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Michigan TBI Implementation Project

Southeastern Michigan Traumatic Brain Injury System (SEMTBIS)

Ohio Regional TBI Model System

Michigan Protection and Advocacy Services (MPAS)

Traumatic Brain Injury Model System (TBIMS)

Michigan TBI Implementation Project
(Partners: Department of Community Health, Family Independence Agency)

In April 2001, the Michigan Department of Community Health (MDCH) received a grant from the Health Resources and Services Administration-Maternal and Child Health Bureau for the purpose of increasing knowledge about Traumatic Brain Injury (TBI) and access to services throughout Michigan. MDCH is working with the Family Independence Agency and BIAMI to meet the goals of the grant as described below.

In order to provide a common understanding of the problem , the Michigan Resource Guide for Persons with Traumatic Brain Injury and their Families (MRG) has been printed and distributed to over 500 agencies and organizations throughout Michigan. This guide includes information on many statewide services available to persons with TBI. Information about eligibility and who to contact is included for organizations providing one or more of the following services: assessment and rehabilitation, advocacy, legal services, assistive technology, living and care, education, transportation, substance abuse and mental health, respite and vocational rehabilitation.

To create greater awareness, two brochures have recently been reprinted: Resources for Persons with Brain Injury and Their Families and Important Information about Working with Persons with TBI and Their Families.

Acknowledging the diversity of the state, the MRG and the brochures will be available in Arabic and Spanish in December 2002. Contact BIAMI at 1-800-772-4323 to request free copies of any of these products.

Two pilot regions have been chosen to test a training curriculum for both service providers and consumers. One region includes all of the Upper Peninsula and the other includes Southwestern Michigan. Three trainings for service providers took place in October: one in the U.P. and two in Southwest Michigan. Providers from the following agencies participated: Community Mental Health, Family Independence Agency, Area Agency on Aging's Waiver Agents, and public schools. Service providers were instructed on characteristics to look for to identify persons with TBI, strategies for working with persons with TBI and understanding some of the obstacles persons with TBI and their family members or support systems face. A portion of the training was devoted to identifying barriers that occur in public agencies, and finding solutions to those barriers.

Training, specifically for persons with TBI and their families will be scheduled in Southwest Michigan for December, and a second training will be scheduled in the Spring for the U.P. The trainings for persons with TBI and their families will focus on describing the services that are available in Michigan. The trainings will also discuss the steps that must be followed to apply for these services.

Another task of the grant is to collect data regarding the incidence of TBI and the medical expenses related to treatment for TBI. The project’s data committee has examined data from hospital emergency rooms across Michigan and will also be examining Medicaid claims and private insurance company claims for cost of treatment related to TBI.

The final goal of the grant is to present recommendations for changes in policy that will make accessing services for persons with TBI easier and allow agencies to work together to provide coordinated care and maintain a reasonable level in the overall cost of care for persons with traumatic brain injury.

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Southeastern Michigan Traumatic Brain Injury System (SEMTBIS)
(Partners: Wayne State University, Rehabilitation Institute of Michigan)

The Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), housed at the Rehabilitation Institute of Michigan, was recently awarded a 5-year grant totaling $1.8 million, from the National Institute on Disability and Rehabilitation Research (NIDRR). The grant earns RIM the rare distinction of being one of only 16 centers of excellence in the country for the care and research of those with traumatic brain injury (TBI).  This competitive renewal represents the fourth cycle of funding for SEMTBIS, since the NIDRR TBI Model Systems program began in 1987. SEMTBIS is one of only three centers in the country to be continually funded by NIDRR since the program's inception.

SEMTBIS, is a federally funded TBI "model system" (TBIMS) of care for individuals who sustain a traumatic brain injury and is a joint effort between Rehabilitation Institute of Michigan, Wayne State University's School of Medicine, Detroit Receiving and Sinai-Grace Hospitals.  This unique partnership between an expert trauma center and a leading rehabilitation facility allows for the efficient and continuous care of people with traumatic brain injuries and their families. The potential benefits of participation in a TBIMS include:

The primary purpose of the SEMTBIS is to expand and enhance our comprehensive, multidisciplinary model system of care, largely through involvement in innovative research activities aimed to improve outcomes for persons with TBI and their families. Research findings are utilized to develop, implement, and improve current intervention strategies, as well as to create and expand service delivery options. SEMTBIS conducts ground-breaking research in the field of physical medicine and rehabilitation, sharing the resulting innovations with other traumatic brain injury professionals and researchers throughout the world. This ongoing research is vital to future advances in the treatment of brain injury.

