Summary Abstract of the 1989-1990 Oregon Task Force on Head Injury Report to the Governor and the 66th Legislative Assembly

Summary
Overview of Testimony
Recommendations
Sub-committee on researching federal and state laws, rules and regulations
Sub-committee on Centers for Independent Living and programs
Sub-committee on in-home demonstration programs
Sub-committee on education - early intervention and K-12
Sub-committee on education - post secondary
Sub-committee on prevention
The report includes draft legislation for the following

Summary
This report was prepared based on the combined efforts of 6 work groups consisting of task force members and 25 at large members and testimony from more than 200 people at meetings throughout Oregon.
The main purpose of the task force was to identify the needs of people with head injuries and develop recommendations on how services may be provided and funded.

The report from the task force includes statistics such as:

• estimates place incidence of head injury between 200-500 per 100,000 population
• 85% of head injuries occur to individuals between the ages of 15 and 25
• head injury is the leading cause of death for individuals under the age of 35
• direct and indirect cost of head injury increased from $3.5 billion in 1980 to $5 billion for 1985

Overview of testimony:

• Inadequate funding - insurance coverage and other monies are often exhausted before post acute recovery is complete
• Inappropriate placement - individuals are discharged into whatever accommodations are available, appropriate or not, once their resources are depleted
• potentials are not being reached - especially as services are not available when individuals are ready for them because they are beyond the limits that coverage allows
• Inappropriate transition - with placement often away from their home communities, with no system or resources in place for a successful transition back into their home communities
• Inadequate attention/funding to address underlying issues - before-injury disposition of the individual, lifestyle, drug/alcohol use, family dynamics, family involvement, individual motivation
• Long term services needed - to return individuals to productive lives, and to relieve caregiving roles for parents/spouses, relatives, to have placement with trained TBI professionals who can include more stimulation and encourage more individuals toward recovery
• Long term support is needed - supported work, job coaching, training employers and fellow employees about TBI and its behaviors and strategies
• Case management needed - to coordinate rehab efforts and provide stability with a single contact person to coordinate interactions and reduce confusion
• Concern about future care - especially when parents are care providers
• Centers for Independent Living - needed for IL services including peer counseling, information and referral and ongoing advocacy and assistance as needed
• Improved information to the general public - prevention/awareness campaigns, media involvement, information shared with schools and legislative advocacy could lead to more understanding and acceptance of brain injury survivors
• Medical model view is not productive - network of community support systems needed to offer opportunities for independence, social activities, and accomplishments so people may develop self esteem and confidence about their abilities, instead of the medical model focus on their Disabilities.
• Family support - emotional support, counseling, and respite from stressful care-giving
• Education - families often unaware of services available for school-age survivors, and red tape makes it difficult to access services.
• Housing - need for more affordable and supported living housing
• Long term care facilities - more are needed, specifically for young individuals with programs aimed at increasing quality of life, improving recovery potential and involving family
• Other issues - sensitive issues where there is uncertainty about how they may relate to brain injury need attention; i.e. chemical dependency, sexuality, sexual and physical abuse issues, co-dependent and dysfunctional behavior patterns prior to injury, implications of lowered behavior control due to injury and its influence on individual outcomes

Recommendations:
Sub-committee on researching federal and state laws, rules and regulations

• Write a definition of TBI (none exists in federal or state law)
• Rewrite existing statutes to include TBI definition
• Direct an appropriate agency to develop a "state of the art" assessment/ evaluation tool for TBI
• Write legislation to require evaluation tool use in determining eligibility for services
• Recommend state agency coordination of services overseen by the Disabilities Commission

Sub-committee on Centers for Independent Living and programs

• Stabilize existing Centers for Independent Living
• Fund development and ongoing core services for 25 new Centers for Independent Living (CILs) over the next three biennium's; target 5-10 new communities to develop CILs in each of the 91-93, 93-95, and 95-97 biennium's
• Identify public agency to handle administrative responsibilities; recommending Oregon Disabilities Commission

Sub-committee on in-home demonstration programs

• Develop demonstration program with solid information base serving 10 trainees the first year and 15-20 trainees for the 2"d through 4th years
• Establish a positive attitude of long term counseling as opposed to crisis intervention
• Obtain legislative authority to use appropriated dollars to acquire property for individuals to pay mortgage rather than rent. With state maintaining property, reverting to state property when person leaves

Sub-committee on education - early intervention and K-12

• Create information/education network to increase awareness/understanding of TBI
• Develop communication between hospitals/schools about TBI students as early as possible
• Develop Natural Helpers program for TBI students modeled after A & D prevention programs
• Develop TBI management team to coordinate services and insure arrangements for students with TBI
• Use existing resources to expand prevention education statewide

Sub-committee on education - post secondary

• Provide services to teach daily living skills, either through CILs and/or college classes
• Develop community support system
• Provide case management dollars for an advocate to coordinate successful programs for students with TBI
• Develop assessment tool to evaluate skills/deficiencies of students with TBI Identify agency to provide education to educators/students about TBI Identify education/transportation alternatives for rural areas

Sub-committee on prevention

• Write legislation to fund expansion of 2 existing prevention programs statewide with curriculum to reach students K-12, educators, law enforcement personnel, EMT and paramedics; assist other prevention programs - i.e. seat belts, bike helmets, etc.
• Provide incentive funds to Area Trauma Advisory boards to develop prevention programs in their areas
• Create Governor's Task force on Injury Prevention
• Write legislation to mandate protective headgear for bicyclists and passengers 12 years old and younger
• Require helmets for drivers and passengers of all ATV's and snowmobiles Require flags for snowmobiles
• Oregon Health Division responsible to coordinate and oversee prevention programs

The report includes draft legislation for the following:

1. Bicycle helmet requirement for children 12 years of age and younger; maximum $50 fine for no helmet
2. Revisions for definitions of certain "disabled" individuals to include people with TBI
3. Requirement for pretreatment screening for TBI, to include neuropsychological evaluation; prescribes content of evaluation
4. Create Governor's Task Force on Injury Prevention; sets membership and prescribes duties; allocates funding
5. Allocates money to Health Division for Level 1 Trauma Prevention programs, area trauma advisory boards and for coordinator and supplies for prevention programs
6. Allocates funds for CILs and programs; Directs Oregon Disabilities Commission to administer CILs and programs
7. Establishes demonstration project to train community based care giver with appropriation for project
8. Creates Head Injury Cost Reduction Fund; specifies use; increases minimum insurance premium tax to supply moneys for fund
9. Requires flags for snowmobiles

Requires operators and passengers of snowmobiles and ATVs to wear protective headgear