Educational Services for

Children with TBI

Ann GlangTeaching Research Institute

Eugene, OR

David

“The teachers say David is fantastic, such a joy. A little slow. But that’s David now. They don’t know David as any way else.”

-David’s mother

David

“I don’t know if the information about his brain injury got passed along to the 2nd grade teacher. It’s in his cumulative file, but I don’t know if anyone reads those.”

-David’s mother

David

“I had no training in TBI. It was tough…I wanted to push him, but I didn’t want him to get frustrated and shut down.”

-David’s teacher

Overview

What do we know about transition and school services for children/youth with TBI?

Factors impacting service delivery

Special Education

For most children, rehabilitation takes place in school

Identification for special education is necessary to access services

Special Education

Once identified, child is entitled to: Comprehensive assessment

Development of Individual Education Plan (IEP) based on unique needs

Instruction tailored to needs

Most appropriate classroom placement

Special Education

Once identified, child is entitled to: Annual review of IEP

Re-assessment every 3 years

If child doesn’t qualify, some services can be provided under Section 504

Under-identification for Special Education Annually: 30,000 with persisting

disabilities from brain injury

Annually: 10,000 (1/3) needing special education supports

Cumulative total (K-12): 130,000

Total on federal Sped. census (2002): 14,844

Under-identification for Special Education

0

100,000

200,000

300,000

400,000

Expected cumulativetotal K-12

If 1/3 require SpecialEducation

Actual total

Under-identification

Lack of Awareness

Apparent Low Incidence

Lack of Training

Lack of ResearchMoney

Inappropriate Services

Under-identification Cycle

Back to School Study

Examining under-identification for special education services

Study conducted in Oregon and Washington

Annual surveys

Annual interviewswith sub-sample

Quantitative

Qualitative

Back to School Project Design

Classroom observations and in-depth interviews

Back to School Project (n = 74)Gender

60%40%

Male Female

Back to School ProjectGeographic Distribution

68%24%

8%

Rural Suburban Urban

Back to School ProjectSeverity of Injury

24%

76%

Severe Mild/Moderate

Back to School ProjectAge at Injury

Mean 10.92

Median 12.00

Range 4-15

SD 3.26

Back to School ProjectCause of Injury

24% 24% 24%20%

8%0%

10%

20%

30%

MVA Ped/Bicycle-MVASports/Recreation FallUnknown

Back to School Project

Identification for Special Education at 3 months Post-

Discharge74 children enrolled in tracking study

28 report no problems

21 are served under TBI category

5 are served under another category

6 are served under 504

14 are experiencing challenges and are not identified for special education

Back to School Project

Preliminary findings from interviews with

parents

N = 57

Parent interviewDid you receive

information about TBI from hospital?

74%

26%

YES NO

Parent interview Was there communication between hospital & school?

50%

39%11%

YES NO Do Not Know

Parent interview Did communication create smoother school re-entry?

73%

18%9%

Helpful Not Helpful Do Not Respond

Parent interviewSchool programming

0

10

20

30

40

50

60

70

reentry 12 months 24 months

IEP 504 No Services

%

Parental concernsRe: speech, language,

communication

0

10

20

30

40

50

60

70

80

Re-Entry 12 mo 24 mo

No IEP IEP

%

Parental concernsRe: physical / motor skills

0

10

20

30

40

50

60

Re-Entry 12 mo 24 mo

No IEP IEP

%

Parental concernsRe: social/behavioral skills

0

10

20

30

40

50

60

70

Re-Entry 12 mo 24 mo

No IEP IEP

%

Back to School Project

Educator surveys

N = 34

Educator surveysHave you attended TBI workshops/trainings?

15%

85%

YES NO

Educator surveysHave you found other resources about TBI?

29%71%

YES NO

Educator surveysHow many school staff are

aware of student’s TBI?

48%36%

12%4%

All Some None Do Not Know

How much of a concern is this for your student?

2.47 2.47 2.5 2.03

0

1

2

3

4

5

New Learning Organization

Attention/Focus Behavior

How prepared do you feel to provide support in this

area?

3.41 3.32 3.26 3.35

0

1

2

3

4

5

New Learning Organization

Attention/Focus Behavior

Emerging Themes

Students may be viewed as malingering, lazy, disorganized, “just adolescent”

Many parents are not aware of potential school services available to their child

Emerging Themes

The parents usually bear the responsibility to educate school personnel about the effects of TBI

Even when schools are aware of the TBI, they don’t associate certain behaviors with the injury

Why are Students with TBI

Under-Identified and

Under-Served?

Under-identification

• Educator’s knowledge/awareness• Lack of preservice training• Lack of feelings of competence

• “Forgotten” injuries

Appropriate Identification

Increased Awareness

Accurate Incidence

Appropriate Funding

Breaking the Cycle

More Appropriate

Services

Training for

teachers

Promising Practices

Systematic training for educators

can lead to increased awareness and

identification for services

100

125

150

175

200

225

250

275

300

325

350

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

Num

ber

of Id

entifi

ed S

tud

ents

Oregon Students (Age 3-21) with Special Education Eligibility in the

Area of TBI (1994-2004)

0

50

100

150

200

250

300

350

400

1998 1999 2000 2001 2002 2003 2004

Arizona Students with Special Education Eligibility

in TBI(1998-2004)