartmentofEducation,SpecialEducation,andtheDepartmentofHealthandHumanServices(DHHS)inimplementinggrantobjectivesandgoalsundertheNebraskaStatePlanforSystematicServicesforIndividualswithBrainInjuries.StatePlangoalsfor2013-2018areto:��Increaseawarenessandknowledgeaboutbraininjury��Increaseaccesstocommunityresourcesforindividualswithbraininjury��Increasefundingforservices��PromoteindividualizedservicesforpeoplewithbraininjuryFormoreinformationabouttheNebraskaStatePlanforSystematicServicesforIndividualswithBrainInjuries,pleasevisittheBrainInjuryAdvisoryCouncil’swebsiteatwww.braininjury.ne.gov.Thisreportsummarizesgrant-fundedprojectoutcomesforFY2015-2016.NebraskaVRandtheBrainInjuryAdvisoryCouncillookforwardtoworkingwithourpartnersandstakeholderstobuildbetterfuturesforNebraskanswithbraininjuryandtheirfamilies.
Sincerely,
KeriBennett,M.S.Ed,CBISNebraskaVRProgramDirectorforABITBIGrantProjectDirector
Thisprojectwassupported,inpartbygrantnumber90TBSG0013-01-00,fromtheU.S.AdministrationforCommunityLiving,DepartmentofHealthandHumanServices,Washington,D.C.20201.Granteesundertakingprojectsundergovernmentsponsorshipareencouragedtoexpressfreelytheirfindingsandconclusions.Pointsofvieworopinionsdonot,therefore,necessarilyrepresentofficialAdministrationforCommunityLivingpolicy.
TableofContents
ExecutiveSummary........................................................................................................................1
ProjectPurpose..............................................................................................................................3
GrantObjectives.............................................................................................................................3
DisseminationofInformation........................................................................................................4
InformationandReferral................................................................................................................6
ResourceFacilitationCaseManagement.......................................................................................7
ResourceFacilitationCommunityOutreach.................................................................................12
TBITrainings.................................................................................................................................13
TBIScreenings..............................................................................................................................20
PARTNERTool...............................................................................................................................23
CostofTBIAnalysis......................................................................................................................26
SurveillanceData..........................................................................................................................29
Appendix......................................................................................................................................33
Reportpreparedby:
402.477.5407 [email protected]
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ExecutiveSummaryThepurposeofNebraska’sTBIgrantproject(fundedbytheU.S.DepartmentofHealthandHumanServices)istoincreaseaccesstorehabilitationandotherservicesforindividualswithTraumaticBrainInjury(TBI)andtheirfamiliesbyimplementingactivitiesrelatedtoeachofthefollowingcomponents:1)InformationandReferralServices;2)ProfessionalWorkforceDevelopmentTrainings;3)ScreeningforTBI;and4)ResourceFacilitation.Activitiesfromyear2(June2015-May2016)aresummarizedbelow.DisseminationofInformation
• 11,712lettersweredeliveredtoindividualsontheTBIRegistry.• 12,177hitstotheNebraskaBrainInjuryAdvisoryCouncilWebsite(thisnumberalsoincludes
hitstotheAssistiveTechnologyPartnershipsofNebraska).• NumerousmaterialsdistributedattheAnnualBrainInjuryConference.• 10informationcampaignsconductedthroughConstantContactwith231to243recipientsfor
eachcampaign.InformationandReferral
• 377TBI-relatedcallsfrom131individualswerefieldedbytheBrainInjuryAllianceofNebraska.• 40informationandreferralserviceswereprovidedtoindividuals(someduplication)by
DisabilityRightsNebraska.• 27informationandreferralserviceswereprovidedtoindividualsbyHotlineforDisabilities.
ResourceFacilitationCaseManagement
• DesignedprograminYear1.• Providedinformation/intakeandreferralservicesto18individuals,someofwhomwillmove
intocasemanagement.• Providedcasemanagementservicesto14individuals,11ofwhosecasesstillremainopen.
ResourceFacilitationCommunityOutreach
• 209outreachactivitieswereconductedbyResourceFacilitators,withanestimatedreachof3,870individuals.
TBITrainings
• Atotalof222individualsreceivedtrainingfromoneoffiveTBItrainingsthatwereoffered.• Trainingparticipantsfromallfivetrainingsgavepositivefeedback,indicatinganincreasein
knowledgeinareassuchasTBIprevention,causes,and/orrecovery;waystoidentifyaTBI;andwaystoserveindividualswithaTBI;amongotherareas.
TBIScreenings
• Atotalof558elderlyadultsinruralNebraskawerescreenedbyAAAcoordinators,86ofwhomhadapositivescreenforbraininjury.Ofthe86withpositivescreensforabraininjury,75werepreviouslyundiagnosedwithabraininjury.
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PARTNERTool• ThePARTNERToolwasrepeatedin2015tomeasurethecollaborationofkeystakeholdersand
partnersaroundTBIinNebraska.• Thelevelsofperceivedtrust,value,power/influence,andotherindicatorsremained
consistentlystrongfrom2014to2015,indicatingthecontinuationofcollaborativestrength.CostofTBIAnalysis
• UsingaCDCtoolknownasWISQARS,theestimatedmedicalandworklosscostsduetoTBIsinNebraskain2013wasdeterminedtobeover$800million.Notethatmanyofthesecostsaresustainedovermultipleyears,especiallyworklosscosts.
• The15-19and20-24year-oldagegroupshadthehighestcostsduetoTBIinthestate,duetothehighnumbersofinjuriesandthehighaverageworklosscostsfortheseagegroups.
SurveillanceData
• Deaths,hospitalizations,emergencydepartmentvisits,andTBIRegistrydatacontinuetobemonitored.
• TherateofdeathsduetoTBIhasremainedrelativelystable,whiletheratesofhospitalizationsandemergencydepartmentvisitsduetoTBIhaveincreasedsubstantiallysince2000.
• SurvivorsofaTBIareplacedonaregistry.FromJanuary2015throughSeptember2015therewere9,733newcasesintheTBIregistry.Therewereonaverage1,081newcasesofTBIpermonthduringthisnine-monthperiod.
