Lessons Learned: 15 Years of BrainSTARS in the U.S. Jeanne E. Dise-Lewis, Ph.D. Professor University of Colorado School of Medicine Director, Psychology Programs in Rehabilitation Medicine Children’s Hospital Colorado Jeanne.firstname.lastname@example.org Vilans Medical Education
Jeanne E. Dise-Lewis, Ph.D.
University of Colorado School of Medicine
Director, Psychology Programs in Rehabilitation Medicine
Children’s Hospital Colorado
Vilans Medical Education
June 7, 2012
June 7, 2012
The primary agents of cognitive rehabilitation are parents and school personnel.
School personnel are not prepared and do not feel competent as brain-injury educators.
Relatively brief education can be effective.
Effective intervention requires some kind of follow-up.
Effective intervention requires a team approach.Lessons Learned: 15 Years of BrainSTARS in the U.S.
In surveys of workshop attendees, more than 800 school personnel were asked “Before today, how much education/training have you had in TBI in children and youth?”
None 17% A Little 32%
Some 38% A lot 13%
Where did you receive your education/training?
Grad school 32%
Continuing education 19%
On job experience 58%
Professional reading 40%
Talk with colleagues 40%
Guided use of BrainSTARS Manual
Participant receives a manual to keep
Understand sources of PABI and its associated behavioral, psychosocial, and learning disabilities: 4.71
Understand the impact of PABI at different stages of development: 4.75
Understand interventions effective for various behavioral and learning difficulties: 4.60
Feel competent in using the BrainSTARS Manual to look up target symptoms, identify underlying neurodevelopmental weaknesses, and develop intervention plan: 4.80
1= not at all 2= somewhat 3= well 4= very well 5= exceptional
53% contributed TBI-educated information at IEP, school staffing or other student-related meeting.
98% reported workshop was moderately (36%) or very (62%) helpful in understanding and addressing cognitive and academic problems of students who have ABI.
96% reported workshop was moderately (26%) or very (70%) helpful in understanding and addressing behavioral problems of students who have ABI.
65% sought more consultation regarding a student who had ABI.
76% had used the manual some (51%) or quite a bit (25%).
Medical and physical therapeutic needs are identified and met well, regardless of home community.
There is a critical need for psychological services and “something different” to happen in school regardless of home community.
This need is not identified at one-month after hospital discharge, but appears at about 5-8 months after hospital discharge, as well as at developmental stage transition points.
This need varies by developmental stage.
Need increases three-fold for every five years’ age change from age 2 through age 18.
Transfers medically-based brain injury knowledge to parents and school personnel of a specific child, via BrainSTARS consultant.
Develops competent team functioning, so that the parents and school personnel can rely on each other for continued problem solving and support.
Leaves a resource (BrainSTARS Manual) to support ongoing collaborative problem-solving regarding developmental needs of the child.
It takes a team effort by normal people in student’s life to get the child back on track.
Knowledge about the impact of brain injury on children’s development is a necessary foundation for a well-functioning team.
Teams need functional, practical suggestions.
Accommodations need to be flexible and routinely updated.
Develop and support family-school-consultant teams.
Educate team members about brain injury and interventions/ accommodations.
Develop strategies and functional accommodations with BrainSTARS Manual.
Three consultation sessions over 4+ months.
Create a neurodevelopmental understanding of the child’s problems
Teach effective responses to problems in learning/behavior that result from ABI
Actively support family-school team interaction
Teach team members to rely on the BrainSTARS Manual and each other for problem solvingBrainSTARS Consultation Objectives
I can identify (Andrew)’s cognitive or behavior problems clearly and specifically in a way that allows for accurate observation and measurement.
I can link (Andrew)’s problems/symptoms to underlying neurodevelopmental deficits/challenges.
I can identify learning objectives for (Andrew) that are specific and progressive.
I can structure my home/ classroom to support (Andrew’s) positive behavior and effective learning.
I can arrange positive antecedent conditions to set the stage for (Andrew) to display more organized, successful behaviors.
I think that other members of the team and I have a similar understanding of (Andrew)’s needs and of what to do to assist him/her.
I can use testing information effectively in planning programs and accommodations for (Andrew).
*p<.05 (1-tailed t-test)
Parents N=26 School Personnel N=37
I feel confident in my ability to respond effectively when (Andrew) has a behavior problem.
I can figure out the causes of a recurring behavior problem that (Andrew) has.
I can understand how (Andrew)’s behavior and challenges have affected his/her family and can contribute to identifying and meeting family needs/priorities.
I can identify and obtain community supports and services for (Andrew) and his/her family.
I can perform a “task analysis” in order to break down a complex skill in to component sub-steps so that (Andrew) can learn/build the skill more effectively.
I can participate in the IEP process in such a way that (Andrew)’s educational and other school-related needs are addressed in a specific, individualized, and comprehensive way.
* p<.05 (1-tailed t-tests)
Parents N=26 School Personnel N=37
Pre and Post BrainSTARS Consultation
1) arrange meeting time at school’s convenience; prepare school point-person to receive forms and get them filled out/returned
2) send Self-Assessment of Skills forms and BRIEF to parents and school personnel with mechanism for return of these before meeting # 1
1 BRIEF-Parent and 1 BRIEF-School
1 BASC-Parent and 1 BASC-School
1 Skills form for each person who will participate in consultation program
3) review Skills forms; score BRIEFs and BASCs
1) Hold team discussion to identify student’s areas of cognitive and behavioral difficulties and strengths.
2) Use team discussion of problems/strengths, with BRIEF and other data to zero in on likely neurodevelopmental deficits.
3) Identify up to 5 neurodevelopmental deficits on NDC and rate them as a group.
4) Use Skills forms to identify educational needs of team members and discuss intervention approaches, directing participants to Chapters 5 and 6.
5) Look at Blue Tab sections that correspond to NDCs and begin discussion of specific interventions, personnel, etc. to address one or two problems.
6) Direct team to manual sections of greatest relevance; bookmark these and assign homework reading of Chapter 3 and section of Chapter 4.
7) Set up a system of proactive parent-school communication.
8) Set next meeting date/time.
1) Review progress/snags.
2) Reinforce connection between symptoms and neurodevelopmental deficits– new wine in old bottles.
3) Assist team to develop exercises, accommodations, or interventions to respond to ongoing problems.
4) Look for examples, settings in which child is behaving appropriately or intervention is working; turn to team members for ideas/ suggestions/ problem solving.
1) Review progress/snags.
2) Reinforce connection between symptoms and neurodevelopmental deficits; refine interventions.
3) Fill out post-measures:
Neurodevelopment Cluster ratings (Team)
Self-Assessment of Skills (each member)
BRIEF (one parent and one teacher)
BASC (one parent and one teacher)
4) Discuss developmental stages and encourage team to anticipate need for next BrainSTARS consultation.