training objectiveswhich were presented in the previous module) 3. previous page 2 of 20 next module...
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Training Objectives
Describe TBI.Explain how the brain may be affected by different types of injuries.Explain the significance of TBI.Describe TBI in Michigan.Explain the possible long-term impacts of TBI to individuals.Explain the possible long-term impacts of TBI to family members.Recognize some of the changes or issues that may arise due to a TBI.Identify strategies to handle people with TBI appropriately.Recall that each letter in the HELPS acronym stands for a question in theTBI screening tool.Recall how to score the TBI screening tool positive or negative.Identify when a referral for further assessment for TBI is appropriate.List appropriate referrals to public agencies for services from which peoplewith TBI may benefit and for which they may be eligible.
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Screening for a history of TBIObjectives of Module 3 are to:
Learn how to administer and score a TBI screening tool 1.Know when to make a referral for further assessment 2.
When you complete this module, you should know:
The rationale of the TBI screening tool •When to use the TBI screening tool •How to interpret the results of the screening tool •What to do next if TBI is identified•
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Screening for a history of TBIScreening for TBINot everyone who suffers a TBI will have long term impairments or problems. Alternatively, some people who do suffer from a TBI will not realize that subsequent problems are due to the earlier injury. Therefore, screening for TBI addresses three things:
Whether there was an incident in which the person suffered a serious head injury (such as a car accident, assault, or fall)
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How serious the injury seemed at the time (Was there loss of consciousness? Did the person seek treatment?)
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Whether the person suffers from symptoms consistent with TBI (many of which were presented in the previous module)
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Screening for a history of TBIThe HELPS screening tool
The screening tool presented in this course is based upon the HELPS TBI screening tool (Picard et al., 1991) and guidance from the Centers for Disease Control and Prevention regarding mild TBI (CDC, 2003)
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Twenty-three intake and assessment workers in three regions of Michigan pilot tested a previous version of this screening tool in 2003 and 2004
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Nearly 80% of these workers recommended that the tool be permanently incorporated into existing eligibility, needs assessment, and/or care planning protocols
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Screening for a history of TBIWhen should the screening tool be administered?
This screening tool should be administered during the most appropriate stage of your internal process, depending on the intake and assessment protocols of your organization
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The HELPS TBI screening tool can be incorporated into the intake and assessment process of your organization, or later as services are provided and the client is monitored
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Screening for a history of TBITo whom should the screening tool be administered?Depending on your agency’s policies and procedures, the screening tool can be administered to all persons applying for services, or it can be used as needed in the following situations:
When there is any suspected trauma that could have caused a brain injury •When a consumer is having difficulties functioning or is exhibiting unexplained behaviors - especially those described in Module 2
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When you suspect the possibility of a dual diagnosis, such as substance abuse and TBI
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Screening for a history of TBIEach letter in the HELPS acronym stands for a question
H - Have you ever hit your head or been hit on the head?E - Were you ever seen in the emergency room, hospital or by a doctor because of
an injury to your head?L - Did you ever lose consciousness or experience a period of being dazed and
confused because of an injury to your head?P - Do you experience any problems in daily life since you hit your head?S - Have you ever experienced a significant sickness?
Disclaimer: The HELPS Tool is only a screening tool and is not intended as a diagnostic instrument for purposes of
treatment planning.
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HELPS BRAIN INJURY SCREENING TOOL
The original HELPS TBI screening tool was developed by M. Picard, D. Scarisbrick, R. Paluck, 9/91, International Center for the Disabled, TBI-NET, U.S. Department of Education, Rehabilitation Services Administration, Grant #H128A00022. The Helps Tool was updated by project personnel to reflect recent recommendations by the CDC on the diagnosis of TBI. See http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/physicians/mtbi/diagnosis.htm. This document was supported in part by Grant 6 H21 MC 00039-03-01 from the Department of Health and Human Services (DHHS) Health Resources and Services Administration, Maternal and Child Health Bureau to the Michigan Department of Community Health. The contents are the sole responsibility of the authors and do not necessarily represent the official views of DHHS.
headaches dizziness anxiety depression difficulty concentrating difficulty remembering
difficulty reading, writing, calculating poor problem solving difficulty performing your job/school work change in relationships with others poor judgment (being fired from job, arrests,
fights)
Consumer Information:
Agency/Screener’s Information:
H Have you ever Hit your Head or been Hit on the Head? Yes No Note: Prompt client to think about all incidents that may have occurred at any age, even those that did not seem serious: vehicle accidents, falls, assault, abuse, sports, etc. Screen for domestic violence and child abuse, and also for service related injuries. A TBI can also occur from violent shaking of the head, such as being shaken as a baby or child.
E Were you ever seen in the Emergency room, hospital, or by a doctor because of an injury to your head? Yes No Note: Many people are seen for treatment. However, there are those who cannot afford treatment, or who do not think they require medical attention.
L Did you ever Lose consciousness or experience a period of being dazed and confused because of an injury to your head? Yes No Note: People with TBI may not lose consciousness but experience an “alteration of consciousness.” This may include feeling dazed, confused, or disoriented at the time of the injury, or being unable to remember the events surrounding the injury.
P Do you experience any of these Problems in your daily life since you hit your head? Yes No Note: Ask your client if s/he experiences any of the following problems, and ask when the problem presented. You are looking for a combination of two or more problems that were not present prior to the injury.
S Any significant Sicknesses? Yes No Note: Traumatic brain injury implies a physical blow to the head, but acquired brain injury may also be caused by medical conditions, such as: brain tumor, meningitis, West Nile virus, stroke, seizures. Also screen for instances of oxygen deprivation such as following a heart attack, carbon monoxide poisoning, near drowning, or near suffocation.
Scoring the HELPS Screening Tool A HELPS screening is considered positive for a possible TBI when the following 3 items are identified:
1.) An event that could have caused a brain injury (yes to H, E or S), and 2.) A period of loss of consciousness or altered consciousness after the injury or another indication that the
injury was severe (yes to L or E), and 3.) The presence of two or more chronic problems listed under P that were not present before the injury.
Note: A positive screening is not sufficient to diagnose TBI as the reason for current symptoms and
difficulties - other possible causes may need to be ruled out Some individuals could present exceptions to the screening results, such as people who do have
TBI-related problems but answered “no” to some questions Consider positive responses within the context of the person’s self-report and documentation of altered
behavioral and/or cognitive functioning
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Screening for a history of TBIHHave you ever hit your head or been hit on the head?
Prompt your client to think about all incidents that may have occurred at any age, even those that did not seem very serious, such as vehicle accidents, falls, an assault, abuse, sports accidents, blast injuries, etc.
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Screen for domestic violence and child abuse •Screen for military service-related injuries •Screen for violent shaking of the head, such as whiplash or being shaken as a baby or child
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Screening for a history of TBIEWere you ever seen in the emergency room, hospital, or by a doctor because of an injury to your head?
Many people are seen for treatment of a head injury. This can be an indication that the individual felt the injury was serious at the time.
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However, there are those who do not receive treatment because they cannot afford treatment or do not think they require medical attention. Be sure to ask your client if she or he feels they should have been seen by a doctor for the injury, even if she or he was not.
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Screening for a history of TBILDid you ever lose consciousness or experience a period of being dazed and confused because of an injury to your head?
The length of time a person remained unconscious is associated with the severity of TBI
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People with TBI may not lose consciousness but experience an "alteration of consciousness." This may include feeling dazed, confused, or disoriented at the time of the injury, or being unable to remember the events surrounding the injury (CDC, 2003).
