Copyright 1999 Federal Document Clearing House, Inc.
Federal Document Clearing House Congressional Testimony
September 16, 1999
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 10214 words
HEADLINE:
TESTIMONY September 16, 1999 ALLEN I BERGMAN ASSOCIATE PROFESSOR OF PEDIATRICS
SENATE HEALTH, EDUCATION, LABOR & PENSIONS CHILDRENS HEALTH
BODY:
Testimony on Children's Health: Protecting
Our Most Precious Resource In Support of Reauthorization of The Traumatic Brain
Injury Act of 1999 Respectfully submitted to United States Senate Committee on
Health, Education, Labor and Pensions Subcommittee on Public Health September
16, 1999 Allan 1. Bergman President and CEO Brain Injury Association, Inc.
INTRODUCTION My name is Allan Bergman. I am the President and Chief Executive
Officer of the Brain Injury Association, a position I have been privileged to
hold since October 1998. The mission of our Association is to create a better
future through brain injury prevention, research, education and advocacy. I am
pleased to be here today to speak with you. Traumatic Brain Injury is a major
national Public Health problem. I also will be testifying in favor of a
five-year Reauthorization of the Traumatic Brain Injury Act of 1996. The
Association was founded in 1980 by a group of family members of persons who had
sustained a traumatic brain injury (TBI). During the past 19 years the
association (formerly the National Head Injury Foundation) has grown from a
small family-based organization to a broad- based organization representing
persons with brain injuries and their families, clinical practitioners,
researchers and advocates. Today BIA represents 43 chartered state affiliates
across the Nation and is the only national association which advocates on behalf
of the estimated 5.3 million children and adults living with moderate to severe
disabilities as the consequences of a traumatic brain injury and their families.
As a professional in disability and health policy, I am distressed to report to
you that persons with TBI represent the most unserved and underserved population
within the disability field. A DOUBLE -EDGE SWARD: FEWER TBI FATALITIES, MORE
SURVIVORS The founding of the association in 1980 was primarily the result of
advances in medical trauma care and access to emergency medical technology. Many
of the persons who sustained a traumatic brain injury, whose family members came
together in 1980 for information and mutual support, probably would not have
lived had their trauma occurred IO or more years earlier. Even today there is
both good news and bad news in the data reported by the Centers for Disease
Control and Injury Prevention (CDC). We all are very elated when we read that
the number of fatalities from auto crashes, for example, is down during the past
decade. We rejoice that the use of seat belts and air bags are making a
difference, as we should. And we should do more. On the other hand, we need to
recognize that some of the persons whose injuries would have been fatal are now
children and adults living with long term disability attributable to traumatic
brain injury. For them and their families, we must do more, much more! Public
funds have generated a large portion of the medical research and standards for
trauma care and centers throughout this Nation. The Federal Government must
commit public funds as an investment into the development and stabilization of
long term community service and support systems for the estimated 5.3 million
children and adults who have survived their trauma with long term disability
from a traumatic brain injury. -Moreover, the federal government must take the
lead in funding research into outcome based, cost-effective treatment and
recovery, community reintegration, family support and community long term
supports for this growing and very large population of Americans. TRAUMATIC
BRAIN INJURY The TBI Act defines Traumatic Brain Injury as an insult to the
brain, not of a degenerative or congenital nature but caused by an external
physical force, that may produce a diminished or altered state of consciousness,
which results in an impairment of cognitive abilities or physical functioning.
TBI can also result in the disturbance of behavioral or emotional functioning.
The long term disabilities and functional impairments from TBI can include: (1)
Physical impairments such as: seizures of all types; muscle spasticity; double
vision or low vision, even blindness; speech impairments such as slow or slurred
speech; hearing loss; fatigue, increased need for sleep-, and balance problems.