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NEBRASKA’STBIIMPLEMENTATIONPARTNERSHIPGRANTYEAR2EVALUATIONREPORT
(June1,2015throughMay31,2016)June2016
ProjectPurposeThepurposeofNebraska’sTBIgrantproject(fundedbytheU.S.DepartmentofHealthandHumanServices)istoincreaseaccesstorehabilitationandotherservicesforindividualswithTraumaticBrainInjury(TBI)andtheirfamiliesbyprovidinginformationandreferral,professionaltraining,TBIscreeningandresourcefacilitationservices.The$1,000,000four-yeargrantwasawardedtoNebraskaVRinJuneof2014.Thetargetpopulationidentifiedfortheproject’sstrategiesischildren,youth(includingstudentathletesatriskforconcussion)andtheelderlywhoexperienceTBIorareatriskforTBI.KeriBennett,withNebraskaVRistheprojectdirector.
GrantObjectivesTheTBIimplementationgrantprojectfocusesonfivecoreareaswhichprovidesthebasisforthegrantobjectives:1. Enhanceandexpandexistinginformationandreferralservicestoreachchildren,youthandelderly
withTBI,theirfamilymembersandtheprofessionals,serviceproviders,andagencystaffwhoservethem,providingeducationalresourcesandreferraltoappropriateservicesandsupportsasrequested.
2. Providetrainingtokeyprofessionals,serviceprovidersandagencystaffservingchildren,youthandtheelderlyonthepotentiallong-termcognitive,physical,emotionalandbehavioraleffectsofTBI(includingconcussionormildTBI),andresultingimplicationsforhousing,work,andcommunityliving.
3. Teachprofessionals,serviceprovidersandagencystaffservingchildren,youthandtheelderlytoimplementsimplemethodstoscreenindividualsforTBIatthepointofprogrameligibilityandserviceneedsplanning.
4. Developasustainablemodeltoimplementresourcefacilitationforthechildren,youth,andelderlywithTBIandtheirfamilymemberswhorequireassistanceinnavigatingcomplexservicesystemstomeettheirneedsandachievetheirgoals.
5. Developaplanandidentifypotentiallong-termfundingsourcesforsustainingkeyTBIserviceinfrastructureelementsbeyondgrantfunding,withafocusonthetargetedpopulationsofchildren,youth,andtheelderlywithTBI.
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DisseminationofInformationThedisseminationofinformationconductedbytheNEVRTBIprogramisorganizedunderthreemainheadings:NebraskaBrainInjuryRegistryLetters,NebraskaBrainInjuryAdvisoryCouncilWebsite,andMaterialsDistributedattheBrainInjuryConference.Figure1containsasummaryoftheinformationdisseminatedundereachofthesethreeareas.
Figure1 DisseminationofInformationSummary:June1,2015–May31,2016
NebraskaBrainInjuryRegistryLetters
Ø Registrylettersmailed:12,868Ø Lettersreturnedundeliverable:1,156Ø Totalregistrylettersdelivered:11,712
NebraskaBrainInjuryAdvisoryCouncilWebsite*
Ø 12,177websitehitsØ 6,389uniquevisitors(seefullsummarybelow)
MaterialsDistributedatBrainInjuryConference(March31andApril1,2016)
Ø LashBrainInjuryTipCards-240Ø OnlineTBITrainingCoursepostcards-50Ø ProviderTrainingManuals-25Ø Screeningbrochure/tools-25Ø Registrybrochures-25Ø CDCSeniorFallPreventionbrochures-150Ø TheCostofTBI-25Ø BIRegistryReports-20Ø BIRSSTTeamContactlist-10Ø Councilapplications–resultedinanewBIAdvisory
CouncilmemberfromNorthPlatte.
ConstantContactStatistics
Ø Conducted10distinctinformationcampaignsthroughConstantContactduringthegrantyear.
Ø Therewerebetween231and243recipientsforeachConstantContactcampaignthatwassentout.
*ItappearsthatanalyticsfortheBrainInjuryAdvisoryCouncilwebsitehavebeenlumpedinwithanalyticsfromtheAssistiveTechnologyPartnershipofNebraska.Atthispoint,thereisnothingthatcanbedonetoseparateanalyticsfromthetwosites.
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ChangestotheNebraskaBrainInjuryRegistryLetterTheregistryletterandbrochurewereredesignedinordertoexpandtheinformationandmakethemmoreuserfriendly.Aperforatedsymptomchecklistwasaddedtothebrochure.Itisdesignedtobecompletedanddiscussedwithaphysician.ResourcesandtrainingforhealthcareprofessionalsandalinktotheAffordableHealthCareActarenowlisted.AlogoforPartnersforBrainInjurywasdesignedtodepicttheregistrypartnershipofNebraskaDepartmentofHealthandHumanServices,theBrainInjuryAdvisoryCouncil,andtheBrainInjuryAllianceofNebraska.MaterialsweretranslatedandprintedinSpanishwithotherlanguagesavailableuponrequest.Brochuresweredistributedattheannualbraininjuryconference,toNebraskaVRstaff,braininjurysupportgroups,andothers.Atotalof11,712lettersweredeliveredduringthegrantyear(June1,2015throughMay31,2016)toindividualswhoenteredthebraininjuryregistry.NebraskaBrainInjuryAdvisoryCouncilWebsiteAnalyticsAnalyticsfortheNebraskaBrainInjuryAdvisoryCouncilWebsitearelimitedduetothefactthatthatanalyticsfromtheAssistiveTechnologyPartnershipofNebraskahavebeencombined,andareunabletobeseparatedatthistime.Nevertheless,keyhighlights(forbothsitescombined)include12,177hitsfrom6,389uniquevisitors(Figure2).
Figure2 AnalyticsfortheNebraskaBrainInjuryAdvisoryWebsite*(June1,2015–May31,2016)
Websitehits: Ø 12,177Uniquevisitors Ø 6,389
Newusers: Ø 6,041(49.6%)Averagesessionduration: Ø 3:28
Averagenumberofpagespersession: Ø 2.8Bouncerate(Percentagewhonavigate
awayafterviewingonlyonepage): Ø 49.3%
Channels(howvisitorscametothesite):
Ø Direct:42.6%Ø Organicsearch:34.4%Ø Referral:21.5%Ø Socialmedia:1.4%
*ItappearsthatanalyticsfortheBrainInjuryAdvisoryCouncilwebsitehavebeenlumpedinwithanalyticsfromtheAssistiveTechnologyPartnershipofNebraska.Atthistime,thereisnothingthatcanbedonetoseparateanalyticsfromthetwosites.
