We must be willing to get rid of the life we planned so as to have the life that is waiting for us
This presentation is the property of its rightful owner.
Sponsored Links
1 / 98

We must be willing to get rid of the life we planned, so as to have the life that is waiting for us. PowerPoint PPT Presentation


  • 40 Views
  • Uploaded on
  • Presentation posted in: General

We must be willing to get rid of the life we planned, so as to have the life that is waiting for us. Joseph Campbell. TRANSITION INTO ADULTHOOD FOR STUDENTS WITH TBI. Bonnie Todis, Ph.D. Center on Brain Injury Research & Training. Our Questions:.

Download Presentation

We must be willing to get rid of the life we planned, so as to have the life that is waiting for us.

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

We must be willing to get rid of the life we planned, so as to have the life that is waiting for us.

Joseph Campbell


Transition into adulthood for students with tbi

TRANSITION INTO ADULTHOOD FOR STUDENTS WITH TBI

Bonnie Todis, Ph.D.

Center on Brain Injury Research & Training


Our questions

Our Questions:

  • What are the transition experiences of students with TBI?

    • What are their transition outcomes?

    • What factors are associated with positive outcomes?

    • What factors are associated with negative outcomes?

    • What is transition like for students and families?


Transition services idea

Transition Services IDEA

  • Mandated, but not fully funded

  • Students with TBI are under-identified for special ed and transition services

  • Transition services are highly variable

    • district to district

    • disability to disability

    • severity of disability


Post secondary outcomes project pso

POST-SECONDARY OUTCOMESPROJECT(PSO)


Project pso

Project PSO

  • 8-year study of transition outcomes

  • Funded by OSEP and NIDRR

  • 90 students in Oregon and Washington

  • Recruited at exit from high school

  • Rolling recruitment over 2-3 years

    • School districts

    • VR


Pso participants

PSO Participants

  • 77% had severe injuries

  • 2/3 were identified for special education

  • Half were injured while in high school

  • Mean time since injury 7.7 yrs (range: 0-19)

  • 2/3 male


Project pso1

Project PSO

Purpose:

  • Systematic tracking of quantitative data on transition outcomes

    Methodology:

  • In-person/phone interviews with young adult, parent

  • 6-12-month intervals


Pso survey domains

PSO Survey Domains

  • Education and training

  • Education accommodations

  • Satisfaction ratings

  • Employment history & plans

  • Type of work, pay, hours

  • Employment supports & accommodations

  • Living/rent arrangements

  • Sources of community support

  • Satisfaction ratings

  • Community integration & activities

  • Social relationships

  • Health issues

  • Life satisfaction


Results

RESULTS


Life transition planning

Life Transition Planning

At initial interview


Written transition plan

Written Transition Plan

At initial interview

Bonnie Todis, Ph.D.

Center on Brain Injury Research and Training


Person who helped plan transition

Person Who Helped Plan Transition

At initial interview


Transition outcomes

TRANSITION OUTCOMES


Employment outcomes ages 19 25

Employment Outcomes Ages 19-25


Post secondary employment outcomes 19 25

Post-Secondary Employment Outcomes 19-25


Closer look employment at age 25

Closer Look:Employment at Age 25

  • 60% employed

    • 74% of males,

    • 35% of females

  • Hours per week

    • Mean 21-30

    • No one worked more than 30 hrs per week


Employment outcomes by gender

Employment Outcomes by Gender


Employment at age 25

Employment at Age 25

  • Wages

    • Mean $8.22 per hour

    • No difference between males and females

  • Type of Job

    • 81.3% in menial, unskilled, or semi-skilled categories

    • The rest in skilled (11.3%) clerical/sales (5%) or technicians (2.5%)

    • None in the top 3 categories


Comparison with typical peers

Comparison with Typical Peers

  • Bureau of Labor Statistics of the U.S. Department of Labor, January 19, 2007


Factors predicting employment

Factors Predicting Employment

  • Hierarchical Linear Modeling Results

    • Family SES: Those with higher SES were less likely to be employed at the beginning of the study, more likely to be employed over time

    • For every unit change in SES there was a 3.3% increase in the odds of employment and a .7% increase in the rate of change in employment over time.


