III-1 Module III ______________________________________________________ Returning To School

III-2 Module III Goal ______________________________________________________ To provide information that will facilitate the successful return of students with TBI to their schools

III-3 Module III Learning Outcomes ______________________________________________________ At the end of this module you will: –Understand the responsibilities of hospital and school in school re-entry planning –Be familiar with the IEP team process for students with TBI –Recognize common problems of students with TBI –Be able to plan an evaluation of a student with TBI

III-4 Transition to School ______________________________________________________ Preparing for transition to school begins at the time of injury

III-5 Transition to School ______________________________________________________ What can the medical facility do? What can the educational facility do?

III-6 School Re-entry Planning: Whose responsibility is it? _______________________________________________________ Responsibilities of school staff and medical staff shift over time Medical staff: assumes leadership for patient care in the hospital Educational staff: takes more responsibility for school planning as needs are known and discharge nears The family is involved throughout

III-7 Three Stages of School Re-entry Planning ______________________________________________________ At the time of injury During the hospital/rehabilitation stay Prior to discharge

III-8 Strategies for the Medical Facility ______________________________________________________ At the time of the injury –Identify a medical contact person (e.g., care coordinator or social worker) During hospitalization –Provide updates on progress and needs –Arrange for hospital visits for school staff –Educate family and school staff –Refer for special education if need is suspected

III-9 Strategies for the Medical Facility (cont.) ______________________________________________________ Prior to discharge –Inform family and school of discharge date –Provide discharge summary –Participate in IEP team if possible –Establish and communicate follow-up and reevaluation schedule

III-10 Re-entry Strategies for Schools ______________________________________________________ At the time of the injury –As soon as you know a student has been injured, designate a school contact person to receive and provide information –Identify the medical contact person

III-11 Role of the School Contact Person ______________________________________________________ Be a support to the family Get appropriate releases signed to share information Gather information from hospital personnel as it becomes available Inform others (such as teachers, peers, and siblings’ teachers) as needed

III-12 Re-entry Strategies for Schools (cont.) ______________________________________________________ During hospitalization –Obtain parent’s permission to release/receive information –Request updates from medical contact –Visit student in the hospital –Share information with school staff

III-13 Re-entry Strategies for Schools (cont.) _______________________________________________________ During hospitalization (cont.) –Refer for special education if appropriate –Educate parents about special education process –Arrange for staff training

III-14 Re-entry Strategies for Schools (cont.) ______________________________________________________ Prior to discharge –Obtain current hospital records –Complete IEP team process before discharge, if possible, but within statutory timeframes. –Collaborate with medical facility to obtain consultation and in-service training

III-15 Strategies For Successful School Re-entry of Students With TBI _______________________________________________________ Summary of strategies used by medical and school facilities appears on pages 15a-15b. Which strategies have participants used? Are there other strategies participants have found helpful in the transition from hospital to school?

III-16 Transition to School Checklist _______________________________________________________ The Transition to School Checklist is designed to help school personnel monitor completion of transition activities Please refer to the Checklist on page 16a.

III-17 Transitions also include ______________________________________________________ Transitions between classes Transition to new schools Transition to post school settings Other students See Transition Checklist on p. 17a

III-18 The IEP Team Process _______________________________________________________ 1. Refer the student to the LEA 2. Identify IEP Team members 3. Evaluate the student’s eligibility and determine needs 4. Develop the IEP 5. Offer placement

III Refer the student to the LEA ______________________________________________________ In moderate and severe brain injuries referrals usually occur while the student is hospitalized As soon as you suspect a student is a child with a disability, inform the parent of your intent to refer, and refer in writing to the LEA

III Identify IEP team members _______________________________________________________ The IEP Team must include members designated in Chapter These requirements are reproduced on the next page of your manual Others with special expertise or knowledge may be included at the discretion of parent or school

III Identify IEP Team Members (cont.) ______________________________________________________ Who would you want on Serena’s IEP team? Who would you want on Monty’s IEP team?

III Evaluate the student’s needs _______________________________________________________ As part of the evaluation the IEP team: –Reviews existing evaluation data evaluations and information provided by parents previous interventions and their effects current classroom-based assessments and observations observations by teachers and related services providers

III Evaluate the student’s needs (cont.) ______________________________________________________ After review of data the IEP team determines – if additional data are needed, and if so, who should gather it –if child has an impairment –present levels of performance –if child needs SE and related services

III Develop the IEP ______________________________________________________ If the IEP team determines that the student has an impairment (TBI) and needs special education and related services, the team prepares the Individualized Education Program

III Offer placement _______________________________________________________ An educational placement is developed to implement the child’s IEP To the maximum extent appropriate, a child with a disability is educated with nondisabled children (Chapter )

III-26 Designate a case manager _______________________________________________________ It is best practice to appoint a case manager who coordinates communication among IEP team members

III-27 What types of problems can the school anticipate? _______________________________________________________ Serena Monty Mike

III-28 Common Problems of Students with TBI ______________________________________________________ Certain types of difficulties are common in students with TBI Anticipating these difficulties can facilitate successful re-entry to school Problems can be physical/medical, cognitive, sensory, motor, social, emotional, and behavioral

III-29 Physical/Medical Problems _______________________________________________________ Problems –Seizures –Fatigue –Headaches –Swallowing/Eating –Self-care activities Medication issues (see p. 29a) Is an Individualized Health Care Plan (IHCP) needed? (see p. 29c-d)

III-30 Common Motor Problems ______________________________________________________ Apraxia Ataxia Coordination problems Paresis or paralysis Orthopedic problems Spasticity Balance problems Impaired speed of movement Fatigue See p. 30a