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InformationandReferralInformationandreferralservicesforsurvivorsofTBIareconductedbythreeorganizations:TheBrainInjuryAllianceofNebraska(BIA),DisabilityRightsNebraska,andHotlineforDisabilities.Betweenthesethreeorganizations,404informationandreferralserviceswereconductedduringthegrantyear(notethatduplicationoccurs–someindividualsreceivemultipleinformationandreferralservices)(Figure3).
Figure3 InformationandReferralSummary:June1,2015–May31,2016
BrainInjuryAlliance(BIA)ResourceFacilitationInformationandReferral(formerlyknownasTBIOmbudsperson)
Ø Received377callsrelatedtoTBIfrom131individuals
(survivors,familymembers,professionals,andothers)Ø 289(76.7%)ofallcallsresultedinalinkagetoa
resource
DisabilityRightsNebraska
Ø Conducted40informationandreferralservicesfor
individualswithaTBI(someduplicationoccurs).
HotlineforDisabilities
Ø Conducted27informationandreferralservicesfor
individualswithaTBI.
Total Ø 404informationandreferralserviceswereconductedinthisgrantyear
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ResourceFacilitationCaseManagementResourceFacilitationCaseManagementconductedbytheBrainInjuryAllianceofNebraska(BIA)involvesclose,potentiallylong-term,one-on-oneinteractionbetweenabraininjurysurvivorandaresourcefacilitator.TheResourceFacilitatorassiststhesurvivorinnavigatingresourcesintheircommunity,evaluatingprogresswiththesurvivorandfamily/caregivers,andsettingandachievinggoals.Atthistime,resourcefacilitationservicesareopentoallsurvivorsofbraininjuryintheLincolnandOmahaareas.AtthebeginningofYear1,thereweretwoResourceFacilitators(oneservingtheLincolnarea,theotherservingtheOmahaarea).TheindividualservingtheLincolnarearesignedfromherpositionmid-waythroughtheyear.MovingintoYear2,twonewResourceFacilitatorshavebeenhiredtoserveLincolnandOmaha.TheindividualformerlyservingOmahawillmoveintoanewrolefocusingmoreonmanagerialdutiesandcommunityoutreachefforts,whilestillstayinginvolvedasaResourceFacilitator.Inaddition,GinaSimanekcontinuestocoordinateallstatewideinformationandreferralactivitiesfortheBIA(herworkisdocumentedinthesectiondirectlyabove).GinaanswersthebulkofthecallscomingintotheBIAandprovidesreferralstotheresourcefacilitatorswhenthesituationcallsforit.InYear1,aftergettingtheprogramofResourceFacilitationCaseManagementdesigned,thetwoResourceFacilitatorsprovidedinformation/intakeandreferralservicesto18individuals(someofwhomwilleventuallymoveintocasemanagement),andcasemanagementservicesto14individuals(11ofwhomstillhaveopencasesatthetimeofthisreport)(Figure4).
Figure4 ResourceFacilitation:Year1Summary
Information/IntakeandReferral:Ø 18(someofthesewill
moveintocasemanagement)
CaseManagement Ø 14(11casesremainopenatthistime)
ClientDemographicsFigures5through9presentdemographicinformationofcasemanagementclients.
Figure5 AgeofCaseManagementClients(n=12)
0-12 13-18 19-26 27-40 41-50 51-64 65-74 75+ Average Missing/Unknown
1 0 3 2 2 1 3 0 41.7 2
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Figure7 CauseofInjurytoCaseManagementClients(n=14)
Caraccidents/struckbyacar 3Caraccidentsandassault 1Fall 2Gunshotwound 2ArterialVascularMalformation(AVM) 1Bombblast 1Surgeries 1Meningitis/Encephalitis 1Accidents/incidents(unspecific) 2
TBI,8MultipleTBI,2
ABI,1
MultipleABIs,1
TBI(Concussion),2
Figure4.TypeofInjuryforCaseManagementClients(n=14)
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Figure9AdditionalDemographicsofCaseManagementClients(n=14)
Ø Gender:Male–8,Female–6Ø Veterans:3Ø Employmentstatus
o Currentlyemployed:1o Currentlyunemployed:4o Retired/disability/notapplicable:9
Ø Locationo Lincoln/LancasterCounty:4o OmahaMetroArea:10
ClientNeedsDataonclientneedshasbeenprovidedfor14casemanagementclients.Belowisasummaryoftheneedsidentifiedbytheseclients.Onaverageeachcasemanagementclienthashad6.7distinctneeds(Figure10).
Figure10 CaseManagementClientNeeds(n=14)Housingassistance 7Neurobehavioralneeds 7Educationandemployment 7Socialsupport 7Transportation 5In-home/ADLsassistance 5
Alone,3
Family/friends,10
Institution,1
Figure8.LivingArrangementofCaseManagementClients(n=14)
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Medicalspecialist(rehabdoctors,neurologist,psych) 5
Coping 5Concussion/MTBIevaluations 4Mentalhealthservices 4Legalservices 4Other 4Food 3Financialassistance/information 3Sleep 3AgingafterBI 3Alternativetherapies 2Vision 2Fatigue 2Substanceabuse 2Violence/angermanagement 2Clothing 1Insurance 1Coma/disordersofconsciousness(DOC) 1Seizures 1BIResearch 1Statistics 1Pediatric/schoolsupport 1Assistivetechnology 1Averagenumberofneedsperclient 6.7
TheMayo-PortlandAdaptabilityInventoryTheMayo-PortlandAdaptabilityInventory(“shortversion”)isatoolusedtoascertainneedsofindividualswhohavesufferedabraininjury.Thetoolmeasuresself-care,residence,transportation,employment,andotherbasicneeds.Thistoolisbeingusedasapre-postassessmentwithcasemanagementclients.ThehopeisthatimprovementwillbeseeninsomeareasafterworkingwithaResourceFacilitator.Todate,eight“pre”Mayo-PortlandAdaptabilityInventorieshavebeencollected.Nopost-datahavebeencollectedyet.The“short-version”oftheMayo-Portlandincludeseightinventoryitemswithaminimumscoreof0andmaximumof30.ThelowerthescoreontheMayo-Portland,thegreatertheindependence,andthelesserinterferencefrominjuries,foranindividualwithaTBI.Theaverage,healthyadult,wouldlikelyhaveascoreofzeroornearzero.
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Figure11presentstherangeofMayo-Portlandpre-scores.Theaveragepre-scorefortheeightindividualswhohaveparticipatedintheinventoryis17.3,substantiatingthevarietyofindividualneedsofthecurrentcasemanagementprofile.
