BSCIP: ITI

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Background

Florida is the only state in the nation to develop a statewide comprehensive system of care and services to address traumatic brain and spinal cord injuries. There are three types of facilities utilized by the Brain and Spinal Cord Injury Program in Florida. They are Designated Transitional Living, Rehabilitation and Acute Care Facilities.

BSCIP utilized the expertise of leading experts in the field of program development standards and developed criteria for acute training centers, inpatient and outpatient hospitals and transitional facilities. These have been strategically located throughout the State.

Each facility meets the Brain and Spinal Cord injury program standards as well as the highest of national certifications. Facilities are reviewed every three years by a team of medical and rehabilitation experts.

• For tips on selecting the appropriate facility, click here.

First Responders are required to obtain continuing education in evaluation, diagnosis and stabilization of the patient at the accident scene. In addition, all first responders are instructed to transport the patient to the nearest trauma center or designated acute care center. Each facility has an established protocol to treat patients with traumatic brain or spinal cord injuries. All Florida hospitals are required by Florida statute (F.S. 318) to report all patients who have sustained a brain or spinal cord injury to the Central registry immediately upon identification.

What is a Transitional Living Facility?

Transitional Living Facilities (TLF's) are sites where service is provided in a residential setting, it is time limited and goal oriented to improve the person's physical, cognitive, communicative, behavioral, psychological, and social functioning under the necessary support and supervision. TLF's provide specialized health care services, including but not limited to, rehabilitative services, community re-entry training, aids for independent living and counseling to individuals with spinal cord injuries.

Florida currently has four (4) state-approved (TLF's) that provide a supported living environment for individuals to develop skills and competence which will eventually allow them to live independently. In Florida, a Transitional Living Facility must be licensed by the Agency for Health Care Administration and must also be accredited by the Commission on Accreditation of Rehabilitation Facilities in Community Living Programs for persons with spinal cord injuries.

Transitional Living Facilities Objectives (State Plan of SCI Care):

A. To establish and maintain Transitional Living Facilities in an appropriate number of locations to address the needs of individuals who sustain spinal cord injuries.

B. To ensure that individuals are provided appropriate services, which will assist them in reaching their maximum level of functioning in the community.

C. To assist clients in obtaining skills necessary to function independently in the community.

D. To provide services in the least restrictive environment in a safe and supportive setting.

E. These services will be provided in a cost effective and timely manner.

What are Designated Rehabilitation Facilities?

Rehabilitation refers to those events and processes occurring after injury and progressing to ultimate stabilization and maximum possible recovery. This complex care is provided in a rehabilitation facility capable of managing recent injury, comprehensive medical, social, psychological and developmental complications. Services available include: medical/physical restoration, physical and occupational therapy, specialized nursing, family services, recreational therapy, psychological counseling and education of both patient and family, in addition to vocational re-education or school reintegration. Early intervention by a comprehensive rehabilitation center has been documented to result in more independence earlier for a patient with spinal cord injury and fewer complications at a considerable saving both economically and emotionally.

Florida has twenty-one (21) rehabilitation centers that have met the standards and criteria necessary to become a Department of HEALTH, Brain and Spinal Cord Injury Program designated treatment facility. The following key standards must be met in order to be recognized as a state-designated SCI Rehabilitation facility:

The Commission on Accreditation of Rehabilitation Facilities (CARF) shall accredit the licensed rehabilitation center in Comprehensive Rehabilitation and in the area of Spinal Cord Injury. A minimum of 40 new spinal cord injury admissions is required annually to maintain viable inpatient rehabilitation Spinal Cord Injury Center. Up to 25% of these admissions may include non-traumatic paralysis patients. All facilities must be subscribers of the Uniform Data System (UDS) / Functional Independent Measure (FIM) data collection system and sign an agreement to provide aggregate data to the Brain and Spinal Cord Injury Program.

Rehabilitation Objectives (State Plan of Care):

A. Individuals with spinal cord injuries will have available the highest quality inpatient rehabilitation program possible.

B. Individuals with spinal cord injuries will be rehabilitated to optimal independence within the context of an inpatient rehabilitation program.

C. Develop a system of adult and pediatric inpatient rehabilitation centers with expertise in providing optimal comprehensive care for persons with spinal cord injury and their families.

D. Provide a continuum of care by developing an efficient referral pattern between system components with appropriate documentation of services.

E. Individuals with spinal cord injuries will be rehabilitated to optimal independence within the context of an inpatient rehabilitation program.

What are Acute Care Facilities and How They Operate?

Acute care is defined as the time period beginning with the arrival of a new patient with a spinal cord injury/brain injury in an emergency department or acute center until discharge from acute hospitalization. Research has shown that the first few hours after trauma are the most critical in terms of preserving and possibly restoring neurological function. The need for treating persons with spinal cord/Brain injuries in centers that can provide the necessary personnel, therapy and equipment in the most prompt and comprehensive manner is paramount.

There are (10) ten Acute Care Hospitals that have met the standards and criteria necessary to become a Department of Health, Spinal Cord Injury Program designated facility. Designated facilities are required to maintain the highest level of expertise and experience to address the medical, rehabilitation, and psychosocial needs of individuals who sustain traumatic spinal cord injuries. These regional facilities are strategically located throughout the state to ensure accessibility and volume of new admissions. The

Joint Commission on Accreditation of Healthcare Organizations (JACHO) must approve designated acute care hospitals. In addition, a designated center is required to treat a minimum of 24 new patients with spinal cord injury in a 24-month period and meet the reporting requirements of the Central Registry. To ensure individuals are provided the highest quality services, funding from the Brain and Spinal Cord Injury Program (BSCIP) is restricted to BSCIP designated facilities and approved vendors.

Acute Care Objectives (State Plan of SCI Care):

A. To design and maintain a statewide system for acute care of new patients with spinal cord injuries.

B. To establish criteria for designation of centers capable of delivering optimal care to patients who sustain acute spinal cord injury

C. To provide an optimal continuum of care through coordination among pre-hospital emergency medical services, hospital emergency departments, and rehabilitation centers.

D. To increase prompt recognition and initiation of proper emergency medical techniques through information and education including public education on safety and prevention.

E. To provide continuing education for EMT's, paramedics, and emergency department staff and coordinate this information and training with the multi-disciplinary teams of rehabilitation centers, transitional living facilities and home based programs.

Please refer to the BSCIP Locations page for locations of Transitional, Rehabilitation and Acute Care Facilities near you.