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Returning to School After Traumatic Brain Injury (TBI)

Information for Counselors and parents on how to help students who have TBI (traumatic brain injury) when they return to school after being home or hospitalized. Many supports are needed for students and they may require an IEP or 504 to put accommodations or modifications into place. A special education advocate might be helpful if the school is difficult about providing support. Find out more information at https://www.specialmomadvocate.com/returning-school-tbi/

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Returning to School After Traumatic Brain Injury (TBI)

  1. 1. Returning to School After TBI What School Counselors Need to Know presented by Bonnie Landau
  2. 2. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU What is a TBI?  TBI = Traumatic Brain Injury  Insult to the brain that causes damage  Can have internal or external cause ABI: acquired brain injury TBI: traumatic brain injury MTBI: mild traumatic brain injury (concussion)  No two injuries are alike
  3. 3. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Statistics about TBI  Such a severe problem CDC created Heads Up program  Leading cause of death and disability in children 0-18  Incidence  475,000 ER visits for child-related TBIs each year  1 in 500 children 0-18 will require hospitalization for a TBI  Twice as likely for boys than girls  75% of TBIs are mild  1/3 of TBI survivors will suffer more than one TBI  Child abuse causes 60% of head injuries for children 0-3  Long-term effects  26% have long-term issues from the TBI  mTBI symptoms most often attributed to something else.  Children diagnosed with ADHD 1.8x more likely to have history of concussion  30% of students with vision impairment have history of TBI Source: CDC http://www.cdc.gov/TraumaticBrainInjury/ and http://www.headinjuryctr-stl.org/statistics.html
  4. 4. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Statistics about Concussions  At least 10% of all HS athletes will suffer concussions  71% male, 29% female  Bicycling is greatest risk  More kids ride bikes than play football  52% because kids don’t wear helmets!!  Football is 2nd greatest  1 player in every game will have some form of concussion  4-20% of HS football players per season sustain a concussion  11-33% of HS football players will have more than 1 concussion in the same season  50% of HS football players will have at least one concussion over 4 years.  Second or more concussions – symptoms twice as long.  Rate of concussions has doubled in last 10 years Source: http://www.momsteam.com/health-safety/concussion-rates-high-school-sports
  5. 5. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Most Frequent Cause by Age Age (years) 0-2 2-4 4-7 8-13 14-18 Abuse/neglect X X Falls X X Playground accidents X Pedestrian hit by a car X Bike rider hit by a car X X Sports X X Car Accidents X
  6. 6. How TBI Effects School What School Counselors Need to Know
  7. 7. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Cognitive Effects of TBI  Attention  Executive Function  Memory difficulties  Processing difficulties  Learning disabilities  Confusion
  8. 8. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Physical Effects of TBI  Headaches  Nausea and/or vomiting  Fatigue & Reduced Stamina  Balance/coordination  Vision problems  Eye-tracking, convergence, fixation  Photophobia  Sleep disturbance  Auditory issues  Auditory processing disorder (45%)  Hyperacusis  Tinnitus  Seizure disorder
  9. 9. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Personality Changes from TBI – Big One!  Impulsiveness  Short-tempered  Easily frustrated  Social dis-inhibition  Irritability  Aggression  Anxiety
  10. 10. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Mental illness 4x more likely  PTSD (33%)  Depressive disorder (40-50%)  Generalized Anxiety Disorder  Increases risk of post-concussive syndrome  ODD (oppositional defiance disorder)  OCD (obsessive compulsive disorder)  Bipolar disorder  Substance abuse  Increased risk of suicide
  11. 11. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Social Effects of TBI  Communication difficulties  Inappropriate actions  Easily misunderstands  Easily misled  Easily frustrated
  12. 12. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Developmental Difficulties  Brain injury may not be evident until child reaches an age where more difficult tasks are expected.  Especially true for children injured <4
  13. 13. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Christopher Nowinski, athlete  Post-concussive syndrome
  14. 14. Social Challenges After TBI Biggest issue for TBI survivors
  15. 15. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU How TBI Effects Social Skills  Social issues much greater than cognitive issues  Depression issues exacerbate social skills problems  Communication skills severely effected  TBI survivors have a shrinking social support group – they need MORE support!
  16. 16. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Communication Difficulties  Speech problems  Social cue misinterpretation  Interpersonal difficulties  Inappropriate verbalization  Problem solving difficulties  Lack of empathy