Figure11 Mayo-PortlandAdaptabilityInventoryScores(n=8) 0-5 6-10 11-15 16-20 21-25 26-30 Average
Pre 0 1 2 3 2 0 17.3
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ResourceFacilitationCommunityOutreachInadditiontoofferinginformationandreferralservicesandcasemanagement,theBrainInjuryAllianceofNebraska(BIA),alsoconductscommunityoutreachtopromoteandraiseawarenessfortheResourceFacilitationprogram.Duringthisgrantyear(June2015throughMay2016),theBIAconducted209outreachactivitieswithanestimatedreachof3,870individuals.FurtherinformationaboutthenatureofthesecommunityoutreachactivitiesiscontainedbelowinFigures12and13.
Otherincludeshostingbooths,interviews,specialevents,eventplanning,orientation,networking,andotheractivities
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44
4
23
87
40
Training(attendedbyRF)
Communitymeeting(attendedbyRF)
Communityoutreach/training(givenbyRF)
Presentation- Education
Informationexchange(betweenRFandanindividualor…
Other
Figure12.ResourceFacilitationCommunityOutreachActivity(June'15- May'16)
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169
23
10
1
Presenting
Attending
Facilitating
Coordinating
Training
Figure13.BIAMember'sRoleinCommunityOutreachActivities(June'15- May'16)
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TBITrainingsAtotaloffiveTBItrainingswereofferedthisgrantyeartoabroadarrayofprofessionals,individuals,andfamilymembers.ThesetrainingsfocusedonvarioustopicsrelatedtoTBIsuchasTBIprevention,causesandrecovery;servicesforsurvivorsofaTBI;andhowtoassistTBIsurvivors;amongnumerousothertopics.ThedatesandparticipantsofthesefivetrainingsaredetailedbelowinFigure14.Figure14 TBITrainings:DatesandParticipants
Date(s) ParticipantDescription NumberofParticipants
OnlineTBIModules OngoingVariousprofessionalsandfamilymembersservingindividualswithTBI
25(unique)Introtraining:14
Pediatrictraining:5Adulttraining:12
Substancetraining:4
BrainInjuryRegionalSchoolSupportTeams(BIRSST)Symposium
February2016
Primarilyschool-basedprofessionals(schoolnurses,athleticdirectors,athletictrainers,counselors,psychologists,etc.),aswellasahandfulofcommunity-basedserviceproviders
76
OllieWebbCenterTBITraining March2016
Directsupportstaff(jobcoaches,DDprofessionals,educators,etc.)andmanagement
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GetSchooledinConcussions(BIRSST-sponsored) April2016
Schoolstaff,includingathletictrainers,counselors,nurses,principals,andothers
36
NebraskaAssociationofServiceProviders(NASP)TBITrainings(fouridenticaltrainings)
May2016
Directsupportstaff,licensedmentalhealthcounselors,nursingstaff,socialworkers,andnumerousotherserviceprovidertypes
71
Total - - 222
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AdditionalTrainingActivitiesChallengingBehaviorandExecutiveFunctionSixBIRSSTmembersandtheBrainInjuryAdvisoryCouncil’sSpecialEducationrepresentativeattendedtrainingon"ChallengingBehaviorandExecutiveFunction"inColorado,andaresharingwhattheylearnedbydeveloping20-30minutetrainingmodulesforNebraska’sBIRSSTmembersandclassroomteachers."CollaborationwithDHHSInjuryPreventiononHealthcareProviderTrainingModulesNebraskaVRhassupportedtheworkoftheDHHSInjuryPreventionProgramanditspartnerstocreateonlinemodulesforhealthcareprofessionalsonthetopicofconcussions.TheDHHSInjuryPreventionProgramhasdevisedatotalofninemodulesdealingwithvariousaspectsofconcussions,includingidentification,recovery,compliancewithstatelaw,andotherareas,focusingprimaryontheyouthpopulationandsports-relatedconcussions.NebraskaVRsupportedtheworkofModules4,5,and6.Thesethreemoduleswerecompletedduringthisgrantyearandarescheduledtobeofferedtohealthcareprofessionalsinthecomingyear.Post-TrainingEvaluationSurveyResultsPost-trainingevaluationsurveyresultsaredisplayedinFigures15through21belowforallfivetrainingsconductedinthisgrantyear.Ingeneral,grant-fundedtrainingsuseastandardpost-trainingevaluationsurvey.However,duetothenatureandobjectivesofsometrainings,certainitemsonthestandardizedsurveyarenotusedwitheverytraining.Thefiguresbelowshowtheresultsfromeachsurveyitemonthestandardizedsurveybytraining.Ifatrainingisleftofffromafigure,thisisbecausethesurveyitemwasnotapplicabletothattraining.Seetheappendixforaversionofthestandardpost-trainingevaluationsurvey.Thepost-trainingevaluationsurveyshadverypositiveresults.Examplesofsomeofthemanypositivehighlightsfromthecombinedtotalofalltrainingsinclude96.7%oftrainingparticipantsreportingthattheirknowledgeofTBIprevention,causes,and/orrecoveryincreasedasaresultofthetraining(Figure15),99.4%reportingthattheirknowledgeofwaystheycanidentifyindividualsthathaveaTBIandmeettheirneedsincreasedasaresultofthetraining(Figure18),and98.5%reportedbeingsatisfiedorverysatisfiedwiththetraining(Figure21).
