1. TBI T RANSITION, R ESEARCH AND THE O REGON TBI T EAM Bonnie Todis, PhD Center on Brain Injury Research and Training

2. cbirt. org Overview What we know about the transition experiences of students with TBI. What we know about transition in general. What do we do with this knowledge? What does this have to do with you? What do you think?

3. cbirt. org Research on Outcomes after Childhood TBI Most of this research has been conducted by doctors and neuropsychologists. Why would they do this research?

4. cbirt. org What these studies look like Participants recruited from medical files Usually one follow up data point in adulthood Rarely look at school factors

5. cbirt. org What these studies didn’t tell us What are the transition experiences of young adults with TBI? How do employment, etc. fluctuate over time? What factors lead to different outcomes? Special ed? Family support? Community Supports Demographics (age, severity, sex)

6. cbirt. org National Transition Longitudinal Study (NTLS) 10-year study of transition outcomes Funded by OSEP 11,000 students 12 disability categories NTLS1 did not include students with TBI NTLS2 included youth who were 13-19 in 2000 Data collected in 2003 on 28% out of school

7. cbirt. org NTLS: Employment %

8. cbirt. org NTLS: Post-secondary Education %

9. cbirt. org NTLS: Living with Parents %

10. POST-SECONDARY OUTCOMES PROJECT (PSO)

11. cbirt. org Project PSO 8-year study of transition outcomes Funded by OSEP and NIDRR 90 students in Oregon and Washington Recruited at exit from high school Rolling recruitment over 2-3 years School districts VR

12. cbirt. org Employment Outcomes Ages 19-25 Age 19 ( n = 54) 20 ( n = 74) 21 ( n = 85) 22 ( n = 86) 23 ( n = 84) 24 ( n = 75) 25 ( n = 55) Employment 20 (37)36 (49)44 (52)42 (49)37 (44)35 (47)33 (60) Male 17 (46)23 (49)34 (60)34 (59)29 (52)26 (54)26 (74) Female 3 (18)13 (48)10 (36)8 (29) 9 (33)7 (35) <20 hrs/week 11 (55)18 (53)13 (32)14 (35)11 (31)10 (30)9 (29) ≥20 hrs/week 9 (45)16 (47)28 (68)26 (65)25 (69)23 (70)22 (71)

13. cbirt. org Post-Secondary Employment Outcomes 19-25

14. cbirt. org Closer Look: Employment at Age 25 60% employed 74% of males, 35% of females Hours per week Mean 21-30 No one worked more than 30 hrs per week

15. cbirt. org Employment Outcomes by Gender

16. cbirt. org Employment at Age 25 Wages Mean $8.22 per hour No difference between males and females Type of Job 81.3% in menial, unskilled, or semi-skilled categories The rest in skilled (11.3%) clerical/sales (5%) or technicians (2.5%) None in the top 3 categories

17. cbirt. org Comparison with Typical Peers EMPLOYMENT RATE WAGES PER WEEK HOURS PER WEEK TYPE OF JOB PSO Sample 60% $161-232 (male) $124-418 (female) 25.5 hrs 57%menial/unskilled 0%management/pro Typical Young Adults 68% $485 (male) $418 (female) 35.8 hrs 36%menial/unskilled 19%management/pro Bureau of Labor Statistics of the U.S. Department of Labor, January 19, 2007

18. cbirt. org Factors Predicting Employment Hierarchical Linear Modeling Results Family SES: Those with higher SES were less likely to be employed at the beginning of the study, more likely to be employed over time For every unit change in SES there was a 3.3% increase in the odds of employment and a.7% increase in the rate of change in employment over time.

19. cbirt. org Factors That Impact Employment Later age) Earlier age Later age Earlier age Avg age Males Females Work Category by Sex and Age at Injury Over Time Skilled manual labor Clerical, sales Semi-skilled Unskilled work Menial service Job Category by Sex and Age at Injury

20. cbirt. org Bonnie Todis, Ph.D. Center on Brain Injury Research and Training Factors That Impact Employment Early injury Later injury Wages Over Time by Age at Injury and Severity Later injury Severe Mild/Moderate Early injury

21. cbirt. org Factors That Impact Employment Severity Hours Worked per Week Injured earlier later Severity: M/M work > # Hrs. Gender: Males> #hrs. For both genders: Earlier age at injury = work fewer hours/week Females Males Females Males Injured earlier later SevereMild/Mod 21 – 30hr 11-15hr Hours Per Week 16-20hr

22. cbirt. org Factors That Impact Employment Later age Later age Early age Avg age Early age Severe Mild/ Moderate Job Happiness by Severity and Age at Injury Avg age Happy Very Happy Unhappy

23. POST SECONDARY EDUCATION

24. cbirt. org Post-Secondary Education Outcomes Ages 19-25 n(%) Age 19 ( n = 54) 20 ( n = 74) 21 ( n = 85) 22 ( n = 86) 23 ( n = 84) 24 ( n = 75) 25 ( n = 55) Education15 (28)26 (35)34 (40)22 (26)26 (31)18 (24)14 (25) Male7 (19)17 (36)20 (35)11 (19)15 (27)7 (15)6 (17) Female8 (47)9 (33)14 (50)11 (39) 11 (41)8 (40)

25. cbirt. org Post-Secondary Education Outcomes Ages 19-25

26. cbirt. org Comparison with Peers Non disabled young adults 18-25 46% enrollment (Pew 2007) 54% female (2005) NLTS2 45% reported continuing to postsecondary ed within 4 years of leaving high school. 32% community colleges 23% vocational/tech 14% 4-year

27. cbirt. org Factors That Affect Enrollment Higher family SES, shorter time to enrollment Females more likely to enroll Those injured later were more likely to enroll. For every year increase in age at injury there was a 12.3% increase in likelihood of enrollment.

