Idaho State University

Tuesday, December 12, 2017

 

Past Accomplishments:

Summary of Accomplishments 2009-2014

Goal 1: Establish a trust fund to benefit civilian and military personnel with TBI and their families.

  • Completed a feasibility study reviewing trust fund legislation and funding of all states for applicability to Idaho
  • Documented need for TBI trust fund among civilian and military populations and engaged in preliminary processes for creating trust fund legislation to be introduced during the 2011 legislative session.
  • Through the Consortium of Idahoans with Disabilities and Idaho’s P&A contacted every member of the Idaho 2010 legislature with fact sheets around a TBI trust fund for the states.
  • In 2011 through Idaho’s P&A solidified a sponsor and drafted trust fund legislation.
  • In 2012-13 convened an ad hoc committee to explore administration and funding recommendations for a trust fund..
  • Developed a fact sheet and supported the passage of a bill strengthening Idaho’s 2010 concussion legislation by mandating education of coaches and parents about head injuries.
  • The project team is working with the Idaho Hospital Association to help identify a revenue stream for a state TBI trust fund. A consultant facilitated a work group across military and civilian organizations to discuss all aspects of furthering a TBI trust fund for the state. We have a commitment from an organization to administer the trust fund, though securing funding will require more research.
  • Co-sponsored and participated in an expert roundtable discussion and press conference for a TBI summit in 20103 with Sen. Mike Crapo
  • Project team members hosted and presented an inaugural meeting of the Boise VAMC Center of Excellence Patient Centered Medical Home Education Collaborative in 2013.

Goal 2: Move TBI Advisory Council forward.

  • In 2010 we secured non-profit status for our statewide TBI advisory council.
  • Appointed a new member of Idaho’s Veteran’s Sanctuary Program, the first transition and support program of its kind in the United Sates, to the TBI Advisory Council  www.isu.edu/veterans
  • The Advisory Council includes representation from the Executive Director of the Brain Injury Alliance of Idaho. A subcontract to the BIA of Idaho was issued in 2012 to help with infrastructure development.  

Goal 3: Support families of returning service members with TBI.

  • All data from 2001, 2004-2008, 20011 were collected, and analyzed from the TBI needs and resource assessment.  These data were first published in Brain Injury (Vol. 21, pp 837-849, 2007) and (in press) article titled: Traumatic Brain Injury in Idaho: A longitudinal Analysis of Needs and Resource Assessment Data (2001-2011).
  • From 2011 to 2012, the IRH conducted a 7th TBI needs assessment with 117 online respondents, using the REDCap electronic data capture system funded by NCRR at the Institute of Translational Health Sciences.
  • Resources were catalogued and organized by life area and all links have been updated related to Idaho Traumatic Brain Injury Virtual Program Center. www.idahotbi.org Added 200+ links specifically dedicated to Veterans.
  • In 2010 established new avenues via electronic “chat” for connecting family members of returning service personnel with TBI to one another for support and resource sharing. 
  • In 2010 presented a national 5-part Traumatic Brain Injury webinar series with topics specific to military personnel with TBI and their families.  Overall, 252 virtual chairs were filled.  A total of 66 questions were generated and addressed by nationally renowned experts. 
  • More than 74 hours of live instruction dating back to 2003 have been added to the VPC, including the spring 2012 series presented via webinar. All sessions have been archived and evaluated, and copies of PowerPoint presentations, certificate requests and handouts have been posted and are available at www.idahotbi.org. Over 2,800 participants have participated in the TBI Virtual Grand Rounds (VGR) since 2003.
  • In 2012 a third national TBI webinar series was presented with topics specific to Idaho’s trauma registry, concussion legislation, and Veteran’s Sanctuary Program. 170 people registered across 31 states and the District of Columbia.  An evaluation and session post-test generated 83 certificates of attendance, and 69% of respondents stated that the information presented would change their practices. The results were published in the IBIA’s peer reviewed May 2012 newsletter.
  • In 2010, the project team facilitated an assembly across 5 high schools involving over 300 students, and a town hall meeting in collaboration with Sarah Jane Brain Foundation’s 2011 National Pediatric Brain Injury Tour.

Goal 4: Monitor Idaho’s Aged/Disabled Medicaid Waiver and Trauma Registry.

