2007 California Welfare and Institutions Code Chapter 5. Persons With Acquired Traumatic Brain Injury

CA Codes (wic:4353-4359)

4353.  The Legislature finds and declares all of the following:
   (a) There is a large population of persons who have suffered
traumatic head injuries resulting in significant functional
impairment.
   (b) Approximately 80 percent of these injuries have occurred as a
direct result of motor vehicle accidents.
   (c) There is a lack of awareness of the problems associated with
head injury resulting in a significant lack of services for persons
with head injuries, including, but not limited to, in-home and
out-of-home services, respite care, placement programs, counseling,
cognitive rehabilitation, transitional living, and vocational
rehabilitation services.
   (d) Although there are currently a number of different programs
attempting to meet the needs of the persons with head injuries, there
is no clearly defined ultimate responsibility vested in any single
state agency. Nothing in this section shall be construed to mandate
services for persons with acquired traumatic injury through county
and city programs.
   (e) There is no programmatic coordination among agencies to
facilitate the provision of a continuing range of services
appropriate for persons with traumatic head injuries.
   (f) There is a serious gap in postacute care services resulting in
incomplete recovery of functional potential.
   (g) Due to the problems referred to in this section, the state is
not adequately meeting the needs of persons with head injuries
enabling them to return to work and to lead productive lives.




4354.  For purposes of this chapter, the following definitions shall
apply:
   (a) "Acquired traumatic brain injury" is an injury that is
sustained after birth from an external force to the brain or any of
its parts, resulting in cognitive, psychological, neurological, or
anatomical changes in brain functions.
   (b) "Department" means the State Department of Mental Health.
   (c) "Director" means the Director of Mental Health.
   (d) (1) "Vocational supportive services" means a method of
providing vocational rehabilitation and related services that may
include prevocational and educational services to individuals who are
unserved or underserved by existing vocational rehabilitation
services.
   (2) "Extended supported employment services" means ongoing support
services and other appropriate services that are needed to support
and maintain an individual with an acquired traumatic brain injury in
supported employment following that individual's transition from
support provided as a vocational rehabilitation service, including
job coaching, by the State Department of Rehabilitation, as defined
in paragraphs (1) and (5) of subdivision (a) of Section 19150.
   (e) The following four characteristics distinguish "vocational
supportive services" from traditional methods of providing vocational
rehabilitation and day activity services:
   (1) Service recipients appear to lack the potential for unassisted
competitive employment.
   (2) Ongoing training, supervision, and support services must be
provided.
   (3) The opportunity is designed to provide the same benefits that
other persons receive from work, including an adequate income level,
quality of working life, security, and mobility.
   (4) There is flexibility in the provision of support which is
necessary to enable the person to function effectively at the
worksite.
   (f) "Community reintegration services" means services as needed by
clients, designed to develop, maintain, increase, or maximize
independent functioning, with the goal of living in the community and
participating in community life. These services may include, but are
not limited to, providing, or arranging for access to, housing,
transportation, medical care, rehabilitative therapies, day programs,
chemical dependency recovery programs, personal assistance, and
education.
   (g) "Fund" means the Traumatic Brain Injury Fund.
   (h) "Supported living services" means a range of appropriate
supervision, support, and training in the client's place of
residence, designed to maximize independence.
   (i) "Functional assessment" means measuring the level or degree of
independence, amount of assistance required, and speed and safety
considerations for a variety of categories, including activities of
daily living, mobility, communication skills, psychosocial
adjustment, and cognitive function.
   (j) "Residence" means the place where a client makes his or her
home, that may include, but is not limited to, a house or apartment
where the client lives independently, assistive living arrangements,
congregate housing, group homes, residential care facilities,
transitional living programs, and nursing facilities.



4354.5.  The Legislature finds and declares the following:
   (a) Ascertaining the number of Californians who survive traumatic
brain injuries is difficult, but the best estimates are that there
are approximately 225,000 survivors who have sustained "closed" or
"open" head injuries.
   (b) Traumatic brain injuries have a long-term impact on the
survivors, their families, caregivers, and support systems.
   (c) Long-term care consumers experience great differences in
service levels, eligibility criteria, and service availability,
resulting in inappropriate and expensive care that fails to be
responsive to their needs.
   (d) California must develop an action plan with a timetable for
implementation to ensure that there will be an array of appropriate
services and assistance funded and administered by a state structure
that has a focus and commitment to integration and coordination.
   (e) The state must pursue, in a timely manner, all available
sources of federal financial participation, including, but not
limited to, the medicaid home and community-based services waiver
program (42 U.S.C. Sec. 1396n(c)) and Part J of Subchapter II of the
Public Health Service Act (42 U.S.C. Sec. 280b et seq.).
   (f) The department, pursuant to this chapter, has funded and
demonstrated, successfully, through four projects for a postacute
continuum-of-care model for adults 18 years of age or older with
acquired traumatic brain injuries, the array of services and
assistance that meet the needs of these individuals and their
families.
   (g) The state shall replicate these models toward developing a
statewide system that has as a goal the support of existing
community-based agencies and organizations with a proven record of
serving survivors of traumatic brain injuries.
   (h) Implementation of the act that added this section shall be
consistent with the state's public policy strategy to design a
coordinated services delivery system pursuant to Article 4.05
(commencing with Section 14139.05) of Chapter 7 of Part 3 of Division
9.


