TBI in Alaska Presentation

Grace Snider

Resource Navigator Program Director 907-274-2824 toll free: 888-574-2824 grace@alaskabraininjury.net

Alaska Brain Injury Network, Inc.  Track needs of Alaskans  TBI survivors/family members

are the experts.

 Make recommendations to

Department of Health and Social Services and the Alaska Mental Health Trust

 Bring brain injury services close

to home

 Prevention First!

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 Information and Referral  Online Resource Directory and

Library Materials  Online Discussion Group  Library  Advocacy  Network of consumers, professionals, policy makers, and advocates to make systems change!

ABIN Mission: Educate, plan, coordinate, and advocate on behalf of survivors of TBI and their families

Special thank you to: Alaska Native Tribal Health Consortium Injury Prevention Program

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Traumatic Brain Injury in Alaska: Who, How and Where

Alaska Native Tribal Health Consortium Injury Prevention Program

What is a Traumatic Brain Injury?

CDC describes it as: “…caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.”

How do you get a TBI? Many different kinds of events, some that are almost everyday events, can cause a TBI:  Hitting your head when you fall or trip  Crashing your bike, snow machine or ATV  Being in a motor vehicle crash  Injure your head during sports  Being near an explosion

How does a TBI affect you?

If you or someone else gets a TBI, it can cause temporary or permanent changes in:  Thinking (remembering and reasoning)  Physical abilities (walking, coordination)  Sensation (touch, taste, smell)  Language (understanding, communication)  Emotion (depression, aggression, anxiety)

Increased Risk of TBI

Who?

The Gender Gap

Non-fatal TBI Hospitalizations in Alaska 2004-2008

Age Differences

Non-fatal TBI Hospitalizations in Alaska 2004-2008

Age groups and Activities Different age groups have different activities that result in the highest numbers of TBI: Ages (years)

Activities with the most TBI

0-9

Falls

10-19

Motor vehicle, ATV/Snowmachine

20-39

Motor vehicle, Assault

40+

Falls, Motor vehicle

Increased Risk of TBI

Where ?

Region of Patient Residence Non-fatal TBI Hospitalizations in Alaska 2004-2008* All U.S. Rate**: 93 All Alaska Rate*: 92 Alaska Native Rate*: 174 * Crude rates, reported as TBI per 100,000 people ** All U.S. rate for 2002-2006, per CDC.

Specific places of occurrence Non-fatal TBI Hospitalizations in Alaska 2004-2008 Residential Institution

Other

Recreation Sports

Highway

Industrial Place

Public Place Home

Increased Risk of TBI

Is Alcohol a Risk Factor?

Yes

Alcohol Association by Age Non-fatal TBI Hospitalizations in Alaska 2004-2008

Alcohol by Activity

Non-fatal TBI Hospitalizations in Alaska, 2004-2008

ACTIVITY

Cases associated with alcohol

Assault

3 out of every 4

Suicide attempt and Snow machine

1 out of every 2

Pedestrian and All-terrain vehicle

2 out of every 5

Motor vehicle traffic

1 out of every 3

All other

1 out of every 5

Alcohol by Activity

Non-fatal TBI Hospitalizations in Alaska 2004-2008 ACTIVITY

Total Cases

Percent of cases associated with alcohol

Assault

375

72%

Snow machine

121

49%

Suicide attempt

27

48%

Pedestrian

108

41%

All-terrain vehicle

240

39%

Motor vehicle traffic

644

32%

Bicycle

132

23%

1034

18%

408

18%

Falls All other

Increased Risk of TBI

How severe?

Time in Hospital For TBI hospitalizations from 2004-2008, the length of time patients spent in the hospital: Average: 5.6 days (compared to 3.9 for non-TBI injuries) Maximum:

305 days (10 months)

Patient destination at discharge Non-fatal TBI Hospitalizations in Alaska 2004-2008 71

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29 97

Home,No Assistance

83

Acute Care Hospital 162

Inpatient Rehabilitation Skilled Nursing

521 2082

Home,Rehab Outpatient Home,Health Care Left against medical advice (AMA) Other or unknown

Patient’s General Condition on Discharge Condition

Frequency

%

Good, Return to Previous Level of Function

861

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Temporary Disability, Expected to Return to Previous Level of Function

1111

36

Moderate Disability with Self Care

133

4

Severe Disability, Dependent

155

5

Persistent Vegetative State

4

.1

Unknown

825

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Risks of TBI

How much $$?

