Facilitator: Monique Parish Funded by California Department of Mental Health October 2009 Traumatic Brain Injury Grant Project Stakeholder Session

 California Department of Mental Health (DMH) was awarded a federal Traumatic Brain Injury (TBI) Grant ( ).  Primary Grant Objectives:  Establish TBI Advisory Board & strengthen TBI partnerships.  Promote TBI systems change through public policy & education.  One year No-Cost Extension Project (through March 2010):  Solicit stakeholder input regarding access to and development of comprehensive and coordinated TBI services.  Develop project report to assist with the development of a Medicaid (Medi-Cal) waiver and/or State Plan Amendment to enhance TBI services with additional federal support. Overview: Traumatic Brain Injury Grant 2

AB 1410: Traumatic Brain Injury  Overview AB 1410 (Feuer, Chapter 676, Statutes 2007) Requires that a system of post acute continuum of care models for adults 18 years+ with TBI be developed. If needed, development of a home- and community-based services waiver application, or an amendment of the state plan for home- and community-based services, to serve at least 100 adults with TBI who would otherwise require care in a Medi-Cal (Medicaid) funded institutional setting. Services under the waiver would be provided by the seven TBI project sites currently operating in California. 3

TBI Grant: No-Cost Extension Project Report  To create a report that summarizes stakeholder recommendations and feedback on establishing a comprehensive TBI service system in California.  The report will be used by designated state departments to help them create a waiver and/or State Plan Amendment. A Home and Community-Based Services Waiver allows states to treat certain Medicaid populations in home or other community based settings rather than in institutional settings. State Plan Amendment is the means by which a state changes its Title XIX Medicaid State Plan. 4

California’s Current TBI Service System Structure 5

TBI Core Services  Community Reintegration Services  Family and Community Education  Service Coordination Services  Vocational Support Services/Extended Supported Employment Services  Supported Living Services 6

Community Reintegration Services  Community reintegration consists of “services needed by participants that are designed to develop, maintain, increase, or maximize independent functioning, with the goal of living in the community and participating in community life.”  Community reintegration services may include but are not limited to providing or arranging for access to housing, transportation, medical care, rehabilitative therapies, day programs, chemical dependency recovery programs, personal assistance, and education. 7

Family and Community Education  Family and community education refers to the provision of information designed to improve overall understanding of the nature and consequences of TBI, including public and professional education designed to facilitate early identification of persons with TBI, prompt referral of these persons to appropriate services, and improvement of the system of services available to them. 8

Service Coordination Services  Service coordination activities may include provision of information and resources for participants, advocacy, participant and family education about options, liaison for participants among service providers, problem-solving with participants, and monitoring and following-up on well-being and progress. 9

Vocational Support Services/ Extended Supported Employment Services  Vocational support services means a method of providing vocational rehabilitation and related services to targeted individuals not served or underserved by existing vocational rehabilitation services.  Extended supported employment services includes means ongoing support services and other appropriate services needed to support and maintain an individual with TBI in supported employment. 10

Supported Living Services  Supported living services are designed to increase a participant’s independent living skills, and include supervision, support, and training in the participant’s place of residence or other setting. 11

Follow-Up Questions for Each TBI Core Service Area 1. What is reimbursed, what is not reimbursed under insurance (Medicare, Medi-Cal, private insurance, etc.)? 2. What services are needed and for whom (which specific communities or populations)? 3. What are the barriers to existing services and development of new services? 4. Who are the providers? Who can be a provider – what are their qualifications? 5. What opportunities are there at the local level for collaboration to better serve persons, long-term, with TBI? 12

Recommendations Matrix 13

Stakeholder Conference Call Information  Two statewide toll-free conference calls are scheduled on Thursday, October 29, 2009: 10:00 A.M. to 12:00 P.M. 3:00 P.M. to 5:00 P.M.  Call-in number is (800)  If you would like to participate in one of these statewide conference calls, complete and submit the registration form found on this website: tm tm 14

For More Information…  If you would like to provide additional comments, please submit them to: Cielo Avalos California Department of Mental Health th Street, Room 150 Sacramento, CA