Back to School Identifying the needs of students following head injury

1. Back to SchoolIdentifying the needs of students following head injury Ann Glang, Ph.D. & Bonnie Todis, Ph.D. Principal Investigators The Teaching Research Institute – Eugene Western Oregon University Anne Stilwell Project Coordinator

2. Faces of Brain Injury

3. Scope of the Problem: National • 60,000 children hospitalized annually • Approximately 30,000 experience persisting disabilities as a result of changes in cognition, behavior, physical abilities

4. Scope of the Problem: Oregon • 600 children hospitalized annually • Approximately 300 experience persisting disabilities

5. Under-identification: Nationally • Annually: 30,000 with persisting disabilities from brain injury • Annually: 10,000 (1/3) needing special education supports • Cumulative total (K-12): 130,000 • Total on federal census (2002): 14,844

6. Education Issues: Under-identification

7. Under-identification: Oregon • Annually: 300 Oregon students with persisting disabilities from brain injury • Annually: approx. 100 (1/3) needing special education supports • Cumulative total (K-12): 1300 • Total on Oregon census (2004): 310

8. Oregon Students (Age 3-21) with Special Education Eligibility in the Area of TBI (1994-2004)

9. Arizona Students with Special Education Eligibility in TBI • 1998-1999 70 • 1999-2000 93 • 2000-2001 307 • 2001-2002 313 • 2002-2003 319 • 2003-2004 374

10. Effects of Brain Injury • No two brain injuries are exactly the same. • The effects of a brain injury are complex and vary greatly from person to person. • The effects of a brain injury depend on such factors as cause, location and severity. • Long-term effects are influenced by internal and external factors.

11. Motor coordination Hearing and visual changes Spasticity and tremors Fatigue and/or weakness Taste and smell Balance Mobility Speech Seizures Possible Changes after TBIPhysical Changes

12. Possible Changes after TBIEmotions and Behavior • Disinhibition • Impulsivity • Socially inappropriate behavior • Lack of initiation

13. Attention/concentration Perception Processing speed Language Memory Decision making Planning Judgment Problem solving Organization Possible Changes after TBICognition

14. Impact on school performance:Memory & Learning • Recent learning usually more affected then long-term memories • Prospective memory (i.e., ability to carry out intended actions) frequently impaired • Motor/procedural learning often less impaired

15. Growing Into It Performance Growing Up

16. Two critical intervention stages for children after brain injury Normal Development Performance Brain Injury Growing Up Credit: Sandra Chapman, Dallas Children’s Hospital

17. Challenge of Pediatric TBI • School = Rehabilitation setting • Key to accessing rehabilitation: accessing special education • Need to identify students who need rehabilitation when they return to school • For those students who “grow into” disability, need to remember their TBI

18. Apparent Low Incidence Under-identification Lack of Training Lack of Awareness Lack of ResearchMoney Lack of Right Services for Kids who are ID Under-identification Cycle

19. Outcomes • What happens to students with TBI when they return to school? • How do these students do in school over time? • What factors lead to good school outcomes for students with TBI?

20. Quantitative PHASE 1: Brief annual parent questionnaire (retrospective & prospective). All children (birth to 19 yrs) treated for TBI 1990 – 2009. PHASE 2: Annual in-depth structured parent interviews. Brief annual educator questionnaire. (120 Participants) Qualitative PHASE 3: Parent & educator interviews & observations. (24 Participants) BacktoSchool Project Design

21. Inclusion Criteria • Child observed/treated at least overnight • Age 0-19 at injury (not including birth trauma) • Injury fits CDC list of ICD-9 codes for TBI

22. Recruitment Sources • Four Oregon hospitals • Educational and medical professionals

23. Identification at Discharge • 72 children enrolled in tracking study • 27 report no problems • 21 are served under TBI category • 5 are served under another category • 19 are experiencing challenges and are not identified for special education

24. Emerging Themes • Changes that cause parents concern may be too subtle for schools to pick up • School personnel often assume recovery from TBI is complete if no physical signs are present • Problems may not appear until weeks/months/years after injury • Students maybe viewed as malingering, lazy, disorganized, “just adolescent”

25. Under-identification:Educators’ knowledge • Lack of preservice training • Limited knowledge of the impact of TBI on school performance • Lack of feelings of competence • Teacher training in TBI identified as critical need--nationally and in Oregon

26. David “The teachers say David is fantastic, such a joy. A little slow. But that’s David now. They don’t know David as any way else.” -David’s mother

27. David “I don’t know if the information about his brain injury got passed along to the 2nd grade teacher. It’s in his cumulative file, but I don’t know if anyone reads those.” -David’s mother

28. David “I had no training in TBI. It was tough…I wanted to push him, but I didn’t want him to get frustrated and shut down.” -David’s teacher

29. Accurate Incidence Increased Awareness Communication Appropriate Identification TRACKING Information Improved Training Appropriate Funding Breaking the Cycle

30. Improving Identification of Children with TBI • Improving the link between medical and educational settings • Helping schools “remember” the brain injury • Providing information, training, and resources

31. ResourcesOregon Brain InjuryResource Network • Comprehensive library (books, videos, journals) • Statewide database of available resources and services • Web site with relevant links • Telephone assistance & individualized information search 800-544-5243 or 503-413-7707 www.tr.wou.edu/tbi

32. ResourcesOregon TBI Consulting Team • Inservice training & consultation to educators working with students with brain injury • General or tailored to an individual student • Multidisciplinary team trained in pediatric brain injury 877-872-7246 or 541-346-0593 www.tr.wou.edu/tbi/team/index.html