of the world and it's because the men and women who serve this country. so thank you very much. with that, i ask unanimous consent that all members have five legislative days to extend remarks and include any extraneous materials. without objection, so ordered. thank you again to all of our witnesses in today's hearing and our audience members for joining in today's conversation. the hearing is now adjourned. the supreme court today issued a number of decisions in several cases though it did not announce the ruling on the president's health care law. that decision is expected thursday, which is the court's last day in this term. today the court struck down arizona's illegal immigration

law. justices are allowing one part of that to go forward. the requirement that police check the status of someone they suspect is in the country illegally. in another ruling today the justices overturned a montana law limiting corporate campaign spending. coming up live on c-span 2, bank president fred hocberg, releasing the bank's annual report on u.s. competitiveness. and it looks like a busy week ahead in congress. the house convenes tomorrow to consider spending for agriculture, transportation, and housing programs and also a vote on holding eric holder in contempt of congress. republicans want the attorney general to turn over more documents related to the fast and furious gun tracking operation. live coverage on c-span. in the senate, lawmakers gavel in at 2:00 eastern with two bills on the agenda. the flood insurance program and

user fees that the fda collects. you can watch that on c-span 2. there's a july 1st deadline hanging over congress. without action student loan rates will double on the first of july. money runs out for the nation's highway and mass transit programs. this is c-span 3 with politics and public affairs programming throughout the week and every weekend 48 hours of people and events telling the american story on american history tv. get our schedules and see past programs on our websites. you can join in on the conversation on social media sites. according to the centers for disease control, 1.7 million americans suffer a traumatic brain injury every year and 50,000 die from those injuries. a subcommittee held a hearing on the issue and whether more resources should be devoted to research and treatment.

joe pits chaired the hearing. >> subcommittee will come to order. the chair recognizes himself for five minutes for an opening statement. as many of you know, march is brain injury awareness month. according to the cdc an estimated 1.7 million people sustained a traumatic brain injury each year and of that figure, 1.365 million or 80% are treated and released from the emergency room. 275,000 are hospitalized and 52,000 will die. tbi affects everyone. it is 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, but dollars alone do not paint a complete picture of the scope of these injuries. it does not take into account the suffering of a person with a brain injury who may be disabled for life or the strain of a loved one's -- loved ones that tbi places on family members who are so often the caregivers. federal efforts to address tbi began with the traumatic brain injury act of 1996. the act aimed to identify and increase awareness of tbi through new research and programs. the tbi amendments of 2001

amended the 1996 law by extending to include for the brain injury education and awareness campaign, it reauthorized the program to conduct a study to examine the information gathered by hhs and 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 prevelance of tbi, jump reporting and linking individuals with tb ito support services 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 hhs' efforts? how is that knowledge being applied in real world situations?

and 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. flora winston from the children's hospital in philadelphia. it's a wonderful instutituion that has served many of my constituents and i would also like to welcome those with us today who have tbi as well as their families and caregivers who make enormous sacrifices every day and we're glad that you're all here. i yield the balance of my time to the vice chairman, dr. bergess. >> today's hearing is of vital importance that the center of disease control confirm that over 52,000 of them do not survive. of those that do survive 11,000 are children. this makes pediatric brain injury the leading cause of death and injury to children.

there exists no viable therapeutic option for patients and all of the interventions are designed to prevent progression of the injury or secondary injury. in order to successfully treat traumatic brain injuries you must equip health care professionals and researchers with the resources needed to improve outcomes and 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 and the tbi center and the centralized, and coordinated approach is lacking and the government accountability office report released this january entitled coordinating authority needed for psychological health and traumatic brain injury activities that emphasized the need for coordination of care and coordination of services and traumatic brain injury in patients for the department of defense. they know in conducting their research there was no central

location to obtain information and they had to use a variety of resources in order to obtain their data. i believe we will not achieve our goals to better coordinate research and support services, if we don't get a grasp and this hearing is designed to do that on funding and projects that are meant to address traumatic brain injury. hr-2600 would lead state centers like the center for brain health at the university of brain center for texas at dallas and the country's lead category for pediatric-required brain injury to continue benefiting individuals with systems of care. additionally, the money will be allocated from the discretionary funds and will be on hand to advance our knowledge of the brain over the next several years.

thank you, mr. chairman for the recognition and i yield back the remainder of the time. >> i yield back for 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 an update on the current landscape of traumatic research and treatment. as we all know traumatic brain injuries are a spectrum of diseases that can have devastating outcomes. when i was chairman of the subcommittee we held a field hearing regarding pediatric concussions in new jersey and it takes a broader perspective on this critical issue. according to the cdc, over 1.7 million people are subjected to a traumatic brain injury each year. they account for one-third of all injury-related deaths. these statistics it is unclear how many people are misdiagnosed or don't receive treatment after a traumatic brain injury. it also affects many sectors of our population. these injuries continue to plague primarily our young people and the elderly, some of the most vulnerable members of our society. traumatic brain injuries also

have a profound impact on the community and the sports injury. i would be remiss as my chairman said how a member of our own body gabby giffords was a victim of a brain injury while of a brain injury while performing her congressional duties. we must prioritize this issue in the prevention and research efforts. it is my understanding that the overwhelming majority of people that suffer a traumatic brain injury do not die from their injury, however, that also means these patients are at risk of developing long-term complications that can develop from a mild traumatic brain injury. they can suffer from memory lost, impaired communication skills and mental illness, epilepsy and at risk of developing parkinson's disease or alzheimer's disease. this can create devastating disability and hinder an individual's productivity and they create a burden to families and society as a whole.

