Today's topic is: "Structured Day Programs and How it Fits with TBI Waiver Services"

Our Guest is: Dr. Marie Cavallo, Director of TBI Services, AHRC TBI Services, New York

[19:02:30] mod: Welcome Dr. Cavallo. Dr. Cavallo is a professional in the brain injury field for almost 20 years.
[19:03:00] mod: She was involved with the Rehabilitation and Research Center on Head Trauma and Stroke at NYU Medical Center from 1983 to 1994.
[19:03:41] mod: Dr. Cavallo had authored and co-authored numerous articles about TBI and is the co-author of the NYU Head Injury Family Interview.
[19:04:44] mod: Dr. Cavallo is with us tonight to discuss Structure Day Programs and how it fits with TBI Waiver Services.
[19:05:13] mod: rail: Are there many 'Day Care' programs in the New York Area?
[19:06:04] Marie: I'm not sue if Day Care is the right term. there are a couple of different models of day programs available. would you like me to tell you about some?
[19:07:30] Marie: There are a couple of what you might term Adult Day Care Programs that are serving individuals with more physically disabling TBI's, but the model we have developed at AHRC is more of a community rehabilitation program
[19:07:48] mod: Welcome to Sue: Are TBI day centers becoming more prevalent? This might be a help to others.
[19:08:35] Marie: I think the answer to that is Yes! When we opened our program 5 years ago, we were the only one of its kind in NYC. Others have opened since then.
[19:08:38] mod: Sue: Thank you for the complement to Marie. She is doing a great job and have always been a help when needed.
[19:09:10] Marie: I think the availability of the waiver funding has helped provide funding to do this kind of thing.
[19:09:15] mod: Marie: What is TBI-CSS?
[19:10:00] Marie: TBI -CSS stands for Traumatic Brain Injury Community Support Services.  It is the array of long term community based services and supports we have developed at AHRC for individuals with TBI.  It includes services like Service Coordination (like Case management), in the home training and supervision services, and our structured day programs. We also have a TBI sobriety service.
[19:13:30] mod: rail: How might the CSS model dovetail with the score need of Respite Services? Are the supervised settings that can give the primary caregivers a break?
[19:14:40] Marie: Respite is actually a service that we provide. Respite is a service that is funded under both waivers available to individuals with TBI, the OMRDD waiver and the DOH waiver. In addition, other services like day programs and one on one training services can help individuals become more independent and less demanding of caregivers time.
[19:14:48] mod: Sue: Hi this is Amanda. Do these have case management, a very important for someone with a TBI who may not have a strong advocate with them?
[19:16:30] Marie: Actually the service that is funded through the waivers is called Service coordination, which is very much like case management. However the philosophy of the waiver (and of course our services) is that people are not cases to be managed but that we can help with coordinating services.  This includes serving as an advocate. you are right, this is a central service and sometimes the service coordination in and of itself can be very very helpful
[19:17:12] mod: Sue: Should all Adult Day Programs be lic. by DOH and follow OSHA?
[19:17:44] Marie: No, not necessarily.
[19:18:13] Marie: The OMRDD provides day programming for people with tbi through its waiver. DOH has a TBI specific waiver and of course that is DOH approved.  Other day program models are funded through medicaid as Adult Day Programs and are also under DOH, but not directly through the TBI Program.  OHSA of course is a federal agency that has to do with site specific and person specific health and safey issues and all programs should be operating under general OHSA regs.
[19:20:31] mod: Sue, your questions are very important tonight. Thank you. Sue asks: Do you have to have a case management from ARCH to get respite from them?
[19:21:26] Marie: AHRC is one of many agencies that provides service coordination. WE are also one of many agencies that provide respite services.  Usually what one does is first figure out which waiver (if any) they are eligible for, then follow the appropriate path to getting on the wiaver and choosing a provider to provide the service coordination or respite.  If it is the OMRDD wiaver, you would contact the local Developmental Disabilities Services Office.  If it is DOH you would contact the locial Regional Resource Development Office.
[19:23:22] mod: Sue: Having this is all relatively new due to much effort and I think its great that there is now a structured, intensive that fits the needs of those with TBI.
[19:24:53] Marie: Yes, the stae of NY has actually done a lot of work to try to meet the needs of individuals with TBI. Of course, the state moves slowly but with the development of the mediciad waivers, programs and services are starting to come into being. You know, if it can be funded it is much more likely to happen!
[19:25:37] mod: What kind of services are available through TBI-CSS?
[19:26:54] Marie: Service Coordination, Structured Day Programs, Respite, In-home Services. We also have a sobriety service for individuals with alcohol and chem. dep. issues.  But besides my agency, others also may provide things like e-mods.
[19:27:42] mod: Can an individual participate in TBI-CSS while still receiving traditional out-patient rehabilitation services?
[19:28:13] mod: Can you give us an example?
[19:28:49] Marie: yes. Let me say that TBI-CSS is AHRC's set of services. Other agencies may have some or all of these services also but may have other names for them.  TBI-CSS is a set of ongoing community based supports and services which can complement traditional rehabilitation services.  In fact, TBI-CSS also provides a whole range of traditional clinical rehabilitation services, such as speech therapy, in addition to our more innovative community based rehabilitation program.
[19:31:15] Marie: An example of how we can complement traditional services:  An individual may be receiving speech therapy, OT and cognitive rehab at a local rehabilitation hospital two days per week.  While continuing to receive those services, this individual can attend the Structured Day Program at AHRC's TBI Community Resource Center where this individual may take advantage of our Transitional Work Center,  continue to work on needed skills in community settings and socialize with others in the community. Therefore, receiving rehabilitation services 5 days per week.
