In September 2013, the Arkansas Department of Health (ADH) developed a new procedure for funding injury and violence prevention (IVP) initiatives. It involves giving the Trauma Regional Advisory Councils (TRACs) $20,000 each to be spent as they see fit on evidence-based IVP interventions that are approved by the ADH IVP Section.
Question: Does this mean that trauma centers and emergency medical services (EMS) providers can no longer spend any money from trauma system funding for things related to IVP?
Answer: No. The ADH IVP Section’s vision is that our state emphasize evidence-based interventions that address our leading causes of injury morbidity and mortality. This is what the above-mentioned $20,000 sub-grants are designed to do and procedures have been implemented to allow this to occur. Many discussions have taken place with our partners and stakeholders and everyone strongly endorses this concept. These discussions have also led to the realization that IVP awareness and building community support for IVP initiatives are important features in a comprehensive IVP program.
The question therefore arises that if the $20,000 sub-grants are to be used for focused, evidence-based interventions, how will IVP awareness and other IVP initiatives be funded? This question was brought to the Finance Subcommittee of the Governor’s Trauma Advisory Council on September 3, 2013. Part of the discussion revolved around the Subcommittee’s previous findings that the trauma funding for hospitals and EMS providers be used for trauma and not for IVP. This was one of the reasons that the $20,000 IVP-specific sub-grants were set aside for the TRACs. The ADH IVP Section recommended that a small amount of the trauma funding that goes to hospitals and EMS providers be set aside for IVP awareness and other IVP initiatives. The Finance Subcommittee agreed and tasked the ADH IVP Section to provide guidance in a “Frequently Asked Questions (FAQ)” document that addresses this issue.
As a result of the above, this FAQ was developed. In short, each Level I and II trauma center that receives trauma funding may expend up to $2,000 per year from this funding on IVP awareness and other IVP initiatives. Each Level III and IV center and each EMS provider may similarly expend up to $1,000 per year. Per standards set forth in the Rules and Regulations for Trauma Systems, all trauma centers (Levels I-IV) are required to engage in IVP activities (Sections III. C. and VII. G.). Therefore, in addition to the amounts set forth above in this paragraph, each trauma center that has an employee (full or partial FTE) performing injury prevention work may pay for their salary (for that time devoted to injury prevention) from trauma funding. To be clear, trauma centers and EMS providers may expend the above amounts from trauma funding for IVP purposes but are not required to do so.
This allowance will be retroactive to the beginning of each entity’s FY 2014 grant period (most begin on July 1 but some begin later). Prior approval is not required. As long as the expenditure reasonably relates to IVP activities, invoices submitted to the ADH IVP Section will be paid. It is noted that this is a change to wording in the FY 2014 trauma sub-grants to both hospitals and EMS providers that states trauma funding may not be used for injury prevention initiatives. Questions concerning the above should be directed to Teresa Belew, IVP Section Chief, at (501) 671-1563.
Date of answer: October 4, 2013
Under the current Rules and Regulations for Trauma Systems, Level I-IV trauma centers are required to engage in injury prevention activities (Sections III. C. and VII. G.)
Question: During site surveys, what will reviewers consider adequate participation in order to fulfill this requirement?
Answer: Other than stating it “could be a collaborative effort by multiple hospitals or the region”, and that the prevention activities relate to “in the home and industry, and on the highway and athletic fields”, there is little or no guidance on this issue provided in the Rules. It is impossible to cover every scenario, so it will come down to a common sense approach as to what would be considered meaningful participation in injury prevention activities. For instance, attendance at one TRAC IVP Subcommittee meeting during the review period at which an intervention is discussed would most likely not be viewed as adequate participation. However, consistent (and possibly even intermittent) attendance with actual trauma center resources (personnel, equipment, etc.) being devoted to evidence-based interventions selected by the TRAC would almost certainly be acceptable. Use of the limited trauma funds for IVP activities as discussed in #1 above would also enter into the picture, but participation in a TRAC-sponsored effort approved by the ADH IVP Section is where the focus should be.
Date of answer: October 4, 2013