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Even a minor injury can result in lasting problems
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If the person was a child at the time of the injury, you may not be able to know
if a symptom dates to the time of injury. Review the slide about Children
& TBI in Module 1.
Screening for a history of TBIPDo you experience any of the following problems in daily life since you hit your head? Ask your client if she or he experiences any of the following problems, and ask when the problem presented. You are looking for a combination of two or more problems that were not present prior to the injury.
Headaches •Dizziness •Anxiety •Depression •Difficulty concentrating •Difficulty remembering •Difficulty reading, writing, calculating •Poor problem solving •Irritability •Difficulty performing your job/school work •Change in relationships with others •Poor judgment (e.g., being fired from a job, arrests, fights) •
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Screening for a history of TBISHave you ever experienced a significant sickness? Traumatic brain injury implies a physical blow to the head. However, acquired brain injury may be caused by medical conditions, such as:
Brain tumor •Meningitis •West Nile virus •Stroke •Seizures •
Also screen for instances of oxygen deprivation, such as:
Near drowning •Suffocation •Heart attack •Asphyxia •Carbon monoxide poisoning •
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Screening for a history of TBIHow to score HELPSA HELPS screening is considered positive for a possible TBI when the following 3 items are identified:
An event that could have caused a brain injury (yes to H, E or S) 1.A period of loss of consciousness or altered consciousness after the injury or another indication that the injury was severe (yes to L or E)
2.
The presence of two or more chronic problems listed under P that were not present before the injury
3.
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Screening for a history of TBIHow to score HELPS (continued)Please Note!!!
A positive screening is not sufficient to diagnose TBI as the reason for current symptoms and difficulties - other possible causes may need to be ruled out
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Some individuals could present exceptions to the screening results, such as people who do have TBI-related problems but answered "no" to some questions
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Consider positive responses within the context of the person’s self-report and documentation of altered behavioral and/or cognitive functioning
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This information in concert with your judgment can be used as a basis for further inquiry
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Follow your agency’s protocols on how to obtain further assessment •
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Screening for a history of TBIIf screening leads you to suspect TBIMost public human services agencies do not require a diagnosis of TBI for a person to receive services. Eligibility for services is typically based on functional or financial difficulties that a person is experiencing. Therefore, a person with a suspected TBI should continue to be assessed for service eligibility while undergoing the process of further evaluation for determination of a TBI diagnosis. Depending on your agency’s protocols and your role in serving the client, consider the following next steps:
Confer with the client about the possibility that the head injury and current problems or symptoms are linked
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Document reasons for suspecting a TBI in your client’s file 2.Continue with the normal eligibility and assessment protocols of your agency or organization
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Screening for a history of TBIIf screening leads you to suspect TBI (continued)Possible next steps (continued):
Follow your agency’s protocols for evaluation and referral 4.As always, when appropriate, refer your client to other sources for services for which they may be eligible
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Consider referring your client to a physician or primary care provider for further assessment. Such a provider may use the following sources of information to diagnose TBI:
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Medical records from the injury •A neuropsychological assessment •
If a person is diagnosed with impairments related to TBI, his/her plan of care should incorporate appropriate treatment, rehabilitation, and compensatory strategies, as described in Module 2
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If a specialist diagnoses the client with impairments related to TBI, in your continued role of serving your client, you may be in a position to consider referral to an advocacy or support group for assistance
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Screening for a history of TBICase StudyThe theoretical case study of Judy will allow you to explore this module's topics further. Below you will find a brief description of this study. Use the next button at the bottom of the page to begin. Case study: Judy – This study describes the situation of a woman with a possible TBI that has not been identified.
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Case Study - JudyJudy’s backgroundJudy is a 24 year old single woman who is being referred for a substance abuse intake. Six months ago, after having too much to drink, she crashed her uninsured car. Her six year old daughter was killed in the crash. Neither mother nor daughter were wearing seatbelts, and Judy went through the windshield. Judy had a brief loss of consciousness and a long hospital and acute rehabilitation stay due to multiple trauma, including a spinal cord injury causing paraplegia. She doesn’t remember a large portion of her hospital stay, including the time of her daughter’s funeral. She now uses a wheel chair for mobility. Judy was independent before her injury. She demonstrated good job stability and was actively involved with her community. She believes she was unable to return to her minimum wage job in the tourism industry because of her wheelchair. She is unable to return to her apartment because it is too expensive now that she is unemployed, and it is not barrier free. She has no immediate family in the area, but does have several close friends. None of her friends, however, have barrier free housing.
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Case Study - JudyJudy’s background (continued)Judy was discharged to a wheelchair accessible Adult Foster Care (AFC) Facility where she feels she has no friends since the average age of others in the house is 65 years and most have a lifetime of chronic mental illness. Judy leaves the AFC occasionally with friends, but often returns drunk. Judy denies that she had problems with drugs or alcohol before she was hurt, and there is no documentation to the contrary. According to AFC staff members, Judy has begun to request additional pain medications, complaining that her pain is very severe. AFC staff report that Judy displays signs of depression and cries often. She will not discuss the death of her daughter with her therapist or anyone else. She is distrustful of her doctors and is uncooperative at her physical therapy appointments. Judy spends long periods of time simply sitting and staring and rarely shows emotion.
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Case Study - JudySummary of Judy's issues
She does not interact with the other residents•Judy reports severe pain and often requests larger doses of pain medication
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She cries often with vivid recollections of the crash and her daughter’s death, and she complains frequently of being depressed
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She is distrustful of her therapists and doctors, and is not cooperative at her physical therapy appointments
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She is listless and her affect is very flat•
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Case Study - JudyYou now have the option to view an expert's solution to this case scenario on video or to view a transcript of this solution. Please make your selection below. View the Video View the Transcript
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Possible strategies to address Judy’s issues - transcript There are ways to help Judy. She’s dealing with some pretty significant changes in her life including the death of her daughter, a new living situation and reliance on a wheelchair. An undiagnosed brain injury might be making her adjustment even more difficult. If you were to administer the HELPS screening tool to Judy, she would screen positively for a possible TBI. Although, Judy has several issues that should be addressed before trying to determine if she has disabilities resulting from a brain injury. Judy’s treatments should be provided with the understanding that she may have a coexisting brain injury, and Judy should be given some resources on TBI, such as the Michigan Resource Guide for Persons with Traumatic Brain Injury and their Families. Judy has not spoken to a therapist regarding the loss of her daughter. She needs an evaluation for depression and grief counseling. She may also benefit from a substance abuse evaluation and possibly a support group meeting for persons who use substances. Judy needs to see a rehabilitation physician to manage and evaluate her pain issues and to explore alternative pain management options. Judy’s pain may be related to her spinal cord injury and may require special attention. Special exercises taught by a physical therapist may also reduce her pain and discomfort and improve her mobility. Other suggestions that could help Judy live a better life include the following. Judy needs to learn that use of certain substances might physically affect her differently post injury. Judy needs a co-occurring disorder model of substance abuse treatment. Based on Judy’s positive employment history, she would likely benefit from vocational counseling and getting back to work. Judy should be encouraged to get out into the community, which will give her more opportunities for interaction with friends and may help lessen her listlessness. Judy may be inappropriately placed in the Adult Foster Care Facility. Other housing options should be explored for Judy, such as section 8 housing or financial assistance to make an apartment barrier free. If Judy remains uncooperative with her physical therapy appointments, alternative forms of activity should be encouraged, such as a recreation program that she can participate in with her peers or a home exercise stretching program. Once Judy’s immediate issues have been addressed, she should see a neuropsychologist for an evaluation to identify if any of her issues are related to an injury to her brain.
