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Bonnie Todis, Ph.D.Center on Brain Injury Research and

Training

STEP:Student Transition and re-Entry

Program

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www.TBIFocus.org

Rehabilitation Research and Training Center on Interventions for Children and Youth with Traumatic Brain Injury

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Partners

Cincinnati Children’s Hospital Medical Center Nationwide Children’s Hospital Rainbow Babies & Children’s Hospital MetroHealth, Cleveland The Children’s Hospital, Denver   Center on Brain Injury Research and Training Tufts University University of Oregon

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Ann Glang, Ph.D.Bonnie Todis, Ph.DDeborah Ettel, Ph.D.Center on Brain Injury Research and Training

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David“The accident happened when David was in first grade. He was in the hospital for just 3 days. He was unconscious for just a few hours. We were so, so lucky! Nobody from the hospital contacted the school, but we thought that was ok. We knew David was going to be just fine in a couple of weeks.”

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DavidDavid“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

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DavidDavid“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

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DavidDavid“Eventually I found out about the accident, but 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

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“As educators, we don’t have a handle

on this disability”

~Oregon special education

administrator

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Importance of Hospital-School Transition

Special education is the ticket to rehabilitation in school

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Challenges

There is a lack of understanding of TBI in the school setting

Parents and educators have different perspectives and have a difficult time working together

There is no systematic method for connecting children and their families with services within the school and community following TBI.

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Back to School Study(US Department of Education, Grant # H324C010113)

Purpose: Document hospital-school transition experience of children with TBI

N = 56Inclusion criteria: 24 hour hospitalization76% of children had severe TBI

Glang, Todis, Thomas et al., 2008

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Back to School Study FindingsKey factors related to provision of formal

special education or 504 services:

injury severity hospital-school transition services

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Improving the link between hospital and school

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STEP 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

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STEP (Student Transition and re-Entry) model

State 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

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STEP ongoing support

School staff access training and support as needed

Parents can contact the liaison at any timeProgress of students is tracked by DOE

annually

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R4

R3

R6 R1

R2

R7

R5

R8

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Key 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”

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STEP Evaluation

Randomized controlled trialSites in Ohio, Colorado, Oregon

5 hospitals, 3 Depts. Of EducationCurrent N = 55 (rolling enrollment; total

sample = 140)

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Sample

Children/youth ages 5-19 who:Are enrolled in schoolSustain TBI Are hospitalized at least overnight

One ParentTwo Teachers

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Study Design: RCT

Student assigned to STEP or usual careParent and 1-2 teachers complete baseline

measuresReassessment at one year T0 in hospital, T1 at 30 days post-injury, T2

at 1 year post-injuryT2 now coming in

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MeasuresParents TechersState/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

Demographics-including experience/training

Teacher KnowledgeSTEP measures of

teacher concerns/services needed/provided/satisfaction

BRIEF (full)CBCLSSBS – School Social

Behavior Scales (Scale A)

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Preliminary Findings

Measures (reported here)Parent surveySchool records

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Sample: Age at Injury

Mean age: 11.8 years (SD =3.8 yrs)Range: 5 – 17 years

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Severity of Injury

N = 55

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Student Grade

N = 55

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Received inpatient rehabilitation services?

N = 55

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Special Education Services

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Results by TX Condition

No statistically significant differences between outcomes for STEP vs. Usual Care

Example: parent satisfactionsatisfied or very satisfied

Usual care: 78%, STEP: 84%

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Does the effect of STEP depend upon whether or not the

student had rehabilitation

services?

Control for rehabilitation services status

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Tx effects controlling for rehabilitation services statusProcedures:

Sample divided by Rehab (28) vs. No Rehab (27)

Each group contained tx & control

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% Participants with IEP at Time 2

N = 55

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Parent Satisfaction with IEP Time 2

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Services

Students in STEP received more support services across domains than students in Usual Care condition:

Academic 47% vs. 18% Speech/Language 24% vs. 9%Social behavioral 24% vs. 0% Medical 18% vs. 9%

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Parent Overall Satisfaction at Time 2

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Big Picture

When they returned to school, children/youth who received inpatient rehabilitation received similar services in school setting across treatment condition

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Big Picture

For children/youth who did not receive rehabilitation, those in STEP showed better results compared with Usual Care

Were more likely to be identified for special education

Received more support services Parents found school staff more helpful Parents expressed more satisfaction with IEPs and

with overall services

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Positive Features of STEP modelMakes modest demands on hospitals,

school systems, and parentsAffordableFlexible/Adaptable Sustainable

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Next Steps on STEP

Continue data analysesTeacher measuresOne-year student outcome measures

One-year follow-up studyFunded by OH Emergency Medical Services (Dr.

Keith Yeates lead investigator)One additional data point: T3 18-24 months post-

recruitmentIncludes participants in OH, OR, and CO

Dissemination of the model to local and regional hospitals, other states

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Contact meContact me

Bonnie Todis, PhDCenter on Brain Injury Research

and TrainingTeaching Research InstituteWestern Oregon Universitywww.cbirt.orgtodisb@cbirt.org