As part of the Needs and Resource Assessment, eleven (11) state agencies were surveyed. Each of the agencies is represented on the Ohio Brain Injury Advisory Committee (OBIAC). These agencies are the:
Most of these state agencies do not provide direct services to individuals with brain injury, but rather fund - or purchase - those services. As mentioned earlier in this report, no single state agency in Ohio is responsible for developing and funding services for individuals with brain injury. Instead, people with brain injury seek generic services from a broad range of providers, several of which get state funding from one or more of the state agencies surveyed.
Each agency surveyed, except Public Safety, responded that individuals with TBI were eligible for services from their agency. Individuals with brain injury, therefore, represent a portion of each agency's constituency. (It should be noted that all of the questions on the state agency surveys referred to traumatic brain injury, rather than the broader term of brain injury.)
The survey asked several questions about data collection for people with TBI. One question asked if the agency's data system included a field that identified if the person receiving services from the agency had a TBI. Seven of the ten agencies do have a field in the data system to capture this information, and those agencies were able to report - to some degree - how many individuals with brain injury they served. However, those seven agencies serve only half as many people as the three agencies that do not collect data. In other words, the state agencies that served the most people did not collect data on whether those people had a TBI.
| Number of agencies that answered: Yes |
Number of agencies that answered: No |
Number of agencies that answered: Not Applicable |
|---|---|---|
| 7 | 3 | 1 |
It is significant that, of the agencies that do collect data on TBI, most noted that they felt that the data was incomplete. OLRS compared the total number of people served by the agency with the total number of people the agencies served who were also identified as having a brain injury. OLRS also considered that the Centers for Disease Control (CDC) estimate that slightly over 2% of the general population has TBI. It is likely that in a state like Ohio, where there is not a single agency for brain injury, the surveyed agencies serve a higher percentage of people with TBI than the general population. 2.8 million Ohioans were reported to have received state funded services, but only .1% of those people were identified as having a traumatic brain injury (3,429 across all agencies).
| Department of MRDD | Department of Aging | Bureau of Workers' Compensation | Department of Education | Ohio Legal Rights Service | Rehabilitation Services Commission |
|---|---|---|---|---|---|
| .09 percent | .03 percent | .21 percent | .32 percent | 3.78 percent | 2.51 percent |
Since reliable data should drive policy decisions, it is extremely important for agencies to collect this data, and to identify patterns of services for people with brain injury, and modify their agency's service delivery as appropriate. A tool that screens service recipients for BI can help agencies develop more effective ways to provide services.
The survey also included a question about staffing levels at the agencies, more specifically the number of staff who work on brain injury issues. Four agencies reported that they had specific staff working on brain injury issues. All four of these agencies reported that staff worked, at least in part, on education issues. In two of the four agencies, the designated staff also dealt with a broad range of issues affecting individuals with brain injury. However, only two of the agencies reporting have any staff that work on brain injury more than 50% of the time. RSC has one staff person - the Brain Injury Program Director, while the Bureau of Worker's Compensation has seven. Both agencies did not consider the number of staff available to be sufficient.
Only three agencies reported that they provided training for their staff on brain injury and only three agencies provided training about brain injury outside of the agency. All three of the agencies that provide training outside their agencies provide training to educators. Two of the agencies provide training to health care professionals. Only one agency provides training to individuals with brain injury or their families. None of the state agencies have regularly planned staff training or training outreach programs that include brain injury.
The table that follows shows the number of state agencies that fund or provide services in eight general service areas. (All of the state agencies that provide or fund services responded that individuals with brain injury are eligible for services [if they meet other eligibility criteria for services]).
| Type of service | Number of agencies that answered: Yes | Number of agencies that answered: No | Number of agencies that did not answer |
|---|---|---|---|
| Long-term Care Community Support Services | 8 | 2 | 1 |
| Employment Services | 7 | 3 | 1 |
| Education Services | 7 | 1 | 3 |
| Prevention Services | 6 | 5 | 0 |
| Acute Medical Care | 5 | 5 | 1 |
| Rehabilitation Services | 5 | 4 | 2 |
| Education/training Programs on TBI | 3 | 8 | 0 |
| Financial Resources for Individuals with TBI | 3 | 7 | 1 |
Each of the general service areas included a breakdown of specific services. OLRS looked at the funding/services that state agencies provided and compared those numbers against what individuals and families reported they needed the most.
The most needed service identified by individuals and families was cognitive training, yet only two agencies fund this service during rehabilitation. The second most needed service was recreation or social activities yet only one agency funds those services. Family counseling, behavioral supports, neuropsychology and individual counseling ranked next as the most needed services. The state agency responses show that Mental health services are provided by three agencies and two agencies provide or fund family support, education, and training. Only one agency funds chronic neurobehavioral treatment. Only two agencies fund neuropsychology services - one of which only funds it in an employment situation.
The Needs Assessment of individuals with TBI and their families found that case management was among both the top ten received services, and the top ten needed services. Five agencies provide or fund case management services.
Eight of the ten service agencies reported that they provide or fund long-term supports. However, it is important to mention that individual and family member survey results expressed a frustration at the lack of long term supports. In that survey, respondents commented about getting short term rehabilitation after their injury, but being unable to get long term supports.
Comparing what individuals and families say they need with what agencies provide will assist state agencies in determining what is meaningful for their service recipients who have BI, and will help state agencies modify their service funding and delivery accordingly.
The Needs Assessment asked state agencies to identify gaps that they saw in services, both within their own agency and across state service systems. State agency responders identified the following needs:
Further study of the service delivery system of the Bureau of Workers' Compensation is recommended. In contrast to other state agencies responses, BWC noted that:
Although state agencies fund or provide a variety of different services the results of the Needs Assessment show that there is very little focus on brain injury, little expertise to address the needs of brain injury survivors, and limited funding of the services that individuals with BI need the most. Recommendation 6 addresses specific actions that state agencies can take to begin to improve services to individuals with brain injury.