ACL Traumatic Brain Injury

Stakeholder Day

March 8, 2022

TBI TARC is supported by contract number 

HHSP233201500119I from the U.S. Administration for 

Community Living, Department of Health and Human 

Services, Washington, D.C. 20201
Welcome

Shawn Callaway

Project Officer

Administration for Community 

Living

Elizabeth Leef

Project Officer

Administration for 

Community Living

2
Webinar Logistics

• Participants will be in listen-only mode during the 

webinar. Please use the chat feature in Zoom to post 

questions and communicate with the hosts. 

• During specific times in the webinar, we will have 

opportunity to respond to questions that have been 

entered into chat.

3
Feedback and Follow-Up

• After the webinar, you can send follow-up questions 

and feedback to tbitarc@hsri.org

(Please note: This email address will not be monitored 

during the webinar.)

• A recording, including a pdf version of the slides, will 

be available on the ACL website (acl.gov)

4
Who’s Here?

“In what role(s) do you self-identify? Select all that apply.”

1. Person with a traumatic brain injury

(TBI) or other disability

2. Family member or friend of

a person with a TBI or other

disability 

3. Self-advocate / advocate

4. Peer-specialist / peer-mentor

5. Social worker, counselor, or care 

manager

6. Researcher / analyst

7. Service provider organization 

employee

8. Government employee 

(federal, state, tribal, or municipal)

5
OPENING 

REMARKS
Meet Our Speaker

Alison Barkoff

Principal Deputy 

Administrator

Administration for 

Community Living

7
Session 1-4 Facilitators

Maria Crowley

NASHIA

Judy Dettmer

NASHIA

TBI Technical Assistance & Resource Center 

(TBI TARC) 

 Managed by the Human Services Research 

Institute in partnership with the National 

Association of State Head Injury 

Administrators (NASHIA)

 Provides: 

o Technical assistance and support to 

TBI SPP grantees and funded partners 

o Resources to other stakeholders – including other states, policymakers, 

providers, people with lived 

experience with TBI and their family 

members

o Logistical support to ACL 

8
SESSION 1: 

SURVIVOR 

ENGAGEMENT

STRATEGIES
Session 1 Speakers

Clifford 

Hymowitz

BI Survivor/Advocate

TBI Advisory Board 

and Leadership 

Group (TAL-Group)

Kelly Lang

BI Survivor, Caregiver & 

Former Board Member

TAL-Group

Maria 

Martinez

BI Survivor/Advocate

TAL-Group

Carole Starr

TBI Survivor, Speaker, 

Author & Advocate

TAL-Group
Survivor Experiences on Boards

• Describe your best experience as a brain injury 

survivor serving on a board/committee/task force. 

What worked? 

• Describe your worst experience as a brain injury 

survivor serving on a board/committee/task force.

What didn’t work?

11
Recruitment/Retention

• As a brain injury survivor, what would be your 

advice for boards looking for more survivors?

• As a brain injury survivor, why do you stay on a 

board versus leave?

12
Advice for Board Chairs

• What’s one piece of advice you have for board 

chairs?

13
Engagement Strategies for Survivors

This guide is a resource for individuals with brain 

injury to be fully participating board members. It 

was developed by the TBI Advisory and 

Leadership (TAL) group to serve as a companion 

document to the 

Traumatic Brain Injury Advisory Board Toolkit 

available at 

https://acl.gov/sites/default/files/programs/2021-

07/Traumatic%20Brain%20Injury%20Advisory%2

0Board%20Toolkit.pdf

The guide is available at: 

https://acl.gov/sites/default/files/programs/2021-

09/TBITARC_EngagementStrategiesForSurvivors

_Final_Accessible.pdf

14
QUESTIONS: 

SURVIVOR ENGAGEMENT STRATEGIES

Session 2 Speakers

Monica A. 

Lichi

Ohio Valley Center for 

Brain Injury Prevention 

and Rehabilitation, The 

Ohio State University 

Wexner Medical Center

Rachel 

Ramirez

Center on Partner- Inflicted Brain 

Injury

17
Ohio Brain Injury

Program 

Brain Injury & 

DomesticViolencein

Ohio: A Relationship 

Story

 

Monica Lichi, MS, MBA, CCRP
John Corrigan, PhD Monica Lichi, MS,MBA Brei Miller, MA, AT, CSCS Beth Windisch, LISW-S Amy Lawson, RN,MSN

Our Team

Collaboration

Ohio Brain Injury Advisory 

Committee

Ohio Domestic Violence Network 

Steering Committee / 

Community of Practice
Alone we can do so

little; together we

can do so much.

