REPORT TO THE TWENTY-SIXTH LEGISLATURE STATE OF HAWAII 2012

Transcription

1 REPORT TO THE TWENTY-SIXTH LEGISLATURE STATE OF HAWAII 2012 PURSUANT TO SECTION 321H-4, HAWAII REVISED STATUTES, REQUIRING THE DEPARTMENT OF HEALTH TO PROVIDE AN ANNUAL REPORT ON THE ACTIVITIES UNDER THE NEUROTRAUMA SPECIAL FUND PREPARED BY: STATE OF HAWAII DEPARTMENT OF HEALTH December 2011

2 EXECUTIVE SUMMARY In accordance with the provisions of Section 321H-4, Hawaii Revised Statutes (HRS), Neurotrauma, the Department of Health (DOH) is submitting this annual report on the activities of the Neurotrauma Special Fund (NSF). The NSF was established in 2002 by Act 160 for funding and contracting for services relating to neurotrauma. Funds are acquired through surcharges on traffic citations (speeding, drunk driving, not wearing seat belts, leaving the scene of an accident involving bodily injury) that are related to causes of neurotrauma injuries. Beginning January 1, 2003, surcharges from the specified traffic citations were deposited into the NSF. The DOH has worked with neurotrauma survivors and their families to identify priorities for expenditure of monies in the NSF. The prioritized need was for assistance to access services and supports. The Neurotrauma Advisory Board (NTAB) provides stakeholder input into the DOH s neurotrauma activities and advisory recommendations regarding the special fund. The three positions budgeted in the Neurotrauma program were not established and filled pending a division reorganization. The program has been unable to sustain the neurotrauma help line, neurotrauma registry, educational activities and promotion of neurotrauma awareness statewide as well as the ability to implement new activities. With limited personnel, the DOH prioritized the need to identify key activities to implement in accordance with the mandate of Section 321H-4, HRS. The DOH accomplished this through collaboration with the State s Traumatic Brain Injury Advisory Board, NTAB, Brain Injury Association of Hawaii, families, survivors and other community stakeholders. During FY 2011, the DOH has worked diligently and successfully to implement activities to use the NSF. The DOH is continuing efforts to fund a traumatic brain injury peer mentoring project and a concussion management study involving high school athletes in Hawaii s public schools. Additionally, the DOH funded the following programs: 1) The Queen s Medical Center funds provided to develop and implement a Statewide StrokeNetwork to provide citizens of Hawaii with appropriate access to care in their respective communities; 2) The Rehabilitation Hospital of the Pacific funds provided to administer the ThinkFirst educational curriculum to school aged children targeted at injury prevention, including brain and spinal cord injuries; and 3) The Brain Injury Association of Hawaii funds provided to design, develop and implement a brain injury resource center. For FY 2012, the DOH will continue to work closely with the NTAB in providing funding to organizations to further the goals of the NSF in accordance with Chapter 321H-4, HRS. 1

3 REPORT TO THE LEGISLATURE IN COMPLIANCE WITH SECTION 321H-4, HAWAII REVISED STATUTES Introduction Pursuant to Section 321 H-4, Hawaii Revised Statutes (HRS), the Department of Health (DOH) is to submit to the legislature an annual report on the activities of the Neurotrauma Special Fund (NSF). Act 160, signed into law on June 7, 2002, mandated the DOH to develop, lead, administer, coordinate, monitor, evaluate, and set direction for a comprehensive system to support and provide services for survivors of neurotrauma injuries. The Act also required the DOH to establish a Neurotrauma Advisory Board (NTAB) and administer a NSF. The NSF started to accumulate monies January 1, This report provides a status report on the fund activities for the period of October 2010 to September Neurotrauma Advisory Board The NTAB was established, per Act 160, to advise the DOH on the use of the NSF and development of a system of supports for persons with neurotrauma. The Board s membership constitutes key stakeholder group representation on a statewide basis and has developed a strategic plan to carry out their functions. There are three working subcommittees: 1) Special Fund; 2) Legislative; and 3) Registry (the latter two joint with the State Traumatic Brain Injury Advisory Board). Current members of the Board are listed in Attachment I. Use of the Neurotrauma Special Fund Section 321H-4, HRS, specifies that the NSF shall be used as follows: 1) education; 2) assistance to obtain access to services; 3) creation of a registry of neurotrauma injuries; and, 4) necessary administrative expenses. The three positions budgeted in the Neurotrauma program have not been established and filled pending a division reorganization. Their duties will include planning and coordination of neurotrauma awareness/education activities, information and referral supports for individuals with neurotrauma and their families, support to access services, support to the Neurotrauma and State Traumatic Brain Injury Advisory Board (STBIAB), needs assessment, neurotrauma trending, and systems analysis. Because these 2

