WHAT IS WORKING
AWARENESS	People seem to care and want to help Better awareness of TBI issues in public services More TBI advocacy throughout U.S.
INSURANCE	Oregon Health Plan
ADVOCACY	BIAOR
QUALITY OF SERVICES	Emergency and acute care are improving Caring, empathetic medical providers Improved medical practices Some improved/outstanding services locally throughout Oregon State agencies are trying to provide better services for people with TBI
ACCESS TO SERVICES	Long term support groups for survivor and family members more available Portland Support Group Supported work opportunities Better access to long-term case management Technology Brain Train Assistive Technology TBI Website
EDUCATION / CHILDRENS' ISSUES	Children's issues are better addressed School services for students with TBI are improving TBI is a disability category under IDEA TBI Inservice teams Better communication between hospital and school
UNMET NEEDS
AWARENESS	Not enough information about TBI for survivors and parents The general public is not aware of the issues people with TBI face
INSURANCE	Doesn't cover needed services Doesn't cover long enough Insurance gap: people in the middle, are stuck
ADVOCACY	No mechanism for advocacy "People are made to feel crazy or demanding if they keep fighting to get what they need'
QUALITY OF SERVICES	Services are not designed for persons with TBI Service providers don't understand the nature of TBI, don't know what people with TBI need or how to provide it Services am not specific to age or severity of disability
ACCESS TO SERVICES	The service system is confusing It's hard to know what's available, what you are entitled to Services are hard to access Even fewer services in rural areas Not enough: employment training and opportunities support for families recreational and social opportunities cognitive rehab available appropriate residential placements counseling and mental health services No supports in community colleges Medical and rehab services are too limited Educators are not trained in TBI
EDUCATION / CHILDRENS' ISSUES	Educators are not trained in TBI Eligibility for school services can be a problem Appropriate, individualized school programs for TBI are rare Not enough supports for challenging behavior Not enough social supports No residential care for children with severe injuries Transition services are needed
OBSTACLES
AWARENESS	Lack of funding Funding is accessed through other disability categories Funding for some services is not long enough TBI is "invisible disability," hard for public to understand TBI is a complex, very individual disability Outcomes for people with TBI are misrepresented in the media The medical community is not aware of the needs of people with mild TBI
INSURANCE	Coverage is inadequate Coverage reflects poor understanding of needs of people with TBI Insurance is hard to access, qualify for Lack of options on Oregon Health Plan Training for employment jeopardizes Oregon Health Plan
ADVOCACY	Lack of advocacy because of poor public awareness Problems with self-advocacy Low-incidence Family burn-out Difficult for families and survivors to communicate with the medical community
QUALITY OF SERVICES	Service providers don't understand TBI Services are delivered by program approach, not based on need Medical personnel (who are point of contact and who know TBI issuesbest) are over-extended and can't address non-medical issues
ACCESS TO SERVICES	Services are not coordinated, there are gaps and overlaps It's hard to get information about what's available--what the eligibility requirements are The rural nature of the state is an obstacle to service delivery Family support is inadequate and not set up so families can access it Lack of linkage between rehab and community services No resource guide
EDUCATION/ CHILDREN'S ISSUES	The Oregon Department of Education has no TBI specialist There is no system to provide in-service training to educators Schools are not prepared to deal with severe behavior problems or with mild TBI
STRATEGIES
AWARENESS	Corporate sponsor for TBI fair Educate and seek support from key legislators, politicians Make TBI a reportable medical condition Track outcomes Public service announcements Focus on prevention Use professional organizations to raise awareness of service providers and Educators Have survivors share experiences with schools, communities
INSURANCE	Coordinate benefits Educate insurance providers
ADVOCACY	Find legislative allies Support Oregon Advocacy Center/Panel Support family advocacy Appoint TBI ombudsman/state TBI advocate Support BIA0R
QUALITY OF SERVICES	Restructure servicesAgencies contract for private services for clients with TBI Provide in-service training to service providers Put TBI on agency agendas Train home care givers Provide written specific strategies for working with people with TBI Train consultants in the areas where they are needed
ACCESS TO SERVICES	Regional community reentry service--across the age span Coordinate services statewide Regional single point of contact Increase, improve case management Provide advocates through Social Security to support family Broaden access to ILC's Provide reliable access points into the service system Develop resource guide and referral network, print and on-line