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Test your knowledgeThis final section of Module 3 consists of eight questions.
You must complete the questions to receive a score for this module on your training transcript.
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When you submit an answer for each question, a box will appear stating whether or not your answer was correct, along with an explanation of the correct answer.
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Once you submit an answer for each question, it cannot be changed. However, you may return to the assessment section of this module on another day and retake the test. Your most recent score will appear on your transcript.
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Begin Test
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Test your knowledge1. Why should service providers screen clients for TBI?
(a) Some people who suffer a TBI do not realize that their symptoms are caused by their injury.(b) Identifying TBI as the cause of a client’s symptoms can facilitate identifying appropriate services.(c) Understanding how brain damage might be affecting a client’s behavior can lead to more productive interaction strategies.(d) All of the above.
Submit
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Test your knowledgeThat is correct. It is important to screen clients for TBI because it is often undiagnosed or misdiagnosed, TBI can have long-term consequences, and appropriate services can lead to improved functioning.
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Test your knowledge2. What does HELPS stand for?
(a) Hit head, extra services, loss of consciousness, poor judgment, stressed state (b) Hit head, emergency room, loss of consciousness, problems in daily life, significant sickness (c) Health problems, emergency room, lobe damage, problems in daily life, stressed state (d) Health problems, epileptic seizures, life support, personality changes, support services
Submit
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Test your knowledgeThat is correct. The acronym HELPS stands for: H - have you ever hit your head or been hit on the head? E - were you ever seen in the emergency room, hospital, or by a doctor because of an injury to your head? L - did you ever lose consciousness or experience a period of being dazed and confused because of an injury to your head? P - do you experience any problems in daily life since you hit your head? S - Have you ever experienced a significant sickness?
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Test your knowledge3. Which of the following constitutes having been "hit in the head" for the
purposes of the HELPS screening tool?
(a) The client played football and had one concussion. (b) The client was pushed down the stairs during a domestic assault. (c) The client hit the windshield in a car accident. (d) All of the above.
Submit
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Test your knowledgeThat is correct. Any of these events could have caused a brain injury.
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Test your knowledge4. Maria is a teenager living with adoptive parents. Although Maria showed no
developmental delays in elementary school, her grades have declined over the last few years - especially since middle school. In addition she is showing behavioral problems: lack of attendance, not turning in homework, and generally seeming very disorganized. You ask whether Maria has ever had a serious blow to the head. Maria’s parents reply that they do not know of a specific incident in which Maria lost consciousness due to a blow to the head. However, Maria was taken from her biological parents for child abuse when she was 2 years old. When scoring the HELPS, would you indicate that Maria screened positive for TBI?
(a) Yes, this is a possible case of TBI (b) No, Maria’s current difficulties are probably not due to TBI
Submit
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Test your knowledgeThat is correct. Research indicates that a large percentage of children suffering from abuse experience traumatic brain injury (Donohoe 2003).
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Test your knowledge5. Which of the following are not "problems in daily life" as defined by the
HELPS screening tool?
(a) Headaches & dizziness (b) Poor medical coverage & minimum wage (c) Depression & anxiety (d) Poor judgment & poor problem solving
Submit
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Test your knowledgeThat is correct. Poor medical coverage and minimum wage may be problems for an individual; however, "problems in daily life" refer to physical, cognitive, and emotional problems that may be the result of a head injury.
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Test your knowledge6. When administering the HELPS screening tool, you ask your client, Martin, if
he has ever experienced a significant sickness or an event that caused oxygen deprivation. Your client indicates that he was trapped under the pool cover as a child and almost drowned. How would you score this response?
(a) Yes, Martin had a significant sickness that may have resulted in a TBI. (b) Yes, Martin had a significant sickness that may have resulted in an acquired brain injury. (c) No, Martin did not have a significant sickness. (d) It would be necessary to determine whether Martin lost consciousness before deciding how to score his response.
Submit
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Test your knowledgeThat is correct. A near drowning event can cause brain damage through loss of oxygen. However, a near drowning event is an acquired brain injury, not a traumatic brain injury, because traumatic brain injury involves external trauma to the head or violent movement of the head.
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Test your knowledge7. Which of the following is required for a positive HELPS result?
(a) An event that could have caused a brain injury. (b) A period of altered consciousness or a loss of consciousness or another indication that the injury was severe. (c) The presence of two or more problems in daily life that were not present before the injury or event. (d) All of the above.
Submit
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Test your knowledgeThat is correct. A positive HELPS result indicates that a TBI is possible, and these three findings are required to establish a positive result.
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Test your knowledge8. Your client, Angie, has been having difficulty at work completing tasks, staying
organized, and prioritizing her work. You administered the HELPS and found that Angie had a car accident six months ago during which she hit her forehead on the dashboard and lost consciousness. You find that, since the accident, Angie has experienced difficulty with problem solving, judgment, and concentration. Given these findings, you determine that Angie may have a TBI. Which of the following should not be included in your next steps?
(a) Tell Angie that she has a TBI. (b) Document your findings. (c) Refer Angie to a medical professional for further assessment. (d) Identify other services for which Angie may be eligible.
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Test your knowledgeThat is correct. A positive HELPS result indicates that a TBI is possible; it does not indicate that an individual has suffered a TBI.
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Test your knowledge
You have completed Module 3 of this course. You may print the Module 3 pages for reference or review.
Print Module 3 Pages To see your test results, click the transcript button below.
Transcript To continue with the course, click the link below, or you may access any module from the main menu at any time.
Begin Module 4
Navigation TipsThis course contains four modules plus supplementary information. You may complete the modules atyour own pace. You must complete each module and spend at least three hours studying coursematerial to receive CE credit. Please see Continuing Education (CE) Credit Requirements for moreinformation.
Throughout this course, you may have five main windows open in your browser at any given time. If youhave a window open but in the background, and click on a link that would normallyopen in that background window, it will not automatically come to the fore. The linkwill open, but you will have to use your program buttons at the bottom of yourscreen to switch to that window. Training content that will appear in each of the windows is asfollows:
1. Main menu
The first window, the Main menu, will remain open while you are logged into this course,unless you use your browser buttons to move forwards, backwards, or exit. From the Mainmenu you may access any module by clicking on the module number. You may also accesssupplementary materials from the sidebar at the left of the screen.
2. Modules
The modules will open in a second window. You will not have access to your browser buttonsfrom this window. To advance through these modules, click on the arrows on the bottom, rightcorner of the screen. You may exit a module at any time by selecting Exit from the sidebar onthe left. If from the Main menu you select a module other than one that is already open, themodule you select will replace the open one in this window.
Each module concludes with a series of Assessment or quiz questions. Once you get tothe quiz questions, select your answer choice and then click submit . When you havecompleted the self assessment questions, you will be able to view your quiz results andadvance to the next content area of the course. The results of the assessment will be savedonce you have submitted an answer to the last question in each module.
In Module 4 only, numerous acronyms are used for state agencies and non-profitorganizations. Positioning your curser/pointer over an acronym will cause the full name of theagency or organization to appear on the screen.
At the end of Module 4 , you will be asked to give us feedback by filling out a briefEvaluation form. This is required for CE credits.
