Critical Service Gaps Addressed by TBI Sites

Critical TBI specific services are not always available through other programs and funding sources in ways to meet the unique needs of individuals with TBI. Through different waiver programs and other community-based services, CATBI sites can provide these critical services to those in need.

Developmentally Disabled (DD)
  • Developmentally Disabled (DD) waiver services contains all of the TBI community’s preferred services, but this waiver has eligibility restrictions such as formal diagnosis of development disability prior to age 18.
    • TBI Service Gaps: Many individuals with TBI who have significant cognitive disabilities often need the same services provided under the DD waiver such as case management, supported living, community integration, and vocational support but are not eligible due to acquiring the TBI after the age of 18.
Assisted Living Waiver (ALW)
  • Assisted Living Waiver (ALW) has a tier in place for some individuals with TBI, but this waiver contains a housing restriction (i.e., either Residential Facilities for the Elderly or public subsidized housing). Participants must be over 21 years old.
    • TBI Service Gaps: The ALW is limited in California with many communities, especially rural communities, not having access to the waiver. ALW is a more restrictive environment then living in an apartment or house with the needed supports. Often ALW residents are older and younger individuals with TBI often want to live in more age appropriate settings.
Nursing Facility/Acute Hospital (NF-A)
  • Nursing Facility/Acute Hospital (NF-A) waiver has no age limit and represents the best existing-waiver option for adding or expanding services for the TBI population. Many desired services are already included in the waiver, with the exception of vocational supportive services.
    • TBI Service Gaps: This waiver is only available to individuals with TBI who are at the NF-A level of care. There are many individuals with TBI that need case management, supported living, community reintegration, and vocational support to live independently and maintain employment but are not eligible because the do not meet the NF-A level of care designation.
Multipurpose Senior Services Program (MSSP)
  • Multipurpose Senior Services Program (MSSP) has an age restriction of 65 years, but contains many of the preferred services.
    • TBI Service Gaps: The MSSP waiver is only for individuals over the age of 65 years. MSSP service provider locations are geographically limited and there are often wait lists. The MSSP does not have any vocational supportive services.
Community Based Adult Services (CBAS)
  • Community Based Adult Services (CBAS) has an age restriction of 18 years and contains services for individuals with cognitive disorders and brain injuries. Providers are adult day health care centers and work mostly with Medi-Cal managed care plans, although exemptions exist.
    • TBI Service Gaps: While the CBAS waiver is available for individuals over the age of 18, it is often not an appropriate setting for younger individuals. CBAS service provider locations are geographically limited, especially in rural areas, and there are often wait lists. CBAS does not have any vocational supportive services
Behavioral Health Services
  • Behavioral Health Services offers community mental health services and alcohol and drug treatment services.
    • TBI Service Gaps: Behavioral components of TBI often resemble psychiatric disabilities and can be difficult to diagnose. Individuals with TBI have higher than average substance abuse issues. Behavioral health services are often unequipped to serve individuals with TBI due to lack of specialized services and capacity. There is often misunderstanding about TBI and mental health or lack of access to service due to diagnosis. County behavioral health will not serve TBI because it is out of their scope through the implementation of managed care.
Vocational Rehabilitation (VR)
  • Vocational Rehabilitation (VR) Services provides services to job seekers with physical and mental disabilities.
    • TBI Service Gaps: The VR system only services individuals with TBI who are work ready. Many individuals with TBI need pre-employment and job-readiness services. Individuals with TBI have historically been underserved by the VR system due to the need for on-going supported employment type services to find and maintain employment for individuals with TBI. Job coach to consumer ratios must be reduced in-order for the job coach to have the time needed for successful employment outcomes. Job coaches who specialize in serving people with TBI who have employment goals is needed.
Independent Living Centers (ILCs)
  • Independent Living Centers (ILCs) serve people of any age and with any type of disability and provide some of the needed TBI services such as information and referral and community reintegration services.
    • TBI Service Gaps: Many of the ILCs do not have the capacity to provide on-going service coordination and case management, supported living, and vocational supportive services to meet the needs of individuals with TBI that need higher levels of on-going service. Many of the ILCs do not have staffing with the specific specialization to TBI.