Welcome to today’s webinar for ACL Grantees!...Before we begin today’s webinar…a few...
Transcript of Welcome to today’s webinar for ACL Grantees!...Before we begin today’s webinar…a few...
Welcome to today’s webinar for
ACL Grantees!
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RHI-EAGLE HIGHLANDS INPATIENT AND
OUTPATIENT SERVICES
4141 Shore Drive
Indianapolis, IN 46254
RHI-NORTHWEST BRAIN INJURY CENTER
9531 Valparaiso Court
Indianapolis, IN 46268
RHI-CARMEL OUTPATIENT SERVICES
12425 Old Meridian Street, Suite B2
Carmel, IN 46032
RHI is a community collaboration between
Indiana University Health and St. Vincent Health
317-329-2000 | rhin.com
Resource Facilitation Webinar Series
Presentation to ACL Grantees
Today’s Topic: Resource Facilitation as a Model to
Manage TBI as a Chronic Condition
Today’s Speakers: Flora Hammond, MD
Nila Covalt Professor and Chair,
Physical Medicine and Rehabilitation,
Indiana University School of Medicine
Chief of Medical Affairs,
Rehabilitation Hospital of Indiana
Lance Trexler, PhD, HSPP, FACRM
Executive Director, Brain Injury
Rehabilitation Research and Program
Development, Rehabilitation Hospital of Indiana
Clinical Assistant Professor,
Physical Medicine and Rehabilitation,
Indiana University School of Medicine
March 31, 2020| Welcome ACL Mentor State Indiana’s Webinar Series on
Resource Facilitation
Overview:
It has been recently recognized that recovery and long term
stability following TBI is variable and inconsistent, within and
between people with TBI and some people with TBI will have a
chronic condition as a consequence. There is currently no health
care model to manage TBI as a chronic condition. There is
however a number of research findings for Resource Facilitation
that may suggest that this intervention could serve as an initial
model.
Learning objectives for this webinar include:
1) Participants will be able to describe the results of long-term
follow-up studies with respect to recovery and stability.
2) Participants will be able to identify three characteristics of
Resource Facilitation.
3) Participants will be able to state three different types of
outcomes that are associated with Resource Facilitation.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Flora Hammond, MDProfessor & Chair, PM&R
Indiana University SOM
Rehabilitation Hospital of Indiana
Indianapolis, IN
Managing Brain Injury as a Chronic
Condition
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
NIDILRR TBI Model Systems National Database
• 30 years with >17,000 database participants
• Admitted to acute care within 72 hours of TBI & received inpatient rehabilitation
• > 16 years of age
• Complicated mild, moderate or severe TBI• neuroimaging abnormality, PTA, LOC, or ED GCS score
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
5-year Rehabilitation OutcomesCorrigan JD, Cuthbert JP, Harrison-Felix C, Whiteneck GG, Bell JM, Miller AC, Coronado VG, Pretz CR. J Head Trauma Rehabil 2014:29(6):E1-9.
• TBI Model Systems participants
• Received rehabilitation October 2001 - Dec 2007.