Hospitalization costs Hospitalization costs for TBI in all Alaska averages $29,000 per injury, compared to the $20,000 average for all injury hospitalizations Estimated total per year: $16.7 million Highest hospitalization cost for TBI: $1,010,000

Medivac costs These costs vary dramatically depending on the contract with the Medivac company.

These are cost ranges Alaska companies provided for actual trips taken: Juneau to Seattle:

$17,000 to $37,000

Anchorage to Seattle:

$27,000 to $56,000

Nome to Seattle:

$37,000 to $75,000

Anchorage to Richmond, VA:

$63,000 to $124,000

Prevention

What is being done?

Snowmachine, ATV, and Motorcycle Safety

Child Motor Vehicle Safety

Reducing harm from guns Gun Safes

Home Safety Survey Date:

Resident:

Assessment by:

This Home Safety Survey is designed to look for hazards in and around the house so they can be fixed before they cause problems. Home safety problems could lead to unintentional injuries from falls, burns, or poisoning. Falls can be a major problem for an elder. Falling can result in serious injury or loss of independence. This survey can be done by a CHA/P, CHR, or a family member.

YES

NO

Home Entrance Steps and walkways in good repair; no broken edges or boards or other hazard Secure ramp installed if resident uses a wheelchair or finds stairs difficult Exterior stairs and landing are slippery when wet Area on roof for ice/snow to accumulate and slide onto landing, stairs, or ramp Secure, sturdy railing on both sides that is easy to grasp with both hands Lights that light up a wide area of the yard and walkway

Raising awareness

Lock that does not need a key to open from inside (unless wandering is an issue) Mat, carpeting or textured floor in entryway to prevent slipping when wet Seat available for putting on and removing ice grippers or cleats Living Areas Doorways wide enough to use a walker, a wheelchair, or if carrying a load Open pathways with no small furniture, clutter, or "stuff" Throw rugs or mats Thresholds between rooms/floor textures are smooth with visible color contrast Electric phone cords running under rugs or carpeting or across open areas Frayed electric cords Electric outlets and switches overloaded (warm to the touch) Lights can be turned on without walking across a dark room

Ice cleats Home modification

Bike Safety

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Pedestrian Safety

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ANTHC Traumatic Brain Injury Contacts Jaylene Wheeler, Injury Prevention Coordinator (907) 729-3799 jzwheeler@anthc.org Hillary Strayer, Senior Injury Prevention Specialist (907) 729-3513 hdstrayer@anthc.org

Website: http://www.anthc.org/chs/wp/injprev/

Once an injury occurs…  Ideal system of care vs. Alaska’s

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CASE MANAGEMENT/ SERVICE COORDINATION

COMMUNITY

Pre -

Prevention

Trauma Alaskans suffer TBI 28% more than the lower 48

Hospital, Emergency Medical

Emergency Department

Services

Acute care Acute Care Post Acute Care

Out Patient Rehab Education Out Patient Rehab -Training

-Resource Navigator Education

Family Support Services Family Support Services Housing Housing Vocational Vocational Training/Employment Training/Employment

Physicians

Physicians

Long Term Services and Inpatient

Supports

Rehabilitation Screening

RESEARCH

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Locating needed services…  Information and Referral  Care Coordination (Case Management)  Acute and Post-acute Rehab  Education and Related Supports  Vocational Training and Rehabilitation  Long-Term Community Supports

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Alaska Brain Injury Network’s Resource Navigation Program Available to ANYONE in the State looking for resources for brain injury.

Helping people find…

 Information about brain injuries  Services to help them recover  Help brainstorming solutions  Someone to listen and understand.

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How ABIN can help you?  Information and Referral  Aka Resource Navigation!

 Online Discussion Group  Website  Resource Directory  Online Resource Library

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Resource #1: Alaskan Brain Matters  Online Discussion Group – Email Group  Group for survivors, caregivers, and providers to share

information and offer support  Dialogues that make a difference  Urgent needs met immediately (case example)  Advocacy Works! Your voices make a difference

 To join, email contact@alaskabraininjury.net

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Resource #2: Website  Website www.alaskabraininjury.net  Resource Directory  Find community resources: physical therapists, occupational therapists,

speech therapists, vision therapy, biofeedback, counseling, assessment, independent living centers, accessibility, state agency programs, vocational rehab, and more.

 Library of articles  Find educational materials for various topics.