3. Supplementary information
Supplementary information will appear in a third browser window. This information will beavailable from the sidebar on the left of the Main menu screen and the modules.
1. Navigation tips: This document.
2. Glossary: You may also access the glossary by selecting any underlined word inthe modules.
3. References: You may also access references by clicking on any referencesthroughout the modules.
4. Resource links: List of links to additional information available from otheragencies/organizations on the World Wide Web.
In addition, the following supplementary material is available from the Main menu screen:
5. Course outline: Lists the content contained in each module.
6. Update registration/password information: Update the information on youremail address, place of work, etc., so that we may notify you in the case of majorchanges in course content. Also, you may change your password for purposes ofcourse login from this page.
7. Course transcript: View the results of your quiz scores for each module, updateyour time log, or submit for SB CE credit once all necessary requirements are met.
8. Continuing Education (CE) Credit Requirements (click here): Explains therequirements that must be met in order to earn CE credits for completion of this TBItraining course.
4. Case studies
At the end of each module you will have the opportunity to view case studies relating to thetopics covered. These case studies will open up in a fourth window. Please note: If you arecurrently using Mozilla or Firefox you may need to reopen the training site in Netscape orInternet Explorer in order to view these case studies. Also, if you have difficulty viewing thevideos or hearing the audio, you will have the option to read the video transcript.
5. Websites outside of the training course
Throughout the modules and on the Resource Links page you will have the chance toaccess information from many websites outside of the training course. These external sites willopen up in a fifth window. Only one external site may be opened at a time, with each new sitereplacing the one that was opened last.
If you are having technical difficulties, please report them to us at: [email protected].
Continuing Education (CE) CreditRequirementsIn order to activate the training with the correct features for earning CE credit, you must FIRST indicate your interest inearning CE credit on the Course Registration page. If you have not already done this, go back to the Main Menu pageand select "Update Registration/Password Information" from the blue bar on the left. On the Course registration page youmust select yes for earning CE credits, indicate the type of profession, update all necessary information, and then click"Submit" at the bottom of the page.
Professionals in the areas of
Nursing (3 Contact Hours available)Education (3 SB-CEU available)Case Management (3 Clock Hours available)Social Work (3 Instructional Continuing Education Hours available)Nursing Home Administrators (3 Credit Hours available)Licensed Professional Counselors (3 Clock Hours available)Disability Management Specialists (4 Clock Hours available)Rehabilitation Counselors (4 Clock Hours available)Adult Foster Care (3 CEU's available)Certified Health Education Specialists (3 CECH)
have the opportunity to earn continuing education (CE) credits toward their respective Michigan licenses for completion ofthe “Traumatic Brain Injury and Public Services in Michigan” training course. In order to earn CE credits toward one ofthese licenses, each participant must meet the following requirements:
(1) Time Log: You must record all time spent on the “Traumatic Brain Injury and Public Services in Michigan” training inthe online time log. This time log is available from the Main Menu page of the training by clicking the “Course Transcript”link in the blue bar at the left. The instructions on the course transcript will ask you to enter the date and the number ofhours/minutes spent going through the TBI training materials. You will need to add an entry to your time log each time youaccess the training and review more materials, and then save the changes by clicking the “Save Time Log Updates”button at the bottom of that page. Because this is an online training and can be completed in multiple sessions, you mayneed to make several entries into your time log before finishing the entire training. The time log will serve as a personalaccount of your efforts put toward this training and must be completed for CE credit. Note: to earn the number ofhours/credits listed above you must spend at least three hours studying the curriculum.
(2) 84% Cumulative Quiz Score (Total Score): You must complete the multiple choice quiz at the end of each ofthe four training modules and obtain a Total Score of 84%. Each quiz contains 8-10 questions – there are 37 questionstotal. To obtain the necessary 84% Total Score, you must answer at least 31 questions correctly. This means you canmiss a total of six questions.
Upon completion of a quiz, the score and the date of the quiz will be recorded into your course transcript. Quizzes may beretaken as many times as desired. Your Total Score will be calculated on your course transcript once all four modulequizzes have been completed.
(3) Evaluation: You must complete an online evaluation of the TBI training course. When you have completed theModule 4 quiz, you will be directed to this evaluation. Completion of this evaluation will also be recorded on your coursetranscript and is required for CE credit.
When you have met the above requirements, please review the information on your course transcript one last time. If allinformation is correct and complete, please print by clicking the “Print Course Transcript” button toward the bottom of thecourse transcript page and save this copy for your records.
In order to submit your completed course transcript for credit toward your professional license, you will need to click the“Submit for CE credit” button at the bottom of the course transcript page. Clicking this button indicates that you agree thatall the information on the course transcript is correct, complete, and meets the above requirements. Once you haveclicked the submit button you will receive a confirmation that your course transcript has been submitted successfully.Assuming all requirements were met, you can expect to receive your Course Completion/CE Credit Certificate in the mailwithin 4-6 weeks following submission.
Additional Information on Nursing Contact Hours
This continuing nursing education activity was approved by the Ohio Nurses Association (OBN-001-91), anaccredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Approval valid through July 15, 2012. Assigned ONA #14,391-I3.0 nursing contact hours will be provided.This continuing education activity will be available to nurses until July 15, 2012.
Criteria for successful completion include finishing all four training modules and receiving a cumulative quiz average of atleast 84%. Participants must also complete the evaluation survey at the end of the training. Certificates of completion willbe mailed to eligible training participants.
The authors and planning committee have declared no conflict of interest. There is no commercial support orsponsorship for this event.
If you have any questions or problems, please contact [email protected].
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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Acquired brain injury (ABI): An acquired brain injury is an injury to the brain,which is not hereditary, congenital, degenerative, or induced by birth trauma. Anacquired brain injury is an injury to the brain that has occurred after birth.
Activities of daily living (ADLs): Basic tasks that a person performsthroughout the course of his/her day, such as: eating, bathing, toileting,grooming, transferring and moving about. Tasks that are related to independentliving are called instrumental activities daily living and include: takingmedications, preparing meals, laundry, housework, shopping, and errands.
Acute: In reference to healthcare for TBI, describes the medical proceduresundertaken to stabilize a patient in a hospital; care that is provided on a short-term basis for an immediate need, usually right after the injury occurred. Postacute care is care provided after initial stabilization on a longer-term basis.
Advocate: To argue for a cause, or plead on another’s behalf for education,legal, personal, or vocational rights, or a person who argues for their own, oranother person’s rights.
Anoxia: The cessation of oxygen supply to the brain -- can lead to brain celldeath and loss of function.
Assistive technology (assistive devices, adaptive technologies, adaptiveequipment): Any technology that enables someone to do something that s/henormally cannot do. A special device that assists in the performance of self-care,work, play/leisure, or physical exercise. Some assistive technologies can beuseful in compensating for cognitive deficits. Examples include: personal digitalassistants, voice organizers and recorders, reminders, watches, and smartphones.
Antecedents: Factors or events that occur prior to a current situation. Attentionto antecedents can assist in promoting desired behaviors and avoiding negativebehaviors.
Ataxia: Inability to coordinate voluntary muscle movements.
Axonal shearing: When the brain is moved back and forth against the skullafter a head trauma, it is alternatively compressed and stretched because of itssoft, gelatin-like structure. The long, fragile axons of the neurons that make upthe brain are also compressed and stretched. If the impact is severe enough,axons can be stretched until they are torn. This is called axonal shearing. Whenthis happens, the neuron dies. An injury with substantial axonal shearing is morediffuse -- spread throughout the brain.
