Background: The challenges involved in caring for individuals with brain injuries, particularly those with complex neurobehavioural challenges, has been a topic of international concern. Survivors of brain injury encounter many barriers in accessing care, including funding for services, coexisting diagnoses and limited self-advocacy. Persistent neurobehavioural issues further compromise individuals’ capacities to engage in professional, social and educational activities. Further, providers encounter barriers that necessitate interagency training and education regarding risk assessment, psychosocial adjustment symptoms and biomechanical causes of psychiatric symptoms.

Methods: This presentation addresses these concerns by reporting the findings of a priority, mixed methods research initiative. In order to examine this complex problem systemically and empirically, the research team conducted a comprehensive review of the literature to formulate an integrated understanding of neurobehavioural issues, evaluated best practices within and external to the state and employed a mixed methods investigation that evaluated influential factors (e.g. the political landscape), attended to regulatory guidelines (e.g. funding, legal), inventoried model systems of care within USA, surveyed care providers to assess statewide needs and conducted interviews to expand upon survey findings.

Results: Based on comprehensive findings from this investigation, approaches to improving access are grounded in change that emphasizes a continuum of care reliant upon interagency collaboration. To address an unmet need for community-based and intensive neurobehavioural services, it is necessary to coordinate an integrative system of care that addresses three primary areas on the continuum: (1) prevention, education and screening/identification; (2) crisis stabilization in a 24-hour, secured unit; and (3) provision of short- and long-term residential and community-based supports. As the data suggest, each component of the system should be considered when developing or expanding services. For instance, it is unreasonable to implement a 24- hour security unit for high-need cases without also considering the role of education and prevention, transitional and supportive living and crisis stabilization. Supported by the Commonwealth Neurotrauma Initiative (CNI) Trust fund with oversight by the Department for Aging and Rehabilitative Services (DARS), the findings of this research will have guided public policy in the Commonwealth of Virginia to enhance the continuum of community-based and residential-based services for individuals with neurobehavioural issues.

Conclusions: This presentation further discusses and provides updates on the work group that is currently exploring opportunities for enhancing and expanding services through a statefunded pilot programme, a Medicaid waiver or both. This interagency effort, which culminated in a decision-brief submitted to governmental decision-makers, combines the resources of numerous state agencies, to guide our next steps to address neurobehavioural care. These findings, though specific to Virginia, provide insights for other states and nations facing similar challenges.