4355.  (a) The department shall designate sites in order to develop
a system of postacute continuum-of-care models for adults 18 years of
age or older with an acquired traumatic brain injury.
   (b) The project sites shall coordinate vocational supportive
services, community reintegration services, and supported living
services.  The purpose of the project is to demonstrate the
effectiveness of a coordinated service approach that furthers the
goal of assisting those persons to attain productive, independent
lives which may include paid employment.
   (c) Project sites that are authorized to provide home- and
community-based waiver services pursuant to Section 14132.992 shall
also provide extended supported employment services, as defined in
paragraph (2) of subdivision (d) of Section 4354.




4356.  (a) The department shall provide support to the four original
pilot sites.
   (b) (1) The department shall award and administer grants to four
additional sites, to be selected through a competitive bidding
process.  One site shall be within each of the regions listed in
Section 4357.2.  It is the intent of the Legislature that one site be
located in a rural area.  Implementation of new project sites shall
be contingent upon the availability of funds, and new project sites
shall be selected on an incremental basis as funds become available.

   (2) Priority shall be given to applicants that have proven
experience in providing services to persons with an acquired
traumatic brain injury including, but not limited to, supported
living services, community reintegration services, vocational support
services, caregiver support, and family and community education.
   (3) The department shall convene a working group, established
pursuant to Section 4357.1, to assist them in developing requests for
proposals and evaluating bids.  In addition, the department shall
use this working group as an advisory committee in accordance with
requirements of Part J of Subchapter II of the Public Health Service
Act (42 U.S.C. Sec. 280b et seq.) in order to pursue available
federal funds including, but not limited to, Section 300d-52 of Title
42 of the United States Code.
   (4) Each new site shall be in operation within six months
following the grant award.
   (5) The four additional sites prescribed by this subdivision shall
be established to the extent that the availability of federal funds
or other appropriate funds permit.
   (c) (1) The department, with the advice and assistance of the
working group, shall develop an independent evaluation and assist
sites in collecting uniform data on all clients.
   (2) The evaluation shall test the efficacy, individually and in
the aggregate, of the existing and new project sites in the following
areas:
   (A) The degree of community reintegration achieved by clients,
including their increased ability to independently carry out
activities of daily living, increased participation in community
life, and improved living arrangements.
   (B) The improvements in clients' prevocational and vocational
abilities, educational attainment, and paid and volunteer job
placements.
   (C) Client and family satisfaction with services provided.
   (D) Number of clients, family members, health and social service
professionals, law enforcement professionals, and other persons
receiving education and training designed to improve their
understanding of the nature and consequences of traumatic brain
injury, as well as any documented outcomes of that training and
education.
   (E) The extent to which participating programs result in reduced
state costs for institutionalization or higher levels of care, if
such an estimate can be obtained within the 10 percent of funds
allowed for the evaluation.
   (3) The department shall expend not more than 10 percent of the
annual program amount on the evaluation.  The evaluator shall be
chosen by means of competitive bid and shall report to the
department.
   (4) The evaluator shall make a final report to the Legislature by
January 1, 2005.


4357.  (a) The sites shall be able to identify the special needs and
problems of clients and the services shall be designed to meet those
needs.
   (b) The sites shall match not less than 20 percent of the amount
granted, with the exception of funds used for mentoring.  The
required match may be cash or in-kind contributions, or a combination
of both, from the sites or any cooperating agency.  In-kind
contributions may include, but shall not be limited to, staff and
volunteer services.
   (c) The sites shall provide at least 51 percent of their services
under the grant to individuals who are Medi-Cal eligible or who have
no other identified third-party funding source.
   (d) The sites shall provide, directly or by arrangement, a
coordinated service model to include all of the following:
   (1) Supported living services.
   (2) Community reintegration services.
   (3) Vocational supportive services.
   (4) Information, referral, and, as needed, assistance in
identifying, accessing, utilizing, and coordinating all services
needed by individuals with traumatic brain injury and their families.

   (5) Public and professional education designed to facilitate early
identification of persons with brain injury, prompt referral of
these persons to appropriate services, and improvement of the system
of services available to them.
   The model shall be designed and modified with advice from clients
and their families, and shall be accessible to the population in
need, taking into account transportation, linguistic, and cultural
factors.
   (e) The sites shall develop and utilize an individual service plan
which will allow clients to move from intensive medical
rehabilitation or highly structured living arrangements to increased
levels of independence and employment.  The goals and priorities of
each client shall be an integral part of his or her service plan.
   (f) The sites shall seek all third-party reimbursements for which
clients are eligible and shall utilize all services otherwise
available to clients at no cost, including vocational rehabilitation
services provided by the Department of Rehabilitation.  However,
grantees may utilize grant dollars for the purchase of nonreimbursed
services or services otherwise unavailable to clients.
   (g) The sites shall endeavor to serve a population that is broadly
representative with regard to race and ethnicity of the population
with traumatic brain injury in their geographical service area,
undertaking outreach activities as needed to achieve this goal.
   (h) The sites shall maintain a broad network of relationships with
local groups of brain injury survivors and families of survivors, as
well as local providers of health, social, and vocational services
to individuals with traumatic brain injury and their families.  The
sites shall work cooperatively with these groups and providers to
improve and develop needed services and to promote a well-coordinated
service system, taking a leadership role as necessary.