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100%94.4% 97.1% 96.7%
OllieWebbCenterTBITraining(n=14)
GetSchooledinConcussions(n=36)
NASPTBITrainings(n=70) Total(n=120)
Figure15.KnowledgeofTBIprevention,causes,and/orrecoveryincreasedasaresultoftraining
100%
92.9%88.9%
97.1% 95.5%
BIRSSTSymposium(n=37)
OllieWebbCenterTBITraining(n=14)
GetSchooledinConcussions(n=36)
NASPTBITrainings(n=70)
Total(n=157)
Figure16.KnowledgeofwaysaTBIcanbedetectedincreasedasaresultofthetraining
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92.3%97.2% 97.1% 96.6%
OllieWebbCenterTBITraining(n=13)
GetSchooledinConcussions(n=36)
NASPTBITrainings(n=70) Total(n=119)
Figure17.Knowledgeofservicesand/orprovidersthatmaybeabletohelpwithrecoveryafterTBIincreasedasaresultofthetraining
100% 100%97.2%
100% 99.4%
BIRSSTSymposium(n=45)
OllieWebbCenterTBITraining(n=14)
GetSchooledinConcussions(n=36)
NASPTBITrainings(n=70)
Total(n=165)
Figure18.KnowledgeofwaystheycanidentifyindiviualsthathaveaTBIandmeettheirneedsrelativetotheirpractice,and/orrefer
elsewhereincreasedasaresultofthetraining
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Figure20 AmongthoseanticipatingthattheywillbemoreabletoassistindividualswithTBI,etc.(seeFigure19directlyabove),reportedwaysinwhichtheywillbebetterabletoservethem
OllieWebbCenterTBITraining(n=13)
GetSchooledinConcussions
(n=35)
NASPTBITrainings(n=67)
Total(n=115)
Ihaveinformationtoprovidetoindividuals/familiesaboutTBI
69.2% 85.7% 83.6% 82.6%
Ihaveinformationtoprovidetoindividuals/familiesaboutlocalresources/services
53.8% 48.6% 80.6% 67.8%
IcanmoreeasilyrecognizesymptomsofTBI 69.2% 51.4% 71.6% 65.2%
IcanbetterinteractwithindividualswithTBIinthecourseofmywork
76.9% 68.6% 74.6% 73.0%
IknowwhattodowhenIencounteranindividualwithTBIinmywork
69.2% 57.1% 68.7% 65.2%
94.4% 92.9%97.2% 95.7% 95.7%
OnlineTBIModules(n=18)
OllieWebbCenterTBITraining(n=14)
GetSchooledinConcussions(n=36)
NASPTBITrainings(n=70)
Total(n=138)
Figure19.Asaresultofthistraining,theyanticpatebeingmoreabletoassistindividualswithTBIandtheirfamiliesinaccessingthe
servicestheyneed
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NebraskaAssociationofServiceProviders(NASP)TBIProjectTheNASPTBITrainings(includedintheabovepost-trainingevaluationsurveyresults)werepartofalargerprojectdirectedtowardscommunity-basedproviderswhoserveindividualswithbraininjury.Thisprojectisdescribedinmoredetailbelow.Purpose:Thepurposeoftheprojectwastobuildcapacityamongdevelopmentaldisabilityserviceproviderstoserveindividualswithbraininjury.Capacityincludesawarenessofneed,knowledgeoffundingstreams,trainingonserviceprovision,andadvocacyforMedicaidwaiversupport.ActivitiesCompleted:Activitiescompletedincludedastakeholdersmeetingtoanalyzeawarenessandneed,collectionandsummaryofdata,developmentandexecutionoffourtrainings,andmeetingsleadingtorecommendationsregardingMedicaidwaiverredesigntobetterserveindividualswithbraininjury.Outcomes:OutcomesincludedcompletionofinformationalmemosformembersoftheNebraskaAssociationofServiceProviders,asummaryofrecommendationsforMedicaidwaiverredesign,completionoftrainingstatewide,andthedevelopmentofaresourcetoolkitfordevelopmentaldisabilityserviceproviders.Conclusions:Severalconclusionscanbedrawnfromthisproject.First,thereisadisconnectbetweentheneedordemandforservicesforindividualswithbraininjuryandagenciesthatcanprovideservicesandtheopportunitiesforfundingfortheservices.Second,relationshipsmustbedevelopedbetween
94.9%98.4% 100% 100% 98.6% 98.5%
OnlineTBIModules(n=18)
BIRSSTSymposium(n=62)
OllieWebbCenterTBITraining
(n=14)
GetSchooledinConcussions
(n=36)
NASPTBITrainings(n=69)
Total(n=199)
Figure21.Satisfiedorverysatisfiedwiththetraining*
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servicecoordinatorsfortheAgedandDisabledWaiver,resourcecoordinators,anddevelopmentaldisabilityserviceproviders.Third,developmentaldisabilityserviceprovidershavesome,butnotall,ofthecapacitiesandskillsetsneededtoserveindividualswithbraininjury.NextSteps:Torespondtolessonslearned,severalnextstepsaresuggested.First,tobetterunderstandthedisconnectbetweenthedemandforservicesandfundingandserviceproviders,moredataanalysisshouldbecompleted.DevelopmentaldisabilityserviceproviderscouldbeprovidedwithcapacitybuildingfundingtodeveloprelationshipsandsetupthesystemsneededtobecomeAgedandDisabledWaiverproviders.Second,pilotprojectscouldbedevelopedtodirectindividualswithbraininjuryidentifiedbyresourcecoordinatorstotargeteddisabilityserviceproviders.Third,individualizedstaffdevelopmentcouldbedevelopedtofilltheorganizationalgapsfordisabilityserviceproviderstoserveindividualswithbraininjury.Additionaltrainingcouldbeprovided.Finally,additionalworktoidentifycommunitybasedservicesavailableundertheAgedandDisabledWaivercouldprovidemorecommunitybasedsupportsforindividualswithbraininjury.
