perspectives in teaching students with abi · perspectives in teaching students with abi 2 abstract...

PERSPECTIVES IN TEACHING STUDENTS WITH ABI

Grey Matter: Perspectives in Teaching Elementary Students

with Acquired Brain Injury in Ontario

By

Hedellaine Bosque Valentin

A research paper submitted in conformity with the requirements

For the degree of Master of Teaching

Department of Curriculum, Teaching and Learning

Ontario Institute for Studies in Education of the University of Toronto

Copyright by Hedellaine Bosque Valentin, April 2017

PERSPECTIVES IN TEACHING STUDENTS WITH ABI 2

Abstract

As a result of the uncategorized status of acquired brain injury (ABI) as an exceptionality under

the Ontario Education Act (1990), students with ABI are provided minimal support in the school

setting. The literature reviewed revealed interventions to be a consistent area of research, and that

there exists a discrepancy in the field which reflects the lack of evidence-based research exploring

ABI as a recognized exceptionality. The study assumed a qualitative research approach and

collected data through semi-structured interviews with two elementary teacher participants from

Ontario schools. The study addressed the primary research question: What are the challenges

facing teachers who teach and support students with ABI? Key findings that emerged from this

research study include teachers’ knowledge on ABI, the demands of the classroom, the absence of

specific ABI protocols, and the quality of support from the home-school-community network.

Recommendations are provided based on implications influenced by the key findings. If teachers

are to establish equitable classrooms, they must be prepared with knowledge relevant to the

realities of the classroom in order to be genuine ambassadors of equity in education for all.

Keywords: acquired brain injury (ABI), special education, exceptionalities


Acknowledgements

I would like to acknowledge those who have supported me throughout this journey. I

would like to thank God for the grace of this opportunity and for the strength to have persevered

through this process and see it to the end. I would also like to express my gratitude to my

Research Advisor, Dr. Hilary Inwood, my Research Professor, Dr. Victorina Baxan, as well as

all my professors at OISE. With your guidance, I have been able to achieve far beyond the goals

I have set for myself and can truly say that I am proud of the work I have accomplished here -

you have encouraged me to keep dreaming. To my interview participants, I would like to express

my heartfelt thanks to you for your openness in sharing your experiences - you have enriched my

research greatly. To my awesome cohort at the Master of Teaching program, I am overwhelmed

with gratitude for the friendship and kindness you have shown me these past two years - I will

cherish these moments often. I would like to express my deepest gratitude to my parents, my

family, and my friends. Your constant love and support have sustained me through my trials, and

I am forever grateful for you all. Finally, to the love of my life, Stephen - I am blessed to have

you by my side and I am grateful for your endless support and encouragement, now and always.

You embolden and inspire me to work hard every day - thank you for always believing in me!

I dedicate this in memory of my beloved sister, Kae Anne Valentin, and my dear cousin

Andrea Mariano. You are forever in my heart.


Table of Contents

Abstract ............................................................................................................................................2

Acknowledgements ..........................................................................................................................3

Chapter 1: Introduction ...................................................................................................................6

1.0 Research Context ...........................................................................................................6

1.1 Research Problem ..........................................................................................................8

1.2 Purpose of the Study ......................................................................................................9

1.3 Research Questions ........................................................................................................9

1.4 Preview of Methodology..............................................................................................10

1.5 Background of the Researcher .....................................................................................10

1.6 Overview of the Study .................................................................................................12

Chapter 2: Literature Review ........................................................................................................14

2.0 Areas of Literature Reviewed ......................................................................................14

2.1 What is Acquired Brain Injury (ABI)? ........................................................................16

2.2 Implications to Students with ABI ...............................................................................17

2.2.1 Health ...........................................................................................................18

2.2.2 Cognitive impairments ..................................................................................18

2.2.3 Communication, sensory and perceptual impairments .................................20

2.2.4 Behavioural and emotional implications to student with ABI ......................20

2.2.5 Other influencing factors to recovery ...........................................................21

2.3 Impact on School Policies and Procedures ..................................................................22

2.3.1 Assessments .................................................................................................22

2.3.2 Developing Individual Educational Plans (IEPs) .........................................22

2.3.3 Interventions and strategies...........................................................................23

2.4 Challenges Facing Teachers ........................................................................................24

2.4.1 Lack of training and preparation ...................................................................24

2.4.2 Growing demands of the classroom ..............................................................24

2.4.3 Absence of standards ....................................................................................25

2.4.4 Lack of resources ..........................................................................................25

2.5 A New Category of Exceptionality in Ontario ............................................................25

2.6 Summary ......................................................................................................................26

Chapter 3: Research Methodology ................................................................................................28

3.0 Introduction to the Chapter ..........................................................................................28

3.1 Research Approach and Procedures.............................................................................28

3.2 Instruments of Data Collection ....................................................................................30

3.3 Participants ...................................................................................................................34

3.3.1 Sampling criteria ...........................................................................................34

3.3.2 Participant recruitment ..................................................................................35

3.3.3 Participant biographies..................................................................................36

3.4 Data Analysis ...............................................................................................................37

3.5 Ethical Review Procedures ..........................................................................................38

3.6 Methodological Limitations and Strengths ..................................................................39

3.7 Conclusion ...................................................................................................................40


Chapter 4: Findings .......................................................................................................................41

4.0 Introduction to the Chapter .........................................................................................41

4.1 Lack of ABI Training for Teachers Results in a Lack of Confidence in Teachers

and Diminishes Their Preparedness in Teaching and Supporting Students with ABI ......42

4.2 The Demands of the Classroom Limit Teachers from Establishing Effective

Strategies in Teaching and Supporting Students with ABI ...............................................44

4.3 Absence of a Set of Standards and Policies in Carrying Out Accommodations for

Students with ABI. .............................................................................................................46

4.3.1 In-school team meetings and IPRC meetings ...............................................47

4.3.2 Individual Educational Plans (IEPs) .............................................................47

4.3.3 Documentation of ABI and seeking extra supports ......................................49

4.4 Inadequate Support from Home-School-Community Network Presents Challenges in

Meeting the Needs of Students with ABI. .........................................................................51

4.5 Additional Challenges in the Classroom......................................................................53

4.6 Summary ......................................................................................................................55

Chapter 5: Implications .................................................................................................................57

5.0 Introduction to the Chapter .........................................................................................57

5.1 Overview of Key Findings and Their Significance .....................................................57

5.2 Implications..................................................................................................................60

5.2.1 Broad: The identification of ABI as a legal exceptionality .........................60

5.2.2 Narrow: Professional identity and practice ..................................................61

5.3 Recommendations ........................................................................................................63

5.3.1 Ontario Ministry of Education ......................................................................63

5.3.2 Ontario school boards and educational institutions. ....................................64

5.3.3 Healthcare professionals ...............................................................................65

5.3.4 Community agencies and organizations. .....................................................66

5.3.5 Families and friends. ....................................................................................66

5.4 Areas for Further Research ..........................................................................................67

5.5 Concluding Comments ................................................................................................68

References ......................................................................................................................................70 Appendices .....................................................................................................................................74

Appendix A: Letter of Consent for Interview ....................................................................74

Appendix B: Interview Questions .....................................................................................76


Chapter 1: Introduction

1.0 Research Context

Students sustaining an acquired brain injury (ABI) pose a distinct and challenging

situation to the Ontario school system. An ABI can be defined as being any type of injury

causing temporary or permanent damage to the brain after birth (Bennett et al., 2004) and mostly

refers to injury caused by trauma, such as a fall, motor vehicle accident, or severe sports impact.

ABI can also occur as a result of near drowning, suffocation, infections like encephalitis and

meningitis, tumors, strokes, and other vascular accidents, toxicity and metabolic disorders

(Savage, 1997; Garcia et al., 1998; Bennett et al., 2004).

In Ontario, students with ABI lack support in educational programming that aims to meet

curriculum expectations and standards. This lack of support is driven by an absence of explicit

identification of ABI as an exceptionality by the Ontario Education Act (1990). Amendments

were made under this act in 1980 to specify the provisions that govern special education

programming throughout Ontario school boards (Ontario Ministry of Education, 2012). Bill 82,

as the amendments are commonly known, outlines five specific categories when identifying a

student as exceptional: behaviour, communication (autism, deaf, hard of hearing, language

impairment, speech impairment, learning disabilities), physical (physical disabilities, blind/low

vision), intellectual (gifted, mild intellectual delay, developmental delay), or multiple. Students

whose abilities align with any of the five categories are provided supports in special education

programming; ABI does not fall within any of the categories or subcategories defined (Bennett et

al., 2003).

Without being overtly acknowledged as a student with exceptionalities, students with

ABI are often assessed improperly and classified as having a learning disability or other


exceptionality (Bennett et al., 2004). Brock University and the OBIA (2003) offer their

perspective on this issue by stating that these are markedly distinct from one another, although

similarities run consistent and parallel between these two conditions. The two differ quite

distinguishably by the onset of each of the conditions. This difference alone should warrant the

support of strategies and teaching practices specific to ABI, to be employed by teachers. Though

differences may be subtle, the idiosyncratic nature of ABI and its ever-changing characteristic

distinguishes it from other conditions. It is pertinent that teachers are aware of the complex

medical and health needs of students with ABI, and that, since the brain is a living organ, it is

possible that new symptoms may appear even years after the injury (Bennett et al., 2003). Zinga

et al. (2005) assert that the diagnosis of children who sustain an ABI is “more unpredictable than

that of adults as the interruption of the nervous system’s development can have a profound

effect, …[where] severe injuries can result in good outcomes while apparent mild injuries can

result in poor outcomes” (p. 3).

Many students with ABI are confronted with challenges and barriers to achieving success

in the classroom. Among these challenges are barriers are the insufficient amount of training

opportunities and support for teachers around ABI, as well as the lack of funding provided for

students with ABI (Zinga et al., 2005). According to Educating Educators About ABI (2003),

“many of the strategies and teaching practices used with students who have learning disabilities

(LD) [are also] effective when used with students who have an ABI, it is often the case that

particular strategies […] can cause great frustration with students who have sustained an ABI”

(p. 59); and, the inattention to this difference may be detrimental to the learning experience of

the student with ABI (Brock University and the OBIA, 2003). Although students with ABI may

seem to benefit from strategies and resources provided, their needs demand a more


knowledgeable and focused approach due to the complex nature of acquired brain injury (Zinga,

2005).

Another common barrier to receiving appropriate supports for students with ABI is

funding. Zinga et al. (2005) report that when school boards in the province of Ontario were

required to form an Identification, Placement, and Review Committee (IPRC) procedure in order

to identify students as exceptional, they were limited to the five specific categories of

exceptionality outlined in the Education Amendment Act (1980): behaviour, communication,

physical, intellectual, or multiple. It seems that ABI does not fit these recognized categories, and

the inclusion of ABI within these categories may challenge, and even weaken, the policy`s

efficacy in delivering services to those students who may be eligible to access them (Zinga et al.,

2005).

These are but a number of such discrepancies that may occur in schools throughout

Ontario where students with ABI encounter barriers to having their needs met in the classroom.

If teachers are expected to develop equitable classrooms, the Ontario Ministry of Education must

be diligent in laying the proper foundations in order for teachers and other educators to meet

these expectations and be ambassadors of equity and accessibility in education for all.

1.1 Research Problem

An examination of the literature on the topic of students with ABI reveals that the matter

has been discussed for decades. Significant themes in the literature include the implications of

ABI for students, the influencing factors for recovery of these students, the impact on teachers

regarding programming for ABI students and the challenges teachers face in implementing these

programs (Zinga et al., 2005). However, it is apparent that Canadian research, specifically the

studies grounded in the Ontario school system, have yet to influence the advancement of current


legislation that governs special education programming for students with ABI. This analysis of

Zinga et al. (2005) also presents incongruences with the eligibility of students with ABI for

services to support their educational needs, and notes that there is a lack of evidence-based

research exploring ABI as a categorical exceptionality in the province of Ontario. The movement

towards inclusion of students with exceptionalities in the Ontario public school system seems to

be a gradual process. It has promoted changes in curriculum and instruction; but still requires

significant development in the roles of teaching professionals and school personnel.

1.2 Purpose of the Study

The research found in this study explored teachers’ experience in working and supporting

students with ABI at two Ontario schools, including public elementary classrooms and

classrooms with some degree of special education programming, whether integrated or

specialized. It investigated the impact of the approaches and strategies in place at schools for

students with ABI. Beginning with an analysis of the current literature on the nature of ABI and

the process of reintegration of students with ABI into schools, and then an examination of the

responses from teacher interviews, I will present the perspectives of teachers in teaching and

supporting students with ABI. This investigation will focus on the educational background and

training of teachers, their preparedness in meeting the needs of students with ABI in the

classroom, the strategies and practices they use to meet the needs of students with ABI-

especially in regards to the IPRC process and other protocols, and their challenges in delivering

the curriculum to students with ABI.