(2) Cognitive impairments such as: short term or long term memory loss; slowed
ability to process information; trouble concentrating or paying attention for
periods of time; difficulty keeping up with a conversation or other
communication difficulties such as problems finding the correct words spatial
disorientation; organizational problems and impaired judgment; and inability to
do more than one thing at a time. (3) Psychosocial, behavioral or emotional
impairments such as: a lack of initiating activities, or once started,
difficulty in completing tasks without reminders; increased anxiety; depression
and mood swings; denial of deficits; impulsive behavior; lowered self esteem;
sexual dysfunction; and excessive laughing or crying. INCIDENCE AND PREVALENCE
OF TBI According to the most recent data from the Centers for Disease Control
and Injury Prevention, it is now estimated that there are 5.3 million children
and adults living with the consequences of sustaining a traumatic brain injury
in the United States. This number represents nearly 2 percent population. TBI
does not discriminate. It can happen to a child or adult of any age, gender,
race, religion or socio- economic status. The risk of TBI is highest among
adolescents, young adults and persons over the age of 75. In comparing the
national prevalence rate for TBI of 5.3 million with other more commonly cited
and discussed conditions and disabilities, it is easily understood why TBI is
often referred to as the "silent epidemic". Examples of other prevalence rates
are as follows: 400,000 with Spinal Cord Injuries; 500,000 with Cerebral Palsy;
2.3 million with Epilepsy; 3.0 million with Stroke Disabilities; 4.0 million
with Alzheimer's Disease; 5.3 Million with TRAUMATIC BRAIN INJURY; 5.4 million
with Persistent Mental Illness, 7.2 million with Mental Retardation. An
estimated TWO MILLION people receive a traumatic brain injury each year and
someone will sustain a brain injury every 15 seconds. An estimated ONE MILLION
people are treated for TBI and released from hospital emergency departments each
year. Each year 230,000 Americans are hospitalized as a result of a TBI. Each
year 80,000 Americans experience the onset of long term disability as a result
of sustaining a traumatic brain injury. More than 50,000 people die every year
as a result of TBI. Vehicle crashes are the leading cause of brain injury. They
account for 50% of all TBIs. Falls are the second leading cause of TBI and the
leading cause of brain injury in the elderly. Violence is also a major cause of
brain injury. CAUSES OF PEDIATRIC BRAIN INJURY Brain injury is the most frequent
cause of disability and death among children in the United States and more than
one million children sustain brain injuries every year; approximately 165,000
require hospitalization. FALLS: During a fall, a child's brain is at special
risk because of the size and weight of the head in relation to the body. Infants
are at greater risk of falls from changing tables, cribs & other pieces of
furniture, stairs and baby walkers. Toddlers and school age children are most at
risk for falls from windows, balconies, porches, stairs & playground
equipment. Each year approximately 21 1,000 U.S. children receive emergency
department care for injuries sustained on playground equipment, making the use
of this equipment the leading cause of injuries to children in school and child
care environments. Number of Number of %With a Brain Injury I Play Equipment:
Injuries Brain Injuries Swings100,69418,40718 Monkey Bars175,4898,79411
Slides53,2199,47217 Seesaws10,0121,52315 Motor Vehicle-Crashes: Unrestrained
children of any are more likely to incur a brain injury and/or die in motor
vehicle crashes than children that are restrained. It is estimated that 80% of
children who are placed in child safety seats in automobiles are improperly
restrained. Correctly installed child safety seats in passenger cars are
extremely effective, reducing the risk of brain injury and death. Bicycle
Crashes: A child is four times more likely to be seriously injured in a bicycle
crash than to be kidnapped by a stranger. Between 70 and 80 percent of all fatal
bicycle crashes involve brain injuries. The use of bicycle helmets reduces the
risk of brain injuries by up to 88%. Abuse: Child abuse is the leading cause of
brain injury among infants. Two-thirds of children under one year of age that
are physically abused sustain brain injuries. Shaken Baby Syndrome is caused by
a vigorous shaking of the infant or child by the arms, chest or shoulders and
can result in brain injury and even death. Pedestrian Injury: Each year,
approximately 50,000 children are hit by motor vehicles, often receiving serious
brain injuries. Children are vulnerable to pedestrian brain injury because many
traffic situations and threats exceed their cognitive, developmental, behavioral
and physical abilities. CAUSES OF TEEN AGE BRAIN INJURY Faced with issues such
as peer pressure, underage drinking, alcohol and drug abuse and inexperienced
and impaired driving, teenagers are very vulnerable to brain injuries. Impaired
driving: Driving while under the influence of drugs and/or alcohol is dangerous
because it slows reaction time, impairs judgement and affects alertness and
coordination. The 15-21 -year-old age group is over-represented in impaired
driving crashes, deaths and injuries. Inexperienced driving: Motor vehicle
crashes are the leading cause of brain injuries and death in teenagers 15-20
years of age. Inexperienced driving is one factor for this, as well as
risk-taking behavior and greater risk exposure. CAUSES OF ADULT/ELDERLY BRAIN
INJURY Injury is the leading cause of death among Americans under 45 years of
age and brain injury is responsible for the majority of these deaths. Alcohol is
a significant factor in the occurrence of brain injury. More than 50% of persons
with brain injury were intoxicated at the time of injury Motor Vehicles. In the
adult population (ages 22-65) motor vehicle crashes are the leading cause of
brain injuries. Impaired driving is so dangerous because it slows reaction time,
alters judgement and affects alertness and coordination. According to studies,
driving after alcohol consumption is most prevalent in adult drivers ages 21-49.
