nashia presentation part two - ncoa...brain injury and disability program manager iowa department of...

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National Association of State Head Injury Administrators | NASHIA.org

FallsandBrainInjuriesAmongOlderAdults

Part2:Partnerships,Programs,andPublicPolicies

December 12, 2018


KeriBennett(NE),ChairNASHIATrainingandEducationCommittee

WebinarModerator

HaleighCushen,NASHIAMembershipServicesandTraining&Education

[email protected]


NASHIAisanonprofitorganizationcreatedtoassistStategovernmentinpromotingpartnershipsandbuilding

systemstomeettheneedsofindividualswithbraininjuryandtheirfamilies.

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TheRoleoftheNationalAssociationofStateHeadInjuryAdministrators(NASHIA)

u  Only organization to represent State employees working to support individuals with brain injury and their families.

u  Membership:

ª  State Employees in Various Agencies

u  Public Health, Vocational Rehabilitation, Medicaid, Mental Health, Education, Developmental Disabilities, Aging

ª  Advocacy Organizations

ª  Health Care and Service Providers

ª  Individuals and Families with Lived Experience

National Association of State Head Injury

Administrators | NASHIA.org

WhatWeDou  Advocacy

ª  Funding:TBIActprograms(ACL/CDC);NIDILRRResearch;DODResearch;andVArehabilitationprograms

ª  Legislation:TBIAct;JuvenileJusticeandDelinquencyPreventionAct;OlderAmericansAct;ViolenceAgainstWomenAct;andmore

ª  CongressionalTBITaskforceandMarchTBIAwarenessDay

u  TechnicalAssistanceª  StateTA:StatePlansandStateSystemDevelopment;DedicatedFundingSources/TrustFunds;

Registries;MedicaidWaivers;BrainInjuryCouncilDevelopment;Advocacy;andmore

ª  FederalTA:HRSATBIProgramTAC;ACLNationalCenterforAdvancingPersonCenteredPlanningSystems(NCAPPS)

u  Trainingª  Webinars:ProfessionalEthics;PersonCenteredPlanning;PartnershipswithProtection&

Advocacy;andOlderAdultFalls/BrainInjurySeries

ª  AnnualSOSConference


u  NoCosttoAttendu  CertificatesofParticipationavailablethroughNASHIA.org

ª  $10forMembersª  $15forPotentialMembers

u  RecordingAvailableª  Linkincludedinafollow-upemailª  ArchivedatNASHIA.organdNCOA.orgforlaterviewingª  CertificateofParticipationwillbeavailableafterviewing

archiveu  Q & A at the end of webinar if time allows

u  Handouts


Objectives:

u  Explorecommunity-basedprogramsandpreventioninitiatives

u  Identifystateandcommunitypartnerships

u  Highlightpublicpolicyrelatedtoadultswithtraumaticbraininjury

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Presenter from National Association of State Head Injury

ChelseaGilchrist,M.G.S.SeniorProgramManagerCenterforHealthyAging

NCOA


Presenter from National Association of State Head Injury

ThomasEagen

ResearchConsultant

NationalCouncilonAgingHealthandAgingPolicy

PostdoctoralFellow


Presenter from National Council on Aging

LizHarnois,CBISCommunityOutreach

ManagerBrainInjuryAssociationof

Massachusetts



MaggieFerguson,CRC,CBIS

BrainInjuryandDisabilityProgramManager

IowaDepartmentofPublicHealth

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SusanVaughn

DirectorofPublicPolicyNASHIA


Questions? Please send your questions to the

moderator on the chat board.


Part Two Coming Soon Falls and Brain Injuries Among Older Adults, Part 2:

Partnerships, Programs, and Public Policies

November (Date TBD) @ 12:00 pm - 1:30 pm Eastern

Part two will highlight community-based programs and prevention initiatives, state and community partnerships between professionals in the falls and brain injury prevention networks, and public policy connected to systems and partnerships.


Not a Member? Join NASHIA Today! Haleigh Cushen

Member Services and Training & Education Coordinator 205-296-8783

[email protected]

Rebeccah Wolfkiel Executive Director

PO Box 1878 Alabaster, AL 35007

202-681-7840 [email protected]

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Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 1

NASHIA and NCOA have partnered on a two-part webinar series to increase education and awareness about strategies and resources to prevent falls and brain injuries among older adults.