• Weighted for national population characteristics • age, sex, race, race/ethnicity, marital status, primary insurance, FIM
motor & cognitive score at rehab admit, and RLOS
• Status 5 years post-TBI:• 84% known outcome
• 10% lost to follow-up
• 6% withdrew/refused/unknown
• 39% declined (GOS-E) Y1/2 Y5
• 22% dead by Y5
From Y1 or 2 to 5:
2 in 10 die
3 in 10 deteriorate
Death associated with older age
Decline not associated with age
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
13% 11% 9% 10%19% 17% 16% 19%
48% 45% 42% 39%
12% 14%13% 8%
9% 13% 21% 24%
0%
20%
40%
60%
80%
100%
Year 2 vs.Year 1
(N=4,986)
Year 5 vs.Year 2
(N=2,867)
Year 10 vs.Year 5
(N=796)
Year 15 vs.Year 10(N=194)
% 2 categ. Declined % 1 categ. Declined % no change
Change in Function Over Time: Glasgow Outcome Scale (GOS-E)
Corrigan JD & Hammond FM Arch Phys Med Rehabil 2013
BI is a dynamic
condition: Significant
change years after TBI
No Change: - 39 - 48%
Improvement: - 24 - 31%
Decline: - 20 - 34%
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
• Cardiovascular
• Unintentional
• Septicemia
• Cancer
• Pneumonia; Other resp
• Digestive
• Homicide
• Suicide
• Seizure
• Seizure (37x)
• Septicemia (12x)
• Pneumonia & aspiration PNA (4x)
• Other respiratory (3x)
• Digestive (3x)
• External (3x)
• Unintentional (3x)• Accidental poisoning (4%)(11x)
• Opioids
• Homicide (3x)
• Suicide (1x)
Most Frequent Causes > Expected for General Population
• 7-year reduction in life expectancy
• Causes of death vary over time post-injury
• Association with older age & > disability at rehab discharge
Premature Mortality with Moderate-Severe TBIHarrison- Felix C, Whiteneck G, DeVivo MJ, Hammond FM, Jha A: JHTR 2006
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
• Among those >50: DM, Cholesterol, HTN, OA• Among those < 50 years: panic attacks (3x)• No age differences for back pain, fractures, sleep disorders,
depression, anxiety
Ten Most Prevalent Comorbidities
10 years after Moderate-Severe TBIHammond FM, Corrigan JD, Ketchum JM, Malec JF, Dams-O’Connor K, Hart T, Novack TA, Bogner J, Dahdah MN, Whiteneck GC : JHTR 2019
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Comorbidities & Consequences
• Pain• Substance use• Social isolation• Incarceration• Reinjury• Psychiatric disorders • Neuroendocrine
dysfunction• Seizure• Stroke• Dementia• Higher rates diabetes,
hypertension, myocardial infarction, cerebrovascular disease, peripheral vascular disease, chronic pulmonary disease, & renal disease
• Premature mortality
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Primary Medical Care & Brain InjuryHarrington AL, Hirsch MA, Hammond FM, et al. Am J PMR 2009;88:852
• People with BI less likely to have PCP
• Reasons no PCP: • no transportation
• $
• can’t find
• would not understand disability
• “don’t need one”
• 36% had to teach their PCP about disability
• 3% physical access issues
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Chronic Brain Injury2012 Galveston Brain Injury Conference
“Injury to the brain can evolve into a
lifelong health condition termed
chronic brain injury (CBI). CBI impairs
the brain and other organ systems
and may persist or progress over an
individual’s life span. CBI must be
identified & proactively managed as a
lifelong condition to improve health,
independent function and
participation in society.”
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Chronic Disease Management Programs
CommunityHealth Systems
Delivery System DesignCreate
Supportive Environment
Build Public Policy &
Resources
Provide Self-Management
Support
Decision Support
Clinical Information
Systems
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Target the right people with the right care & intensity
High risk, complex needs: intensive professional & case management
Some risk, increased need: shared care with self, close others, & professionals
Low risk: (70-80% of chronic disease population); supported self-management
Problem-driven, Risk-stratified Care
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
• Paradigm shift to treat BI as a chronic condition to enhance care & access to optimize outcomes
• Design & test models of care
• Indiana Resource Facilitation
• Tailored to individual needs, problems, and risks
Summary
Flora Hammond, MD
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Survivor Perspective
"I think I may need it to have periodic evaluations to determine my level of capacity on a regular basis. Some things have improved and some symptoms have worsened and others are just now beginning to surface. I think that establishing a history of capacity would give a better picture of services needed and other medical tests that may need to be done. This would provide a full range of services that would better serve your clientele."