  • Appointed member of the Trauma Registry Advisory Committee to the TBI Advisory Council to facilitate open communication about TBI to registry planners and developers.
  • Conducted an analysis of state and national mortality data regarding TBI resulting from motor vehicle accidents. (In press) journal article titled: Comparison of Intentional Deaths (Suicide) and Unintentional Motor Vehicle Traffic Deaths with and Without Traumatic Brain Injury as an Underlying Cause by State by Year Across Selected Demographic, Economic and Geographical Characteristics in the U.S (1999-2011).

Summary of Accomplishments 2006-2009

Goal 1: Continue the annual Needs and Resources Assessment

  • All data from 2001, 2004-2008 were merged in an Excel database and graphed for use in presentations at the local, regional and national levels.
  • Posters were developed and presented at annual TBI Grantee meetings and other venues.  One such poster includes all data 2001-2007.
  • Presentations were given at the 4th and 5th Pacific NW Brain Injury Conferences
  • Manuscript utilizing a portion of the data was published in Brain Injury[1].
  • Plans are underway for writing and submitting a follow-up manuscript utilizing 2004-2008 (post-baseline) data, allowing the team to examine change in service and support need and life quality among Idahoans with a TBI.
  • In addition to a paper copy included an electronic version for completing the N&R assessment via the Idaho TBI-VPC and linked to the ISU-IRH website.
  • Over six years a total of 1004 individuals & family members (28% rate of return) completed a (TBI) statewide needs and resources assessment. During this same time 576 (15% rate of return) of private and agency providers also completed an assessment.

Goal 2: Sustain the TBI Virtual Program Center (VPC).

  • Resources were catalogued for the VPC and organized by life area.
  • User statistics evaluated via Urchin software.   Most recent count indicates the VPC has received over 16,000 “hits” since March, 2006.
  • Content was refined and updated via Assistguide (a.k.a. AGIS Network) toolbox training
  • Extended contract with AssistGuide (a.k.a. AGIS Network) through 03/31/09 to maintain VPC.
  • Presented Idaho’s TBI VPC to Advisory Council members, Twenty One (21) Telehealth Partners (5th Annual Meeting), and most recently as part of the TBI Virtual Grand Rounds (December 2007).
  • Developed a fact sheet on Idaho’s TBI Virtual Program Center.
  • Digitized 50+ hours of live, participant evaluated instruction (2003 to 2007). Copies of PowerPoint handouts were included in the postings.
  • Over 200 internet links added, specifically dedicated to needs of Veterans with TBI.
  • Continued evaluation of potential permanent placement sites for VPC.
  • Continued marketing of the VPC via the Advisory Council members.
  • Plans are underway (depending on the availability of funds) to develop a fact sheet about the VPC to be mailed to participants of the FY08 annual Needs and Resources assessment.

Goal 3: Move TBI Advisory Council forward.

  • Maintain quarterly (when appropriate) in-person and televideo meetings to facilitate participation and cross-communication among all council members
  • Obtain ongoing Advisory Council input on VPC and VGR content, and use of Needs and Resource Assessment data.
  • Completion by Council members of self-assessment tool.
  • Included representation from Council on statewide seat belt coalition (I-Belt)
  • Participation by Council members in annual HRSA TBI Grantee meetings.
  • Participating Council members (above) presented ideas/perceptions of meeting and outcomes to non-attending Council members.

·       Encouraged Council feedback for improvement to state agency representative responsible for most TBI-related services.

·       Encouraged representation on the new Trauma Registry Advisory Committee.

·       Ongoing discussion between Council and project team members to discuss the future of this group and its role within an Idaho TBI infrastructure.

  • Plans are underway to explore with the Council members (December 2008 meeting) their understanding of the current political climate and their commitment toward securing gubernatorial or legislative authority for the Council.

Goal 4:  Advance TBI Virtual Grand Rounds/Educational activities.

