Arkansas TBI Needs Assessment

Arkansas TBI Needs Assessment

for Individuals with a TBI and their Support System

You have been asked to complete this survey either because you are an individual with a traumatic brain injury (TBI) or provide some type support for an individual with a TBI. The information you provide will be used to assess strengths and weaknesses in the state’s responses to individuals with a TBI and to guide the planning for better coordination of services.

Use the <Tab> key to advance to the next question or next selection.
Do not use the <Enter> key as that will submit the survey, probably before you are ready.

The survey is anonymous – no identifying information will be associated with any response.

Deadline for submitting this survey is July 31, 2005.

Demographic Information

Q1. Who are you?

Individual with traumatic brain injury

Family member of individual with traumatic brain injury. Please identify your relationship

Non-family member. Please identify your relationship

If you checked family member or non-family member in Q1, please complete the following questions on the individual you know with a traumatic brain injury.

Q2. Sex:

Male

Female

Q3. What is your age? years

Q4. Race

African American

Caucasian

Hispanic

Asian

Other, Please identify

Q5. What is your highest level of education?

Non-high school graduate

High school graduate

Some college or vocational education

Completed undergraduate or vocational education

Post graduate education

Q6. Are you currently employed?

Yes

Q7. What is your living situation?

Live independently

Live with family member or friend

Live in supported setting with other individuals with TBI.

Q8. In what county of Arkansas do you live?

Injury Background

Q9. How did your injury occur?

Motor vehicle

Recreation, Please specify activity

Work, Please specify activity

Fall

Firearm

Other, Please specify

Q10. In what year did the injury occur?

Q11. What was your age at the time of the injury?

Q12. Were Intensive Care Unit (ICU) services received?

Yes for (length of time)

Q13. Were Acute Care services received?

Yes for (length of time)

Q14. Were inpatient rehabilitation services received at a hospital or a specialty center?

Yes for (length of time)

Q15. Were outpatient rehabilitation services received from a hospital or specialty center?

Yes for (length of time)

Q16. Which of the following services were received by the person with TBI? Check all that apply.

Supported housing

Employment

Personal care

Household care

Speech therapy

Occupational therapy

Physical therapy

Appropriate education

Nursing services

Recreational opportunities

Money management/financial counseling

Transportation

Mental health counseling

Substance abuse counseling

Family counseling

Respite care

Medical services

Access to information

Support groups

Service coordination

Other (please specify)

Q17. Which of the following services were needed by the person with TBI but were not obtained? Check all that apply.

Supported housing

Employment

Personal care

Household care

Speech therapy

Occupational therapy

Physical therapy

Appropriate education

Nursing services

Recreational opportunities

Money management/financial counseling

Transportation

Mental health counseling

Substance abuse counseling

Family counseling

Respite care

Medical services

Access to information

Support groups

Service coordination

Other (please specify)

Q18. What barriers were experienced in receiving essential services? Check all that apply.

Transportation

Inability to pay

Lack of insurance

Services not located locally

Difficulty understanding process or paperwork

Difficulty with English language

Lack of support/patient advocacy

Unaware of services and resources

Difficulty with enrollment/admissions

Other, please specify

Injury Resources

Q19. What do you believe are the most important issues experienced by individuals after a brain injury? Please rate each issue from 1 (critically important) to 5 (not important at all).

Q20. What do you believe are the top priorities for funding/resources? Please rate each issue from 1 (highest priority) to 5 (lowest priority).

Q21. What resources have you used from the Brain Injury Association of Arkansas? Check all that apply.

Peer support

Website (www.brainassociation.org)

Newsletter

Brochures

Meetings

Conference

Referral information

None

Q22. What resources have you used from the schools or other educational agencies? Check all that apply.

Website (http://arksped.k12.ar.us/

Brochures

Meeting with principals and/or teachers

Testing

Counseling

Referral information

None

Q23. What resources have you used from the Disability Rights Center? Check all that apply.

Website (www.arkdisabilityrights.org)

Brochures

Meeting with staff

Referral information

None

Q24. What has been the biggest obstacle(s) since the brain injury?

Q25. What has been the biggest help for you since the brain injury?

Q26. Are you aware of successful programs elsewhere that might be helpful to replicate in Arkansas?

Yes, Please specify

Q27. Please provide suggestions that will improve services for Individuals with TBI and/or their families?

Please add any other comments you wish to make in the area below:

Thank you for taking time to complete this survey. Your responses will be very helpful in planning for the needs for persons with TBI and their families in Arkansas.

Please click the [Submit] button below when you are ready to submit your survey.
Your survey will be sent to Beverly Miller.

Beverly Miller may be contacted at:

Beverly Miller

Center for Health Promotion

Dept. of Pediatrics, UAMS

800 Marshal Street

Issue	Critically Important 1	2	Somewhat Important 3	4	Not Important at all 5
Medical Issues/Medications
Personal Relationships
Fulfilling Vocation/Employment
Memory/Cognition
Attention/Focusing Skills
Anger Management
Recreation Options
Housing Issues
Transportation Issues
Feelings of Isolation
Financial Issues
Public Awareness of TBI
School/Educational Issues
Family stress/needs

Activity	Highest Priority 1	2	Medium Priority 3	4	Lowest Priority 5
Peer support for individuals with TBI
Peer support for family members
Medical care resources
Mental health resources for individuals with TBI
Mental health resources for family members of individuals with TBI
Community education events
Community resource guides
Research into improving medical outcomes
Research into improving social outcomes
Research into improving vocational outcomes
Research into improving cognitive and/or educational outcomes
Developing resources in language other than English
Outpatient care
Education opportunities
Public Awareness of TBI
TBI education for health providers
TBI education for teachers/educational system