3. Challenges
• Students with TBI are unique
• There is a lack of understanding of TBI
• Parents and educators have different
perspectives
• There is no systematic method for connecting
hospital and school
• Narrow definition of TBI
5. But, we do not have an accurate number
of how many children with TBI have
persisting disability…and should be
receiving special education
6. Impact
Each year, approximately 10,000 children,
ages 3-21 experience long-term challenges
as a result of TBI
Approximately180,000 children need special
education supports
Students with TBI on special education
census: 25,000
7. Wide Variability
• Massachusetts (pop. 6.5 million)
• Students with TBI: 5,826
• Washington (pop. 6.5 million)
• Students with TBI: 350
www.ideadata.org
12. Back to School Project
Age at Injury
Mean 10.92
Median 12.00
Range 4-15
SD 3.26
13. Back to School Study
(N = 68)
At one month post-discharge:
• 21 report no problems
• 23 receive formalized educational
support services
• 24 are experiencing challenges and
are not referred for special education
19. Summary of Findings
• Many children are not identified for
special education
• Service patterns are stable, although
TBI is not
• Communication is lacking
• Parents and educators are dissatisfied
20. Promising Practices
• STEP: hospital-school linkage to
improve access to services
• TBI Team model
• Brain 101: Proactive training for all
members of school community
21. STEP model
Grounded in experience of families and of
hospital and school personnel
• Focus groups with hospital rehabilitation
personnel, administrators, social workers
• Interviews and observations with parents,
teachers, school administrators, support
personnel
22. STEP model
• State Department of Education (DOE)
provides a single point of contact
• DOE informs trained regional liaison
• Regional liaison
• informs the school
• offers resources to family and school
• Parent training in advocacy skills
23. STEP ongoing support
• School staff access training and support as
needed
• Parents can contact the liaison at any time
• Progress of students is tracked by DOE
annually
26. Sample
N = 108
Children/youth ages 5-19 who:
• Were enrolled in school
• Were hospitalized at least overnight
for TBI
27. Study Design: RCT
• Student assigned to STEP or usual care
• Parent and 1-2 teachers complete baseline
measures
• Reassessment at 1 year post-injury
• T0 in hospital, T1 at 30 days post-injury, T2 at
1 year post-injury
28. Parent Measures
• State/Trait Anxiety Index
• Brain Injury Partners measures of advocacy skills
• Child Behavior Checklist
• CASP – Child & Adolescent Scale of Participation
• CASE – Child & Adolescent Scale of Environment
• Brief BRIEF (24 questions)
• STEP survey: parent concerns; services needed; services
provided; satisfaction with school services
34. Does STEP make a difference?
Significant findings:
• STEP parents report less anxiety (1 year
post-injury)
• At 1 mo. post-injury STEP students
demonstrated lower anxiety (parent rating,
ASEBA DSM-4R criteria)
35. Significant findings:
STEP parents report higher satisfaction with
academic, vision/hearing, and physical/motor
services (p < .05)
STEP parents who had training on child advocacy
skills showed significantly higher performance on
advocacy knowledge (effect size, g = .71)
Does STEP make a difference?
36. Does the effect of STEP depend upon
whether or not the student had rehabilitation
services?
