According to the Oregon Health Authority, nearly 35,000 Oregonians visited emergency rooms in 2023 with brain injuries. These injuries can result in a range of symptoms, from confusion and short-term memory loss to depression, anger issues and lack of impulse control. Depending on the severity of the injury, survivors may need access to resources such as employment and housing assistance in addition to medical and mental health services.
Oregon launched a program last year to help brain injury survivors access those services. A team of trained navigators is available at 833-685-0848 to help people understand and connect with resources in their community.
Nakeshia Knight-Coyle is the director of ODHS’s Office of Aging and People with Disabilities. Claire Madhavan is a navigator for the Oregon Brain Injury program. They both join us to talk about how the program is going.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. According to the Oregon Health Authority, nearly 35,000 Oregonians visited emergency rooms in 2023 with brain injuries. These injuries can lead to a range of symptoms, from confusion and short-term memory loss to depression, anger and lack of impulse control. Depending on the severity of the injury, survivors may need access to resources like employment and housing assistance in addition to medical and mental health services.
Starting last year, Oregonians who suffer from these injuries now have access to more targeted help. The Oregon Brain Injury Program launched in 2025 to connect TBI survivors with resources in their communities. Claire Madhavan is a navigator for the program. Dr. Nakeshia Knight-Coyle is a director of the state’s Office of Aging and People with Disabilities, which oversees the program. They both join me now. It’s great to have both of you on Think Out Loud.
Nakeshia Knight-Coyle: Thank you.
Claire Madhavan: Thank you, Dave.
Miller: Dr. Knight-Coyle, first – how big of a problem is brain injury in Oregon?
Knight-Coyle: It’s a big problem and it’s a growing problem. In 2023, there were about 45,000 people with brain injuries in Oregon, and roughly 17,000 people in Oregon sustained a brain injury each year. This means that the total number of people living with brain injuries in Oregon is growing fast. And our population is also aging. This also contributes to an increase in brain injuries, as one of the most common causes of a brain injury is a fall, and older adults are at a higher risk of falls.
Miller: What are some of the other common reasons for brain injuries?
Knight-Coyle: Accidents, as you were teeing up at the beginning of this, accidental injuries. There are any number of reasons and situations that can result in an individual experiencing a brain injury.
Miller: Claire Madhavan, what drew you to work for this program, to work specifically with and for people who have brain injuries?
Madhavan: I was drawn to this program through my graduate school internships at the University of Oregon, where I worked one on one with community members, including veterans with various types and severities of brain injuries. I’ve always been motivated by public service and supporting people who need it the most.
Miller: Was there something in particular about this population that made you say, “I want to focus on them for my career?”
Madhavan: So I worked with specifically veterans at the VA hospital in Roseburg, and so I was doing a lot of cognitive communication therapy with that population, part of my studies in communication disorders and sciences. So I was just really drawn to the work and the population. They’re working really hard and that’s kind of what drew me here.
Miller: Dr. Knight-Coyle, how did this new program come to be?
Knight-Coyle: The Brain Injury Program came about as a result of strong advocacy that started more than 10 years ago. This advocacy led to Senate Bill 420, which was passed in 2023, and this bill created the Brain Injury Program. It was initially funded with $1.4 million in state general funds and that funding has been maintained through the current biennium. And as you mentioned, the brain injury program was officially launched in January of 2025. This is one of many programs that we have that are designed to meet the needs of people with disabilities and older adults, and it fills a critical need by helping people with brain injuries get the help they need from existing programs and services.
Miller: What have you seen in terms of call volume over the course of the year?
Knight-Coyle: On average, we experience about 200 calls per month and each call is about two hours each. And between January and November, we served just over 1,300 callers with a total of almost 2,800 hours spent on callers.
Miller: Claire, I gotta say I’m really surprised by the average length of a call: two hours. So let’s dig into this. First of all, when you answer the phone, when people call you, where do you start?
Madhavan: I think the most important starting place is starting to build that rapport. Because oftentimes people are calling in and they’re really stressed, and they’ve got a lot going on in their lives. Every navigator has a little bit of a different style, but in general our program prioritizes active listening and meeting people where they’re at. From the start, Oregonians are in the driver’s seat. They’re setting the goals and we’re here as navigators to help support, guide, and offer advice if and when they want it. It can also take time because everyone’s needs are so different, so the key is adapting how we’re working with people so that Oregonians feel supported. That’s also a big part of building rapport during those initial calls.
Miller: In general, do you find that people are calling you after they’ve been dealing with a brain injury for a while and after they’ve been running into roadblocks? Or is it early in their recovery when they find you?
Madhavan: It really varies, but from my experience, I’m finding callers who have been living with a brain injury for years and years and years, and are needing help untangling resources and the complexities that are involved in accessing resources, that sort of thing.
Miller: So they may be calling you with some degree of pent up frustration?
Madhavan: Yes, certainly.
Miller: What are the services that you find people are most in need of?
Madhavan: The top services are resource navigation, so finding those available resources, and then also service coordination. So what we mean by that is helping people get connected to the resources and services – helping them apply, reaching out to community partners for them, initiating phone calls, sometimes advocating for them and alongside them, that sort of thing.
