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 gabriela.Lawrence-soto@massmail.state.ma.us

www.mass.gov/mrc

Liz Harnois Elders Information and Resource Specialist

Brain Injury Association of Massachusetts Tel: (508) 475-0032 ext. 14

lharnois@biama.org www.biama.org