Traumatic Brain Injury (TBI) Program

The Traumatic Brain Injury (TBI) Program provides information and referral and services to individuals with traumatic brain injury and their families. It assists with relocating people with TBI in out-of-state facilities to community-based residential and day programs. It can also help individuals currently residing in nursing homes, psychiatric facilities or in their family's homes to be re-situated into more appropriate community settings, where they can live more independent lives. This program, whose motto is "Working hand-in-hand with people who have experienced brain injury...to build bridges within their communities.", can identify and help to address the gaps that exist in the continuum of care for TBI - from coma to re-entry into the community.

What is Traumatic Brain Injury (TBI)?

Traumatic Brain Injury (TBI) is any damage to the brain caused by an external physical force such as:

• motor vehicle accidents;
• falls;
• sports injuries;
• assaults;
• gunshot wounds;

It may also result from violently shaking a child, as well as the following:

• too much or too little oxygen in the brain (e.g., near drowning);
• toxic substances;
• allergic reactions;
• electric shock (e.g., lightning);
• acute medical/clinical incidents.

People with TBI may experience temporary or permanent difficulties with language, thinking, memory, attention, reasoning, judgment, problem-solving, and fatigue. Other physical and motor problems, as well as changes in mood and personality, may also be experienced.

TBI does not include:

• Alzheimer's disease or other progressive dementias;
• depression/psychiatric disorders with no obvious central nervous system damage;
• mental retardation;
• neurological conditions present at birth.

Program Background

The New York State Department of Health Traumatic Brain Injury Program was created by the New York State Legislature in 1994 to further develop and coordinate statewide services for people with traumatic brain injury and their families. The Home & Community Based Services Medicaid Waiver for Individuals with Traumatic Brain Injury (HCBS/TBI WAIVER) was developed by New York State to provide a cost effective, community based alternative to nursing facility placement. From the on-set of the TBI Waiver in April of 1995, the Waiver has provided individually tailored services to comprehensively meet the needs of individuals with TBI.

What is a Waiver?

The Federal Government "waives" certain Medicaid rules enabling New York to select a portion of the population on medicaid to receive specialized services not available to all Medicaid recipients.

Eligibility

The Waiver Applicant:

1. . Must be a Medicaid recipient.
2. Diagnosed with TBI or other type of brain injury, such as stroke, anoxia, etc.
3. Must be 22-64 years old with the injury occurring on or after 22nd birthday. For individuals injured before age 22, contact OMRDD at (518) 473-1890 (individuals 18-22 years old can be served by DOH when OMRDD does not have available funds).
4. Must be eligible for a nursing facility level of care (determined by PRI/Screen).
5. Must choose to live in the community rather than in a nursing facility.
6. Can identify a safe living arrangement that will meet their needs.
7. Can be supported safely within the community with the funds and services available under the HCBS/TBI Waiver.

Services Available

In addition to services available through State Plan Medicaid, individuals determined eligible for the Waiver Program may also develop an individual Service Plan including any of the services listed below.

• Service Coordination - a coordinator is chosen by the Waiver participant and/or guardian to work with them in identifying and coordinating supports and services.
• Independent Living Skills Training - provides one-to-one support to focus on increasing independence in practical skills, such as cooking, shopping, banking, etc.
• Structured Day Program - provides an environment focused on task oriented activities and social skill building.
• Community Integration Counseling - counseling is provided to participant or family members to assist with issues related to community integration.
• Home and Community Support Services - provides guidance and assistance to enable the Waiver participant to reside safely within the home and community environments.
• Substance Abuse Program - services implemented are based on the unique challenges associated with TBI to reduce and/or eliminate substance abuse that interferes with integration into the community.
• Intensive Behavioral Program - provision of direct technical assistance to individuals with challenging behaviors and staff training for development of program support strategies.
• Environmental Modification - provides adaptations to residences to promote independent and to ensure safety.
• Respite - provides short-term relief to care-givers.
• Special Medical Equipment & Supplies - provides durable and non-durable equipment not funded under state plan Medicaid.
• Transportation - provides access to non-medical services in the community.

