1. TBI and Transition Lauren Lindstrom, University of Oregon Robin Harwick, Center for Brain Injury Research and Training

2. Session Overview Youth with TBI TransWeb Project Focus Group: what are the current needs? Wrap-up & Resources

3. What’s Unique about TBI? Sudden onset. Half of all childhood TBIs occur between ages 14-19 By high school, students with early injuries are different from students with later injuries Parents and students cling to pre-injury post-secondary plans Learning challenges are unique

6. What do we know? Transition Outcomes PSO project: 89 students with TBI in Washington and Oregon Tracked for up to 6 years: 18-25 Employment Post-secondary education Community integration

7. Going to College: Youth with TBI Non disabled young adults 18-25 = 46% enrollment Youth with TBI = 45% enrollment (within 4 years of leaving high school) 32% community colleges 23% vocational/tech 14% 4-year Only 17% remained in college one year after high school

8. 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.

9. Post-secondary outcomes Important qualitative finding of PSO: Students injured later (in high school) tend to follow their pre-injury transition plans. Often go to college where they are likely to struggle and fail. Parents and teachers support this because they don’t know what else to do. And because they hope it works out.

10. What about employment? 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

11. 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

12. What this means for Transition Some of the strategies you use with other students may need to be modified to address these challenges Awareness of strengths and challenges Planning, remembering, initiating, following through Managing impulsivity, inertia, rages, frustration Speech/communication impairment Reading/responding to social cues

13. What this means for transition Working with the family may be challenging May be be protective (this child almost died) May assume rapid post-injury recovery rate will continue until full recovery May expect school to focus on recovery rather than maximizing education

14. Trans Web Project Why do we need this? Students with TBI have poor transition outcomes Several aspects of TBI are challenging for educators and employers Because TBI is considered “low incidence” most educators aren’t trained Because of sudden on-set, most parents aren’t prepared for transition

15. Transition Web Project Student component Parent Component Teacher component

16. What do you think? Focus Group

17. Wrap-up/Resources TBI Teams TBI Toolkit cbirt.org

18. TBI Toolkit Examples Transition StrategyTBI Challenge & Adaptation Learning in context -teach competencies a student will need in the contexts that they will need to use them Many students with brain injury look “normal” and it is easy to overestimate skills and abilities until the individual performs in the desired setting. Learning in context helps employers and students understand what is easy or hard for the student and how to adapt to help the student be successful. Self Awareness -most transition age students are working to discover who they are and what they will do in life Students with TBI are often discovering skills and abilities (and needs and deficits) as they are healing and maturing. Students with TBI often need to actively work on self awareness as they create a new understanding of themselves, their abilities, strengths and challenges following the brain injury.

19. TBI Toolkit Examples Transition StrategyTBI Challenge & Adaptation Family Involvement- a predictor of school and transition success for at risk youth As with the youth him or herself, many families are adjusting to life after the brain injury. Especially true for recent injuries. Person Centered Transition Plans Students with TBI may need several explicit plans over time that change as the student changes and adapts to the student’s new understanding of him or herself. Helping students with unrealistic goals; use their explicit plans to reflect on abilities, gain self awareness, self determination and self advocacy while evaluating their steps toward personal goals.

20. TBI Toolkit Examples Transition StrategyTBI Challenge & Adaptation Mentorship/Coaching Students with TBI are often unaware of their own limitations or create information to fill gaps in memory or knowledge (confabulation). It is important for mentors to understand the reason for this behavior and not attribute it to lying or being intentionally misleading. Initiation and Motivation Many students with TBI demonstrate neurologically-based initiation impairments that are the direct result of their injuries. A student may be unaware that difficulty starting new tasks is a challenge and need a plan to begin work on a task or set of tasks. For students with limited motivation, use routine to replace internal motivation and create a sense of success.