Tbi Ppr

Traumatic Brain Injury (TBI) State Partnership Program

0066 TBI_PPR_Revisions Cover Sheet

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Administration for Community Living (ACL)
Traumatic Brain Injury State Partnership Grants
Performance Progress Reporting (PPR)
Cover Sheet
1. ACL Grant Award #:
2. Grantee State:
3. Grantee Name:
4. Date for Total Project Period:
5. Reporting Period:
February 1, 2023-July 31, 2023
August 1, 2023 – January 31, 2024
February 1, 2024 – July 31, 2024
August 1, 2024 – January 31, 2025
February 1, 2025 – July 31, 2025
August 1, 2025 – January 31, 2026
February 1, 2026 – July 31, 2026

6. Date of Report Submission:
7. ACL Project Officer:
Note: This cover page will need to be completed only for a paper submission, which is not expected to
occur- all of this information is available from administrative data in the online submission.
1

ACL Traumatic Brain Injury State Partnership Grants
Performance Progress Reporting (PPR) TABLE OF CONTENTS
A.

Grant Activities (all grantees respond) ................................................................................................. 3

Partnership Activities (all grantees respond) ........................................................................................ 6

Planning and Infrastructure (all grantees respond) .............................................................................. 8

Information and Referral and Assistance (I&R/A) (if applicable to grant activities) .......................... 11

Screenings (if applicable to grant activities) ....................................................................................... 13

Resource Facilitation (all grantees respond) ...................................................................................... 15

Trainings, Outreach and Awareness (if applicable to grant activities) ............................................... 17

Other (if applicable to grant activities) ............................................................................................... 21

Narrative Responses (all grantees respond) ....................................................................................... 22

NOTE TO REVIEWERS: The Performance Progress Reporting (PPR) will be programmed into an online
reporting system. Some guidance and instructions are presented in this document. More detailed
guidance is provided in the PPR Guidance Document. For future submissions of the PPR in the online
reporting system, some of the responses will be prepopulated from previous reports. Grantees will be
able to edit or delete the information previously entered, as applicable.
PURPOSE AND GENERAL INSTRUCTIONS: ACL designed this report to provide opportunities for
Traumatic Brain Injury State Partnership Program grantees to submit information about the activities
they carry out using program funds. ACL will use these data to measure the aggregate performance of all
grantees. ACL’s primary purpose for requesting this information is to understand how grantees use TBI
State Partnership Program funds and the impact it has across all participating states. Please review the
PPR Guidance Document prior to and as you complete the PPR, as guidance/instructions are provided on
how to respond to each question.
The questions included in this report are questions ACL would like all grantees to be able to answer in
the future, to the extent they are applicable to grantees’ work. However, ACL understands that grantees
have different reporting capacities. We encourage grantees to report as comprehensively as they can
and use the notes fields to describe the data they report as needed so ACL can interpret it correctly.
Grantees should focus on reporting activities funded with program funds only. Program funds are
defined as those funds awarded to the grantee by ACL plus any funds or other resources (e.g., facilities,
staff time) used as the required match for the grant award. Grantees should not report activities that
program funds do not support – even if they are related to other program-funded activities. If a mixture
of program funds and funds from other sources are used to carry out an activity, grantees should report
on that activity in the most appropriate way they can. For example, if program funds and other funds
are blended together and the people being reached with these funds include a mix of people with TBI
and others, grantees may report about these activities in different ways. Noted below are two scenarios:
2

Scenario 1: One grantee may be able to access data from all funded partners and report the total
number of people with a TBI reached or served with program funds.
Scenario 2: Another grantee may only have data about the total number of people served including
people with TBI and others, by one funded partner only, and cannot distinguish between those
reached with program funds and those reached with other funds.
Both grantees should report the data they have about the people reached and use the notes field to
describe the parameters and limitations of their data as appropriate.

