1. UMASS MEMORIAL HEALTH CARE TRAUMA PROGRAM Pediatric Brain Injury Rehabilitation in Central Massachusetts- Adding Insult to Injury Michael P. Hirsh, MD, FACS, FAAP Director, Pediatric Trauma Services UMMHC

2. UMASS MEMORIAL HEALTH CARE TRAUMA PROGRAM

3. Trauma Center Factoids Established 1979Established 1979 First Hospital-Based Helicopter Aeromedical Service (New England Life Flight, or NELF) in 1981First Hospital-Based Helicopter Aeromedical Service (New England Life Flight, or NELF) in 1981 First American College of Surgeons (ACS) accredited Level 1 Center in Mass. (1991)First American College of Surgeons (ACS) accredited Level 1 Center in Mass. (1991) Became Dual Level 1 Pediatric/Adult Trauma Center in 2005 (one of two)Became Dual Level 1 Pediatric/Adult Trauma Center in 2005 (one of two) Admitting 2500 pts/year (Pediatric: 550<18yo, 350 <15)Admitting 2500 pts/year (Pediatric: 550<18yo, 350 <15)

5. UMASS MEMORIAL HEALTH CARE TRAUMA PROGRAM Adult Rehabilitation FEATURES Physiatry team lead by Dr. Faren WilliamsPhysiatry team lead by Dr. Faren Williams Unique relationships with local adult rehabilitation partners such as Fairlawn (Health South), WhittierUnique relationships with local adult rehabilitation partners such as Fairlawn (Health South), Whittier Multi-disciplinary Discharge Planning rounds with DC planners, SW, rehab team, Trauma TeamMulti-disciplinary Discharge Planning rounds with DC planners, SW, rehab team, Trauma Team

6. UMASS MEMORIAL HEALTH CARE TRAUMA PROGRAM Pediatric Rehabilitation Problems Pedi Rehab in Central Mass. nonexistent for Patients less than 15yo.Pedi Rehab in Central Mass. nonexistent for Patients less than 15yo. Patients discharged to sites in Boston, New Hampshire, ConnecticutPatients discharged to sites in Boston, New Hampshire, Connecticut Live-in facilities for parent in these sites limitedLive-in facilities for parent in these sites limited Families in these situations have additional stressors of child-care, work obligations, travel expenses, boarding expenses and school issuesFamilies in these situations have additional stressors of child-care, work obligations, travel expenses, boarding expenses and school issues Travel to these facilities difficult for Central Mass. FamiliesTravel to these facilities difficult for Central Mass. Families Patients sent to these outside facilities frequently do not return- this affects our follow-up, outcomes analysis, and billing.Patients sent to these outside facilities frequently do not return- this affects our follow-up, outcomes analysis, and billing. Realizing these problems, our LOS on inpatient kids with rehab needs goes upRealizing these problems, our LOS on inpatient kids with rehab needs goes up Some unaddressed rehab needs fall back on local school systems to fixSome unaddressed rehab needs fall back on local school systems to fix

9. Pediatric Brain Injury Rehabilitation in Central Massachusetts- Adding Insult to Injury Pediatric Rehabilitation Remedial Measures for UMMHC Pediatric Trauma Program Find LOCAL Pediatric Rehab partner for transfer agreements and possible in-patient coverageFind LOCAL Pediatric Rehab partner for transfer agreements and possible in-patient coverage Find DISTANT Pedi Rehab partner with facilities to allow parents to room-inFind DISTANT Pedi Rehab partner with facilities to allow parents to room-in DEVELOP DAY FACILITIES for local families with kids with BIDEVELOP DAY FACILITIES for local families with kids with BI ? Consider development of small inpatient rehab cluster as transitional area for Pedi trauma patients? Consider development of small inpatient rehab cluster as transitional area for Pedi trauma patients

10. Pediatric Rehabilitation challenges in Central Mass. Can Brain Commission garner support ($ or leverage) to help local rehab facilities expand services to include kids needing inpatient, outpatient and day service help?Can Brain Commission garner support ($ or leverage) to help local rehab facilities expand services to include kids needing inpatient, outpatient and day service help? Can Insurers be pushed to cover neuro-cognitive rehab for BI in kids?Can Insurers be pushed to cover neuro-cognitive rehab for BI in kids? Can additional help to BI families be uncovered? (Transportation, tutoring, boarding,Can additional help to BI families be uncovered? (Transportation, tutoring, boarding, Can school systems reintegrating BI kids be given extra support?Can school systems reintegrating BI kids be given extra support? Pediatric Brain Injury Rehabilitation in Central Massachusetts- in Central Massachusetts- Adding Insult to Injury Adding Insult to Injury