1.3 Research Questions

The primary question guiding my research pertains to the experiences of teachers and

their practices: What are the challenges facing teachers who teach and support students with


ABI? Secondary questions were as follows: What special education training is provided to

Ontario teachers and educators to prepare them in teaching and supporting students with ABI?

How prepared do teachers feel in meeting the needs of students with exceptionalities, especially

students with ABI? What are the instructional strategies and practices employed by teachers in

elementary schools who educate students with ABI? and, How do the instructional strategies and

practices employed by teachers in elementary schools meet the needs of students with ABI?

1.4 Preview of Methodology

The study assumed a qualitative research approach, and underlying perspectives that

align with the general views of Creswell (2007) whose works “[model] reflexivity, or self-

awareness” (p. 12). Other works that have helped to develop my perspective of qualitative

research inquiry include Hoepfl (1997), Turner (2010), Tracy (2010), Bogdan and Biklen (2006),

Denzin and Lincoln (2000), Marshall (1996), and Golafshani (2003). The instrument selected for

data collection was a semi-structured, face-to-face interview that was conducted with teachers as

research participants. A teacher participating in this study had to be a teacher in an Ontario

elementary or secondary school with experience in teaching students with ABI and had to have

worked with other school personnel throughout these experiences. The data collected was

transcribed, coded by themes and topics, sorted and categorized. The findings of this study will

be presented in Chapter Four and areas of further research will be outlined in Chapter Five, the

conclusion to the study.

1.5 Background of the Researcher

The motivation to pursue a career in education stems from my commitment to serve

others, my advocacy for equity and accessibility, and my experience in working with

differently-abled populations in the community. Thus, this topic is quite significant for me. My


passion for knowledge, enthusiasm for teaching, and love of serving the community have helped

to shape my perspective on healthcare and rehabilitation, and have developed a hunger to

advocate for equity and accessibility, especially for those experiencing social injustices. This,

coupled with my drive to become a teacher, has given me the confidence to explore this topic in

research.

My employment with a community-based rehabilitation centre as a Rehabilitation

Support Worker for individuals with ABI has given me exposure to the needs of individuals with

ABI and has fueled my desire for change. This desire has sharpened my skills as a prospective

educator, and has enriched my practices with the ABI community. In my experience working

with clients, I have been able to witness the personal challenges that individuals with ABI endure

in order to integrate back into the community and lead lives with a comfortable quality of living.

Individuals with ABI are restricted access to some services that are available to other individuals

with varied abilities. These experiences and skills have inspired me to focus my research in

promoting the improvement of special education programs helping to integrate students with

ABI into their school communities.

Through this analysis, I hope to influence and motivate future investigations in

establishing progress that benefits students with ABI and enriches their learning experience in

the Ontario school system. I believe that the role of teachers is to work alongside families,

friends, and health care providers to foster an environment of learning most gratifying to their

needs. My hope is that I may be able to provide the kind of insight into the practice of teachers

that can help to shift the conversation about the preparation, training, and assistance teachers

receive in working with students with ABI. I also want to contribute to the voice that demands


for equitable schools and I aspire to enhance and broaden society’s perspective on diversity and

ability.

The purpose of this study was to examine the challenges facing Ontario teachers who

teach and support students with ABI. This study investigated the perspectives of teachers

regarding their educational background and training, their preparedness in meeting the diverse

needs of the classroom, the strategies and practices they utilize for students with ABI,

specifically regarding the IPRC (Identification, Placement, and Review Committee) process and

other protocols, and any influence their strategies may have had on students with ABI. The

greater goal of this study was to gain some insight from the experiences of teachers who have

taught and supported students with ABI and how these experiences have impacted these

students’ academic success.

1.6 Overview of the Study

In Chapter 1 above, I placed the study in the context of the current landscape of the issue

and provided a brief history of special education programming and acquired brain injury (AVI)

in the Ontario public school system. Chapter One has also outlined the purpose of the study, as

well as the research questions that propelled the study. It also presented a preview of the

methodology of the study and a background profile of the researcher. In chapter Two, the

foundation of the research study begins with a review of significant literature on the topic of

students with exceptionalities and ABI, and the experiences of teachers who educate them. The

research methodology is found in Chapter Three of this study, where procedures, methods,

sample criteria, participants, and data collection used in this research are outlined. Chapter Four

is an exposition of the research findings that this study reveals, where the data collected has been

analyzed, organized into a system of themes and topics, and presented with interpretation. And


finally, Chapter Five hosts the discussion surrounding the implications of this study,

recommendations offered in light of the findings of this research, suggestions for further research

and other areas that were not included in the conversation that ensued this study. Concluding

comments consolidate the information obtained and serves to summarize the research study as a

whole. It addresses the significance of this research subject and the urgency to advocate for

students in the ABI community who are being denied resources and services, and lack the

necessary support they need to achieve success in the classroom.


Chapter 2: Literature Review

2.0 Areas of Literature Reviewed

In the province of Ontario, students with acquired brain injury (ABI) experience

insufficient support in meeting elementary curriculum expectations and standards. This lack of

support results from the ineligibility of ABI as an exceptionality under Regulation 181/98 of the

Ontario Education Act (1990). The five categories of exceptionality that are outlined this Ontario

legislation are: behaviour, communication (autism, deaf, hard of hearing, language impairment,

speech impairment learning disabilities), physical (physical disabilities, blind/low vision),

intellectual (gifted, mild intellectual delay, developmental delay), or multiple. As stated in

Regulation 181/98, students whose abilities are defined by the legislation must undergo the

Identification, Placement, and Review Committee (IPRC) process in which their abilities, after

being formally identified, must align with any of the aforementioned categories. This

identification qualifies a candidate as a student with exceptionality and is then provided with

supports through special education programming. ABI is not a defined exceptionality as it does

not belong to any categories or subcategories under Regulation 181/98 (Bennett et al., 2003).

Without being acknowledged as an exceptionality, acquired brain injury is disregarded by

provincial special education programming policies and legislation.

In examining the literature on the topic of students with ABI, it is evident that much has

been discussed about this matter for decades. Nevertheless, this analysis accounts for the latest

twenty years of works and captures the most recent scholarly writings on the topic of students

with ABI. Significant themes explored in this literature review include the implications of

acquired brain injury to students, the influencing factors of recovery for these students, the


impact on teachers regarding programming for ABI students, and the challenges teachers face in

implementing these programs.

Among the literature assessed, two particular resources served as foundational sources of

information on students with acquired brain injuries. The document Teaching Students with

Acquired Brain Injury: A Resource Guide for Schools from British Columbia Ministry of

Education (2001), and the manual Educating Educators About ABI: Resource Binder from Brock

University and the Ontario Brain Injury Association (OBIA), by Bennett et al. (2003) outline a

variety of themes under the broad topic of students with ABI and the school system. These

resources seemed to have covered much ground in terms of outlining the diverse issues

surrounding the education of students with ABI. They discuss a range of topics from strategies

and interventions, to the roles and responsibilities of various professionals that interact with

students sustaining an ABI.

This analysis of the literature reveals that the body of evidence-based research exploring

ABI as a categorical exceptionality in the province of Ontario is insubstantial to the current state

of the matter. This research paper will seek to provide evidence in support of a new category of

exceptionalities under Regulation 181/98 of the Ontario Education Act (1990). It will explore

teachers’ experiences in working and supporting students with ABI and will consider the impact

of the approaches and strategies in place at various Ontario schools, including public elementary

classrooms and classrooms with some degree of special education programming already, whether

integrated or specialized. Informed by this analysis, an examination of the responses from

teacher interviews will survey the following: the impact of the ways in which teachers ensure

students with ABI are achieving curriculum expectations, the perspective of teachers on their


preparedness in meeting the needs of students with exceptionalities, and the challenges that they

encounter in delivering the curriculum to students with ABI.

2.1 What is Acquired Brain Injury (ABI)?

An acquired brain injury (ABI) is “any type of sudden injury that causes temporary or

permanent damage to the brain after birth, or according to some definitions after two years of

age” (Bennett et al., 2004, p. 116) and mostly refers to traumatic damage to the brain, such as a

fall, motor vehicle accident, or severe sports impact. ABI can also occur as a result of near

drowning, suffocation, infections like encephalitis and meningitis, tumors, strokes, and other

vascular accidents, toxicity and metabolic disorders (Savage, 1997; Garcia, Krankowski, &

Jones, 1998; Bennett et al., 2004).

It is important to note that the literature gathered presents information on both acquired

brain injury (ABI), as well as traumatic brain injury (TBI). Since a TBI classifies as an ABI, this

paper will refer to all as ABI. Bennett et al. (2004) have cited the definition of mild traumatic

brain injury (TBI), according to the American Congress of Rehabilitation Medicine Mild

Traumatic Injury Committee, as manifesting at least one of the following:

Any period of loss of consciousness;

Any loss of memory for events immediately before or after the accident;

Any alteration in mental state at the time of the accident (e.g. feeling dazed,

disoriented or confused); and

Focal; neurological deficit(s) that may or may not be transient but where the

severity of the injury does not exceed the following:

Post-traumatic amnesia PTA that does not exceed 24 hours

After 30 minutes, an initial Glasgow Coma Scale of 13-15; and


Loss of consciousness of approximately 30 minutes or less (i.e. those

accompanied by a brief loss of consciousness or altered state of

consciousness) (p.119).

An ABI can cause a child many difficulties in the areas of health, cognition,

communication, sensory and perception, emotion and behaviour (Bennett et al., 2004). For these

reasons, an ABI is a distinctive exceptionality in that it is “acquired at some point during

development; and that it alters the functioning of the brain in significant and highly

individualized ways” (Zinga et al., 2005). Its idiosyncratic nature brings about such

individualized outcomes that are as unique as those who sustain them.

2.2 Implications to Students with ABI

An acquired brain injury presents many difficulties for a child and affects various areas of

their development including health, cognition, communication, sensory and perception, emotion,

and behaviour. Many authors discuss the health and medical conditions that follow a brain

injury; thus, evidence of this listing of conditions were found throughout many of the articles

examined by this review. Authors who address these implications systemize the many areas

affected by ABI and the assortment of impairments that ensue. Bennett et al. (2003, 2004),

Bowen (2005), and Lucas (2010) have organized the impairments and implications using charts

that foster ease of legibility for the reader, as well as clearly defined scenarios and possible

evidence from students exhibiting such symptoms. For the purposes of this paper, brief

summaries are outline the following: health implications, cognitive impairments,

communication, sensory and perceptual impairments, behavioural and emotional implications,

and other influencing factors to a student’s recovery from their injury.


2.2.1 Health. Repercussions of an ABI can affect physical functioning and can cause

“loss of function in all or some extremities, spasticity, decreased motor speed, and poor

coordination in fine or gross motor movements may require physical and environmental

accommodations and/or assistance with self-care skills (feeding and toileting) in the school

setting” (Bowen, 2005, p. 35).

Damage to the brain can also result in physical fatigue, and is marked by inability to

participate in class discussions, irritability, distractedness, listlessness, yawning, lethargy (caused

by medication), and lack of initiative (Bennett et al., 2003). Corresponding authors include

Bowen (2005), Clark (1996), and Garcia (1998). Specific detail on physical fatigue was

contributed by Lucas (2010) who discusses the implications of ABI on teaching Physical

Education to students who sustain them. This author features possible strategies in the Physical

Education setting for every characteristic of brain injury that students may present. For example,

Lucas suggests to “limit the repetitions of more demanding activities - especially when the

student has not been feeling well” (p. 12).

Children sustaining an ABI are also at a greater risk for developing seizure disorders, and

require continuing medication management for medical concerns like seizures and headaches

(Clark, 1996). Educators should practice sensitivity and be knowledgeable with regards to

handling seizures and possible implications due to medications when assisting students with ABI

to cope with their seizures (Bennet et al., 2003).

2.2.2 Cognitive impairments. Almost all of the literature reviewed by this paper state

forms of cognitive challenges and impairments following an ABI. Overall, there was an accord

of the information presented, stating that cognitive processes are affected following damage to

the brain. According to the scholars cited by Bennett at al. (2004), cognitive issues are concerned


with “problems maintaining attention, slowed processing speed, poor judgement, lack of

anticipation skills, poor perception, difficulties with problem solving, inability to transfer new

learning to different situations, poor memory, cognitive fatigue, and lack of initiation” (p.118).

