Legislature(2009 - 2010)CAPITOL 106
02/04/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Building Alaska's Systemic Capacity to Deal with Brain Injury | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 4, 2010
3:11 p.m.
MEMBERS PRESENT
Representative Wes Keller, Co-Chair
Representative Tammie Wilson, Vice Chair
Representative Bob Lynn
Representative Sharon Cissna
MEMBERS ABSENT
Representative Bob Herron, Co-Chair
Representative Paul Seaton
Representative Lindsey Holmes
COMMITTEE CALENDAR
PRESENTATION: BUILDING ALASKA'S SYSTEMIC CAPACITY TO DEAL WITH
BRAIN INJURY
- HEARD
PREVIOUS COMMITTEE ACTION
No Previous Action to Record
WITNESS REGISTER
JILL HODGES, Executive Director
Alaska Brain Injury Network (ABIN)
Anchorage, Alaska
POSITION STATEMENT: Testified and presented a PowerPoint
entitled "Alaska is Combating Traumatic Brain Injury."
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Testified about the role of the Alaska
Mental Health Trust Authority with relation to Traumatic Brain
Injury.
PAT HEFLEY, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
Traumatic Brain Injury presentation.
DR. NIKOOSH CARLO, Intern
to Representative Bob Herron
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Read a statement from Representative Herron
with regard to the seriousness of Traumatic Brain Injury.
MARGARET CARLONI, RN
Alaska Native Medical Center (ANMC)
Anchorage, Alaska
POSITION STATEMENT: Testified to the need for better Traumatic
Brain Injury care.
SHANNON COGSWELL
Juneau, Alaska
POSITION STATEMENT: Testified as a patient to the difficulties
of Traumatic Brain Injury.
JODY WADE
Juneau, Alaska
POSITION STATEMENT: Answered questions about the challenges for
Traumatic Brain Injury support.
MARTHA MOORE, Chair
Alaska Brain Injury Network (ABIN)
Juneau, Alaska
POSITION STATEMENT: Testified about the ABIN program.
ACTION NARRATIVE
3:11:06 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:11 p.m.
Representatives Keller, Wilson, Lynn, and Cissna were present at
the call to order.
^PRESENTATION: Building Alaska's Systemic Capacity to Deal with
Brain Injury
PRESENTATION: Building Alaska's Systemic Capacity to Deal with
Brain Injury
3:11:25 PM
CO-CHAIR KELLER announced that the first order of business would
be a presentation on Alaska's systemic capacity to deal with
traumatic brain injury.
3:12:08 PM
JILL HODGES, Executive Director, Alaska Brain Injury Network
(ABIN), introduced the other panel members and mentioned that
this was the fourth year for a presentation to the legislators.
[Included in the committee packets was the PowerPoint entitled
"Alaska is Combating Traumatic Brain Injury."]
3:13:31 PM
MS. HODGES pointed to slide 2, "Past legislative hearings," and
reviewed the presentation topics since 2007, which included
"What is traumatic brain injury," "Military issues related to
TBI," and "Importance of Medicaid Waiver..."
3:14:16 PM
MS. HODGES quickly reviewed the outline of the topics and
speakers featured on slide 3, "Today's presentation."
3:15:02 PM
MS. HODGES moved on to slide 4, "TBI Systems Development in AK,"
and shared that this was a time when the Department of Health
and Social Services (DHSS), the Alaska Mental Health Trust
Authority, the Alaska Brain Injury Network, the state provider
network, and the tribal communities were all working together to
start developing TBI treatment in Alaska. She opined that this
was a good opportunity to include the military in this
partnership. She reflected on the history of the TBI movement
in Alaska, and shared that the Brain Injury Association of
Alaska was organized and advocacy begun in 1990. She pointed
out that, in 1995, the State of Alaska became much more
involved, and, with the award of federal money, an
infrastructure began to form.
3:17:45 PM
MS. HODGES acknowledged slide 5, "TBI Systems Development in AK
2000-2007," and affirmed that federal grants were the key to
development of a greater awareness for the needs. She spoke
about the formal needs assessment and the state action plan to
access federal funding for treatment of brain injury.
3:18:39 PM
CO-CHAIR KELLER clarified that this focus was for the sub acute
treatment.