•  Webinar #1: Falls and Brain Injuries Among Older Adults: Connection, Prevention, and Resources •  Risk factors, screening and assessment tools, and resources for

professionals and consumers

•  Webinar #2: Falls and Brain Injuries Among Older Adults: Partnerships, Programs, and Public Policies •  Community-based programs and education initiatives, state and

community partnerships, and public policy initiatives


About NCOA

Who We Are: NCOA is the national voice for every American’s right to age well

Our Vision: A just and caring society in which each of us, as we age, lives with dignity, purpose, and security


How We Accomplish Our Mission

•  Innovative Programs: NCOA’s online and in-community programs empower individuals to take small steps that can significantly improve their daily lives.

•  Advocacy: NCOA works in a bipartisan manner to protect and improve federal programs that Americans depend on, like Medicare, Medicaid, and the Older Americans Act.

•  Partnerships: NCOA supports a national network of local partners that provide personalized services to help individuals stay healthy and economically secure as they age.

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NCOA’s Center for Healthy Aging

§  Goal: Increase the quality and years of healthy life for older adults and adults with disabilities

§  Two national resource centers funded by the Administration for Community Living q  Chronic Disease Self-Management

Education (CDSME) q  Falls Prevention

§  Other key areas: Behavioral health, physical activity, immunizations, oral health


National Falls Prevention Resource Center

§  Increase public awareness about falls prevention

§  Serve as the national clearinghouse for tools and resources

§  Support and stimulate evidence-based programs and strategies

www.ncoa.org/healthy-aging/falls-prevention/


Falls and Brain Injuries Among Older Adults Falls •  One in four Americans aged 65+ falls each year. •  Every 11 seconds, an older adult is treated in the emergency room for a fall; every

19 minutes, an older adult dies from a fall. •  In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid

shouldered 75% of these costs.

Brain Injuries •  Falls are the leading cause of traumatic brain injuries (TBI) among older adults. •  Rate of mortality due to TBI is increasing among adults over 75 years of age. •  In 2003, aggregated charges for treating TBI in old adults exceeded $2.2 billion.

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Falls and Brain Injuries Impact Quality of Life Falls can lead to •  Serious injuries, such as traumatic brain injuries, hip and spinal fractures, and broken bones •  Increased fear of falling and restriction of activities, social isolation, depression, helplessness •  Result in a loss of independence and mobility •  Falling once doubles an older adult’s chance of falling again

Brain injuries can lead to •  Worse or new cognitive impairment •  Vestibular dysfunction and gait instability or vertigo •  Fatigue •  Depression or behavioral changes •  Sleep difficulties •  Hearing or vision changes •  Migraines/Headaches


Evidence-Based Falls Prevention Programs •  Proven to help older adults reduce their risk of falling and/or fear of falling •  Programs available for older adults with low, moderate, and high risk for a fall •  Program content includes one or more of the following:

•  Cognitive restructuring •  Balance, strength, and gait training exercises •  Group discussion •  Practical solutions •  Home safety modifications •  Educational presentations from experts in the community


Effect of Programs on Participants with TBI

•  Older adult participants with TBI that attended a Tai Chi Qigong program for 8 weeks reported improvement in mood and self-esteem.

•  Older adult participants with TBI that attended a Tai Chi Chuan exercise program for 6 weeks reported reduction in confusion, anger, tension and fear and improvement in energy and happiness.

•  Veterans aged 21-48 years-old with mild TBI that attended a Tai Chi program for 6 weeks reported reduced anxiety and an increased ability to regain control of their emotions.

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Effect of Programs on Participants with TBI

•  Programs with methodical, slow, and structured movements with a mindfulness component demonstrated effectiveness in reducing the effects of TBI.

•  Participants with a TBI benefit from the social component of fall prevention programs.

•  Programs like Tai Chi have the potential benefit to reach younger populations with TBI.


§  A Matter of Balance §  CAPABLE §  EnhanceFitness §  FallsTalk/FallScape §  Fit & Strong! §  Healthy Steps in Motion §  Healthy Steps for Older Adults §  Otago Exercise Program §  Stay Active and Independent for Life

Stepping On

§  Stay Safe, Stay Active §  Tai Chi for Arthritis §  Tai Ji Quan: Moving for Better Balance §  YMCA Moving for Better Balance

Evidence-Based Falls Prevention Programs

For program information including training, costs, and outcomes, visit: https://www.ncoa.org/resources/select-evidence-based-falls-prevention-programs/


Evidence-Based Tai Chi Programs •  Tai Chi for Arthritis •  Tai Ji Quan: Moving for Better

Balance •  YMCA Moving for Better

Balance

Tai Chi Program Components •  Fitness and balance training

•  Classes are often ongoing and not limited to certain weeks

•  Does not include educational component

•  Participants should be able to stand on their own on one leg for 5 seconds

Tai Chi

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•  Ongoing, one-hour classes held 3 times per week