Difficulties regarding a student’s attention and concentration may also present themselves

in students sustaining an ABI. Problems with attention and concentration may prove to be

detrimental to a student’s learning experience, most of all with an ABI. Examples of these

difficulties include decreased on-task behaviour, disorganization, difficulty transitioning from

one activity to another, inconsistent performance from day to day on similar or identical tasks,

trouble identifying key points in a reading passage, shorter attention span, distractibility, and

slowed rate of information processing (Aldrich & Obrzut, 2012; Bennett et al., 2003)

Memory deficits may also be experience by students with ABI and can be particular to

the content or information that is being presented and how it is presented. However, memory

skills are highly intricate and children enduring an ABI can exhibit a relatively successful

recovery of pre-injury information related to personal experience, along with overlearned

knowledge and procedural skills like number facts and daily routines (Ministry of Education,

2001, p. 22). According to Teaching Students with Acquired Brain Injury: A Resource Guide for

Schools (2001), there are disparities in recall that may occur, especially with more recently

acquired knowledge and skills; other memory deficits can include difficulties with forgetfulness,

immediate and short-term memory, rate of new learning, retention of new information in long-

term memory, and recall of information from memory storage (Bennet et al., 2003; British

Columbia Ministry of Education, 2001).

Students with ABI typically will have difficulty with their executive functions, the skills

that allow for self-monitoring, self-regulating, planning, and organizing one’s knowledge base;


specifically, organizing information, sequencing and prioritizing information, planning ahead of

time, anticipating outcomes, shifting topics/thoughts, thinking conceptually, and making sound

judgements. Difficulties such as these “become more obvious in older children since the

demands for these sophisticated skills are more apparent as [the student with ABI] progresses

through the academic system” (Bennett et al., 2003, p. 154).

Aldrich and Obrzut (2012), along with Bowen (2005), Bennett et al. (2004) present

corresponding details and findings with the resource guides by the British Columbia Ministry of

Education (2001) and the Brock University and the OBIA (2003) that outline the characteristics

of the information processing speed difficulties experienced by students with ABI. Students

sustaining an ABI will perform “invariably… slower to intake and process information, and will

be slower to respond (verbally, physically) than their cohorts” (Bennett et al., 2003, p. 153).

2.2.3 Communication, sensory and perceptual impairments. Along with cognitive

impairments, individuals sustaining an ABI may also undergo difficulties in areas such as

speech, hearing, vision, taste, olfaction, somatosensation, muscle spasticity, contracture, paresis

or paralysis, loss of fine motor control (manipulation), and loss of gross motor control (balance,

gait) (Bennet et al., 2004).

2.2.4 Behavioural and emotional implications to student with ABI. Clark (1996),

Bennett et al. (2004), Bowen (2005), and both resource documents Educating Educators About

ABI (2003) and Teaching Students with Acquired Brain Injury (2001) identify a number of

adversities encountered by students with an ABI. These involve experiencing agitation, increased

impulsivity, sudden outbursts of anger, difficulty monitoring and controlling emotion,

irritability/short temper, aggression, passive behaviour or lack of initiation, depression, decreased

maturity, sexually inappropriate behaviour, denial, lack of insight, interruptions, impulsiveness,


and social isolation. For every scholarly writing examined, it is observed that authors have also

provided strategies to be used when challenged with these behavioural and emotional difficulties.

2.2.5 Other influencing factors to recovery. The road to recovery for many students

with ABI may mean many years of enduring physiological, functional, and neuropsychological

difficulties. An individual’s prognosis can vary from another and depends on several factors that

include the site of the injury, the severity of the injury, the etiology of the injury, and at the age

at which the injury occurred (Bennett et al., 2004, p. 120).

Arroyos-Jurado and Savage (2008), along with Bullock, Gable, and Mohr (2005) and

Deidrick and Farmer (2005), emphasize ideas on the importance of a successful re-entry protocol

customized for each student’s recovery based on their particular needs. Bullock et al. (2005)

highlight the notion of “continuously monitoring progress and individualizing instruction and

behavioral planning, given that each student’s injury and recovery is unique” (p. 253).

This concept of “continuously monitoring progress” is not a novel idea. Such notions

have their foundations in the ideas of D’Amato and Rothlisberg (1996), Garcia, Krankowski, &

Jones (1998), Littleford (2000), and Savage (1997). These authors underscore the significance

and the need to evaluate the progress and recovery of students with ABI. Students with ABI

differ from others with disabilities in that their progress is unpredictable and not well-defined

(D’Amato & Rothlisberg, 1996, p. 673).

In supporting students with ABI, a team of various professionals achieves success.

According to Bennett et al. (2004), the recovery success of a student with an ABI can depend on

various factors from the site of the injury, how the injury originated, and even the age of the

child when the injury occurred (p. 120). These authors make a reference to Glang, Singer, and

Todis (1997) in stating that the outcome of a student’s recovery from an ABI is contingent on the


support of the people in the student’s environment. This support network can comprise of family

and friends that surround them, school staff and personnel, rehabilitation and medical

professionals, and community leaders and other figures providing support (Bennett et al., 2003;

Clark, 1996; Garcia et al., 1998; Keyser-Marcus, Briel, Sherron-Targett, Yasuda, Johnson, &

Wehman, 2002; Littleford, 2000; British Columbia Ministry of Education, 2001; Savage, 1997;

Witte, 1998).

2.3 Impact on School Policies and Procedures

The resulting effect on school policies and procedures impacts various aspects of

operations throughout the school including assessments, the development of Individual

Educational Plans (IEPs), and the interventions and strategies employed by staff and teachers of

the school.

2.3.1 Assessments. Assessment is also one of the frequent topics of discussion

throughout the literature examined. However, it is the work of Bowen (2005) that was most clear

and distinct among others. Bowen makes recommendations to have the special education team

complete a Functional Behavioral Assessment (FBA) to assess, measure, and treat the deficits

related to a student’s brain injury. An FBA is comprised of an observational “descriptive

assessment… of the student, structured interviews, and manipulation of variables to determine

function of problematic behaviours” (p. 35). In the article, Bowen also provides an example of an

FBA called and ABC (Antecedent-Behavior-Consequence) assessment on which a range of

information can be recorded. Following an FBA, Bowen states that the team can then design an

optimal education program based on the information collected.

2.3.2 Developing Individual Educational Plans (IEPs). In regards to Individualized

Education Plans, the work of Clark (1996) highlights that, upon the student’s arrival at school


(re-entry stage), the special education team, which includes school staff, rehabilitation and

medical professionals, along with family and friends may come together to reassess the needs of

the student in order achieve a successful reintegration. Clark states that it is at this time that

modifications can be made, parents may discuss possible services with the school, all parties be

informed on the special education laws and procedures, the assessment processes, and obtain

more information to further develop the student’s IEP (p. 556).

2.3.3 Interventions and strategies. The examination of the literature surrounding the

topic of students with ABI presents many authors (Aldrich & Obrzut, 2012; Arroyos-Jurado &

Savage, 2008; Bowen, 2005; British Columbia Ministry of Education, 2001; Bennett et al., 2003;

D’Amato & Rothlisberg, 1996; Deidrick & Farmer, 2005; Garcia, Krankowski, & Jones, 1998;

Keyser-Marcus et al., 2002; Littleford, 2000; Lucas, 2010; Rees & Skidmore, 2008, 2008, 2011;

Savage, 1997; Witte, 1998) discussing a variety of interventions and strategies. It is quite evident

that most of works analyzed had much to offer in regards to interventions and strategies. The

resource binder produced by Brock University and the OBIA (2003), and the document by the

British Columbia Ministry of Education (2001), along with Bowen’s work (2005), proved to be

most comprehensive among the literature considered. Key features that were present in all three

sources include extensive descriptions of the various symptoms associated with ABI, examples

of case studies throughout Canada and the United States, concrete strategies for both classroom

and school-wide settings interventions, accommodations and modifications, as well as models of

assessment tools that can be helpful for teachers.

Concerning the efficacy of teaching and learning strategies, the numerous works of Rees

and Skidmore (2008, 2008, 2011) delivered findings that support the redesigning of the

scaffolding strategy, the implementing of more classical and traditional styles of teaching, and


the encouraging of egocentric speech that can benefit a student with ABI and guide them towards

a more successful path to recovery.

2.4 Challenges Facing Teachers

The assessment of the current literature presented many challenges faced by teachers as

they play a role in the integration of students with ABI into classrooms. Bullock et al. (2005),

Zinga et. al (2005), and Keyser-Marcus et al. (2002) provide a variety of issues teachers may

encounter in teaching and supporting students with ABI, in particular a lack of training and

preparation to support students with ABI, the growing demands of a diverse classroom, the

absence of a set of standards specific for supporting students with ABI, and a lack of support

from the home-school-community network.

2.4.1 Lack of training and preparation. Bullock et al. (2005), and Clark (1996) relate

to the work of Keyser-Marcus et al. (2002). These authors recommend closing the gap between

the medical and rehabilitation care of students with ABI and the educational system. Clark

(1996) states that “[a] thoughtfully composed and well-informed team is critical for ensuring that

services are provided, and are done so in a timely manner” (p. 553). Clark furthers this idea of a

cohesive team and suggests that coordinating services goes beyond the boundaries of the school

system, and it is necessary for this system to communicate well with each of the parties involved.

These services and agencies can provide training for all members who require the practical

information; they are valuable resources for school personnel, as well as the family and friends

of the student with ABI (p.553).

2.4.2 Growing demands of the classroom. According the Educating Educator About

ABI (2003), due to the nature of ABI and its “subtle and varied manifestations, there is no set of

strategies that will guarantee optimal learning for every student with ABI” (p. 62); thus, teachers


supporting a student with ABI “will have to be creative, willing to experiment, and extremely

patient and forgiving, both with the student and themselves” (p. 62). The lack of such strategies

can also be attributed to the absence of standards in programming for students with ABI.

2.4.3 Absence of standards. Developing Individualized Educational Plans (IEPs) for

students with ABI can be challenging for teachers due to a number of factors (British Columbia

Ministry of Education, 2001) and this task can be especially daunting without a set of policies

designated to support students with ABI (Zinga et al., 2005).

2.4.4 Lack of resources. In facing the challenge of the lack of resources available for

individuals with an ABI, the work of Bullock et al. (2005) neatly summarize the types of services

that are emergent. They trace the growth and potential of the services that are currently being

developed and are slowly being implemented throughout the United States. There is no doubt

that the close relationship of the Canada and the United States will inevitably result in similar, if

not identical, services for individuals with an ABI.

2.5 A New Category of Exceptionality in Ontario

Research by Zinga et al. (2005) finds that in Canada, education is under legislation by

each province and territory and lacks the federal legislation to govern how it is provided

nationally. These authors cite the work of Dworet and Bennett (2002) and state that this creates a

variety of special education programming policies across provinces and territories. And although

these differences exist in terms of policies, there are many other laws that are similar and

identical with throughout the nation. These include mandatory education laws that support

inclusion of special education students, choice for inclusion by students requiring special

education, individualized education programming for students with identified needs, parental


participation in assessment and placement processes, and procedures for the appeal of special

education decisions (p. 4).

Historically, in Ontario, the Education Act (Bill 82, 1980) declared that every child was

to receive education, notwithstanding having an exceptionality (Zinga et al., 2005). Many

changes have been made to the Act since then; but, the conditions that outline special education

programming remain unchanged and unrevised. The Act states that school boards in Ontario

must establish an Identification Placement Review Committee (IPRC) process to identify

students as exceptional. The Act further defines exceptionalities as being within five specific

categories of either behaviour, communication, physical, intellectual, or multiple

exceptionalities. Therefore, since funding is closely associated with the IPRC process, this

process creates barriers for individuals who do not qualify for such programming; moreover, it

challenges the interpretation of how such policies should be put to practice (Zinga et al., 2005).

2.6 Summary

The analysis of the literature on the topic of students with ABI of the most recent twenty

years reveals that strategies and interventions are a consistent area of research and professional

development. This examination also encounters a discrepancy in the research completed in these

latest twenty years, which reflects the body of evidence-based research exploring acquired brain

injury as a categorical exceptionality in the province of Ontario to be insufficient.

This study provides support to the significance of a new category of exceptionality that is

inclusive of students with acquired brain injury (ABI). In doing so, it explored the implications

of ABI to students, the influencing factors for recovery of these students after their injury, the

impact on teachers regarding programming for ABI students, and the challenges teachers that

face in implementing these programs. It also serves to underscore the urgency of a new category


of exceptionalities under Regulation 181/98 of the Ontario Education Act. Furthermore, this

study investigated the impact of the ways in which teachers ensure students with ABI in special

education programs are achieving curriculum expectations, the perspective of teachers on their

preparedness in meeting the needs of students with ABI, and the challenges that they encounter

in delivering the curriculum to students with ABI. In the next chapter I describe in detail the

methodology used in this study.


