1. cbirt. org. Deborah Ettel, Ph.D. Center on Brain Injury Research and Training Principal Investigators: Ann Glang, Ph.D, Bonnie Todis, PhD NARRTC 2012 Annual Conference Advancing and Sustaining Research in Disability and Rehabilitation April 26-27 2012 Alexandria, VA

2. cbirt. org School support There is no systematic method for connecting children and their families with services within the school and community following TBI. Issue: Students with TBI underidentified & underserved in schools, lack of awareness,

3. cbirt. org School support

4. cbirt. org STEP (Student Transition and re-Entry) model Hospital call to State DOE State Department of Education DOE single point of contact - informs trained regional liaison Regional liaison informs the school offers resources to family and school ongoing communication family, support tracking by DOE

5. cbirt. org R4 R3 R6 R1 R2 R7 R5 R8

6. cbirt. org Sample Current N = 136 Preliminary analysis: N = 70 Children/youth ages 5-19 who: Are enrolled in public school Were hospitalized at least overnight for TBI Testing STEP: NIDRR Randomized controlled trial Ohio, Colorado, Oregon 5 hospitals, 3 Depts. Of Education

7. cbirt. org Study Design: RCT Student randomly assigned to STEP or usual care Parent and 1-2 teachers complete baseline measures Reassessment at one year T0 in hospital, T1 at 30 days post-injury, T2 at 1 year post-injury

8. cbirt. org What happens upon return to school after TBI? Parent and Teacher Measures State/Trait Anxiety Index Brain Injury Partners measures of advocacy skill Child Behavior Checklist (CBCL, aka Achenbach) CASP – Child & Adolescent Scale of Participation CASE – Child & Adolescent Scale of Environment Brief BRIEF (24 questions) STEP measures of parent concerns/services needed/provided/satisfaction

9. cbirt. org Severity of Injury –mostly mod-sev Frequency Count N = 70

10. cbirt. org Received inpatient rehabilitation services? Percent of total sample N = 136 Special Education Services

11. cbirt. org Does STEP make a difference? Results by TX Condition No statistically significant differences between outcomes for STEP vs. Usual Care

12. cbirt. org Does the effect of STEP depend upon whether or not the student had rehabilitation services? Tx effect controlling for rehabilitation services status Sample divided by Rehab (28) vs. No Rehab (42) Each group contained tx & control

13. cbirt. org % Students (non-rehab) with IEP at Time 2 N = 42 No Rehab Sample divided by Rehab (28) vs. No Rehab (42) Each group contained tx & control

14. cbirt. org % Parent Overall Satisfaction at Time 2 N = 42 No Rehab Sample divided by Rehab (28) vs. No Rehab (42) Each group contained tx & control

15. cbirt. org Big Picture For children/youth who did not receive rehabilitation, those in STEP showed better results compared with Usual Care: More likely to be found eligibility for special education under the TBI category Parents report school staff more helpful Parents express more satisfaction with school services Equivalent at T0

16. cbirt. org STEP in your state?: Key components Coordinator at state/regional Department of Education Regional liaisons Coordinator at hospital Using part of the recipe for success may not lead to the same outcomes Stay tuned! Next Steps for STEP: Continue data analyses