The Governor's Task Force on Traumatic Brain Injury

Meeting of August 22, 2002

A. Introduction
Review Discuss Task Force Report Outline
B. Subcommittee minutes
Registry and surveillance
Advisory Board / Trust Fund Financing Sources
Coordinated State Response
C. Next Meeting and Notes

The fourth meeting of the Oregon Brain Injury Task Force was called to order at 12:35pm on August 22 in the Department of Education Building, Room 251 A, in Salem by Bill Olson.

Task Force Members:
Bryan Andresen, Rep.Vic Backlund, Mary Bunch, Kris Kennedy, Bill Olson, Eric Peterson, Claudia Roberts
Associate Task Force Member: Martha Morvant
Guest: Lisa Millet representing Mel Kohn
Staff: Sherry Stock
Absent: Bill Allen, Randall Chestnut, Carol Christofero-Snider, Steve Johnson, Mel Kohn, Anna Mallard, Sandra Moreland, Sen. Bill Morrisette, Laurel Russell.

A. Introduction
Bill Olson welcomed all attendees to the meeting. Minutes from the August 22, 2002, meeting were approved with minor corrections. Bill introduced the two newest members of the task force: Kristine Kennedy from Voc Rehab, and Claudia Roberts from SAIF Corporation.

Bill Olson and Sherry Stock reviewed the information in the agenda packets.

Review Discuss Task Force Report Outline

  • Dr. Andresen inquired about the definition of brain injury and suggested that it was fundamental to the TF report. Olson summarized discussion at the August meeting which concluded that for task force purposes, the broader definition of brain injury was preferred except:
    o 1) as it relates to prevention and the registry since TBI is reported as part of the trauma registry and hospital discharge data and is the focus of prevention efforts; and
    o 2) special education where federal and state definitions are specifically limited to TBI (though the policy implications in terms of special education eligibility and individual education plans are ambiguous). He indicated that the definition will be addressed in the report and Dr. Andresen's critique would be welcome.
  • Mary Bunch suggested that in organizing the report, the first paragraph should include the critical information being conveyed recognizing that many readers will skim and not read in detail. That it is important to make the first paragraph of each section have a summary of the basic information in that section and it should be very strong.
  • Focus: The purpose of the task force is to cover areas not typically covered.
  • Support with strong background information, illustrations, and supporting examples from other states, Backup information is very important
  • Use 'challenges' rather than 'disabilities'
  • Introduction: Suggested change: Brain Injury: Defined. How it is unique.

B. Subcommittee minutes

TBI Registry and Surveillance
Discuss Q&A on Registry by Mel Kohn

  • Lisa Millet representing Mel Kohn;
    • Presented from Hospital discharge data:
    • 5028 TBIs 1999-2000 for all ages
    • 65.5% males
    • 26% 19 years and under
    • 41% from MV Traffic Accident
    • 34.5% from falls
    • Average overall age is 41 with average length of stay 6 days
    • Average for 17 and under is 9 years old and stay of 4.4 days
  • What evidence do we have that a registry helps with prevention strategy?
    • identifies areas to focus prevention efforts on; example: helmets and BI in children leading to helmet laws.
    • Without registry don't have aftercare background data for prevention
  • Discussion:
    • Andresen: most ER discharges don't have long term problems; he asked Lisa Millet if discharge data could be made available by length of stay in hospital. She said it could and provided an overview of length of stay info.
    • Re: cost and benefit:
    • Cost of care for persons with brain injury? Can we get these data? Examples? Lisa will gather data and get it back to Task Force.
    • Andresen: Can we use data from other states to devise strategies?
    • Millet: Urban/rural disparity in services; Lisa to provide a geographic breakdown (of what? in incidents or hospital discharge)
    • Millet: can identify risk factors from causes (circumstantial data); at least make inferences
    • Kris Kennedy: SFP Program changed so that it does not penalize TBI youth as much as old program did.

Reviewed What Makes BI Unique? Determine Need to Address in Report and agreed that some of the statements might be used in the report.

Discussed the Q & A on Special Education by Steve Johnson & Related Items

Discussion of Q & A on Developmental Disabilities by Janna Starr

  • Kris Kennedy said that in the past the SFP (Special Funds Programs) had only so many slots for TBI-now there is universal access and that slots are filled upon need rather than stated label.

