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Strong Infrastructure Components for Brain Injury 

(BI): State Self-Assessment Tool

Building a strong state infrastructure takes time, effort, and planning from many 

individuals and organizations. There are several key components necessary to create a 

comprehensive state system of services, partners, funding, and policy. Infrastructure 

building is a process and requires routine assessment, regardless of what level your 

state may have achieved. BI partners and collaborators identified the following 10 

components necessary for building a solid system of sustainable services and supports: 

1. Designated Lead State Agency 

2. Advisory Board 

3. Needs and Resources Assessment 

4. State Plan 

5. BI Advocacy for Policies 

for Services and Supports 

6. Access to Services / 

Service Provision 

7. Program Evaluation 

8. Funding / Sustainability 

9. Partnerships 

10. Systems Data 

How to use this tool

1. Check all the levels (basic, intermediate, and advanced) that describe your 

state’s progress. It is possible to have items checked across multiple levels; this 

is merely a general guide to assist you in reviewing your system. 

2. Please select items if the statements mostly fit for your system. Please 

note, you do not have to meet all the conditions for an item listed below to be 

checked. Again, this is just meant to be a guide. 

3. A state should consider re-assessing at various points of time to assist in 

state planning efforts. Examples of opportune times may include: 

• Conducting a new needs assessment 

• Developing, revising, or updating a state plan 

• Applying for a significant grant opportunity 

Person Completing Form:

Name of Lead Agency/Organization:

State: Date Form Completed: 

TBI TARC | tbitarc@hsri.org
TBI TARC | tbitarc@hsri.org

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Component 1 Basic Intermediate Advanced

Designated Lead 

State Agency

A designated lead 

agency 

demonstrates a 

commitment to 

assist people with 

BI and their 

families, supports 

the advisory 

board, and seeks 

funding 

opportunities to 

create and 

sustain these

supports at a 

state systemic 

level.

The lead agency:

Is selected 

Selects/contracts 

for staff and/or 

other resources to 

assist with 

activities 

Communicates 

with other 

agencies to 

develop 

awareness of the 

need for resources 

and services 

Supports full 

participation of 

people with BI, 

family/caregivers 

Supports diverse 

representation in 

planning, policy, 

and program 

development 

The lead agency:

Is recognized by 

multiple entities as 

having expertise and 

access to resources 

for BI 

Collaborates with 

multiple organizations 

Collaborates on 

development of an 

infrastructure to 

coordinate state BI 

services and supports 

Builds relationships for 

assistance in data 

collection/analysis, 

strategic planning, 

program development, 

and state plan 

implementation 

Participates in 

development and 

dissemination of 

resources 

The lead agency:

Is proactive in seeking/ 

maintaining funding and 

resources outlined in the state 

plan 

Works with broader disability 

or healthcare organizations 

on issues related to BI 

Invites people with BI to 

participate in broader 

disability-related activities 

Provides other agency staff 

opportunities to receive BIrelated training 

Includes BI-related 

information and resources in 

other agency programs and 

services 

Offers opportunities for 

screening and identification of 

BI for populations with a high 

prevalence rate of BI, for 

example, those experiencing 

homelessness 

Enters into memoranda of 

understanding (MOUs) for 

sharing records, data, or 

funding 

Holds legislative authority for 

services, resources, and 

funding
TBI TARC | tbitarc@hsri.org

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Component 2 Basic Intermediate Advanced

Advisory Board

The advisory board 

provides an 

opportunity to 

ensure a variety of 

stakeholders 

participate in 

determining the 

needs of individuals 

with BI, their 

families, and 

support systems. It 

creates structure for 

statewide crosssystems 

collaboration, which 

is essential for 

systems change 

work.

