Grant Purpose To improve health outcomes, following a traumatic brain injury, by building a TBI-informed system of services and supports, and through the utilization of Resource Facilitation.

Indiana State Department of Health (ISDH) is the Lead Agency ACL Grant 2018-2021 Indiana State Department of Health (ISDH) is the Lead Agency Goals: Improve health care outcomes following TBI Prevent substance abuse, especially opioid misuse Prevent institutionalization, including incarceration and out-of-state residential placement Strategies: Research on the Efficacy of Resource Facilitation for Health Outcomes Indiana TBI Advisory Board Mentoring other States

Grant Project Leadership & Organization ACL Federal Project Officer: Dana Fink Project Director: Katie Hokanson, ISDH Epidemiologist: Jeremy Funk, MS, ISDH Principal Investigator: Lance E. Trexler, PhD, RHI Research: Devan Parrott, PhD, RHI Indiana TBI Advisory Board: Laura Trexler, OTR, RHI RF, State Mentoring Indiana TBI Advisory Board: Judy Reuter, RHI TBI Outcomes Research Indiana TBI Advisory Board State Mentoring

ACL Grant Consultants Flora Hammond, MD, FACRM, Chair, Department of PMR, IU School of Medicine and RHI Summer Ibarra, PhD, Clinical Director, RHI Departments of Rehabilitation Neuropsychology and Resource Facilitation Jess Fann, MD, MPH, Professor, Department of Psychiatry and Behavioral Sciences, University of Washington Stephen Sutter, President, CreateAbility Concepts

Resource Facilitation: Acute to Chronic Care Continuum Acute and Clinical Services community-based Services - - - - - - - - - - - - - - - - - - - - Resource Facilitation - - - - - - - - - - - - - - Follow-Up Follow-up E.g., Mental Health, employment services E.G., PCP and Neuropsychological Treatment

The Resource Facilitation Team at RHI… Supports the individual’s health, return to community, return to school, and return to independence goals through an integrated team approach Serves to build & strengthen the individual’s continuum of care Facilitates communication among/between continuum partners

The Resource Facilitation Team at RHI… Routinely, and on a scheduled basis, provides guidance, assistance, resources and support to individual’s, support person(s), care partners Is composed of specialists trained in brain injury recovery/rehabilitation, who offer BI related education to the individual, support person(s), care partners, state agency personnel, and community partners Help bridge the gap(s) in the recovery journey…

Acute Care Return to Life

ACL Grant - RF Model TBI Collaborative Care Team Methodist Trauma Center TBI Collaborative Care Team TBI Integrated Care Pathway St. Vincent’s Trauma Center BEAM = Basic Everyday Activity Monitoring: Cloud-based interface for monitoring individualized health care metrics for surveillance of risk factors & RF outcome measures

Collaborative Care + RF for TBI Health Outcomes Trexler, Hammond, Parrott, Trexler, and Ibarra; Indiana ACL grant (2018 – 2021) Patient Primary Care Provider Consultants PMR Neuropsychology Occupational Therapy Neuropsychiatry Resource Facilitator Feedback to MD Decision support Care coordination Monthly case supervision Treatment adjustment Manage treat-to-target Motivate adherence to tx Monitor response to tx Ongoing Assessment Provide access to services and supports Negotiate tx plan Provide follow-up and treatment adjustment ACL grant 2018 Indiana State Department of Health Lead Agency Primary Goal: improve health care outcomes following TBI through Resource Facilitation Secondary Goals: Prevent opioid misuse Prevent institutionalization, including incarceration Prospectively recruit 150 TBI from the trauma center and randomize 100 to Resource Facilitation (RF) RF will navigate to a TBI-Coordinated Care Team (TBI-CCT) PCP Patient and Family RF Consulting PMR and Neuropsychology TBI-CCT will develop a care plan and metrics to me used for surveillance to ensure progress/monitor for decline Cohort and individualized health metrics will be managed/shared between TBI-CCT participants through cloud-based application 2 years of Resource Facilitation

ACL Grant: Research Two Hypotheses: Primary Individuals who receive RF will demonstrate better health outcomes Health-related quality of life Level of disability Secondary Individuals who receive RF will demonstrate less opioid misuse Individuals who receive RF will have lower incidence of incarceration

ACL Grant: Research Methods: Randomized Controlled Trial (RCT) study with outcome assessments, performed by blinded researchers, at end of treatment and at 3-month follow-up. 150 individuals with traumatic brain injury will be recruited from trauma center(s). 100 individuals will be randomly selected to receive Resource Facilitation and 50 individuals will received standard follow up care as usual. 12 months of Resource Facilitation & 3 month follow-up.

RF Model An Initial Assessment will drive Resource Facilitation Goals Ongoing observation and treatment monitoring will determine the level of concern/risk for each individual, as well as the intensity and type of care and follow-up needed

RF Model The TBI Collaborative Care Team: Primary Care Physician, Client and Resource Facilitator Consultants: Physical Medicine and Rehabilitation Physician Clinical Rehabilitation Therapist Rehabilitation Neuropsychologist Neuropsychiatrist

Anticipated Outcomes Improved health outcomes, decreased level of disability, and decreased health care costs. Improved outcome for TBI- informed treatment (e.g., mental health outcomes). Decreased incarceration and institutionalization. Decreased substance abuse, especially opioid misuse.

ACL Grant: Additional Aspects Mentor other States in Resource Facilitation Outcomes Measurement Task Force Annual Webinar on RF Workgroups Using Data to Connect People to Services Transition and Employment

ACL Grant: Additional Aspects TBI Advisory Board Composition Individuals with TBI and caregivers State Agencies Relevant provider and professional organizations Indiana TBI State Plan Consultation-Feedback on ACL Grant & Indiana TBIMS Grant

Indiana TBI State Plan Mission statement: To develop, implement and provide oversight for a statewide coordinated care structure for Traumatic Brain Injuries (TBI) aiming to: Reduce the number of injuries. Improve the care and outcomes of TBI patients. Increase the access to resources and rehabilitation for TBI patients Provide Evidence-based education to patients and families of those with TBIs. .

Indiana TBI State Plan Vision: Core values: Prevent Brain Injuries & improve long-term outcomes of TBI patients in Indiana. Core values: Health promotion and prevention. Data collection, analysis, and information dissemination. Evidence-based best practices for public health promotion, training, and health care quality.

Disclosures Funding for this presentation was made possible (in part) by the Administration for Community Living. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.