Chapter 3: Research Methodology

3.0 Introduction to the Chapter

This chapter discusses the methodology carried out in this study and outlines the course

of action executed for this research, the motivation behind methodological decisions, and the

principles that anchored the methods to the research purpose and question. The chapter begins

with an explanation of the research approaches and procedures and establishes a benchmark for

the sections to follow. Subsequently, a description of the instrument of data collection is

presented before the chapter profiles the participants of the study. This section on participants

defines the sampling criteria and the participant recruitment procedures I have used for selection,

and also provides the background information of the participants of the study. Here, I outline the

procedures I have used for data collection, address the ethical review procedures that have been

established, draw attention to the methodological limitations related to this research, and

highlight the strengths of the study. The chapter concludes with a summary of the research

methods and protocols used; as well as, the impetus behind the preferred methods of this study.

3.1 Research Approach and Procedures

In conducting this study, I adopted the claims of Hoepfl (1997) who purported that the

aim of qualitative researchers is to obtain an illumination on topics examined, gain enriched

perspectives on the themes studied, and develop ways to extrapolate learned knowledge to

similar situations. These goals are distinguished from the goals of quantitative researchers who

typically “seek causal determination, prediction, and generalization of findings” (Hoepfl, 1997,

p. 48). This distinction is a result of the differences that characterize quantitative research apart

from qualitative research.


In its design and function, this study assumed a qualitative research approach. Hence, a

literature review was completed to survey the current landscape of the matter and served to

buttress the foundational principles of this research. The personal philosophies that support my

rationale behind the study are grounded in my beliefs in the promotion of equity and accessibility

in the field of education, specifically for students with ABI in the Ontario school system. The

literature exposes the reality for students with ABI in Ontario classrooms, and it is the

contributions of teacher participants in this study that have now given insight to my own

teaching practices, as well as the larger education community, which have the potential to change

this reality.

Qualitative research approaches place an emphasis on instruments like interviews and

observations for data collection; according to Golafshani (2003), these methods are “dominant”

in qualitative research, such that “qualitative researchers have come to embrace their

involvement and role within the research” itself (p. 600). They ensure that the data they collect

from participants encapsulates their perspectives and views accurately (Bogdan & Biklen, 2006).

The primary data collection method in this study consisted of two semi-structured, face-to-face

interviews with teachers as research participants. Participant criteria aided the selection of those

who contributed to the research study. Successful participants were Ontario elementary school

teachers with experiences in educating students with ABI students with exceptionalities. The

data I had gathered from these interviews were transcribed and grouped into more topicalized

collections of information. In keeping with the work of Kvale (as cited in Turner, 2010), I had

organized the data by codes, categories, and then themes when they presented consistent phrases,

expressions, or ideas that were common among research participants’ responses to the interview

questions. I then evaluated these findings and compared them against the literature reviewed


earlier to ascertain a deeper understanding of the experience of teachers in educating students

with ABI and students with exceptionalities.

The goal of qualitative research is not to approach the study bringing forth explicit

questions to answer, problems to solve, or hypotheses to test (Bogdan & Biklen, 2006). Rather,

in qualitative research, the researcher attempts to comprehend how people, participants related to

the study, think and develop their thinking in particular situations (Golafshani, 2003). It is this

juxtaposition that creates a distinction between the two paradigms of research approaches and

provides this study with its foundations in qualitative research.

3.2 Instruments of Data Collection

A distinct attribute of the qualitative approach in research methods is its array of data

collection protocols. The form of data collection this study has conducted is the interview

protocol. Turner (2010) remarks that the interview protocol is “one of the more popular areas of

interest in qualitative research design” as it yields “in-depth information pertaining to

participants’ experiences and viewpoints” (p. 754), supporting the aim and goal of qualitative

research as a whole. In the case of this study, the interview protocol assisted in obtaining data

from two Ontario elementary school teachers and their experiences in teaching and supporting

students with ABI and other students with exceptionalities. The responses of the participants

were, of course, influenced by the questions asked by the researcher, fostering and engaging in a

constructivist approach to develop and establish knowledge by illuminating the insights of the

participants in the study. Denzin and Lincoln (2000) state that the input of the researcher, by

means of the interview questions asked, are as valuable to the study as the responses of the

participants. It is the researcher that controls the pace of the interview, who regards the


questionnaire as if it were a theatrical script to be followed and carried out in a standardized and

straightforward way (Denzin and Lincoln, 2000).

There is a wide range of interviews that can be employed for data collection, varying

from structured and formal, to conversational and casual interviews. Turner (2010) proposes

three formats of interview design: the informal conversational interview, the general interview

guide approach, and the standardized open-ended interview. Deciding on which design to use for

the purposes of this study required a shallow analysis of the advantages and disadvantages of

each format.

In order to develop an understanding behind the choice of interview for the study, brief

summaries of each type follow. The informal conversational interview design relies heavily upon

an open dialogue between the researcher and the participant; therefore, selecting this design

would not benefit this study as it does not render consistency (Turner, 2010). The general

interview guide approach offers a more controlled environment, allowing the interviewer to

obtain responses from participants by means of a single set of predetermined questions. This

design calls for the researcher “to play a neutral role” that establishes a “balanced rapport” and

maintains a style of “interested listening” that rewards the contribution of the participant

(Denzin, 2000, p.650). According to the works of Turner (2010) and McNamara (2009), the

general interview approach places significant onus on the researcher to convey uniformity and

requires consistency in the delivery of its questions. Although it sustains a more focused method

than the conversational interview approach, its demands inhibited the decision to use this design

in its complete form. Lastly, the standardized open-ended interview presents a more focused, yet

adaptable, manner of interviewing that asks participants identical questions, without restricting

their responses. As Turner (2010) has outlined, this format encourages “participants to contribute


as much detailed information as they desire and […] allows the researcher to ask probing

questions as a means of follow-up”; thus, making it a popular choice for research studies in the

qualitative approach (p. 756). Open-ended interviews allow participants to give a response about

their specific situation from their own perspective, rather than from a set of prescribed questions

to answer (Bogdan & Biklen, 2006).

Ultimately, it was the semi-structured interview design, closely aligned with the standard

open-ended interview proposed by Turner (2010) that proved to be the optimal choice for this

study. I found this interview design to be the most efficient approach in collecting data for this

research as it allows the researcher to elicit information in a consistent manner, while giving

participants the flexibility to respond in as much, or as little, as they had wanted. This approach

enables the researcher to ensure that multivocality was present in this research study through the

collaboration efforts of both the researcher and the participant (Tracy, 2010).

According to Bogdan & Biklen (2006), the semi-structured interview protocol also allows

the researcher to have a better, more detailed, understanding of his or her participants’ thinking

and how this thinking came to be. These authors state that, for this understanding to transpire, the

researcher must devote a considerable amount of time with participants in a “naturalistic”

manner. They comment that, qualitative research methods in education are considered to be

“naturalistic” as the researcher “frequents places where the events he or she is interested in

naturally occur” (p. 3). This was evident in the preparation phase of this research study. The

experiences I gained in my practicum classrooms strengthened my understanding of the role of

teachers, as well as the daily demands of the classroom mentioned in the responses of my

participants. The practicum experiences prior to conducting this study have given me an

opportunity to observe teaching strategies for students with exceptionalities personally, allowing


me to consider a variety of practices, including ones that respond to the specific needs of

students with exceptionalities.

For Bogdan and Biklen (2006), qualitative researchers have the opportunity to establish

measures that allow them to reflect on the experiences from their participants’ perspectives;

therefore, facilitating a “dialogue or interplay between researchers and their subjects” (p. 8). This

ability demonstrates credibility, a crucial aspect of qualitative research (Tracy, 2010) and

facilitates open lines of communication between the researcher and the participant, such that both

parties are able to discuss points about the research with honesty and sincerity.

Tracy (2010) presents and defines eight significant criteria to consider in executing

qualitative research: worthy topic, rich rigour, sincerity, credibility, resonance, significant

contribution, ethical, and meaningful coherence. Qualitative research, she suggests, must include

these “key markers of quality” (p. 837) and can be approached through various paths and

professions, depending on the researcher, context, theory and purpose of study. It is pertinent for

researchers in this field of education to consider the context in which teachers are employing

their strategies and must also evaluate the institutions of which participants belong (Bogdan &

Biklen, 2006). In order to establish a clearer understanding of such a context, a “naturalistic”

approach to research must acknowledge how “human behaviour is significantly influenced by the

setting in which it occurs” (p. 5). Therefore, the use of this approach offered me validation in

having conducted the semi-structured interviews at the school in which my participants were

familiar with and in the communities where participants are members.

These interviews served as the primary source of data for the purposes of this study, and

facilitated discussions surrounding the established protocol. Preparations were made to respond

to unexpected situations, and, in doing so, had helped to advance the knowledge being shared by


the participants in the study. Conducting face-to-face interviews allowed me to establish an

inductive system of analysis that has revealed interconnectedness between themes and

associations between the experiences of my participants from the data collected in the interviews.

Once the interviews were completed and the researcher had dedicated some time to debriefing

participants, the direction of the research was then dictated by the data collected (Bogdan &

Biklen, 2006). Therefore, after conducting the interviews and debriefing the participants, I had

analyzed the data collected, and acknowledged the themes that emerged from it.

The interview protocol used in this study was divided into three sections: (i) the

participant’s background information, (ii) the experiences and attitudes of the participant, and

(iii) the next steps for the participants. A list of the interview questions that were used in this

study can be found in Appendix B.

3.3 Participants

Establishing a sample for data collection is an important stage in any research project as

it is often impractical, inefficient, and unethical to study whole populations (Marshall, 1996).

Therefore, for the purposes of this study, I conducted semi-structured interviews with two

Ontario elementary school teachers with experiences teaching students with ABI and students

with exceptionalities. I ensured that the sample of participants shared commonalities in relation

to the research question and complied with the sampling criteria defined by this study.

3.3.1 Sampling criteria. A number of criteria were applied in selecting the participants

for this study. Participants to this study had to have worked or work in an Ontario elementary

school; to have had training in special education, or to have taken courses in special education; to

have had experience in educating, supporting, and providing strategies and teaching practices

for, at least, one student with ABI; and to have had, at least, one experience through the


Identification Placement Review Committee (IPRC) process. Participants had to be able to

satisfy all the requirements of this set of criteria in order to align with the purposes of this study

and to provide evidence most suitable for the scope of this research. Since the study strived to

explore the Ontario education system at the elementary level, it was appropriate to seek teachers

and educators with experience in elementary schools in public boards from Ontario to provide a

narrow focus of experiences. In selecting the sample of participants, I maintained the viewpoint

that participants with training and background in special education could offer more

comprehensive responses and, therefore, could appropriately address the provision of strategies

and practices that support students with ABI, including offering their experiences with the IPRC

process.

3.3.2 Participant recruitment. For the purposes of this study, I recruited participants

mainly through a type of sampling categorized as “convenience sampling” (p. 523) by Marshall

(1996). I shared my research with teachers and educators within my personal and professional

networks throughout the months of April to August of 2016. Through informal conversations, as

well as conversations through digital platforms, including email and social media, and expressed

to those interested in my research that the study had the potential to illuminate the strategies and

practices of teachers supporting students with ABI. I also contacted specific centres and

organizations that provide support for students with ABI through out-patient programs as part of

my recruitment, as I valued their works to advance the knowledge-base of ABI support which

fits well within the scope of this study. I have chosen these measures for my rationale in the

recruitment of participants for this study and was successful in recruiting my participants by this

approach.


Participant biographies. The information presented in this section strives to preserve the

anonymity of the participants involved in the study with the use of pseudonyms and will be

referenced by them throughout the chapter. Other information identifying particular institutions,

schools, or organizations will not be disclosed with respect to the participants involved. A

concise profile of the participants will follow in order to outline the background of the teachers

interviewed. This briefing outlines each participant’s involvement in teaching students with ABI,

their teaching experiences and qualifications, training they may have, as well as their experiences

in teaching students with exceptionalities other than ABI.

Participant 1: Jane (pseudonym). The first participant, Jane, was an employee of a

rehabilitation centre in Toronto as a teacher for students with ABI and other exceptionalities.

Jane had been certified to teach Primary, Junior, and Intermediate classes, but, spent the majority

of her career teaching grades 4, 5, and 6. Her teaching career began with a focus on integrated-

arts. However, it expanded as Jane received a Specialist certification in Special Education

programming. Jane also held qualifications in Math, Computers, and Reading. Her first

experience in teaching students with ABI began almost twenty years into her teaching career.