The Advisory Board:

Determines an 

effective number of 

board members 

Represents individuals 

with BI, 

families/caregivers, 

providers, vulnerable 

and underserved 

populations, key state 

agencies, disability 

community-at-large, 

and other 

collaborators 

statewide 

Agrees on a shared 

vision and an 

established mission 

statement

Hosts a regular 

schedule of meetings 

The Advisory Board:

Establishes operational 

procedures 

Routinely reviews the 

mission statement and 

board goals 

Establishes a formal 

planning process for 

board development 

Establishes work 

groups, committees, or 

other working bodies to 

share the work 

Involves members who 

serve as liaisons to 

relevant collaborative 

partners 

Maintains a focus on 

the current state plan to 

guide board priorities 

and activities 

The Advisory Board:

Establishes formal bylaws 

Involves members working 

as a unified board and as 

individual liaisons to and 

from their respective 

agencies, associations, or 

advocacy groups in 

carrying out the mission 

Uses an ongoing process 

to identify and address BI 

policy issues 

Is instrumental in moving 

the State Plan forward 

Operationalizes within the 

state’s governmental 

system, ideally with 

adequate staff and funding 

support

Includes individuals with 

lived experience in 

positions of leadership and 

decision making 

Engages in regular 

monitoring of state plan 

implementation progress
TBI TARC | tbitarc@hsri.org

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Component 3 Basic Intermediate Advanced

Needs and

Resources 

Assessment

The lead agency 

facilitates a 

statewide needs 

assessment, 

starting with a 

vision of what the 

system should be, 

what it currently is, 

measurement of 

the gap and short 

and long-term 

recommendations 

to close the gap.

The lead agency:

Demonstrates knowledge of 

methods to assess needs 

Creates plan to disseminate 

surveys etc., to ensure 

diverse input including 

multiple methods of 

dissemination 

Involves individuals with BI 

and their family members in 

development of the 

assessment tool 

Uses plain language and 

provides alternative formats 

Disseminates assessment 

using culturally sensitive 

methods 

Identifies existing services, 

gaps, or barriers to services 

in both the private and 

public sectors 

Uses a process for 

reviewing the assessment 

results leading to state plan 

recommendations 

Establishes a method for 

disseminating the results 

The lead agency:

Represents the 

state’s diversity, 

cultural needs, and 

underserved 

populations within 

the assessment 

Involves individuals 

with BI and family 

members in 

evaluating the tool 

and recommending 

improvements 

The lead agency:

Commits resources to 

fund an ongoing 

assessment process 

(3-5 year cycle) 

Provides information 

about the costs of 

existing services and 

supports in the private 

and public sectors in 

order to assist with 

state plan development 

Considers and 

implements targeted 

needs assessments as 

needed to gather 

information about 

specific infrastructure 

components
TBI TARC | tbitarc@hsri.org

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Component 4 Basic Intermediate Advanced

State Plan

The state plan 

determines how 

to best improve 

the services and 

supports for 

people living with 

BI. Plans include 

goals for 

addressing unmet 

needs and 

sustaining current 

initiatives in the 

state. State plan 

oversight lies with 

the lead state 

agency; 

however, full 

implementation 

requires multiple 

partners.

The Plan:

Incorporates 

specific timeframes 

Reflects the needs 

and resources 

assessment results 

and other available 

data 

Involves strategic 

partners, 

individuals with BI, 

family members in 

development 

Reflects the needs 

prioritized by 

people with BI and 

family members 

Describes a 

person-centered, 

person- and familydirected, and 

culturally 

competent 

framework related 

to desired service 

delivery 

The Plan:

Describes a process for 

measuring and documenting 

actions that build 

collaboration and 

sustainability of services and 

supports 

Utilizes SMART (Specific, 

Measurable, Attainable, 

Relevant, and Time-based) 

objectives 

Provides strategies to 

support collaboration among 

relevant partners and 

agencies 

Cites relevant historical 

information and justification 

for activities 

Incorporates a mechanism 

for structured feedback to 

promote continued dialogue 

and evaluation among 

partners 

Includes recommendations 

for policy development for 

coordinated systems of 

services and supports 

Incorporates available data 

in the assessment of needs 

and resources 

The Plan:

Promotes and reflects 

interagency buy-in 

through MOUs or 

MOAs, letters of 

commitment, or 

mandated involvement 

from other agencies 

involved 

Identifies a collaborative 

interagency structure for 

building and maintaining 

interagency support, 

planning, and problemsolving 

Functions as a living 

document and is 

reviewed on a regular 

basis 

Becomes a vehicle to 

assess potential 

feasibility, relevance, 

and evaluation of 

existing efforts and new 

initiatives. 