Firearms: In 1992, firearms surpassed motor vehicle crashes as the number one
cause of brain injury fatalities in the United States. An estimated 30% of all
unintentional shootings could be prevented by safety features such as trigger
locks and loading indicators. Falls: Due to factors such as medications that
affect balance, limitations brought on by aging and lack of exercise, falls are
the leading cause of brain injury in the elderly. FEDERAL GOVERNMENT INVOLVEMENT
IN TBI I. NIDRR AND THE, TBI MODEL SYSTEMS OF CARE - 1986-87 Building upon work
begun in the 1970's to establish model systems of care for persons with spinal
cord injury, the Rehabilitation Services Administration had established seven
such centers by 1976. After a detailed planning effort in 1987, the National
Institute on Disability and Rehabilitation Research (NIDRR) announced its
intention to fund several model TBI systems. By 1987, NIDRR had already funded
eight field-initiated projects, two directed-research projects and five Switzer
distinguished fellows in TBI research. In April 1986, the Assistant Secretary of
Education announced a major programmatic initiative on TBI in response to the
rapid but disorganized development of programs and resources in the field of TBI
rehabilitation. Five national demonstration projects were awarded and initiated
in 1987. The models focused on the comprehensive delivery of services from
injury through intensive neurological care, comprehensive medical and
psychosocial rehabilitation, and community reintegration and long-term
follow-up. A national TBI database was established as part of the research and
demonstration activity. Five initial projects were funded. The objectives of the
model TBI system were to: demonstrate and evaluate the cost-benefit and service
delivery outcomes of a comprehensive service delivery system for individuals
with TBI; establish a research program to develop new database and conduct
innovative analyses of TBI research data; demonstrate and evaluate the
development and application of improved and innovative methods essential to the
care and rehabilitation of individuals with TBI; and participate in national
studies of the TBI model system concept by contributing to a national TBI
database as prescribed by the Secretary of Education. Unfortunately, all of the
data in the TBI Model Systems are for people 16 years of age and over! We need
data on children! II. CONGRESSIONAL REPORT LANGUAGE - 1988 The Congress
addressed the issues of Traumatic Brain Injury (then referred to as Head Injury)
in the Fiscal Year 1988 Budget for the Department of Health and Human Services.
In Report Language, the House Committee on Appropriations states: "The Committee
encourages the Secretary to consider the establishment of an Interagency Head
Injury Task Force to be made up of key government administrators whose purpose
would be to identify the gaps in research, training and service delivery and to
recommend solutions in addressing the needs of the traumatic head injured. In
addition, attention should be directed to research, which could develop a system
of care, from acute trauma management to extended rehabilitation programs that
would provide individuals an opportunity to return to an optimum level of
function. The Committee also would urge that the Task Force address the
development of a well-coordinated national data base system for traumatic brain
injury that will address epidemiology research, neural recovery, acute medical
management and rehabilitation, extended rehabilitation services, and needs
assessment for community reentry support services. The Committee urges the
Department of Health and Human Services and Department of Education to develop
basic and applied research in rehabilitation and technology." (House Report No.