Factors that impact employment

Factors That Impact Employment

Work Category by Sex and Age at Injury Over Time

Job Category by Sex and Age at Injury

Clerical, sales

Later age)

Skilled manual labor

Earlier age

Avg age

Females

Later age

Semi-skilled

Earlier age

Avg age

Males

Unskilled work

Menial service

Bonnie Todis, Ph.D.

Center on Brain Injury Research and Training


Factors that impact employment1

Factors That Impact Employment

Wages Over Time by Age at Injury and Severity

Later injury

Severe

Mild/Moderate

Early injury

Later injury

Bonnie Todis, Ph.D.

Center on Brain Injury Research and Training

Early injury


Factors that impact employment2

Factors That Impact Employment

Hours Worked per Week

Severity: M/M work > # Hrs.

Gender: Males> #hrs.

For both genders: Earlier age at injury = work fewer hours/week

21 – 30hr

later

Bonnie Todis, Ph.D.

Center on Brain Injury Research and Training

later

Hours Per Week

16-20hr

Injured earlier

Injured earlier

Males

Males

Females

11-15hr

Females

Mild/Mod

Severe

Severity


Factors that impact employment3

Factors That Impact Employment

Job Happiness by Severity and Age at Injury

Very Happy

Early age

Severe

Avgage

Later age

Happy

Early age

Mild/

Moderate

Avgage

Later age

Unhappy


Post secondary education

POST SECONDARY EDUCATION


Post secondary education outcomes ages 19 25

Post-SecondaryEducation OutcomesAges 19-25

n (%)


Post secondary education outcomes ages 19 251

Post-Secondary Education Outcomes Ages 19-25


Comparison with peers

Comparison with Peers

  • Non disabled young adults 18-25 46% enrollment (Pew 2007) 54% female (200?)

  • NLTS2 45% reported continuing to postsecondary ed within 4 years of leaving high school.

    • 32% community colleges

    • 23% vocational/tech

    • 14% 4-year


Factors that affect enrollment

Factors That Affect Enrollment

  • Higher family SES, shorter time to enrollment

  • Females more likely to enroll

  • Those injured later were more likely to enroll. For every year increase in age at injury there was a 12.3% increase in likelihood of enrollment.


Independent living outcomes ages 19 25

Independent Living Outcomes Ages 19-25

Bonnie Todis, Ph.D.

Center on Brain Injury Research and Training

n (%)


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

Post-SecondaryIndependent Living OutcomesAges 19-25


Comparison with peers1

Comparison with Peers

  • Non-disabled peers 18-25 40% live with parents (Pew)

  • NLTS2 ages 17-21 25% have lived independently at some time since high school (65% of these lived in a college dorm or military housing).


Factors that affect ind living

Factors That Affect Ind. Living

  • Age at injury: Those injured earlier take longer to achieve independent living status.

  • For each year older at injury, there is a 12.7% increase in odds of achieving independent living.


Qualitative component

Qualitative Component


Qualitative component1

Qualitative Component

Purpose:

  • Access perspectives of youth with TBI and their parents on the transition experience

  • Identify specific factors that promote positive outcomes

  • Investigate the details of transition services


Qualitative methodology

Qualitative Methodology

Methodology:

  • Unstructured recursive interviews

  • Participant observations with young adult

  • Interviews with knowledgeable others

    1-to-6-month intervals


Selection of respondents

Selection of Respondents

  • Selective sampling for factors of interest

  • Resilience factors

    • Family support

    • Access to/use of agency supports

    • Community/social support

  • Range of high school experiences, severity, age at injury, disabilities, SES, urban/rural


Qualitative findings

Qualitative Findings


Thematic categories

Thematic Categories

  • High School Experiences

  • Employment

  • Post-Secondary Education

  • Community Integration


High school experiences

High School Experiences


Themes high school services

Themes: High School Services

  • Students not identified for special education:

    • Tested at or above grade level (didn’t qualify)

    • Injured junior or senior year, “helped” to graduate on time


Helped to graduate academic

Helped to Graduate: Academic

“My mom worked at the school and all the teachers loved me, so I didn’t have to do anything, they just passed me. All I had to do was come to class. They knew what had happened to me and they felt sorry for me. They thought I was a great kid. Did they do me a favor? Yes and no. I don’t think it was that great for going to [college], but yes, because I don’t think I would’ve graduated.”

