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TBI TRANSITION, RESEARCH AND THE OREGON TBI TEAM
Bonnie Todis, PhDCenter on Brain Injury Research and Training
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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?
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Research on Outcomes after Childhood TBI Most of this research has been
conducted by doctors and neuropsychologists.
Why would they do this research?
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What these studies look like Participants recruited from medical files Usually one follow up data point in
adulthood Rarely look at school factors
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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)
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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
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NTLS: Employment
Series10
10
20
30
40
50
60
70General Youth
Average across all disabili-ties
TBI Youth
PSO Youth
TBI Adult
%
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NTLS: Post-secondary Education
Series10
10
20
30
40
50
60
General YouthAverage across all disabilitiesTBI YouthPSO Youth
%
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NTLS: Living with Parents
Series10
10
20
30
40
50
60
70
80
90
General YouthAverage across all disabilitiesTBI YouthPSO Youth
%
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POST-SECONDARY OUTCOMES
PROJECT(PSO)
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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
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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) 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)
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Post-Secondary Employment Outcomes 19-25
Age in Years0
10
20
30
40
50
60
70
19 20 21 22 23 24 25
Perc
en
t Em
plo
yed
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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
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Employment Outcomes by Gender
19 20 21 22 23 24 250
10
20
30
40
50
60
70
80
MalesFemales
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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
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Comparison with Typical Peers
EMPLOYMENT RATE
WAGESPER 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/unskilled19%management/pro
• Bureau of Labor Statistics of the U.S. Department of Labor, January 19, 2007
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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.
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Factors That Impact Employment
1.00
2.00
3.00
4.00
5.00
Ty
pe
of
wo
rk c
ate
go
ry h
igh
=p
rofe
ss
ion
al
Work category by time sex age at injury
0 1.00 2.00 3.00 4.00
TIME
SEX = 0,AGEINJ3 = -5.985
SEX = 0,AGEINJ3 = 2.897
SEX = 0,AGEINJ3 = 5.119
SEX = 1,AGEINJ3 = -5.985
SEX = 1,AGEINJ3 = 2.897
SEX = 1,AGEINJ3 = 5.119
Later age)
Earlier age
Later age
Earlier age
Avg 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
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5.94
7.20
8.46
9.72
10.98
Wa
ge
s
Wages over time by age at injury and severity
1.00 3.50 6.00 8.50 11.00
Time
AGEINJ3 = -5.985,SEVERE = 0
AGEINJ3 = -5.985,SEVERE = 1
AGEINJ3 = 5.119,SEVERE = 0
AGEINJ3 = 5.119,SEVERE = 1
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
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0.00 1.001.72
2.32
2.91
3.50
4.09
SEVERE
Q2
A9
A1
hours worked per week
SEX = 0,AGEINJ3 = -5.985
SEX = 0,AGEINJ3 = 2.560
SEX = 0,AGEINJ3 = 5.119
SEX = 1,AGEINJ3 = -5.985
SEX = 1,AGEINJ3 = 2.560
SEX = 1,AGEINJ3 = 5.119
Factors That Impact Employment
Severity
Hours Worked per WeekIn
jure
d ea
rlier
late
r
Severity: M/M work > # Hrs.
Gender: Males> #hrs.
For both genders: Earlier age at injury = work fewer hours/week
Females
Males
Females
Males
Inju
red
earli
erla
ter
SevereMild/Mod
21 – 30hr
11-15hr
Hou
rs P
er W
eek
16-20hr
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-8.00 -6.00 -4.00 -2.00 02.80
2.98
3.17
3.35
3.54
time
ho
w h
ap
py
are
yo
u
AGEINJ3 = -4.211,SEVERE = 0
AGEINJ3 = -4.211,SEVERE = 1
AGEINJ3 = 2.575,SEVERE = 0
AGEINJ3 = 2.575,SEVERE = 1
AGEINJ3 = 4.296,SEVERE = 0
AGEINJ3 = 4.296,SEVERE = 1
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
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POST SECONDARY EDUCATION
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Post-SecondaryEducation OutcomesAges 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)
Education 15 (28) 26 (35) 34 (40) 22 (26) 26 (31) 18 (24) 14 (25)
Male 7 (19) 17 (36) 20 (35) 11 (19) 15 (27) 7 (15) 6 (17)
Female 8 (47) 9 (33) 14 (50) 11 (39) 11 (39) 11 (41) 8 (40)
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Post-Secondary Education Outcomes Ages 19-25
Nondisabled
PSO Sample
0
20
40
60
Comparison with typical young adults ages 18-25 (Pew Research Center,
2007)
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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
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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.
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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)
Male 7 (20) 13 (28) 18 (33) 22 (39) 22 (39) 24 (49) 20 (57)
Female 5 (29) 13 (48) 10 (37) 15 (54) 13 (45) 13 (48) 9 (45)
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Age in Years0
10
20
30
40
50
60
19 20 21 22 23 24 25
Perc
en
t En
rolled
Post-SecondaryIndependent Living OutcomesAges 19-25
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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).
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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.
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TRANSITION PRACTICES
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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
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How E-B Practices Are Identified Establish criteria for evidence of
effectiveness Classify practices as Look at what you end up with
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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
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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
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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!)
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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?
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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
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Outcomes so far…. Transition toolkit Transition Web Project IES Proposal
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Transition Website Project History NIDRR Development Project 2011-2014 Three stages
Development Pilot testing Evaluation
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Transition Web Project
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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
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PAR Activities Predevelopment
Qualitative findings from PSOWhat were transition services like?What was difficult for educators? Parents?
Kids?What worked? Where were the gaps in knowledge?
Practice?
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PAR Activities Development
Focus groups Interviews Participant observations
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PAR Activities Pilot test phase
Usability tests Advisory board
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PAR Activities Evaluation
Field test intervention Complete pre-post measures Focus groups
Dissemination Presentations Help with articles Implementing evidence-based
practices*******
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PAR Activities for Team Memberson T-Web Predevelopment
Focus group Development
usability Evaluation
Treatment/Non-treatment
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FOCUS-GROUP/DISCUSSION
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Speaking of Research Opportunities cbiRt
Current projects TATE STEP*** Family Web Transition Web *** MCH *** TEAM ***
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Data on Team Activities ODE reporting requirements
MCH reporting requirements
WOU reporting requirements
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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
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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
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Data we currently collect Number of contact Demographics Concerns Actions Outcomes
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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?
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Why we need these data In order to be accountable to ODE In order to be accountable to WOU,
OSHE
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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
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What do you think? How can we help you send us more
data? On Activities On People Served On Outcomes
Action Plan