•  Focuses on low impact cardiovascular activity and balance/strength training and stretching

•  Classes can be taken seated or standing, and instructors are trained in how to modify the exercises to suit the varying abilities of participants

Enhance Fitness


•  Eight weekly 2-hour sessions including peer group discussion, exercise, education, and some behavior modification

•  All exercises can be done sitting or supported standing

•  Excellent for people who are fearful of falling

Matter of Balance


•  Seven weekly 2-hour classes including peer discussion, exercise, expert lectures

•  Classes include standing exercises that are done by a chair independently

•  Participant should feel safe standing and walking independently before beginning the program

Stepping On®

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•  Series of 17 strength and balance exercises delivered by a Physical Therapist or a Physical Therapy Assistant in the home, outpatient or community setting

•  Exercise and walking program tailored to the participant

Otago Exercise Program


Find a Falls Prevention Community Partner and Program Near You

• State Falls Prevention Coalitions

• Administration for Community Living Evidence-Based Falls Prevention Program Grantees


Mission: Reduce older adult

falls, fall-related injuries, and deaths in their communities or

states.

State Falls Prevention Coalitions

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U.S. Administration for Community Living Evidence-Based Falls Prevention Program Grantees, 2014- 2018

Administration for Community Living/Administration on Aging Falls Prevention Grantees: http://www.aoa.acl.gov/AoA_Programs/HPW/Falls_Prevention/Index.aspx#Awardees

•  Arizona •  California •  Colorado •  Florida •  Georgia •  Illinois •  Iowa •  Maine •  Maryland

•  Massachusetts •  Michigan •  Minnesota •  Missouri •  North Carolina •  North Dakota •  New Hampshire •  New Jersey •  New Mexico

•  New York •  Tennessee •  Texas •  Utah •  Virginia •  Vermont •  Washington •  Wisconsin •  Wyoming


Thank You!

ChelseaGilchrist,MGSSeniorProgramManager

CenterforHealthyAging,[email protected]

ThomasEagen,PhD,MPH

ResearchConsultant,NationalCouncilonAging;Fellow,UniversityofWashington

[email protected]

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www.biama.org

Presentation Highlights

•  Overview of acquired brain injury, emphasizing TBI in older adults •  Connecting falls as the leading cause of TBI in all age group; rates are highest

in those 60 and older in MA

•  Screening for brain injury, utilizing H.E.L.P.S. Tool and encouraging two-way referrals and support of the “No Wrong Door” model

•  Factors that increase fall risk and ways that older adult can reduce their risk,

using information the CDC STEADI Toolkit: •  Speaking to your healthcare provider •  Exercise, including balance & strength •  Annual eye examinations •  Improve safety of home environment

Massachusetts Falls Prevention Coalition

•  The Brain Injury Association of Massachusetts has been a natural partner and collaborator of the Falls Prevention Coalition for over 10 years

•  Met new partners from Coalition to spread awareness to other groups across MA (eg. MA-ALA)

•  Chaired the Planning Subcommittee for the Statewide

Falls Prevention Awareness day at the Massachusetts State House in 2018 & plan to in 2019 as well

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Councils on Aging

•  Through partnerships with the Executive Office of Elder Affairs, attended, shared information, and presented at the Massachusetts Association of Councils on Aging annual conference

•  Presentations for COA directors and outreach workers, at over dozen councils on aging throughout the State

•  The Brain Injury Association of Massachusetts and the Massachusetts

Rehabilitation Commission have formed relationships and spread awareness to 60/85 Councils on Aging in the ACL Elder Grant catchment area

Contact

Liz Harnois Community Outreach Manager Brain Injury Association of Massachusetts 508-475-0032 [email protected]

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IOWA’S FALLS PREVENTION & TBI

PARTNERSHIP Maggie Ferguson, MS, CRC, CBIS Iowa Department of Public Health

[email protected]

Dec 2018

Falls are the #1 cause of TBI in Iowa, and nationally

Falls in Iowa (source: IDPH, 2018)

More than one older Iowan dies each day from a fall

$38,571/person total fall-related hospitalization cost Falls contribute to decreased ability to perform household tasks, reduce quality of life and may result in loss of independence Individuals who fall are more likely to fall again Falls are preventable!