100-256, page 7 1) In addition, in its report on the Fiscal Year 1988 Budget for
the Department of Health and Human Services, The Senate Committee on
Appropriations states: The Committee encourages the National Institutes of
Health to increase efforts to coordinate with other Government agencies in
identifying gaps in research, including service delivery research, and national
data in the area of traumatic head injury." (Senate Report No. 100- 1 89, page
103). III. Interagency Head Injury Task Force Report -- 1989 The Department of
Health and Human Services produced the Interagency Head Injury Task Force Report
in February 1989. The Task Force recommended "a series of actions that would
represent the core of a national strategy for dealing with TBI. In addition, the
Task Force has identified issues to be addressed in the implementation of a
national strategy." Recommendation .1: Establish "traumatic brain injury" as a
category in reporting systems. Recommendation 2: Designate a lead Federal agency
with responsibility to foster overall coordination and planning Federal, state
and private sector activities and establish a government-private sector advisory
group to assist the effort. Recommendation 3: Encourage the establishment of
working groups at the state and local level to provide leadership and
coordination. Recommendation 4: Create a national network of 15 comprehensive
regional head injury research centers, beginning w the immediate establishment
of five centers an adding five additional centers per year for the next two
years. Recommendation .5: Organize a decentralized system of care networked with
regional head injury research centers to ensure accessibility to appropriate
care. Inform TBI victims and their families about the availability of such
service facilities. Recommendation 6: Study and document the financial issues
relevant to patient and family services, societal cost and related economic
impact of TBI. IV. IDEA AMENDED TO INCLUDE TBI - 1990 In 1990, Congress
responded to the reported increase in children with TBI and amended the
Individuals with Disabilities Education Act (PL 10 1 -476) to
include TBI as a separate disability category. TBI is defined as an acquired
injury to the brain caused by an external physical force, resulting in total or
partial functional disability or psychosocial impairment, or both, that
adversely affects a child's educational performance. The term applies to open
and closed head injuries resulting in impairments in one or more areas, such as:
cognition; language; memory; attention; reasoning; abstract thinking; judgement;
problem- solving; sensory, perceptual, and motor abilities; psychosocial
behavior; physical functions; information processing; and speech. The term does
not apply to brain injuries that are congenital or degenerative, or brain
injuries induced by birth trauma. Code of Federal Regulations, Title 34,
300.7(b)(121)1 Despite the high incidence of TBI, many medical and education
professionals are unaware of the consequences of childhood head injury. Students
with TBI are too often inappropriately classified as having learning
disabilities, emotional disturbance or mental retardation. As a result, the
needed educational and related services may not be provided within the special
education program. The designation of TBI as a separate category of disability
signals that schools should provide children and youth with access to and
funding for neuropsychological, speech and language, educational and other
evaluations necessary to provide the information needed for the development of
an appropriate individualized education program (IEP). While the majority of
children with TBI return to school, their educational and emotional needs are
likely to be very different than they were prior to the injury. Although
children with TBI may seem to function much like children born with other
handicapping conditions, it is important to recognize that the sudden onset of a
severe disability resulting from trauma is very different. Children with brain
injuries can often remember how they were before the trauma, which can result in
a constellation of emotional and psychosocial problems not usually present in
children with congenital disabilities. Further, the trauma impacts family,
friends and professionals who recall what the child was like prior to injury and
who have difficulty in shifting and adjusting goals and expectations. In the
20th Report to Congress by the U.S. Department of Education, Office of Special
Education Programs, a total of 5,224,328 children, ages 6-21 were served under
Part B of IDEA during the 1996-97 school year in the 50 states, District of
Columbia and Puerto Rico. Only 10,356 students were coded under the category of
traumatic brain injury. This raises many questions about the identification of
students with brain injuries, the accuracy of coding and the appropriateness of
services being provided, as well as the lack of special services for the many
unidentified students with brain injuries within local schools. V. THE TRAUMATIC
BRAIN INJURY ACT - 1996 In response to the concerted advocacy of the TBI
community on behalf of the recommendations of the Interagency Head Injury Task
Force, Representative Jim Greenwood introduced the first version of the TBI Act
during the 103rd Congress. He was later joined by Representative Henry Waxman as
a lead cosponsor in the House. Senator Orrin G. Hatch and Senator Edward M.
Kennedy introduced similar legislation in the Senate. The legislation was
reintroduced in the 104'h Congress and signed into law as P. L. 10-166 on July
29, 1996. In introducing S.96 on January 4, 1995, Senator Hatch stated:
"Sustaining a traumatic brain injury can be both catastrophic and devastating.
