Building Capacity to Educate Students with Traumatic Brain Injury: B EYOND TBI 101 Patricia Sublette, Ph.D. Teaching Research Institute

What is Unique about TBI? Unexpected, unplanned, variable, dynamic, delayed onset of effects, happens to anyone

Students with TBI National TBI statistics/100, /100,000 children hospitalized for TBI annually-Krause 1995 Students eligible for SPED under TBI in Oregon 308 Oregon students id with TBI in 2007 (primary and secondary eligibility)

SPED Definition of TBI Educational Definition Traumatic Brain Injury …an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.

So What’s Acquired Brain Injury? All other brain injuries Disease processes Cancer, tumor Stroke Tumor Near drowning Students served under OHI Using the same strategies

Adjustment to Brain Injury

Family Recovery Patterns Following TBI 1. Overwhelming shock Focused on student survival 2. Disbelief regarding injury impact believe with enough effort the student can ”recover” mixed with euphoria as a student makes rapid physical recovery may refuse needed services 3. Sorrow and despondency anger as families realize that child is changed permanently

Family Recovery Patterns 4. Adaptation after the family has reorganized around the new needs of the student Semrud-Clikeman, M., Kutz, A., & Strassner, E., (2004). Providing Neuropsychological Services to Learners with Traumatic Brain Injuries. In Handbook of School Neuropsychology. D’Amato, R., Fletcher, Janzen, E., & Reynolds C.R., John Wiley & Sons : Hoboken, NJ.

Stress is higher for families who have an adolescent with moderate to severe TBI compared to students with an orthopedic injury

What Happens at School? Similar pattern of adjustment Great relief if there is physical recovery May overestimate student abilities May not attribute changes to TBI “Tyler is the same as he always was but more so” ~ Principle

Healing, Development and Impact Disability may be latent Continued development may reveal effects of TBI Recovery is superimposed on normal developmental processes, impacting previously learned skills and the development of future skills (Ewing-Cobbs et al., 1997)

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

Why do Schools Need to be Prepared? Number of students ID for SPED under TBI lower than expected Disability may not appear at time of injury TBI may be forgotten Challenging behaviors often not attributed to TBI Schools need to teach executive functioning

Student’s Brain Injury: “invisible” Student looks “fine” Student appears to be “recovered” Student is no longer being followed by medical personnel Medical personnel may have deemed the child ok

TBI the “Forgotten” Injury Early injuries Impact of TBI may not develop until years later Families unaware of injury significance School not informed of TBI Injury happens during summer Injured in early childhood As student transitions through grades information of injury and its impact is lost in file purges

TBI & Previous Disabilities Students may already be ID for SPED Students with ADHD 1.8x more likely to have a concussion 1.7x more likely to have inter-cranial injury

Wrong Label! TBI may lead to issues that are treated as primary disability Vision loss LD EBD Depression Acting out Leads to TBI issues being ignored or attributed to other causes

Most teachers feel un-prepared to teach children with TBI

Program Development is Challenging for Students with TBI Learning and behavioral characteristics are unlike students with other disabilities Extreme diversity within the population within each child

What are the Challenges for Teachers? Executive Function Difficulties Planning Organizing Monitoring effects of own behavior Impulse control Cognitive challenges Memory Initiation Attention Personality changes

Kids with TBI Tend to Have Challenges That….. Are more extreme Are dynamic May not respond to consequences

To Build Capacity Need knowledge Need the ability to teach students with TBI in ways that positively impact the student

Building Knowledge In-service is effective Builds awareness of problem TBI 101 covers methods of addressing problems with  Behavior, Knowledge, Executive Functioning In-service of teachers not likely to change behavior of students

Capacity Building that Changes the Way Teacher’s Teach: Combine in-service and follow-up coaching Coaching should include: verbal feedback praise correction Training Staff serving clients with intellectual disabilities: A metanalysis of aspects determining effectiveness-Wietske, M.W.J.

