Crisis Center
Centers of Excellence
Last Updated:
Centers of Excellence are places that serve a large number of individuals with a specific condition with an exceptional high quality of care. Facilities tend to have a specialty for which they are known and for which they offer a variety of support services surrounding that specialty. Centers of Excellence for brain injury often provide a broad scope of rehabilitation services including acute inpatient rehabilitation, day programs, outpatient therapy services and community transitional programs.
Brain Injury Centers of Excellence have a designated team of rehabilitation specialists including physicians, therapists and psychologists with extensive knowledge and practice in treating persons with brain injury. Programs with fewer resources tend to serve people with a variety of other conditions. As a result, all team members may not have expertise in brain injury. For example, orthopedic injuries (broken hips, legs) and degenerative neurological diseases (ALS, MS) require a set of specialized services very different from brain injury. Because of the physical, emotional and psychological challenges unique to brain injury, the gap between brain injury rehabilitation and other types of rehabilitation can be difficult to bridge. A rehabilitation program that treats only brain injury would tend to have doctors and therapists who have more in-depth experience in treatments specific to head trauma.
Comfort level is a powerful draw for those in crisis. The pull to be close to home or in a facility with which they are familiar may override considerations about the whether the facility can best provide the services needed. Unless finances are not an issue, it’s imperative that rehabilitation dollars be spend on the highest level of care possible. In most instances, funding sources will not pay twice for services that should have been initially provided or were not maximized because of equipment, staff, or program limitations.
One potential resource for identifying a Center of Excellence for brain injury is the TBI Model Systems program. This program is comprised of federally designated centers throughout the United States that conduct research and collect data related to the treatment and outcomes of individuals with traumatic brain injury (TBI). However, since the number of centers in the Model System is relatively small, not all Centers of Excellence for brain injury can be selected to participate in the Model Systems program.
Unfortunately, there is not a list of Centers of Excellence because no official designation exists. A facility becomes known as a “Center of Excellence” among medical professionals and the families it serves based on its reputation and the scope of services it provides. Referrals and observation of the outcomes of those who participate in the program are the most common ways of identifying quality programs. Among those considered Centers of Excellence in brain injury are The Shepherd Center (Atlanta, Georgia), Craig Hospital (Denver, Colorado), Kessler Medical Rehabilitation Research and Education Corporation (New Jersey, several locations), Charlotte Rehabilitation Institute (Charlotte, North Carolina) the University of Alabama (UAB Birmingham), Medical College of Virginia (Richmond, Virginia), The Institute for Rehabilitation and Research (TIRR – Texas), and Rehabilitation Institute of Chicago.
Your local brain injury association may provide good contacts for finding Centers of Excellence. Also the Brain Injury Association of America (BIAA) has a National Directory of programs by state. See www.biausa.org. Look up hospitals and programs in your area. Call the admissions coordinator, social worker, internal case manager or administration associated with that facility and ask the following questions:
- How many patients with brain injury do you treat each year?
- What is the average age of the patient in the brain injury program? Often programs treat primarily younger or older segments of the population.
- What is the scope of rehabilitation services available? Acute inpatient rehabilitation? Day Programs? Outpatient therapy services? Community transitional programs?
- Is the facility accredited by JCAHO (Joint Commission on Accreditation of Healthcare Organizations and/or by CARF (Commission on Accreditation of Rehabilitation Facilities)? Some post acute rehabilitation facilities are not eligible to be accredited under JCAHO because the scope of their services is not covered by JCAHO standards. Typically, it is the community-based program that serves as a transition between the medical and community model that falls into that category. These programs do not need and therefore do not offer certain medical services (such as labs and emergency care) that JCAHO accreditation requires. Facilities that are eligible for JCAHO should be accredited. Surveys for accreditation for both JCAHO and CARF are performed at the facilities every few years to maintain quality standards.
- What services does the program provide for transitioning back into home, school, work and the community after discharge?
The Brain Injury Association of America website (www.biausa.org) also has an excellent feature that families may find useful called “Guide to Selecting and Monitoring Rehabilitation Services” found under Rehabilitation and Treatment tab.
As with all medical decisions, information and education are keys to making the right choice for the person needing care and the family. In brain injury, finding a Center of Excellence is an important step towards securing the services needed for maximum recovery.
Brain Injury Association of America
National Institute on Disability and Rehabilitation Research
Model Systems
Center for Outcome Measurement in Brain Injury
Joint Accreditation of Healthcare Organizations
Commission on Accreditation of Rehabilitation Facilities
LuRae Ahrendt is a certified rehabilitation nurse and certified case manager. She provides catastrophic case management services and life care plans for children and adults with disabilities and chronic illnesses and has extensive experience in the development, coordination and implementation of plans of care for individuals with brain injuries. Ms. Ahrendt presents to numerous professional and disability support organization. She is a current board member and former board chairperson for the Brain Injury Resource Foundation.