ensuring that they have innovative and vital treatments is a great challenge that we must all work together to achieve. since the passage of the traumatic brain injury act of 1996 and subsequent reauthorization, several federal agencies have led efforts to understand, prevent and treat traumatic brain injury. most recently these efforts have undergone formal coordination from the brain injury. this committee which includes hhs agencies and non-hhs agencies will hopefully accelerate and coordinate developments in traumatic brain injury initiatives. i look forward to hearing more about the proposed plans and activities. i would also like to highlight the importance of federal partnerships with addressing this important cause. i greatly appreciate the presence of mr. william ditto who hails from the great state of new jersey. mr. ditto is a recently retired director of the brain injury program and also represents the national association of head injury administrators. mr. ditto along with his

colleagues have made great strides in limiting the federal and state funds to coordinate and provide services for individuals with traumatic brain injury. strengthening partnerships like these will improve the outcomes of the families and patients affected by traumatic brain injury. i look forward to today's testimony. mr. chairman, i'd like to ask, as i think you know, congressman bill pascrell, has been a leader on this whole issue and i know he's not a member of the committee but he asked if i could by unanimous consent to include his statement into the record? >> without object. so ordered. >> thank you, mr. chairman, i look forward to your testimony and i appreciate the fact that you held this hearing today. thank you. >> chair thanks the gentleman and i now recognize mr. upton for five minutes for opening statement. >> thank you, mr. chairman. according to a recent report from the cdc, 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 the tbi. children injured by care takers or car accidents, and athletes by multiple concussions and soldiers disabled from war and one of our colleagues wounded at a constituent event in arizona last year. with efforts being undertaken at the department of veterans affairs and the department of defense and several agencies at the department of hhs it is incumbent upon us to examine these activities so that they can work in a coordinated and efficient manner and i proudly serve on the congressional brain injury task force that encourage bipartisan support for tbi research and rehabilitation and with that support i am confident that the committee will make even greater strides to help patients living with the aftermaths of tbi. so i want to extend a warm welcome to the families 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. today we have four witnesses on our panel. dr. bonnie strickland, director of divisional services for children with special health care needs at u.s. department of human services. mr. william ditto, director of the new jersey tbi division. new jersey board of health. dr. flora winston, children's hospital, philadelphia, and dr. mark ashley president of the center for neuroskills. your written testimony will be made part of the record and we ask that you summarize your opening statements in five minutes and dr. strickland, you are recognized at this time for five minutes to summarize and make your opening statement. >> chairman pitts, ranking member palome, and members of

the subcommittee, thank you for the opportunity to testify on the traumatic brain injury programs. i am dr. bonnie strickland, director of the division of services for the maternal and child health bureau at the health resources, department of health and human services. hrsa and hhs colleagues, and we welcome the opportunity to discuss the program with you and to provide some highlights of other hhs activities. congress has charged hrsa with implementing a grant program your american indian consortia to improve access to rehabilitation and other services. the nih has responsibilities in the areas of research and the cdc has responsibility for prevention and surveillance. samsa also conducts activities provided under the health service act. hrsa consists of two consist grant programs and protection and advocacy grants. state partnership grantees are required to have or develop a state-wide needs and resource assessment and a comprehensive statewide action plan. with these tools, states have made remarkable progress in

increasing access to tbi services and supports through tbi screening programs, training health professionals and service coordination. hrsa's protection and advocacy programs provide specialized legally-based services to help recipients understand laws and training in self-advocacy ensures that individuals with tbi and their families can pursue needed services even if outside representation is unavailable. nih has primary responsibility for tbi research. the breadth of nih research reflects the complexity of the problems that tbi presents both immediately and in the aftermath of the injury. for example, nih supports studies of the mechanisms of damage and the development of diagnostics and therapies and clinical trials and research on brain plasticity and recovery. nih leads a broad range of research related to tbi rehabilitation, falls of the elderly and disorders that often

co-occur such as post-traumatic stress disorder. cdc is responsible for prevention and surveillance. it implements educational materials and clinical guidelines, informs evidence-based policies through activities such as the head's up initiative and educates health departments on shaken baby syndrome. they have the field triage guidelines which provides uniform stand arts for emergency medical service providers and first responders to ensure that patients with tbi are taken to hospitals best suited to address their particular injuries. samhsa focuses on the tbi. samhsa provides services that reflect an understanding of military culture, service members' experiences and the range of potential post-trauma effects. this is primarily accomplished through samhsa's service member,

veterans and their family's policy academies. additionally, samhsa has training materials for behavioral health providers who encounter veterans or service members with tbi. in 2011, hrsa convened the first meeting on traumatic brain injury in order to share information, facilitate collaboration and minimize duplication across agencies. to facilitate this purpose the committee plans to create a centralized online clearing house of federal resources. the current representatives on the committee are the departments of defense, education and veterans affairs and the social security administration and within hhs, the indian health service, cdc, nih, samhsa and hrsa. cdc's surveillance may identify a high incidence of tbi in child athletes in a particular state and they may develop educational materials to address the issue.