The financial and emotional costs to the individual, family, and community are
enormous. Traumatic brain injury is the leading cause of death and disability
among Americans under the age of 35. In the State of Utah, for example, the main
affected age is 28, which often is the beginning of an individual's maximum
productivity... " Senator Kennedy's introductory statement included the
following: "In 1988, Congress recommended that the Secretary of Health and Human
Services establish an interagency Head Injury Task Force to identify gaps in
research, training, medical management, and rehabilitation. This legislation
responds to the prevention, research, and service needs identified by the Task
Force. This bill will promote coordination in the delivery system and assure
greater access to services for victims suffering from the disabling consequences
of these injuries. By improving the quality of care, we can reduce severely the
disabling effects and reduce the heavy toll from these injuries. This measure
has great potential for savings lives, reducing disabilities and reducing health
care costs and I urge my colleagues to support Traumatic Brain Injury Act. " The
current law contains four major sections: A. CDC Activities in Surveillance,
Prevention and Education Although the CDC has been supporting state health
departments in carrying out TBI surveillance in selected States since 1990, the
TBI Act provided an explicit authority for such activities. Surveillance is the
ongoing and systematic collection analysis, and interpretation of health data
used to describe and monitor a health event. Surveillance gives an indication of
the number of TBIs that occur, where and how these injuries occur and which
groups in the population are at highest risk. By identifying the circumstances
of each TBI, surveillance help program planners best use their resources to
prevent more traumatic brain injury and to better prepare to care for those that
do occur. For those individuals who already have sustained a traumatic brain
injury, there is no going back to the time before the injury occurred. A related
goal of surveillance, then, is to locate people with TRT.' In order to provide
,information as well as to assess medical, prevention, and social service-needs
to -help improve the quality of their lives, and to prevent secondary conditions
associated with TBI, TBI surveillance in the States is useful in four major
areas: education raises public awareness of the problem and provides health
professionals and policy makers with knowledge about the circumstances of brain
injuries sustained in their regions; prevention programs based on TBI
surveillance allow resources to be used most effectively to target particular
causes, risk groups, and geographical areas; legislation helps implement and
enforce collective prevention measures to reduce TBIs; and follow-up helps
ensure that people who have sustained a TBI receive the services they need. B.
HRSA State Demonstration Grants This new authority was created in order to
demonstrate need and to begin to build capacity in the states for service
delivery to person with TBI and their families. As stated in the House Committee
on Commerce report, 104-652, of June 27, 1996, "Because of the serious
consequences of TBI and the failure of human services systems and educational
programs to meet their needs properly, people with TBI want to be identified as
people with brain injuries, not be to labeled as having some other disability.
This is extremely important if appropriate services are to be developed and
targeted and prevention efforts are to be conducted... TBI is different from
other disabilities due to the severity of cognitive loss. Most rehabilitation
programs are designed for people with physical disabilities, not cognitive
disabilities which require special accommodations. In most States, there is no
central point of referral and no central authority to coordinate and target
appropriate services." C. Programs of the National Institute of Health (NIH)
This new authority to make awards of grants or contracts for the conduct of
basic and applied research regarding TBI was heavily focused on medical research
in diagnosis, assessment, prognosis, and therapies. D. TBI Consensus Conference
The legislation directed the Secretary to conduct a national consensus
conference on managing traumatic brain injury and related rehabilitation
concerns. The Consensus Conference on Rehabilitation of Persons with Traumatic
Brain Injury was convened by the NIH on October 26-28, 1998. The final report
has been published. It contains numerous conclusions based on a review of the
literature, testimony provided and an evidence based medicine report. Although
the final report makes reference to both the needs for increased prevention and
biomedical research, the focus is on community reintegration and quality of life
for persons who have sustained a traumatic brain injury and their families. The
focus of the report is on persons over the age of 16 and does not deal with
children with TBI. The report states in part, "Persons with TBI, their families,
and significant others are integral to the design and implementation of the
rehabilitation process and research. Consequently, rehabilitation services,
matched to the needs of persons with TBI, and community- based non-medical
services are required to optimize outcomes over the course of recovery. Public
and private funding for rehabilitation of persons with TBI must be adequate to
meet these acute and long-term needs, especially in consideration of the current
health care environment where access to these treatments may be jeopardized by
changes in payment methods for private insurance and public programs."
Additional findings of the report included: "TI31 is a heterogeneous disorder of
major public health significance; consequences of TBI can be lifelong; given the
large toll of TBI and absence of a cure, prevention is of paramount importance;
identification, intervention, and prevention of alcohol abuse and violence
provide an important opportunity to reduce TBI and its effects; rehabilitation
services, matched to the needs of persons with TBI, and community-based
non-medical services are required to optimize outcomes over the course of
recovery; public and private funding for rehabilitation of persons with TBI
should be adequate to meet acute and long-term needs; access to needed long-term
rehabilitation may be jeopardized by changes in payment methods for private
insurance and public programs; and funding for research on TBI needs to be
increased." PUBLIC SPENDING ON TRAUMATIC BRAIN INJURY In preparation for the
Reauthorization of the Traumatic Brain Injury Act, the Brain Injury Association
sponsored a non-scientific "snapshot" study of federal and state government
spending on TBI in FY '98. The study was completed during the spring and summer
of 1999 and a final report will be issued shortly. A copy of Draft 2 of the
report is attached to this testimony for reference. The States, in partnership
with the Federal Government, spent $226.5 Million on behalf of 38,357 recipients
of TBI services in FY '98. These data do not include special education and
primarily represent persons over the age of sixteen receiving a range of adult
employment and long term support services. These data can be compared to more
refined data sets in the field of Mental Retardation/Developmental Disabilities.