A. Grant Activities (all grantees respond)
1. Which activities did you carry out as part of your ACL project using program funds during this
reporting period? (Check all that apply)
[To relieve burden, the responses will be prepopulated in the online reporting system for future
reporting periods but can be edited as needed.]
Partnership Activities - identifying and reaching out to new partners, coordinating and
aligning activities, information exchange, collaboration on grant activities, collaboration on
activities related to the grant
b.
Planning and Infrastructure - state planning, policy and procedures development, state
councils, needs assessment, surveillance, registry, IT systems
c.
Information and Referral and Assistance (I&R/A) - bringing people and services
together, answering questions from individuals and families about human service
resources, helping people get connected to public benefits, sharing information about
available services like home care and adaptive equipment. Note: I&R/A is about bringing
people and services together. Individuals may reach out once or many times, but I&R/A
typically does not involve ongoing engagement of individuals like Resource Facilitation. For
I&R/A there is not typically a “case” established and the support in considered a one-anddone interaction; though as previously noted, individuals may make use of the support
more than once. If the description provided here does not align with how your program
defines this activity, please provide your definition here:
a.

Screenings - using a standardized procedure, structured interview, or tool to elicit
the lifetime history of TBI for an individual. Screening can be used for clinical, research,
programmatic, eligibility determination, service delivery or treatment purposes. If the
description provided here does not align with how your program defines this activity,
please provide your definition here:

Resource Facilitation – this category of activity could include development of
resources such as databases, resource directories, and communications tools to improve
service delivery. It could also mean providing assistance through an accessible, holistic,
and person-centered process that engages individuals in decision making about their
options, preferences, values, and financial resources and helps connect them with
programming, services and supports they choose. In some states this may be called service
3

coordination, service navigation, case management, options counseling, or personcentered counseling. Resource facilitation could be of short term or long-term duration. If
the description provided here does not align with how your program defines this activity,
please provide your definition here:
f.

g.
h.
i.

Trainings, Outreach and Awareness - continuing education for professionals who may
work with or provide services for people who have experienced a TBI, training for
individuals who have experienced a TBI, public education and awareness, training for
caregivers, on-the-job training for agency staff, cross-training with partnering agencies. If
the description provided here does not align with how your program defines this activity,
please provide your definition here:
Other 1 (Describe):
Other 2 (Describe):
Other 3 (Describe):

2. Did you target some or all your grant activities to support people in a particular setting or
population during this reporting period?
a.
Yes (Go to Q3)
b.
No (Go to Q4)
3. Please select the populations or settings that were targeted by your grant activities during this
reporting period. (Check all that apply)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.

Athletes
Children and youth (younger than 22)
Adults (22-59)
Older adults (60 or over)
People who are homeless
People who are hospitalized
People who are incarcerated or formerly incarcerated
Medicaid home and community-based services patients
Native Americans
Other ethnic, racial, or linguistic minorities
Residents of nursing facilities, rehab facilities or ICFs-MR
Rural populations
People who experience unhealthy substance use or a substance use disorder
Students
Veterans or current service members
People who are victims of crime, domestic violence, or intimate partner violence
Other 1 (describe):
Other 2 (describe):
Other 3 (describe):

4. Number and percent of your state’s counties (parishes or boroughs) targeted and reached
through your grant’s activities during this reporting period. The percent of counties targeted
and reached will be auto generated in the on-line reporting system.
[To relieve burden, the responses will be prepopulated in the on-line reporting system for future
reporting periods but can be edited as needed.]
Counties Questions

Number

Percent

a. Total number of counties in state
b. Number of counties targeted for this project
c. Number of counties reached this reporting
period

5. Did your project promote the use of evidence-based practices, interventions, or programs as
part of your grant activities during this reporting period?
a.
b.

Yes (Go to Q6)
No (Go to Q7)

6. What evidence-based practices, interventions, or programs did your project promote as part
of your grant activities during this reporting period? Please describe.

7. Is there anything else you would like to let ACL know about your grant activities during this
reporting period? This question is not mandatory.