4357.1.  (a) The department shall convene a working group including
the following persons as selected by the director:
   (1) A survivor currently using services in the program.
   (2) Two family members of persons surviving traumatic brain
injuries, one of whom shall be a family member of a person with
significant disabilities resulting from injuries.
   (3) A representative of the Brain Injury Association of
California.
   (4) A representative of each of the existing sites.
   (5) A representative of the Caregiver Resource Centers.
   (6) A representative of the California Foundation for Independent
Living Centers.
   (7) A representative of the Public Interest Center for Long-term
Care.
   (8) A representative of the California Rehabilitation Association.

   (9) A member from a survivor's organization.
   (10) Representatives of the Department of Rehabilitation and the
State Department of Health Services and others as determined by the
director.
   (b) Members of the working group shall participate without
compensation.  The working group may be reimbursed by the department
for expenses related to the meetings, as determined by the director.

   (c) The department shall consult with the working group on the
following, as determined by the director:
   (1) Development of the evaluation instrument and plan.
   (2) Selection and development of the four new sites.
   (3) Progress reports and input from participating state or local
agencies and the public.
   (4) Project implementation, achievements, and recommendations
regarding project improvement.
   (5) Development of recommended strategies and guidelines for
accident prevention and training of peace officers in awareness of
brain injury issues.  These recommendations shall be made available
for use by the department, project sites, other state agencies, and
other appropriate entities.
   (6) A recommended plan including financial requirements for
expansion of the project to all regions of the state to be completed
and issued by January 1, 2003.
   (d) Contracts awarded pursuant to this part and Part 4 (commencing
with Section 4370), including contracts required for administration
or ancillary services in support of programs, shall be exempt from
the requirements of the Public Contract Code and the State
Administrative Manual, and from approval by the Department of General
Services.



4357.2.  (a) New sites shall be chosen from areas of the state that
are not currently served by a site.  Two new sites shall be located
in the southern portion of the state and two new sites shall be
located in the northern portion of the state.  Of these, at least one
site shall be located in a rural area.  Nothing in this chapter
shall prohibit a site from serving multiple counties.  Implementation
of the new sites shall be contingent upon funds appropriated by the
Legislature and funds becoming available for this purpose.
   (b) The department, in conjunction with the existing sites, shall
develop guidelines and procedures for the coordinated
continuum-of-care model and its component services.  The existing
sites shall assist the department in providing orientation, training,
and technical assistance to the new sites.
   (c) Up to 10 percent of funds allocated to new sites during their
first year of operation may be expended for training, technical
assistance, and mentoring by existing sites and any other source of
assistance appropriate to the needs of the new sites.  A plan and
budget for technical assistance and mentoring shall be included in
the proposals submitted by potential sites.
   (d) Mentoring activities shall include, but not be limited to,
assisting new sites in refining their continuum-of-care model and its
component services, developing guidelines and procedures, and
providing advice in meeting the needs of traumatic brain injury
survivors and their caregivers, as well as carrying out community
outreach and networking with community groups and service providers.
Mentoring shall be carried out with the goal of responding to the
needs identified by the new sites, transferring the knowledge and
expertise of the existing sites, and helping each new site to be
successful in developing an effective program that takes into account
the needs, resources, and priorities of their local community.
Mentoring shall be coordinated with and overseen by the department.
   (e) Department staff and site directors shall meet quarterly as a
group for ongoing technical assistance, transfer of knowledge, and
refinement of the models of continuum of care.
   (f) Existing and new sites may allocate up to 15 percent of annual
program funds to any appropriate caregiver resource center to assist
in caregiver services.



4358.  There is hereby created in the State Treasury the Traumatic
Brain Injury Fund, the moneys in which may, upon appropriation by the
Legislature, be expended for the purposes of this chapter.



4358.5.  (a) Funds deposited into the Traumatic Brain Injury Fund
pursuant to paragraph (8) of subdivision (f) of Section 1464 of the
Penal Code shall be matched by federal vocational rehabilitation
services funds for implementation of the Traumatic Brain Injury
program pursuant to this chapter. However, this matching of funds
shall be required only to the extent it is required by other state
and federal law, and to the extent the matching of funds would be
consistent with the policies and priorities of the State Department
of Rehabilitation regarding funding.
   (b) The department shall seek and secure funding from available
federal resources, including, but not limited to, Medicaid and drug
and alcohol funds, utilizing the Traumatic Brain Injury Fund as the
state's share for obtaining federal financial participation, and
shall seek any necessary waiver of federal program requirements to
maximize available federal dollars.



4359.  This chapter shall remain in effect until July 1, 2012, and
as of that date is repealed, unless a later enacted statute enacted
prior to July 1, 2012, extends or deletes that date.