 

 

– Helen Keller
Domestic Violence and 

Children

Rachel Ramirez, LISW-S
Domestic Violence

A web of coercive behaviors 

that are hard to identify until 

an adult is trapped
More versions of the power and control 

wheel available at: 

https://www.theduluthmodel.org/wheel-gallery/
Abusers 

intentionally 

harm the 

abused parent 

and children in 

the home
Abusers also 

sabotage the 

victim's parenting

and their 

relationship with 

children
Victims often 

blame 

themselves for 

how their 

children have 

been impacted 
A survivor 

shares her 

reflections

PAULA

CHILDRE

HO

N I

W

MPA

 WE

CT

RE

ED? 

MY 
Victim parent safety and child 

safety are almost always 

inseparable, and the victim 

parent is key to resilience and 

recovery for children. 
Children are 

involved in multiple 

ways 

• Get hurt 

• See 

• Hear

• Intervene

• See the aftermath

• Are told about it
Every child's experience 

with domestic violence is as 

unique as they are. 
Use three lenses:

Development

Resilience

Trauma
Nature

+ 

Nurture

+ 

Experiences

=

Developmental 

Outcomes
Resilience

The capacity to 

recover quickly 

from difficulties.

Adapting well in 

the face of 

adversity. 
DV causes toxic and 

traumatic stress to victims

and children

 
Ohio Domestic Violence Network 

Resource: Experiencing Trauma 

Affects Our Children 

This resource is available in a 

variety of formats and languages 

on the ODVN website : 

https://www.odvn.org/order-printmaterials/
Ohio Domestic Violence Network 

Resource: Play. Move. Imagine. I 

Matter! I Belong! (Youth Journal)

This resource is available

on the ODVN website : 

https://www.odvn.org/order-printmaterials/
An advanced service provision 

approach providing guidance and tools

to raise awareness on brain injury

Trauma-informed

toolbox to help you 

raise awareness on 

brain injury caused 

by violence
CARE tools at www.odvn.org

Kemble H, Sucaldito A, Kulow E, Ramirez R, Hinton A, Glasser A, Wermert A, Nemeth JM. How CARE tools are being used to address brain injury and mental health struggles with survivors of domestic violence. Journal of Head Trauma and Rehabilitation.
Rachel Ramirez,

LISW-S

Founder and 

Director

The Center on 

Partner-Inflicted 

Brain Injury

rachelr@odvn.org
QUESTIONS: 

DOMESTIC VIOLENCE AND THE EFFECT ON 

CHILDREN
BREAK 1

Up Next: 

• Session 3: Effective Partnerships with 

Behavioral Health 

• Session 4: Strategies for Using and 

Leveraging Data 

43
SESSION 3: 

EFFECTIVE 

PARTNERSHIPS 

WITH 

BEHAVIORAL 

HEALTH 
Alabama 

Department of 

Rehabilitation 

Services and 

Alabama 

Department of 

Mental Health

EFFECTIVE TBI 

PARTNERSHIPS WITH 

BEHAVIORAL HEALTH
Meet our Presenters

KIMBERLY G. BOSWELL

COMMISSIONER

ALABAMA DEPARTMENT OF MENTAL HEALTH
Meet our Presenters (cont.)

April B. Turner, MS, CRC

State Head Injury Coordinator

Alabama Department of Rehabilitation Services
ALABAMA DEPARTMENT 

OF REHABILITATION 

SERVICES

TBI PROGRAM STRUCTURE
•ADRS TBI Navigation Program- Helpline/Referral Line

•ADRS Adult TBI Program (ICBM)

