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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 [email protected]