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TBIScreeningsScreeningandIdentificationofElderlyIndividualswithBrainInjurythroughtheAreaAgencyonAginginRuralNebraskaPurposeThescreeningprojectfocusedontheneedforroutinebraininjury(BI)screeningsforahigh-riskagegroup,those65yearsandover.Theresearchersutilizedascreeningtoolwithelderlyindividualsinarurallocation.DatawascollectedfromservicecoordinatorsemployedbytheAreaAgencyonAgingatthreelocationsinruralNebraska:NorthPlatte,Scottsbluff,andKearney.Theresearchersprovidededucationaboutbraininjuryandmeasuredtheeffectivenessoftheeducationwithatrue/falsepre-andpost-survey;trainedtheservicecoordinatorstoadministeraspecificbraininjuryscreeningtool(theOSU-TBI,seetheAppendixforthetool);interviewedafocusgroupofservicecoordinatorsabouttheeffectivenessofthetrainingandtheirfeelingsofpreparednessinusingthescreeningtool.Theservicecoordinatorsthenadministeredthescreeningtoolandtheresearchersacquireddataregardingthenumberofpositivebraininjuryscreensattainedbythem.Finally,theresearchersconductedafollow-upinterviewwithservicecoordinatorsapproximately3-4monthsaftertheeducational/trainingsessionregardinginformationabouttheirperceptions,preparedness,anduseofthescreeningtoolwithclients.ParticipantsThereweretwogroupsofparticipantsforthisstudy.GroupAconsistedof24servicecoordinatorsemployedbyanAreaAgencyonAgingatthreelocations.Theseparticipantswererecruitedforthisprojectbecauseoftheiremploymentresponsibilitiesthatincludedevaluatingelderlyindividualsforhealthcareservices.GroupBconsistedofclientsseekingservicesthroughtheAreaAgencyonAging(N=558,43%male).TheywerescreenedforbraininjurybyGroupAwiththeOSUTBI-IDscreeningtoolandtheirresultswereenteredintoade-identifieddatabase.Results:ServiceCoordinators(GroupA)Preliminaryanalysisofthepre-posttestsindicatedthatGroupAparticipants(N=24)increasedtheirknowledgeofbraininjuryintheareasofrecoveryprocess,BIsequelae,anddisordersofconsciousness.TheresearchersaskedGroupAfollow-upquestionsregarding:1)educationalsessiononbraininjury;2)previoustrainingsessiononuseofscreeningtool;3)screeningprocesswithclientswiththebraininjuryscreeningtool.Thefollowingthemesemergedfromtheinterviews.Caseworkers…1)learnedmoreabouttheirclientsthroughthescreeningprocess;2)statedadjustmentstheywouldmaketothescreeningformforeaseofadministrationanddatacollection;3)describedthehelpfulnessofeducationandtrainingsessionsonbraininjuryandscreeningtool;4)describedtheirlackofpriortrainingonbraininjuryandpositiveeffectsofthistraining;5)expressedenthusiasmforthescreeningtool’sfitwiththeirexisting
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screening/intakeprocedures;and6)expressedadesiretoknowabouttreatmentoptionsandreferralprocesstospeechlanguagepathologiststoprovidemorecompleteservicesforclients.Results:ScreeningData(GroupB)Atotalof558elderlyadultswerescreenedbytheAAAservicecoordinators.Ofthese,86(15%)hadapositivescreenforbraininjury(BI)(Figure22).
Figure22 BrainInjury(BI)ScreeningResults
TotalNumberScreened
HaveInjuriesPotentiallyCausingaBI
PositiveScreenforBI
Number 558 201 86PercentageofTotal - 36% 15%
Amongthosewithpositivescreens,thevastmajority(87%)hadbeenpreviouslyundiagnosedwithBI(Figure23).
Figure23 UndiagnosedBrainInjuries(BI)(amongthosewithpositivescreens)
PositiveScreenforBI
PreviouslyUndiagnosedwith
BINumber 86 75Percentage - 87%
Amongthosewithpositivescreens,22%hadtwobraininjuriesand15%hadthreeormorebraininjuries(Figure24).
Figure24 NumberofBrainInjuries(amongthosewithpositivescreens)(n=86)
1injury 2injuries 3ormoreinjuries63% 22% 15%
Amongthosewithpositivescreens,36%wereage65oroveratthetimewhenthebraininjuryoccurred(Figure25).
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Figure25 AgeatTimeofBrainInjury(amongthosewithpositivescreens)(n=86)
0-4 5-14 15-24 25-44 45-64 65+5% 10% 19% 19% 12% 36%
Amongthosewithpositivescreens,themajority(75%)wereidentifiedashavingamildbraininjury(Figure26).
Figure26 SeverityofBrainInjury(amongthosewithpositivescreens)(n=86)
Mild Moderate Severe75% 20% 5%
Themajority(66%)ofthosewithapositivescreenreportedatleastsomelossofconsciousness(Figure27).
Figure27 LossofConsciousness(amongthosewithpositivescreens)(n=86)
NoLossofConsciousness
LossofConsciousnessfor
LessThan30Minutes
LossofConsciousnessfor30Minutesto24
Hours
LossofConsciousnessforMoreThan24
Hours34% 41% 20% 5%
EarlyChildhoodBrainInjuryScreeningsThreeEarlyChildhoodPlanningRegionTeamsbeganusingtheSAFEChildScreenforBirththrough2years(developedunderapreviousTBIgrant)withchildrenbeingscreenedforIndividualswithDisabilitiesAct(IDEA)PartC(birththroughage-2)servicesfromMay15throughAugust15thandaredocumentingthenumberofscreensadministeredandthenumberofpositivescreens.ThisdatawillbereportedafterAugust15,2016andwillbeincludedinnextyear’sAnnualTBIGrantreport.Thecompletedscreenformwillbeplacedineachchild’seducationalfileregardlessoftheoutcomeofthescreen.AllSAFEChildscreenforms(Birth–2Years;Ages3-Kindergarten;Grades1–5andSAFEStudent–MiddleandHighSchool)havebeentranslatedtoSpanishandVietnamesealongwiththeParentBrochuresforfamiliesofscreenedchildrenaged0throughhighschool.”
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PARTNERToolOneoftheaimsoftheTBIprojectistoincreasethecollaborationamongthekeystakeholdersorpartners.Partnershipsareanimportantelementforreachingtheoutcomesoftheproject.Asameasureofthelevelofcollaborationandeffectivenessofthepartnerships,thePARTNERtoolwasselectedtobeadministeredtokeypartnerseveryyearaspartofthegrantevaluation.ThePARTNERtoolhasbeenconductedtwice(December2014andDecember2015)with13projectpartners.Followingaresomekeyhighlightsfrombothyearsofadministration.Ingeneral,itcanbeconcludedthatthestrengthofthecollaborationhasremainedconsistentacross2014and2015(Figure28).Figure28 PARTNERToolSummary
2014 2015Collaborationhasbeensuccessfulorverysuccessfulatreachingitsgoals
7outof10(3noresponses) 10outof13
Topthreeaspectscontributingtothesuccessofthecollaboration
1. Havingasharedmission,goals
1. (tied)Exchanginginfo/knowledge
3. Bringtogetherdiversestakeholders
1. Exchanginginfo/knowledge
2. Bringingtogetherdiversestakeholders
2. (tied)Informalrelationshipscreated
Topthreemembercontributionstothecollaboration1. Info/feedback1. (tied)Community
connections3. Paidstaff
1. Info/feedback2. Community
connections2. (tied)Advocacy
Topthreeoutcomesofthecollaborativework
1. Publicawareness2. Improved
communication2. (tied)Increased
professionalTBIknowledge
1. Improvedcommunication
1. (tied)Publicawareness
1. (tied)Improvedresourcesharing
Densityscore(percentageoftiesinthenetworkinrelationtothetotalnumberofpossibleties) 65% 63%
Degreecentralizationscore(thelowerthescorethemoresimilarthemembersareintermsoftheirconnectionstoothers–i.e.,moredecentralized)
41% 44%
Trustscore(100%occurswhenallmemberstrustothersatthehighestlevel) 85% 84%
Value
(Scale:1
-4) OverallValueScore 3.28 3.33
Power/influencevaluemeasure 3.14 3.34Levelofinvolvementvaluemeasure 3.45 3.30Resourcecontributionvaluemeasure 3.24 3.35
Trust
(Scale:1
-4) OverallTrustScore 3.57 3.55
Reliabilitytrustmeasure 3.70 3.66Insupportofmissiontrustmeasure 3.43 3.42Opentodiscussiontrustmeasure 3.58 3.58
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NetworkMapsfromthePARTNERToolFigures29and30showthenetworkmapsfromthe2014and2015PARTNERTooladministrations.EachlinerepresentsanetworkbetweentwodifferentorganizationscollaboratingaroundtheissueofTBI.Morelinesindicatemorecollaboration.Therearethreelevelsofcollaboration:
• CooperativeActivities:involvesexchanginginformation,attendingmeetingstogether,andofferingresourcestopartners.Example:InformsotherprogramsofRFArelease.