Since then, Jane’s teaching practices had been enhanced by her attendance of workshops and

training sessions provided by her school board, and centres designated to study autism spectrum

disorders, as well as brain injury organizations.

Participant 2: Michael (pseudonym). The second participant is Michael, who had worked

in the Greater Toronto area for thirty-eight years teaching Kindergarten to grade eight students,

and was retired from the teaching profession at the time of the interview. Michael had received his

Specialist certification for Special Education and his experiences included teaching Special

Education classes, Learning Disabilities (LD) classes, as well as classes of students with


giftedness. He held qualifications to teach English, Science, and Math, but had also taught Drama,

Health Sciences, and Social Studies. His first experience in teaching students with ABI also began

later in his career, approximately thirty-four years after he began teaching. Throughout the duration

of his career, Michael had attended numerous workshops and training sessions on a variety of

topics. These have informed his teaching practices over the years, and have since helped him to

support students with exceptionalities as a whole in his classroom.

3.4 Data Analysis

Turner (2010) cites the works of Creswell (2003, 2007) and comments that it is “during

this phase [that] the researcher must make ‘sense’ out of what was just uncovered” (p. 759).

After the transcription of the data collected from my interviews, I ensured the validity of my

research in my analysis by coding and sorting the data, grouping like information together, and

then establishing themes of commonality throughout the responses elicited by the interviews. For

each theme outlined, data representative of the participants’ responses were presented in relation

to the literature reviewed in previous chapters. Participants’ responses were analyzed and

examined with rigor and was subjected to a thematic networks analysis as proposed by Attride-

Stirling (2001) as a means of methodically investigating the patterns of information gathered

through this qualitative research study. This categorical system supported the interpretation of

my data, as it revealed themes and topics that were evident in the responses of my participants.

As I discovered emergent themes, I separated the data accordingly, in keeping with my main

research question and sub-questions. This procedure led to my findings and has informed the

connections and relationships I present in the interpretation of the data found in the final chapters

of this study.


3.5 Ethical Review Procedures

This study complies with the ethical review approval procedures for the Master of

Teaching Program, under the regulations outlined by the Research Ethic Boards of the University

of Toronto. I contacted potential participants with respect and awareness of the current political

climate of the topic in question. I provided each participant with a letter of consent that they

read, understood, and signed after participation was agreed upon (see Appendix A for Letter of

Informed Consent). Participants were given pertinent information regarding the research study,

the Ethical Review process with which the Master of Teaching program complies, and the

purposes and conditions of the use of the information collected. Confidentiality, anonymity and

honesty of the responses and data collected were enforced methodically and thoughtfully. The

comfort and understanding of the participants were my priority and I ensured that this was

maintained throughout all stages of the study. Participants had the opportunity to change or

revise their answers, opt out of answering any interview questions, ask questions for

clarification, or speak to or correspond with myself or my research supervisor at any time during

the study was being conducted.

The raw data of interview responses were kept anonymous and confidential throughout

the study and the production of this research paper. As explained in the Letter of Informed

Consent, the anonymized information I collected was shared with my research supervisor and the

participants had given their consent for to this matter (see Appendix B for Letter of Informed

Consent). All information collected was stored on my personal devices which are all password-

protected.


3.6 Methodological Limitations and Strengths

One concern to address as a limitation of this research is its small sample size. Marshall

(1996) outlines such a sampling as “convenience sampling” and is comprised of participants that

are most accessible and are within the scope of the purpose of the research study (p. 523). After

interviewing two teachers, I realized that sounder associations could have been made and

established with more participants to gather a variety of perspectives. Considering a larger

sample size would also warrant a consideration for a more effective means in conducting my

interviews with a survey, or another form of data collection. I could have also considered

multiple teachers from different school boards and regions that have had similar experiences in

supporting students with exceptionalities and students with ABI.

Another drawback of this research study is in the limited research on teacher preparation,

strategies, and practices particular to educating students with ABI. In addition, a majority of the

research analyzed for the purposes of the literature review of this study had been conducted

outside of Canada. From the research that had been conducted within Canada, most were based

on school systems outside of Ontario.

Strengths of this research study are reflected in its design and protocol. The sampling

criteria captured the participants it had hoped to recruit. The semi-structured interview approach

enabled me, the researcher, to obtain a first-hand account from teacher participants who have

experiences to contribute to the research. Its methods are well-organized and grounded on

theoretical frameworks that are sound and evidence-based. The literature referenced have been

peer-reviewed and have been published by respectable journals and organizations that conduct

themselves with integrity and honesty, and who are leaders in their field of research.


Overall, an assessment of the limitations of this research study establishes that although

the themes and topics researched are relevant, current, and important to elementary education in

Ontario, the findings of this qualitative research study may be partial only to those within the

circumstances outlined.

3.7 Conclusion

This chapter has explained the research methodology followed for the purposes of this

study. The research approach and procedures were discussed, ensuring that the approach chosen

aligned with and were supported by qualitative researchers before me. This chapter also

described in depth the instruments of data collection, identifying interview responses as the

primary source of data. The benefits of semi-structured interviews were explored, and the

participants of the study identified. In doing so, the participant criteria were listed and had been

applied to all interviewees. This section has also provided brief profiles of those selected for the

study and some background information on the participants. This chapter also described

recruitment procedures which entailed the purpose of sampling in the overall scope of the

research study. It explained the process of data analysis utilized, and outlined how I examined

individual interviews before looking for common patterns and themes across the data. Ethical

issues such as consent, risks of participation, member-checks, right to withdraw, and data storage

were also considered, as well as the ways in which to address potential problematic issues.

Finally, this chapter addressed the methodological limitations of the study, such as the

interpretive abilities and biases of the researcher, while also highlighting some of the strengths,

such as first-hand accounts with teachers. In the next chapter, I present the findings of this

research, including a comprehensive analysis.


Chapter 4: Findings


This chapter serves to present the findings of this study from interviews conducted with

two elementary teachers and offers insight into the experience of teaching students with acquired

brain injury (ABI). The primary question that motivated this research pertains to the experiences

of teachers and their practices: What are the challenges facing teachers who teach and support

students with ABI? Secondary questions were as follows: What special education training is

provided to Ontario teachers and educators to prepare them in teaching and supporting students

with ABI? How prepared do teachers feel in meeting the needs of students with exceptionalities,

especially students with ABI? What are the instructional strategies and practices employed by

teachers in elementary schools who educate students with ABI? and, How do the instructional

strategies and practices employed by teachers in elementary schools meet the needs of students

with ABI? In the province of Ontario, students with ABI experience insufficient support in

meeting elementary curriculum expectations and standards. This lack of support is driven by an

absence of identification as an exceptionality under the Ontario Education Act (1990). Without

the acknowledgement of identification with an exceptionality, students with ABI are excluded

from receiving support through special education programming that is essential to their

educational success.

The data from this study revealed by the following key findings: inefficient ABI training

results in a lack confidence in teachers and diminishes their preparedness in teaching and

supporting students with ABI; the demands of the classroom limit teachers from establishing

effective strategies that are responsive to the needs of students with ABI; the absence of a set of

standards and policies in carrying out accommodations for students with ABI; and the inadequate


support from the home-school-community network presents challenges in meeting the needs of

students with ABI. These are described in detail in what follows.

4.1 Lack of ABI Training for Teachers Results in a Lack of Confidence in Teachers and

Diminishes Their Preparedness in Teaching and Supporting Students with ABI

Both participants have many years of experience and have received Specialist

certification in Special Education. Jane had been a teacher for about 27 years, and Michael’s

career had spanned 38 years before he had retired earlier this year. Despite their seasoned

teaching careers, both participants expressed a lack of formal training on supporting students

with ABI early on in their careers.

Participants considered the basic training they received about ABI in their pre-service

teacher education program to be insufficient for them. They commented that it was not until after

they received their Specialist certification that they were self-assured enough to give basic

support. Jane stated that her interests in ABI are rooted in an intrinsic motivation to learn more

about her own conditions as she herself has sustained a brain injury from childhood, and also had

a young relative with ABI in an Ontario public school for whom she advocated. Jane commented

that Special Education certification should be a compulsory component of the teaching

profession province-wide. When asked to comment on her training, she said that:

[The] Special Education additional qualification courses should be mandatory for

teachers because it really depends on your administration, and your methods and resource

teacher, and your Special Education teachers - some teachers get the support they need,

and some just wing it, or learn through osmosis, or find another colleague …but it wasn’t

until my Special Education training that things became very clear …before then, I would

admit there was a sense of ‘I’m not sure I’m doing everything that I’m supposed to do’.


Jane’s first experience in teaching a student with ABI was recent and she recalled not

having much support provided for her in teaching the student with ABI in her classroom. The

only information made known to her was that the student had sustained a concussion from a

hockey injury, leaving Jane to seek out her own supports.

A newly retired teacher, Michael had taught his first student with ABI in the latter part of

his teaching career. Michael’s views aligned with those of Jane as he, too, stated that his

pre-service teacher education training did not prepare him for teaching students with ABI. He

recalled enrolling in additional qualification courses out of personal interest and eventually

received his Special Education certificate. In regards to the lack of training provided specifically

for ABI, Michael’s views aligned with those of Jane. Michael, too, had received his Specialist

certification in Special Education; yet, he believed his training to have been insufficient. In

retrospect, Michael expressed that having had the opportunity, he would have approach his

practices differently. He commented about the changes he would make and stated that those

changes would have to be “a little more with the background research, and maybe take it to the

next level.”

Participants attended many other types of training sessions offered by their school board;

mainly instructional workshops about new technology or software, or informational meetings

about the trajectory of the school and its board-wide initiatives. Michael felt that these meetings

were not being used effectively for training as they were not valuable to educators in teaching

their students with ABI. He expressed in his response to the interview that in teaching students

with exceptionalities and ABI, “it was more important for me to get my paperwork ready for the

next day” as he commented that he did not gain much more than what he had learned in the

Special Education course he had taken.


Jane shared that she enjoyed taking courses that helped her to develop a better sense of

herself as a teacher professional, specifically workshops and seminars on ABI and

exceptionalities. She commented on the infrequency of the workshops that were provided by her

school board and mentioned that she found herself enrolling in workshops offered by particular

organizations serving the ABI community. Regarding ABI training at the school board level,

Jane asserted that “lunch-and-learn workshops do not cut it” as there is much information to

learn about ABI. She expressed her concerns, saying:

I don’t think a lot of teachers realize that there’s a lot of support material out there, and

there are so many things we need to know […] Special Education programs do offer great

insight into acquired brain injuries, but there’s not enough information.

This insufficient training and support in teaching students with ABI further creates

difficulties for teachers. Many educators in Ontario, and within Canada “are not provided with

any specific training in regard to the needs of students with ABI, either in pre-service programs

of in-service courses” (Zinga et al., 2005, p. 16). Provision of services for students with special

needs requires more training for teachers as access to these services do not prove to be

satisfactory and appropriate in meeting the needs of the student (Zinga et al., 2005).

4.2 The Demands of the Classroom Limit Teachers from Establishing Effective Strategies

in Teaching and Supporting Students with ABI

It is quite evident from the literature reviewed for this study that the daily demands of the

classroom are enough to keep teachers occupied throughout the day. Participants observed that in

their own practices, teaching and supporting students with ABI makes the conditions in

classrooms more tense in addition to facing the various stresses involved in their day-to-day

teaching. Interwoven into the responses gathered from the interviews conducted were indications


of these stresses and how, coupled with a lack of teacher knowledge on ABI, teachers faced

difficulties establishing effective strategies for students.

For the participants of this study, the demands centred on managing the preconceived

ideas of their current students. Both participants reported experiencing extensiveness inquiries

about the expected student with ABI and their students’ reservations about befriending them

after having learned of their injury. Jane shared that she believed “there [was] a certain amount

of intolerance with kids that have acquired brain injury because I don’t think kids can really

conceptualize the idea of a brain injury and that having as many strategies as possible on reserve

for use is important.” She commented throughout the interview that teachers need more time to

prepare to meet the diverse needs within their classroom.

Michael remarked that, in his opinion, the teaching profession has changed. He

considered the benefits of teaching to be quite different from what they used to be, and states that

the “demands are harder.” Michael’s responses revealed that his perspective of such demands

prevent teachers from being able to take the time to prepare themselves to meet the needs of

students with ABI in his class. He shared an experience from his career and said:

We just get really, really busy, and we’re always told to go through every kid’s OSR

when they come in. And it’s like, “How much do you want us to juggle?” With the

‘Special Ed.’ end, I had thirty-eight kids two years ago, a grade seven-eight split, two

curricula, and thirty-eight kids, and so going through all those OSRs in detail is difficult.