B. Partnership Activities (all grantees respond)
8. Which organization in your state received funding through the ACL State Partnership Program to
carry out and/or support grant activities (primary awardee) in this reporting period?
[To relieve burden, the information for a and b will be prepopulated from previous reports
and/or based on existing information from Notice of Award. Grantees will be able to edit if it is
incorrect.]
a. Lead Grantee Agency Name:
b. Type of organization (Check all that apply):
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.

State Medicaid Agency
State Vocational Rehabilitation Agency,
State Department of Education
State Department of Criminal Justice/Corrections
State Unit on Aging
State Department for Developmental Disabilities
State Behavioral and/or Mental Health Agency
State Department of Public Health
Tribal Council
Other State Agency
University Center on Excellence for Developmental Disabilities
University
Other (describe)

9. Which types of organizations are program partners and support program activities and received
program funds (sub-awarded partners) during this reporting period? (Check all that apply)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.

q.
r.
s.
t.
u.
v.
w.

x.
y.

Community-Based Services Organization (e.g., CAA, ADRC, AAA, CIL)
Public Health Department or Clinic
Recovery or Substance Abuse Treatment Center
VA Medical Center
Other Health Care Provider
Private Business/Employer
Other 1 (describe):
Other 2 (describe):
Other 3 (describe):

10. Which types of organizations are program partners and support program activities but did not
receive program funds during this reporting period? (Check all that apply)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.

x.
y.

State Medicaid Agency
State Vocational Rehabilitation Agency
State Department of Education
State Department of Criminal Justice/Corrections
State Unit on Aging
State Department for Developmental Disabilities
State Behavioral and/or Mental Health Agency
State Department of Public Health
Tribal Council/Organization
Other State Agency
University Center on Excellence for Developmental Disabilities
University
State Independent Living Council
State I/DD Council
Affiliate of National Brain Injury Organization
County or Local Government Entity,
Community-Based Services Organization (e.g., CAA, ADRC, AAA, CIL)
Public Health Department or Clinic
Recovery or Substance Abuse Treatment Center
VA Medical Center
Other Health Care Provider
Private Business/Employer
Other 1 (describe):
Other 2 (describe):
Other 3 (describe):

11. Is there anything else you would like to let ACL know about your Partnership activities during this
reporting period? This question is not mandatory.

C. Planning and Infrastructure (all grantees respond)
12. Please identify the characteristics that apply to your advisory board/council: (Check all that
apply)
[To relieve burden, the responses to this question will be prepopulated for future reporting
periods but can be edited as needed.]
a.
It is designated by statute
b.
It was established by executive order or the governor
c.
Seats must be approved by governor or another executive authority
d.
It is located within the State’s Lead Agency
e.
It is located within the Executive Branch
f.
It is located within another State Branch
g.
It is an independent body
h.
It is appointed by the governor or lieutenant governor
i.
It is appointed by a commissioner or department head
j.
It is voluntary – people self-identify
k.
Requires the involvement of specific representatives (e.g., state agency)
l.
The size of the board is limited to certain number of slots
m.
Subcommittees are used to meet the people with TBI requirement
n.
Other 1 (describe):
o.
Other 2 (describe):
p.
Other 3 (describe):
13. What supports are provided to people with a TBI that are involved in your advisory
board/council? (Check all that apply)
a.
Stipends for participation
b.
Formal mentoring program
c.
Formal on-boarding/orientation process
d.
Virtual attendance of meetings allowed
e.
Promote use of plain language in meetings
f.
Meeting materials are shared in advance of meeting
g.
Meeting materials provided in accessible or alternative formats
h.
Reimbursement for travel expenses (i.e., mileage, tolls, etc.)
i.
Other 1 (describe):
j.
Other 2 (describe):
k.
Other 3 (describe):

