III-1

1
Module III_______________________________________
_______________

• Returning To School

2
Module III Goal __________________________________
____________________

• To provide information that will facilitate the
  successful return of students with TBI to their
  schools

3
Module III Learning Outcomes_____________________
_________________________________

• At the end of this module you will
• Understand the responsibilities of hospital and
  school in school re-entry planning
• Be familiar with the IEP team process for
  students with TBI
• Recognize common problems of students with TBI
• Be able to plan an evaluation of a student with
  TBI

4
Transition to School_____________________________
_________________________

• Preparing for transition to school begins at the
  time of injury

5
Transition to School_____________________________
_________________________

• What can the educational facility do?

• What can the medical facility do?

6
School Re-entry PlanningWhose responsibility is
it?______________________________________________
_________

• Responsibilities of school staff and medical
  staff shift over time
• Medical staff assumes leadership for patient
  care in the hospital
• Educational staff takes more responsibility for
  school planning as needs are known and discharge
  nears
• The family is involved throughout

7
Three Stages of School Re-entry
Planning_________________________________________
_____________

• At the time of injury
• During the hospital/rehabilitation stay
• Prior to discharge

8
Strategies for the Medical Facility______________
________________________________________

• At the time of the injury
• Identify a medical contact person (e.g., care
  coordinator or social worker)
• During hospitalization
• Provide updates on progress and needs
• Arrange for hospital visits for school staff
• Educate family and school staff
• Refer for special education if need is suspected

9
Strategies for the Medical Facility
(cont.)__________________________________________
____________

• Prior to discharge
• Inform family and school of discharge date
• Provide discharge summary
• Participate in IEP team if possible
• Establish and communicate follow-up and
  reevaluation schedule

10
Re-entry Strategies for Schools__________________
____________________________________

• At the time of the injury
• As soon as you know a student has been injured,
  designate a school contact person to receive and
  provide information
• Identify the medical contact person

11
Role of the School Contact Person________________
______________________________________

• Be a support to the family
• Get appropriate releases signed to share
  information
• Gather information from hospital personnel as it
  becomes available
• Inform others (such as teachers, peers, and
  siblings teachers) as needed

12
Re-entry Strategies for Schools
(cont.)__________________________________________
____________

• During hospitalization
• Obtain parents permission to release/receive
  information
• Request updates from medical contact
• Visit student in the hospital
• Share information with school staff

13
Re-entry Strategies for Schools
(cont.)__________________________________________
_____________

• During hospitalization (cont.)
• Refer for special education if appropriate
• Educate parents about special education process
• Arrange for staff training

14
Re-entry Strategies for Schools
(cont.)__________________________________________
____________

• Prior to discharge
• Obtain current hospital records
• Complete IEP team process before discharge, if
  possible, but within statutory timeframes.
• Collaborate with medical facility to obtain
  consultation and in-service training

15
Strategies For Successful School Re-entry of
Students With TBI________________________________
_______________________

• Summary of strategies used by medical and school
  facilities appears on pages 15a-15b.
• Which strategies have participants used?
• Are there other strategies participants have
  found helpful in the transition from hospital to
  school?

16
Transition to School Checklist___________________
____________________________________

• The Transition to School Checklist is designed to
  help school personnel monitor completion of
  transition activities
• Please refer to the Checklist on page 16a.

17
Transitions also include________________________
______________________________

• Transitions between classes
• Transition to new schools
• Transition to post school settings
• Other students
• See Transition Checklist on p. 17a

18
The IEP Team Process_____________________________
__________________________

• 1. Refer the student to the LEA
• 2. Identify IEP Team members
• 3. Evaluate the students eligibility and
  determine needs
• 4. Develop the IEP
• 5. Offer placement

19
1. Refer the student to the LEA__________________
____________________________________

• In moderate and severe brain injuries referrals
  usually occur while the student is hospitalized
• As soon as you suspect a student is a child with
  a disability, inform the parent of your intent to
  refer, and refer in writing to the LEA

20
2. Identify IEP team members_____________________
__________________________________

• The IEP Team must include members designated in
  Chapter 115.78
• These requirements are reproduced on the next
  page of your manual
• Others with special expertise or knowledge may be
  included at the discretion of parent or school

21
2. Identify IEP Team Members (cont.)_____________
_________________________________________

• Who would you want on Serenas IEP team?
• Who would you want on Montys IEP team?

