PARTNERSHIPS AND CHALLENGES IN BUILDING CAPACITY FOR ELDERS WITH TBI THROUGH TRAINING By Gabriela Lawrence-Soto, Massachusetts Rehabilitation Commission Liz Harnois, Brain Injury Association Of Massachusetts
PARTNERSHIPS AND CHALLENGES IN BUILDING CAPACITY FOR ELDERS WITH
TBI THROUGH TRAINING
By Gabriela Lawrence-Soto, Massachusetts Rehabilitation Commission
Liz Harnois, Brain Injury Association Of Massachusetts
SYSTEM OF CARE FOR TBI IN MA MRC is the Lead State agency for Brain injury services in MA. MRC and BIA-MA together are make up the system of care for TBI in MA. The Statewide Head Injury Program is now housed under the Community Based Services (CBS) Department. The department provides community support and services for individuals with brain injuries (BI) and a variety of disabilities in order for them to live as independently as possible. The department programs also include: Rolland Services, Traumatic Brain Injury in Elders (TBI) Implementation Grant, and 3 HCBS waivers (the TBI Waiver, an Acquired Brain Injury (ABI) community waiver and an Moving Forward Plan (MFP) community waiver.
TBIs continue to go underdiagnosed or misdiagnosed.
Statewide epidemiological study released in 2014 • Revealed Northeast and Metrowest area of the state has the highest incidences of TBI.
MRC and BIA-MA wanted to better support the needs of elders with TBI and the knowledge of those working with elders.
• SHIP services were initially designed for a younger population. • Elders in SHIP made up less than 4%. • SHIP clients are aging in place. • SHIP staff may not know how to navigate the elder service system.
ADRC staff are serving elders with TBI – and often, unknowingly. • Understand TBI enough to be able to implement strategies that will allow staff to maximize
delivery of ADRC services provided in the community.
The State of TBI in MA
http://www.mass.gov/eohhs/docs/mrc/acquired-brain-injury-ma.pdf
Review the MA Brain Injury Commission’s full report
“IMPROVING THE MA SYSTEM OF CARE FOR ELDERS SUSTAINING A TBI”
Timeline: June 2014 – May 2018
Funding source: Administration of Community Living,
Goal: To maximize existing resources in both the TBI and elder care service delivery
systems.
Vision: To enhance the “No Wrong Door” model in MA 5
This project, “Improving the MA Systems of Care for Elders Sustaining a TBI”, was supported, in part by grant number 90TBSG0001-01-00, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
OUR GRANT PARTNERS
MRC - Statewide Head Injury Program (SHIP) Brain Injury Association of MA (BIA-MA) Executive Office of Elder Affairs (EOEA)
6
ADRC of the MetroWest Metrowest Center for Independent Living HESSCO Elder Services Baypath Elder Services Inc.
ADRC of the Greater North Shore Link Independent Living Center of the North Shore and Cape Ann Senior Care Inc. North Shore Elder Services Inc. Greater Lynn Senior Services Inc.
ADRC of the Merrimack Valley Northeast Independent Living Program Elder Services Of The Merrimack Valley Inc.
PRE-TRAINING WORK Develop Training Curricula for Field Professionals • Survey Monkey Response of 363 of 435 ADRC staff as of 2015 • 100% of MRC staff
Screening Tool Selection OSU TBI-ID Screening Tool by Dr. John Corrigan in Ohio
ACE Screening Tool by the CDC
HELPS Brain Injury Screening Tool by Dr. Piccard H - Hit your Head E - Emergency room, Hospital or Doctor
L - Lose consciousness, Dazed or Confused P - Problems experienced since Hitting Head S - Sicknesses
AWARENESS PRESENTATIONS (1-1.5hrs)
TBI overview Incidence of TBI in MA vs. United States Risk Factors for the Elder population Importance of Screening for TBIs Accessing to Brain Injury Services in MA
CLASSROOM CLINICAL TRAININGS (4hrs long)
Everything above in more detail: Incidence of TBI in elder population (U.S. vs. MA).
Review the definition of ABI vs. TBI. Identify consequences of TBI on individuals and impact on families.
Provide instruction on implementation of HELPS screening tools. Explore strategies for working with TBI population.