Miller: How often are there available resources for the problems that people are asking to help you out with? I mean, I’m just wondering … navigation is only going to be helpful if there’s a place where people can go. The simplest way to put it is, are there resources available for the people that are calling you, asking for help?
Madhavan: We usually prioritize meeting people’s needs. So we’re looking at, do they have food? Do they have transportation? Do they have medical care? We’re focused on the immediate needs and very often we are able to connect people with resources. If there is an unmet need or no available resources for a particular need, because we are looking at the whole person, we’re looking at other immediate needs that we might be able to address.
Miller: Claire, how would you put together the list of resources that are available? Say somebody calls in from Burns or Tillamook, wherever, how do you know what’s actually available for them?
Madhavan: We use a statewide resource data bank to look for available resources. Each resource that is in this bank is reviewed and vetted by state staff before it’s added to the resource bank. So as navigators, we’re constantly learning about and discovering new brain injury resources, and general resources, all the time, primarily through word of mouth and collaboration with community partners. When we do come across a new resource, like for example a TBI support group or a shelter, our process is to reach out to that organization, introduce ourselves, share a little bit about our program and see if they’d like to be added to the resource bank that we’re using.
Miller: Yesterday we talked to an artist, activist, documentary producer and a traumatic brain injury survivor who talked about her own experiences and the experiences of many people who’ve had brain injuries, in terms of both sensory or language processing issues and cognitive issues. How do you deal with that on the other end of the telephone?
Madhavan: We’re constantly adapting how we’re working with folks. So some people, like you say, they might have these cognitive challenges where, for example, they might benefit for me to slow down a little bit when I’m talking and presenting information so that they have time to process. Other folks might need written reminders or after-visit summaries, outlining what we talked about, or a written to-do list that they’re going to work on this week. We’re just constantly adapting and trying to support people’s needs as best we can.
Miller: Dr. Knight-Coyle, how are you working as an agency to get the word out about the program? How are you making sure that people who need to know about the service do know about it?
Knight-Coyle: We have a toll-free number. And people can access a navigator by calling Monday through Friday from 8:00 a.m. to 5:00 p.m. Our staff who answer the call, as Claire mentioned, are trained in understanding the challenges that people with brain injuries live with every day. We have interpreters on hand as well and we also have a website, which is braininjury.oregon.gov. And on this site, it contains a number of resources. The website is available in English and Spanish, and it also contains downloadable flyers that our navigators work with local community organizations to ensure that they’re able to share this information with individuals that come into their organizations, into their lobbies and the like.
So we have a number of mechanisms that we use to get the word out and definitely appreciate being with you this afternoon as another mechanism for getting the word out about this important program.
Miller: How is this program funded?
Knight-Coyle: This program is state general funded. As I mentioned earlier, it was funded initially with $1.4 million in state general funds, and that funding level has been sustained.
Miller: Are you at all worried with looming Medicaid cuts and the serious concerns about the state budget that that funding might not be sustainable?
Knight-Coyle: I’m not so worried about the sustainability of this with regards to Medicaid. Again, this is a state funded program. We don’t have any federal Medicaid match. However, with the competing demands on more limited state resources, it’s always a consideration. However, we’ve got a great team doing the work and we will continue to work to keep pace with the needs of people with brain injuries in Oregon.
Miller: Would it be possible to use data that is generated from the calls that Claire and others are having to actually figure out better ways to serve people with brain injuries in Oregon? If some number of people are calling up and saying, “I need help with X or Y,” and there’s a limit in those services, could you use that to provide better services going forward?
Knight-Coyle: Absolutely. And what you’re describing is an iterative process where we’re able to incorporate some quality improvements as we go along, and also work toward refining the system and our approach as we go. So yes.
Miller: Claire, what does a successful interaction look like to you? What makes you say to yourself, “I helped somebody today?”
Madhavan: To me, a successful interaction is when someone says they feel back on track with their goals. I’ve had a lot of Oregonians tell me that because of their brain injury, making a plan and sticking to the plan can be really tricky. So when they say to me that the program helped make things feel more manageable and doable, that’s when I know that the program is working.
Miller: As we heard from Dr. Knight-Coyle, the average length for these calls could be two hours. I imagine that maybe that’s for the first call. How much follow-ups are you able to do?
Madhavan: We generally do weekly follow-ups with clients.
Miller: So you have ongoing relationships with clients?
Madhavan: Correct.
Miller: Dr. Knight-Coyle, are there other similar hotlines for people with other disabilities who are dealing with other issues that they can call? Is there something like this for other communities in Oregon?
Knight-Coyle: Absolutely, we’ve got what we call an Aging and Disability Resource Connection, or ADRC, which is a place that individuals and families can call for information and resources that they can access, as well as counseling on those available options.
Miller: Nakeshia Knight-Coyle and Claire Madhavan, thanks very much.
Knight-Coyle: Thank you.
Madhavan: Thank you so much, Dave, for the opportunity.
Miller: Nakeshia Knight-Coyle is the director of the Oregon Department of Human Services Office of Aging and People with Disabilities. That is the agency that oversees Oregon’s new one-year-old Brain Injury Program. Claire Madhavan is a navigator for the program.
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