Mental Retardation/Developmental Disabilities has a prevalence of about 150% of
TBI. The field is older and better established throughout the nation. Comparable
data for FY '98 in that field is $26.5 Billion on behalf of nearly 600,000
recipients of services; primarily adults. Another comparative index is in the
area of Medicaid Home and Community Based Waivers. The 1997 GAO Report on TBI
determined that these programs covered an estimated 2,478 individuals and spend
$118 million. In 1997, these waivers covered an estimated 375,000 individuals
with Mental Retardation/Developmental Disabilities and spent approximately $5.5
Billion. The need for the development and expansion of community support
services for children and adults with Traumatic Brain Injury and their families
is very large, indeed. CURRENT STATUS AND RECONUVIENDATIONS FOR REAUTHORIZATION
Much has been accomplished in the past three years, but much more remains to be
done. In order to prepare for this reauthorization, the Brain Injury Association
convened a Stakeholders Meeting on July 21-22, 1999 including representatives
from the Federal Government (day one only), State Government, persons with brain
injury and family members, providers, advocates and researchers. The proposed
outcome for the meeting was to develop a consensus set of recommendations to
take to Congress for a five-year reauthorization. The 30 participants reviewed
the current law and its accomplishments and have prepared a draft consensus
Reauthorization Bill which is attached to this testimony as an Appendix.
Prevention: The Centers for Disease Control and Prevention carried out projects
to reduce the incidence of traumatic brain injury. The CDC has published TBI
surveillance methods and guidelines for public health purposes and funds 15
states creating a multi-state, uniform reporting system to provide nationally
representative data to define groups at higher risk, causes and circumstances,
and outcomes of injury. We need to continue the TBI Act in order to allow CDC to
expand patient follow-up registries. There is a strong need to determine
long-term disabilities and related problems from TBI. Based upon the current
incidence and prevalence studies, CDC needs funding to expand education and
prevention programs. Research: The National Institutes of Health conducted
research on the development of new methods and modalities for more effective
diagnosis, measurement of degree of injury, post-injury monitoring and
assessment of care models for brain injury recovery and long term care. More
research needs to be done using applied research. Extensive research is needed
regarding life long issues for children with TBI and their families. The applied
research needs to be conducted through the National Institute on Disability and
Rehabilitation Research (NIDRR) in the Department of Education. NIDRR
administers the TBI model systems of care, and with additional funding
Rehabilitation Research and Training Centers and Rehabilitation Engineering
Centers dedicated to TBI can best conduct the necessary applied research. State
"Demonstration" Projects. The Administration for Health Resources and Services
Administration (HRSA) made grants to states for the purpose of carrying out
demonstration projects to improve access to health and other services regarding
traumatic brain injury. There are 32 states who have received HRSA funded TBI
Demonstration Grants. The following 19 states have not received any HRSA State
Grant Funds to date: Alaska, Arkansas, Connecticut, Hawaii, Idaho, Kansas,
Louisiana, Maine, Massachusetts, Montana, Nebraska, New Mexico, North Dakota,
Pennsylvania, South Dakota, Tennessee, Utah, Vermont, Washington and Wyoming. In
order to allow new states to apply for planning grants and to move participating
states into the implementation phase, we need to continue funding for HRSA. The
authority also needs to be expanded to authorize states to go beyond
demonstrations to system capacity building. CONCLUSION The TBI Act represents a
foundation for coordinated Public Policy in prevention, education, research and
community living for persons with brain injury and their families. TBI is a
major public health problem that requires national attention. It is important
that Congress Reauthorize the TBI Act and continue to significantly increase
appropriations. As a nation, we must continue to conduct surveillance projects
and target prevention and public education. We also must collect reliable data
on the needs of person with brain injury, assist states in providing needed
services, and conduct research in order to establish more effective acute, care
rehabilitation techniques and lifelong supports for community participation.
LOAD-DATE: September 21, 1999
