The Disabilities Law Program (“DLP”) of the Community Legal Aid Society, Inc. provides services to address the advocacy needs of persons with traumatic brain injury (“TBI”) consistent with Section 1253 of the Public Health Service Act. This document identifies the priorities, rationale, and projected outcome measures for the DLP’s Protection & Advocacy for Traumatic Brain Injury (PATBI) program for FY 08.

• I. PREVENTION
  • GOAL: The PATBI will promote TBI prevention and recourse options.

  • SYSTEMIC ADVOCACY OBJECTIVE:
    • Collaborate with the State Council for Persons with Disabilities ["SCPD"] Brain Injury and Policy & Law Committees in development and analysis of State legislation, regulations and selected policies with significant effect on TBI prevention and recourse options.

  • OUTCOME MEASURE:

    • As a result of PATBI intervention, a minimum of 5 laws, regulations, or policies affecting TBI prevention and recourse options will be adopted or improved.

  • RATIONALE: In a prior fiscal year, the PATBI drafted affirmative prevention legislation which would: 1) raise the age limit for wearing a helmet on bicycles and motorized hybrid 2-wheeled vehicles from 16 to 18; and 2) update helmet standards in the Delaware Code. The legislation (S.B. No. 58), which was endorsed by the Division of Public Health, passed the Senate but not the House. In 2007, the DLP prepared revised helmet legislation earmarked by the Legislature as S.B. No. 174. Introduction was deferred until 2008 at the suggestion of the prime sponsor. In recent years the Legislature has been actively considering several transportation-related bills which would reduce the prevalence and severity of TBI. For example, in 2006, the PATBI critiqued several bills affecting driver safety, including enacted S.B. No. 270 (DUI) and H.B. No. 256 (teen driver restrictions). In 2007, the PATBI critiqued the following: 1) S.B. No. 46 (resurrecting mandatory motorcycle helmet requirement); 2) and H.B. No. 78 (banning driver hand-held cell phone use in vehicles). When enacted, such traffic safety bills have proven effective. For example, the Office of Highway Safety reported in July, 2007 that seat belt usage has increased from 67% in 2001 to 87% in 2007 based on enforcement of seat belt legislation. The PATBI anticipates introduction of more traffic safety bills in 2009. In FY 09, the PATBI anticipates provision of technical assistance to policymakers concerning such legislation as well as other prevention-related initiatives. The PATBI also envisions supporting implementation of the TBI objectives in Delaware’s Strategic Plan for Injury Prevention (2005-2010). Finally, the PABTI anticipates collaboration with the SCPD Brain Injury Committee in revising and implementing its education initiative to reduce the incidence and severity of youth sports concussions.

• II. SPECIAL EDUCATION

  • GOAL: The PATBI will advocate for access to appropriate special education services by students with TBI.

  • SYSTEMIC ADVOCACY OBJECTIVE:

    • A. Collaborate with SCPD and Governor's Advisory Council for Exceptional Citizens ["GACEC"] to promote the timely and valid identification of students with TBI in implementation of S.B. 105.

  • INDIVIDUAL ADVOCACY OBJECTIVE:

    • B. Provide legal advocacy services to students with TBI denied special education eligibility or essential direct or related services.

  • OUTCOME MEASURES:

    • A. The number of students identified as eligible for special education under the “TBI” classification will increase from the FY 04 baseline of zero (0), FY 05 baseline of seven (7), FY 06 baseline of twenty-six (26), FY 07 baseline of thirty-eight (38) students, to a minimum of at least forty (40) students.

    • B. As a result of PATBI intervention, a minimum of 3 students with TBI will secure special education identification or access to essential services.

  • RATIONALE: Disincentives to identify students with TBI were removed based on enactment of legislation [S.B. No. 105] authored by the PATBI with an effective date of July 1, 2004. In subsequent fiscal years, the PATBI collaborated with the Developmental Disabilities Council, GACEC, the DuPont Hospital for Children, Delaware BIA, and SCPD to educate key public school staff in identification and program needs of students with TBI. These efforts resulted in increased identification of students with TBI. The PATBI anticipates a “learning curve” for public schools to fully implement S.B. No. 105. Advocacy will be needed to prompt public schools to properly identify and program for students with TBI. In 2007, the PATBI supported and exhibited at a one day conference entitled “Traumatic Brain Injury (TBI): Return to School - ‘So What Do I Do Now?’” During FY 08, the PATBI anticipates continued collaborative efforts to sponsor training on TBI for public educators. The PATBI also envisions promotion of student access to educational services. during the summer of 2007, the PATBI spearheaded opposition to a Department of Education proposed regulation which would have eliminated the entitlement of students with TBI to extended school year services (a/k/a summer school). The PATBI also opposed a regulation relegating school psychologists to an optional role in determining special education eligibility. Having less qualified and sophisticated evaluators would predictably undermine identification of students with TBI. Finally, the PATBI contemplates individual advocacy on behalf of students with TBI to secure special education identification and access to essential services.