A variety of new research projects were proposed by SEMTBIS staff and approved for funding during the next grant period. The SEMTBIS proposes to conduct multifaceted research projects with a strong focus on one of the research agenda items in NIDRR’s Long Range Plan, also described in the New Freedom Initiative: Full Access to Community Life. These studies address different aspects of life post-TBI, including adjustment, coping, support, and community integration. These research activities specifically focus on (1) the effectiveness of peer mentoring for survivors and significant others with respect to gaining knowledge of TBI and skills to access available resources, quality of life, and community integration; (2) characteristics of the survivor and caregiver family dynamic that may affect community reintegration; and lastly, (3) barriers to the resumption of driving following TBI, including the validity of various methods of driving evaluation, and the role of driving in community reintegration . The projects include the use of satellite videoconferencing capabilities as part of the educational program for community and mentor participants in the Peer Mentoring Project, as well as a state-of-the-art driving simulator in the Resumption of Driving Study.

In addition to conducting innovative research, the SEMTBIS will continue to expand and enhance the existing TBI model system of care through the implementation and development of several initiatives. These activities include, but are not limited to, developing consumer education classes, enhancing the SEMTBIS website (www.semtbis.org), continuing to build collaborative relationships with the Brain Injury Association of Michigan and Michigan's TBI Advisory group, disseminating the SEMTBIS newsletter "Thinking Cap", participating in local, state, and national TBI conferences, and publishing manuscripts and other written materials related to multiple aspects of TBI that may be of interest to survivors, families, caregivers and professionals.

The SEMTBIS staff is very enthusiastic and optimistic about the upcoming grant cycle. The 2002-2007 TBIMS grant cycle assures many opportunities to expand TBI knowledge through local and collaborative research, as well as offers the prospect of enhancing current TBI services and community outreach activities.

For more information about SEMTBIS and/or the TBIMS program, please contact Deborah Wood, M.S., TBI Outreach Coordinator at (313) 745-1188 or e-mail dwood@dmc.org.

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The Ohio Regional Traumatic Brain Injury Model System

The Traumatic Brain Injury (TBI) Model Systems program is funded by the National Institute on Disability and Rehabilitation Research (NIDRR) and has the mission to improve the quality of life of people who experience TBI and their families by creating and disseminating new knowledge about the course, treatment and outcomes of this condition. At the heart of the program is a long-term, longitudinal study of patients who receive rehabilitation for TBI. Consenting patients are followed 1, 2, 5, 10 and every 5 years thereafter to learn about the long-term effects of moderate and severe TBI. Founded in 1987, there are currently 14 TBI Model System centers around the country. The Ohio Regional TBI Model System was first funded in 1997 and was recently selected to continue as a Model Systems Center for the next 5-year cycle.

The Ohio Regional TBI Model System is located in the Department of Physical Medicine and Rehabilitation at the Ohio State University Medical Center. John D. Corrigan, PhD, is the Principal Investigator (PI), Jennifer Bogner, PhD, is the co-PI and Director of Research, and W. Jerry Mysiw, MD, is the Medical Director. The project operates under the umbrella of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation, which provides a means for consumer participation via its 30-member Advisory Council. Composed primarily of consumers from a multi-state region, the Advisory Council prioritizes needs, reviews funding opportunities, participates in grant implementation, monitors progress and evaluates program outcomes.

The Ohio Regional TBI Model System serves a catchment area consisting of 2.5 million people in a 25-county area covering central and southern Ohio. All three Level I trauma centers in the region, and one of two Level II centers, are participants in the Ohio Regional TBI Model System. Brain injury rehabilitation is provided in the 24-bed, CARF-accredited, specialized Brain Injury Unit in the OSU Department of Physical Medicine and Rehabilitation. Post-acute treatment and follow-up are provided through the department’s Brain Injury Clinic, the outpatient NeuroRehabilitation program, and the TBI Network, a specialized treatment program for persons with TBI and substance use disorders.