Housing Program
The Rent Subsidies and Housing Support Program provides subsidies to individuals participating in the HCBS/TBI Waiver. Rent subsidies allow participants to obtain safe affordable housing at a fair market value.

Program Coordination
The NY state-wide TBI Program is divided into twelve (12) regional centers. WILC, which is the Hudson Valley Region center, provides services for the residents of seven (7) lower Hudson Valley counties (Westchester, Rockland, Orange, Sullivan, Putnam, Dutchess, and Ulster counties).

Program Philosophy
An individual with a Traumatic Brain Injury (TBI) has:

• the right to be in control of his or her own life.
• the right to choose where and with whom he or she will live.
• the right to take risk and learn through experience.

For more information about the HCBS/TBI Waiver, contact WILC's TBI Coordinator at (914) 682-3926 (Voice), (914) 682-0926 (TDD), (914) 682-8518 (FAX), or E-mail at: info@wilc.org.

Other agencies that can provide information on TBI:

• Brain Injury Association of New York State (BIANYS)
  A chapter of the National Brain Injury Association, BIANYS, serves as a centralized advocacy, educational and information source for people with TBI and their families. BIANYS has 42 chapters and support groups across the state.
  (800) 228-8201
• Research and Training Center on Community Integration of Individuals with TBI (TBI NET) at Mt. Sinai Medical Center
  (888) 241-5152
• Long Island Head Injury Association
  An advocacy and educational organization for people with TBI and their families on Long Island.
  (516) 543-2245
• COMA Recovery, Inc.
  An advocacy and information organization for people with TBI and their families on Long Island.
  (516) 355-0951
• Headway for the Brain Injured
  An advocacy and information organization for people with TBI and their families in the Buffalo/Western New York area.
  (716) 822-2261
• FACTS: Family Advocacy, Counseling and Training Services
  A program of BIANYS, FACTS is a support service for individuals who sustained a brain injury and their families.
  (518) 459-7911
  (800) 228-8201 Family Help Line
• Office of Mental Retardation & Developmental Disabilities (OMRDD)
  Education, rehabilitation and residential services for people whose injury occurred before the age of 22. A statewide coordinator and a TBI coordinator in each regional DDSO provides access to services.
  (518) 473-1890

New York State Department Of Health TBI Programs:

• Long Island Region
  (516) 543-2245
• Lower Hudson Region -
  Westchester, Rockland, Orange, Sullivan, Putnam, Dutchess, and Ulster
  (914) 682-3926
• New York City -
  Boroughs of Manhattan, Brooklyn, and Staten Island
  (212) 564-8769 and (212) 564-8646
• New York City -
  Boroughs of Bronx and Queens
  (718) 515-5500 ext. 2003
• Albany South -
  Albany, Schenectady, Greene, Rensselaer, Schoharie, Otsego, and Columbia
  (518) 437-5769
• Albany North -
  Fulton, Montgomery, Saratoga, Washington, Warren, Hamilton, Essex, Franklin, and Clinton
  (518) 773-2047
• Syracuse North -
  Onondaga, Madison, Herkimer, Oneida, Oswego, Lewis, Jefferson, and St. Lawrence
  (315) 797-4642
• Syracuse South -
  Broome, Tioga, Delaware, Tompkins, Cortland, Chenango, and Cayuga
  (607) 770-8187
• Rochester North -
  Monroe, Wayne, Ontario, Seneca, Livingston, and Yates
  (716) 442-6420
• Rochester South -
  Steuben, Schuyler, and Chemung
  (607) 962-8225
• Buffalo North -
  Erie, Chautauqua, Wyoming, Genesee, Orleans, and Niagra
  (716) 822-2261
• Buffalo South -
  Cattaraugus and Allegany
  (716) 373-4602

For complaints about the quality of care in facilities and services licensed by DOH, call the appropriate area office.

• Buffalo Area Office
  (716) 847-4302
• New Rochelle Area Office
  (914) 632-3701
• New York City Area Office
  (212) 613-4900
• Northeastern Area Office
  (518) 271-2600
• Rochester Area Office
  (716) 423-8041
• Syracuse Area Office
  (315) 426-7710