Michael’s responses also rendered the idea that teachers are only in a place to supplement

the care and learning the student with ABI is receiving from external supports, like hospitals, and

rehabilitation centres. Similar to Jane’s experiences, Michael also had to manage his students’

investigation of their peer and debrief them before his arrival. He commented:


I do remember there was a little bit of hesitation in certain kids, ‘Who is this kid? And,

why is he coming in the middle of the year?’ and then, I’m sure he told them, ‘I had a car

accident, and I was hospitalized, I had to go to a special school.’ And the ones that

gravitated to him, gravitated to him because he wasn’t an outgoing, social kid; but, he

held his own okay. So, he worked within a certain group of kids. But, like all kids, they

become all cliquey. So, he had a certain group of kids he was friends with and it was fine.

They were apprehensive at first because I’m sure he would have told them, “Okay, well

I’m here now because of…” And then he didn’t care, he was fine.

It is significant to note that both accounts of Jane and Michael reveal that that students

with ABI “are often different from their peers with other kinds of special learning needs,” and

that “those differences have important implications for educational programming” (Clark, 1996,

p. 553). Students do not attend school isolated from others; thus, many factors must be

considered as students with ABI integrate back into classrooms. These factors include the

teacher’s management style, classroom organization, and one’s degree of control and level of

emotional support (D’Amato & Rothlisberg, 1996, p.678); this certainly intensifies the daily

demands of the classroom.

4.3 Absence of a Set of Standards and Policies in Carrying Out Accommodations for

Students with ABI.

Devoid of the classification of ‘exceptionality’, ABI remains to be without a set of

standards and policies that meet the needs of its students. Sub-sections further categorize the

information on this theme from the interview responses of participants: school initiatives and

IPRC meetings, IEPs and assessments, documentation of ABI, and seeking external supports.


4.3.1 In-school team meetings and IPRC meetings. Michael’s experiences include

school-wide initiatives in intake meetings for all students with exceptionalities. This initiative

called the ‘in-school team meeting’ (IST) takes place so that staff may meet together to discuss

issues pertaining to the student either before they arrive at the school or within the first few

weeks of their arrival. According to Michael, it served to “prepare everyone” involved in the

education of the student at the school setting. Michael did not recall when the ISTs happen, but

believed that they only occurred once for each student. This demonstrates that there is no

standard for such meetings, since it had only occurred once, challenging the proposal of Brock

University and the OBIA’s Educating Educators About ABI (2003), which recommends that

IEPs developed should be reviewed on a regular basis.

Jane was quite familiar with the IPRC process and noted that she often attended them at

her current school. She mentioned that familiarity with the process only comes with experience.

She stated that she was comfortable in preparing, and contributing to the IPRC meetings, but

admitted that not many of them that she had attended focused on discussing the needs of students

with ABI. Participants’ experiences in attending IPRC meetings are limited to those for students

with giftedness, students with learning disabilities, and students with physical disabilities. Due to

the lack of classification of ABI as an exceptionality, participants stated that they had not

attended and were not aware of others attending IPRC meetings for students with ABI. Since

Ontario legislation does not consider such an exceptionality, there exists no protocols to be

mandated in supporting students with ABI.

4.3.2 Individual Educational Plans (IEPs). From Jane’s experiences, many of her peers

questioned the purpose of IEPs for students with ABI. She stated that the comments shared with


her seemed to fall out of feeling overwhelmed. In regards to writing IEPs, training, and

assessments, Jane added:

IEPs are kind of a scary thing to write if you have never had training in it. And a lunch

and learn now and again - that doesn’t cut it; or an afternoon session. You need a good

few months of training; not just to be able to learn how to do it, but, what to put in it and

then how to interpret it. And, there’s no consistency from boards all over Ontario. In

some boards, IEPs are a lot more detailed than in others. And then just in terms of one

teacher to another, you don’t know what assessments each are using. We’re all using

different things, a different standard, and I think that’s a disservice to students because

we need to be on the same page.

IEPs differ from one another, reflecting the diversity of students and their variety of

needs and developing IEPs for students with ABI may also reveal other factors that distinguish it

from other IEPs (Clark, 1996). Bennett et al. (2003) state that, other than what is typically

included in IEPs, teams developing the IEP must consider students’ academic history, recent

assessment information, other medical concerns, immediate physical and cognitive concerns (p.

121). In addition, it must consider placing conditions on the team such as having the IEP

reviewed regularly, the ability to access community agencies, and the ability of family, peer, and

student to make adjustments to it (p. 121). Considering the numerous items that should be carried

out by the team developing the IEP, Jane firmly commented that:

There needs to be a lot more education on acquired brain injuries, and teachers cannot

expect the students to go back to the same level that they were at before …there has to be

all sorts of supports in place. If [a student] has an acquired brain injury, they should

automatically get an IEP, and teachers should know that.


The above, she said, reflected her personal connection to ABI, and more importantly, it

was a response to the current practices of school boards province-wide.

According to Educating Educators About ABI (2003), the IEP is “a vehicle for

programming and monitoring school progress for those students who require a differentiated

program than that which is being offered in the regular curriculum” (p. 118) and can be

developed “if the school feels that the child requires special education programming or services”

(p. 119).

4.3.3 Documentation of ABI and seeking extra supports. Prior to Jane’s employment

with the rehabilitation centre, ABI had only been documented in her student’s file once. She

recalled that in all other cases, whether it was a concussion or another form of ABI, it had only

been verbalized to her. Cautionary directions for the student, for example, activities to avoid like

physical education, were communicated informally through conversation, and were never written

or recorded. This is contrary to the aforementioned recommendation of reviewing the IEP

regularly. Verbalizing information about the condition of students and their needs runs the risk of

not being reviewed for its validity.

Many times throughout his responses, Michael indicated that he took initiative in seeking

answers to his questions about his students with ABI to see what information he could find to

inform his teaching practices. Although there is not a standard for doing so, both participants

have accomplished their own undertakings in obtaining support for their students. Participants

adapted their practices and executed them on a trial-and-error basis. When asked to comment on

the strategies that were successful and unsuccessful, Michael commented:

I don’t know in advance. Unless I’m given a crib sheet of what to do, or direct advice,

because this student has these problems, and we have to follow this set of criteria. Unless


I get that kind of material, I do hit and miss with the [student]. I work with them as

regular. And as I [stated] before, I make my observations, and then I see; it’s like

tweaking an engine, like machinery. So, I make adjustments, or I had made adjustments

as I saw fit.

The absence of a set of standards and policies in carrying out supports for students with

ABI imposes many challenges onto teachers. These challenges set boundaries to providing the

necessary supports for teachers in helping their students with ABI achieve success.

Special Education policies within Canada differ by each province and territory as

education is legislated. According to Zinga et al. (2005), similarities can be found across

policies, including:

compulsory education laws that support the inclusion of special education students, the

tendency to support inclusion or at least inclusion as the first choice, individualized

education programming for students with identified needs, parental involvement in

assessment and placement processes, and procedures for the appeal of special education

decisions (p. 4).

Each individual province and territory legislation impacts students with ABI in their own ways.

Specifically, in Ontario, exceptionalities identified may be of the following: behaviour,

communication, physical, intellectual, and multiple. And although ABI is not recognized as an

exceptionality in the province, students with ABI may still have an Individualized Education

Plan (IEP) developed for them without being presented at an Identification, Placement, and

Review Committee (IPRC) meeting for recommendations in special education programming

(Bennett et al., 2003).


4.4 Inadequate Support from Home-School-Community Network Presents Challenges in

Meeting the Needs of Students with ABI

Students with ABI can benefit from strong foundations in their home, school, and

community (Bennett et al., 2003; Clark, 1996; Garcia et al., 1998; Keyser-Marcus, Briel,

Sherron-Targett, Yasuda, Johnson, & Wehman, 2002; Littleford, 2000; British Columbia

Ministry of Education, 2001; Savage, 1997; Witte, 1998). However, the tendency to rely on the

home-school-community network cultivates the risk of not receiving ample support for students,

especially for students with ABI. Participants experienced difficulties in meeting high

expectations of school administration, the absence of support from healthcare professionals in

the school setting, and the oppositional views of parents who deny the recommendations made

for their child.

For Michael, the infrequent occurrence of in-school team meetings (ISTs) contradicts the

efficiency of maintaining the information on the Individual Educational Plan (IEP) current. In

order to keep up with the recovery of the student with ABI, ISTs must take place regularly as

“scheduling regular team meetings will provide an opportunity for the exchange of ideas and

creative problem solving” (Clark, 1996, p. 553). In Michael’s case, ISTs did not involve parents,

rehabilitation support staff, board-sanctioned healthcare professionals, doctors, nor others that

might be a part of the student’s network of practitioners helping with their recovery. As a result,

Michael did not feel like he was able to fulfill his role as a teacher because he was not able to

collaborate with the rest of team in developing a plan of action for his student.

In light of their sentiments on the need for Special Education certification to be

compulsory in teacher education programs, Jane and Michael commented on the potential

positive impact that the home-school-community network can make in helping to support


students with ABI. Jane also stated that “this could only come into fruition with a strong

administrative presence that is equipped with knowledge from other specialized teachers and

educators that are willing to help.” She commented that she had observed the role of all three

components of the home-school-community network to work together for the greater good of the

student, especially a student with ABI.

Michael shared a discussion with one of his students with ABI, Rafael (pseudonym), and

his father about what they perceived to be possible changes in Rafael after sustaining the ABI.

Michael reported that both, Rafael and his father, seemed disengaged with the conversation and

seemed to be uninterested. Michael noted that, with Petra (pseudonym), another student of his

with ABI, her parents seemed to be distant from their child and believed that Petra could “fend

for herself.” Michael expressed that, although children at the pre-teen age are able to fend for

themselves, they are still quite vulnerable. Michael seemed to respect the decisions of his

students’ parents; however, there may have been more to what Petra’s parents let on. Brock

University and OBIA (2005) caution educators and state that “parents of children who have

sustained an ABI have most likely been through an extremely traumatic experience” and it seems

that “it is not uncommon for some parents to struggle with acceptance of their child’s brain

injury, especially if the physical symptoms have healed and disappeared” (p. 158). In the case of

Petra, this appears to apply as Michael has noted in his responses that Petra was left with an

almost invisible scar above her eye and this he felt that this dynamic in the parent-child

relationship was not beneficial to the recovery and re-integration of his student with ABI.

Returning to school from the home, hospital, or rehabilitation centre after the injury is

one of the most difficult transitions for students with ABI, according to British Columbia

Ministry of Education (2001). Their resource Teaching Students with Acquired Brain Injury: A


Resource for Schools provides steps to ensure a successful return, and that establishing a

connection with a student’s rehabilitation team is a key to achieving a smooth and successful

return.

In Michael’s experience, he did not connect Rafael to other supports outside of school as

Rafael’s mother expressed disinterest in being connected. Michael stated that Rafael’s mother

sensed her son’s difficulties, but did not seek other supports from Rafael’s school. Michael

believed that Rafael may have already been receiving supports from the rehabilitation centre

which he attended prior to his return to school, at the onset of his recovery. Michael also recalled

a conversation he had when Rafael’s mother said that her son, who Michael described as being

severely concussed, was “going to be fine” told Michael to “give him some time.” In Michael’s

opinion, it is imperative to “seek the help you need [in order] to get the support for you

students.” He stated that in education, most people are willing to help each other, but, only if

they connect with one another.

4.5 Additional Challenges in the Classroom

Participants reported that in their experiences, some students had dual-identification of

exceptionalities. Michael recounted the students in a class he had taught one year with students

with giftedness and learning disabilities, as an example. The nature of ABI is quite multifaceted

and is also influenced by the condition of the student with ABI prior to sustaining the injury.

Jane described her experiences with occurrences of misdiagnoses that happens in identifying

ABI and discussed having taught students with MS (multiple sclerosis) and an ABI, which were

first misdiagnosed as ADHD. Jane believes that there is a relation between ABI and other mental

health disorders, and claimed that "there seems to be a pre-existing diagnosis of ADHD". She

shared an example where some of her students who sustained an ABI also had a history of


ADHD. Jane wondered if their ABI could be attributed to their “tendency to take risks in life.”

She commented on the nature of ABI, and the connection between ABI and other mental health

issues:

[Individuals] are going on skateboards, and jumping off, and things like that. But, then

again, I’ve had students who have had MS, and at first it was misdiagnosed as ADHD

[…] I’d have to say, behaviour-wise is the one I’ve heard most people say --that their

behaviour has changed, they’re a little bit more depressed. But, then again, that might be

a result of their diminished capacity; some of them, they’re aware of what they used to be

able to do. And then self-regulatory …one person that I’m working with, her self-

regulatory skills have diminished significantly.