Over its 10 years of involvement in the TBI Model Systems Program, the Ohio Regional TBI Model System has recruited almost 600 patients into the National Dataset, and more than 200 5-year follow-ups have been completed. By the end of the upcoming funding cycle we expect to have enrolled 900 patients from the OSU Medical Center in the longitudinal study.

The Ohio Regional TBI Model System has made other valuable contributions to the TBI Model Systems via local and multi-center research projects and participation in leadership positions among the Model Systems Centers. For the upcoming 5-year cycle of funding, Dr. Corrigan has been elected by his fellow Project Directors to Chair the TBI Model Systems Executive Committee. Among other responsibilities, he will represent the centers’ concerns to the public, funding bodies and other national organizations concerned with the long-term effects of TBI.

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Michigan Protection and Advocacy Services (MPAS)
(Partners: Michigan Protection and Advocacy)

Approximately fifty percent of people who acquire TBI are covered by Michigan's no-fault auto law which provides a life-time of needed services and supports. Those who did not acquire their brain injury through an auto accident depend on private insurance and/or the public heath system. For a person with a traumatic brain injury, accessing public services can be a difficult, and many times futile, process. Community Mental Health Service Programs (CMHSP's) provide local, public mental health services. Because CMHSP's do not have an identified funding source for serving people with TBI, individuals with TBI are often denied services stating that the person is not eligible because he or she does not have a developmental disability, serious emotional disturbance, or serious mental illness.

Focus Areas

On April 30, 2001, the Michigan Department of Community Health issued a technical assistance consultative advisory to CMHSP's stating that traumatic brain injuries could be classified as a developmental disability, a serious emotional disturbance, or a serious mental illness. This advisory has increased access to local CMHSP services, but people with TBI are still frequently denied access to these services. Also, the Family Independence Agency, which determines Medicaid and SSI/SSDI eligibility, often do not understand how to assess traumatic brain injuries.

The next identified area involves lack of discharge planning from congregate care facilities, such as, residential rehabilitation facilities, nursing homes, and state psychiatric and developmental disability facilities. Without proper discharge planning, a person can remain in a facility much longer than is necessary. At times, persons with disabilities are discharged without a plan for where the person will go, what supports and services they’ll need, and who will provide the services and supports

The last focus area of need is training for people with traumatic brain injuries, their families and advocates. In the focus groups conducted, people with TBI and their families identified a strong desire to learn more about the system and access to advocates who can help them get services and supports. Understanding and navigating the public health system can be very complex and frustrating. The more knowledge people have about their rights, the services available, and how to access these services, the more successful they will be in getting what they want and need to fully participate in their communities.

MPAS will address these focus areas in several ways: direct representation, TBI Advocacy Network, training, technical assistance, information and referral, and system-based advocacy.

What is Michigan Protection and Advocacy Service, Inc. (MPAS)

Michigan Protection and Advocacy Service, Inc. (MPAS) is the federally designated protection and advocacy (P&A) system in Michigan. The P&A system is a nationwide network of nonprofit corporations and state agencies providing information and advocacy to individuals with disabilities. Under federal law, each state and territory must designate a P&A program.

Federal mandates require that P&A programs have access to a full range of remedies for the individuals they serve, including information and referral, training, negotiation, monitoring, administrative actions, and legal remedies. In addition, Federal law gives P&A programs access to individuals, their records, and programs when necessary to carry out their mission of investigating and redressing abuse and neglect of P&A customers.

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Traumatic Brain Injury Model System (TBIMS)

The Traumatic Brain Injury Model System (TBIMS) program was created and funded by the National Institute on Disability and Rehabilitation Research (NIDRR) in 1987 to demonstrate the benefits of a coordinated system of neurotrauma and rehabilitation care and conduct innovative research on all aspects of care for those who sustain traumatic brain injuries. Each Center systematically collects important data about each individual who meets criteria for inclusion in the TBI National Database and sends this information to the TBI National Data Center at KMRREC. The Centers are currently located at 16 sites throughout the United States that provide comprehensive systems of brain injury care to individuals who sustain a traumatic brain injury, from acute care through community re-entry. The mission of the TBIMS is to improve the lives of persons who experience traumatic brain injury, their families and communities by creating and disseminating new knowledge about the course, treatment and outcomes relating to their condition.

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