Includes components to 

address sustainability of 

programs, services, and 

supports
TBI TARC | tbitarc@hsri.org

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Component 5 Basic Intermediate Advanced

BI Advocacy for 

Policies for 

Services and 

Supports

The lead state 

agency is 

positioned to 

partner with the 

appropriate 

entities to 

promote state 

policies that 

ensure access 

and support for 

people with BI. 

The State:

Incorporates 

items from the 

needs 

assessment to 

develop an 

agenda for 

policy change 

and evolution 

of services/ 

supports 

Identifies key 

agencies/ 

individuals to 

collaborate 

and advocate 

for policy 

improvements 

Builds 

partnerships 

with 

organizations, 

individuals 

with BI, and 

their families 

to advocate 

for and 

foster the 

development 

of BI public 

awareness 

and policy 

agenda 

The State:

Uses the assessment and the State 

Plan to advocate for increased 

collaboration/focus on policy 

Facilitates the implementation of the 

State Plan by developing a working 

knowledge of State governmental 

structure and functions 

Establishes mutually beneficial 

relationships with champions in 

state agencies, legislature, 

associations, and communities 

Enlists commitment from key 

agencies/individuals to strengthen 

focus and build strategies for 

development and implementation of 

policy 

Seeks agencies and organizations 

who represent unserved/ 

underserved, vulnerable, and/or 

ethnic/racial and minority 

populations 

Creates a comprehensive policy 

agenda and action plan that reflects 

the consensus of key partners and 

has been vetted by the broadest 

possible community including 

individuals with BI and 

Families/Caregivers 

Benchmarks policy issues identified 

against national data and 

evidenced-based/best practice 

research 

The State:

Integrates the State 

Plan elements into the 

strategic 

initiatives/plans of 

relevant State 

agencies 

Actively engages key 

collaborators in 

ongoing processes of 

evaluation of policy 

impact and advocating 

for evolution of policy 

Consults with policy 

analysts or state 

strategic planners to 

optimize opportunities 

to include BI policy 

and program policy 

language and 

recommendations 

Pursues public-private 

partnerships to 

maximize access to 

establish long-term 

sustainable funding 

Addresses and 

integrates BI at all 

levels within the 

state’s laws, 

regulations, and 

funding systems 

Seeks opportunities to 

pilot service 

approaches
TBI TARC | tbitarc@hsri.org

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Component 6 Basic Intermediate Advanced

Access to 

Services / 

Service Provision

Individuals with BI 

and families are 

supported through 

an array of services 

that address needs 

across recovery 

and over a lifetime.

Needs are identified 

and support is 

person-centered 

and customized. 

The State:

Implements 

core 

components 

(Advisory 

Board, Lead 

Agency, 

Needs and 

Resources 

Assessment, 

and State 

Plan) as the 

foundation for 

coordinating 

state systems 

of services 

and supports 

Researches 

existing 

service 

models for 

use based 

on current 

assessment 

data 

The State:

Develops easily identified 

and user-friendly points of 

entry to the state’s service 

delivery systems 

Develops in-service basic 

training programs that 

may include screening, 

support, referral, basic 

information for the state’s 

service providers, 

administrators, community 

providers and decision 

makers 

Develops a state plan that 

outlines the mechanism 

and methods for 

coordinated systems of 

services/supports 

Develops a BI screening 

process of new applicants 

and existing clients for the 

state’s systems of 

services/supports 

Formalizes state agency 

and other key partner 

commitments to 

coordinate the State’s 

systems of 

services/supports 

The State:

Implements BI screening of 

new applicants and existing 

clients for the state’s systems 

of services/supports. 

