Foreign entities are not eligible to compete for, or receive, awards made under this announcement.
A. Statement of Need / Purpose
According to the Centers for Disease Control and Prevention, about 1.5 million Americans sustain a traumatic brain injury (TBI) every year . An estimated 80,000-90,000 of these people experience long-term or permanent disability that impacts their daily living activities . The effects of TBI may occur immediately following an incident in which a person acquires a TBI or may develop months or even years after an injury is sustained. Depending on the severity, TBI may affect a person’s cognitive, physical, emotional, and/or behavioral capacities, which may impact an individual’s ability to attend and/or fully participate in various aspects of community living, including education and employment.
The complex nature of TBI coupled with the variability of symptoms take a toll on individuals with TBI across the lifespan, their families, their support networks, and society. COVID-19 has compounded the negative impacts for everyone living with a TBI in multiple ways and on many levels. Furthermore, when intersectionality is considered for multiply marginalized individuals, those impacts grow exponentially.
The purpose of the TBI State Partnership Program is to create and strengthen person-centered, culturally competent systems of services and supports that maximize the independence and overall health and well-being of people with TBI across the lifespan and the people who support them. As a result of the TBI State Partnership Program, AoD envisions individuals with TBI will experience:
Increased self-determination, independence, and quality of life
Highly streamlined, coordinated pathways to services and supports
Increased availability of high quality, person-centered, culturally competent, evidence-based services and supports
Person-centered, culturally competent services and supports with the capacity to serve and support diverse and underserved populations
B. Program History / Background
Congressional funding for traumatic brain injury programming dates back to the TBI Act of 1996 (PL 104-166). The current authorizing legislation, the Traumatic Brain Injury Program Reauthorization Act of 2018 (P.L 115-377; (42 U.S.C. 300d–52), raised the authorization levels for the TBI State Partnership Program and the TBI Protection and Advocacy program and officially designated ACL as the administering agency for both programs. The FY 2021 funding cycle provides one level of funding for states to create and strengthen person-centered systems of services and supports that maximize the independence and overall health and well-being of people with TBI across the lifespan and all other demographics and that also support their family members and support networks. The TBI State Partnership Program also requires grantees to work with one another collaboratively through interstate workgroups focused on specific issues related to providing the best services and supports for individuals with TBI.
C. Program Goals (Outcomes and Performance Measures)
The goals of this funding opportunity are:
To increase collaboration and coordination of state level activities across systems and supports and to ensure all people with TBI, including those from diverse and underserved populations, and other stakeholders are provided ample opportunity to contribute meaningfully to needs assessments and state plans that will drive improvement of TBI services and supports.
To allow for more comprehensive data collection that shows the level of need for various types of services and supports across systems and identify barriers to services and supports.
To create a greater understanding of state demographics, resources, and program impact among partners as well as the effectiveness of different services or supports.
To create a better coordinated public investment in effective, high-quality, equitable, evidence-based services and supports for all individuals with TBI, their families, and their support networks that results in fewer people with TBI encountering barriers to needed services and supports.
The TBI State Partnership Program has approved performance measures that all grantees are required to report on semi-annually. Performance measures can be found in Section I.D.7. of this funding announcement and include but are not limited to the following:
Planning and Infrastructure
Information and Referral and Assistance
Screenings (if applicable)
Trainings, Outreach, and Awareness
D. Required Activities
Applicants should respond to this funding announcement by submitting proposals that demonstrate the approach they will take, if funded, to create and strengthen a person-centered, culturally competent system of services and supports within their state that maximizes the independence and overall health and well-being of people with TBI across the lifespan, their families, and their support networks. Applicants should explain how they plan to implement the seven required activities listed here along with other activities they deem necessary to achieve the outcomes for people with TBI of
Increased self-determination, independence, and quality of life;
Highly streamlined, coordinated pathways to services and supports;
Increased availability of high quality, person-centered, culturally competent, evidence-based services and supports; and
Person-centered, culturally competent services and supports with the capacity to serve and support diverse and underserved populations.
1. State TBI Advisory Board
Per 42 U.S. Code § 300d–52, all recipients of this funding opportunity must agree “to establish an advisory board within the appropriate health department of the State or American Indian consortium or within another department as designated by the chief executive officer of the State or American Indian consortium.”
The state TBI advisory board provides the forum through which grantees assure a variety of diverse stakeholders participate in determining the needs of all individuals with TBI within the state. It also creates a structure for statewide cross-systems collaboration essential for the success of the project.
Applicants should describe how their program’s advisory board representation will be in accordance with 42 U.S.C, § 300d–52, which specifies “an Advisory Board shall be comprised of representatives of:
the corresponding State, Territory or American Indian consortium agencies involved;
public and nonprofit private health related organizations;
other disability advisory or planning groups within the State, Territory or American Indian consortium;
members of an organization or foundation representing individuals with traumatic brain injury in that State, Territory or region;
injury control programs at the State or local level if such programs exist; and
a substantial number of individuals with traumatic brain injury, or the family members of such individuals.”