  • Co-sponsored a conference June 6-7, 2006 on the Behavioral Aspects of Epilepsy.
  • Developed a fact sheet for the National Traumatic Stress Network on pediatric brain injury and child trauma
  • Provided 53 hours of digitized training to 1,910 individuals, across three states and up to 21 sites.
  • Obtained course evaluations from approximately 75% of attendees; 95% of evaluators rated the sessions as “good” to “excellent.”
  • Participation by 414 individuals across three states during Fall of 2007 in a VGR series devoted to returning Veterans with a TBI.
  • The Department of Defense, Deployment Health and Family Readiness Library included Idaho’s Veterans series in its general resources section: http://deploymenthealthlibrary.fhp.osd.mil
  • Plans are underway for a second VGR series on veterans and TBI.
  • Continued discussion toward technological improvements to facilitate viewing of VGR presentations from home/office (i.e., webcast forum).
  • Continue digitization of future presentations for post-hoc viewing via the VPC.

Goal 5:  Monitor the implementation of the State Trauma Registry and use of the TBI Medicaid Waiver.

  • Provided written comments to the state Medicaid office concerning policy changes to the TBI Medicaid waiver based on the Deficit Reduction Act.
  • Sunset provision for Trauma Registry lifted during the FY07 legislative session.

Cross-Goal accomplishments

  • Served on a NASHIA pre-conference grantee meeting that focused on veterans with a TBI.
  • Participated in a Center for Disease Control (CDC)-sponsored pubic awareness conference call entitled “Helping Seniors Live Better Longer: Prevent Brain Injury Project.”
  • Presented on the status of TBI in Idaho at the National Rehabilitation Association summer conference.
  • Presented at the Veterans Service Officer Annual Training Conference.
  • Incorporation of Veterans’ information into Idaho’s TBITAC profile, NASHIA’s Technical Assistance Resource Tool “Assisting Veterans with Traumatic Brain Injury.”
  • Developed a fact sheet on pediatric brain injury and trauma for the National Traumatic Stress Network.
  • Developed of an Idaho-based TBI support group list.
  • Presented as part of a “Veterans with TBI” Learning Community for discussion on who from service organizations should sit on TBI statewide advisory boards.

Summary of Accomplishments 2003-2006

Goal 1: Continue the annual Needs and Resources Assessment.

  • All data from 2001, 2004-2008 were merged in an Excel database and graphed for use in presentations at the local, regional and national levels.
  • Posters were developed and presented at annual TBI Grantee meetings and other venues.  One such poster includes all data 2001-2007.
  • Presentations were given at the 4th and 5th Pacific NW Brain Injury Conferences
  • Manuscript utilizing a portion of the data was published in Brain Injury[1].
  • Plans are underway for writing and submitting a follow-up manuscript utilizing 2004-2008 (post-baseline) data, allowing the team to examine change in service and support need and life quality among Idahoans with a TBI.
  • In addition to a paper copy included an electronic version for completing the N&R assessment via the Idaho TBI-VPC and linked to the ISU-IRH website.
  • Over six years a total of 1004 individuals & family members (28% rate of return) completed a (TBI) statewide needs and resources assessment. During this same time 576 (15% rate of return) of private and agency providers also completed an assessment.

Goal 2: Sustain the TBI Virtual Program Center (VPC).

  • Resources were catalogued for the VPC and organized by life area.
  • User statistics evaluated via Urchin software.   Most recent count indicates the VPC has received over 16,000 “hits” since March, 2006.
  • Content was refined and updated via Assistguide (a.k.a. AGIS Network) toolbox training
  • Extended contract with AssistGuide (a.k.a. AGIS Network) through 03/31/09 to maintain VPC.
  • Presented Idaho’s TBI VPC to Advisory Council members, Twenty One (21) Telehealth Partners (5th Annual Meeting), and most recently as part of the TBI Virtual Grand Rounds (December 2007).
  • Developed a fact sheet on Idaho’s TBI Virtual Program Center.
  • Digitized 50+ hours of live, participant evaluated instruction (2003 to 2007). Copies of PowerPoint handouts were included in the postings.
  • Over 200 internet links added, specifically dedicated to needs of Veterans with TBI.
  • Continued evaluation of potential permanent placement sites for VPC.
  • Continued marketing of the VPC via the Advisory Council members.
  • Plans are underway (depending on the availability of funds) to develop a fact sheet about the VPC to be mailed to participants of the FY08 annual Needs and Resources assessment.

Goal 3: Move TBI Advisory Council forward.