3:19:00 PM
MS. HODGES, in response to Co-Chair Keller, agreed. She
continued and discussed the role of the full time brain injury
coordinator and the advocates, who formed the TBI Advisory
Board. This advisory board ultimately became the Alaska Brain
Injury Network (ABIN) in 2003. She explained that, at the time,
the Division of Behavioral Health was the lead state agency, and
it utilized brain injury screening questions to identify that
almost 34 percent of its new behavioral health clients had brain
injury. She relayed that the momentum for TBI awareness and
advocacy slowed during 2005-2007 for a variety of reasons. She
shared that this time period brought recognition of the need for
a cohesive TBI workforce.
3:21 :36 PM
MS. HODGES detailed slide 6, "Momentum builds- 2007-2009," and
said that a lot was happening very quickly. She discussed the
ten-year plan, which included hundreds of recommendations to
improve care in Alaska. She pointed to the partnership of ABIN,
the Alaska Mental Health Trust Authority, and four advisory
boards for brain injury services, which included information
referral and case management. She noted that legislation was
introduced for a Medicaid waiver, and that providers had started
meeting regularly.
3:23:02 PM
MS. HODGES directed attention to slide 7, "Key Points," and
explained that Phases 1-4 (1990-2005) focused on advocacy,
planning, and increasing awareness, while Phases 5-6 (2005-2009)
focused on direct services and workforce development. She
identified that Phase 7 (2010-2020) would focus on treatment and
rehabilitation.
3:23:59 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority, Department of Revenue, lauded the work and the
advocacy by Ms. Hodges on behalf of the TBI population. He
pointed to slide 10, "The Trust's Role," and noted that people
with TBI faced many of the same functional and service
limitations as several other beneficiary groups. He observed
that TBI was not mental health, disability, or senior services,
consequently, it did not fit into the existing structure. He
offered his belief that Alaska was too small to support three
separate systems of care: tribal, Veterans Affairs (VA), and
state. He opined that it was difficult to work with the VA
bureaucracy. He reported that, over the prior 10 years, the
Alaska Mental Health Trust Authority had invested $2.8 million
in brain injury systems development, with $628,000 budgeted for
FY09.
3:27:30 PM
CO-CHAIR KELLER asked for details of the designated areas for
funding.
3:27:48 PM
MR. JESSEE pointed out the difficulty of finding the available
resources. He explained that there was an information and
referral specialist at the ABIN.
3:28:22 PM
MS. HODGES reported that the FY09 funding was for: information
referral, which to date had served more than 600 Alaskans; case
management and coordination of care, which had proven to be a
cost effective means of connecting patients to care; technical
assistance for planning, which was one of the four focus areas,
and included long term care planning; anti stigma campaign,
which funded public awareness programs; workforce development,
which funded academic and vocational courses and programs; and
the ABIN.
3:31:09 PM
REPRESENTATIVE CISSNA asked how this worked in other states, and
if it was affected by Alaska's ratio of doctors to patients.
3:32:09 PM
PAT HEFLEY, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), said that he
had found that about 50 percent of the states had waiver
programs, but that some states had a limit for the number of
patients that could be served. He detailed that some waivers
focused on vocational rehabilitation. He noted that, along with
federal waivers and state general funds, funding was also from
the private sector. He shared that some care service required
very specialized training.
3:34:39 PM
MR. HEFLEY, directing attention to slide 11, "Department of
Health and Social Services Role," discussed his trip to seven
states in seven days. He reported that he had met with state,
private, and military providers. He described his visits to
acute and post acute service providers, and he emphasized that
these were now developed professions. He pointed out that 24
states had a waiver for TBI programs.
3:38:50 PM
MR. HEFLEY said that he would focus on four critical areas in
preparation for participation with the Medicaid waiver: what is
offered, how it is offered, how many people will receive the
services, and how much will it cost. He shared that there was a
huge array of services from hospital discharge to day service,
and it would be necessary to narrow down which services to be
provided. He spoke about how these services would be provided,
and indicated limits and caps that might be necessary. He
deliberated on how many people would be included for each
service, and how much would it cost. He mentioned that it was
only 13 months until the writing of renewable waivers. He
shared that many TBI patients were not receiving any
rehabilitative service.