EDUCATION/ CHILDREN'S ISSUES	TBI resource person for Department of Education Provide inservice training for teachers Get school administrator buy-in to improve services to students with TBI

	OBSTACLES	STRATEGIES
FUNDING	Lack of funding Funding is accessed through other disability categories Funding for some services is not long enough	Corporate sponsor for TBI fair Educate and seek support from key legislators, politicians
AWARENESS	TBI is "invisible disability," hard for public to understand TBI is a complex, very individual disability Outcomes for people with TBI are misrepresented in the media The medical community is not aware of the needs of people with mild TBI	Make TBI a reportable medical condition Track outcomes Public service announcements Focus on prevention Use professional organizations to raise awareness of service providers and educators Have survivors share experiences with schools, communities
INSURANCE	Coverage is inadequate Coverage reflects poor understanding of needs of people with TBI Insurance is hard to access, qualify for Lack of options on Oregon Health Plan Training for employment jeopardizes Oregon Health Plan	Coordinate benefits Educate insurance providers
ADVOCACY	Lack of advocacy because of poor public awareness Problems with self-advocacy Low-incidence Family bum-out Difficult for families and survivors to communicate with the medical community	Find legislative allies Support Oregon Advocacy Center/Panel Support family advocacy Appoint TBI ombudsman/state TBI advocate Support BIA0R
QUALITY OF SERVICES	Service providers don't understand TBI Services are delivered by program approach, not based on need Medical personnel ( who are point of contact and who know TBI issues best) are over-extended and can't address non-medical issues	Restructure services Agencies contract for private services for clients with TBI Provide inservice training to service providers Put TBI on agency agendas Train home care givers Provide written specific strategies for working with people with TBI *Train consultants in the areas where they are needed
ACCESS TO SERVICES	Services are not coordinated, there are gaps and overlaps It's hard to get information about what's available--what the eligibility requirements are The rural nature of the state is an obstacle to service delivery Family support is inadequate and not set up so families can access it Lack of linkage between rehab and community service No resource guide Oregon Department of Education has no TBI specialist	*Regional community reentry service--across the age span *Coordinate services statewide *Regional single point of contact * Increase, improve case management * Provide advocates through Social Security to support family *Broaden access to ILCs Provide reliable access points into the service system Develop resource guide and referral network, print and on-line TBI Resource person for Department of Education
EDUCATION/ CHILDREN'S ISSUES	There is no system to provide in-service training to educators Schools are not prepared to deal with severe behavior problems or with mild TBI	Provide in-service training for teachers Get school administrator buy-in to improve services to students with TBI

TABLE 4
Prioritized Strategies for Improving Service Delivery System for Individuals with TBI in Oregon
	Strategies	Category	# of Votes
1.	Single point of contact/clearing house to provide life planning -- Plan to include Current needs and appropriate Service/agencv -- Revisited on a set time line to reflect changing needs	Access	17
2	Coalition Building: cross-disability, professional -state chapters, inclusion of TBI at table	Funding Advocacy Data	10
3	Statewide coordinator of TBI and resources	Education	9
4	Statewide ID and reporting to designated school district	Education	8
4	Establish Quality Programs: standards, children-adults, residential-transitional-independent	Quality	8
5	Linking and Coordinating Data: cost benefit, service effjcacy, outcome	Funding Advocacy Data	6
6	Web site providing information about service providers/Information about survivors including history, interventions, outcomes	Access	5
6	Awareness/Education/Training: standardized training materials, recipient I.D., job conches, mentors	Quality	5
6	Increase awareness of TBI issues in drug treatment agencies	Awareness	5
7	In-service training for local district educational/support personnel as needed	Education	4
8	Expanded Service Delivery: survivors, family, providers, i.e. depression, skill building, med. needs, respite care, AIOD prev/tx	Quality	2
8	Access to Employment: training for survivors, support for employers, accommodations, including technology-to increase opportunity	Access	2
	Educate medical community regarding long-term outcomes	Awareness	0
	Re-entry education for companies of injured employees	Awareness	0
	Services available from birth to 18 that replicate those provided to adults	Access	0
	Increase availability of alternative housing along continuum of needs, esp. for behavioral/severe challenges	Access	0
	Develop and implement an ongoing monetary strategy -including state and federal options	Funding Advocacy Data	0
	Contacts and feed-back loop to service providers	Education	0