28. cbirt. org Independent Living Outcomes Ages 19-25 n(%) Age 19 ( n = 54) 20 ( n = 74) 21 ( n = 85) 22 ( n = 86) 23 ( n = 84) 24 ( n = 75) 25 ( n = 55) Independent Living 12 (23) 26 (36)28 (35)37 (44)35 (41)37 (49)29 (53) Male7 (20)13 (28)18 (33)22 (39) 24 (49)20 (57) Female5 (29)13 (48)10 (37)15 (54)13 (45)13 (48)9 (45)

29. cbirt. org Post-Secondary Independent Living Outcomes Ages 19-25

30. cbirt. org Comparison with Peers Non-disabled peers 18-25 40% live with parents (Pew) NLTS2 ages 17-21 25% have lived independently at some time since high school (65% of these lived in a college dorm or military housing).

31. cbirt. org Factors That Affect Ind. Living Age at injury: Those injured earlier take longer to achieve independent living status. For each year older at injury, there is a 12.7% increase in odds of achieving independent living.

32. T RANSITION P RACTICES

33. cbirt. org What We Know about Transition Practices Transition has been mandated since the 80s Lots of programs have been developed Some programs have been evaluated USDoE provided funding to identify and disseminate research-based transition practices NSTTAC

34. cbirt. org How E-B Practices Are Identified Establish criteria for evidence of effectiveness Classify practices as Look at what you end up with

35. cbirt. org Taxonomy of Evidence-Based Practices Student-focused planning Involving student in IEP process Self-Advocacy Strategy Self-Directed IEP Student development Life skills Self-advocacy Employment skills reading, math Self-determination

36. cbirt. org Taxonomy of Evidence-Based Practices Family Involvement Training for parents about transition Program structure Community-based instruction Extending services beyond high school Check and Connect Interagency collaboration

37. cbirt. org Caution! Evidence is not strong Effectiveness have not been established for students with TBI Not included in most of the studies that were reviewed Why? (Top secret story that you can’t tell anyone!)

38. cbirt. org What does this mean? Knowing about transition outcomes for students with TBI Knowing what transition practices are most effective What is your next step as an educator?

39. cbirt. org What does this all mean? We have a pretty good idea what kids with disabilities need to prepare for transition We’re pretty sure kids with TBI need these things, too The things that work for other kids may need to be tweaked for kids with TBI

40. cbirt. org Outcomes so far…. Transition toolkit Transition Web Project IES Proposal

41. cbirt. org Transition Website Project History NIDRR Development Project 2011-2014 Three stages Development Pilot testing Evaluation

42. cbirt. org Transition Web Project

43. cbirt. org What does this have to do with you? Participatory Action Research Involve the people who are the stakeholder in the research in every phase of the research process Stakeholders Students with TBI Educators Family members

44. cbirt. org PAR Activities Predevelopment Qualitative findings from PSO What were transition services like? What was difficult for educators? Parents? Kids? What worked? Where were the gaps in knowledge? Practice?

45. cbirt. org PAR Activities Development Focus groups Interviews Participant observations

46. cbirt. org PAR Activities Pilot test phase Usability tests Advisory board

47. cbirt. org PAR Activities Evaluation Field test intervention Complete pre-post measures Focus groups Dissemination Presentations Help with articles Implementing evidence-based practices*******

48. cbirt. org PAR Activities for Team Members on T-Web Predevelopment Focus group Development usability Evaluation Treatment/Non-treatment

49. F OCUS - G ROUP /D ISCUSSION

50. cbirt. org Speaking of Research Opportunities cbiRt Current projects TATE STEP*** Family Web Transition Web *** MCH *** TEAM ***

51. cbirt. org Data on Team Activities ODE reporting requirements MCH reporting requirements WOU reporting requirements

52. cbirt. org

53. Other ways we use these data Dissemination – extending the team model Presentations Articles Grant proposals SOS Project Back to School/TOP STEP Transition Web - mentioned 5 times

54. cbirt. org Transition Web and the Team 18 years of working with educators on the TBI team provides knowledge about what p. 9 students and educators need and want. Team members will participate in development and evaluation pp. 19, 25 Prior research and development on which the new project is based p. 20 Transition pilot project (toolkit) p. 20

55. cbirt. org Data we currently collect Number of contact Demographics Concerns Actions Outcomes

56. cbirt. org Data we would like to have More specific information about Action Inservice training? Consultation? Information Number of people “touched” Educators, students, family members More specific information about Outcomes Did the training/information get used? How? What was the outcome for the educator? What was the outcome for the student? Parent?

57. cbirt. org Why we need these data In order to be accountable to ODE In order to be accountable to WOU, OSHE

58. cbirt. org Why we would like these data We could establish an evidence base for the team model Increased/stable funding for team activities and other TBI services We could disseminate the model to other states We could improve educational services nationally

59. cbirt. org What do you think? How can we help you send us more data? On Activities On People Served On Outcomes Action Plan