14. How is the advisory board/council involved in the TBI SPP program? (Check all that that apply)
a.
Not directly involved with the TBI SPP program
b.
Provides oversight
c.
Needs assessment activities
d.
Setting priorities for the TBI State Plan
e.
Planning activities
f.
Collaboration and/or coordination activities
g.
Education activities
h.
Advocacy activities
i.
Prevention activities
j.
Medical and/or rehabilitation activities or concerns
k.
Engaged in peer mentoring or on-boarding of people with TBI
l.
Other 1 (describe):
m.
Other 2 (describe)
n.
Other 3 (describe)
15. a. Describe what it means for your advisory board/council to be representative (e.g., of your
state’s demographics, types of brain injury, severity of brain injury, etc.).

15.b. What efforts or actions are being taken to ensure that the advisory board/council is
representative?

16. Please list your advisory council members for this project period and place an ‘X” by their affiliations. Please use initials or some other
non-identifying method (e.g., AC #1) to identify the members. You may select all that apply if a person represents two or more affiliated
entities. The totals for each column will be auto calculated in the online reporting system.
Advisory
Council
Member
initials or
some other
nonidentifying
method

Person with
a TBI

Family
Member of
person with
a TBI

Center for
Independent
Living/State
Independent
Living Council
representative

Aging and
Disability
Resource
Center
representative

Protection &
Advocacy
agency
representative

Long-term
ombudsman
representative

TBI Model
Systems
representative

Affiliate or
National Brain
Injury Association
representative

State agency
representative

Other (describe
category and
not title)

Totals for
each column

17. What planning and infrastructure accomplishments or activities of the last six months do you
think have been or will be most impactful? Consider how you are working toward systems change
and what progress you are seeing.

18. Is there anything else you would like to let ACL know about your planning and infrastructure
activities during this reporting period? These activities may be related to the needs assessments,
state plans, evaluation, and registries. This question is not mandatory.

D. Information and Referral and Assistance (I&R/A) (if applicable to grant
activities)
19. a. How many I&R/A contacts occurred during this reporting period (across the grantee and all
funded partners providing grant-related I&R/A)? Please enter a number or select zero or unknown.
a. Number:
b.

Zero
Unknown

19.b. Notes about data provided: (e.g., unknown because none of our partners collect this
information, data are incomplete because only some of our partners collect this information.
Please describe.): This question is not mandatory.

20. What I&R/A services were people commonly referred to during this reporting period? (Check all
that apply)
a.
Grant-funded resource facilitation, service coordination
b.
Other type of resource facilitation, service coordination (provided by other
unfunded partners or other organizations such as an affiliate of national brain injury
organization, ADRC, CIL, other ABI association, or other organization)
c.
Older Americans Act services (e.g., nutrition services, LTC Ombudsman)
d.
Behavioral health services
e.
Brain injury support groups
f.
Caregiver supports
g.
Independent living services
h.
Domestic violence help services
i.
Employment counseling
j.
Educational counseling or school disability services
k.
Health insurance information or counseling (e.g., SHIP, Medicaid eligibility)
l.
General medical services
m.
Specialized TBI/ABI services
n.
Homeless services provider
o.
Housing supports
p.
Medicaid waiver services
q.
Physical, occupational, recreational or speech therapy
r.
Legal or advocacy services
s.
Transportation services
t.
Social Security
u.
Veteran’s hospital or clinic
v.
Vocational rehabilitation services
w.
In-home services and supports
x.
Other 1 (describe):
y.
Other 2 (describe):
z.
Other 3 (describe):

21. Is there anything else you would like to let ACL know about your I&R/A activities during this
reporting period? This question is not mandatory.

