1. Grant Purpose
To improve health outcomes, following a traumatic brain injury, by building a TBI-informed system of services and supports, and through the utilization of Resource Facilitation.

2. Indiana State Department of Health (ISDH) is the Lead Agency
ACL Grant
Indiana State Department of Health (ISDH) is the Lead Agency
Goals:
Improve health care outcomes following TBI
Prevent substance abuse, especially opioid misuse
Prevent institutionalization, including incarceration and out-of-state residential placement
Strategies:
Research on the Efficacy of Resource Facilitation for Health Outcomes
Indiana TBI Advisory Board
Mentoring other States

3. Grant Project Leadership & Organization
ACL Federal Project Officer: Dana Fink
Project Director: Katie Hokanson, ISDH
Epidemiologist: Jeremy Funk, MS, ISDH
Principal Investigator: Lance E. Trexler, PhD, RHI
Research: Devan Parrott, PhD, RHI
Indiana TBI Advisory Board: Laura Trexler, OTR, RHI RF, State Mentoring
Indiana TBI Advisory Board: Judy Reuter, RHI
TBI Outcomes
Research
Indiana TBI Advisory Board
State Mentoring

4. ACL Grant Consultants
Flora Hammond, MD, FACRM, Chair, Department of PMR, IU School of Medicine and RHI
Summer Ibarra, PhD, Clinical Director, RHI Departments of Rehabilitation Neuropsychology and Resource Facilitation
Jess Fann, MD, MPH, Professor, Department of Psychiatry and Behavioral Sciences, University of Washington
Stephen Sutter, President, CreateAbility Concepts

5. Resource Facilitation: Acute to Chronic Care Continuum
Acute and Clinical Services
community-based Services
Resource Facilitation
Follow-Up
Follow-up
E.g., Mental Health, employment services
E.G., PCP and Neuropsychological Treatment

6. The Resource Facilitation Team at RHI…
Supports the individual’s health, return to community, return to school, and return to independence goals through an integrated team approach
Serves to build & strengthen the individual’s continuum of care
Facilitates communication among/between continuum partners

7. The Resource Facilitation Team at RHI…
Routinely, and on a scheduled basis, provides guidance, assistance, resources and support to individual’s, support person(s), care partners
Is composed of specialists trained in brain injury recovery/rehabilitation, who offer BI related education to the individual, support person(s), care partners, state agency personnel, and community partners
Help bridge the gap(s) in the recovery journey…

8. Acute Care Return to Life

9. ACL Grant - RF Model TBI Collaborative Care Team
Methodist Trauma Center
TBI Collaborative Care Team
TBI Integrated Care Pathway
St. Vincent’s Trauma Center
BEAM = Basic Everyday Activity Monitoring: Cloud-based interface for monitoring individualized health care metrics for surveillance of risk factors & RF outcome measures

10. Collaborative Care + RF for TBI Health Outcomes
Trexler, Hammond, Parrott, Trexler, and Ibarra; Indiana ACL grant (2018 – 2021)
Patient
Primary Care Provider
Consultants
PMR
Neuropsychology
Occupational Therapy
Neuropsychiatry
Resource Facilitator
Feedback to MD
Decision support
Care coordination
Monthly case supervision
Treatment adjustment
Manage treat-to-target
Motivate adherence to tx
Monitor response to tx
Ongoing Assessment
Provide access to services and supports
Negotiate tx plan
Provide follow-up and treatment adjustment
ACL grant 2018
Indiana State Department of Health Lead Agency
Primary Goal: improve health care outcomes following TBI through Resource Facilitation
Secondary Goals:
Prevent opioid misuse
Prevent institutionalization, including incarceration
Prospectively recruit 150 TBI from the trauma center and randomize 100 to Resource Facilitation (RF)
RF will navigate to a TBI-Coordinated Care Team (TBI-CCT)
PCP
Patient and Family RF
Consulting PMR and Neuropsychology
TBI-CCT will develop a care plan and metrics to me used for surveillance to ensure progress/monitor for decline
Cohort and individualized health metrics will be managed/shared between TBI-CCT participants through cloud-based application
2 years of Resource Facilitation

11. ACL Grant: Research Two Hypotheses: Primary
Individuals who receive RF will demonstrate better health outcomes
Health-related quality of life
Level of disability
Secondary
Individuals who receive RF will demonstrate less opioid misuse
Individuals who receive RF will have lower incidence of incarceration

12. ACL Grant: Research Methods:
Randomized Controlled Trial (RCT) study with outcome assessments, performed by blinded researchers, at end of treatment and at 3-month follow-up.
150 individuals with traumatic brain injury will be recruited from trauma center(s).
100 individuals will be randomly selected to receive Resource Facilitation and 50 individuals will received standard follow up care as usual.
12 months of Resource Facilitation & 3 month follow-up.

13. RF Model An Initial Assessment will drive Resource Facilitation Goals
Ongoing observation and treatment monitoring will determine the level of concern/risk for each individual, as well as the intensity and type of care and follow-up needed

14. RF Model The TBI Collaborative Care Team:
Primary Care Physician, Client and Resource Facilitator
Consultants:
Physical Medicine and Rehabilitation Physician
Clinical Rehabilitation Therapist
Rehabilitation Neuropsychologist
Neuropsychiatrist

15. Anticipated Outcomes
Improved health outcomes, decreased level of disability, and decreased health care costs.
Improved outcome for TBI- informed treatment (e.g., mental health outcomes).
Decreased incarceration and institutionalization.
Decreased substance abuse, especially opioid misuse.

16. ACL Grant: Additional Aspects
Mentor other States in Resource Facilitation
Outcomes Measurement Task Force
Annual Webinar on RF
Workgroups
Using Data to Connect People to Services
Transition and Employment

17. ACL Grant: Additional Aspects
TBI Advisory Board
Composition
Individuals with TBI and caregivers
State Agencies
Relevant provider and professional organizations
Indiana TBI State Plan
Consultation-Feedback on ACL Grant & Indiana TBIMS Grant

18. Indiana TBI State Plan Mission statement:
To develop, implement and provide oversight for a statewide coordinated care structure for Traumatic Brain Injuries (TBI) aiming to:
Reduce the number of injuries.
Improve the care and outcomes of TBI patients.
Increase the access to resources and rehabilitation for TBI patients
Provide Evidence-based education to patients and families of those with TBIs. .

19. Indiana TBI State Plan Vision: Core values:
Prevent Brain Injuries & improve long-term outcomes of TBI patients in Indiana.
Core values:
Health promotion and prevention.
Data collection, analysis, and information dissemination.
Evidence-based best practices for public health promotion, training, and health care quality.

21. Disclosures
Funding for this presentation was made possible (in part) by the Administration for Community Living. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.