Axons: Long nerve fibers that conduct impulses away from the cell body of aneuron.
Glossary
Brain injury: Any injury that results in brain cell death and loss of function.
Brain Injury Association of Michigan (BIAMI): A non-profit consumerorganization that works to improve the lives of those affected by brain injurythrough education, advocacy, research and local support groups.
Brain swelling (cerebral edema): The brain swells after a severe trauma, justlike any other part of the body. This is also a major cause of damage after braininjury. Very severe swelling can cause death by compressing the brain stem.Brain swelling can lead to neuronal damage by squeezing the cells or fromanoxia caused by disrupting the flow of blood and oxygen to the brain.
Centers for Disease Control and Prevention (CDC): One of 13 majoroperating components of the Department of Health and Human Services; andleads the nation’s public health efforts to prevent and control infectious diseases,injuries, workplace hazards, disabilities, and environmental health threats.
Centers for Independent Living (CILs): Centers located throughout Michiganto provide services designed to maximize self-sufficiency and independence ofpeople with disabilities.
Cognitive functioning: A function of the brain that refers to how one thinks,reasons, stores, and processes information.
Community Mental Health Services Programs (CMHSP): Programscontracted by the Michigan Department of Community Health to provide a fullarray of community-based support services for eligible individuals (persons witha qualifying developmental disability or mental illness) and their families. Whilesome CMHSPs may directly operate treatment programs, most CMHSPs establisha network of agencies and professionals to provide treatment services.
Congenital condition: Circumstance that is present at birth.
Contusion (of the brain): Bruising and bleeding of the brain due to the tearingof small blood vessels upon impact. It can lead to the death of neurons. Smallcontusions (as in concussion) are not usually treated unless blood flow isinterrupted.
Coordinating Agency (CA): Agencies contracted by MDCH, Office of DrugControl Policy, to provide access to publicly funded substance abuse services.They have administrative responsibility for an Access Management System thatdetermines eligibility, manages resources and assures quality of care.
Coup-contracoup: A pattern of contusion whereby one contusion occurs at thesite of the initial impact on the brain ("coup") and another at the site directlyopposite ("contracoup"). This pattern is the result of the brain moving back andforth inside the skull upon impact.
Culture: An integrated pattern of socially transmitted human behavior thatincludes thoughts, communication, actions, customs, beliefs, values, institutions,and all other products of human work or thought, characteristic of a particularcommunity or population (Cross et al., 1989). Though culture is often viewed assimply race and ethnicity, the term encompasses much more. Other groups of
people display distinct cultural characteristics and in turn receive culturallyinsensitive responses from society. Examples of such groups include the poor,the homeless, and the disabled.
Cultural competence: The ability and the will to respond to the unique needs ofan individual client or family that arise from the client’s culture and the ability touse the person’s cultural strengths as resources or tools to assist with thetreatment, intervention or helping process. Cultural competence is generallyregarded as a long term process towards which one strives. In addition, culturalcompetence can be thought of as an attribute of an individual provider and as anattribute of an organization.
Department of Human Services (DHS) (formerly Family IndependenceAgency or FIA): Michigan state agency that directs the operations of publicassistance and service programs in every county in Michigan. In particular, DHSdetermines eligibility for the Medicaid insurance programs and provides AdultServices to persons who are Medicaid eligible.
Depressed skull fracture: This is when bones of the skull are broken orcracked with loose bone fragments actually placing pressure or penetrating thebrain, thereby causing damage.
Developmental disability (DD) -- According to the Michigan Mental HealthCode, a developmental disability is a severe mental or physical impairment that:1) occurs before an individual is 22 years old; 2) is likely to continue indefinitely;3) results in substantial functional limitation in three or more of the followingareas of major life activities: self care, mobility, learning, self direction, receptive& expressive language, capacity for independent living, and economic selfsufficiency; and 4) reflects the individual’s need for special, interdisciplinarytreatment, or other services that are of lifelong or extended duration. For minorsfrom birth to age five, a developmental disability is a substantial developmentaldelay or a specific congenital or acquired condition with a high probability ofresulting in developmental disability if services are not provided.
Diffuse injury: An injury to the brain in which damage is not limited to onelocation in the brain, but affects multiple areas.
Eligibility: Requirements that need to be met by the applicant, in order toreceive services or enroll in a program.
Executive functioning: Cognitive functions having to do with planning, abstractreasoning, problem-solving, information processing, judgement,workingmemory, etc.
Glasgow Coma Scale (GCS): The GCS is commonly used for initial assessmentof brain injury severity. The GCS uses a 15 point scale to rate eye opening,motor, and verbal response functions. Unfortunately in practice, the time of theassessment can vary (e.g., at the scene of injury, upon arrival in the emergencydepartment, etc.) -- making results from one patient to the next difficult tocompare. Moreover, GCS results may not be valid for children, people under theinfluence of alcohol, or people with language differences.
HELPS: Acronym for the brain injury screening tool described in this training.Each letter of the acronym stands for one of the five questions of the tool.
Hematoma: If the blood vessels damaged by the impact inside the skull arelarge enough, they may bleed enough to create a pool of blood or hematoma. Ahematoma can cause brain injury by directly damaging the neurons it comes incontact with or by squeezing neurons through increased pressure in the braindue to its volume. The treatment for a hematoma is to surgically drain it, ifpossible.
Hypovolemic shock: After injury, loss of blood volume can further compromisehealthy brain tissue.
Incidence: In reference to TBI data, incidence refers to the number of a giventype of events, or new instances of TBI, in a year.
Increased intracranial pressure: intracranial pressure occurs because of abuild-up of pressure within the skull. Because the brain, membranes andcerebrospinal fluid are encased with the bones of the skull, the fluid formed as aresult of swelling or bleeding "backstop" in the brain causing increased pressureinside the brain which results in further damage to brain tissue.
Individualized Education Program (IEP): A written plan for a child or studentwho has a disability and who qualifies for special education services. The IEPmust include, among many other specific features, measurable annual academicand functional goals; and the types of special educational and related servicesand supplementary aids and services that the child will receive (such as speechand language services, or physical or occupational therapy) to enable the child orstudent to be involved in and make progress in the general educationcurriculum. The IEP is developed, reviewed and revised in a meeting consistingof a team that includes school personnel, family members, and other individuals.
Individuals with Disabilities Education Act (IDEA): A federal law, firstenacted in 1975 and most currently re-authorized and revised in 2004, thatrequires public schools to determine whether a child has a disability, develop aplan that details the education and support services that children and studentswill receive, provide the services, and re-evaluate the plan periodically. There isfederal funding available for some of these responsibilities.
Initiation: The act of beginning a task or setting in motion a course of events.
Long Term Care services: Long term care (LTC) services are the medical,social, personal care, and supportive services needed by people who have lostcapacity for self-care due to a chronic illness or condition. It's different fromacute health care because assistance is required for an indefinite period of time,and because recovery of function may be incomplete.
Medicaid Fee for Service (FFS): A Medicaid service plan in which coveredservices are reimbursed separately. Most individuals in Michigan who are onMedicaid are not covered by Medicaid FFS, but are enrolled in a Medicaid(managed care) Health Plan. (Although most Long Term Care is covered byMedicaid FFS)
Mental illness (MI): A mental condition characterized by a substantial disorderof thought or mood that interferes with an individual’s ability to function in day-to-day life.
Michigan Department of Community Health (MDCH): The department ofstate government that is responsible for health policy and management of thestate's publicly-funded health service systems.