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Evidence for Resource Facilitation to Manage Outcomes following Chronic TBI
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Resource Facilitation Defined
• Individualized assessment
• Provide brain injury specific education and promote awareness of resources
• Proactive navigation to community-based supports, resources and services
• Remove instrumental barriers (e.g., housing) as well as brain injury-specific barriers (e.g., memory impairment) to successful community re-integration and return to work.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Resource Facilitation to Manage TBI as A Chronic Condition
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Indiana Resource Facilitation Research Findings for Vocational Outcomes
• RCT 1: 64% return to work rate after 9 months of RF versus 36% for controls (P<.0001)
• RCT 2: RF group return to work/school significantly earlier and more often than controls (P<.027), and
Group assignment was a significant predictor of outcome (P=.027) and the RF group was found to be 7 times more likely to return to work
• Trexler, L.E. & Parrott, D.R (2018). Models of Brain Injury Vocational Rehabilitation: The Evidence for Resource
Facilitation from Efficacy to Effectiveness. Journal of Vocational Rehabilitation, 49(2), 195-203.
• Trexler, LE, Parrott, DR, & Malec, JF (2016). Replication of a Prospective Randomized Controlled Trial for Resource
Facilitation to Improve Return to Work after Brain Injury. Archives of Physical Medicine and Rehabilitation, 97(2), 204-210.
• Trexler, LE, Trexler, LC, Malec, JF, Klyce, D., & Parrott, D. (2010). Prospective randomized controlled trial of resource
facilitation on community participation and vocational outcome following brain injury. Journal of Head Trauma
Rehabilitation, 25(6), 440-446.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Resource Facilitation and Return to Work
• Prospective Clinical Cohort 1 (n=69):• Subjects referred from Indiana Vocational Rehabilitation
• 9.28 years post-injury
• 67% return to work rate after 9 months of Resource Facilitation versus 18%
• Prospective Clinical Cohort 2 (n=141):• Subjects referred from Indiana Vocational Rehabilitation
• 10.10 years post-injury
• 70% return to work rate after 11.6 months of Resource Facilitation versus 18%
Trexler LE and Parrott, D.R (in press). Models of Brain Injury Vocational Rehabilitation: The Evidence for Resource Facilitation from Efficacy to Effectiveness.
Journal of Vocational Rehabilitation.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
CENTER FOR BUSINESS AND ECONOMIC RESEARCH Phone: 765-285-5926
MILLER COLLEGE OF BUSINESS Fax: 765-285-8024
February 21, 2017
Economic Impact of Resource
Facilitation:
Workforce Re-entry Following
Traumatic Brain Injury Brandon Patterson, Graduate Research Assistant
Srikant Devaraj, Ph.D., Research Economist and Research Assistant Professor
Michael J. Hicks, Ph.D., George & Frances Ball Distinguished Professor of
Economics, Director of Center for Business and Economic Research
Annual Aggregate Lifetime Economic Impact of Resource Facilitation
• Wages and benefits = $249.1 million
• Revenue from taxes = $30.97 million
• Savings to SSDI/private disability = $80.1 million
• SNAP = $6.6 million
• Total = $366.77 million/year
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Other Non-Vocational Research Findings
for Resource Facilitation
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Activities of Daily Living Scale
• Self Care Activities
• Household Care
• Employment and Recreation
• Shopping and Money Management
• Travel
• Communication
• Total
Results demonstrated a statistically
significant decrease in the reported
amount of assistance required to
complete activities of daily living
after RF (t=5.35, p=.000).
•Johnson, N., Barion, A., Rademaker, A., Rehkemper, G., & Weintraub, S. (2004). The
Activities of Daily Living Questionnaire: a validation study in patients with dementia.
Alzheimer disease & associated disorders, 18(4), 223-230.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Mayo-Portland Adaptability Inventory
MPAI-4 results show a significant (t=4. 07, p=.000). decline in level of disability across all subscales:
• abilities (e.g., mobility, memory),
• adjustment (e.g., depression social interaction), and
• participation (e.g., managing money, transportation) after RF
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Survey of Unmet Needs and Service Use
Heinemann, A.W. et al. (2002). Measuring unmet needs and services among persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 83, 2052-1059
• Developed specifically for brain injury
• Variety of instrumental and service needs
• Addresses both what they are receiving and perceived needs
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Survey of Unmet Needs
• Number of services used declined significantly from baseline to discharge (t=2.83, p=.005).
• Desired services declined significantly from baseline to discharge (t=13.53, p=.000).
