1. Improving the Recovery of Students with Brain Injury in Georgia

2. National Perspective Traumatic Brain Injury
There is 5.3 million people living with TBI in the US.

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

4. Good News: Which Means:
Dramatic reduction in brain injury mortality rates over the past 20 years.
We are saving roughly 70% of those who previously died in serious motor vehicle accidents.
Which Means:
Increasing number of young, otherwise healthy individuals with chronic neuropsychiatric disabilities.
Traumatic Brain Injury in the United States: A Report to Congress. Division of Acute Care,
Rehabilitation Research, and Disability Prevention, CDC, US Dept HHS. December, 1999

5. 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
511,257
Children with Traumatic Brain Injury years of age
Most children who sustained a TBI (92.7%) were treated and released from the emergency department.

6. National Data – TBI by Age
0-4 year old group most at risk,
Weak reporting between pre-school setting over to elementary school level
Concern with abused children injuries and parents understanding of long term effect of young injury
14-19 age group
Concern with multiple injuries and unreported injuries (emer rm) thus untreated
Jail population research showed as high as 60% of inmates 1-2 untreated head injuries

7. Traumatic Brain Injury Georgia Statistics

8. How Common is TBI in Children in Georgia?
Each year, approximately
29, 991
children in Georgia sustain
a traumatic brain injury
(mild, moderate, or severe)
Source: Georgia Brain & Spinal Injury Trust Fund Commission, 2010

9. Statistics in Georgia 2010
28,962 children ages 0-21 made visits to the ED and 1228 children ages 0-21 were hospitalized with TBI. Only 422 were served in the school system that year.
Talking points:
These are numbers of DOCUMENTED cases per the GA BSITF resgitry. Does not include those who went to PCP with symptoms that occurred later or those who were not seen at all (e.g., child abuse).

10. Statistics in Georgia 2010 REMOVED REMOVED
We can assume that many kids seen in the ED for TBI will need school services but difficult to say exactly how many. Safe to say if hospitalized with mod-severe TBI would expect services are needed. Look at discrepancy of 2010 hospitalizations vs. number served that year, noting that the number served is representative of students receiving TBI in previous years (not just newly diagnosed in 2010).

11. 2 year Comparison of Trends Statistics in Georgia
TBI In 2009
29,839 ED visits
1346 hospitalized
423 students received school services for TBI
TBI In 2010
28,963 ED visits
1228 hospitalized
422 students received school services for TBI
At first glance – looks consistent – but this is not a good thing considering the number of new additions and the stability of the number served. Pattern/trend
Documented – reported by hosp & does not even include private physician or pcp visits
Lack of increase in TBI services despite increase in #s
Even though another 1228 were hospitalized in 2010 for TBI there were almost exactly the same number of students served the next year. Are we to assume all the ones from 2009 turned 22, graduated or no longer had effects from their mod-severe tbi?

12. Why don’t the numbers add up?
Not all students with a TBI experience lasting effects
Only TBI students with Special Ed Services are identified
Students with 504 Plans are not tracked
Not all parents report that their child was injured
They don’t want student classified
Parents don’t understand impact of TBI
Effects of TBI mimic other disabilities causing
mis-identification and inappropriate instruction and programming
May not be found eligible for services
Poor recognition of BI deficits due to limited staff knowledge
Weak links between hospitals & school (except rehab)

13. Why is Identification Important?
Injury at early ages 0-4 has a major impact on the actively developing brain
Deficits may not appear until later when higher level skills are needed
Deficits can worsen over time
Behavioral changes are not seen or treated as related to a brain injury
Learning needs of kids with TBI differ from those with developmental disabilities (e.g. static vs. dynamic changes)
follow up studies illustrate the long term effects of a TBI on school performance, such as academic performance worsens over time, as measured by the degree of difference in non-disabled peers. Additionally, employment and post secondary enrollment rates are lower than that of non-disabled peers.

14. Importance of Hospital-School Transition
Special education is the ticket
to continued rehabilitation in school

15. School Re-Entry after TBI
MEDICAL
FAMILY
TBI
Re-Entry
Identification
Evaluation
Services/
Programming
Trauma Care
Neurological
Stabilization
Rehabilitation
(from Mimi’s bridge slide)
IMPORTANT TO EXPLAIN; Transition begins with contact at the hospital, identify person who may assist with school planning.
Hospital model: medical model, acute/intensive care, acute/inpatient care, stabilization/discharge
 *Rehab: medical and educational, day program weekly, outpatient therapy, transition planning
 Family: home model, exhaustion/overwhelmed, financial/insurance, weak knowledge, limited support
 School: educational model, re-entry planning, limited BI knowledge, evaluation/ongoing, therapy needs, medical needs / nurse availability, monitor recovery
*decreasing number of patients qualify