Michigan Department of Education (MDE): The department of stategovernment that is responsible for, or interacts with those responsible for, allaspects of education of the state’s 1.8 million children and students in publicschools. An eight-member elected State Board of Education oversees the work ofthe department.
Michigan Protection and Advocacy Service (MPAS): A private, nonprofitorganization that provides information and advocacy to people with disabilities inMichigan.
Michigan Rehabilitation Services (MRS): Part of the Department of Laborand Economic Growth, MRS offers services necessary to assist eligible individualswith disabilities in preparing for, securing, retaining, or regaining employment.
Mild TBI: Medically defined as any period of loss of consciousness (typically lessthan 15 minutes); any loss of memory for events immediately before or after theaccident; or any alteration in the mental state at the time of the accident (e.g.,feeling dazed, disoriented or confused). Mild TBI generally does not includeposttraumatic amnesia greater than 24 hours (NIH, 1998). Mild TBI is associatedwith a Glasgow Coma Scale score of 13-15.
Moderate TBI: Medically defined as a loss of consciousness that can lastminutes or a few hours and is followed by a few days or weeks of confusion.Persons with moderate TBI may have a longer period of impaired consciousness,more impaired verbal memory shortly after the injury and a lower likelihood ofachieving a good recovery within 6 months than persons suffering mild TBI (NIH,1998). Moderate TBI often is associated with a GCS of 9 -- 12.
Motor functioning: Involving or relating to movements of the muscles.
Multidisciplinary Evaluation Team (MET): The team that assesses studentsto determine eligibility for special education or early intervention services.
Negative reinforcement (escape and avoidance): When the consequence ofa behavior resulted in avoiding or getting out of an unpleasant situation, and theeffect is to encourage the behavior again in the future.
Neurologic: Related to the nervous system and its structure and functions.
Neurologic exam: An examination conducted by a neurologist, which mightinclude the following: a detailed medical history and assessment of neurologicfunctions (reflexes, cranial nerve functioning, gross movements, muscle tone,and perception of sensory stimuli).
Neuropsychological assessment/evaluation: A thorough testing of cognitive,emotional, and intellectual functioning that can assist in diagnosing brain injury
and planning care.
Neurons: Impulse conducting cells that constitute the brain, spinal column, andnerves, consisting of a nucleated cell body with one or more dendrites and asingle axon.
Neuropsychologist: A professional who evaluates the relationship betweenbrain and behavior; conducts extensive testing and counseling; does notprescribe medication.
Occupational therapy (OT): The use of self-care, work and play activities toincrease independent function, enhance development and prevent disability; OTmay include the adaptation of a task or the environment to achieve maximumindependence. An Occupational Therapist is a professional who helps a personto regain skills in activities of daily living (e.g., dressing, eating, bathing, etc.)and routine “occupations” (e.g., cooking, shopping, scheduling, driving, etc.).
Physical Disability Services (PDS): PDS are those necessary services andexpenditures targeted for medically stable persons 18 years of age or older whohave functional limitations which are physical in nature. Services are provided toenable functionally limited people to live as independently as possible.
Physical therapy (PT): Treatment that uses physical agents such as exerciseand massage to restore or facilitate recovery of physical abilities. A PhysicalTherapist is a professional who treats injury or physical dysfunction withexercises and other physical treatments to restore or facilitate recovery ofphysical abilities.
Positive reinforcement (rewards): When good things happen following abehavior and that behavior is repeated in the future in order to achieve thatresult, the behavior is likely to continue -- it has been reinforced.
Posttraumatic amnesia: The loss of memories of events after the brain injury;also refers to the length of time that it takes for the return of full consciousnessand memory for recent events following trauma.
Posttraumatic depression: The occurrence of the psychiatric condition ofdepression following brain injury.
Primary event: In reference to TBI, brain damage, such as contusion andaxonal shearing, that occurs during the initial phase of injury (during impact).The primary event is distinguished from the secondary event, or subsequentbrain damage, that occurs because of the body’s reaction to the primary event(such as brain swelling and anoxia).
Psychiatric evaluation: An assessment of mental, emotional, or behavioraldisorders.
Psychological/behavioral strategies of pain management: Behavioraltechniques to deal with physical pain. The focus of treatment is to increase aperson’s ability to manage, function, and cope with pain. Such techniques mayinclude relaxation training, developing coping skills to deal with emotions such assadness, anxiety, or anger, and to deal with beliefs and expectations related topain. Problem-solving techniques and communication skills regarding expressing
and dealing with pain may also be included.
Psychological testing: Standardized assessment of emotional and intellectualfunctioning, and the personality characteristics of an individual.
Skull fracture: Bones of the skull are broken or cracked. Injury severity canrange from simple, undisplaced fractures to compound fractures which involveloose bone fragments placing pressure on or penetrating the brain.
Secondary event: In reference to TBI, this is the injury or complicationresulting from the reaction of the brain to the primary event, including: brainswelling (edema), pooling of blood (hematoma), increased intracranial pressure,hypovolemic shock, and loss of oxygen (anoxia).
Seizures: Waves of synchronized nerve cell activation that can involve the entirebrain, or can be confined to a particular area of the brain. When the entire brainis involved it is called a generalized seizure or grand mal; and symptomsinclude loss of consciousness, rhythmic jerking body movements, and otherpossible symptoms. If only part of the brain is involved, it is called a partial orfocal seizure; generally the person does not lose consciousness and othersymptoms depend on the area of the brain affected.
Self monitoring: Regarding behavior, the ability to act appropriately and refrainfrom inappropriate behavior based on a given social situation.
Sequencing: The ability to recognize the necessary order of events.
Severe TBI: Medically defined by a loss of consciousness, or coma, for 6 hoursor longer, either immediately after the injury or after an intervening period ofclarity. Severe TBI is often associated with a GCS of 8 or lower.
Sleep routines: The activities and environment surrounding sleep can affect aperson’s ability to get enough rest. The following might have an impact: going tobed on a consistent schedule, limiting sleep during the day, having a relaxingbedtime routine, having a comfortable sleeping environment, etc.
Sleep study: Monitoring the cycles and stages of sleep using direct observationor by using electrodes to make continuous recordings of brain waves, electricalactivity of muscles, eye movement, respiratory rate, blood pressure, bloodoxygen saturation, and heart rhythm. The test is performed for people who sufferfrom insomnia, excessive daytime sleepiness, obstructive sleep apnea, breathingdifficulties during sleep, or behavior disturbances during sleep.
Spasticity: Involuntary increase in muscle tone (energy sent to the musclesfrom the brain and spinal cord) which causes the muscle to resist being stretchedand move in an coordinated fashion.
Special Education and Early Intervention services: The commonly usedphrase that encompasses the wide variety of services and supports availablethrough intermediate, local public school districts and charter schools (PublicSchool Academies) to eligible children and students from the ages of birththrough age 21, who have not earned a regular high school diploma. Servicesavailable are based on federal and state laws and rules and are often consideredaccording to the ages of the youth being served: Early On is a system inMichigan designed to arrange for services and supports for infants and toddlers
ages birth to 3 years and their families; while Special Education in Michiganusually means the wide array of services and supplemental aids and services forchildren and students through ages 25. (See also Individualized EducationProgram and Individuals with Disabilities Education Act).
Speech and language therapist: A professional who evaluates and treatscommunication and cognitive skills including speaking and understanding writtenand spoken language.