3:41:38 PM
MR. HEFLEY reflected on his research of treatment outcomes, and
how well they worked. He reminded the committee that HHSS had
added "productive" to its overall mission. He commented that
success was often measured by an active involvement in society.
3:42:39 PM
CO-CHAIR KELLER, referring to the array of services, asked when
it was most effective.
3:43:02 PM
MR. HEFLEY said that, although more research was needed, the
studies of groups admitted to rehabilitative services right
after discharge, and admitted one year later, reflected no
significant difference in most of the treatment outcomes. The
review concluded that it was not too late to begin treatment.
He complimented the military for its excellent research and
rehabilitation work, but opined that it was often a closed
system. He referred to slide 8, "2010 Session: SB 219 and House
Companion," which the Department of Health and Social Services
was reviewing. He moved on to a discussion about maladaptive
behavior, patients who did not fit into managed programs. He
opined that many of these patients were TBI, and that DHSS and
ABIN were reviewing proposed plans for services.
3:47:35 PM
MR. HEFLEY reiterated that the upcoming waivers would be for
"true clinical services."
3:48:32 PM
REPRESENTATIVE T. WILSON asked how a person would find out whom
to call for services.
3:48:51 PM
MS. HODGES replied that it depended on the severity of the brain
injury. She clarified that most of this discussion had centered
on moderate to severe injury. She compared the Alaska response
to breaking a leg: one goes to the hospital, is treated,
receives some physical therapy, is discharged, and goes home.
She stressed that going home should not be that next step, as
the transitional level for post acute rehabilitation and therapy
was necessary, but was not currently included in the direct
Alaska treatment network.
3:51:45 PM
REPRESENTATIVE LYNN asked about the who and the where of the
aforementioned military contacts.
3:52:14 PM
MS. HODGES listed the contacts she had made at the VA, Elmendorf
Air Force Base, the Alaska Federal Health Care Partnership, the
Defense and Veterans Brain Injury Center, and the National
Intrepid Center of Excellence.
3:54:11 PM
REPRESENTATIVE LYNN suggested that she contact the Surgeon
General.
3:54:44 PM
DR. NIKOOSH CARLO, Intern to Representative Bob Herron, Alaska
State Legislature, shared that she has a Ph.D in Neuroscience,
and that TBI was important to her field. She read from a
prepared statement [original punctuation provided]:
Rep. Herron could not be here today and he asked me to
make a few comments with regard to the seriousness of
traumatic brain injury. I know that Rep. Herron was
at the Alaska Brain Injury Networks' meeting in Bethel
earlier this year and he wants to help in any way that
he can with efforts towards getting treatment to
individuals suffering from traumatic brain injuries.
· 800 Alaskans are treated in hospitals for TBI
· 34% of those treated are Alaska Native
As someone who studies the brain, I think there are a
few things about the brain that are important for you
to know:
· The brain itself is the consistency of jello and
it is protected by layers of tough tissue, then
surrounded by fluid, and finally by the skull
bones and skin.
· Egg floating in a Tupperware analogy
· A traumatic brain injury breaks through these
protective barriers and is a direct insult on
brain matter.
· The special thing about the brain is that it has
some plasticity, meaning that it is adaptable:
· Traumatic brain injury to a part of the
brain breaks the connections between that
brain region and the areas to which it
communications.
· Connections can be rebuilt through intensive
therapy.
· Treatment is critical to helping individuals cope
with TBI.
Rep. Herron is a co-sponsor on the House Companion
bill to SB 219, which will be read across the house
floor tomorrow. Some of the things this bill will do
are to establish a traumatic or acquired brain injury
registry, and provide case management for treatment.
I believe that clinical data on TBI will help
providers offer essential services to individuals
suffering from a traumatic brain injury.
3:57:53 PM
MARGARET CARLONI, RN, Alaska Native Medical Center (ANMC),
stated that she traveled throughout Alaska to teach trauma nurse
courses. She worked in TBI care and shared that there was not
much needed rehabilitation service after discharge. She said
that this was especially true in rural areas. She detailed that
self medication with alcohol and drugs was a problem. She
expressed the need for better rehabilitative care and TBI
partnerships in Alaska.