Discuss how MRC, BIA-MA and Field staff can best work together. Review MRC and BIA-MA services and supports
WEB COURSE (7hrs) Everyone in the Classroom Clinical Training packaged
PLUS additional lessons on: Mental Health/ Psychopharmacology/ Alcohol, Drug Use and Prescription Abuse/ and Homelessness
Challenges Faced • Agencies historically worked in silos
• Overcoming biases and perceptions of MRC
• Competing demands on ADRC staff
• Leadership changes in several key areas
• Job function limitations
• High Staff turn-over in ADRCs
• Data collection constraints
• Geography - 84 town catchment area – LARGE! • Regional approach was best at times • Limited resources to go deeper at municipal level in
all towns. • We didn’t ask the ADRCs to join in the outreach
efforts early on.
Successes • Strong EOEA partnership
• Leveraging existing and new partnerships • Integrating MRC and BIA-MA into tight
knit Elder care system.
• Integrating ADRCs into TBI system of care.
• Maintaining ADRC buy-in for 4 years
• High training attendance with Incentives • Scheduled in waves • Free training sites/ onsite • Free lunch and CEUs • Created a buzz
• Archiving educational materials
• Reinforcing lesson learned
WHY TRAIN THIS WAY? Limited Trainers at MRC
• Cost (salaries, room rental, CEUs, etc.) • Travel & Distance
Staff Participation Constraints • Job role • Time • Travel
Sustainability • Content relevance and user ability • Accessible by all Statewide • Funding for maintenance needed to be achievable
Affordable
Flexible
Sustainable
TRAINING OUTCOMES Training Implemented 2015 thru 2017 • 13 Cross-Training Sessions on Elder services and Aging
• 21 Clinical Classroom Sessions completed
• 772 Field Staff trained in over 20 categories – Job Role/Function
Curriculum exposure to Target Groups across the state without the web course • 7 of 11 ILCs
• 16 of 26 ASAPs
Trend Observed • Growth in elders marked as having a “Head Trauma” in the ASAP assessment Tool Question #
2111.
G f S
SIGNIFICANCE FOR MA
The Mass Options Counseling Program • Mechanism for accessing community based
aging and disability related services Based on Staff Trained to Date • 1/3 are Statewide Options Counselors (OCs) • 34 of 57 OCs within Catchment Area remain TBI trained
OPPORTUNITIES FOR COLLABORATION Modeled after Nebraska’s Pediatric and TBI web Course – 4 Modules
Funding = Unused Year 1 Carry Over $$ + DPH grant $$
Web Course collaborators included: • Massachusetts Rehabilitation Commission
• Brain Injury Association of MA
• Subject Matter Experts
• Executive Office of Elder Affairs
• Department of Public Health – Bureau of Substance Abuse Services
• Michigan Public Health Institute
Nebraska
Module 1 – TBI 101
Module 2 - Impairments & Strategies
Module 3 - Screening for TBI
Module 4 – Public Services for TBI
Massachusetts
Module 1 – TBI 101
Module 2 – Screening & Resources
Module 3 - Mental Health
Module 4 – Psychopharmacology
Module 5 – Alcohol & Drug Use
Module 6 - Homelessness
2015 – Pediatrics and TBI 2017 – Elders and TBI
WEB COURSE DEMONSTRATION
BENEFITS OF A WEB COURSE
Flexibility • Time, depth, and expandable
Participation • Self-paced learning • Refreshing skills • Onboarding for NEW staff
Data Tracking and Analysis • Built-in Tool
• Geographical picture of where curriculum is being accessed/consumed • Level professional and types of Agencies/disciplines • # CEUs disseminated
• Gather feedback from the field on what they need • Ideas for future trainings
THE TBI MODEL OF CARE FOR OLDER ADULTS
MRC Grant Program Coordinator • Establish new partnerships • Conduct outreach • Consultant for MRC staff • Cross train MRC staff on aging
services and issues • Use guidance from Project Advisory
Board
ADRCs TBI Specialists • Implementation the HELPS
Screening Tool • Provide TBI case consultations • Facilitate brain injury referrals • Disseminate educational materials • Promote TBI trainings
opportunities
BIA-MA Elders Information & Resource Specialist • Conduct Outreach • Build up database of elder resources, statewide • Manage the Information & Resource Line: 1-844-839-7154
This project, “Improving the MA Systems of Care for Elders Sustaining a TBI”, was supported, in part by grant number 90TBSG0001-01-00, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
QUESTIONS
Gabriela Lawrence-Soto HRSA/ACL Elder Grant - Program Coordinator Massachusetts Rehabilitation Commission
Community Based Services Department Statewide Head Injury Program
Tel: (617) 204-3662 [email protected]
www.mass.gov/mrc
Liz Harnois Elders Information and Resource Specialist
Brain Injury Association of Massachusetts Tel: (508) 475-0032 ext. 14
[email protected] www.biama.org