Traumatic Brain Injury (TBI) is a cognitive, psychological, neurological or anatomical change in brain functions caused by an external blunt force trauma to the head. Each year, 22,000 traumatic brain injuries are on record in California alone. The Brain Injury Association of America (BIAUSA) reports that TBI can cause epilepsy and increases the risk for conditions such as Alzheimer's disease, Parkinson's disease, and other brain disorders that become more prevalent with age.

Section 4353 of the Welfare & Institutions Code authorizes the Department of Mental Health (DMH) to fund TBI pilot projects for recovering adults. DMH contracts with organizations to develop and operate sites statewide that demonstrate diverse approaches to service delivery and resource coordination. These individual sites help TBI lives through community-based strategies and support systems. DMH does not provide direct funding assistance to individuals or directly administer TBI programs. Program funding comes from fees collected for California’s Vehicle Code violations, including the seatbelt law.

Two sites are hospital-based - Mercy Healthcare, Sacramento in Roseville and St. Jude Medical Center in Fullerton. The others are community-based.  Recent legislation requires an independent evaluation of current TBI services. An advisory workgroup convened by DMH will evaluate programs and assist with overall program administration. Assistance will include development and evaluations of requests for proposals, objective data collection and review, and TBI awareness and prevention strategies for peace officers and the general public.

The sites provide a coordinated service model, directly or by arrangement. Core services include the following:

• Supported Living Services include a range of appropriate supervision, support and training in the participant’s place of residence, designed to maximize independence. Residence means the place where a participant makes his or her home, including a house or apartment where the participant lives independently, assisted living arrangements, congregate housing, group homes, residential care facilities, transitional living programs and nursing facilities.


• Community Reintegration Services include services as needed by participants, designed to develop, maintain, increase, or maximize independent functioning, with the goal of living in the community and participating in community life. These services may include, but are not limited to, providing or arranging for access to housing, transportation, medical care, rehabilitative therapies, day programs, chemical dependency recovery programs, personal assistance and education.


• Services Coordination is the assessment and identification of participant’s special needs and problems and includes the development and planning of services to meet such needs. Services coordination should:
1. 1.) be participant driven,
2. 2.) extend participant empowerment,
3. 3.) provide ongoing support and encouragement,
4. 4.) afford personal advocacy and outreach when necessary,
5. 5.) maintain linkages to services,
6. 6.) monitor progress and
7. 7.) provide for reassessment.


• Vocational Supportive Services include methods for providing vocational rehabilitative and related services that may include prevocational and educational services to individuals who are unserved or underserved by existing vocational rehabilitation services. Vocational supportive services differ from traditional vocational rehabilitation and day activity services in the following four areas:
  • 1.) service participants appear to lack the potential for unassisted competitive employment;
  • 2.) ongoing training, supervision and support services are provided;
  • 3.) the opportunity is designed to provide the same benefits that other persons receive from work, including an adequate income level, quality of working life, security and mobility; and
  • 4.) there is flexibility in the provision of support which is necessary to enable the participant to function effectively at the work site.
    
    Beginning in fiscal year 1998, an interagency agreement was developed between the DMH and the Department of Rehabilitation (DOR) to provide a new and different pattern of services at the existing local TBI programs that previously were separate efforts of DOR and DMH. The agreement resulted in the development of vocational rehabilitation programs specifically focused upon the needs of adults with TBI. Currently, three of the sites participate in the interagency agreement with DOR.


• Family and Community Education is the provision of information designed to improve overall understanding of the nature and consequences of TBI, including public and professional education designed to facilitate early identification of persons with TBI, prompt referral of these persons to appropriate services and improvement of the system of services available to them.