Individuals with TBI and other disabilities, particularly those from culturally and linguistically diverse populations, have the right to be engaged in and lead the decision-making processes related to their services and supports. Applicants should describe how your state TBI advisory board meets the following membership requirements:
Includes at least 50% of people with TBI (including those from diverse and underserved populations)
Includes family member(s) of individuals with TBI
Includes representation from Centers for Independent Living and/or the State Independent Living Council
Includes representation from an Aging and Disability Resource Center (if one exists within your state)
Includes representation from the Protection & Advocacy agency in your state
Includes representation from the long-term care ombudsman in your state
Includes representation from a TBI Model System Center (funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR)) if one exists within your state
Is representative of the state and includes individuals from culturally and linguistically diverse populations from both rural and urban areas.
If your state TBI advisory board does not currently meet all these membership requirements, describe in your application your plan to bring it into compliance in a timely manner if you are funded. Not currently meeting these requirements will not disqualify you from receiving a grant award, but please note that ACL may take the following actions with regard to grantees who do not make significant progress toward meeting these requirements within the first 12-months of the grant (particularly the requirement that your state TBI advisory board is comprised of 50% people with a TBI):
More frequent (quarterly) reporting
Conversion from advanced to reimbursement payments
Loss of funds
2. TBI State Plan
Within the first 12 months of the grant, each grantee will develop a culturally competent state plan that will serve as a strategic plan for the TBI efforts in the state, including all efforts required under this program. The state plan will be a living document and help guide the state in determining how best to improve the services and supports for all people living with TBI in their state. ACL expects grantees to use the information in the state plan as a foundation for advancing their statewide systems of TBI services, including how they will target and deliver such services in a culturally competent manner and address known gaps in services. ACL will review each grantee's state plan to ensure it aligns with program goals.
Applicants for this program should outline a clear process for how they will develop the state plan in collaboration with the state TBI state advisory board. Applicants who are current/former grantees working under a previously developed state plan may outline how they will review and update their existing state plans. Applicants should describe how they will also involve individuals with TBI from outside the state TBI advisory board who represent underserved populations, including individuals from culturally and linguistically diverse backgrounds in the development and/or updating of the state plan. The process should make use of the results of a comprehensive review and analysis of the services, supports, and other assistance available to all people with TBI, as well as the extent of the unmet needs, especially with regard to unserved and underserved regions and culturally and linguistically diverse groups in the state. State plans will include goals for closing the gap of unmet or insufficiently met needs of children, youth, adults, and older persons with TBI from culturally and linguistically diverse backgrounds in the state along with objectives and activities for the grantees’ funded projects.
In addition to the above, applicants should indicate in their application which of the following goals they anticipate incorporating into their state plan:
Mitigating and overcoming the impact of the COVID-19 crisis
Working towards racial equity and addressing the impact of systemic racism
Supporting the economic recovery of communities and families
3. TBI Resource Facilitation
Individuals with TBI are often in need of individualized assistance to facilitate connection with community support services. Resource facilitation (RF) is an evidence-based, personalized intervention that promotes access between individuals with TBI and their support networks and the appropriate community-based resources, supports, and services. Applicants should describe how their TBI State Partnership Program will establish and/or increase capacity in a statewide resource facilitation service that assists all Individuals with TBI, their family members, and their support networks with education and information to effectively identify and navigate the resources, services, and supports within their state and/or communities.
4. TBI Grantee Workgroups
TBI State Partnership Program workgroups are collaborative teams of grantees that focus on individual topics and issues that affect people with TBI. Applicants should indicate in their applications the top three or four topics on which they are most interested in working. Applicants should also indicate if they have any additional areas of interest and/or expertise that are not listed here. Applicants should also describe how they will support full engagement in the workgroups.
Active workgroups and their current projects are described below. These particular projects may be continued into the new grant cycle, or the workgroups may choose other projects that fit within the context and topic area of the workgroup.
Advisory Board & Survivor Engagement: This workgroup focuses on developing and maintaining effective advisory boards as well as best practices for engaging people with TBI. Workgroup members collaborate on a tool kit that addresses all aspects of advisory board development, management, and engagement
Using Data to Connect People to Services: This workgroup supports state efforts in using data to expand access to services for individuals living with brain injury, their families, and their support networks by developing and sharing tools and best practices.
Return to Learn & Return to Play: This workgroup identifies and shares best practices across states with regard to students' transition back to school after sustaining a brain injury.
Criminal & Juvenile Justice: This workgroup focuses on information sharing among states with interest in brain injury identification and implementation of supports in a variety of criminal and juvenile justice settings.
Opioid Use & Mental Health Needs: This workgroup identifies and shares best practices across states with regard to addressing the intersections between substance use-related disorders, mental health, and brain injuries.
