prevail over prejudice in their decision concerning the election that is coming up for. the preside the president. >> we're going to break in. take you live now to capitol

hill. we have a hearing under way looking at the treatment and impact of traumatic brain injuries. live coverage now on c-span3. >> or 80% of treated and released from the emergency room. 275,000 are hospitalized. 52,000 will die. tbi effects everyone. it's not restricted to one race, gender or socioeconomic group. while children age 4 and under and adults over the age of 75 are particularly at risk, brain injury affects soldiers, athletes, and even members of congress like our former colleague gabby giffords. the annual cost of tbi is estimated at $48 billion. dollars alone do not paint a complete picture of the

injuries. it does take into account the suffering of a person of a brain injury who may be disabled for life or the strain of a loved one's tbi places on family members who are so often the caregivers. federal efforts to address tbi began with the act in 1996. the act aimed to identify an increased awareness of tbi through new research and programs. the tbi amendments of 2001 amended the 1996 law by extending the authorization to include the implementation of a national trauma brain injury education and awareness campaign. the traumatic brain injury act of 2008 reauthorized the program and also authorized a study to examine the information gathered by hhs, assess appropriate interventions and develop practice guidelines. i look forward to the results of this study which will come out

in november of this year. the 2008 act also focused on the incidents and prevalence of tbi, uniform reporting, and linking individuals with tbi to support services and academic institutions to conduct research. i would like to hear an assessment from each of our witnesses of these federal programs. what have we learned about the causes, the diagnosis, the treatment of tbi through the efforts. how is that knowledge being applied in real world situations? i would also like to hear their ideas about where we should go from here. i would like to say a special hello to dr. flaura winston from the children's hospital in philadelphia. a wonderful institution that has served many of my constituents. i would also like to welcome those with us today who have tbi as well as their families and care givers who make enormous

sacrifices every day. we're glad that you're all here. i yield the balance of my time to the chairman. >> thank you for the recognition. today's hearing is of vital importance as the center for disease control estimates that over 1.5 million people sustain a traumatic brain injury annually and over 52,000 of them do not survive. of those that do survive, 11,000 are children. this makes pediatric acquired brain injury the number one cause of death and disability for children. there exists for vital therapeutic option for patients and all interventions are designed to prevent secondary injury. in order to successfully treat traumatic brain injury, researchers look to improve the quality of life for those affected. although there are numerous research projects under way

across the country including the university of texas and north texas brain injury model system, tbi center, a centralized research approach that avoids duplication is lacking. a report released this january including coordinating authority for psychological health for traumatic brain injury activities emphasized the need for coordination of care and services in traumatic brain injury in patients in the department of defense. they have been conducting their research and there was no central location to obtain accurate and timely information on traumatic brain injury and they had to use a variety of resources to obtain their data. i believe we will not better coordinate services if we don't get a grasp and this hearing is designed to do that on funding of projects that are meant to address traumatic brain injury. hr-2600 would lead centers like

the country's leading center for pediatric brain injury, to continue benefiting individuals with system and care. the money will be allocated from the fund on hand to advance our knowledge of the brain over the next several years. i'll yield back my time. >> your opening statement. >> thank you, mr. chairman. today this committee will have the opportunity to hear from some of the leading experts in the traumatic brain injury community about update on the current landscape of traumatic brain injury prevention, research and treatment. as we know traumatic brain injuries are serious effects from disease as that can have devastating outcomes. wi today i look forward to an informative hearing that takes the perspective on this critical

issue. according to cdc, 1.7 million are subjected to a traumatic brain injury each year. furthermore, traumatic brain injuries account for one-third of all injury related deaths. these statistics are only part of the story as currently it's unclear how many young people are misdiagnosed or don't receive treatment after a traumatic brain injury. traumatic brain injury affects many in our population. they plague our young people and the elderly, some of the most vulnerable members of our society. traumatic brain injuries have a profound impact on our military and the sports community and in addition i would be remiss as my chairman said if i didn't mention how a member of our own body, gabrielle giffords, was also the victim of a traumatic brain injury in carrying out her duties. the overwhelming majority of people that suffer a traumatic brain injury do not die from their injury.