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Head Injury Support Groups  Juneau:

Margie Thomson/SAIL

(907) 796-6465

 Anchorage:

Frank Box, Access Alaska

(907) 263-1905

 Fairbanks:

Access Alaska

(907) 479-7940

 Mat-Su: Angie Boardman Access Alaska/Mat-Su Health Serv.(888) 574-2824  Homer:

Cathy Stingley, Thoughtful Therapies

(907) 235-6226

 Ketchikan:

Pat Chapman

(907) 617-5704

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Mentoring  Similar Experiences  Share what resources and supports that have worked for

them

 Don’t feel so alone  A Friend

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Information about brain injuries  Trust Training Cooperative  Acquired Traumatic Brain Injury Case Management training  https://www.ttclms.org/class_detail.php?z_classid=101877

 Lash and Associates  www.lapublishing.com

 Tip cards, books, DVD’s  3rd Thursday Teleconference Training lrivard@lakeview.ws  American Academy of Certified Brain Injury Specialists,

www.aacbis.net  National Websites 44

What is being done to improve the system of care in Alaska:

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Developing Initiatives  Information and Referral (ABIN, ADRC, 211)  Case Management DHSS, Senior and Disabilities

Services (2009)  State ATBI Program (2010)  TBI Program Coordinator  Data collection  Expand Care Coordination

 TBI Training-Intro to TBI course, Advance Management in

Brain Disorders (2008)  ImPACT-concussion management, Alaska Neuro Associates  Public Awareness- Callan Chylook-Sifsof, television commercials, newspaper ads, posters.

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The Alaska Acquired and Traumatic Brain Injury Program SB 219 – ATBI Program  "An Act establishing a traumatic or acquired brain injury program

and registry within the Department of Health and Social Services; and relating to medical assistance coverage for traumatic or acquired brain injury services."

 SB 219 Introduced by Senator Lesil McGuire, family

member of a TBI survivor, January 19, 2010, added “acquired” brain injury - ATBI

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The Alaska Acquired and Traumatic Brain Injury Program SB 219 – ATBI Program

 State responsibilities under SB 219  Assessment of the scope, availability and effectiveness of

current ATBI services

 Supervision, coordination and expansion of ATBI services  Development of standards for prevention and treatment

of ATBI

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The Alaska Acquired and Traumatic Brain Injury Program SB 219 – ATBI Program

 State responsibilities under SB 219  Development and maintenance of an ATBI Registry to track

the status and outcomes for people served by the ATBI Program

 The addition of targeted case management as a

Medicaid service for people with ATBI, which will require SDS to develop standards and regulations for delivery of this service ($1.2 million fiscal note)

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What works for you?

Case by Case basis  Difficult to know what will work for someone until you get      

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to know them.

Find colleagues to brainstorm with.

Get comfortable with ambiguity. (from Dr. Jeffrey Barth) Recognize and embrace the complexity of TBI and treat it as a challenge to your scientific and clinical skills. (from Dr. Jeffrey Barth) Feel free to contact me.  Jennifer at 907-274-2824 jennifer@alaskabraininjury.net

Troubleshooting brain injury…

• Understanding the symptoms • Brainstorming solutions

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What you might see after TBI  Four areas of effects  Physical  Linguistic  Cognitive  Emotions and Behaviors

What you might see: physical effects  Headaches  Fatigue  Sleeping in class  Seems tuned out  Physical weakness  Seizures  Clumsiness

What you might see: language/linguistics  Difficulty finding the right word  Cocktail party language  Receptive or expressive language

What you might see: cognitive effects  Distractibility

 Memory

 Motivation

 Reasoning

 Following directions

 Judgment

 Organizational skills  Grades/work performance  Attention

What you might see: emotions and behaviors  Irritability, angry outbursts, impulsivity  Aggressive acting out  Passive behavior  Social immaturity  Sexually inappropriate behavior  Depression  Frustration  Disinhibition  Self monitoring  Interpreting social cues

What can we do?  Shorter day

 Frequent breaks  Person driven solutions  Build in success

What can we do?  Shorten tasks/assignments  Be flexible with expectations

What can we do?  Follow routine  Daily schedule/picture schedule

What can we do?  Minimize distractions  Give choices  Limit changes  Predictability

What can we do?  Use cues!  Visual  Tools  Planner  Computer  Watch/alarm  Timers

 THANK YOU FOR YOUR TIME