22
3. Evaluate the students needs__________________
_____________________________________

• As part of the evaluation the IEP team
• Reviews existing evaluation data
• evaluations and information provided by parents
• previous interventions and their effects
• current classroom-based assessments and
  observations
• observations by teachers and related services
  providers

23
3. Evaluate the students needs
(cont.)__________________________________________
____________

• After review of data the IEP team determines
• if additional data are needed, and if so, who
  should gather it
• if child has an impairment
• present levels of performance
• if child needs SE and related services

24
4. Develop the IEP______________________________
________________________

• If the IEP team determines that the student has
  an impairment (TBI) and needs special education
  and related services, the team prepares the
  Individualized Education Program

25
5. Offer placement_______________________________
________________________

• An educational placement is developed to
  implement the childs IEP
• To the maximum extent appropriate, a child with a
  disability is educated with nondisabled children
  (Chapter 115.79)

26
Designate a case manager_________________________
______________________________

• It is best practice to appoint a case manager who
  coordinates communication among IEP team members

27
What types of problems can the school
anticipate?______________________________________
_________________

• Serena
• Monty
• Mike

28
Common Problems of Students with
TBI______________________________________________
________

• Certain types of difficulties are common in
  students with TBI
• Anticipating these difficulties can facilitate
  successful re-entry to school
• Problems can be physical/medical, cognitive,
  sensory, motor, social, emotional, and behavioral

29
Physical/Medical Problems________________________
_______________________________

• Problems
• Seizures
• Fatigue
• Headaches
• Swallowing/Eating
• Self-care activities
• Medication issues (see p. 29a)
• Is an Individualized Health Care Plan (IHCP)
  needed? (see p. 29c-d)

30
Common Motor Problems____________________________
__________________________

• Apraxia
• Ataxia
• Coordination problems
• Paresis or paralysis
• Orthopedic problems

• Spasticity
• Balance problems
• Impaired speed of movement
• Fatigue
• See p. 30a

31
Sensory/Perceptual Problems______________________
________________________________

• Visual deficits
• field cuts
• tracking (moving and stationary objects)
• spatial relationships
• double vision (diplopia)
• Neglect
• Auditory deficits
• Tactile deficits

32
Cognitive/Communication Problems_________________
______________________________________

• Executive functions
• Memory
• Attention
• Concentration
• Information processing
• Sequencing

• Problem solving
• Comprehension of abstract language
• Word retrieval
• Expressive language organization
• Pragmatics

33
Executive Functions______________________________
________________________

• Planning, prioritizing, sequencing,
  self-monitoring, self-correcting, inhibiting,
  initiating, controlling or altering behavior
• (Savage Wolcott, 1995, p. 150)

34
Cognitive/Communication Deficits_________________
______________________________________

• See p. 34a for additional information regarding
  cognitive/communication problems
• See p. 34b for an example of Montys difficulties
  at school

35
Social-emotional Problems________________________
_______________________________

• Irritability
• Impulsivity
• Disinhibition
• Perseveration
• Emotional Lability
• Insensitivity to social cues
• Low frustration tolerance

• Anxiety
• Withdrawal
• Egocentricity
• Denial of deficit/lack of insight
• Depression
• Peer conflict
• Sexuality concerns
• High risk behavior

36
Social-emotional Problems________________________
______________________________________

• See p. 36a for descriptions of social-emotional
  deficits
• See p. 36b for an example of Serenas
  difficulties at school

37
Behavioral Problems _____________________________
_________________________

• Deficits (all types) may lead to challenging
  behaviors
• non-compliance
• aggression
• confrontational behavior
• lack of initiative
• withdrawal

38
Traumatic Brain Injury Checklist_________________
______________________________________

• Orientation and Attention to Activity
• Starting, Changing, and Maintaining Activities
• Taking in and Retaining Information
• Language Comprehension and Expression
• Visual-Perceptual Processing
• Visual-Motor Skills

• Sequential Processing
• Problem-Solving, Reasoning, and Generalization
• Organization and Planning Skills
• Impulse or Self-Control
• Social Adjustment and Awareness
• Emotional Adjustment
• Sensorimotor Skills