however, that also means that these patients are at risk of developing long-term complication that can develop from a mild traumatic brain injury. patients can suffer from cognitive impairment like memory loss, impaired communication skills, mental illness, epilepsy and are even at risk of developing parkinson's disease or alzheimer's disease. these complications create devastating disability and injure a person's productivity and a financial burden to families and society as a whole. ensuring these patients have access to innovative and vital treatments and critical services is a great challenge that we must all work together to achieve. since passage of the traumatic brain injury of 1996 and subsequent reorganization, several federal agencies have led efforts to understand, prevent and treat traumatic brain injuries. they have undergone federal coordination through the federal inter agency committee on traumatic brain injury.

this committee will hopefully center and coordinate development in traumatic brain injuries initiatives and i look forward to hearing about their proposes plans and activities. i would like to highlight the importance of addressing this important cause. i appreciate the presence of william ditto. the recently retired director of the brain injury program in new jersey. mr. ditto, along with his colleagues, have made great strides in leveraging their limited funds to coordinate and provide services for individuals with traumatic brain injury. strengthening partnerships like these will improve outcome of the families and patients affected by traumatic brain injury. i look forward to today's testimony. mr. chairman, i would like to ask as i think you know my colleague from new jersey has

been a leader on this whole issue and i know he's not a member of the committee, but he asked if i would by unanimous consent to include his statement for the record. >> no objection. >> i look forward to the testimony and appreciate the fact that you held this hearing today. thank you. >> chair manthanks the gentlema. mr. upton, five minutes for opening statement. >> thank you, mr. chairman. at least 1.7 million folks sustain a traumatic brain injury every year. we don't have to look very far to see the profound effects of a pa major tbi. with efforts being undertaken at the department of veterans affairs and department of defense and several agencies at

the department of hhs. it is incumbent us on to examine these activities to work in a coordinated and efficient manner. i proudly serve on the brain injury task force and encourage bipartisan support for tbi research and rehabilitation and with that support i am confident that the committee will make greater strides to help patients living with the aftermath of tbi. i want to extend a warm welcome to the families attending today's hearing as part of brain injury awareness month and i look forward to your testimony. i yield back to the chairman. >> the chair thanks the gentleman. we have four witnesses on our panel. dr. bonnie strickland, director of division services for children with special health care needs, u.s. department of health and human services. mr. william ditto, director of the new jersey tbi division, new jersey department of health. dr. flaura winston, children's

hospital of philadelphia and dr. mark ashley, president centre for neuro skills. we ask that you summarize your opening statements in five minutes and dr. stickland, you're recognized at this time for five minutes to make your opening statement. >> chairman, members of the subcommittee, thank you for the opportunity to testify today on the department of health and human services traumatic brain injury program. i'm dr. bonnie strickland, director of the division of services for children with special health care needs at the health resources and services administration department of health and human services. our colleagues appreciate your interest in our work and welcomes this opportunity to discuss our tbi program with you and to provide some highlights of other hhs activities. congress is charged us with implementing a grant program to

improve access to rehabilitation and other services. the responsibility in the areas of research and the cdc has responsibility for prevention and surveillance. also activities are conducted through authorities provided under the public health services. the tbi program consists of two distinct grant programs. partnership grants and protection and advocacy grants. state department grant partnerers nepartner es need assessment. with these tools states have made progress in accessing to tbi screenings and support through screenings and coordination. there are specialized legally based services to help recipients understand laws for self-advocacy. training and self-advocacy ensures that individuals can get

service. the primary responsibility for tbi research. the breast of research reflects complexity that is presented. nih support study for develop of diagnostics and therapy and corri clinical trials. they lead a broad range of research related to tbi rehabilitation, falls in disorderly and disabilities that offer occur with tbi. they are response for surveillance. they implement evidence based tbi educational material and clinical guidelines, informed evidence based policy through activities like the heads-up initiative and educates departments on shaken baby syndrome. cdc works with national experts to produce the field triage