• CoordinatedActivities:includescooperativeactivitiesinadditiontointentionaleffortstoenhanceeachother'scapacityforthemutualbenefitofprograms.Example:Separategrantingprogramsutilizingsharedadministrativeprocessesandformsforapplicationreviewandselection.
• IntegratedActivities:inadditiontocooperativeandcoordinatedactivities,thisistheactofusingcommonalitiestocreateaunifiedcenterofknowledgeandprogrammingthatsupportsworkinrelatedcontentareas.Example:Developingandutilizingsharedprioritiesforfundingeffectivepreventionstrategies.Fundingpoolsmaybecombined.
Figure29.2014NetworkMap
All(100%) CooperativeOnly(49%)
CoordinatedOnly(30%) IntegratedOnly(14%)
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Figure30.2015NetworkMapAll(100%) CooperativeOnly(48.1%)
CoordinatedOnly(21.52%) IntegratedOnly(21.52%)
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CostofTBIAnalysisTheWeb-basedInjuryStatisticsQueryandReportingSystem(WISQARS)isaprojectoftheCentersforDiseaseControlandPrevention(CDC).WISQARSprovidesvaluableinformationonthetopicofinjuryintheUnitedStatesintheformofdatareportsandquerysystems.TheCostofInjuryReportsapplicationwasusedinthistodeterminethecosts(bothmedicalandworkloss)associatedwithtraumaticbraininjury(TBI)inNebraskain2013.TheCostofInjuryReportsApplicationprovidesanaverageestimatedcostforaTBIbyageandgender.ThedatainthissectionrepresentthecostsforTBIsthatweresustainedin2013.Thecostspresentedinthisreportshouldnotbeunderstoodasbeingaccruedentirelyin2013.BothmedicalandworklosscostsassociatedwithTBImayextendthroughoutanindividual’slifetime.InthetragicincidenceofadeathduetoTBI,theaverageworklosscostscanextendbeyondamilliondollars.Furthermore,worklosscostsarecalculatedastheamountofworklostbyanindividualwhosustainedaTBI.TheworklosscostsdonotincludetheworklossacquiredbyparentsandcaregiversofTBIsurvivors.Formoreinformation,seethefullreport,availablebycontactingKeriBennett([email protected]).Figure31presentsthetotalnumberofemergencydepartmentvisits,hospitalizations,anddeathsduetoTBIinNebraskain2013.Basedonageandgenderbreakdownsofthesedata,atotalcost(includingbothmedicalandworklosscosts)ofTBIsinNebraskaoccurringin2013wasdeterminedtobeover$800million.Totalscostsarealsobrokendownbygenderandageinsubsequenttablesinthissection(Figures31through36).
Figure31 Emergencydepartmentvisits,hospitalizations,anddeathsduetoTBIinNebraska(2013)
EDVisits Hospitalizations Deaths10,672 1,701 344
(Source:NebraskaTBIRegistryandNebraskaVitalStatistics,2013)
Figure32 ThetotalestimatedcostofTBIbyemergencydepartmentvisits,hospitalizations,anddeathsinNebraska(2013)
EDVisits Hospitalizations Deaths TotalMedicalCosts $52,112,808 $144,396,731 $3,991,653 $200,501,192WorkLossCosts $42,440,973 $313,433,021 $245,735,663 $601,609,657TotalCosts $94,553,781 $457,829,752 $249,727,316 $802,110,849
(Source:NebraskaTBIRegistry,2013;NebraskaVitalStatistics,2013;andWISQARSCostofInjuryReports,2013)
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Figure33 ThetotalestimatedcostofTBIbygenderinNebraska(2013)
Male Female Unknown TotalMedicalCosts $124,003,990 $76,483,303 $13,899 $200,501,192WorkLossCosts $468,023,686 $133,570,610 $15,361 $601,609,657TotalCosts $592,027,676 $210,053,913 $29,260 $802,110,849
(Source:NebraskaTBIRegistry,2013;NebraskaVitalStatistics,2013;andWISQARSCostofInjuryReports,2013)
Figure34ThetotalestimatedcostofTBIbyemergencydepartmentvisits,hospitalizations,anddeathsinNebraska(2013)
EDVisits Hospitalizations Deaths TotalMedicalCosts $52,112,808 $144,396,731 $3,991,653 $200,501,192WorkLossCosts $42,440,973 $313,433,021 $245,735,663 $601,609,657TotalCosts $94,553,781 $457,829,752 $249,727,316 $802,110,849
(Source:NebraskaTBIRegistry,2013;NebraskaVitalStatistics,2013;andWISQARSCostofInjuryReports,2013)Figure35 ThetotalestimatedcostofTBIbygenderinNebraska(2013)
Male Female Unknown TotalMedicalCosts $124,003,990 $76,483,303 $13,899 $200,501,192WorkLossCosts $468,023,686 $133,570,610 $15,361 $601,609,657TotalCosts $592,027,676 $210,053,913 $29,260 $802,110,849
(Source:NebraskaTBIRegistry,2013;NebraskaVitalStatistics,2013;andWISQARSCostofInjuryReports,2013)
Figure36 ThetotalestimatedcostofTBIbyageinNebraska(2013)
MedicalCosts WorkLossCosts TotalCosts0to4 $8,608,985 $19,376,743 $27,985,7285to9 $4,483,412 $9,261,424 $13,744,83610to14 $5,175,412 $12,008,411 $17,183,82315to19 $12,888,350 $55,776,947 $68,665,29720to24 $14,718,566 $80,781,016 $95,499,58225to29 $11,265,844 $62,743,240 $74,009,08430to34 $11,028,560 $63,354,373 $74,382,93335to39 $6,548,191 $32,560,928 $39,109,11940to44 $7,941,884 $43,168,884 $51,110,76845to49 $9,960,390 $47,408,984 $57,369,37450to54 $10,796,746 $57,731,808 $68,528,55455to59 $10,511,581 $28,160,101 $38,671,68260to64 $10,878,622 $24,011,898 $34,890,52065to69 $11,760,112 $21,151,736 $32,911,848
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MedicalCosts WorkLossCosts TotalCosts70to74 $9,881,674 $7,949,955 $17,831,62975to79 $15,179,508 $11,298,109 $26,477,61780to84 $14,386,541 $9,660,148 $24,046,689
85andover $24,486,814 $15,204,952 $39,691,766Total $200,501,192 $601,609,657 $802,110,849
(Source:NebraskaTBIRegistry,2013;andWISQARSCostofInjuryReports,2013)
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SurveillanceDataDeaths,Hospitalizations,andEmergencyDepartmentVisitsFigures37through39presentratesofdeath,hospitalization,andemergencydepartmentvisitsduetoTBIfrom2000through2014.TherateofdeathsduetoTBIhasremainedrelativelystable,whiletheratesofhospitalizationsandemergencydepartmentvisitsduetoTBIhaveincreasedsubstantiallysince2000.Asignificantcontributortotheseincreasesinhospitalizationsandemergencydepartmentvisitsmaybeduetotheincreasedawarenessofconcussions.