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Iowa’s Advisory Council on Brain Injuries

Collaboration for Increased Awareness

■  Falls Prevention Symposium ■  Information

dissemination ■  Community

partnerships

Iowa Falls Prevention Grant ■  Administration for Community Living/Administration on

Aging – PPHF HHS –  2014-2016 Iowa Department on Aging –  2016-2018 Iowa Department of Public Health

■  Increase number of older adults and adults with disabilities participating in EB falls prevention programs

■  Embed EB falls prevention programs into an integrated,

sustainable network

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Partners ■  Iowa Dept. on Aging & Iowa Dept. of Public Health ■  Iowa Association of Area Agencies on Aging ■  YMCA of Greater Des Moines ■  Iowa Falls Prevention Coalition ■  Iowa Advisory Council on Brain Injuries ■  Brain Injury Alliance of Iowa ■  Iowa Healthcare Collaborative ■  Des Moines Fire Department ■ Many program leaders across the state

Increased Variety of Awareness Activities ■  Webinars, Presentations, and archived

videos ■  Exhibits ■  Falls Prevention Awareness Day ■  Online repository of falls prevention

information (LifeLongLinks and IDPH falls prevention page)

■  Dissemination of STEADI toolkits

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www.nashia.org

State of the States: TBI Resources

Susan L. Vaughn NASHIA Director of Public Policy

www.nashia.org

Beginning in the 1980s . . .

•  Registries •  Data/Surveillance, linkage to services

•  State TBI programs and services •  State appropriations •  Trust fund programs •  Medicaid •  Multiple funding sources

•  Advisory Councils/Boards

www.nashia.org

TBI Programs: Trust Fund and State Appropriations

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www.nashia.org

Trust Fund/State Programs

•  Revenue generator, usually traffic fines •  Advisory boards/councils or task forces •  Purposes – vary:

• research, public information, prevention administration, services and supports

• thru contracts, grants, provider agreements or direct program staff

www.nashia.org

ABI/TBI HCBS Waiver Programs

Blue: ABI/TBI Waivers Red: 1115 Demonstration Waivers included TBI HCBS Waiver Green: Pending Approval Buff: Terminated HCBS Waiver

www.nashia.org

State Agencies for TBI Programs

•  Vocational Rehabilitation •  Health •  Education •  Developmental Disabilities •  Mental Health •  Social Services/Human Services •  Medicaid

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www.nashia.org

TBI Act of 1996 (P.L.104-66)

•  Defined TBI •  Appropriation authority to HHS

•  Prevention/surveillance – CDC • Research – NIH •  State grants on service delivery - HRSA

www.nashia.org

State Grants

•  Required advisory boards •  Also to include representative of injury control

programs, if in existance •  Purpose: to improve service coordination • Use of Funds •  To enhance community supports

•  Outreach to unserved/underserved •  Reflect best practices •  State capacity building

www.nashia.org

TBI Act Reauthorization

•  2000 Amendments (P.L. 106-310) • Expanded CDC TBI surveillance, education • Added grants for state Protection & Advocacy • TBI Act of 2008 (P.L. 111-36) • Added American Indian consortia to State

grant program • Directed CDC/NIH to collaborate with DoD/VA

on determining incidence/prevalence of military-related TBIs

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www.nashia.org

TBI Act Reauthorization

•  2014 Reauthorization (P.L. 113-96) •  Removed HRSA from State grant and P&A

grant programs, leaving discretion to HHS Secretary

•  Directed HHS to develop a plan for the improved coordination of federal activities

•  Directed CDC, in consultation with NIH, to review the scientific evidence research related to brain injury management in children

www.nashia.org

TBI Act Reauthorization of 2018

•  S. 3657 and H.R. 6615 •  Designated the Administration for Community

Living for State and P&A Grant Programs •  Includes section and authorizing

appropriations for CDC to conduct National Concussion Data Collection and Analysis

www.nashia.org

Administration for Community Living

•  HRSA TBI programs moved to ACL’s Administration on Disabilities -- 2016

•  State Grants -- Independent Living Administration

•  P&A Grants -- AIDD

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www.nashia.org

ACL TBI State Partnership Grants

Blue: Mentor Grants Red: Partner Grants

www.nashia.org

2018 TBI State Partnership Grants

•  Advisory Boards & Survivor Engagement •  Criminal & Juvenile Justice •  Opioid Use and Mental Health Needs •  Return to Learn/Return to Play •  Sustainable Partnerships •  Transition & Employment •  Underserved Populations •  Using Data to Connect People to Services •  Waivers and Trust Funds

www.nashia.org

Other HHS Programs

•  ACL National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) • Research Training Centers • 16 TBI Model Systems; Database • MSKTC: https://msktc.org/tbi

• National Institutes of Health (NIH) • NINDS

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www.nashia.org

Further Information

• NASHIA website: www.nashia.org • Webinars – archived •  30 Annual National State of the States

(S0S) Meeting Sept. 23 – 26, 2019 Kansas City, MO •  Social media

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