BrainSTEPS Child & Adolescent Brain Injury School Re-Entry Program

S S trategies T T eaching E E ducators P P arents S S tudents

What is BrainSTEPS? Brain injury consulting teams available to families and schools throughout Pennsylvania. Teams are extensively trained in the educational needs of students returning to school following brain injury. Teams will work with local school staff to develop educational programs, academic interventions, strategy implementation, and monitoring of students.

What BrainSTEPS Can Do: 1.Conduct observations of the student 2.Communicate with the district and medical professionals to ensure a smooth re-entry 3.Review medical, rehabilitation, & educational reports to assist in making educational recommendations.

What BrainSTEPS Can Do: 4. Create & provide a training for the school on the educational impact of the student’s specific brain injury. Educate and support district staff & family. 5. Provide Peer Trainings, so peers understand how brain injury has impacted their classmate.

6. Consult on all aspects of the student’s educational plan & make recommendations to the district team. 7.Assist in transitioning a student from grade to grade or school to school by training new teachers What BrainSTEPS Can Do:

Who should be referred to BrainSTEPS? 1.A student who continues to have CONCUSSION symptoms 2 WEEKS after injury, should be referred to BrainSTEPS. 2. A student who sustains a more moderate to severe brain injury should be referred prior to the student’s return to school. 3.A student who has an older injury, but begins to experience educational impacts as their brain matures/develops can be referred at any time through graduation.

Traumatic Brain Injury STATISTICS

Brain injury is a leading cause of death and disability in children & young adults.

Children with Traumatic Brain Injury 0-14 years of age CDC Statistics Average ANNUAL number of Traumatic Brain Injury Emergency Department Visits and Hospitalizations in the United States Most children who sustained a TBI (91.5%) were treated and released from the emergency department. United States. Centers for Disease Control. Traumatic Brain Injury in the United States ,000

Each year, approximately 26,000 children in Pennsylvania sustain a traumatic brain injury (mild, moderate, or severe) Source: The Brain Injury Association of Pennsylvania, 2008 How Common is TBI in Children in Pennsylvania?

Causes of Traumatic Brain Injury Infants Accidental Dropping Physical Abuse Toddlers Falls Vehicular Accidents Preschoolers Falls Vehicular Accidents Physical Abuse Elementary School Children Bicycle Accidents Recreational Injuries Falls Vehicular Accidents Adolescents Sports Injuries Assault Vehicular Accidents

Causes of Acquired Brain Injury Post Cancer Treatment Toxic Substances Infections Aneurysms Stroke Anoxia (i.e. choking, respiratory / heart conditions)

Brain injury can occur even if there is no loss of consciousness.

A Concussion is a Traumatic Brain Injury!

Concussions in Pennsylvania: Annually, approx. 22,000 children ages 0-21 years suffer concussions

A Child’s Brain Underdeveloped – the younger the child, the less developed is their brain Easily Injured – infant’s neck is weak New skills build on ESTABLISHED skills over time Brain injury interrupts skill development, and can prevent new skills from developing

Important Developmental Stages Child’s stage of development when injury happened Child’s stage of development NOW

Pre-Existing Conditions & TBI Children with pre-existing behavioral weaknesses are much more likely to have a TBI. Effects of TBI will compound and add to pre- existing learning, behavioral or psychological problems, such as: » Dyslexia » ADHD » Paranoia » Depression

Effects of Brain Injury on Children

Examples of Physical Effects Headaches Changes in speech & language Stamina/weakness Difficulty with balance Seizures Sensory changes Taste Smell Hearing Vision

Cognitive Effects Executive Function Challenges: – Attend or concentrate – Initiate, organize, or complete tasks – Sequence, generalize, or plan – Flexibility of thinking, reasoning, or problem solving – Working memory

Cognitive Effects Metacognitive Challenges: – Abstract thinking – Information processing (slowed speed) – Judgment or perception – Long-term or short-term memory

Cognitive Effects Related Challenges: – Confabulation – Ability to acquire or retain new information – Inconsistent and unpredictable learning rate

Social, Emotional,Behavioral Issues Distractibility Impulsivity Irritability Aggression Motivation & Initiation Depression Lack of Social Judgment Denial/Lack of Self-Awareness Rigidity/Inflexibility Low Frustration Tolerance

Instructional Strategies to Consider Classroom rules & expectations should be well structured and explicitly taught Instruction should contain repetition & feedback Avoid multi-step instructions if possible From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

Instructional Strategies to Consider Supplement verbal instructions with writing and modeling Provide ample time to process, complete tasks, and respond Assist the student in keeping his/her materials and schedule organized From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

Instructional Strategies to Consider Teach compensatory strategies for test-taking, note-taking, reading materials, etc. Try external aids such as lists, diaries, computers, calculators Videotape the student’s progress in class to provide feedback and show progress From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

Modifications to Consider Consider scheduling adjustments, i.e. breaks, study hall, eliminating non-core classes, etc. Assist the student in changing classes Introduce student gradually, i.e. small group Need for supervision Consider ESY, homebound services, instruction in the home, or tutoring for summer months From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

BrainSTEPS Partnerships in our Region – Discharge Info from: Children’s Hospital Pittsburgh Children’s Institute Pittsburgh

Pennsylvania’s BrainSTEPS Program is Considered a National Model for Brain Injury School Re-Entry! BrainSTEPS received the Award of Excellence for Programs & Services December 2008, from the national Brain Injury Association of America

For More Information on the BrainSTEPS Program Contact: Jamie Moder, MHPE, CHES Adapted Recreational Education Consultant Allegheny Intermediate Unit Brenda Eagan Brown, M.S.Ed., CBIS BrainSTEPS Program Coordinator Brain Injury School Re-Entry Program Brain Injury Association of Pennsylvania

REFERENCES Chapman SB. Neurocognitive stall: a paradox in long term recovery from pediatric brain injury. Brain Injury Professional, 3(4): 10-13, Kennedy, M. & Krause, M., University of Minnesota, Symposium on Disability Studies & Inclusive Education, July 23, 2010 ppt presentation Savage RC. The Child’s Brain – Injury and Development, Lash and Associates Publishing, Wake Forest, NC, Savage, Ronald C. “The utilization of allostatic load theory to predict long term deficits in children/adolescents with TBI” presented at North American Brain Injury Society conference. October, 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),