Back to School Identifying 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

Faces of Brain Injury

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

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

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

Education Issues: Under-identification

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

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

Arizona Students with Special Education Eligibility in TBI

Effects of Brain Injury  No two brain injuries are exactly the same.  The effects of a brain injury are complex and vary greatly fromperson 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.

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

Disinhibition Impulsivity Socially inappropriate behavior Lack of initiation Possible Changes after TBI Emotions and Behavior

Possible Changes after TBI Cognition Attention/concentration Perception Processing speed Language Memory Decision making Planning Judgment Problem solving Organization

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

Growing Up Performance Growing Into It

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

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

Under- identification Lack of Awareness Apparent Low Incidence Lack of Training Lack of Research Money Lack of Right Services for Kids who are ID Under-identification Cycle

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?

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

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

Recruitment Sources Four Oregon hospitals Educational and medical professionals

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

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”

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

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

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

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

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

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

Resources Oregon Brain Injury Resource Network Comprehensive library (books, videos, journals) Statewide database of available resources and services Web site with relevant links Telephone assistance & individualized information search or

Resources Oregon 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 or