According to the participants, the effects of ABI on the student impacts their self-

awareness and limits the student’s ability to be engaged in their own learning; giving the illusion

that ABI is an “invisible disability”. Because the nature of ABI sometime displays subtle and

varied manifestations, there is no set of strategies that will guarantee optimal learning for

everyone student with ABI. Therefore, teachers who teach and support students with ABI would

have to be creative, willing to try, patient, and forgiving (Bennett et al., 2003).

Educators must consider that students with ABI may have complex medical and health

needs and, often, changes in behaviour exhibited in the classroom can be attributed to health care

needs (Bennett et al., 2003). As introduced in the earlier chapters, the nature of brain injury is

ever changing and its symptoms being as characteristic as the individual who sustains it;

occasionally resulting in new symptoms appearing at various times as the individual gets older.


4.6 Conclusion

The four themes outlined in this chapter bring to light the key findings of this research

study: inefficient ABI training results in a lack confidence in teachers and diminishes their

preparedness in teaching and supporting students with ABI; the demands of the classroom limit

teachers from establishing effective strategies that are responsive to the needs of students with

ABI; the absence of a set of standards and policies in carrying out accommodations for students

with ABI; and the inadequate support from the home-school-community network presents

challenges in meeting the needs of students with ABI.

These major themes emerged from the interviews conducted with two elementary school

teachers from Ontario. Both have taught for more than twenty years in the Ontario public school

system and have had experiences in teaching students with ABI and students with

exceptionalities. Their contributions are evident of the attention and consideration that students

with ABI require. Their needs warrant a careful attentiveness that responsiveness, not only of the

teachers that lead their classrooms, but, also those in the larger education community who govern

public policies and legislation.

The analysis has shown that there is a lack of pre-service and in-service training for those

teaching and supporting students with ABI, the demands of the classroom limit teachers from

establishing effective strategies, there is an absence of a set of standards and policies particular to

accommodating students with ABI, and that there is inadequate support from the home-school-

community network for students with ABI.

The findings of this study demonstrate the unique nature of ABI, exemplify the intricacy

of such an exceptionality that demands the establishment of a level of care and support that is

appropriate for students with ABI, and most importantly brings a deeper understanding of the


experiences of teachers who support students with ABI in their classrooms without the provision

and funding awarded by special education programming. The quality and provision of special

education programming and services is a direct result of the funding it receives. And, as

discovered in the responses of this study’s participants, particular programming for students with

ABI can help to render the quality of support that students with ABI require in order to achieve

the success they deserve, bringing need for the acknowledgement and classification of ABI as an

exceptionality forward.


Chapter 5: Implications


This chapter serves to present the implications of this study and addresses the issues of

this research in the recommendations that follow. These implications and recommendations have

been developed in response to the findings of this study. The responses have been gathered from

the interviews conducted with two participants and investigating the primary question of this

study: What are the challenges facing teachers who teach and support students with ABI?

Secondary questions that have been examined are as follows: What special education training is

provided to Ontario teachers and educators to prepare them in teaching and supporting students

with ABI? How prepared do teachers feel in meeting the needs of students with exceptionalities,

especially students with ABI? What are the instructional strategies and practices employed by

teachers in elementary schools who educate students with ABI? and, How do the instructional

strategies and practices employed by teachers in elementary schools meet the needs of students

with ABI? Subsequent to an overview of the key findings of this study and their significance,

broad and narrow implications of the findings, recommendations, and areas for further research

are discussed.

5.1 Overview of Key Findings and Their Significance

A summary of the research findings is presented in this section. The key findings, or

themes, that emerged from this study are comprised of teachers’ knowledge on ABI, the

demands of the classroom, the absence of protocols and procedures specific to students with

ABI, and the quality of support from the home-school-community network.

In spite of their seasoned teaching careers, participants expressed that they lack

confidence in supporting students with ABI. The participants attributed this limited confidence to


ineffectual training through teacher education programs, pre-service courses, and in-service

workshops. Teachers considered the training they received about ABI to be insufficient and

commented that it was not until after they completed their Special Education additional

qualification course that they were even introduced to ABI.

Participants stated that it was upon the completion of their Special Education additional

qualification course that they became aware of ABI as an exceptionality and learned to provide

basic support for their students with ABI. Teacher participants believed that Special Education

certification should be a compulsory component of the teacher education programs province-

wide. According to Zinga et al. (2005), the provision of services for students with special needs

requires more training for teachers as access to these services do not prove to be satisfactory and

appropriate in meeting the needs of the student, and that many educators in Ontario, and within

Canada “are not provided with any specific training in regard to the needs of students with ABI,

either in pre-service programs of in-service courses” (p. 16).

The demands of the classroom intensify the challenges brought forth by inadequate

training in teaching and supporting students with ABI. Interwoven into the responses gathered

from the interviews conducted were indications of these stresses and how, coupled with the lack

of knowledge of ABI, teachers faced difficulties establishing effective strategies for students. For

the participants of this study, the demands centred on managing the preconceived ideas of their

current students. Students with ABI “are often different from their peers with other kinds of

special learning needs,” and that “those differences have important implications for educational

programming” (Clark, 1996, p. 553), certainly intensifying the daily demands of the classroom.

Policies in special education programming within Canada differ by province and

territory. In Ontario, exceptionalities eligible for such programming must be identified in the


Ontario Education Act (1990) and, as it stands currently, the Act has yet to classify ABI as

qualifying. Thus, ABI remains without policies and standards and cannot effectively meet the

needs of its students exclusively. The responses of teacher participants credited the absence of

standards and policies for not carrying out supports for students with ABI. They understood this

absence to be an imposition that causes many challenges for teachers like themselves who are

faced with limitations in providing the necessary supports for their students with ABI to access

their learning just as their peers do.

The previous chapter presented a discussion of a unique support system between parents

and guardians at home, teachers and other staff at school, and leaders like coaches and those in

organizations that help students within the community. This synthesis of the home-school-

community network influences the provision and quality of support that students receive as a

whole; especially in the case of students with ABI. In this regard, participants shared that they

experienced difficulties with various aspects of this crucial network, from meeting the high

expectations of school administration, to the absence of support from healthcare professionals at

the school level, as well as the opposing views of parents who deny the recommendations made

for their child. In their publication, Teaching Students with Acquired Brain Injury: A Resource

for Schools (2001), British Columbia Ministry of Education suggests that for a smooth and

successful return to school, it is essential to establish a connection with a student’s rehabilitation

team. The publication outlines this team to include those players who provide support to the

student at home, at school, and within the community.

Educators must also be mindful that students with acquired brain injury (ABI) may have

complex medical and health needs and, often, changes in behaviour exhibited in the classroom

can be attributed to health care needs (Bennett et al., 2003). Participants reported that, in their


experiences, some students have dual-identification of exceptionalities. According to the

participants, the effects of ABI also had an impact on students’ self-awareness and limited their

self-initiated learning, emphasizing that ABI portrays an “invisible disability” that is difficult to

assess. Because the nature of ABI, it displays subtle and varied manifestations, thus teachers

supporting these students will have to be creative, willing to try, patient, and forgiving (Bennett

et al., 2003). These key findings lead to the following implications to the wider education

community and personal professional practice.

5.2 Implications

For the education community, these findings provide the basis for the identification of

ABI as an exceptionality. As for my personal practice, these findings give me the impetus to

continue my pursuit in advocating for both students with ABI and for teachers who support them

in classrooms.

5.2.1 Broad: The identification of ABI as a legal exceptionality. Implications resulting

from these findings reveal the need for school boards to establish particular policies and

standards for assessment of students with ABI, proper documentation for communicating the

symptoms of ABI, as well as the specific practices that respond to the needs of students with ABI

in the classroom. Many students with ABI are confronted with challenges and barriers to

achieving success in the classroom. Among these challenges and barriers is the lack of funding

for services and programming provided for students with ABI (Zinga et al., 2005), and

ill-advised strategies that do not address the specific needs of students with ABI (Brock

University and the OBIA, 2003). According to Zinga et al. (2005), these needs demand a more

knowledgeable and focused approach due to the complex nature of ABI. Resources such as the

ones published by Brock University and the OBIA, as well as the manual by the British


Columbia Ministry of Education, are exemplars for the kind of materials necessary for those

involved in the care and support of students with ABI, especially teachers.

Overall, the resulting findings support the need for the acknowledgement and

classification of Acquired Brain Injury (ABI) as an exceptionality to be included in Regulation

181/98 of the Ontario Education Act (1990). Students sustaining an ABI pose a challenging

situation to the Ontario school system as they do not receive the same quality of support through

special educational programming as students with exceptionalities identified under this

legislation. This uncategorized status places students with ABI at a crossroads between deficient

programming caused by a lack of funding and continued disregard of the specific needs of those

with ABI. Therefore, being ineligible for special education programming exposes them to

vulnerable situations where they cannot receive the support they need to cope and succeed in

their Ontario classroom.

5.2.2 Narrow: Professional identity and practice. As for my professional identity as a

teacher, these findings propel me to take action in pursuit of equity in my personal teaching

practices. As an educator, I am encouraged to adopt pedagogies that are inclusive of all students

and that put to practice differentiated instruction to its capacity. For me, it will be a way to foster

the access to education students with ABI, and other students whose exceptionalities have yet to

be legally identified, are not experiencing, but deserve. Moreover, I am empowered to champion

the case of students with ABI by fostering active relationships with parents and guardians, fellow

school staff, healthcare professionals, and others belonging to the rehabilitation team. Finally, I

hope to advocate for myself and my peers to request the training and guidance from school

administration through in-service workshops and seminars. My understanding of the importance

of this training has been developed and informed by the responses of the teacher participants of


this study. I see now that, without further training in special education programming, teachers

cannot provide the appropriate support to their students with ABI.

These findings provide me with a better grasp of the current landscape within special

education programming pertinent to students with ABI. In their contributions to the study,

participants have allowed me to become introspective of my own teaching practices and my

profession as a whole. I now have a clearer understanding of the experiences of teachers who

support students with ABI as they integrate back into the school setting. I envision a practice that

embodies social justice where I can champion equity, celebrate diversity, and inspire hope

alongside all of my students.

Social justice in classrooms necessitates that all students deserve to have their stories

told. From listening to the experiences of my participants, I gathered that, after their accidents,

the students of these participants were hastily forgotten by administrators in their respectful

schools. Participants shared details of how students with ABI were overlooked partially due to a

lack of information from the students’ families, but, they also did not have the opportunity to

speak up about their needs due to the demands of the daily workload in the classroom. I hope to

work with my students to establish a space where they can share their experiences and have them

valued by school administration also.

I hope that this kind of perspective in teaching will guide me in responding to the current

practices in Ontario schools today. In particular, I aspire to bring equity, welcome diversity, and

enlighten others with hope as I continue my professional development in special education and

the field of acquired brain injury. Through this, I would like to build partnerships with

community organizations that can supplement support for our students with ABI where it is due.

I also hope to deepen my understanding of the nature of ABI by enrolling in courses and


workshops for further professional development as the teacher participants of this study had

done. I seek to learn more about ABI so that I can help to develop strategies practice in my own

classroom, as well as to share with others. I look to further investigate this area of education and

hope to motivate other teachers also contribute to this work.

5.3 Recommendations

As a result of the findings revealed by this study, the recommendations presented are

closely associated with those of the aforementioned implications. This section outlines

recommendations for the Ontario Ministry of Education, Ontario school boards, health care

professionals, community agencies and organizations, and families and friends of students with

acquired brain injury (ABI).

5.3.1 Ontario Ministry of Education. First is the recommendation to the Ontario

Ministry of Education. The focus on special education programming in Ontario is to make

education accessible to all students. In their professional knowledge, teacher participants

purported that, with ABI as an uncategorized and unidentified exceptionality within the province,

students with ABI are not receiving the supports they deserve to be able to access education as

their peers do. The aforementioned literature review reveals that the quality and provision of

special education programming and services is a direct result of the funding it receives. This

aligns with the responses of both participants who commented that programming specific for

students with ABI can help to render the quality of support that students with ABI require in

order to achieve the success they deserve. In agreement with my participants, I believe that the

Ontario Ministry of Education must enable funding for these services to deliver the access they

are promising all Ontario students.


In addressing the lack of confidence in supporting students with ABI, participants helped

to develop these recommendation for the provision of supplementary documents. I believe that

publications like resources and materials on ABI could also aid teachers by helping to enhance

their knowledge of ABI. Similar to the British Columbia Ministry of Education, Ontario should

also provide a comprehensive resource for information for teachers and other educators in the

school setting on teaching students with ABI. AS a response to the experiences of the

participants of this study, producing guides for teachers can enhance the learning experience of

students, as well as strengthen the confidence of teachers. It is this provision of materials that can

allow teachers in school boards to be self-assured in their practices as they support students with

ABI.