Sustainable Partnerships: This workgroup focuses on product development related to creating and sustaining partners; technical assistance for workgroup members and others; identifying opportunities for partnerships; addressing challenging prospective partners; sustainability planning; and working with advisory board members.
Transition & Employment: This workgroup focuses on describing the core knowledge, skills, and abilities (competencies) direct service professionals should possess to help individuals with brain injury achieve and sustain successful employment.
Underserved Populations: This workgroup identifies and shares best practices across states with regard to underserved populations accessing appropriate resources after sustaining a brain injury. Underserved populations include rural/ frontier communities, victims of violence, those struggling with substance use disorder, unhoused, and those affected by co‑occurring disorders.
Waivers & Trust Funds: This workgroup focuses on identification of needs and products that would help further the work of states interested in Medicaid Home and Community-Based Services (HCBS) waiver programs and trust fund programs.
Workforce Training & Development: This workgroup focuses on establishing a nation-wide culturally competent professional development training infrastructure for TBI service professionals.
5. Program Sustainability Plan
ACL expects to realize tangible, measurable, and sustainable advancements in the capacity of states to serve people with TBI, their families, and their support networks in a culturally competent manner through this funding opportunity. Applicants should outline a plan for project sustainability beyond the period of federal funding that is reasonable and feasible. AoD encourages applicants to consider and propose a range of potential approaches for ensuring sustainability of project efforts once federal funding has ended.
6. Grantee Meetings
Grantees will participate in two national or regional TBI-related conferences convened by ACL or ACL partners annually. These events provide grantees the opportunity to learn from each other, to share educational resources and promising practices, and to expand partnerships across states. Applications should include a budget that provides funding for at least two individuals to participate in two meetings annually.
7. Data Collection and Performance Reporting
Applicants should describe the process they will use for collecting data that shows the impact of grant activities, including in the following areas represented by the approved program performance measures:
Increased capacity to provide access to comprehensive and coordinated services for individuals with TBI and their families
The strengthening of a system of services and supports that maximizes the independence and overall health and well-being of all people with TBI across the lifespan and supports their family members and support networks
Improved national coordination and collaboration around TBI services and supports
The establishment of innovative community living programs with respect to TBI
Improved access to health, community living, employment, and other services for individuals with TBI and their families
Identifying gaps in existing systems of services and supports and potential solutions for filling those gaps
Data collection and how to utilize collected data to fulfill the intended purpose of the TBI State Partnership Program
In addition to providing statewide data, grantees will work with ACL, the TBI Technical Assistance and Resource Center, and other state or federal partners as appropriate to submit common data elements that will be used to generate indices, products, technical assistance, and services that will be useful to TBI stakeholders.
E. Optional Activities
Applicants should describe how they will use remaining funds for other activities that strengthen the system of services and supports that maximizes the independence and overall health and well-being of persons with TBI across the lifespan. Examples of some of these allowable activities are listed below. This list is illustrative and not exhaustive:
Hosting trainings for service professionals in the state who are working with people with TBI
Providing training for people with TBI on areas of interest such as employment, advocacy, independent living skills, peer support, TBI self-management, health promotion, or cross disability systems change
Screening people for TBI
Providing information and referral services
Establishing/supporting statewide TBI registries as well as reporting procedures of incidents of TBI
Establishing/enhancing a TBI Home and Community-Based Services (HCBS) waiver within the state
Establishing/enhancing a TBI trust fund in the state
Performing a needs and resources assessment for specific subpopulations of people with TBI
Hosting or presenting at conferences
Establishing/enhancing a peer or family mentorship program or support groups
Person-centered planning: A process for selecting and organizing the services and supports that an older adult or person with a disability may need to live in the community.
Diversity: The practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different genders, sexual orientations, etc.
Resource facilitation: A process that involves identifying, navigating, and obtaining needed resources, services, and supports for individuals with TBI, their families, and their support networks. Resource Facilitation begins with assessing an individual's needs and providing on-going support to meet those needs. Depending on the availability of resources, resource facilitation may also include advocating for and accessing services and supports, routine follow-up, and/or reassessment to determine additional needs or efficacy of existing services and supports. 
Intersectionality: Intersectionality is an analytical framework that describes how individual characteristics like race, class, gender identity, disability, sexual preference, and socioeconomic status, and their relationship to privilege and oppression, intersect to have a compounded impact on the individual. 
 https://www.cdc.gov/traumaticbraininjury/pubs/tbi_report_to_congress.ht… #:~:text=Traumatic%20brain%20injury%20(TBI)%20is,people%20are%20hospitalized%20and%20survive.
 Vos, P., & Diaz-Arrastia, R. (2015). Traumatic brain injury. John Wiley & Sons Inc.
 Adapted from NORC resource facilitation state survey, 2009
 Crenshaw, Kimberlé (1989) "Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics," University of Chicago Legal Forum: Vol. 1989 , Article 8.