•ADRS Vocational Rehabilitation Service 

•ADRS Children’s Rehabilitation Service 

•ADRS State of Alabama Independent Living Program & Waivers

•Alabama Head Injury Foundation

ALABAMA CORE TBI SERVICE 

SYSTEM
ALABAMA DEPARTMENT 

OF MENTAL HEALTH 

STRUCTURE

HOW DID THE PARTNERSHIP 

BETWEEN ADRS-TBI PROGRAM AND 

ADMH BEGIN?
WHY WOULD ADMH WANT TO 

PARTNER WITH THE TBI PROGRAM?
WHY DOES ADMH BELIEVE 

THE PARTNERSHIP IS 

IMPORTANT?
STRATEGIES FOR PARTNERSHIP FOR 

OTHER STATES TO TAKE BACK TO THEIR 

TBI AND MENTAL HEALTH PROGRAMS
ADRS TBI PROGRAM- DOORS THAT OPENED 

AFTER PARTNERING
THE TBI/BEHAVIORAL 

HEALTH LEADERSHIP 

TEAM
FINDING PREVALENCE: SCREENING, 

TRAINING & DISSEMINATING 

FINDINGS
The Screening for TBI in Mental Health and Substance Use Disorder Settings infographic. This was created as a tool to demonstrate 

Alabama’s pilot study findings related to screening, supports and recommendations. It can be downloaded here: 

http://www.alabamatbi.org/uploads/1/3/8/3/13834569/admh_pilot_study_findings_2021-compressed.pdf
PARTNERING GOING 

FORWARD
FREE TRAININGS FOR BEHAVIORAL 

HEALTH STAFF
Alabama’s TBI and Behavioral Health Handout for state Mental Health system providers and staff.

It can be downloaded here: http://www.alabamatbi.org/mental-health.html 
FOR MORE 

INFORMATION

WWW.ALABAMATBI.ORG

WWW.REHAB.ALABAMA.GOV/TBI

WWW.MH.ALABAMA.GOV
QUESTIONS: EFFECTIVE PARTNERSHIPS 

WITH BEHAVIORAL HEALTH 
SESSION 4: 

STRATEGIES 

FOR USING 

AND 

LEVERAGING 

DATA 
Session 4 Speakers

Chris Miller 

Director

Virginia Department of 

Aging and Rehabilitative

Services, Brain Injury 

Services Coordination 

Unit 

Matthew 

Breiding

Team Lead

Centers for Disease 

Control and Prevention, 

Division of Injury 

Prevention

66
Registry Data (slide 1 of 2)

• Outreach 

• In partnership with the Brain Injury Association of Virginia

• Return rate of approximately 3%

• How else can we use this data?

• To prepare federal grant application

• To analyze geographic, demographic, transition or other 

trends

• To provide preliminary information for legislative action

• To compare with other data sources
Registry Data (slide 2 of 2)

From the Virginia Trauma Registry
No Wrong Door Partnership

• Embedding modified OSU TBI Screening questions into NWD 

• Tags to identify BI resources – better access for customers + 

better data from the system

• Where do people live who are – and who are not - looking for 

BI information

• What else are they looking for?

• Track referrals from provider to provider

• Individuals with BI also able to self-refer

• Social Isolation and social determinants of health 

69
No Wrong Door Easy Access

70
Shared Outcomes (slide 1 of 2)

Current Brain 

Injury Scorecard

Measures aren’t 

relevant

Measures aren’t 

clearly defined

71
Shared Outcomes (slide 2 of 2)

• Over 3 years all 8 state-funded Case Management and 

Clubhouse/Day Support programs will develop individual 

logic models and outcome measurement plans

• DARS and the 8 programs will then create a set of shared 

outcome measures on which all will keep data

• Outcomes to be shared at the state and regional level on 

the BI Dashboard

• Opportunities for federal, state, and local funding, 

program development, and policy development

72
Virginia’s Plan for Data Sharing

“Data by itself is rich, but not a complete picture. There are 

still gaps. So we make a lot of presumptions that may not 

be accurate. Sharing data across agencies, systems, or 

programs fills in those gaps and develops a complete 

picture from which good decisions can be made to benefit 

people living with traumatic brain injury.” 

Amol Karmarkar PhD. 

Virginia Commonwealth University

TBI Model Systems

73
The Goal of the Data Plan

• Data is siloed across state agencies and community 

organizations

• Can we build connections that will help improve access to 

services and service delivery?

• How would more complete data impact decision making by 

statewide agencies?

The data plan will help to:

• Draft a more accurate picture of services needed after brain 

injury and the methods used to distribute those services. 

• Help establish an outline for communication between 

statewide agencies concerned with the outcomes and 

services for individuals after traumatic brain injury. 