Substance Abuse services: Services to treat substance abuse issues that mayinclude types of outpatient therapy, short-term and long-term residentialtreatment, detoxification, and intensive outpatient services.
Traumatic Brain Injury (TBI): TBI is defined as an alteration in brain function,or other evidence of brain pathology, caused by external force.
Beckwith B, Dimambro L. TBI Basics. Brain Injury Association of Michigan AnnualConference. 1996-2002.
Black K. Caregiver college presentation. Michigan: Detroit Medical Center,Rehabilitation Institute of Michigan. 1998.
Brain Injury Association of America website. Acquired Brain Injury. 1997. Availableat: http://www.biausa.org/Pages/types_of_brain_injury.html#aquired. Accessed July15, 2005.
Brain Injury Association of America website. “What is the Difference Between anAcquired Brain Injury and a TBI”. Available at:http://www.biausa.org/FAQRetrieve.aspx?ID=43913&A=SearchResult&SearchID=2840376&ObjectID=43913&ObjectType=9.Accessed September 7, 2011
Brain Injury Association of America website. “BIAA Adopts New TBI Definition”.2011. Available at http://www.biausa.org/AnnouncementRetrieve.aspx?ID=66290&A=SearchResult&SearchID=2840249&ObjectID=66290&ObjectType=7.Accessed September 7, 2011.
Braunling-McMorrow D, Davie C, Ferriera-Bedford T, et al. Acquired Brain InjuryPrograms, Preservice Materials Manual. Illinois: Mentor, 2000.
Centers for Disease Control and Prevention. Heads Up: Facts for Physicians AboutMild Traumatic Brain Injury (MTBI). 2003. Available at:http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/physicians/mtbi/diagnosis.htm.Accessed July 15, 2005.
Centers for Disease Control and Prevention, National Center for Injury preventionand Control. (1999, Dec.) Traumatic Brain Injury in the United States: A Report toCongress.
Center for Disease Control. Report to Congress on Mild TBI in the US: Steps toPrevent a serious Public Health Problem. 2003. Available athttp://www.cdc.gov/traumaticbraininjury/pdf/mtbireport-a.pdf. Accessed onSeptember 7, 2011
Faul M, Xu L, Wald MM, Coronado VG.Traumatic Brain Injury in the United States:Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta(GA): Centers for Disease Control and Prevention, National Center for InjuryPrevention and Control; 2010.
Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulativeeffects of concussion in high school athletes. Neurosurgery. 2002, 51(5), 1175-79.
Corrigan JD, Lamb-Hart GL, Rust E. A program of intervention for substance abusefollowing traumatic brain injury. Brain Inj. 1995 Apr;9(3):221-36.
Corrigan PW, Bach PA. Behavioral Treatment, in Textbook of Traumatic BrainInjury. Edited by Silver JM, McAllister TW, Yudofsky SC. Arlington, VA, AmericanPsychiatric Publishing, Inc.; 2005, pp 661-678.
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Dunn K.A., Thurman D.J., Clinton J.A. (1999). The Epidemiology of Traumatic BrainInjury Among Children and Adolescents. Centers for Disease Control andPrevention.
Faces of Brain Injury. Produced by the Brain Injury Association of Florida, Inc.(www.biaf.org); funded in part by Florida Department of Health, Brain & Spinal CordInjury Program and Health Resources Services Administration Grant #: CFDA#93-234A.
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Links and Additional Resources
Additional information on public services for individuals with TBI in Michigan is available atwww.michigan.gov/tbi. If you want more information about a topic you do not see here, try BIAMI firstat www.biami.org. Also see other websites listed below under “General brain injury information,advocacy, and support.”
Try the links below for more detailed information (presented in alphabetical order by topic area):
Assistive technologyAgency/organization websites
Michigan Assistive Technology Loan Fundhttps://www.disability.gov/viewResource?id=1830858Michigan Assistive Technology Programhttp://www.copower.org/assistive-tech.htmlMichigan’s Integrated Technology Supports (for Michigan PK-12 public schools) http://mits.cenmi.org/LendingLibrary.aspx
ChildrenAgency/organization websites
Michigan Department of Education (MDE) http://www.michigan.gov/mdeMichigan Intermediate School District (ISD) – County Office Informationhttp://michigan.gov/cepiNational Dissemination Center for Children with Disabilitieshttp://www.nichcy.org/
Documents/training materialsBack to School [After a TBI] http://www.biausa.org/LiteratureRetrieve.aspx?ID=43317&A=SearchResult&SearchID=1989375&ObjectID=43317&ObjectType=6A Training Program for School Personnel in Indiana http://www.biausa.org/LiteratureRetrieve.aspx?ID=47494&A=SearchResult&SearchID=1989375&ObjectID=47494&ObjectType=6Guidance & Technical Assistance from the Office of Special Education and EarlyIntervention Services http://focus.cenmi.org/wp-content/uploads/2010/08/GATA06-02.pdfTeaching Strategies for Students with Brain Injuries http://www.biausa.org/LiteratureRetrieve.aspx?ID=48657&A=SearchResult&SearchID=1989346&ObjectID=48657&ObjectType=6Traumatic Brain Injury (TBI) Central - Students with Traumatic Brain Injury:Identification, Assessment, and Classroom Accommodations http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publications/students-with-tbi
Concussion/Mild Traumatic Brain InjuryAgency/organization websites
Centers for Disease Control and Prevention - “Heads Up: Concussion in HighSchool Sports” http://www.cdc.gov/concussion/HeadsUp/high_school.htmlCenters for Disease Control and Prevention - “Heads Up: Concussion in YouthSports”http://www.cdc.gov/concussion/HeadsUp/youth.htmlCenters for Disease Control and Prevention - “Heads Up to Schools: Know YourConcussion ABCs”http://www.cdc.gov/concussion/HeadsUp/schools.html
Centers for Disease Control and Prevention - "Heads Up: Brain Injury in YourPractice Tool Kit" (available to order, free of charge) http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.htmlSports Concussion Information for Athletes - BIAMIhttp://sportsconcussionsmichiganathletes.com/Sports Concussion Information for Coaches - BIAMIhttp://sportsconcussionsmichigancoaches.com/Sports Concussion Information for Parents - BIAMIhttp://sportsconcussionsmichiganparents.com/
Cultural competenceAgency/organization websites
National Center for Cultural Competence http://gucchd.georgetown.edu/nccc/index.htmlNational Library of Medicine – American Indian Health http://americanindianhealth.nlm.nih.gov/National Library of Medicine – Asian American Health http://asianamericanhealth.nlm.nih.gov/
Documents/training materialsMinnesota Department of Human Services – Guidelines for Culturally CompetentOrganizations https://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3963-ENG
Defense and veterans' issuesAgency/organization websites
Defense and Veterans Brain Injury Center http://www.dvbic.orgMichigan Department of Military and Veterans Affairs http://www.michigan.gov/dmvaMilitary HOMEFRONT is the central source for Service members and families toobtain information about all Quality of Life programs and services http://www.militaryhomefront.dod.mil/Military Severely Injured Joint Support Operations Center (MSIJSOC) http://www.military.com/supportTraumatic Brain Injury: The Journey Home (for Veterans) http://www.traumaticbraininjuryatoz.org
