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Clinicians describe gaps in specialty brain‑injury care, long‑term follow‑up and mental‑health integration
Summary
Penn State clinicians and fellowship directors said Pennsylvania lacks consistent specialty coverage, that many patients face barriers from emergency discharge to long‑term follow‑up, and that mental‑health and substance‑use care needs adaptation for brain‑injury patients.
Dr. Theru Anaswamy, professor and chair of physical medicine and rehabilitation at Penn State Health, and Dr. Lori Grafton, assistant clinical professor and co‑director of the Brain Injury Fellowship, told the House Human Services Committee that specialty brain‑injury care in Pennsylvania is limited and unevenly distributed.
"We treat brain injury patients across the continuum," Anaswamy said, describing care from emergency consultations to inpatient acute rehabilitation and lifelong outpatient follow‑up. He said only about 31 accredited brain‑injury medicine fellowships exist nationwide and four are in Pennsylvania, which constrains the supply of specialists.
Clinicians described a common pattern: patients discharged from emergency departments are often referred back to primary care and may experience delays before accessing specialty evaluation, therapy or neuropsychology. ‘‘There are many factors. It’s not just about the injury...it depends on their insurance coverage. It depends on their family support,’’ Grafton said. The physicians urged clearer clinical pathways so emergency and primary care clinicians can identify when to refer for specialty assessment.
Both doctors highlighted gaps in behavioral and mental‑health care tailored to cognitive impairment. Grafton said many standard substance‑use and behavioral‑health programs do not work well for people with memory and executive‑function deficits and called for adapted therapies and additional training for community providers.
The Penn State clinicians also described practical barriers inside correctional settings: when patients move from hospitals into jail custody, access to stimulants and certain therapies can be limited, and the availability of therapies inside correctional facilities is uncertain.
They proposed several system responses: better education for emergency and primary care clinicians about referral triggers, expansion of fellowship and training slots, stronger neuropsychology and adapted behavioral‑health capacity in community settings, and pilot programs (the clinicians mentioned a Sunflower Program pilot to flag hidden disabilities) to improve interactions in health‑care and other settings.
Ending: Clinicians said improving clinical pathways, expanding specialized training and adapting mental‑health and substance‑use treatment for people with cognitive deficits are priorities for improving outcomes.