(Source:NebraskaDeathCertificates,2000-2014)
(Source:NebraskaHospitalDischarge-E-Code,2000-2014)
18
15
2018 18
1718 18
19 1917 17
2018
1718 18
1918 18
0
5
10
15
20
25
Figure37.AgeAdjustedDeathRateDuetoTraumaticBrainInjuryinNebraskaper100,000Population
5245 46
5045 48
5257
6266
78 7988
8177
6368
7579 81
0
25
50
75
100
Figure38.AgeAdjustedHospitalizationRateDuetoTraumaticBrainInjuryinNebraskaper100,000Population
YearlyRates 5-YearAverages
YearlyRates 5-YearAverages
30
(Source:NebraskaHospitalDischarge-E-Code,2000-2014)
TBIRegistrySurvivorsofaTBIareplacedonaregistry.TBIRegistrydataareshownbelowinFigures40through43.FromJanuary2015throughSeptember2015therewere9,733newcasesintheTBIregistry.Therewereonaverage1,081newcasesofTBIpermonthduringthisnine-monthperiod.Notethatthesedataonlycoverapartialyearandarepreliminary.Thoseage15–19werethemostcommonagegroupintheTBIregistryduringthistimeperiod,accountingfor1,092cases.Amongthoseundertheageof45,TBIsaremoreprevalentamongmales.However,amongthoseage45andoverTBIsaremoreprevalentamongfemales.TheleadingcauseofTBIduringthisnine-monthtimeperiodwasfalls,accountingfor47%ofallTBIs.Notethatthefullcalendaryear2015dataarenotyetfinalized.ChangesareoccurringtothewaydataarecollectedduetohospitalsswitchingfromtheICD-9totheICD-10codingsystem.
240 241264 261 251
273
338
394 412
487518 517 529 549 557
430466
493520 534
0
100
200
300
400
500
600
Figure39.AgeAdjustedEmergencyDepartmentVisitRateDuetoConcussionsinNebraskaper100,000Population
YearlyRates 5-YearAverages
31
Figure40.ReportedcasesintheTBIRegistrybymonth,Jan.2005–Sept.2015*
*CountsforthemonthofSeptemberarepreliminary
(Source:NebraskaTBIRegistry,2015)
Figure41.TBIRegistryCasesDistributedbyPatientAge-Group,Jan.2015–Sept.2015
(Source:NebraskaTBIRegistry,2015)
32
Figure42.NumberofTBIRegistryCasesDistributedbyAgeandGender,Jan.2015–Sept.2015
(Source:NebraskaTBIRegistry,2015)
Figure43.TBIRegistryLeadingCausesofInjurybyPercentofCases,Jan.20015–Sept.2015
(Source:NebraskaTBIRegistry,2015)
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Appendix
34
TBIGrant–TrainingQUESTIONS
TrainingEvaluation
Date:_____________ Profession:_____________________________Didyourknowledgeinthefollowingareasincreaseasaresultofthistrainingevent?
1. TBIprevention,causesand/orrecovery ¨Yes ¨No2. WaysaTBIcanbedetected(screeningtools,orwarningsignsthatshould
promptareferralforscreening) ¨Yes ¨No
3. Servicesand/orproviderthatmaybeabletohelpwithrecoveryafterTBI ¨Yes ¨No4. WaysthatI,inmyprofessionalrole,canidentifyindividualsthatmayhave
TBI,meettheirneedsrelativetomypractice,and/orreferthesestudentselsewhereforneededservices
¨Yes ¨No
5. Asaresultoftoday'straining,doyouanticipatebeingmoreabletoassistindividualswithTBIandtheirfamiliesinaccessingtheservicestheyneed?
¨Yes ¨No
6. Ifyouanswered“Yes”toquestion#5,inwhatwaysdoyouthinkyouwillbebetterabletoservethispopulation?Pleasecheckallthatapply.¨ Ihaveinformationtoprovidetoindividuals/familiesaboutTBI¨ Ihaveinformationtoprovidetoindividuals/familiesaboutlocalresources/services¨ IcanmoreeasilyrecognizesymptomsofTBI¨ IcanbetterinteractwithindividualswithTBIinthecourseofmywork¨ IknowwhattodowhenIencounteranindividualwithTBIinmywork
7. Howsatisfiedareyouwithtoday'straining?¨Verysatisfied ¨Satisfied
¨Neithersatisfiednordissatisfied
¨Dissatisfied ¨Verydissatisfied
OPTIONAL:8. Howconfidentdoyoufeelinusingthematerialsandmethodsprovidedattoday'strainingtotrain
someoneelse?¨Veryconfident ¨Confident
¨Neutral
¨Notconfident ¨Notconfidentatall
9. Aftertoday'straining,howconfidentdoyoufeelinassistingindividualswithTBI?¨Veryconfident ¨Confident
¨Neutral
¨Notconfident ¨Notconfidentatall
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