  • Maintain quarterly (when appropriate) in-person and televideo meetings to facilitate participation and cross-communication among all council members
  • Obtain ongoing Advisory Council input on VPC and VGR content, and use of Needs and Resource Assessment data.
  • Completion by Council members of self-assessment tool.
  • Included representation from Council on statewide seat belt coalition (I-Belt)
  • Participation by Council members in annual HRSA TBI Grantee meetings.
  • Participating Council members (above) presented ideas/perceptions of meeting and outcomes to non-attending Council members.

·       Encouraged Council feedback for improvement to state agency representative responsible for most TBI-related services.

·       Encouraged representation on the new Trauma Registry Advisory Committee.

·       Ongoing discussion between Council and project team members to discuss the future of this group and its role within an Idaho TBI infrastructure.

  • Plans are underway to explore with the Council members (December 2008 meeting) their understanding of the current political climate and their commitment toward securing gubernatorial or legislative authority for the Council.

Goal 4:  Advance TBI Virtual Grand Rounds/Educational activities.

  • Co-sponsored a conference June 6-7, 2006 on the Behavioral Aspects of Epilepsy.
  • Developed a fact sheet for the National Traumatic Stress Network on pediatric brain injury and child trauma
  • Provided 53 hours of digitized training to 1,910 individuals, across three states and up to 21 sites.
  • Obtained course evaluations from approximately 75% of attendees; 95% of evaluators rated the sessions as “good” to “excellent.”
  • Participation by 414 individuals across three states during Fall of 2007 in a VGR series devoted to returning Veterans with a TBI.
  • The Department of Defense, Deployment Health and Family Readiness Library included Idaho’s Veterans series in its general resources section: http://deploymenthealthlibrary.fhp.osd.mil
  • Plans are underway for a second VGR series on veterans and TBI.
  • Continued discussion toward technological improvements to facilitate viewing of VGR presentations from home/office (i.e., webcast forum).
  • Continue digitization of future presentations for post-hoc viewing via the VPC.

Goal 5:  Monitor the implementation of the State Trauma Registry and use of the TBI Medicaid Waiver.

  • Provided written comments to the state Medicaid office concerning policy changes to the TBI Medicaid waiver based on the Deficit Reduction Act.
  • Sunset provision for Trauma Registry lifted during the FY07 legislative session.

Cross-Goal accomplishments

  • Served on a NASHIA pre-conference grantee meeting that focused on veterans with a TBI.
  • Participated in a Center for Disease Control (CDC)-sponsored pubic awareness conference call entitled “Helping Seniors Live Better Longer: Prevent Brain Injury Project.”
  • Presented on the status of TBI in Idaho at the National Rehabilitation Association summer conference.
  • Presented at the Veterans Service Officer Annual Training Conference.
  • Incorporation of Veterans’ information into Idaho’s TBITAC profile, NASHIA’s Technical Assistance Resource Tool “Assisting Veterans with Traumatic Brain Injury.”
  • Developed a fact sheet on pediatric brain injury and trauma for the National Traumatic Stress Network.
  • Developed of an Idaho-based TBI support group list.
  • Presented as part of a “Veterans with TBI” Learning Community for discussion on who from service organizations should sit on TBI statewide advisory boards.

Traumatic Brain Injury in Idaho:
A Longitudinal Analysis of Needs and Resource Assessment Data (2001-2011)

LINKAGE TO GOALS OF CURRENT GRANT:  This project is an effort to complete a longitudinal analysis of the seven statewide Needs and Resources (N&R) Assessments completed from 2001 to 2011.  

BACKGROUND:  The first N&R was conducted in 2001, focusing on why individuals with TBI were not receiving various services, how satisfied those receiving services were with the services received, and in what areas additional services were needed. Subsequent surveys completed in 2004, 2005, 2006, 2007, 2008 and 2011 focused on similar issues, replicating many of the data categories over time.  During each of those years, individuals with TBI (or a family member) and providers concomitantly completed separate surveys. The longitudinal data gathered from the surveys tracked which services were available, which services were needed, which were provided, and which needs went unmet. Consumer and provider data were analyzed both individually and together. This crossed analysis improved the reliability of estimates in regard to supply (by providers of services) and demand (by individuals with TBI).