• Examples of needs that were met through RF:
• controlling alcohol and/or drug use,
• increasing independence in eating, dressing, and bathing, and
• finding housing that is affordable and accessible.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
TBI, Resource Facilitation and Re-Arrest: New Findings
Recidivism for Offenders:
• With TBI = 24.2%
• Without TBI = 17.7%
RF Findings:
• 195 offenders with TBI, 31 of whom got RF.
• 10% re-offended who got RF.
• 25.6% of the control group re-offended.
• Offenders with TBI who did not get RF were found to have a risk for re-offending of over two and a half times greater than those who got RF (RR =2.64)
• RF can cut the risk of re-offending by 60% (25.6% vs 10%)
Trexler LE & Parrott DR (in preparation). Resource Facilitation and
the Prevention of Re-Incarceration in People with TBI.
Z=2.05,
p=0.02
Z=1.93,
p=0.027
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Conclusions
• Resource Facilitation significantly improves return to
work and school for acute and chronic TBI
• These effects result in a significant economic benefit
• Preliminary data suggests that Resource Facilitation may
• Reduce level of disability in chronic TBI
• Reduce services used and desired services
• Reduce recidivism
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Utilization of BEAM in a Randomized
Controlled Trial of Resource Facilitation
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
BEAM/MyBRAIN
• Clinical Individual and Cohort Purpose:• Surveillance
• Assessment and Re-Assessment
• Risk Stratification
• Intensity and Type of Resource Facilitation Follow-up
• Self-Management Training
• Use data for research on • Predictors of recovery – stability – decline
• Effectiveness of treatment
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
BEAM/MyBrain Risk Assessment: Pre-Injury Variables
Domain MeasureReassessment
Frequency
Monthly Surveillance
measure
Criteria for High or Low Risk
Risk RatingLow = 1 High=2
Substance Abuse PROMIS Severity of SAat Baseline 2
(RA)T < 59 T > 60
CriminalityMinnesota House Research Dept, 2007
at RF Intake No criminal history
misdemeanor, gross misdemeanor, or felony
Previous TBI OSU-TBI-IDat Baseline 2
(RA)No history or single mTBI
multiple mild or greater
Psychiatric Illness
at RF Intake No psychological/ psychiatric diagnosis
Medicated, treated, and/or hospitalized for psychological/ psychiatric diagnosis
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
BEAM/MyBrain Risk Assessment:
Post-Injury Variables Related to Primary Aims
Domain MeasureReassessment
Frequency
Monthly Surveillance
measure
Criteria for High or Low Risk
Risk RatingLow = 1 High=2
Substance Abuse
PROMIS Alcohol -Negative Consequences
Over-Ride Monthly T < 59 T > 60
PROMIS Severity of Substance Abuse
Over-Ride Monthly T < 59 T > 60
DyscontrolPROMIS Self-efficacy for Managing Emotions 8a
Over-Ride Monthly T > 60 T < 59
SleepPROMIS Sleep-Related Impairment 8a
Over-Ride Monthly T > 60 T < 59
Cognitive Impairment
PROMIS Cognitive Function 8a
Over-Ride Monthly T > 60 T < 59
Level of Disability MPAI Total Score Over-Ride Monthly
30-44 >45
Social/Family Isolation
PROMIS Ability to Participate in Social Roles and Activities 8a
Over-Ride Monthly T > 60 T < 59
TOTAL RISK RATING (16-32 is the possible range) Green YellowRed
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
MyBrain© Risk Assessment: Post-Injury
Variables Related to Secondary Aims
Domain MeasureReassessment
Frequency
Monthly Surveillance
measure
Criteria for High or Low Risk
