Traumatic Brain Injury

Authorizing Legislation - Sections 1252 and 1253 of the Public Health Service Act.

Allocation Method:

• Formula grant
• Competitive grant

Program Description and Accomplishments
The Traumatic Brain Injury (TBI) Grant Program funded the development and implementation of Statewide systems that ensured access to comprehensive and coordinated TBI services including: pre-hospital care, emergency department care, hospital care, transitional services, rehabilitation, education and employment, and long-term community support.

TBI core capacity included: a Statewide action plan, statewide needs assessments, a designated State agency staff, and a State advisory board for TBI systems development to improve services to individuals with TBI and their families. In treatment of traumatic brain injury, rapid, organized treatment is vital not only to saving the lives of victims, but also improving the quality of life for TBI survivors. In FY 2005, 51 States achieved a minimum TBI core capacity, exceeding the target of 48. In addition, funding was provided for all 57 State Protection and Advocacy (P&A) systems to evaluate State TBI P&A capacity and to ensure the continuation of P&A services, e.g., individual and family advocacy, self-advocacy training, self-advocacy assistance, information and referral services, and legal representation.

Through FY 2007, 48 States have received funding to implement “Implementation Partnership Grants”. These grants are designed to provide the states and territories with flexible resources that can be used in a variety of ways to promote systems and infrastructure development including the four core components (a designated State agency and staff, a statewide action plan, statewide needs and resource assessments, and a State Advisory Board). In FY 2007, six additional States were awarded in the grant category, Implementation Partnership grants (IPGs), which combined with the 42 grants awarded in FY 2006, brings the total number of States with IPGs to 48 which can focus on those special populations with high rates of TBI that have not necessarily received adequate attention in the past, including veterans, children and youth, incarcerated juveniles, those with substance abuse problems, as well as Native Americans and African Americans. The Federal program also continued support for a National Technical Assistance Center and completed an evaluation of the program in FY 2006, through a contract with the Institute of Medicine.

Section 1253 of the Public Health Service Act recognizes that State P&A systems are critical to achieving the goals and objectives of the TBI program. In FY 2003, grants were awarded to all 57 State P&A systems to evaluate State TBI P&A capacity and to develop plans to ensure P&A services, e.g., individual and family advocacy, self-advocacy training, specific self-advocacy assistance, information and referral services, and legal representation. These formula grants were continued to be awarded through FY 2008.

The TBI Act was a partnership of the Health Resources and Services Administration (HRSA), Centers for Disease Control (CDC), and National Institutes of Health (NIH). Collaboration also occurred with the Department of Education’s Office of Special Education and Rehabilitation Services, the Department of Veterans Affairs, and the Administration for Children and Families’ Administration on Developmental Disabilities.

In FY 2003, the TBI program was reviewed by OMB using the Program Assessment and Review Tool (PART). The program was rated as Results Not Demonstrated, primarily due to the absence of a long-term outcome measure, and an independent evaluation of the program. As a result of this review, the Agency contracted with the Institute of Medicine (IOM) to evaluate the HRSA TBI program. The IOM released the evaluation report in 2006. The program has also begun to develop a long-term health outcome measure.

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

Budget Request
The FY 2009 request continues the President's FY 2008 Budget request and provides no funding for this program. Activities previously funded under this authority may be addressed by the more flexible MCH Block grant.

See Table