• III. HEALTH & FINANCIAL BENEFITS

  • GOAL: The PATBI will advocate for enhanced access to "safety-net" health and financial benefits for persons with TBI.

  • SYSTEMIC ADVOCACY OBJECTIVE:

    • A. Collaborate with the SCPD Brain Injury and Policy & Law Committees in analyzing State legislation, regulations, Medicaid waivers, and selected policies with significant effect on access to "safety-net" health and financial benefits.

  • INDIVIDUAL ADVOCACY OBJECTIVE:

    • B. Provide advocacy services to individuals with TBI facing program eligibility or significant service denials/terminations in “safety-net” health and financial public benefits contexts (e.g. SSI; Medicaid; Food Stamps).

  • OUTCOME MEASURES:

    • A. As a result of PATBI intervention, a minimum of 5 laws, regulations, Medicaid waivers, or policies affecting access to health and financial benefits will be improved.

    • B. As a result of PATBI intervention, a minimum of 5 individuals with TBI will secure enhanced access to "safety-net" public health or financial benefits.

  • RATIONALE: In the Spring of 2007, the Department of Health & Social Services (DHSS) abandoned efforts to amend existing Medicaid waivers to include TBI-related services in favor of developing a distinct adult TBI waiver effective December, 2007. The PATBI and SCPD anticipate provision of continuing technical assistance and support for the waiver. During the summer of 2007 the PATBI, SCPD, BIA, and Brain Injury Committee agreed to collaborate on research and planning of a children’s TBI Medicaid waiver and TBI data collection system. This assessment will commence in FY 07 and continue into FY 08. In 2007, the PATBI supported State funding for a family-support waiver which would cover clients of the Division of Developmental Disabilities (DDDS). DDDS includes some individuals with TBI within its client base. The State declined to include implementing funds in its FY 08 budget adopted in June, 2007. The PATBI envisions renewed advocacy to secure State funds for the waiver to allow implementation in FY 09. In 2007, the PATBI supported State legislation to expand access to health insurance by persons with disabilities, including persons with TBI. Multiple health insurance bills remain pending at the beginning of FY 08, including H.B. No. 128 (expanding CHIP eligibility to 300% of poverty level); S.B. No. 37 (authorizing Insurance Commissioner to regulate health insurer rates); and S.B. No. 6 and H.R. 38 (authorizing study and creation of State-subsidized insurance pool). The State included funds in its FY 09 budget to implement Medicaid Buy-in and Money Follows the Person programs in 2008. The PATBI envisions supporting implementation of these new programs.

• IV. GOVERNMENT PROGRAMS & SERVICES

  • GOAL: The PATBI will sustain and promote non-discriminatory and effective access to governmental programs.

  • SYSTEMIC ADVOCACY OBJECTIVE:

    • A. Collaborate with the SCPD Brain Injury and Policy & Law Committees to reduce statutory, regulatory, and policy barriers and promote effective constituent access to governmental programs.

    

  • INDIVIDUAL ADVOCACY OBJECTIVE:

    • B. Provide direct advocacy services if an individual has been prevented from effectively accessing important governmental programs based on systemic policy or barrier(s) contrary to Federal or State law.

  • OUTCOME MEASURES

    • A. As a result of PATBI intervention, 5 laws, regulations, or policies will be changed or other barriers to accessing government services will be reduced.

    • B. As a result of PATBI intervention, 3 persons with TBI will secure non-discriminatory or equal access to governmental services.