guidelines for the injured patient which provides uniform standard for emergency medical service providers and first responders to ensure that patients with tbi are taken to hospital best suited to address their particular injury. the focus is on behavioral health aspect of tbi. they have partnership with va and d.o.d. with an understandig of the military culture, service members experience and post-trauma effects. additionally, they have developed training materials for behavioral health providers who encounter veterans or service members with tbi. in 2012, the first meeting on traumatic brain injury and ordered information to facilitate collaboration and minimize duplication across

agencies. they plan to create an online clearing house of federal resources. the current representatives are the departments of defense, administration and veteran affairs and social security administration and the agency for health care research and quality, the indian health service, cdc, nih. our agencies complement each other's work. there may be a high incident of tbi in a particular group in a state. they may then use cdc material and conduct statewide education campaign for students, parents and schools about the risk and consequences of tbi. likewise, they may utilize screening protocol by nih research to implement a student athlete tbi screening program. in addition to education and screening, they would connect students and families with needed resources.

strategies like these allow grantees to leverage resources of other agencies to identify and serve children with sustaining tbi. opportunities for such collaboration is a key focus of the inner agency committee. they will have assess bl and appropriate services and support and nih are making strides in areas of research and surveillance and behavioral health working to ensure that efforts are complementary and strategy e strategic levering of resources. this completes my prepared remarks. thank you for the opportunity to testify today and provide an overview of our program. >> we recognize mr. ditto for five minutes for your opening statement. >> thank you very much. chairman and ranking member from

new jersey, just to clear things up. i am the retired director of the division of disability services in the new jersey department of human services. since i've been given a variety of interesting previous titles when i was introduced. i'm really here today not so much in that role but more in my role as chair of public policy committee for the national association of safe head injury administrators. we are the only nonprofit organization that represents state government agencies and services who are involved in the provision of short and long-term rehabilitation and community services for individuals with tbi and their families. i'm pleased to give you an opportunity to understand where state government stands with regard to serving these individuals. the big item here that i want to emphasize is that no two

individuals with tbi are the same. and neither are any two states the same with regard to the extent that they are able to address these needs. the one thing that is the common thread throughout this country is that brain injury is in fact the leading cause of disability. not only in the state of new jersey but all across the country. i think this is not been recognized and not been recognized well. if you go out on the street and ask folks what's the most significant disability, you'll get mental retardation, cerebral palsy, autism. all sorts of different things. in fact it is head injury and it's such a disability because it cradles and affects people of all age categories and as a result individuals with this type of disability have to interface with a lot of different governmental programs over their time as a survivor of brain injury and as someone on

the panel has already -- someone on the committee already mentioned, individuals with brain injuries are in fact surviving and they are thriving to the extent that they can get services that they need. in the early '80s, families began advocating for states to provide rehabilitation and other services and there are so many different needs for people with brain injuries, there really are no two individuals with brain injuries who are just the same. we also have the mild, moderate and severe classification of brain injury, which makes it in my experience a little less clear cut. in many other forms of disability, we can quite clearly state what the extent of the disability is through clinical observation and medical evaluation. this is not true with brain injury. not only that, there was for a long time a feeling that people with brain injury could only achieve a certain plateau.

a certain level and nothing would happen after that. research has proven that individuals even ten years post-brain injury can make significant improvements when given the right services. about 20 states administer medicaid and home programs for individuals with disabilities that are intended to provide for services in lieu of more extensive institutional or long-term care. what our big concern at this point is the systems need to be coordinated and available to people of all ages. we have found from the cdc who has moved brain injury up to the top of its list of concerns when it was not always at the top of this list, we have found from them that the leading cause right now is falls. falls to individuals over the age of 75 and i think we're all familiar with the baby boomers and where we're headed with that.

