Indiana Traumatic Brain Injury State Plan 2018 – 2023

Overview TBI trends among Hoosiers. Overview of proposed goals. Advisory board feedback and questions.

National TBI Trends

TBI Data, Tools, and Surveillance Inpatient and Outpatient: Indiana Hospital Association Data Indiana Trauma Registry ESSENCE Mortality: Death Certificate Longitudinal Data: TBI Model Systems Eskenazi Health Brain Center & Regenstrief Institute

Indiana TBI Trends Statista https://www.statista.com/topics/3810/concussion-and-traumatic-brain-injury-tbi-in-the-us/

Indiana TBI Gender Trends Statista https://www.statista.com/topics/3810/concussion-and-traumatic-brain-injury-tbi-in-the-us/

Indiana TBI Severity Trends

TBI Trends in Rural Areas Statista https://www.statista.com/topics/3810/concussion-and-traumatic-brain-injury-tbi-in-the-us/

Chronic TBI in Indiana

TBI Within the Indiana Justice System The role of TBI within Indiana’s criminal justice system is not fully understood. 83% of screened respondents reported sustaining a TBI before their initial involvement with the criminal-justice system. ~60% of the Indiana prison population has a lifetime history of TBI compared to 8.5% of the general population. TBI during childhood /adolescence increased the risk of criminality and conduct disorder 18.7 fold.

State Priorities

Identified Priorities 1. Conduct a comprehensive TBI Needs Assessment to: Pinpoint the incidence of TBI, stratified by severity, across Indiana that are seen at emergency departments (ED) and to what services and resources they are directed. Identify at which types of facilities people with TBI are being seen and the percentage of their overall caseload, including a sample of mental health/substance abuse, vocational and employment services. Locate gaps in services. This assessment will include the full range of TBI severity, from concussion/mild TBI to severe.

Identified Priorities Develop statewide systems and supports to proactively manage chronic TBI to prevent co-occurrence and co-morbidity, to minimize the disability associated with TBI, and to maximize health-related quality of life and independence in the community. Determine goals and strategies for the assessment of concussion (mTBI) diagnostic and treatment services throughout the State and promote awareness and utilization of evidence-based concussion management guidelines.

Identified Priorities 4. Compliance to the recommended priority actions outlined by the CDC regarding Traumatic Brain Injury (TBI). The priority recommendations include: Identify the prevalence of disabilities due to TBI among their residents. Screen for TBI history among persons who receive state-funded health and social services. Train health and social service professionals to recognize and minimize the effects of TBI on behavior. Make home and community services more accessible to people with TBI.

Identified Priorities Improve the use of information and data from electronic sources to: Develop statewide TBI reports Connect those with TBI to supports and services, and Sponsor outcomes-driven programs.

Goals and Recommendations

Goals and Recommendations Identify the strengths and weakness of Indiana’s TBI infrastructure.

Goals and Recommendations Identify the strengths and weakness of Indiana’s TBI infrastructure. A third party consulting company (Ghost Map Analytics) will conduct a comprehensive needs and resources assessment of TBI-care system. Identify the key agencies and organizations with active TBI grants and prevention interventions. Establish the prevalence, incidence, and supplemental information of TBI within Indiana Residents.

Goals and Recommendations 2. Improve Access to Educational Resources and References for Medical Professionals, Patients, and Their Families.

Goals and Recommendations 2. Improve Access to Educational Resources and References for Medical Professionals, Patients, and Their Families. Establish a centralized web-portal for stakeholders to find current TBI data and educational resources. Provide an aggregate list of the recommended detailed services provided throughout the state. Publish “Best Practice Guidelines” for the recommended acute care, post-acute rehabilitation and surveillance of TBI patients. Develop materials aimed at educating legislators on TBI. Create a TBI symptom checklist for the patient to advocate with their health care providers, that includes a listing of TBI resources

Goals and Recommendations 3. Increase the Access to Care for TBI Patients in Indiana

Goals and Recommendations Increase the Access to Care for TBI Patients in Indiana Explore funding opportunities to expand the use of the RF Model by hospitals and rehabilitation centers. Cultivate a new TBI wavier alternative to the Medicaid TBI wavier. Establish an integrated care pathway to reduce early termination of services. Improve the collaboration and connectivity of the trauma centers with TBI services and supports. Identify and improve TBI care for underserved communities. D. including relationships and partnerships with key stakeholders, coalitions and networks throughout the state and the nation.

Goals and Recommendations 4. Improve the Surveillance and Prevention of Youth TBI

Goals and Recommendations Improve the Surveillance and Prevention of Youth TBI Establish formal procedures for returning youth and adolescent TBI patients to class and sports. Create a surveillance tool to monitor the TBI trends in youth and adolescent sports. Provide teachers, counselors and school nurses educational resources about managing TBI patients in the classroom. Improve the collection and accuracy of ICD-10 coding for sport-related TBI seen in EDs and urgent care clinics.

Goals and Recommendations Diversion of TBI Patients within the Justice System.

Goals and Recommendations Diversion of TBI Patients within the Justice System. Expand the screening of incarcerated individuals for TBI within the justice system of additional counties. Establish recommendations for diversion of TBI patients within the justice system. Develop a diversion prediction model to identify high-risk TBI patients not yet incarcerated. Institute a centralized database to store data from screened incarcerated individuals and estimate the prevalence of TBI within the Indiana Justice System . Offer recommendations to expand the services offered to incarcerated individuals recovering from a TBI.

Contact Information Jeremy Funk, MPH Syndromic Surveillance Epidemiologist Epidemiology Resource Center Indiana State Department of Health (317) 234-9741 (office) JFunk1@isdh.IN.gov www.StateHealth.in.gov