Risk RatingLow = 1 High=2
Pain PROMIS Pain Intensity 1a Over-Ride Monthly T < 59 T > 60
Opioid UsePROMIS Prescription Pain Medication Misuse 7a
Over-Ride Monthly T < 59 T > 60
Anger BAAQ Over-Ride Monthly 0-8 ≥9
Mood
PHQ-4: Items 1+2 Over-Ride Monthly < 2 (score 1)≥2 admin GAD-
7
PHQ-4: Items 3+4 Over-Ride Monthly < 2 (score 1)≥2 admin PHQ-
9
PHQ-9 Over-Ride Monthly 0-4 5-27
GAD-7 Over-Ride Monthly 0-4 ≥5
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Intensity of RF Based on Level of Risk
Level of
Risk
Definition Intensity of Follow-up
High
(28-32)
Significant intensity or number of
biopsychosocial risk factors that
could lead to deterioration or
failure to recover, and are not
stable
RF: Minimum of weekly (in-person/telephonic)
with participant/family
Weekly RF Program Manager update
RF Program Manager determines if case
consultation with Neuropsychology or
Physician is indicated and/or case conference
required sooner
15-minute Case Conference every 2 weeks
Medium
(21-27)
Some biopsychosocial risk
factors that could lead to
deterioration or failure to recover,
but stable
RF: Minimum of weekly (in-person/telephonic)
with subject/family
Bi-Weekly RF Program Manager update
RF Program Manager determines if case
consultation with Neuropsychology or
Physician is indicated and/or case conference
required sooner
10-minute Case Conference every 4 weeks
Low
(16-20)
Few to no biopsychosocial risk
factors and evidence of good
recovery/stability of adjustment
RF: Minimum of bi-weekly (in-
person/telephonic) with subject/family
10-Minute Case Conference every 4 weeks
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
MyBRAIN© Self-Management Apps
Domains Type of Intervention If HIGH risk… If LOW risk…
Pain Relaxation Play their favorite music;
"Clear Picture" activity;
"New Me" activity
Relaxation Music
"New Me" activity
Free relaxation apps
Opioid Use Alterntives to urges HALT,
Clear Picture
Mindfulness for
Anxiety/Stress
Skills System skills
Anger Positive expressions of
energy or charge
Mindfulness for Anger Skills System skills
Mood Improving mood Mindfulness for
Depression
HALT
Skills System skills
Substance
Abuse
Distractions;
Alternatives to giving
into thoughts or urges
HALT,
Clear Picture
Mindfulness for
Anxiety/Stress
HALT
Skills System skills
Dyscontrol Awareness of
emotions/feelings
Clear Picture
HALT
Mindfulness Relaxation
Skills System skills
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Preliminary Findingsfrom BEAM & myBrain
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Case 1: Sometimes it is easierto tell an avatar!
• 36 year old married male working as a carpenter
• Motorcycle crash with TBI and bilateral temporal and orbital fractures 1 month before entering RF
• Pre-injury history of opioid misuse and depression
• In Resource Facilitation intake, denied depression twice
• On BEAM-MyBrain PHQ-9, endorsed “Thoughts that you would be better off dead, or hurting yourself.”
• Triggered Resource Facilitation response and got patient into treatment
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Case 2: Getting worse
• 30 year old man with 16 years of education working as a server
• Preinjury history of DUI and felony theft
• Fell our of a second story window and may have been using ETOH and Xanax at party beforehand
• Initial risk stratification was low risk
• Risk Stratification changed to medium (yellow) that resulted in more intense RF follow-up, case conferences and directed to PCP
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Case 3: Question stability?