[19:33:27] mod: DMC: Do you find a big need for sobriety services for persons with TBI? How is it structured differently from people who are not injured?
[19:34:32] Marie: Yes, the literature shows that there is a very high percentage of individuals who become vulnerable to alcohol and drug addiction because of isolation, depression and even pain issues.  The program is run by our sobriety director
[19:35:33] Marie: Our sobriety service in general is certified by OASAS which is the state agency that certified alcohol clinics.  The director of the program has reworked the more traditional approach to sobriety to account for individual's with TBI cognitive issues.  So there may be more repetition, for example and use and training in compensatory strategies within the context of sobriety issues.
[19:37:46] Marie: Its hard for me to be more specific since I do not personally run that program, but I know it has been very successful and of course there are adaptations to meet the needs of individuals with TBI
[19:37:53] mod: That's OK Carol. Better late than never! Carol: Sorry I'm a little late I had problems with AOL,,,How can people apply for respite services and if you have such a service for how long can you get help?
[19:38:54] Marie: Ok, as I said before the first thing is to figure out if the person who needs the service is eligible for either of the Meidciad waivers that serve individuals with TBI.
[19:39:17] Marie: Let me digress a little here and give a real brief mention of the waivers.
[19:40:06] Marie: Mediciad waiver is a funding stream available to individuals with Medicaid. then of course there are other criteria depending on which waiver you are looking at.
[19:40:28] Marie: The two waivers available to inds. with TBI are the OMRDD waiver and the DOH TBI Waiver.
[19:41:37] Marie: The OMRDD waiver is for inds. with TBI who are injured before the age of 22 because then the state considers them developmentally disabled and so they can access the OMRDD waiver (OMRDD= Office of Mental Retardation and Developmental Disabilities Office)  This is a waiver that is available to people with TBI if injured before age of 22. If this is the case, you need to call the local Developmental Disabilities office. there is one in every borough. to get the numbers, call the brain injury association. they can help with that.
[19:45:03] Marie: BIA also has staff that helps with inds. injured before the age of 22. The OMRDD waiver has a respite service available . So you call the Office and tell them you are interested in the waiver and specifically in respite. Or you can call an OMRDD provider, like my agency, and ask for the respite department in Home Care. At my agency the number would be 212-780-2500 and ask for Home Care Dept.  but other agencies do this also.
[19:45:32] Marie: Now, the DOH waiver is for inds. injured after 22 and provides a respite service also.  To access this you must call the local regional resource development office. for Man/Bklyn/SI this would be Gloria Liu at 212-634-8674. for the Bronx and Queens it would be Ronnie Gala at 718-515-5500 X2003.
[19:46:46] mod: Melanie: If a person is severely physically disabled and needs 1:1 for all ADL's how does this fit into the scheme of the program? Can they come with a HHR if OK'd by HRA?
[19:48:27] Marie: In general, the program at AHRC is a community based program, where people are out in the community in very small groups with a staff person. Our programs are not best for more severely physically disabled
[19:48:41] Marie: In general HRA does not want to approve overlap of services. However there is a program , for example in Brooklyn (Fairview) that specializes in the more medically complex and physically disabled.  Our program is a better match for inds. with moderate to severe cognitive problems, and less severe physical, although we have a number of inds. who are wheelchair users
[19:50:14] mod: Roger: Does the program offer any assistance to those patients and families that need assistive technological devices?
[19:51:49] Marie: Assistive Technology is sometimes covered by medicaid or other private ins. and service coordinators can sometimes asset with helping the person access these devices.  However, at our day program since we serve less physically disabled individuals and are funded through medicaid primarily, we have not utilized assistive technology as much as I would like
[19:52:46] mod: Marie, can you tell me where the TBI Community Resource Centers are located?
[19:54:17] Marie: At AHRC, we can our program sites TBI Community resource Centers because we feel that the center itself is a starting place for accessing the community at large. Most of the rehabilitation work we do through our day program takes place out in the community.
[19:54:54] Marie: The two current centers are on 29th St. and 8th ave. in Manhattan and on Woodside Ave in Queens.  We will be opening a new center in the Bronx hopefully in January, at Bronx Blvd. If you would like more information about any of our services or centers you can call Dr. Shelly Levy at 212-634-8672 or e-mail me at AHRCTBI@aol.com
[19:56:07] mod: Roger, How can one go abut registering someone for your day program and is transportation provided?
[19:57:14] Marie: Transportation is provided, although we encourage any one who can travel on their own to do so. the goal of the program is empowerment and moving toward independence. we will also help with travel training.
[19:57:53] Marie: As I said, if you are interested in our day program or other services call Dr. Levy.  But let me just say that if you are interested in being funded under the DOH waiver, you need to go through the Regional Resource Office first. If you are OMRDD eligible we can take the referral directly.
[19:59:08] mod: Melanie: I've heard of Fairview. They are great. To tell you the truth my son goes there. With regard to assistive devices sometimes the DDSO can help with funding.
[20:00:09] Marie: Yes, sometimes the Developmental Disabilities office or the DOH can help with assistive technology, sometimes even directly through mediciad.
[20:00:20] mod: Thank you Marie for a very interesting and informative evening. I hope that we can invite you back in the future.
[20:00:50] Marie: Thank you very much for inviting me.  If anyone has any other questions or comments for me, please feel free to e-mail me at AHRCTBI@aol.com.
[20:01:19] mod: Good Evening to all and thank you for your participation.   Just one more item. Please check our Resource Page for a link to AHRC NYC. Thank you