Documents/training materials“Veterans Health Benefits 101 for TBI Advocates,” Archived webcast, Maternaland Child Health Bureau (MCHB) of the Department of the US Department ofHealth and Human Services, Health Resources and Services Administration http://128.248.232.90/archives/mchb/dcafh/tbi/july2005/mchbtbijuly2005transcript.htmTraumatic Brain Injury Among Veterans http://www.nashia.org/pdf/tbi_among_veterans_may_2011.pdf
Employment and vocational rehabilitation of people with TBIAgency/organization websites
Freedom to Work Web Site http://www.freedomtoworkmedicaid.comMichigan Department of Licensing and Regulatory Affairs - Michigan RehabilitationServices http://www.michigan.gov/mdcd/0,1607,7-122-25392---,00.html
Documents/training materialsAchieving Vocational Success After Traumatic Brain Injuryhttp://www2.ed.gov/rschstat/research/pubs/vrbriefs/vrbrief-success-after-tbi.pdfJob Accommodation Network – Work-site Accommodation Ideas for Persons withBrain Injuryhttp://www.jan.wvu.edu/media/BrainInjury.htmlMichigan Department of Career Development http://www.state.mi.us/career/Core/pdfactsheet/MRS-198.htmlTraumatic Brain Injury Facts: Vocational Rehabilitation and Employment Services
http://nashia.org/pdf/hotopics/vrbrief-success-after-tbi%202010.pdf
General brain injury information, advocacy, and supportAgency/organization websites
Brain Injury Association of Michigan (BIAMI) http://www.biami.orgBrain Injury Association of America (BIAA) www.biausa.orgBrainLine.org www.brainline.orgCDC: Injury Control and Prevention: Traumatic Brain Injury http://www.cdc.gov/TraumaticBrainInjury/Center for Neuro Skills(CNS)www.neuroskills.com/resources.shtmlCommission on Accreditation of Rehabilitation Facilities (CARF)www.carf.orgDepartment of Health and Human Services, Health Resources and ServicesAdministration - Traumatic Brain Injury Program http://www.hrsa.gov/gethealthcare/conditions/traumaticbraininjury/Lash & Associates Publishing / Training, Inc. http://www.lapublishing.com/Michigan Department of Community Health - Injury & Violence Prevention Section
https://www.michigan.gov/mdch/0,1607,7-132-54783_54879---,00.htmlMichigan Disability Rights Coalition (MDRC) http://www.copower.org/Michigan Protection and Advocacy Service (MPAS) http://www.mpas.orgNational Association of State Head Injury Administrators (NASHIA) www.nashia.orgNational Information Rehabilitation Center (NARIC) www.naric.comNational Resource Center for Traumatic Brain Injury http://www.neuro.pmr.vcu.edu/The Southeastern Michigan Traumatic Brain Injury System (SEMTBIS) http://www.semtbis.org/semtbis/The Rehabilitation Research and Training Center on Community Integration ofPersons with TBI at Texas Institute for Rehabilitation and Research http://www.tbicommunity.org/resources/index.htm
Documents/training materialsArchived webcasts of the HRSA-MCHB http://www.mchcom.com (click on ‘Archived webcasts’, then ‘TBI’)Brain Injury Research Center of Mount Sinai School of Medicine http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publicationsModel Systems Knowledge Translation Center - TBI Consumer Information http://msktc.washington.edu/tbi/factsheets/index.asp
Housing and residential placementAgency/organization websites
Disability Network Michigan http://dnmichigan.org/Department of Human Services, Adult Services http://www.michigan.gov/dhs/0,1607,7-124-5452_7122---,00.htmlDepartment of Human Services, Michigan Community Service Commission http://www.michigan.gov/mcsc/0,1607,7-137-55459---,00.htmlDepartment of Human Services, Statewide Search for Adult Foster Care/Homesfor the Aged Facilities http://www.cis.state.mi.us/brs_afc/sr_afc.aspHabitat for Humanity http://www.habitat.org/local/affiliate.asp?place=59
Michigan Home Ownership Coalition - HomeChoice Mortgage http://www.hud.gov/local/mi/homeownership/mihoc.cfmMichigan’s MI Choice Waiver Program http://www.michigan.gov/mdch/0,1607,7-132-2943_4857_5045---,00.htmlMichigan Office of Services to the Aging http://www.miseniors.netMichigan Statewide Independent Living Council http://misilc.org/National Association of Area Agencies on Aging – Links to state specific agencieshttp://n4a.org/about-n4a/?fa=aaa-title-VI#MIRefinance & Mortgage Guide for People with Disabilities http://www.refinancemortgagerates.org/mortgage-guide-for-people-with-disabilities/Tenant-based Section 8 Housing Vouchers: MSHDA http://www.michigan.gov/mshda/0,1607,7-141-5555-22085--,00.htmlTenant-based Section 8 Housing Vouchers: Public Housing Authorities (PHA) http://www.hud.gov/offices/pih/pha/contacts/states/mi.cfmUSDA Rural Development http://www.rurdev.usda.gov/mi/
Management of TBI for cliniciansDocuments/training materials
Centers for Disease Control and Prevention - "Heads Up: Brain Injury in YourPractice Tool Kit" (available to order, free of charge) http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.htmlVeterans Health Initiative - Traumatic Brain Injury, Independent Study CourseReleased: April 2010http://www.publichealth.va.gov/docs/vhi/traumatic-brain-injury-vhi.pdf
Public agencies in MichiganAgency/organization websites
Community Mental Health Services Programs – County Office Informationhttp://www.michigan.gov/documents/cmh_8_1_02_37492_7.PDFDepartment of Human Services (DHS) - Home http://www.michigan.gov/dhsDepartment of Human Services – County Office Information http://www.michigan.gov/dhs/0,1607,7-124-5461---,00.htmlMichigan Association of Community Mental Health Boards (MACMHB) http://www.macmhb.org/Michigan Department of Community Health (MDCH) http://www.michigan.gov/mdchMichigan Department of Education (MDE) http://www.michigan.gov/mdeMichigan Department of Licensing and Regulatory Affairs - Michigan RehabilitationServiceshttp://www.michigan.gov/mdcd/0,1607,7-122-25392---,00.htmlMichigan Rehabilitation Services - Locations by City http://www.michigan.gov/mdcd/0,1607,7-122-25392_41191---,00.html
Screening and assessmentAgency/organization websites
The Center for Outcome Measurement in Brain Injury http://www.tbims.org/combi/
Documents/training materialsBrain Injury Resource Center of Mount Sinai: Brain Injury Screeninghttp://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/resources/technical-assistance/brain-injury-screeningOhio Valley Center for Brain Injury Prevention and Rehabilitation – TBI Screeninghttp://ohiovalley.org/informationeducation/screening/
Statistics
Agency/organization websitesCenters for Disease Control and Prevention – Traumatic Brain Injury: Topic Home http://www.cdc.gov/node.do/id/0900f3ec8000dbdc
Substance abuseAgency/organization websites
Ohio Valley Center for Brain Injury Prevention and Rehabilitation – SubstanceAbuse and Brain Injurieshttp://ohiovalley.org/informationeducation/substanceuseinformation/Substance Abuse & Mental Health Services Administration – Substance AbuseTreatment Facility Locatorhttp://www.findtreatment.samhsa.gov/
Documents/training materials2004/2005 Regional Coordinating Agencies Contact Listhttp://www.michigan.gov/mdch/0,1607,7-132-2941_4871-14983--,00.html
Questions? Contact Us.
For more information about specific service programs in Michigan, contact:
Michael Daeschlein
Manager, Home and Community-Based Services Section at the Michigan Department ofCommunity Health
For comments and feedback regarding this training: [email protected]