  • RATIONALE: This priority encompasses enforcement of Title II of the ADA, §504 of the Rehabilitation Act, and Delaware’s equal accommodation law, Title 6 Del.C. Ch. 45. During the summer of 2007, the PATBI spearheaded opposition to a Division of Developmental Disabilities Services revised eligibility regulation. The regulation proposed deletion of an explicit reference authorizing the eligibility of persons with brain injury. Advocacy to preserve DDDS eligibility of persons with brain injury is expected to extend into FY 08. Legislation (S.B. No. 41) co-authored by the PATBI was enacted in June, 2006. It amends Delaware’s equal accommodation law to clarify that it applies to State and local government agencies. The legislation also enhances enforcement options. Given the amendments, the PATBI anticipates an increase in advocacy invoking the equal accommodations law. In the past, the Delaware Division of Child Mental Health Services vacillated on serving children with TBI. The PATBI Project Director joined the DCMHS Advisory Council in 2007 and anticipates provision of on-going technical assistance to preserve TBI eligibility and influence services offered by this State agency.

• V. INAPPROPRIATE INSTITUTIONALIZATION; COMMUNITY LIVING

  • GOAL: The PATBI will deter inappropriate institutionalization of persons with TBI and promote the availability of appropriate community-based housing options.

  • SYSTEMIC ADVOCACY OBJECTIVES:

    • A. The PATBI will collaborate with the SCPD Brain Injury and Policy & Law Committees in analyzing State legislation, regulations, and selected policies with significant effect on diversion of persons with TBI to appropriate community-based housing options.

    • B. The PATBI will continue to provide technical assistance to the Governor’s Commission on Community-based Alternatives for Persons with Disabilities and serve on its Housing Committee to enrich the community-based service delivery system.

  • INDIVIDUAL ADVOCACY OBJECTIVES:

    • A. The PATBI will facilitate appropriate discharge planning for inappropriately institutionalized persons with TBI.

    • B. The PATBI will provide direct advocacy services to individuals with TBI who have experienced housing discrimination in violation of fair housing laws.

  • OUTCOME MEASURES:

    • A. As a result of PATBI intervention, a minimum of 3 laws, regulations, or policies affecting the institutionalization of persons with TBI will be changed.

    • B. As a result of PATBI intervention, a minimum of 3 persons with TBI will secure or retain access to appropriate community-based housing.

  • RATIONALE: The lack of community-based housing options for persons with TBI results in inappropriate institutionalization. The Governor’s Commission on Community-based Alternatives for Persons with Disabilities is engaged in systemic planning to enrich the service delivery system in the community. The PATBI served on its Housing Committee during FY 07 and anticipates continued participation in FY 09 to implement the Commission’s recommendations issued on July 17, 2007. Individuals with TBI often experience difficulty living in the community due to the lack of support services or landlord denial of reasonable accommodations. In FY 07 , the PATBI addressed multiple instances of housing discrimination against persons with TBI. The PATBI anticipates a similar need for housing advocacy in FY 09. In 2007, the PATBI advocated in favor of a New Castle County accessory dwelling unit (ADU) ordinance which was enacted. The PATBI also spearheaded opposition to a proposed New Castle County ordinance reducing the number of cohabiting unrelated individuals qualifying as a “family” from four to three. The latter ordinance would restrict group home and supported housing initiatives for persons with disabilities, including TBI. The PATBI anticipates continued advocacy within New Castle County government to enhance housing options for persons with TBI.

• VI. COMMUNITY EDUCATION

  • GOAL: The PATBI will educate persons with TBI, their families, and professionals to understand the service needs of persons with TBI, civil rights protections, and sources of supports.

  • SYSTEMIC OBJECTIVE:

    • A. The PATBI will co-sponsor or support training events which provide information on the service needs of persons with TBI, civil rights protections, and sources of supports.

  • INDIVIDUAL OBJECTIVE:

    • B. The PATBI will provide technical assistance to persons with TBI, their families, and professionals in response to inquiries concerning service needs, civil rights protections, and sources of support for persons with TBI.

  • OUTCOME INDICATORS:

    • A. The PATBI will co-sponsor or support a minimum of 3 training events which provide information on service needs, civil rights protections, and sources of support for persons with TBI.

    • B. The PATBI will provide information, referral, and technical assistance to 15 individuals with TBI, family members, and professionals.

  • RATIONALE: There is widespread misunderstanding of the needs of persons with TBI and the service delivery system. Consumer empowerment is enhanced through training of individuals with TBI and their families, including events such as the Delaware Brain Injury Association’s annual conference and the LIFE conference. The PATBI will exhibit at the Association’s conference. The PATBI will continue to serve on the design team of the LIFE conference which will include seminars of interest to persons with TBI. For example, the PATBI project director successfully facilitated inclusion of a seminar on health care grievance options in the 2008 conference. In 2007, the PATBI edited an initial resource guide published by the Delaware Brain Injury Association. If updated in 2008, the PATBI will offer editorial assistance.