BrainSTARS: A Model Program for Children and Adolescents with Acquired Brain Injury

1. BrainSTARS: A Model Program for Children and Adolescents with Acquired Brain Injury Jeanne E. Dise-Lewis, Ph.D., Associate Professor, Departments of Rehabilitation Medicine and Psychiatry

2. The Problem Brain Injury Metacognitive Weaknesses Attention Processing Speed Organization Self-Regulation Executive Functions Neurodevelopmental Deficits Specific Learning Difficulties Reading New Learning Note-taking Expressive Language Social Skills Test-taking Problem Solving Long-Rang Projects Behavior Problems Has Temper Tantrums Has Poor Frustration Tolerance Has Messy Handwriting Doesn’t Follow Directions Looks “Blank” Fights With Others Fails Tests Can’t Keep Up With Peers

3. BrainSTARS Model Program Educates about Brain Injury Teaches approaches to interventions Links observable problems to neurodevelopmental deficits Recommends specific interventions for neurodevelopmental deficits Supports a student’s team through 3 scheduled follow-up consultations at school

4. Outcomes

5. I can better support families as they progress through post-injury period I will be able to offer specific strategies to parents Talk to parents regarding stages and ABI symptoms Helped me understand what parents are going through I can help as a mentor now Helped me to communicate with parents I will be better prepared to assist families in my work Use daily picture schedule as parent feedback form Open communication - parent/teacher/ special staff I will be more aware to ask parents about any head trauma Effective strategies for improving communication with parents Able to understand parent and teacher miscommunication better Better Teamwork With Parents

6. All children with ABI are affected differently, depending on age Understanding how ABI affects different levels of development Even though an injury was in preschool, problems can show up later Injury will present itself through various other stages of development The child's age when he had the brain injury plays a huge role How an ABI affects the developmental stages The disruptions you see depend on when a brain injury happens Brain injury affects you depending on your developmental stage Effects of ABI may be varied over time Be more aware of age, developmental demands and strategies A Developmental Understanding

7. Encouraged me to have more patience It helps to have more knowledge Better understanding when I get an unexpected response I'm glad to know I am not doing harm through repetition A relief to get EXCELLENT interventions, very practical and usable I have more at my disposal to identify why kids struggle with learning A new way of looking at my work Reinforces what we are doing I feel better able to consider ABI on initial evaluations Supports my existing knowledge It helps to have strategies I can be much more in-tune with my kids Remember to be patient - with the child and myself This helped me single out particular weaknesses Take a look at students I serve with at new "eye" I have interventions to apply, strategies to try I feel better able to support incoming middle-schoolers with ABI I have many more options for intervention now Change my expectations Reduced my stress Better Teacher Morale

8. Share information with staff at my elementary school Check with all members of the team about their views I will spend time with the staff in developing a better program Be able to help staff figure out practical things to do with a child Share this information with my faculty, for starters Ask more questions at Child Resource Team Meetings I have more information to share with teachers regarding ABI Give my college students more information than I had before I will have more information to share with regular educators It's a team effort to help students with head injury Share information with team members Mentor teammates more effectively Share ideas with teachers on things to try in the classroom I'll be able to talk more directly with teachers, re: child's needs I shall press for more evaluation of specific children I will be more effective with other teachers Better Teamwork Within School

9. Be more aware of brain injury when doing health histories Stronger understanding of brain injury and how it affects learning Realizing the cumulative effects of ABI New learning is most often affected by ABI Look for specific differences to separate ABI from LD or ADHD Ask about head injuries when some of the characteristics are evident Different approach is needed for kids with ABI How relevant brain injury is to special education Dispelling the idea that children bounce back from brain injury Appreciation for the long term (long life) effects of ABI Expect decreased processing speed How under-diagnosed brain injury is I know specific behaviors that will alert me to ABI being a possibility I have a better understanding of how ABI affects a child's function Clearer understanding of effects of ABI Ask more specific questions about mild ABI Evaluate ADD and ADHD students as possible ABIs Some LD kids may really be ABI and need different accommodations Even though an injury was in preschool, problems can still show What ABI is and how to treat students with ABI Education About Brain Injury

10. Restructure thinking and approach to some of my kids I will have a clearer understanding of brain injury and it's symptoms I understand differences between LD & ABI Help student develop strategies rather than telling him how to do a task I have more information to offer I will focus teaching on specific situations I'll be more aware of how I give directions I will teach strategies for generalization I am going to change how I give instructions Be able to identify these students Consider ABI qualifiers when looking at kids in special education Consider possible brain injury more than I have historically Help design more appropriate interventions for behavior difficulties Allocate more planning and thought to organize student's day I have more knowledge about my students I will be sure to give demonstrations as well as directions I wonder if kids who are struggling have had a head injury I can see how cognitive problems cause behavior problems How to change the environment to help meet child's needs Teach strategy which can be generalized in other situations Improved Educator Skills

11. Look at some of my students in a different way Be more responsive to "fatigue” issue Understand why these kids behave as they do Understand better where they are emotionally Understand effect of brain injury on organization and irritability Makes me wonder/think about my students in a different way See students through a different perceptual filter Help teacher and parents understand these kids better A reminder to focus on feelings Assist in transitions more Pay more attention to physical factors than we do Increase my tolerance for students with history of ABI I will have a better understanding of the child's struggles in school Understanding mental inflexibility; it is not just stubbornness Concrete ideas about how my students may be affected Recognize need for more time for processing Need to advocate for more specific interventions for the child with ABI Have a better understanding of what some of the behaviors mean Have more appropriate expectations for children with ABI Understand child's difficulty learning new information Improved Understanding Of Child

12. Establish visual cues for classroom routines Practice and repeat instructions Provide more concrete explanations/directions Use visual daily planners - even with older children Prepare materials needed for lesson Make more visual aids Focus on developing specific strategies for kids Give more visual cues when working on assignments Make directions short and concrete Repeat directions and don't rush Allow for breaks Shorten directions Use daily picture schedule as parent feedback form Provide more structure in the learning environment Maximize hands-on learning opportunities Use environmental strategies in classroom Minimize verbal directions and explanations Break down tasks into smaller pieces Simplify directions to major points instead of elaborating Take the child where he/she is and build structure up from there Classroom Strategies

13. To date, more than 50 children and their parent/school teams have been BrainSTARS Model Participants. We plan to work with an additional 50 teams this year.

14. BrainSTARS is a U.S. Department of Education Model Demonstration Grant Project, Funded by OSEP (Grant # H324M990060)