i myself am one of them. in addition to that, children under 4. look at that age spectrum we have of people suffering from brain injuries as throughout the progre progression of life. it's not the stroke victim or returning service member, it's a large number of people. individuals with brain injuries and their families are specifically looking to states for help and support. we would propose in terms of the federal grant program that the grants are shifted away from pure term projects to allow states to expand initiatives. we would ask that states are given additional flexibility to use funds for case management and other services. that states can target their grant requests on populations which they identify as underserved and that the program move from a competitive grant program to a formula funded

approach contingent upon the availability of federal funds to allow each state to receive a predictable amount of funding. right now the program is competitive in nature. i believe 21 states are receiving grants. the rest of the states are not receiving grants. they are relying totally on their own resources to be able to do that. so just as states are required to coordinate and maximize state and federal programs and resources, the federal agency task force is supported to promote federal coordination of all resources. we look forward to that time when stake holders, the brain injury association of america, the national disability rights network and individual tbis and their families to provide input as we develop a national plan and priority for tbi. thank you. >> chair thanks the gentleman and recognizes dr. winston for

five minutes for an opening statement. >> good afternoon. thank you, chairman, for calling this hearing and inviting e ini testify. i'm encouraged to see the increase in attention. my name is dr. flaura winston. i serve at children's hospital philadelphia as well as professor of pediatrics at the university of pennsylvania. in addition to being a doctor, i'm a board certified practicing pediatrician and public health researcher. the children's hospital of philadelphia is the nation's largest pediatric health care network and home to one of the largest pediatric research programs in the u.s. i am humbled by the commitment and skill the hospital brings to pediatric injury, much of which is enabled by investment from

the federal government. i came to care about tbi early in my training when i would hear trauma transport helicopter, i felt a sense of dread for the family whose lives would be changed by their child's tbi. every day more than 125 of our nation's children are hospitalized or die from tbi. car crashes, sports, falls and child abuse are the likely causes largely preventible events at great cost to families and society. annually estimated tbi costs are more than $29 billion for children who die and $53 billion for those who are hospitalized. therefore, as a nation, i propose that our primary success metric should be annual reductions in pediatric traumatic brain injury. to reduce tbi burden, i propose three priority areas. one, prevention. two, timely state of the art acute care and three, optimal

recovery. i hope to demonstrate the importance of research in its translation, professional training and coordinated efforts. together we can address child tbi so that our children and grandchildren can reach their full potential. the good news is that we know how to avoid tbi. protect the brain from blows. prevention is the best medicine. if you get your grandson into a car seat or daughter's sport league to adopt safe play, you can reduce the chance of tbi. unfortunately many safety strategies were designed for adults and not for children. let me demonstrate how we can do better. we found that cars designed to save adults could injury a child. research supported efforts by government and industry to improve air bag design, policies and education and now child air

bag deaths are rare. dramatic steps like this require strong science and collaboration. the national science foundation have provided us with opportunities to work with partners to protect our children's brain in a world designed for adults. research founded by nih, cdc and d.o.t. told us another important lesson. when it comes to tbi, child age affects the brain's response to impacts and recovery. for example, we now know that infants with severe tbi have the worst prognosis. we know when compared to adults, older children with milder tbi recover more slowly, with more physical, emotional and cognitive challenges. federal funded biomechanics and other foundational research is teaching us why. sadly, given the limits of current prevention efforts, tbi will continue. our next level of defense is

timely and proficient acute care. over the past decade, the cdc and many others have raised awareness about early recognition response to tbi. children with severe tbi require highly specialized aggressive care in the hours after impact. children with more mild tbi require cognitive and physical rest within the first 48 hours. federal investments in basic and translational research are leading to improve strategies for those on the front lines and i suggest taking this to the next step by including industry in our partnership. unfortunately, the reality is that there are limits to current prevention and treatment. this is why recovery is our third line of defense. one of the 15 children who suffers tbi today could have been your child or mine and they now face the long road ahead to recovery. we need to be empowered with the

best tools to restore vital cognitive function and help our loved ones recover fully. funding enables innovative partnerships between schools and clinicians. these need to continue. i want to close by looking forward. recently i was selected as a hero by local elementary schoolchildren because i work to save lives. they too want to save lives. but i worry that their dreams may be stunted. we need to shore up necessary training and funding opportunities that young people need to become investigators, inventors, innovators and clinicians in pediatric injuries. mr. chairman, ranking member and members of the subcommittee, as policy numbers please know that i am grateful for your role in helping to save lives. i thank you for inviting me to