4 positions have not been established, it has impacted the ability of one DOH employee to conduct activities in the areas of community outreach, neurotrauma education and awareness, registry development and updating of the neurotrauma website. As a result, partnerships and collaborations with other public and private entities involved in neurotrauma related activities have been an important component in an effort to prioritize and implement key activities that support individuals with neurotrauma and their family members. The NSF currently funds contracts in the areas of education and assistance to individuals and families to obtain access to services. 1) Educational activities: The DOH staff continues to engage in numerous educational activities in the areas of, but not limited to: 1) staff development; 2) participation in conferences; 3) public exhibits; 4) dissemination of educational materials to board members and list serve; and, 5) utilization of the NSF to procure education related materials and activities. Since 2008, DOH continued to provide education through a contract with the University of Hawaii, Pacific Basin Rehabilitation Research and Training Center s Ho oikaika Trauamatic Brain Injury Peer Mentoring Program and the Brain Injury Association of Hawaii (BIA-HI). The Ho oikaika program has been actively engaged in providing education on brain injury through their participation in community events, peer mentoring orientation sessions, and has utilized multimedia sources to increase awareness and education on brain injury. The BIA-HI has been contracted to develop a framework for a brain injury resource center and conduct a brain injury conference in They are committed to securing additional funding for the implementation phase of the resource center and will utilize the center to provide education and awareness activities as well as provide individuals with brain injury assistance to identify and access needed supports. In April 2009, the DOH executed a contract with the University of Hawaii, John A. Burns School of Medicine to conduct a study on fall prevention amongst the elderly. The goal of the research study was to determine if a multi-disciplinary fall prevention program can decrease the number of recurrent falls in elderly patients who are treated at the Queen s Medical Center s Emergency Department. This study will provide educational benefits for service providers and survivors of falls to identify interventions that lead to a reduction in injury, specifically brain injury. Prevention of recurrent falls will assist at-risk seniors to lead an improved quality of life and also reduce the medical costs associated with a fall. This study was completed in May Based on the data that was collected it appears that elderly individuals are indeed falling at high rates, a finding that remains consistent national and international published reports. The study concluded that elderly individuals will take into account many of the recommendations made to them by a physician 3

5 (geriatrician) and occupational therapist with respect to strategies and approaches for reducing their risk of failing. The intervention and control group participants reported that they complied with approximately two thirds of recommendations that were made. This study concluded that many of the recommended changes to lifestyle, medical care and physical/home surroundings that were made by the occupational therapist and geriatrician would probably lead to some diminished risk of sustaining a recurrent fall. Many of these recommendations could be made to a patient by their own family doctor or relatives and would not necessarily involve highly expensive modifications or purchases. In August 2010, the DOH funded the University of Hawaii-Manoa, Department of Kinesiology and Rehabilitation Science to conduct a research study on concussion management for all high school athletes in the state of Hawaii to the following: a) compare the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) concussion management software to obtain baseline and post-concussion test results with the Graded Symptom Checklist (GSC) tool; b) provide primary care physicians and high school athletic trainers with Hawaii only objective data from the concussion management program to make recommendations for student athletes safe return to play; c) provide Hawaii-based longitudinal research evidence for concussion management protocol utilizing data obtained from ImPACT, Standard Assessment for Concussion (SAC), and development of best practices; d) provide training to high school administrators, athletic trainers, physicians, and neuropsychologists participating in the study; and e) provide education to coaches, parents, and athletes on concussion. By the end of the project, students from all 62 public high schools participating in sports with risks for concussion will be administered the GSC/SAC or ImPACT assessment tools for baseline and/or post-concussion screening. In fiscal 2011, the DOH funded the Rehabilitation Hospital of the Pacific (RHOP) to implement and administer the ThinkFirst educational curriculum to school aged youth. This partnership between the DOH and RHOP is an attempt to increase education and awareness of brain and spinal cord injury and in the long term, decrease the incidents of these injuries. DOH staff will continue efforts to promote education and awareness activities through partnerships and collaborations with the respective advisory boards and community stakeholders statewide. (2) Assistance to individuals and families to identify and obtain access to service activities: In FY 2011, the DOH funded the Queen s Medical Center (QMC) to establish a statewide stroke network to improve statewide access to timely, expert stroke care 4