Control for rehabilitation
services status
37. Treatment effects controlling for
rehabilitation services status
Procedures:
• Sample divided by Rehab vs. No Rehab
• Each group contained tx & control
38. One Year Post-Injury: Parent Ratings of Overall Satisfaction with Services
by Treatment Group [No in-patient rehabilitation subgroup]
STEP
CONTROL
All statistically significant differences between groups (P < .05) except medical services
39. Conclusions
• Children with TBI face unique challenges when they
return to school
• Hospital-school transition is key for accessing school
supports
• For students who do not receive rehabilitation, STEP
can help
40. TBI Resource Team model
• Systematic training for inter-disciplinary
team of school-based educators, e.g.,
• School psychologists, parents, special educators,
paraprofessionals, SLPs, PTs, OTs
Promising Practice: Comprehensive
Professional Development for
Educators
Glang, Todis, Sublette et al., 2010
41. Team members participate in year-long training,
e.g.,
• Instructional techniques, behavioral support strategies,
partnerships with families, transition
Team members provide consultation to schools
serving students with TBI
TBI Resource Team model
42. • Hawaii
• Tennessee
• Kansas
• Nebraska
• Oregon
• Pennsylvania
States Implementing a TBI Resource
Team Model
43. • Team members provide training & consultation
to educators working with students with TBI
• General or tailored to an individual student
• Activities can include:
• Attend IEP meetings - Provide materials
• Phone consult - Observe in classroom
Statewide TBI Resource
Team
44. TBI Team model:
Example of Impact (2008-2009)
Liaisons 9
Active Team members 50
Presentations on TBI 43
Attendees at presentations 734
Mean satisfaction rating 3.65 (4 pt scale)
Students coached 156
Student contacts made 486
Avg. meetings/contacts per
student
3.1
45. TBI TEAM
MODEL
Impact of systematic training
on identification rates for
special education services
46. Oregon Students (age 3-21) with Special Education
Eligibility in the area of TBI (1994-2004)
48. Overarching Goal of
Concussion Management
“The biggest challenge in dealing with concussion
is trying to change the culture.”
~Oregon school board member
49. School-wide approach to
concussion management
• Clear rules/expectations: School-wide
concussion management guidelines
• Consistent reinforcement of rules across
settings
• Active involvement of administrators
• Proactive skills training: Students, parents,
athletics staff and educators
50. Brain 101:
The Concussion Playbook
Training in effective concussion
management for:
• Students
• Parents
• Coaching staff
• Educators
51. Content
● CDC Heads Up toolkit and Consensus Statement on Concussion in
Sport (McCrory et al., 2009)
● Interviews with researchers, certified athletic trainers, physicians,
neuropsychologists, and public health professionals
● Input from teen marketing consultant---invaluable!
52. “You don’t know how bad it is until it happens to your
kid.”
~Parent of athlete who sustained concussion
53. “If I suspected my teammate had gotten a
concussion, I wouldn’t want to rat them out. That
would give away their season.”
~High school athlete
54. Recommendations from
interviews about teen athlete
program
Content should be:
• Real and truthful
• Limit reading required
• Use animation and video
• Supportive of the team
60. Brain 101: Does it work?
Evaluation:
24 high schools in Oregon
Criteria:
ATC at school
61. Research Design
•Random assignment to Brain 101 or
usual care condition
•School-wide implementation
- Administrator and ATC lead effort
- Online education for all 4 target groups
- Information about establishing school-wide
management guidelines
65. Evaluation of Brain 101:
Outcome measures
• Student and parent knowledge
• Student attitudes and self-efficacy
• Parent attitudes and intention
• Injury logs: how is concussion managed?
66. Student knowledge
If you get a concussion, it could be bad for you
to text or read for a few days.
True
False
I don’t know
67.
68. Student attitudes
Miguel is a star quarterback and tonight there is a
college scout in the stands. Right before the end
of the first quarter, Miguel is tackled hard. The
coach thinks Miguel might have gotten a
concussion and pulls him from the game. As a
result, the team doesn’t have a good offense and
loses the game.
I feel the coach made the right decision to keep
Miguel out of the game.
Agree Disagree
70. Student Self-efficacy
How likely is it that you would continue playing a
sport even if you thought you had a minor
concussion because you wouldn’t want to let your
team down?
74. Parent attitudes
Your daughter, Katie, suffered a concussion three
weeks ago while cheerleading. She’s mostly
healed but still has a few symptoms. She tires
easily and is bothered by bright lights. She is a
straight-A student and has always participated in
the science fair. She was almost done with her
research and had a project in mind before she got
the concussion. Although the doctor has not
cleared her to go back to school, Katie wants to
start working on her science project.
Should Katie work on the science project?
76. Parent intentions
If Katie was your daughter, how likely is it that you
would let her work on her science project?
Very unlikely
Unlikely
Neither likely nor unlikely
Likely
Very likely
82. Discussion
• What resources could currently be
accessed in Alaska to support
children/teachers/families?
• Vision: What resources would you
like to see put into place?
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