Traumatic Brain Injury Meets Response to Intervention Dr. Jonelle Neighbor Dr. Karen McAvoy. TBI and RTI. Response to Intervention and TBI. TBI may be different from other challenges impacting learning and behavior
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Jim Wright notes in RTI Toolkit: A Practical Guide for Schools (page 178) that
“If there is strong evidence that the student has a type of special education disability (e.g., Speech or Language Impairment, Traumatic Brain Injury), the school should consider bypassing the RTI Team and referring the student directly for a special education evaluation.”
Rushing to a special education evaluation may be like hitting a moving target: the student’s needs may change so rapidly that it is best to wait for stabilization of TBI characteristics before assessing for an Individual Education Plan.
Interventions can be adjusted quickly while IEPs cannot flex with a student’s potentially rapid changes in educationally relevant needs.
As scientist/practitioners, educators know that “best practice” for all students is to:
If educational impact is established via appropriate assessment, intervention, progress monitoring
and adjustment (of a reasonable time and intensity), the school team then has the authority to make the decision of: IDEA, 504 Plan or Not Eligible as appropriate.
Section 504 is a civil rights law that prohibits discrimination against individuals with disabilities. Section 504 ensures that the child with a disability has equal access to an education. The child may receive accommodations and modifications.
To be eligible for protections under Section 504, the child must have a physical or mental impairment. This impairment must substantially limit at least one major life activity. Major life activities include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself, and performing manual tasks. The key is whether the child has an "impairment" that "substantially limits . . . one or more . . . major life activities."
School, Clinical and Rehabilitation Psychologist, Speech Language Pathologist, Special Education Teachers
Nurses, Physical and Occupational Therapist
What are the “hallmarks” of TBI?
What formal assessments are you currently using when you suspect or know of TBI?
What informal assessment/observations are you currently using?
What would be helpful to you in terms of a protocol?
What training needs will you have to be
able to implement the protocol?
Medical Documentation of TBI
Credible History of TBI
It is still best practice to establish traumatic brain injury through medical documentation via hospital records and/or from a doctor or clinician who has knowledge of the Center for Disease Control (CDC) requirements for TBI.
Severe and moderate TBI– usually (not
always) lend themselves to medical documentation.
1. “The gold standard for determining prior TBI is self/parent-report as determined by a structured or in-depth interview” (Corrigan & Bogner, 2007)
Comprehensive Health History Interview
(Health history must be an interview; it cannot be a form mailed to the parent/caregiver)
Credible history of TBI requires a skilled interviewerto know how to ask certain questions, to ask pointed questions multiple times and in a variety of ways, to establish the details of the TBI(s). al (Body)
Medical intervention(s) sought at the time, later, through the recovery
Are answers medically plausible?
Be aware of assumptions – for example, the report of a “scalp laceration” or “head injury” does not automatically define a “brain injury”
2. There needs to be a reported incident(s) as well as on-going symptoms/behaviors that persist beyond the incident (Corrigan & Bogner, 2007).
During the health interview, details of the incident should be clear and consistent. The description of the injury should not vary widely from report to report, from reporter to reporter (if there are multiple reporters of the same incident).
If there are multiple injuries, specifics about each injury should be well-detailed and consistent.
Assess pre versus post-injury learning, behaviors, social skills, personality.
3. Finally, a screen or in-depth interview is not enough to “diagnose” TBI. These tools are simply to “screen” for potential TBI. If a screen or in-depth interview suggest there has been a credible history of TBI, a thorough assessment/evaluation is suggested (Corrigan & Bogner, 2007).
Confirm credible history with:
CSU Brain Checklist Screen
3 Primary Sections
Medical documentation/credible history simply confirms the presence of the TBI. It does not or cannot automatically establish the “impact” of the TBI. Confirming that an injury has occurred does not shed light upon the affect of the injury on subsequent physical, educational, behavioral, emotional, social outcome. Once medical documentation has been established, CDE requires that school teams continue to proceed through the protocol to establish “educational impact”.
Functional Community-Referenced Assessment
Once medical documentation
Educational Impact is established
Once Credible history is determined
Educational Impact is established…
Continue to assess need – set goals and objectives
Apply appropriate interventions
Adjust plan – (reassess need, apply new intervention, progress monitor)