Commonwealth Neurobehavioral Project
Karen W. Brown, Executive Director
Brain Injury Services, Inc.
July 24th, 2015
Joint Legislative Audit Review Commission
(JLARC) 2007
 Among the key findings included: the limited
availability of services for individuals who have
neurobehavioral consequences resulting from the
brain injury.
Neurobehavioral Treatment for Virginians
with Brain injury-”white paper”
Ad hoc committee-May 2009/2010 (published)
Response to the DARS Commissioner
Three level systems of care-treatment options
Cost estimates at every level of demonstration project
Collaborative project between Crossroads for Brain
Injury Recovery and Brain Injury Services
Designed to increase access to critical supports for
persons with brain injury who exhibit
neurobehavioral symptoms
Utilizes an Inter-professional team
Maximize independence and productivity in the
2012- Brain Injury Services received a three year
grant through the Potomac Health Foundation for a
Community Based Neurobehavioral Program
Therapist/Clinical Case Management Team
Interdisciplinary Team collaboration to replicate inpatient setting
Funds for Ancillary Services
Benefits from participants knowing they are part of
a “program”
In 2009, Crossroads to Brain Injury Recovery
received a CNI Trust Fund grant
Needs assessment based on providers’
perspectives on barriers to accessing services,
particularly crisis intervention services for persons
with brain injury
Concept of Inter-professional Triage Team grew
out of this grant
VA Department for Aging & Rehabilitative
Services (DARS)
Commonwealth Neurotrauma Initiative Trust Fund
Brain Injury Services
Crossroads to Brain Injury Recovery, Inc.
James Madison University
Behavioral and cognitive issues are the most
common debilitating consequences of brain
These issues may place persons at greater
risk for:
Repeat hospitalizations
Inter-professional triage team to assess risk and make
treatment recommendations
Intensive case management and increased in-home
Providing / providing for evaluations, counseling,
support and other interventions & facilitating access to
Utilization of assistive devices / technology; telepractice
Team building and education
Co-occurring condition(s)
 health, mental health and/or substance abuse condition
Behaviors are barriers to community integration
◦ Job loss, single or multiple
◦ Loss of a primary relationship such as life partner or close family
◦ Lack of friends or desired social life
◦ Difficulty maintaining a volunteer job
◦ Lack of or major difficulty with social skills
◦ Difficulty maintaining or creating new friendships / relationships
◦ Homeless or unstable / inappropriate housing situation
Improve access to services and resources
Increase quality of life for persons served
Address challenging behaviors that impede
community integration / inclusion
Improve effectiveness and efficiency of
service delivery
Pre- and post-intervention assessments and
 Identified assessment instruments
 Mayo-Portland Adaptability Inventory
 Potential for risk assessment?
 In-house visual analog scale for perceived satisfaction with life
Participant goal achievement
Participant surveys
Reduced hospitalizations, incarcerations, and
placements in other institutional settings
2 or more of the following in addition to basic case
◦ Referred for additional evaluations, assessments
◦ Specialist care including counseling, SA treatment,
psychiatry, neuropsychiatry
◦ Therapies (SLP, OT, PT, etc.)
◦ Community Support Services (life skills training)
◦ Assistive technology
◦ Behavioral supports
◦ Job coaching
◦ Life planning
Identified 52 individuals meeting our definition of having
“neurobehavioral” needs.
75% will demonstrate a decrease in challenging behaviors
and/or increase in positive behaviors
 83.33% maintained or improved on total MPAI scores (increase in
75% will report satisfaction with the quality and type of
services provided
 75% of persons served rated their satisfaction with life more
positively at post-test using the Visual-Analog Scale developed
by the grant investigators
Those served will meet at least 75% of his/her goals as listed
on ISP’s
 95% of goals were achieved as listed on his/her services plans
75% will increase participation in productive activities
 91.67% maintained or improved scores on the MPAI Q28
(employment) scale
At least 14 will maintain and/or improve his/her living
 91.67% maintained or improved on the MPAI Q26 (residence)
Twenty (20) clients participated in intensive
Community Support Services in which they learned
specific skills and strategies targeted to increasing
independence (i.e. budgeting, organizing,
cooking/meal preparation, cleaning).
Ten (10) clients were provided with targeted
behavioral supports (assessments and
interventions), including therapeutic mentoring,
positive behavior supports, brain injury life
coaching, and behavior analytic services.
Nine (9) clients received neuropsychological
Eleven (11) clients were referred for
neuropsychiatric evaluations and
Home modifications were provided for six (6)
clients in order to make their residences more
accessible and safe. One was provided an
auto-shut off device for her stove to ensure
safety while cooking with memory loss.
Eight (8) clients were provided assistive devices
(iPad, laptops, AAC devices) in order to improve
communication and organization.
Fourteen (14) clients were referred for other
general medical/specialist evaluations including
obtaining a primary care physician, speechlanguage therapy, pain management, and dental
1 client received funds to complete several dog
obedience classes to begin therapy dog training
and volunteer for BIS.
4 clients received supports to obtain or
maintain housing
Other services / supports provided include
home organizing supplies, calendars, gas
cards, transportation vouchers, eye glasses,
gym / wellness program memberships,
clothing, pottery class/art therapy,
citizenship fee, educational supports, and
26 year old female- from India
 Injury from being pushed down stairs at 2
years old. Sustained a severe traumatic brain
injury resulting in intellectual disabilities.
 Received comprehensive neuropsychological
evaluation, mental health therapy, nutrition
counseling for thyroid problems, positive
behavioral supports and vocational support.
Outcome: gainfully employed, living in

CONCePT - Department for Aging and Rehabilitative Services