E. Screenings (if applicable to grant activities)
22. a. Please respond to the following questions about screening activities during this reporting
period. Please enter a number or select zero or unknown.
Screening Question

Number

Zero

Unknown

a. How many unduplicated people
were screened to identify their
likelihood of TBI during this
reporting period (by grantee and
across all funded partners
providing grant-related screening)?
b. Of the people screened for a TBI,
how many were positive?
c. Of the people who screened
positive for a TBI, how many were:
1. Under the age of 22
2. Between the ages of 22-59
3. Aged 60 or over
4. Veterans of any age
22b. Notes about data provided: (e.g., unknown because none of our partners collect this
information, data are incomplete because only some of our partners collect this information.
Please describe.) This question is not mandatory.

23. Select which standardized instruments you or your funded partners used for screening
procedures during this reporting period. (Check yes or no for each instrument)
Screening Instrument
a.

The Ohio State University Traumatic Brain
Injury Identification Method (OSU TBI-ID)

A modified version of the OSU TBI-ID

The Brain Injury Screening Questionnaire
(BISQ)

Defense and Veterans Brain Injury Center TBI
Screening Tool (DVBIC TBI), also called The
Brief Traumatic Brain Injury Screen (BTBIS)

HELPS

Military Acute Concussion Evaluation (MACE)

Automated Neuropsychological Assessment
Metrics (ANAM)

Brain Check Survey (BCS)

Traumatic Brain Injury Questionnaire (TBIQ)

Other 1 (describe)

Other 2 (describe)

Other 3 (describe)

Yes

24. Is there anything else you would like to let ACL know about your screening activities this
reporting period? This question is not mandatory.

F. Resource Facilitation (all grantees respond)
25. a. Please respond to the following questions about the resource facilitation activities during this
reporting period. Please enter a number or select zero or unknown.
Resource Facilitation Questions

Number

Zero

Unknown

a. How many unduplicated people with a
TBI were provided resource facilitation
during this reporting period (by grantee
and across all funded partners providing
grant-related resource facilitation)?
b.

Of the people with a TBI provided
resource facilitation, how many were:
1.

Under the age of 22

Between the ages of 22-59

Aged 60 or older

Veterans of any age

25.b. Notes about data provided: (e.g., unknown because none of our partners collect this
information, data are incomplete because only some of our partners collect this information.
Please describe.) This question is not mandatory.

26. What services were people with a TBI who were provided resource facilitation commonly
referred to during this reporting period? (Check all that apply)
a.
Grant-funded resource facilitation, service coordination
b.
Other type of resource facilitation, service coordination (provided by other
unfunded partners or other organizations such as a Brain Injury Alliance or Association,
ADRC, CIL, TBI association or other)
c.
Older Americans Act services (e.g., nutrition services, LTC Ombudsman)
d.
Behavioral health services
e.
Brain injury support groups
f.
Caregiver supports
g.
Independent living services
h.
Domestic violence help services
i.
Employment counseling
j.
Educational counseling or school disability services
k.
Health insurance information or counseling (e.g., SHIP, Medicaid eligibility)
l.
General medical services
m. Specialized TBI services
n.
Homeless services provider
o.
Housing supports
p.
Medicaid waiver services
q.
Physical, occupational, recreational or speech therapy
r.
Legal or advocacy services
s.
Transportation services
t.
Social Security
u.
Veteran’s hospital or clinic
v.
Vocational rehabilitation services
w.
In-home services and supports
x.
Other 1 (Describe):
y.
Other 2 (Describe):
z.
Other 3 (Describe):

27. Is there anything else you would like to let ACL know about your resource facilitation efforts
during this period? This question is not mandatory.

G. Trainings, Outreach and Awareness (if applicable to grant activities)
28. a. What types of trainings, outreach and/or awareness activities were provided with program funds during this reporting period? For
each activity identify the mode for providing the activity, types of people trained or reached, the topics covered in the activity, and the
number of people trained or reached by the activity. Additional rows can be added as needed in the online reporting system and paper
version.

a. Name of
training,
outreach, or
awareness
activity
(e.g., Annual
Brain Injury
Conference)

b. Mode for
providing
training,
outreach, or
awareness
activity
(select one
response)
a.
Inperson only
b.
Virtual
only
c.
Both inperson and
virtual

c. Types of people trained or reached
(select all that apply)

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.