Implements the state plan for 

coordinating systems of 

services/ supports 

Develops a collaborative 

interagency structure devoted 

to ongoing coordination of 

system services/ supports 

Establishes an evaluation 

plan to review, revise, and/or 

expand system coordination 

as needed 

Captures client satisfaction 

Captures provider satisfaction 

and practices 

Coordinates the development 

and delivery of an advanced 

curriculum for in-service 

education programs and 

updates on emerging 

practices and advances in the 

field for service providers, 

administrators, and decision 

makers
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Component 7 Basic Intermediate Advanced

Program 

Evaluation

The lead state 

agency guides

and ensures that 

program 

evaluation is a 

central 

component for 

assuring 

effective 

supports, for 

individuals with 

BI and their 

family members/

caregivers.

The lead agency:

Facilitates 

recognition that 

evaluation is a 

necessary process 

Creates a team to 

make 

recommendations 

for developing an 

evaluation process 

Develops a process 

to gather data 

associated with 

goals, objectives, 

initiatives, and 

programs 

Incorporates the 

results of customer 

satisfaction surveys 

or other feedback 

mechanisms on a 

continuous basis as 

a measure of 

accountability 

The lead agency:

Ensures that dedicated 

resources are available 

for a periodic evaluation 

process 

Conducts evaluations 

routinely to assure the 

most current and relevant 

information 

Utilizes outcome 

measures to gauge 

progress, effectiveness, 

value, and significance of 

programs and services 

Uses data gathered for 

multiple purposes such as 

strategic planning, 

evaluation of existing 

services and supports, 

state plan revisions, and 

the development of 

proposed policies and 

initiatives 

Documents progress in 

the development of 

services and supports. 

Provides justification for 

development, expansion, 

or revision of services and 

supports 

Shares information with 

leadership and relevant 

partners 

The lead agency:

Ensures independent 

evaluation process is in 

place 

Ensures quality feedback 

loops and action item 

development 

Encourages service 

delivery decisions that are 

based on evidence 

generated from data 

collection/cost analysis. 

Promotes multiple service 

systems collaboration 

Anticipates the need to 

justify funding challenges 

affecting services and 

supports

Ensures a process is in 

place for periodic review 

and analysis of programs 

and supports 

Shares results with the 

public, e.g., use of a 

dashboard
TBI TARC | tbitarc@hsri.org

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Component 8 Basic Intermediate Advanced

Funding / 

Sustainability

The lead state 

agency maintains 

program 

sustainability as a 

priority. The goal 

is to ensure that 

capacity building 

and systems 

change activities 

continue, yielding 

positive outcomes 

for individuals 

with BI.

The lead agency:

Applies available state 

funding to leverage 

federal funding streams 

Researches and 

compares eligibility and 

program standards of 

system services to 

determine programs for 

which individuals with BI 

may be eligible 

Explores the concept of 

developing a network of 

collaborators to examine 

promising practices 

related to funding 

Develops collaborations 

with coordinated 

messaging to provide 

outreach, data, and 

education to state 

leaders 

Identifies quality 

improvement and 

outcome-based 

measures for determining 

success in service 

delivery with the aim of 

funding for continued or 

expanded 

services/supports 

The lead agency:

Researches best 

practices related to cost 

effective and efficient 

approaches to service 

delivery 

Develops a plan for 

implementing best 

practices in funding 

services identified 

Explores multiple 

sources of funding (this 

includes grant funding) 

to prevent sole 

dependence on one 

funding source 

Engages collaborators 

to help implement the 

funding of the State 

Plan into the State’s 

systems of 

services/supports 

Develops a strategic 

plan on how quality 

improvement and 

outcome-based 

measures can be used 

to justify continuation or 

expansion of funding 

The lead agency:

Implements best 

practices in funding 

cost effective and 

efficient approaches to 

service delivery. 

Implements the state 

plan and incorporates 

funding for quality 

improvement and 

outcome-based 

measures 

Uses outcome-based 

information to justify 

continuation or 

expansion of funding 

for services/supports. 

