Center for Collaborative Research in Health Outcomes and Policy

Improving Public Services for Persons with Traumatic Brain Injury

The Michigan Department of Community Health (MDCH) Traumatic Brain Injury (TBI) Project began as a collaborative effort to improve public services for persons with TBI in Michigan. Successful collaboration between MPHI, MDCH, the Michigan Department of Education, the Michigan Department of Military and Veterans Affairs, the Department of Human Services, as well as the Brain Injury Association of Michigan has led to the receipt of three successive federal grant awards to Michigan – totaling $1.1 million for eight years of funding. The first grant was received in 1998 from the federal Health Resources and Services Administration (HRSA) - Maternal and Child Health Bureau (MCHB). Since then, MPHI has partnered with MDCH to facilitate, conduct, and evaluate grant activities.

Early project efforts focused on conducting a needs assessment and developing a state action plan to address the needs of Michigan residents with TBI. Because the State of Michigan has limited specialized services in the public sector for individuals with TBI, they may seek services from agencies/programs that focus on physical health, mental health and substance abuse, and other social services – each with their own referral processes, scope of services, eligibility rules, and payment sources. This situation can cause individuals with TBI to fall through the cracks and not receive needed services.

In 2004, the TBI Project produced a report titled Addressing Michigan’s Public Service Gaps for Persons with Traumatic Brain Injury, which focused on incidence, the use and cost of healthcare, public service availability, assistive technologies, consumer experience with public services, and pilot systems change studies. Findings from this report were used to clarify and guide project goals and efforts. Additionally, MPHI has prepared a number of materials to educate both consumers and providers about TBI and available services. One of the most popular is the comprehensive Michigan Resource Guide for Persons with Traumatic Brain Injury and their Families.

Highlights of the TBI Project: 2005-2006

During 2005 and 2006, MDCH, with support from a HRSA-MCHB Post Demonstration Grant, acted to fulfill a number of goals set out in the 2004 report.

Web-based training modules
MPHI – with input from project partners – developed and hosted a web-based training course for providers who serve clients with TBI. Targeted to human services professionals in public agencies and non-profit organizations, this free, online course is an innovative means to reach and educate more individuals than traditional courses for professional development. Since April 2006, more than 500 people have registered to use this online training, which has been very well received at both state and national levels. The TBI Project is currently working to offer continuing education credits for completion of this training course.

Outreach
The TBI Project has been actively disseminating information to individuals in Michigan and nationally to educate about TBI. Outreach efforts include publication of newsletter articles, presentations and product distribution at annual conferences, and discussion of a process that would allow veterans and their families to seek help for TBI, using existing state and federal programs.

Measuring consumer satisfaction
To aid MDCH with systems improvement efforts for people with TBI, MPHI designed and implemented a consumer satisfaction survey. This survey was sent to 98 living beneficiaries (and/or their caregivers) who had been enrolled in the small MDCH Traumatic Brain Injury Rehabilitation Program during the last five years, and for whom MDCH had current addresses. Program beneficiaries were invited to complete the survey themselves or with assistance, as well as nominate a close relative or caregiver to respond. Responses were received from 42 beneficiaries and 16 caregivers. In general, respondents are fairly satisfied with service providers. However, respondents report less satisfaction with accessing needed services in the following areas: education, employment, advocacy, and support services. Barriers to receiving services are most commonly related to paying for services. These data will provide a reference point against which future results may be measured.

Support for systems change
MDCH has convened an interagency workgroup to explore the feasibility of designing a Medicaid Waiver Program for persons with TBI. This will be a service package targeted to persons with TBI who would otherwise be at risk of living in an institutional setting. The workgroup hopes to complete an application to the federal Centers for Medicare and Medicaid Services by the end of 2006. MPHI supports the workgroup through analysis and reporting of data on the significance of TBI and current Medicaid service utilization by persons experiencing TBI.

Next Steps

The TBI Project received a three-year Partnership Grant from HRSA, which will begin in April 2007. This funding will be used for outreach and TBI education, further data analysis in support of TBI systems change, and the continued expansion of current project efforts.

Learn More
For more information about the Michigan Traumatic Brain Injury Project, contact the MPHI Center for Collaborative Research in Health Outcomes and Policy at 2440 Woodlake Circle, Suite 100, Okemos, MI 48864, or call 517-324-7381. To view the TBI online training course, please visit www.mitbitraining.org . Additional materials may be accessed at: www.michigan.gov/tbi.

Author
Courtney Chapin, BS, is a research assistant with the Traumatic Brain Injury Project and various other projects in the Center for Collaborative Research in Health Outcomes and Policy for MPHI.