~Kristi


Themes not identified for sped

Themes: Not identified for SpEd

  • No transition services

    • No IEP

    • Graduated

  • No access to disability services post-graduation

  • Usually tried to follow pre-injury plan


High school services

High School Services

  • Students identified for special education:

    • Not identified TBI

    • Two-track system

    • Rarely received good transition services


Not identified tbi

Not identified TBI

All of the transition services I got were through the school for the deaf, because I had a hearing impairment before the TBI. So one summer I went to camp there, and I got some cooking lessons. That was it.

~Tanya


Themes two track system

Themes: Two-track System

College Prep

  • Focus on graduation requirements

  • Learning problems not like those of LD

  • Often need social and life skills training

  • Minimal transition services


Identification issues

Identification Issues

Because he presents well and isn’t a behavior problem, everybody thought I was nuts when I asked for so much support. But then at the very end of the year, a teacher called me, furious because Mike “belonged in a special class.” Every year I would tell staff this. They’d say, “Ok, ok.” and then mid-year, “Your kid’s got problems!” Then they would spend the last half of the year trying to get something in place, when he’s already missed the first half.

~Mike’s mom


Identified for sped academic

Identified for SpEd: Academic

He has these gaps. He can do math that he learned before the TBI, but I’m not sure he’s really learned anything since the injury, because his teachers don’t know how to deal with his learning problems.

~Jed’s mother


Identified for sped academic1

Identified for SpEd: Academic

“I graduated with a B average. I can’t really read or write, though.”

~Jed


Two track system academic

Two-track System: Academic

  • Typical transition plan activities:

    • Write a resume

    • Take an aptitude test

    • College visitation and meeting with disability services coordinator

    • No time for life skills


What kids need ntls2 needs life skills

What kids needNTLS2: Needs Life Skills

%


Two track system life skills

Two-track System: Life Skills

  • 3 to 4 years of

    • in-school work experience

    • supported employment

    • life skills (bus training, social skills, independent living

    • self-advocacy

  • Little academic work

  • No diploma


Two track system life skills1

Two Track System: Life Skills

“The teachers in my life skills program keep forgetting that I haven’t been this way my whole life. And I remember when I wasn’t this way. I can’t talk very well. I can’t walk very well. But I’m still smart. I know a heck of a lot…More than I should!”

~Mary, injured age 9


Actual transition services

Actual Transition Services

He’s in one of the best life skills programs in the state. I mean, they have everything. But he’s been in it for 4 years now, and every year they have to redo bus training, and he’s still not safe on the bus independently. He’s got a job at a grocery store for work experience, and he loves it, but there’s no indication the store will hire him for real when he’s 22.

~Mike’s mom


Post secondary education1

POST SECONDARY EDUCATION


Themes pre injury plans

Themes: Pre-injury Plans

  • Those injured in high school, and their parents, tended to pursue preinjury plans for transition.

  • This often included college

  • College was extremely challenging for many participants


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

Tina

Before the accident, [my friend April and I] basically had the same life. We were suppose to go away to UO together and be roommates, but because of the accident, I stayed home that year


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

Tina

When she did go to the university the next year, she still, I think, maturity-wise, was probably like at about the level of a 15-year old. Everything was really compulsive. She gained weight because of stress. Drank too much, even though she knew she shouldn’t drink at all. She would drink a lot and just pass out. I never wanted to take her to parties.