4:00:33 PM
SHANNON COGSWELL shared that she was 27 years old and had been
in a car accident in 2002. She said that she started her
physical rehabilitation at a retirement home, where she had to
re-learn to walk and feed herself. She disclosed that her dad
would leave her lists of things to do, which kept her occupied
and challenged. She thanked her mom for help with phonics,
cooking, and brain exercises during this road to recovery. She
stated that University of Alaska Southeast (UAS) had asked her
what help she needed, but that she was not capable of knowing
even that. She mentioned that UAS gave her a tape recorder, and
a person to help with notes and review after her classes. She
revealed that she was only capable of one class at a time. She
said that having a therapist was really helpful, and that neuro
biofeedback with Patrick Neary at Wellspring had brought her a
lot of success, including the retrieval of her taste, smell, and
memory. She pointed out that a consistent routine and
checklists were very important. She analyzed that she was still
very early in her recovery. She acknowledged how difficult it
had been to know where to look for help, and that without her
family, she would not have been able to succeed. She shared
that the expectation upon release from physical rehabilitation
was for her to resume her life, but that she was not even
remotely capable of that.
4:06:29 PM
REPRESENTATIVE T. WILSON asked for her suggestions of help for
the transition.
4:06:49 PM
MS. COGSWELL replied that she had to "re-learn how to live
life," and how difficult it was to get up and even remember to
eat.
4:10:43 PM
REPRESENTATIVE LYNN asked the Wades [Ms. Cogswell's parents]
what they had learned about TBI and for their suggestions of
what could be done.
4:11:05 PM
JODY WADE said that after Shannon's accident, she came home to
look for rehabilitation resources in Juneau. She shared that a
neurologist did an assessment, but that the family did much of
the work, as they did not know where to go for any help. She
reiterated the importance of maintaining a day after day
routine, with a lot of repetition. She recounted that she had
found the resources, including speech therapy and anger
management. She described the anger issues that result from
TBI, and the difficulties this brought to the entire family.
She stressed that "can't" was not a part of the vocabulary, and
that, as there were no guidelines, each day was a challenge.
Both of Ms. Cogswell's parents [Mr. and Ms. Wade] extolled the
virtues of the bio-feedback program and the success that it
brought.
4:15:20 PM
REPRESENTATIVE LYNN complimented Ms. Cogswell's parents, and
opined on the difficulties faced by TBI patients without this
support.
4:16:02 PM
MS. WADE reiterated that TBI patients had no idea of where to go
for help.
4:16:42 PM
MARTHA MOORE, Chair, Alaska Brain Injury Network, detailed that
ABIN had 18 volunteers, 6 liaisons with boards and other
committees, and 4 paid staff in Anchorage. She presented the
continuum of care which had been prepared to illustrate the gaps
of services for TBI survivors. She offered to distribute copies
to the committee. She explained that the network was diligently
trying to find out what people needed. She stressed the two
most important needs to be post acute care rehabilitation and
case management. She offered her belief that the first two
years were the most critical for maximum recovery.
4:21:42 PM
MS. MOORE summarized that ABIN had formulated a 10 year plan,
after an assessment of the gaps of service. She detailed that
the plan philosophy was not to build from scratch, but to
connect the pieces of the TBI system which already existed. She
noted that research into other agencies and other states for
existing programs was a priority.
4:23:15 PM
REPRESENTATIVE LYNN asked about the similarities between stroke
and TBI.
4:24:41 PM
MS. MOORE replied that the functional outcome and the services
were often the same.
4:25:07 PM
MS. HODGES cited that TBI was defined in federal statute in
1996, and, after that, states were required to develop a
strategy for the capacity to serve TBI patients. She pointed
out that many states had then recognized that acquired brain
injuries, such as strokes, aneurisms, and tumors, often needed
the same services as TBI. She reported that it was necessary to
have a Medicaid waiver for both, and she directed attention to
SB 219 and its House Companion bill. She clarified that
"acquired" referred to after birth, and was the umbrella
classification for both traumatic, defined as a jolt or blow to
the head, and non-traumatic, defined as a stroke or aneurism.
4:27:13 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:27 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| TBIN.PDF |
HHSS 2/4/2010 3:00:00 PM |