Traumatic Brain Injury

A traumatic brain injury (TBI) is an injury to the brain that is caused by an external physical force such as hitting your head or other types of blunt force trauma. The most common causes of TBI include slips and falls, motor vehicle accidents and struck by or against events. The injury can cause physical and mental challenges. Every injury to the brain has different effects or consequences.

Federal TBI Grant

The North Carolina TBI Program was awarded a 5 year grant from the federal Administration for Community Living (ACL). The main grant objectives include:

A TBI grant has been approved and funded by the federal Administration for Community Living (ACL).
NC TBI Grant is for $200,179 per year for a total of $1,000,895 over the five-year grant period. .
DHHS contracts with BIANC to implement most grant objectives and deliverables.
Grant Goal- To facilitate the continued development and expansion of a comprehensive, multi-disciplinary, and easily accessible system of care for individuals with lived experience and their families.
Main Grant Objectives
- Contribute to infrastructure development of the whole care system to ensure individuals with Traumatic Brain Injury (TBI) are receiving culturally responsive, quality care in the new managed care system;
- 100% of individuals in NC who seek behavioral health services through a Local Management Entity-Managed Care Organization (LME-MCO) will be screened for a potential TBI;
- Increased provider knowledge, skill and ability across all service programs;
- Develop new partnerships with emphasis on the criminal justice system and domestic violence programs;
- Expanded options for online support groups; 6) increase education to individuals with TBI to promote person-centeredness, empowerment, skill building and other topics.

TBI Grant Products

The following are products that will be developed during the five-year grant cycle.

A new Symptoms Questionnaire (SQ) database for professionals and others	TBI screening and referral
The addition of at least one active online support group	Implementation of Employment and SUD training modules
Updated Salesforce database	Feasibility review of potential Peer Support pilot program
Training curriculum for individuals with TBI	Updated TBI Needs Assessment (Bi-annually)
Training plan for behavioral health providers with emphasis on TBI Waiver, SUD Waiver and MCOs	Updated TBI state plan (Annually)

TBI State Funded Programming

Based upon legislative appropriation, the State funded TBI program operates on approximately $3.9 million dollars for the purposes of services, supports, education and awareness. Out of this appropriation, each Local Management Entity-Managed Care Organization (LME-MCO) is allocated funding to provide TBI specific services and supports to individuals living with TBI in their respective catchment area. The Brain Injury Association of NC (BIANC) also receives funding out of the same legislative appropriation.

$3,413,868 for the LME-MCO’s
- services and supports
$559,218 for the Brain Injury Association of NC (BIANC)
- education and awareness

Click on the link below for the name and contact information of the LME-MCO that serves your county.
Local Management Entity/Manage Care Organization Directory Map

TBI Waiver

The TBI Waiver has been operational for three years. The program is currently available to eligible individuals living in the Alliance Health (LME-MCO) catchment area (Wake, Durham, Johnston and Cumberland counties). It offers a variety of services and supports to eligible individuals.

Division of Health Benefits (DHB) has submitted the TBI Waiver renewal application to the Centers for Medicare and Medicaid Services (CMS). The renewal will include:

Expansion of the Waiver into the two additional counties that are transitioning into the Alliance catchment area (Mecklenburg and Orange);
Increase federal poverty level to 300%
Lower age of date of Traumatic Brain Injury down from 22 to 18;
Add supported living as a service;
Other changes as identified in the renewal application.

The draft TBI Waiver renewal application can be found here. This draft Waiver application is currently being reviewed by the Center for Medicare and Medicaid Services (CMS). The Waiver renewal is anticipated to start in Spring 2022. Until the new application is approved, the current TBI Waiver remains in place.
The original TBI Waiver application to the Centers for Medicare and Medicaid Services (CMS) can be found here.
More information about the TBI Waiver can be found at Alliance Health here.

Data

The CDC estimates that 2% of the population will have a TBI, which equates to approximately 208,000 people in NC.
Overall 365,719 individuals received Behavioral Health Services during SFY 2018.
Of the 365,719 individuals receiving Behavioral Health Services during SFY 2018, 36,068 (10%) indicated a TBI Dx on NC Tracks records. These 36,068 clients are unduplicated across both systems, Medicaid and DMH.
During 2019, there were 29,081 Traumatic Brain Injuries sustained by North Carolinians (NC DHHS-DPH, TBI Special Emphasis Report, 2019).

Data Initiatives

The TBI Program is engaged in several data initiatives to assist in determining the number of individuals living with TBI throughout North Carolina. Data initiatives include:

TBI Screenings at six LME-MCO’s and a Domestic/Intimate Partner Violence (D/IPV) Pilot program;
Youth Sport initiative: TBI screening with all twenty-four teams in the Carolina Champions Soccer League;
Claims Data Reviews - The TBI Program is working with the Quality Management Section at the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) to determine the number of individuals that have accessed publicly funded services such as physical health, mental health and substance use service systems.
Collaborations on data collection with state partners such as Division of Health Benefits (DHB) and Division of Public Health (DPH).

There are 113,852 consumers who had a TBI diagnosis in at least one of seven diagnosis code positions using applicable ICD-9 codes, based on paid claims for any Medicaid-funded service or non-Medicaid-funded (DMH/DD/SAS) mental health service paid through the NCTracks system after July 1, 2013 for services beginning on or before Sep. 30, 2015. July 1, 2013 is when NCTracks began and 10/1/2015 is when use of ICD-10 codes was required.
Please note that there are likely many more people with TBI in NC than this number. This is one of many indicators. For example, it does not include people that have private insurance who have never accessed publicly funded services.

Training and Outreach

The TBI program provides some direct training opportunities:

What if There's a TBI? - Webinar
- Password: NCTBIProgram1
- Event evaluation form

The TBI Program also contracts with the Brain Injury Association of North Carolina (BIANC) to provide a variety of education, outreach and training activities. Some of the training opportunities available include Brain Injury Basics, TBI and Co-Occurring Mental Health and Substance Use Disorders, TBI and Aging, TBI and Post-Traumatic Stress Disorder (PTSD) in the Military and Crisis Intervention Training. Many of these trainings are offered in-person (as permitted) and/or in webinar format.
The online training modules include topics such as Identification of TBI among Medical Professionals and the Primary Care Workforce as well as TBI and Public Services in NC.
Online training opportunities can be found here.

TBI Legislation

North Carolina TBI Definitions

North Carolina Traumatic Brain Injury Waiver legislation
North Carolina Traumatic Brain Injury State Funds legislation
Federal Traumatic Brain Injury Act

Educational Resources

Additional Resources

Brain Injury Advisory Council

The purpose of the Brain Injury Advisory Council (BIAC) is to review the nature and cause of traumatic and other acquired brain injuries in North Carolina. The Council also makes recommendations to the Governor, the General Assembly, and the Secretary of Health and Human Services regarding the planning, development, funding, and implementation of a comprehensive statewide service delivery system to address the needs of brain injury survivors.

BIAC Meeting Notice

This is formal notice of the upcoming BIAC meetings for the remainder of 2021 and 2022. The meetings will occur as follows:
Date	Location
Wednesday Dec. 8, 2021 9:30 a.m. - 12:30 p.m.	Go To Webinar (please email TBIContact@dhhs.nc.gov to request link to the meeting)
Wednesday March 9, 2022 9:30 a.m. - 12:30 p.m.
Wednesday June 8, 2022 9:30 a.m. - 12:30 p.m.
Wednesday Sept. 7, 2022 9:30 a.m. - 12:30 p.m.
Wednesday Dec. 7, 2022 9:30 a.m. - 12:30 p.m.