~Tina’s friend April


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

Tina

She lived with a total stranger in the dorm who didn’t know she had a car accident until after Christmas break. Tina chose not to tell her. I will say, the girls robbed her blind. Tina would think her leather coat was at home, then notice that her roommate was wearing one exactly like it. She didn’t figure out until much later that it was her coat.

~Tina’s mother


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

Tina

I’d be like ‘Oh just come on! Let’s go out and do something.’ And she’d be like, ‘I have to study.’ And she did. I mean she studied relentlessly, and then she’d wake up the next morning and couldn’t remember what she studied. She couldn’t pass any classes. I don’t even know if she even got a credit. She might have gotten like a couple seminar credits, but I don’ think she passed a class.

~April


Themes is it worth it

Themes: Is it worth it?

“Will I be able to perform the job I am preparing for? I can’t sit here in my parent’s house forever until I pick out the perfect career. I have to go try.”

~Jack


Strategies and supports

Strategies and Supports

  • Some participants modified their plans

  • Some developed effective strategies

  • Some accessed effective supports

    SAM’S STORY


Critical features of sam s story

Critical Features of Sam’s Story

  • Parent advocacy

  • Achievable short term goals

  • Manageable environments

  • On-going support


Employment

Employment


Employment themes

Employment Themes

  • Got job through

    • Life Skills

    • Family connections

  • Infrequent promotion

  • Frequent job changes/unemployment

    • Uneven performance

    • Inappropriate behavior

    • Impulsivity/poor judgment


Chelsea

Chelsea

History of quitting jobs if under pressure

Receptionist job at community center

Boss remembered the article in the paper

Part time, no benefits, minimum wage

Accommodations:

schedule to work when office less busy

task list, plan with boss before shift


Chelsea1

Chelsea

She’ll do a good job for you. I always left instruction about what she was supposed to do. She would ask a lot of questions, and she was frustrating for the people who worked with her. But once you give her the guidance, she’ll do exactly what you need her to do without a doubt. She may sometimes do it wrong the first time, but she’ll try to do it right. ~Chelsea’s boss


Chelsea2

Chelsea

Problems at work:

Easily confused and over-whelmed

Talked too loud

Called boss’s pager with trivial questions

PDAs with boyfriend in the office

Lost her job when she couldn’t get time off for a wedding—went anyway.


Chelsea3

Chelsea

At the end of the study

working a few hours a week cleaning a friend’s house

$7 per hour

Cost $5-$6 for transportation/child care

Selling belongings on Ebay


Chelsea4

Chelsea

If I don’t work full time, I can’t make enough money. If I get a full time job, it has to be something I know how to do or I’ll get overwhelmed. I get overwhelmed if I have to multi-task. And I need a break every 10-15 minutes. I get panic attacks, and I get sick a lot. My daughter gets sick a lot, too.


Chelsea5

Chelsea

Work must be structured and routine, but the risk is she will be bored, further eroding her self-confidence and self-esteem. She need to “pick the right supervisor.” She needs structure and accommodations, but also challenge.

~Chelsea’s neuropsychologist


Employment successes

Employment Successes

  • Al: stable cleaning business

  • Jed: tire store

  • Jay: team trainer


Critical features of success

Critical Features of Success

  • Parent advocacy

  • Life skills training (work experience, social skills, money management)

  • Communication with and training for employer

  • On-going family support


Community integration

Community Integration


Community based services

Community Based Services

Pressure on families to access services when they are offered

Whether the young adult can benefit or not

Example: Section 8 Housing


Clay joe ted

Clay, Joe, Ted

  • Section 8 apartments

  • No cooking or house keeping skills

  • “Friends” move in

  • Social service personnel are critical of family

    • Young adult is unsafe, unhealthy

    • Family wants young adult out of the house


Disruption of the empty nest

Disruption of the Empty Nest

  • High rate of divorce following TBI

  • Step parent wants the young adult [male] out

  • Mom feels guilty

  • Strain on the new marriage


Stability in living situation

Stability in Living Situation

  • Family nearby (Sam, Al, Jed, Bethany)