III-31 Sensory/Perceptual Problems ______________________________________________________ Visual deficits –field cuts –tracking (moving and stationary objects) –spatial relationships –double vision (diplopia) Neglect Auditory deficits Tactile deficits

III-32 Cognitive/Communication Problems _______________________________________________________ Executive functions Memory Attention Concentration Information processing Sequencing Problem solving Comprehension of abstract language Word retrieval Expressive language organization Pragmatics

III-33 Executive Functions ______________________________________________________ Planning, prioritizing, sequencing, self- monitoring, self-correcting, inhibiting, initiating, controlling or altering behavior (Savage & Wolcott, 1995, p. 150)

III-34 Cognitive/Communication Deficits _______________________________________________________ See p. 34a for additional information regarding cognitive/communication problems See p. 34b for an example of Monty’s difficulties at school

III-35 Social-emotional Problems _______________________________________________________ Irritability Impulsivity Disinhibition Perseveration Emotional Lability Insensitivity to social cues Low frustration tolerance Anxiety Withdrawal Egocentricity Denial of deficit/lack of insight Depression Peer conflict Sexuality concerns High risk behavior

III-36 Social-emotional Problems ______________________________________________________________ See p. 36a for descriptions of social- emotional deficits See p. 36b for an example of Serena’s difficulties at school

III-37 Behavioral Problems ______________________________________________________ Deficits (all types) may lead to challenging behaviors –non-compliance –aggression –confrontational behavior –lack of initiative –withdrawal

III-38 Traumatic Brain Injury Checklist _______________________________________________________ Orientation and Attention to Activity Starting, Changing, and Maintaining Activities Taking in and Retaining Information Language Comprehension and Expression Visual-Perceptual Processing Visual-Motor Skills Sequential Processing Problem-Solving, Reasoning, and Generalization Organization and Planning Skills Impulse or Self-Control Social Adjustment and Awareness Emotional Adjustment Sensorimotor Skills

III-39 Manifestations of TBI by Age __________________________________________________________ Preschool –Irritability and crying –Temper tantrums –Frustration –Fearfulness –Disabilities become evident over time as higher level skills are expected to develop

III-40 Manifestations of TBI by Age _________________________________________________________ Elementary school –Difficulty with new learning –Short attention span and impulsivity –Frustration –Inappropriate social interactions –Disabilities become evident over time as higher level skills are expected to develop

III-41 Manifestations of TBI by Age ________________________________________________________ Middle school and high school –Difficulty with new learning –Short attention span and impulsivity –Frustration over skill losses –Decreased social judgment –Risk-taking –Depression and anxiety –Sexuality concerns –Effects of earlier injury become evident

III-42 What happens as a result of these deficits and behaviors? _______________________________________________________ Friends leave Families mourn Teachers are frustrated The student is at increased risk for isolation from peers, academic failure, depression, substance abuse, sexual behavior, delinquency, further TBI

III-43 Evaluation of students with TBI _______________________________________________________ Two purposes: Identification of a student as a student with a disability Program planning

III-44 Evaluation Planning ______________________________________________________ Where do you begin after a referral is made? What do you need to know about the student to determine eligibility for special education and related services and to develop an IEP?

III-45 Information to Determine Needs _______________________________________________________ TBI information Information about areas of functioning –Cognition and memory –Speech and language; communication –Sensory and perceptual abilities –Motor abilities –Psychosocial impairments –Physical functions/safety –Academic skills

III-46 Challenges to Evaluation for Programming ______________________________________________________ What factors make evaluation of the programming needs of students with TBI challenging?

III-47 Challenges to Evaluation for Programming: Student Factors ______________________________________________________ Rapidly changing skills (especially during first 6-12 months) Communication, physical, sensory, motor, emotional, and behavioral difficulties may interfere with assessment Uneven skill profile (some higher skills preserved with lower skills lost) Performance influenced by state and situation Problems may emerge later

III-48 Challenges to Evaluation for Programming: Other Factors ______________________________________________________ The family is probably in distress Initial assessment is probably conducted outside school in a setting unlike the classroom Much assessment information is needed from other professionals (who are busy) Medical reports may be difficult to interpret Assessment requires IEP team coordination and planning

III-49 What can be done to address these challenges? _______________________________________________________ Use classroom data to inform instruction Use observation, curriculum-based measures, work samples, trial teaching Assess across content, time, settings Invite parents to provide information Ask medical personnel for assistance Plan team evaluations Share information

III-50 Teamwork: The Family and the School Staff _____________________________________________________ Parent(s) and educators work together Educators recognize and respect the expertise, values, and concerns of the family The family recognizes and respects the skills of educators Communication is frequent and honest

III-51 TBI Evaluation Planning: Group Activity ______________________________________________________ Refer to the TBI Evaluation Planning worksheet on pages 51a and b Monty and Serena have been referred for evaluation for special education. What do you know? What do you need to find out?

III-52 How Can I Gather Additional Information? _______________________________________________________ Record review (school and medical) Direct observation (school or hospital) Student interview (if possible) Teachers/service provider interviews Criterion-referenced assessment Curriculum-based assessment Rating scales and checklists Neuropsychological assessment (if available)

III-53 Test Interpretation: Cautions _______________________________________________________ Standardized, norm-referenced measures –may not assess the full range of skills –testing situation may mask deficits –limited predictive validity Timed tasks –may reflect motor slowing, not ability Measures of prior knowledge –may not reveal difficulty with new learning

III-54 What does Wisconsin law require in evaluations for special education? ______________________________________________________ See Chapter on pages 54a and 54b

III-55 Monty and Serena: Do they meet Wisconsin criteria for TBI? _______________________________________________________ Acquired injury to the brain External physical force NOT congenital or birth trauma Partial functional disability or psychosocial impairment or both Impairments in one or more areas (listed in definition) Need special education/related services

III-56 End of Module III