Staff Need….. Knowledge, Skills & Follow-up Coaching Online coaching is ok

W HAT IS H APPENING IN O REGON

Regional Programs for Low Incidence Disabilities 1 TBI part-time TBI Liaison in each region ARRA dollars allocated Based on the number of students id for SPED under TBI Most regions using fund > FTE for Liaisons

Numbers of Students ID for SPED by Region (07-08 data disk) R EGION 1 21 R EGION 2 25 R EGION 1 37 R EGION 1 31 R EGION 1 43 R EGION 1 82 R EGION 1 24 R EGION 1 44 TOTAL308 (includes primary and secondary eligibility)

Regional TBI Liaisons Offer support to TBI Team Members in Region who support teachers who support students Work districts to build capacity Work with TBI Team to meet the needs of students

Regional Liaison Contact Information 1.Lon Thornberg 2.Sue Hayes 3.Vicki Bernard 4.Betty Capt & Brenda Rioux (south coast) 5.Shannan Murphy-Barlow 6.Penny Jordan 7.Wendy Friedman 8.Laura Bekken

TBI Team Members Give guidance during re-entry to school following TBI Assist with support ideas Offer assistance with SPED Process Offer help with programming ongoing needs of students as needed Mostly based within the district

Teaching Research-Eugene Named PABI National Center in 2008 Researching methods to meet the needs of students with TBI for >20 years Mentors Regional Liaisons Facilitates statewide TBI team Approx 90 team members across the state Training and technical assistance for schools Website Monthly newsletter ( delivery)

C HANGES FOR ….

Maternal Child and Health Grant $45,000 awarded to Region 2 to pilot ideas for service delivery Awarded to Region 2 Used dollars to examine impact of  Increase Liaison FTE  FTE for a school-based TBI Coach  FTE for a Regional TBI Coach

Regional Programs and Teaching Research TBI Working Group (Oct 2007) Created a possible service delivery mechanism Based on focus group work from 2004 Work with ODE, TBI Liaisons & TBI Team members

Model of Service Delivery for Oregon Students with TBI HospitalFamilySchool Outside Agency TRI School Team (Including parent) School Team (Including parent) General Ed IEP 3-yr Re-Eval IEP 3-yr Re-Eval 504 Plan School Contact School Contact Regional TBI Liaison Regional TBI Liaison TBI Coach TBI Coach TBI Coach provides ongoing support as requested and does not carry a caseload TRI O State-wide leadership O Ongoing capacity building O Support evidence- based practices and materials O Educational opportunities open to educators in Oregon O Library services O Referral for parents seeking help O Central point of contact for regional medical centers O Centralized data collection O Build awareness of needs & services for students with TBI

Oregon Department of Education Regional Programs for Low Incidence Disabilities State-wide Leadership Grant (Teaching Research-Eugene) 1 Liaison per region at.5 FTE TBI Coaches 1.0 FTE/region minimum Building capacity for school teams serving students with TBI Coaching teams/staff in schools for students who have TBI Provide state-wide leadership for TBI Liaisons & Coaches, Team Providing leadership for TBI with Districts, Staff, SPED Directors, & 504 coordinators Collect data for continuous program improvement Support evidence-based capacity building at state, regional and district levels Providing educational opportunities open to educators in Oregon Offering evidence-based materials to assist in building capacity Ongoing capacity building for TBI liaisons, coaches & districts Offering materials and referral for parents seeking help Serve as a central point of contact for regional medical centers Serving as a centralized data collection point Building awareness of needs & services for students with TBI Assisting districts to identify need and build regional capacity Receive information & Referring students to TBI Coaches Providing library services for evidence-based interventions

Outcomes of Pilot Study Increase the number of correctly identified students with TBI Decrease the number of behavioral incidents Increase effectiveness of transition plans Measure satisfaction of parents, teachers, admin with services delivered

What is Available Now to Support Districts > Liaison FTE in Regions Statewide Seminars Face to face Webinars TBI Team Members Follow-up coaching for team members who attend statewide training Website for TBI and SPED in Oregon

New TBI Team Members Most Team members work within district Training open to educators throughout Oregon at no charge with permission of supervisor 2 year commitment after training is completed 3, 2 day trainings throughout year with nationally known speakers 2 Webinars Seminars followed by Case study, application & coaching of newly learned material Connection with regional team & Liaison In many regions 1 team member/district

Training for New TBI Team Members TBI 101- Overview, Eligibility & IEP writing Hospital Medical Program-Re Entry following TBI Executive function Academic Success ( instructional methods) Coaching & Consultation for TBI Team Members Addressing Behavior Difficulties following TBI Transition after High School

More Support for Students with TBI in Oregon Oregon Brain Injury Resources Resource librarian available to find specific information for your particular request regarding TBI EB strategies and information

Some Favorite Websites Brain line

Questions? Contact: Pat Sublette, Ph.D. Oregon TBI Education Services Coordinator