  • Spouse (Tom, Cody, Tanya, Jed)

  • Living with family (Tina, Brittany, Jack)

  • Supported living (Jenna, Tiger)


Promising transition practices

Promising TransitionPractices


Promising practices

Promising Practices

  • From young adults with TBI and families

  • From transition research

  • From TBI Team members


Strategies

Strategies

  • Community College vs. 4-year college

  • Modify timeline

  • Access supports

  • Reframe challenges as opportunities

  • Live the life you have now


Strategies acceptance

Strategies: Acceptance

“Every day is different. Some days I can remember things, some days, not. I just take it as it comes, try not to get stressed about it.”


Strategies reframing

Strategies: Reframing

“Don’t think of it as, ‘I’ve been working on a 2-year degree for 5 years.’ Think of it as doing something good for your brain, everyday.”


Strategies manageable goals

“I just try to take things as they happen and have little plans instead of big ones. I wish I didn’t have the problems with school that I do, and that I could have more of a plan. I wish I could do that, but because I can’t, then I just do what I can.”

Strategies: Manageable Goals


Evidence based practices

Evidence-Based Practices

  • Student-Focused Planning

  • Student Development (life skills, career and vocational curricula, self-advocacy)

  • Interagency Collaboration

  • Family Involvement (advocacy training and counselors)

  • Program Structure (program policy and evaluation)

  • www.NSTTAC.org


Not validated for students with tbi

Not Validated for Students with TBI

  • Of 131 studies examining effectiveness of these transition practices

  • 6 involved students with TBI

  • 10 participants out of a total of over 1500


Modifying e b practices

Modifying E-B Practices


What s different for students with tbi

What’s different for students with TBI?

Relearning skills

Dealing with personality changes Understanding how the recovering brain works

Accurately assessing new abilities

Monitoring awareness, behavior, responses of others, physical condition and limits


Explicit plans help

Explicit plans help:

  • reflect on abilities, gain self awareness, self determination and self advocacy while evaluating their steps toward personal goals.

  • Helps students who have memory challenges recall goals and the steps they need to perform.


Explicit plans help1

Explicit Plans Help:

  • Makes planning for the future more tangible and understandable.

  • Highlights connection between actions and the outcome of those actions. (If you don’t go to practice you cannot swim on the team and are less likely to get the swimming scholarship or a spot on the Olympic Swim Team).

  • use of visual supports to enhances new learning and cognitive flexibilty35.


Janell

Janell

Janell, a junior with TBI wanted to attend college but wasn’t exactly sure what courses she wanted to take. She was on track to get a standard diploma, but was unable to complete the course work in her most recent classes.

Janell had a work experience placement in an office near her high school. She believed she was doing well in this placement and started planning to attend college with the goal of being a secretary. However, she was unaware that that her co-workers didn’t think she had the potential to be a secretary and were providing a high level of support for her in her work experience as an office assistance.


Development and training

Development and Training

  • B.R.A.I.N. Program [email protected]

  • Adolescent Executive Functions-Lyn Turkstra

  • College Students with TBI: Mary Kennedy

  • NIDRR Development Project: Defining Success


Transition web project

Transition Web Project


We must be willing to get rid of the life we planned so as to have the life that is waiting for us

Todis B. & Glang, A. (2008). Redefining Success: Results of a qualitative study of post-secondary transition outcomes for youth with traumatic brain injury. Journal of Head Trauma Rehabilitation, 23(4), 252-263.

Todis, B. Glang, A., Bullis, M., Ettel, D., & Hood, D. (2011).Longitudinal Investigation of the Post-High School Transition Experiences of Adolescents with Traumatic Brain Injury. Journal Head Trauma Rehabilitation, 26(2), 138-149.


Contact me

Contact me

Bonnie Todis, PhD

Center on Brain Injury Research and Training

Teaching Research Institute

Western Oregon University

www.cbirt.org

[email protected]


  • Login