  17. 17. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Losing Old Friends  92% of TBI survivors have a change in friendship circles  Personality & communication changes can cause old friends to leave  Old Friends may not understand changes in behavior  Old friends may be embarrassed to be seen with TBI survivor
  18. 18. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Self-awareness therapy helps  Come up with a plan for a situation  Implement the plan  Review result and provide feedback  Problem solve new options  Re-implement new option and evaluate outcome
  19. 19. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Dr. Mariann Young, psychologist  How to deal with friends falling away after TBI
  20. 20. After the Injury What Schools Should Do to Help
  21. 21. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Transition Meetings  Assign a resource coordinator for the student  Pre-meeting to get update on medical condition  Assessments and 504/IEP meeting  Plan review every term  Remember that entire family is in extreme emotional distress
  22. 22. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Assessment  Evaluate current function  Develop profile of strengths and needs  Develop intervention plan  Services  Accommodations  Behavioral support  Response to Intervention Protocol (RTI)  Educate student, parent/guardian and teachers about plan
  23. 23. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Educate Staff  Understanding TBI  85% of teachers have had no TBI training  Parents become source of information, listen to them  Understand which behaviors can be caused by TBI  Help parents understand what services or accommodations are available  Do not call them truant Source: Oregon Dept. of Education
  24. 24. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Emotional Support  Check in with student regularly  Consider regular meetings to review progress or issues  Note patterns in problems that come up  Work together to find solutions
  25. 25. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Britt Payton, athlete  2nd impact syndrome
  26. 26. What Parents Want You To Know For all people who work with kids with TBI
  27. 27. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU It is an invisible disability  Don’t assume all is okay because the child looks “normal”  Child is mentally different even if physically the same  Child struggles with their new self and mourns loss of old self
  28. 28. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Provide strong emotional support  Child is emotionally fragile  Their life has been turned upside down  Many changes will come as they return to school  Social environment change is huge  Consider intervention for old friends – HUGE!  Provide ongoing support group for TBI survivor  Create peer support network  Help child learn coping strategies for new difficulties (like sensory overload)  Help the child learn to self-advocate
  29. 29. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Create a Quiet Space  A place the child can go when over stimulated  Quiet room  Dim lighting  Few if any people  Permission to use whenever necessary
  30. 30. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU Listen to the parents  They are probably TBI experts  They know their child best  They talk with other parents and know about positive solutions  They are going through their own inner turmoil and are easily agitated  Offer the parents resources if you know of any
  31. 31. Thank you! Bonnie Landau Weed
  32. 32. RETURNING TO SCHOOL AFTER TBI: What School Counselors Need to Know Presented by: BONNIE LANDAU References  Anderson, V., Beauchamp, M.H., Yeates, K.O., Crossley, L., Hearps, S., Catroppa, C (2013). Social Competence at 6 Months Following Childhood Traumatic Brain Injury. Journal of the International Neuropsychological Society. 19(5), 539-550. doi: 10.1017/S1355617712001543.  Bay, E. H., Blow, A. J., & Yan, X. (2012). Interpersonal relatedness and psychological functioning following traumatic brain injury: Implications for marital and family therapists. Journal of Marital and Family Therapy, 38 (3), 556-567.  Brain Injury Association of America (2014). Mild Brain Injury. Retrieved from http://www.biausa.org/mild-brain-injury.htm  Centers for Disease Control (2014). Traumatic Brain Injury. Retrieved from http://www.cdc.gov/concussion/  The Center for Head Injury Services (2014). Brain Injury Statistics. Retrieved from http://www.headinjuryctr-stl.org/statistics.html  Henderson, D. A., & Thompson, C. L. (2011). Counseling With Children With Disabilities. In L. Schreiber-Ganster (Ed.), Counseling Children (pp.693-716). Belmont, CA: Brooks/Cole  National Institute of Neurological Disorders and Stroke (2014). Traumatic brain injury: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/tbi/tbi.htm

Information for Counselors and parents on how to help students who have TBI (traumatic brain injury) when they return to school after being home or hospitalized. Many supports are needed for students and they may require an IEP or 504 to put accommodations or modifications into place. A special education advocate might be helpful if the school is difficult about providing support. Find out more information at https://www.specialmomadvocate.com/returning-school-tbi/

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