39
Manifestations of TBI by Age_____________________
_____________________________________

• Preschool
• Irritability and crying
• Temper tantrums
• Frustration
• Fearfulness
• Disabilities become evident over time as higher
  level skills are expected to develop

40
Manifestations of TBI by Age_____________________
____________________________________

• Elementary school
• Difficulty with new learning
• Short attention span and impulsivity
• Frustration
• Inappropriate social interactions
• Disabilities become evident over time as higher
  level skills are expected to develop

41
Manifestations of TBI by Age_____________________
___________________________________

• Middle school and high school
• Difficulty with new learning
• Short attention span and impulsivity
• Frustration over skill losses
• Decreased social judgment
• Risk-taking
• Depression and anxiety
• Sexuality concerns
• Effects of earlier injury become evident

42
What happens as a result of these deficits and
behaviors?_______________________________________
________________

• Friends leave
• Families mourn
• Teachers are frustrated
• The student is at increased risk for isolation
  from peers, academic failure, depression,
  substance abuse, sexual behavior, delinquency,
  further TBI

43
Evaluation of students with TBI__________________
_____________________________________

• Two purposes
• Identification of a student as a student with a
  disability
• Program planning

44
Evaluation Planning____________________________
__________________________

• Where do you begin after a referral is made?
• What do you need to know about the student to
  determine eligibility for special education and
  related services and to develop an IEP?

45
Information to Determine Needs___________________
____________________________________

• TBI information
• Information about areas of functioning
• Cognition and memory
• Speech and language communication
• Sensory and perceptual abilities
• Motor abilities
• Psychosocial impairments
• Physical functions/safety
• Academic skills

46
Challenges to Evaluation for Programming_________
_____________________________________________

• What factors make evaluation of the programming
  needs of students with TBI challenging?

47
Challenges to Evaluation for Programming Student
Factors__________________________________________
____________

• Rapidly changing skills (especially during first
  6-12 months)
• Communication, physical, sensory, motor,
  emotional, and behavioral difficulties may
  interfere with assessment
• Uneven skill profile (some higher skills
  preserved with lower skills lost)
• Performance influenced by state and situation
• Problems may emerge later

48
Challenges to Evaluation for Programming Other
Factors__________________________________________
____________

• The family is probably in distress
• Initial assessment is probably conducted outside
  school in a setting unlike the classroom
• Much assessment information is needed from other
  professionals (who are busy)
• Medical reports may be difficult to interpret
• Assessment requires IEP team coordination and
  planning

49
What can be done to address these
challenges?______________________________________
_________________

• Use classroom data to inform instruction
• Use observation, curriculum-based measures, work
  samples, trial teaching
• Assess across content, time, settings
• Invite parents to provide information
• Ask medical personnel for assistance
• Plan team evaluations
• Share information

50
Teamwork The Family and the School
Staff____________________________________________
_________

• Parent(s) and educators work together
• Educators recognize and respect the expertise,
  values, and concerns of the family
• The family recognizes and respects the skills of
  educators
• Communication is frequent and honest

51
TBI Evaluation PlanningGroup Activity__________
____________________________________________

• Refer to the TBI Evaluation Planning worksheet on
  pages 51a and b
• Monty and Serena have been referred for
  evaluation for special education. What do you
  know? What do you need to find out?

52
How Can I Gather Additional Information?_________
______________________________________________

• Record review (school and medical)
• Direct observation (school or hospital)
• Student interview (if possible)
• Teachers/service provider interviews
• Criterion-referenced assessment
• Curriculum-based assessment
• Rating scales and checklists
• Neuropsychological assessment (if available)

53
Test Interpretation Cautions____________________
___________________________________

• Standardized, norm-referenced measures
• may not assess the full range of skills
• testing situation may mask deficits
• limited predictive validity
• Timed tasks
• may reflect motor slowing, not ability
• Measures of prior knowledge
• may not reveal difficulty with new learning

54
What does Wisconsin law require in evaluations
for special education?___________________________
___________________________

• See Chapter 115.782 on pages 54a and 54b

55
Monty and Serena Do they meet Wisconsin criteria
for TBI?_________________________________________
______________

• Acquired injury to the brain
• External physical force
• NOT congenital or birth trauma
• Partial functional disability or psychosocial
  impairment or both
• Impairments in one or more areas (listed in
  definition)
• Need special education/related services

56
End of Module III