hrsa's state grantee might use the material to conduct a statewide education campaign for students, parents and schools about the risks and consequences of tbi. likewise, hrsa's grantee might utilize a screening protocol that was informed by nih research to implement a student athlete tbi screening program. in addition to education and screening, hrsa would connect students and families with needed resources. strategies like these allow hrsa state grantees to leverage resources of other agencies to identify and serve children with risk of sustaining a tbi. opportunities for such a collaboration is the key focus of the inner agency committee. hrsa is committed to ensuring that individuals with tbi and their families have accessible and appropriate services and support nih, cdc and samhsa are making strides in the respective areas of research, prevention and behavioral health. we're working together to ensure that our efforts are

complimentary and strategic leveraging of resources to address the full spectrum of needs of individuals and families impacted by tbi. mr. chairman, this completes my prepared remarks. once again, thank you for the opportunity to testify today and provide an overview of our tbi program. >> the chair thanks the gentle lady and recognizes mr. ditto for five minutes. >> thank you very much, chairman pitts and ranking member palome 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 titles when i was introduced, but i am really here today not so much in that role, but more in my role as the chair of the public policy committee for the national association of state head injury administrators, better known as nasha, we are the only non-profit organization that represents state government

agencies and services who are involved in the provision of community services for individuals with tbi and their family, and i am 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 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, and i think this has not been recognized and not been recognized well, and if you go out on the street and ask folks what's the most significant disability, you get mental retardation, cerebral

palsy, autism and all sorts of different things, but it is, in fact, head injury and head injury is such a disability because it's cradle to grave. it affects people in 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 has 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 clearcut and 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, but there was for a long time a feeling with people with brain injury can only achieve a certain plateau, a certain level and nothing would happen after that. research has proven that individuals, even ten years post-brain injuries can make significant improvements when given the right services. about 20 states administer medicade home and community-based services programs for individuals with disabilities that are intended to provide for service in lieu of a more expensive institutional or long-term care. what our big concern at this point is that the systems need to be coordinated and they need to be 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 in individuals over the age of 75, and i think we're all familiar with the baby boomers and, you know, where we're headed with that, myself am one of them and then in addition to that it's in children under four. so look at the age spectrum of the people suffering from brain injuries throughout the progression of life. it's not just the typical younger adult male, crash victim or the returning service member. it's really a large number of people. and 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 hrsa/tbi grants program that the grants be shifted to maintain and expand initiatives. upon we would ask that states are given additional flexibility to use funds and other services that states can target their grant requests for populations which they identify as underserved and that the grant move to a formula-funded approach contingent upon the ability 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 and they're 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, nasha supports the federal inter-agency task force

that hrsa has created to promote federal coordination of all resources. we look forward that time where the task force will invite stake holders such as the rights network as well as individuals and 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 upton, chairman pitts, vice chair burgess, ranking member palome and distinguished members of the subcommittee for calling this hearing and inviting me to testify. i am encouraged to see the increased focus on child traumatic brain injury, or tbi, along with emphasis on prevention. i serve as scientific director for the center of injury research and prevention at the children's hospital philadelphia or chop as well as professor of pediatrics at the university of

pennsylvania. in addition to being a doctor trained in bioengineer, i am a pediatrician and public health researcher. it is the largest pediatric health care network and home to one of the largest 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 investments from the federal government. i came to care about tbi early in my training. when i would hear the trauma transport helicopter i felt a sense of dread for the family whose life 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 preventable events, a great cause to families or to 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 injuries to reduce the 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 and its translation, professional training and coordinated efforts. together, we can address child tbi so that our children and our grandchildren can reach their full potential. the good news is that we know how to avoid tbi, protect the brain from blows and jolts. prevention is the best medicine. if you get your grandson into a car seat or your daughter's sports league to adopt safe play, you can reduce the chance of tbi.

unfortunately, many safety strategies were designed for adults, not for children. let me demonstrate how we can do better. at c.h.o.p. we found that early air bags in cars designed to save adults could fatally injure a child. our research supported efforts by government and industry to improve air bag design, policies and education. and now child air bag deaths are rare. dramatic successes like these require strong science and collaboration. the national science foundation has provided us with opportunities to work with partners to protect our children's brains in a world designed for adults. research funded by nih, cdc, hrsa, and dod, when it comes to tbi child age affects the brain's response to impact and recovery. for example, we now know that infants with severe tbi have the worst prognosis.