• Eliminate health disparities in access to care for individuals 

with TBI

• Evaluate the impact of the COVID-19 Pandemic 

74
A Look At Existing Databases

75

Name Agency Inclusion Criteria Unique ID a TBI ID Short-term 

Outcome

Long-term 

Outcome

Virginia Statewide 

Trauma Registry 

(VSTR)

VDH -Trauma 

admissions

-Name

-Address

-MRN

ICD9/10

AIS

-Discharge 

Disposition

-Death Status

-Complications

None

All-Payer Claims 

Database (APCD)

VHI -All Medicare 

claims

-~40% Private 

insurance claims

None ICD9/10 -Complications Info on follow-up 

inpatient/outpatient

visits to be 

determined

VCU Traumatic 

Brain Injury Model 

System (VCUTBIMS)

VCU

NIDILRR

-Inpatient Rehab

-Informed Consent

-Name

-Address

-MRN

TBIMS study 

definition 

(below)

-Discharge 

Disposition

-FIM/Care Tool

-DRS at discharge

Neuropsych

Employment 

Psychosocial 

Functional 

Rehospitalizations

RSA-911 DOE Administrative 

determination

-Name

-Address

-DOB

Self-report None Employment

Brain Injury 

Association of 

Virginia (BIAV)

BIAV Clients -Name

-Address

-DOB

Self-report None Information request
Data Sharing to Improve Brain Injury 

Services Summit

Next Steps – Ideas for Integration and Harmonization

• Who has data related to brain injury and how are they 

using it? 

• How could sharing it improve access and services?

• What is the first step?

76
TBI State Partnership Program

Data Workgroup

Participating 

States

• Alaska

• Alabama

• California

• Colorado

• Idaho

• Iowa

• Maryland

• Nebraska

• Ohio

• Rhode Island

• Virginia

77

Potential Workgroup 

Focus Areas

• Improving registry use for outreach

• Tracking services after hospitalization

• Analysis of data in NWD systems

• Using registry data for social determinants of 

health

• Developing shared measures across states 

i.e. developing a set of BRFSS questions to 

be used by all states 
Best Practices for Using TBI Registries 

to Connect People to Services

This guide includes: 

• A history and purpose of TBI registries 

• An overview of the systems using data to 

connect individuals with TBI to services 

• Core elements and practices for 

development and support of a TBI data 

registry 

• Common barriers that states face to obtain 

meaningful and accurate data 

• An assessment of questions asked (data 

collected) by state registries across the US 

• Other useful sources of data 

78
QUESTIONS: STRATEGIES FOR USING AND 

LEVERAGING DATA 
BREAK 2

Up Next: 

• Federal Partners Update

• Wrap-up

80
SESSION 5: 

FEDERAL 

PARTNERS 

UPDATE 
Session 5 Facilitator 

Rebeccah 

Wolfkiel

Executive Director

National Association of 

State Head Injury 

Administrators 

82
Session 5 Speakers

Donna Bethge

Administration for 

Community Living

Nsini Umoh

National Institute of 

Neurological Disorders 

and Stroke

Genevieve 

Berry

Mountain Plains Mental 

Health Technology Transfer 

Center, Western Interstate 

Commission for Higher 

Education

83
QUESTIONS: FEDERAL PARTNERS UPDATE 
Real-Time Evaluation Questions 

• Please take a moment to respond to these seven evaluation 

questions to help us deliver high-quality TBI TARC webinars

• If you have suggestions on how we might improve TBI TARC 

webinars, or if you have ideas or requests for future webinar topics, 

please send us a note at TBITARC@hsri.org

85
Real-Time Evaluation Questions (cont.)

1. Overall, how would you rate the quality of this webinar?

2. How well did the webinar meet your expectations?

3. Do you think the webinar was too long, too short, or about right?

4. How likely are you to use this information in your work or day-to-day 

activities?

5. How likely are you to share the recording of this webinar or the PDF 

slides with colleagues, people you provide services to, or friends?

86
Thank You

The Traumatic Brain Injury Technical Assistance and Resources Center (TBI TARC) is 

an initiative from the Administration for Community Living that helps TBI State 

Partnership Program grantees promote access to integrated, coordinated services 

and supports for people who have sustained a TBI, their families, and their 

caregivers. The Center also provides a variety of resources to non-grantee states, 

people affected by brain injury, policymakers, and providers.