16. Chris High School Junior TBI - Auto accident Life Goals:
Graduate high school
Go to college
Work on Wall Street
Barriers:
Memory
Processing speed
Divided attention
Executive functioning
Word finding

17. 4 months later…
60 days inpatient
4 weeks outpatient tx
Rehab assisted with contacting school, providing educ & resources to school and family and completing neuropsycholigcal testing and outlining academic needs
Success story – several years ago – now at UT studying finance
Success story: Chris graduated from high school on time with modifications and is a sophomore at Univ. of Tenn.

18. Emily First grader, public sch TBI car hit bike rider
Goal: return to school
Barriers:
-physical endurance
-fine motor skills
-visual perception skills
-memory for new

19. 1 year later photo
90 days inpatient
5 weeks outpatient day program
Rehab assisted school contact
Provided school & family with educational resources
Neuropsychological testing completed which included recomm. for acad needs/modifications
Success story: promoted to 2nd grade, but in 3rd grade speed of skill learning is less than expected given academic testing scores.

20. School Re-Entry after TBI *most students do not get rehab
MEDICAL
FAMILY
TBI
Home Care
Schedule appointments
Advocate
For child’s Needs
Re-Entry
Identification
Evaluation
Services/
Programming
Trauma Care
Neurological
Stabilization
Rehabilitation
(from Mimi’s bridge slide)
IMPORTANT TO EXPLAIN; Transition begins with contact at the hospital, identify person who may assist with school planning.
Hospital model: medical model, acute/intensive care, acute/inpatient care, stabilization/discharge
 *Rehab: medical and educational, day program weekly, outpatient therapy, transition planning
 Family: home model, exhaustion/overwhelmed, financial/insurance, weak knowledge, limited support
 School: educational model, re-entry planning, limited BI knowledge, evaluation/ongoing, therapy needs, medical needs / nurse availability, monitor recovery
*decreasing number of patients qualify

21. QUALITY OF RECOVERY AFTER A BRAIN INJURY
QUALITY OF RECOVERY AFTER A BRAIN INJURY.. is dependent upon the quality of supports a child receives So TEACHERS deserve to know more about brain injury to be able to help

22. Educator’s Knowledge of Brain Injury
Lack of Pre-service Training on brain injury
Less than 8% of graduate level special education training programs cover brain injury
Limited knowledge of the impact of TBI
Which can lead
to student frustration.....

23. How can we help improve a student’s recovery after surviving a TBI
How can we help improve a student’s recovery after surviving a TBI WHERE DO WE START?

24. Solutions for Georgia
Create a system for connecting children and their families with the school following TBI to identify and track ALL TBI students.
Develop an education training module for school staff that is easily accessed by all teachers across the state.
Fix formatting

25. “STEP” Oregon Program (also in OH, CO, OR, TN):
Solution #1
Create a system for connecting children and their families with the school following TBI to identify and track ALL TBI students.
“STEP” Oregon Program (also in OH, CO, OR, TN):
single point of entry at DOE for hospitals to call
DOE informs trained liaison, then liaison informs school
“SCORE” Children’s National Medical Center
4-corners approach (family, hosp, school, athletic/recreation)
Direct connection between hospital & schools
Preparation about TBI, develop protocols for hospital to school

26. Solution #2 “STEPS” Pennsylvania BSITF Georgia
Develop an education training module for school staff that is easily accessed by all teachers across the state.
“STEPS” Pennsylvania
Designated TBI professional by DOE
Built on “consulting teams” in regions of state, staff training
Communication between hosp & school, family & resources
BSITF Georgia
Created a Brain 101 teacher training module
Intended to be used to “train the trainer”

27. Given
the hospital statistics on yearly pediatric brain injury
the discrepancy between hospital & school data
the child’s immediate need for intervention after injury
the child’s need for maximized recovery over time
the possible delay of the appearance of deficits from injury
the family’s ongoing need for support and services
the need for teachers to be able recognize changes after injury
the need for school staff to have knowledge of TBI
Increase grad rates, improve test scores
We must…

28. We must begin to create a plan
to improve the identification of TBI students and train teachers in appropriate instruction to maximize test scores, graduation rates & overall academic success

29. Contacts “STEP” Oregon Program (also in OH, CO, OR, TN):
Contact info:
“SCORE” Children’s National Medical Center
Contact info:
“STEPS” Pennsylvania Program
Contact info: