School to community: Using evidence to improve hospital-school transition for children with TBI
description
Transcript of School to community: Using evidence to improve hospital-school transition for children with TBI
![Page 1: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/1.jpg)
cbirt.org
Ann Glang, Ph.D.Center on Brain Injury Research and Training
cbirt.org
![Page 2: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/2.jpg)
cbirt.orgOutlineSummary of issues in educating children with TBIStudent Transition Re-Entry ProgramPreliminary findings from multi-site study
![Page 3: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/3.jpg)
cbirt.orgPartners
• Cincinnati Children’s Hospital Medical Center
• Nationwide Children’s Hospital
• Rainbow Babies & Children’s Hospital
• MetroHealth, Cleveland• The Children’s Hospital, Denver
• Legacy Emanual Hospital, Portland
Center on Brain Injury Research and Training
Colorado Department of Education
Ohio Department of Education
Oregon Department of Education
![Page 4: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/4.jpg)
cbirt.org
CHALLENGES
WHY ARE CHILDREN WITH TBI WHY ARE CHILDREN WITH TBI DIFFICULT TO SERVE?DIFFICULT TO SERVE?
![Page 5: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/5.jpg)
cbirt.org
Parents often believe that rapid pace of early recovery will continue
Parent and educator expectations may not match
![Page 6: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/6.jpg)
cbirt.org
I think parents can be the biggest obstacle to good transition back to school. They’re dealing with denial, grieving, avoidance. When I call parents at home to follow up after the kid is back at school, I often hear, “They’re fine, they’re fine, everything’s fine.”
~Ohio parent advocate
Parent ExpectationsParent Expectations
![Page 7: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/7.jpg)
cbirt.org
• Often new to the special education system
• Under tremendous stress (emotional, physical, financial)
Parent ExperienceParent Experience
![Page 8: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/8.jpg)
cbirt.orgCHALLENGE
Often parent-professional relationship becomes adversarial Different expectationsHigh stress
![Page 9: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/9.jpg)
cbirt.org
Unique Student Unique Student Characteristics Characteristics Unfamiliar to
educators
CHALLENGE
![Page 10: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/10.jpg)
cbirt.org
Inconsistent learning profilesInitial improvement can be dramaticEffects of TBI are subtle and confusing
Heterogeneity of disability
Student CharacteristicsStudent Characteristics
![Page 11: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/11.jpg)
cbirt.org
Child injured at an early age – impact not seen until years later
““Forgotten” InjuriesForgotten” Injuries
![Page 12: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/12.jpg)
cbirt.org
Two days before her first birthday she was in a head on collision. We didn't realize anything was wrong until she started kindergarten and had a horrible time concentrating and learning. . .
~Kansas parent
![Page 13: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/13.jpg)
cbirt.orgUnique Disability
TBI is an “invisible disability”
Students may have no physical signs of disability
![Page 14: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/14.jpg)
cbirt.orgInvisibility
I need to be careful how I say this… It’s almost like it would’ve been better if the injury were severe enough that we would’ve had to have gotten help. With TBI, the moderate to mild…it’s invisible. People don’t see it and then people don’t get the help that they need.
~Parent
![Page 15: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/15.jpg)
cbirt.orgPoor Awareness of TBI in SchoolsPreservice training in ABI is lacking
Inservice training is often ineffective
![Page 16: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/16.jpg)
cbirt.orgEducator Training in TBI
Survey of educators in Pacific Northwest
Sample: Teachers who were currently working with students with TBI
N = 65
![Page 17: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/17.jpg)
cbirt.orgHave you had training in acquired brain injury?
![Page 18: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/18.jpg)
cbirt.org
“As educators, we don’t have a
handle on this disability”
~Oregon special education
administrator
![Page 19: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/19.jpg)
cbirt.org
There is no systematic method for connecting children and their families with services within the school and community following TBI.
![Page 20: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/20.jpg)
cbirt.orgBack to School Study(US Department of Education, Grant # H324C010113)
Purpose: Document hospital-school transition experience of children with TBI
N = 56Inclusion criteria: 24 hour hospitalization
76% of children had severe TBI
Glang, Todis, Thomas et al., 2008
![Page 21: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/21.jpg)
cbirt.orgBack to School Study FindingsKey factors related to provision of formal special education or 504 services:
injury severity hospital-school transition services
![Page 22: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/22.jpg)
cbirt.orgChallengesStudents with TBI are uniqueThere is a lack of understanding of TBI
Parents and educators have different perspectives
There is no systematic method for connecting hospital and school
![Page 23: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/23.jpg)
cbirt.orgAddressing the challengesLess is more: Identifying one area for intervention
Hospital-school transition: Biggest bang for the buck
![Page 24: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/24.jpg)
cbirt.org
Improving the link between hospital and
school
![Page 25: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/25.jpg)
cbirt.orgSTEP model
Grounded in experience of families and of hospital and school personnel in five statesFocus groups with hospital rehabilitation personnel, administrators, social workers
Interviews and observations with parents, teachers, school administrators, support personnel
![Page 26: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/26.jpg)
cbirt.org STEP (Student Transition and re-Entry)
modelState Department of Education (DOE) provides a single point of contact for all hospitals to call
DOE informs trained regional liaisonRegional liaison
informs the schooloffers resources to family and school
![Page 27: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/27.jpg)
cbirt.orgSTEP ongoing support
School staff access training and support as needed
Parents can contact the liaison at any time
Progress of students is tracked by DOE annually
![Page 28: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/28.jpg)
cbirt.org
R4
R3
R6 R1
R2
R7
R5
R8
![Page 29: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/29.jpg)
cbirt.orgKey elements of STEP
Facilitates Special Education identification of students with TBI—especially those not discharged from rehabilitation
Provides user-friendly resources to families and schools
Tracks kids through school so TBI is not “forgotten”
![Page 30: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/30.jpg)
cbirt.orgSTEP Evaluation
Randomized controlled trialSites in Ohio, Colorado, Oregon5 hospitals, 3 Depts. Of Education
![Page 31: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/31.jpg)
cbirt.orgSample
Current total N = 136 (ages 5 – 20)Preliminary analysis: Subset n = 70, data collected so far
Children/youth ages 5-19 who:Are enrolled in schoolWere hospitalized at least overnight for TBI
![Page 32: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/32.jpg)
cbirt.orgStudy Design: RCT
Student 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
![Page 33: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/33.jpg)
cbirt.orgParent Measures
State/Trait Anxiety IndexBrain Injury Partners measures of advocacy skillChild Behavior Checklist (CBCL, aka Achenbach)CASP – Child & Adolescent Scale of ParticipationCASE – Child & Adolescent Scale of EnvironmentBrief BRIEF (24 questions)STEP measures of parent concerns/services needed/provided/satisfaction
![Page 34: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/34.jpg)
cbirt.orgTeacher Measures
Demographics-including experience/trainingTeacher KnowledgeSTEP measures of teacher concerns/services needed/provided/satisfaction
BRIEF (full)CBCLSSBS – School Social Behavior Scales (Scale A)
![Page 35: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/35.jpg)
cbirt.orgPreliminary Findings
Measures (reported here)Parent surveySchool records
![Page 36: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/36.jpg)
cbirt.orgSample: Age at Injury
Mean age: 14.11 years (SD =3.81 yrs)
Range: 5.0 - 20 years
Note: Analysis results for subset of total sample collected so far, n = 70
![Page 37: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/37.jpg)
cbirt.orgSeverity of Injury
Frequency Count N = 70
![Page 38: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/38.jpg)
cbirt.orgStudent Grade
Frequency count N = 70
![Page 39: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/39.jpg)
cbirt.orgReceived inpatient rehabilitation services?
Percent of total sample N = 136
![Page 40: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/40.jpg)
cbirt.orgSpecial Education Services
Percent of total sample of students post-injury who have IEP N = 136
![Page 41: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/41.jpg)
cbirt.org
Students receiving SpEd. Services n = 35, of sub-sample n = 70
![Page 42: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/42.jpg)
cbirt.orgDoes STEP make a difference?When they returned to school, children/youth who received inpatient rehabilitation received similar school services across treatment condition
![Page 43: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/43.jpg)
cbirt.orgResults by TX Condition
No statistically significant differences between outcomes for STEP vs. Usual Care
![Page 44: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/44.jpg)
cbirt.org
Does the effect of STEP depend upon whether or not the
student had rehabilitation
services?
Control for rehabilitation services
status
![Page 45: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/45.jpg)
cbirt.orgTreatment effects controlling for rehabilitation services statusProcedures:
Sample divided by Rehab (28) vs. No Rehab (42) for n = 70 subset
Each group contained tx & control
![Page 46: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/46.jpg)
cbirt.org% Students (non-rehab) with IEP % Students (non-rehab) with IEP at Time 2at Time 2
N = 42 No Rehab
![Page 47: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/47.jpg)
cbirt.org% Parent Overall % Parent Overall Satisfaction at Time 2Satisfaction at Time 2
N = 42No Rehab
![Page 48: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/48.jpg)
cbirt.org
STEP children/youth who did not receive rehabilitation received more types of support service than did students in usual care
Types of services: Academic, Speech-Language, Vision, Social-Behavioral, Physical, Medical, and Transition
![Page 49: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/49.jpg)
cbirt.orgBig PictureFor 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 categoryparents report school staff more helpful parents express more satisfaction with school services
![Page 50: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/50.jpg)
cbirt.orgWhat does it mean?
Promising initial results suggest that for students who do not receive rehabilitation, STEP can help.
Students who get STEP support are more likely to get connected with appropriate services
![Page 51: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/51.jpg)
cbirt.orgNext Steps on STEPContinue data analyses
Teacher measuresOne-year student outcome measures
One-year follow-up studyFunded by OH Emergency Medical Services (Dr. Keith Yeates lead investigator)
![Page 52: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/52.jpg)
cbirt.orgNext Steps on STEPWork with states to implement
Fidelity is important: Using part of the recipe for success may not lead to the same outcomes
![Page 53: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/53.jpg)
cbirt.org
STEP: Key components
Coordinator at state/regional Department of Education
Regional liaisons Coordinator at hospital
![Page 54: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/54.jpg)
cbirt.org
news and research related to TBI, upcoming events, and new resources!
Join the Conversation
![Page 55: School to community: Using evidence to improve hospital-school transition for children with TBI](https://reader035.fdocuments.in/reader035/viewer/2022070419/56815cc8550346895dcad214/html5/thumbnails/55.jpg)
cbirt.orgContact meContact me
Ann Glang, PhDCenter on Brain Injury Research and Training
Teaching Research InstituteWestern Oregon [email protected]