Facilitates 

opportunities for 

innovation related to 

cost sharing, 

coordinating 

services/supports, and 

working creatively with 

funding sources 

Incorporates 

suggestions from 

individuals with BI, 

their 

families/caregivers, 

and providers
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Component 9 Basic Intermediate Advanced

Partnerships

The lead state 

agency creates and 

maintains 

partnerships to 

share resources 

(products, staff, and 

expertise), increase 

impact, decrease 

challenges, and 

improve systemic 

sustainability. 

The lead agency: 

Identifies partners 

and areas for 

potential 

cooperative 

ventures 

Develops 

relationships with 

other groups 

sharing similar 

missions and/or 

needs as a way to 

build service 

delivery systems 

responsive to 

everyone 

Develops a working 

understanding of 

the mission, vision, 

and goals of 

collaborating 

agencies and 

organizations 

Establishes a 

mechanism for 

identifying issues of 

mutual interest 

between partners 

The lead agency:

Creates new 

partnerships that are 

mutually beneficial to 

agencies and other 

disability groups 

Increases visibility and 

awareness of needs 

resulting from BI and 

related issues within 

relevant health and 

human service agencies 

and councils 

Engages in a variety of 

informational and 

educational 

opportunities, joint 

projects, and regular 

interactions 

The lead agency:

Establishes partnerships 

and shares resources 

through formal contracts 

and other written 

statements of commitment 

that support joint 

strategies and 

approaches 

Develops processes to 

evaluate and strengthen 

the effectiveness of the 

collaboration 

Collaborates on federal 

program funding 

opportunities that could 

enhance services and 

supports
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Component 10 Basic Intermediate Advanced

Systems Data 

The state lead 

agency promotes 

the use of systems 

data to identify 

individual and state 

BI incidence and 

prevalence and 

provide rationale for 

prioritizing and 

increasing funding. 

The lead agency:

Assesses data 

needs for 

surveillance, service 

planning, and/or 

linking individuals to 

services 

Determines 

available sources of 

data 

Determines 

additional data 

needs and 

processes for 

obtaining the data 

Determines which 

agencies are 

involved in collecting 

data 

Determine if 

legislation or 

regulatory 

procedures are 

needed for new data 

sources 

Defines the purpose 

or intended use and 

type of data 

collected 

Obtains buy-in and 

collaboration from 

organizations that 

collect or would 

benefit from data 

The lead agency:

Ensures a process for 

confidentiality through 

MOUs, MOAs, or other 

processes 

Identifies who receives 

information and how 

information will be used 

Develops a process to 

collect and analyze data 

Develops a budget 

needed to collect and 

analyze data 

Develops and pilots 

methods for linking 

people to services based 

on the data 

Develops information on 

resources and assistance 

that may be available for 

people with BI and 

families/caregivers 

Expands existing service 

coordination systems for 

people with other types 

of disabilities to include 

individuals with BI 

Uses data to develops a 

plan for resource 

facilitation or service 

coordination to link 

people to services 

The lead agency:

Ensures there is 

authority in place (for 

example, legislation) to 

implement the registry 

and mandate reporting 

Uses data to link people 

with BI to appropriate 

services/supports and/or 

service coordination 

Institutes a surveillance 

system for service 

delivery issues that 

examines the magnitude 

of the problem, identifies 

the causes, and 

identifies high-risk 

groups 

Implements a service 

linkage system to link 

people with BI to 

resources, services, and 

supports 

Implements a plan to 

identify individuals with 

BI in institutional 

settings who may be 

eligible for home and 

community-based 

services 

Implements a multi-data 

system review for 

comparing data across 

organizations and 

systems
TBI TARC | tbitarc@hsri.org

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This tool is adapted from:

Building Up BI Systems: Tools for Successful BI State Programs, Traumatic Brain Injury 

Technical Assistance and Resource Center (TBI TARC), January 2021.

Pathways for Systems Change: Benchmarks and Self-Assessment Tool for State BI 

Programs, Federal Traumatic Brain Injury Technical Assistance Center, Health 

Resources & Services Administration, 2008.

ABOUT TBI TARC

The Traumatic Brain Injury Technical Assistance and Resource Center (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. The TBI TARC 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.