5.3.2 Ontario school boards and educational institutions. Another recommendation is

for school boards and other educational institutions in Ontario. Participants shared personal

stories of the educational path that lead them to their profession as a teacher. The sharing of their

experiences about the quality of teacher preparation programs they participated in has developed

the following recommendation.

Along with the funding and supplementary materials provided by the Ontario Ministry of

Education, school boards across Ontario, as well as faculties of education in various post-

secondary institutions may also benefit from designing teacher education programs and

additional qualification courses that include content specific to acquired brain injury. The ever-

changing nature of ABI demands that those who teach students must be able to respond with

significant practices that are meaningful to the learning experience of students with ABI. This

can better prepare teachers to be resilient in their teaching practices as they support students with

ABI.


Teacher participants expressed their frustration in the absence of policies and protocols

surrounding the communication of ABI conditions, symptoms, and specificities. They believed

that policies and protocols should also be reflective of the needs of students with ABI. This

recommendation supports their belief and suggests that standards for communicating the

occurrence of head injuries to teachers and other educators, documenting known ABI in

students’ records, and partnering with families and health care professionals ought to be outlined

in policies mandated by all school boards in Ontario. Addressing these would enable the kind of

support the participants of the study longed for in their responses. Both participants stated that

they would have felt more prepared to support the school reintegration of their students with ABI

had these types of protocols been in place for them at their respective school boards.

5.3.3 Healthcare professionals. Along with board-wide policies and protocols,

participants disclosed their being unsatisfied with the lack of presence and involvement from

healthcare professionals. They stated that peers who taught students with ABI in previous years

were not able to provide them with a contact for the students’ healthcare professionals as they

were not involved in the school setting. In one case, a participant initiated his own partnership

with a student’s healthcare professional by conducting his own investigation into the matter. This

following recommendation demonstrates how these board-wide policies and protocols can be

more productive with the help of health care professionals to offer their expertise in caring for

students with ABI

The perspective of participants is that healthcare professionals, such as speech-language

pathologists, occupational therapists, behavioural therapists, psychiatrists, psychologists, and

other sources of knowledge in the field of ABI can offer a wide-range of perspectives in

providing an all-encompassing approach to the support provided.


The contribution of participants in their responses suggest that integration of students

with ABI should involve the health care practitioners that care for them outside of the school

setting. In this way, the recommendation can help to ensure that students receive support that is

more comprehensive, acknowledging the student’s needs as a whole and reinforcing

rehabilitation objectives concurrently. The expertise of these health care professionals should

also inform the development of programming for students with ABI, improving the provision

and quality of care for those students.

5.3.4 Community agencies and organizations. Along with their perspectives on the

involvement of healthcare professionals, participants also believed that the contribution of

external supports can be quite valuable to the learning experience of students with ABI. Teacher

participants shared that they trust community agencies and organizations can also participate in

the integration of students by extending their services to the schools and families of students with

ABI. This recommendation highlights the role of these agencies and organizations as they can be

advantageous in offering services that aid teachers and schools in supporting students with ABI.

This assistance, whether in the form of services, training, or workshops, can help to establish

strategies for students with ABI in their learning at school, at home and in the community.

5.3.5 Families and friends. Students with ABI can get the most out of their learning at

school when it can be reinforced at home and in their community. As participants of the study

alluded to their own experiences, if the needs of students with ABI could be acknowledged by

their families and friends, the quality of support they receive would be positively influenced.

Participants shared their experiences where this would have been possible and suggested

that the stronger the presence of care from family and friends, the more efficient the advocacy

becomes for the student with ABI. Both accounts of teacher participants point to this exact


matter. This participation from families and friends of students with ABI can initiate a new

conversation around the type of support they receive. It engages a notion of education

partnership where collaboration happens between school, community, and home. This can foster

a unique learning experience relevant to the needs of the student with ABI and enables teachers

to play a significant role in their advocacy for their students.

5.4 Areas for Further Research

The literature reviewed, as well as the findings of this study, have helped to identify areas

for advancing the research of this subject. Much of the literature on students with ABI was based

on studies conducted in the United States and Britain. Furthermore, those that were based in

Canada did not reflect the landscape of special education programming specific to ABI in

Ontario, but rather they were mainly based on research from British Columbia.

Areas of research that can thus be significant to this study may include the intake

practices for students with ABI integrating back to school, the linkages between funding and

service provision in special education programming in Ontario, the comparisons of teacher

experiences in subject-specific supports for students with ABI, and further research in the

contrasts between age groups of students with ABI.

Other populations where this study may be expanded are teachers in schools outside of

the Greater Toronto Area, schools in a rural region as opposed to the urban setting, secondary

schools, private academies, homeschools and alternative schools. Moreover, suggestions on other

designs for this study involve conducting interviews for a larger sample of teachers, organizing a

longitudinal study of the two participants interviewed, or, using the same interview questions and

comparing responses of participants from various school boards to examine possible similarities

and differences between groups. These can broaden the scope of this study and advance the


findings revealed to other areas of research; thus, providing support for the identification of ABI

as exceptionality in Ontario.

5.5 Concluding Comments

The purpose of this research study has been to gain insight into the experiences of

teachers supporting students with acquired brain injury (ABI) in Ontario. In particular, the study

investigated the approaches and strategies employed by teachers and their impact on students

with ABI. In the province of Ontario, special education programming is outlined by the Ontario

Education Act (1990), and states that only those identified as having an exceptionality may

receive support in the form of services for special education programming under this legislation.

The difficulty in this classification is that exceptionality is defined and limited to five categories:

behaviour, communication (autism, deaf, hard of hearing, language impairment, speech

impairment, learning disabilities), physical (physical disabilities, blind/low vision), intellectual

(gifted, mild intellectual delay, developmental delay), or multiple categories from the

aforementioned. Those students with acquired brain injury (ABI) cannot qualify for services

within the limits of special education programming as ABI is not an exceptionality recognized by

the province; as such, students with ABI face a problematic situation.

After conducting a qualitative study and reporting its findings, the data gathered from the

responses of teacher participants of this research study revealed that without ABI being classified

as an exceptionality, teachers face challenges when it comes to supporting students with ABI.

These challenges seem to be the outcome of insufficient ABI training opportunities for teachers,

the heavy demands of a diverse classroom, the absence of protocols and procedures specific to

students with ABI, and the poor quality of support from the home-school-community network.


Overall, I believe that this study has accomplished a noteworthy investigation of how the

Ontario legislation impacts students with ABI in elementary classrooms. I was able to gather

data that can serve as evidence underscoring the need for a new category of exceptionality for

ABI under the Ontario Education Act (1990). If teachers are to establish equitable classrooms,

institutions must lead by example in embracing diversity and laying the foundations of equity

within the very legislation that binds us all as one. Institutions hold the key to providing the

necessary support for teachers so that they may respond to the realities of the classroom and be

genuine ambassadors of equity in education for all.


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Appendices

Appendix A: Letter of Informed Consent for Interview

Date:____________________

Dear ____________________,

I am a teacher candidate in the Masters of Teaching program at the Ontario Institute of

Studies in Education (OISE) at University of Toronto. As a graduate student in a pre-service

teaching program, my research focuses on teachers with experiences in the education of students

with exceptionalities, especially students with acquired brain injuries (ABI). The impetus for this

research stems from my interests in advocacy for accessibility, as well as my employment

background in rehabilitation for individuals with ABI. I anticipate that the findings of this research

may be educational my fellow teacher candidates, but, also informative for private organizations,

policy-makers, lobbyists, and other advocates of equity and accessibility within the educational

community. I am confident that your knowledge and experience will provide insights into this

topic.

This research study is a required component of the Masters of Teaching Program that I am

enrolled in. The research coordinator providing me with support throughout this process is Dr.

Angela MacDonald-Vemic. The purpose of this component of the program is to acquaint teacher

candidates with research at the graduate level. The format of my data collection is a 21-question

interview, with an approximate duration of 60 minutes, and will be audio-recorded. Please accept

my invitation to participate in this research study and complete the interview process at a time and

place that is to your convenience.

The information from this interview will be exclusive to the purposes of this study, and

includes a research paper to publish my findings. Informal presentations, prospective conferences

and/or publications may also make use of the data collected. This research study complies with the

ethical standards outlined by the School of Graduate Studies at the University of Toronto, and will

not associate your identity with the information you provide for my written work, oral

presentations, or publications. This information remains confidential, and may only be accessed

by my research supervisor and my course instructor. You have the liberty to decline this invitation,

or retract your participation at any time during this study, even after you have given you consent

to participate. You may decline to answer any specific questions. The audio recording of this

interview will be destroyed after the paper has been presented and/or published, which may take

up to five (5) years after the data has been collected. The topic presented in this study may evoke

emotional responses and may pose a short-term risk in participating in the study. To address this,


you will be provided with the questions ahead of time. There are no other known risks to the

participant in assisting with the project. Once the data is compiled, I will disclose my findings to

you and provide you with a copy of my notes to ensure the accuracy of the information you have

shared for the purposes of this research.

If you would like to participate, please sign and complete the portion below. The second

copy of this letter is for your records. Once again, thank you for your help in my research study,

the knowledge you share is appreciated!

Sincerely,

Hedellaine Valentin

Phone number: _____________ | E-mail: [email protected]

Research Coordinator: Dr. Angela MacDonald-Vemic

Phone number: ______________ | E-mail: [email protected]

Consent Form

I acknowledge that the topic of this interview has been explained to me and that any questions that

I have asked have been answered to my satisfaction. I understand that I can withdraw at any time

without penalty.

I have read the letter provided to me by Hedellaine Valentin and agree to participate in an interview

for the purposes described. I agree to have the interview audio-recorded.

Signature: ________________________________________

Name (printed): ___________________________________

Date: ____________________________________________

mailto:[email protected]

mailto:[email protected]


Appendix B: Interview Questions

First, I would like to express my appreciation for the generosity of your time and

participation in my research study. The motivation behind this research is to gain knowledge on

the experiences of a sample of Ontario teachers in teaching students with acquired brain injuries

(ABI). The duration of this interview is approximately 60 minutes, and involves 28 questions. The

interview protocol is divided into 3 sections:

Section A - Background Information

Section B - Experiences and Attitudes

Section C - Next Steps

I want to remind you that you have the liberty to not answer any question, and can remove

yourself from participating at any time. Do you have any questions before we begin? Once

recording starts, please state your name.

Section A - Background Information: Teaching Experience

1. When did you first start teaching?

2. What grades do you have experience in teaching?

3. Would you describe the kinds of classrooms have you taught in?

How would you describe the types of students’ exceptionalities you have experienced

throughout your teaching career thus far?

4. When did you first teach a student with ABI?

Professional Development

5. As an educator, how would you describe any training you have had in special education?

(i.e.: in-services, workshops, additional qualification courses, etc.)

6. How would you describe any training you have received, if any, in preparation for

teaching students with ABI?

7. How would you describe any other training that you feel have prepared you for teaching

students with ABI?

Section B - Experiences and Attitudes

Attitudes

8. Did you have any reactions towards having students with exceptionalities in your

classroom? If yes, how would you describe them?

9. Did the students have any reactions towards the students with exceptionalities in the

class? If yes, how would you describe them?

10. Did you have any reactions towards having students with ABI in your classroom? If yes,

how would you describe them?


11. Did the students have any reactions towards the students with ABI in your classroom? If

yes, how would you please describe them?

Strategies

12. How would you describe any of the teaching strategies you have used in your classroom

to support students with ABI? If none, please indicate “no strategies” in your response.

13. How would you describe you preparedness in using these teaching strategies for students

with ABI?

14. Would you describe how long you have been using the strategies for students with ABI?

15. In your opinion, would you describe the extent to which these strategies have affected

your students with ABI? (please indicate area: for example, social, behavioural,

academic, self-regulatory, etc.)

Challenges

16. Would you describe, if any, the challenges you faced in having and teaching students

with ABI in your classroom? If none, please indicate “no challenges” in your response.

IPRC Processes

17. How familiar are you with the IPRC (Identification Placement Review Committee)

process?

Could you describe your experiences?

18. Did you receive any training about the IPRC process?

Could you describe the training?

19. Did you receive any support during the IPRC process?

Could you describe the support?

Section C - Next Steps

20. Would you like to offer any advice for other educators who teach and support students

with exceptionalities or acquired brain injury?

21. Do you have any further comments related to our topic that we have yet to mention or

discuss?

Thank you, again for your time and consideration in lending your responses to my

research study.

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