6 evaluation and treatment with Tissue Plasminogen Activator (tpa) without the need to transfer patients to a tertiary facility, educate the public about the signs and symptoms of stroke, the need for emergent evaluation, the availability of effective treatment with tpa, and educate medical providers and support development of stroke care pathways to expedite evaluation and treatment, monitor for complications, and provide standard post-acute stroke care. In May 2011, the DOH extended funding for one year (May 2011-May 2012) to the Pacific Basin Rehabilitation Research and Training Center (University of Hawaii Manoa, John A. Burns School of Medicine) to continue the design, development and implement a peer mentoring project for individuals with Traumatic Brain Injury (TBI). The goal of this project is to train 25 mentors and pair them with 25 peers (persons with TBI) to provide assistance to seek and utilize social services. Efforts by the contractor include the development of a brochure, development of a peer mentoring training program to develop skills in identifying and accessing services, develop public service announcements, produce a video on the mentoring project, and engaging in a variety of activities to recruit potential mentors and peers. To date, a total of 45 individuals with brain injury have applied to the project, with a total of 22 individuals being active in the project activities. The DOH continues to develop a TBI, Spinal Cord, and Stroke Informational Discharge folders to be provided to medical facilities for survivors and families upon their discharge with valuable information specific to the neurotrauma injury, rehabilitation, and local resources. These folders are made available to service providers such as RHOP and QMC. During the year, a total of 600 Informational Discharge folders were sent out to hospitals and rehabilitation facilities. (3) Development of a registry within the State to identify incidence, prevalence, needs, and related information of survivors of neurotrauma injuries: The DOH is planning to continue efforts to maintain a registry through a contract utilizing the NSF. Utilizing efforts of the State Neurotrauma and Traumatic Brain Injury Advisory Boards joint registry subcommittee, the DOH has an established data base to input registry information. Critical elements of the registry have been developed. (4) Necessary administrative expenses to carry out this chapter: Utilization of funds under this category has been expended ($4,160) for various educational and awareness activities on a statewide basis that is consistent with goals and objectives set forth by the STBIAB, NTAB and DOH. Collection and Expenditure of Funds 5

7 In FY 2011, a total of $868,386 has been deposited into the fund from traffic surcharge collections. Total encumbrance as of June 30, 2011 was $1,498,940. As of July 1, 2011, there was a beginning cash balance of $1,044,525 in the NSF. A projected FY 2012 budget for the Neurotrauma Special Fund is provided in Attachment II. The budget reflects activities authorized under Section 321H-4, HRS. Summary Following the Legislative intent of Act 160, the DOH will continue its efforts toward the development of a neurotrauma system of supports to assist survivors of neurotrauma injuries and their families. The State Neurotrauma Advisory Board and the STBIAB have each progressed in their efforts to become an effective advisory body to the DOH. With non-availability of staffing, consideration should be given to the establishment of one advisory board. During the current year, the DOH will be contracting with the QMC to establish a Statewide Stroke Network; RHOP to implement an educational curriculum for school aged children to prevent neurotrauma injuries; BIA-Hawaii to establish a brain injury resource center; and the University of Hawaii, Pacific Basin Rehabilitation Research and Training Center to manage the neurotrauma registry. All proposals have been recommended for DOH funding by the Neurotrauma Advisory Board and its Subcommittee on Special Fund. 6

8 Attachment I NEUROTRAUMA ADVISORY BOARD Chapter 321H-3, HRS VOTING MEMBERSHIP VACANT Joyce Arizumi Lyna Burian Joe Cordova Administrator Vocational Rehabilitation and Services for the Blind Division Department of Human Services Angie Enoka Elzadia Kaina, R.N. Rehabilitation Hospital of the Pacific Greg Keast Case Management Coordinator HMSA Sally Jones, R.N. Queen s Trauma Center Queen s Medical Center Ian Mattoch, Esq. Term/representation At-Large Spinal Cord Injury Support Group/Survivor Traumatic Brain Injury Family Member At-Large Brain Injury Assoc. Representative/Survivor STBIAB Chairperson Private Sector Trauma Center At-Large Glenn Morgan Spinal Cord Injury Survivor Alan Parker Executive on Aging Hawaii County Office of Aging Scott Sagum Karen Seth Manager, Neuroscience Institute Queen s Medical Center At-Large Stroke Survivor Private (Acting Chair) VACANT American Heart/Stroke Association 7

9 Milton Takara Curtis Tom, DDS Stella Wong Vice President Elderly Services Programs Catholic Charities of Hawaii Brain Injury Assoc. Representative/Survivor Stroke Survivor At-Large 8

10 Attachment II Projected Budget for the Neurotrauma Special Fund FY 12 Beginning Cash Balance as of 7/1/11 $1,044,525 Estimated Revenues FY ,000 Projected Expenditures Contracts 1. University of Hawaii Manoa a. Concussion Management Project 322,295 b PBRRTC Neurotrauma Registry 150, Brain Injury Association Hawaii 165, Rehabilitation Hospital of the Pacific 118, Queen s Medical Center 102,504 Education/Awareness Activities 15,000 Administrative Expenses 50,000 Total Expenses 922,799 Estimated Ending Cash Balance as of 6/30/12 $ 991,726 9