Survey Status & Responses

  • Currently about 15 survey's have been received.
  • Survivors are reporting fewer problems than family members
  • Jane-ellen and DHS has promised to print and sent out survey's to providers

Advisory Council & Trust Fund - Draft Legislation & Sources of Financing

  • Group decided to write legislation as drafted with following additions and/or changes:
    • Funds will come from $5 increase on drivers licenses reinstatements
      • Annual Estimate on $5: $1.6 million
      • Annual Estimate on $2: $655, 000
    • Additional section added to include registry
    • Change wording to state that Commission will select chair
    • Commission will meet at least 4 times per year
  • Sherry will create a number of budgets based on project revenues covering:
    • Commission
    • Commission and office-one full time staff/Director
    • Commission, office and registry
    • Commission, office, registry and full time prevention coordinator
  • Draft will be written and presented at next meeting for approval
  • Vic Backlund and Bill Morrisette will walk bill around in pre-session circulating one sheet Executive Summary of legislation

Coordinated State Response

  • ODOT has been major partner to Health Division in funding/administering prevention programs; funds cut from budget and not restored;
  • Millet Itemized Prevention Programs:
    • Graduated Driver's License Program
    • Seat Belt Laws and Program
    • Child Safety Seats
    • Safe Kids Program
    • Trauma Nurses Talk Tough
    • Think First
  • Recommendation: restore funds cut from these prevention programs??
  • Get ODOT input to report: Lisa will help with questions
  • Connecting crash data from ODOT is a major challenge; crash data are detailed, but resulting injury is not included;
  • Health is now doing work on falls, which are another major cause of TBI; trying for mandated E-Coding
  • Claudia Roberts:
    • SAIF insures about 35-40% of employers;
    • Liberty Northwest probably insures another 25-30%;
    • May be able to provide data to help with costs of care over time as well as other data such as causes of injury, # of BI cases vs. other diagnoses, etc.
    • Claudia offered to set up a meeting with SAIF data person to discuss available data.
  • What % of TBI related to occupational injury?? Do we have any idea? Claudia guesses fairly low, since many occur because of drinking and off hours activities.
  • How many TBI injured on job return to work? To former jobs?
  • SAIF also involved in injury prevention as part of cost control efforts; have loss control staff who work with employers.
  • Over time, services such as cognitive rehabilitation are not offered.
  • Discussed possibility of targeted prevention message to persons with TBI since they are more likely to have a second and third TBI after first one.

Employment Issues

  • C. Roberts: Would be desirable to develop a "reasonable accommodation" protocol for employers (and other service providers for that matter) when they have employees with TBI. Need to find from person with TBI what works for them since coping strategies are individual. Guidelines could be developed for:
    • Employers
    • Fellow employees
    • Caseworkers
    • Survivors and family members on how to help others accommodate; standard information to provide to others.
  • Should mention current grant work being done for OVR and need to address and incorporate its findings and recommendations as appropriate. Grant is intended to develop a best practices approach to working with TBI clients to get them back to work. Specifically, discuss the Brain Injury Assessment Model.
  • K. Kennedy: Need disability (and BI) awareness training for staff manning the DHS "one stop" centers being established around the State. This is being done under a Robert Wood Foundation grant - see: http://www.sdsd.hr.state.or.us/oei/rwj.htm.
  • Need to continue State share of funding for long term supported employment and timely intervention which is permitted under the Oregon amendment to its Medicaid State plan, which allows for the continuation of long-term care and health-related services after person is employed. Period covered can be up to two years if both SPD and OVR concur
  • Disability Determination Services: performed by SPD for SSI and SSDI eligibility determination. Office of Vocational Rehabilitation can provide services as long as persons seeking assistance have a documented disability.
  • Youth Transition Programs and Oregon Youth Authority Programs:
    • School Based Health Network - in danger due to budget cuts of 500,000; deal with substance abuse issues
    • 1996 Amendments to the Rehabilitation Act require a transition plan to be prepared for youth with disabilities.
  • Hire TBI survivors to speak about prevention
  • Involve Community Colleges in transition programs
  • Have BI Specialists in OVR; only one now? Bob Weaver and not FTE??
  • Medicaid Waivers: Employed person with disability waiver? Nursing home waiver?
  • Expand criteria for brain injury in Medicaid eligibility criteria; reference made to SSA Blue Book.

Summarize Discussion & Conclusions

Overview of breakout sessions were presented. Vic Backlund stated that Legislation should be ready for pre-session in early November. He and Bill Morrisette will walk it around at that time. He said that pre-session is a very good time to introduce bills.

C. Next Meeting

Next two meetings will be October 24, 2002, and November 14, 2002.

Schedule and Tasks to be Completed
" Bill and Sherry will send specific requests to Task Force members to be fulfilled asap

4:30 pm

Meeting was adjourned at 4:00 pm., will be sent out as soon as possible.


Minutes submitted by: Sherry Stock

The Governor's Task Force on Traumatic Brain Injury is supported by grant number 1 H21MC00043-01 from the Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.
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