METHODS: Data were collected by mail and internet survey. Individuals with TBI provided information on demographics, service need and utilization of provided services. Providers were queried about the type and number of services provided by their organizations or agencies.

QUESTIONS OF INTEREST: The report sought to answer three main questions: 1) Do the reported needs and resources change across time? 2) Do the reported services and supports change across time? and 3) What is the quality of match between the reported needs and resources and the available services and support?  

ANALYSIS AND RESULTS: Longitudinal analyses of variance and frequencies were examined to measure change across time and the match between services used and services available.  The most consistently met needs were reported under the nursing care and personal care assistance categories.  Other categories of need, such as employment supports and mental health services, were reported to be problematic for as many as 1 in 4 of the respondents.  Psychiatric care was identified as particularly lacking in rural Idaho, with many areas having no immediate access to psychiatric care and much lower patient-to-provider ratios than those necessary for adequate care.  Across the decade, the relationship between met and unmet needs was dynamic and changed frequently, with providers reporting that the most significant changes in service provision reflected reduced community-based services.

Comparison of Intentional Deaths (Suicide) and Unintentional Motor Vehicle Traffic Deaths with and without Traumatic Brain Injury as an Underlying Cause 

PURPOSE: This study increases understanding of the complex nature of injury-related death when traumatic brain injury (TBI) is present and compares number of deaths and rate of TBI across two types of injury-related death: intentional and unintentional by motor vehicle traffic (MVT).

QUESTION OF INTEREST: What is the nature of the relationship between MVT deaths and TBI across time, geography, economics, and intent of injury?

BACKGROUND: Injuries are a leading cause of death for all age groups. MVT deaths are the most common fatal unintentional injuries. Some MVT deaths are assumed to be suicides, but there is a scarcity of information about MVT deaths as a mechanism of suicide. Both unintentional and intentional injuries theoretically should have high rates of TBI, but there is little supporting literature. Research links the economy and suicide, with some research linking MVT deaths and the economy. Injury should also vary by state and level of urbanism.

METHODS: A literature review was conducted on intentional and unintentional death with TBI. Additionally, coroners were informally interviewed about how TBI is reported as an underlying cause of death (UCD) and data were integrated with national data on coroner reporting. Cause of death public use data files from the CDC and other government sources at national and state levels were analyzed for Jan. 1, 1999 – Dec. 31, 2010. Classification codes for UCD and TBI were drawn from CDC criteria. Data were stratified by state, year, and urbanism, and were not stratified across age, sex, or race. Economic indicators were calculated at the state level. The CDC WISQARS economic report system was the used to estimate the costs of MVT deaths and suicides, employing a ten-year average (base year 2005) of percent of suicide and MVT deaths that include TBI. Qualitative findings were integrated with national data and quantitative data were analyzed statistically. A multivariate analysis of variance was conducted using suicide and MVT deaths counts by year and by state.

RESULTS AND DISCUSSION: Because of variability in training, background, and algorithms for determining cause of death, it can be difficult for coroners to identify or record TBI among multiple causes of death. Prior to 2009, MVT deaths outnumbered suicide; after 2009, suicide outnumbered MVT deaths both nationally and in Idaho. There is an inverse relationship between MVT deaths and suicide deaths across time. Deaths by suicide and by MVT are similar in prevalence. About half of total MVT death costs include TBI as an UDC. Similarly, about half of the costs of suicide are from suicides with TBI. Conclusion: MVT deaths, while similar in prevalence to suicides, receive more public health attention in safety and prevention, possibly owing to lack of awareness and stigma surrounding suicide. Better TBI coding and further study of TBI as a risk factor for suicide, as well as identifying links among suicide, MVT deaths, and TBI, could reduce risk of suicide attempts or completions by directing prevention toward TBI. There is scant literature on the prevalence of using a motor vehicle as a mechanism of a suicide death, with major differences by state. State-level prevention could be aided by examining characteristics of states. Intentional and unintentional accidents are similar in prevalence, yet it is likely that people would estimate motor vehicle accidents to be far more common than suicide. Stigma and cultural prohibitions may make it easier to talk about MVT deaths than suicide, evidence that suicide affects many more people than society realizes.