TBI

Staff providing grant-related services
Clinical/medical providers
Coaches or other athletics personnel
Domestic violence services staff
Homeless services organization staff
Family, friends, informal caregivers
Individuals who have experienced a

In-home services and supports staff
Law enforcement personnel
Prison or criminal justice system staff
Protection and advocacy staff
Residential rehabilitation center staff
Nursing home staff
Universities, colleges, or school staff
(excluding school coaches)
o.
Veterans & military organization staff
p.
Other 1, specify:
q.
Other 2, specify:
r.
Other 3, specify

d. Topics covered in training, outreach, or awareness
activity (select all that apply)

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.

TBI Basics
Aging and TBI
Assistive technology
Athletics
Behavioral health & TBI
Caregiving
Children & TBI
Concussions & mild TBI
Criminal justice & TBI
Diagnosis
Educational issues
Employment and training of people with TBI
Identification/screening
Independent living
Substance use & TBI
Neurobehavioral aspects of TBI
Public policy
Person centered planning/counseling
Community-based services and support resources
Treatment & therapies
Other 1, specify:
Other 2, specify:
Other 3, specify:

e. Number of
people who
attended the
training or
reached (enter
number or
select
unknown)
Enter Number:
Unknown

a. Name of
training,
outreach, or
awareness
activity
(e.g., Annual
Brain Injury
Conference)

b. Mode for
providing
training,
outreach, or
awareness
activity
(select one
response)
a.
Inperson only
b.
Virtual
only
c.
Both inperson and
virtual

c. Types of people trained or reached
(select all that apply)

d. Topics covered in training, outreach, or awareness
activity (select all that apply)

a.
b.
c.
d.
e.
f.
g.

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.

h.
i.
j.
k.
l.
m.
n.

TBI

e. Number of
people who
attended the
training or
reached (enter
number or
select
unknown)
Enter Number:
Unknown

a. Name of
training,
outreach, or
awareness
activity
(e.g., Annual
Brain Injury
Conference)

b. Mode for
providing
training,
outreach, or
awareness
activity
(select one
response)
a.
Inperson only
b.
Virtual
only
c.
Both inperson and
virtual

c. Types of people trained or reached
(select all that apply)

d. Topics covered in training, outreach, or awareness
activity (select all that apply)

a.
b.
c.
d.
a.
b.
c.

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.

TBI
In-home services and supports staff
Law enforcement personnel
Prison or criminal justice system staff
Protection and advocacy staff
Residential rehabilitation center staff
Nursing home staff
Universities, colleges, or school staff
(excluding school coaches)
k.
Veterans & military organization staff
l.
Other 1, specify:
m.
Other 2, specify:
n.
Other 3, specify
d.
e.
f.
g.
h.
i.
j.

e. Number of
people who
attended the
training or
reached (enter
number or
select
unknown)

b. Notes about data provided: (e.g., unknown because none of our partners collect this
information, data are incomplete because only some of our partners collect this information.
Please describe.) This question is not mandatory.

29. Please list and describe any training materials, outreach materials, fact sheets or other products
you produced during this reporting period.

30. Is there anything else you would like to let ACL know about your training, outreach, and
awareness activities during this reporting period? This question is not mandatory.

H. Other (if applicable to grant activities)
[This section can be duplicated as needed]

31. Describe what activities you undertook in this area this reporting period.

32. a. Please respond to the following questions about your other activities that you undertook
during this reporting period. Please enter a number or select zero or unknown.

File Type	application/pdf
File Title	Administration for Community Living (ACL) Traumatic Brain Injury State Partnership Grants Performance Progress Reporting (PPR) C
Subject	Performance Progress Reporting (PPR) Cover Sheet
Author	ACL Traumatic Brain Injury State Partnership Grants
File Modified	2023-02-09
File Created	2022-09-12