• 59 year old divorced man with
four years in combat zone, history
of domestic battery and ETOH
abuse with TBI two months ago
with left anterior, medial and
frontal lobe contusions and history
of chronic back pain and has not
worked since 2012
• Mild memory and moderate
impairment of executive functions
• Initially found to be a medium risk
• Started using Sleep-relaxation
training application in MyBrain
Now
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Patients Experienced Subtle Improvements in Sleep
19
18
19
17
20
22
20
16
14
12
0
5
10
15
20
25
2 3 4 5 6 7 8 9 10 11
Ave
rage
Sle
ep
Sco
re
Follow-up Interval
Self- Reported Sleep Disturbance among TBI Patients (N=15)
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Potential Relationship between Patient Pain and Mental Depression
0
1
2
3
4
5
6
0
1
2
3
4
5
6
0 2 4 6 8 10 12
Ave
rage
PH
Q-9
Sco
re
Ave
rage
PR
OM
IS P
AIN
Sco
re
Follow-up Inteval
Self-Reported Pain and Depression among TBI Patients Receiving Resource Facilitation (N=15)
PAIN PHQ-9
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Summary and Conclusions
• BEAM/MyBrain is potentially a very useful tool for
surveillance and clinical management of chronic TBI
• Need to continue to develop Resource Facilitation
intervention to promote utilization of BEAM-MyBrain
• Much need for future research
• Need more data on utilization of Self-Management
Applications
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Collaborators
Cori Conners, MA
Research Assistant
Rehabilitation Hospital of Indiana
Jess Fann, MD
Neuropsychiatry
University of Washington
Jeremy Funk, MS
Epidemiologist
Rehabilitation Hospital of Indiana
Flora Hammond, MD
Chair Physical Medicine and
Rehabilitation, Indiana University
School of Medicine
Claire Lyons, MA
Research Assistant
Rehabilitation Hospital of Indiana
Devan Parrott, PhD
Director, RTOC
Rehabilitation Hospital of Indiana
Laura Trexler, OTR, CBIS
ACL Grant Manager
Rehabilitation Hospital of Indiana
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
This presentation and the research
were supported by grants from:
1) Trexler, L (PI), Hammond, F (Co-I), Corrigan, J (Co-I), Davè, S (Co-I). Reducing
opioid misuse and overdose in people with traumatic brain injury. Funded by the
Center for Disease Control and Prevention and the Indiana State Department of
Health. 2018-19.
2) Trexler, LE (PI), Hammond, F (Co-I), Ibarra, S (Co-I), Parrott, D (Co-I), Trexler LC
(Co-I). Improving Health Outcomes following Traumatic Brain Injury through Building
a TBI-informed System of Services and Supports and Resource Facilitation. Funded
by Administration for Community Living (ACL), U.S. Department of Health and
Human Services. 2018-21.
3) Trexler, LE (PI): Reducing recidivism and improving return to work in ex-offenders
with brain injury. Indiana Department of Corrections Traumatic Brain Injury State
Implementation Partnership Grant Program. 2014-2018. Funded by Health Resource
Services Administration.
4) Trexler, LE (PI) and Trexler LC (Co-PI): Developing and Translating a Statewide
System of Support and Collaboration into Local Support Networks Integrated
Through Resource Facilitation. 2009-2013. Funded by Health and Human Services,
Human Resources and Services Administration.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Disclosures
Funding for this presentation was made possible (in part) by the
Administration for Community Living. The views expressed in
written conference materials or publications and by speakers
and moderators do not necessarily reflect the official policies of
the Department of Health and Human Services, nor does the
mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
References• Centers for Disease Control and Prevention. Moderate to Severe Traumatic Brain Injury is a Lifelong Condition [Fact
sheet]. Atlanta, GA: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention.
https://www.cdc.gov/traumaticbraininjury/pdf/moderate_to_severe_tbi_lifelong-a.pdf
• Corrigan JD, Hammond, FM. Traumatic brain injury as a chronic health condition. Arch Phys Med Rehabil 2013; 94:
1199-1201.
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ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
Questions?
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020
RHI-EAGLE HIGHLANDS INPATIENT AND
OUTPATIENT SERVICES
4141 Shore Drive
Indianapolis, IN 46254
RHI-NORTHWEST BRAIN INJURY CENTER
9531 Valparaiso Court
Indianapolis, IN 46268
RHI-CARMEL OUTPATIENT SERVICES
12425 Old Meridian Street, Suite B2
Carmel, IN 46032
RHI is a community collaboration between
Indiana University Health and St. Vincent Health
317-329-2000 | rhin.com
This presentation is provided by the:Indiana TBI State Partnership Program
Mentor State Funding Opportunity Grant No. 90TBSG0034-01-00
ACL Mentor State Webinar Series on Resource Facilitation | Indiana | RF as a Model to Manage TBI as a Chronic Condition | Mar 31 2020