BrainSTEPS Child & Adolescent Brain Injury School Re-Entry Program

1. BrainSTEPSChild & Adolescent Brain Injury School Re-Entry Program

2. Strategies Teaching Educators Parents Students BrainSTEPS

3. What is BrainSTEPS? • Brain injury consulting teams available to families and schools throughout Pennsylvania. • Teams are extensively trained in the educational needs of students returning to school following brain injury. • Teams will work with local school staff to develop educational programs, academic interventions, strategy implementation, and monitoring of students.

4. What BrainSTEPS Can Do: • Conduct observations of the student • Communicate with the district and medical professionals to ensure a smooth re-entry • Review medical, rehabilitation, & educational reports to assist in making educational recommendations.

5. What BrainSTEPS Can Do: 4. Create & provide a training for the school on the educational impact of the student’s specific brain injury. Educate and support district staff & family. 5. Provide Peer Trainings, so peers understand how brain injury has impacted their classmate.

6. What BrainSTEPS Can Do: 6. Consult on all aspects of the student’s educational plan & make recommendations to the district team. • Assist in transitioning a student from grade to grade or school to school by training new teachers

7. Who should be referred to BrainSTEPS? • A student who continues to have CONCUSSION symptoms 2 WEEKS after injury, should be referred to BrainSTEPS. • A student who sustains a more moderate to severe brain injury should be referred prior to the student’s return to school. • A student who has an older injury, but begins to experience educational impacts as their brain matures/develops can be referred at any time through graduation. • www.brainsteps.net

8. Traumatic Brain Injury STATISTICS

9. Brain injury is a leading cause of death and disability in children & young adults.

10. CDC Statistics AverageANNUAL number of Traumatic Brain Injury Emergency Department Visits and Hospitalizations in the United States 474,000 Children with Traumatic Brain Injury 0-14 years of age • Most children who sustained a TBI (91.5%) were treated and released from the emergency department. United States. Centers for Disease Control.  Traumatic Brain Injury in the United States. 2005. http://www.cdc.gov/ncipc/pub-res/TBI_in_US_04/TBI%20in%20the%20US_Jan_2006.pdf>.

11. How Common is TBI in Children in Pennsylvania? Each year, approximately 26,000 children in Pennsylvania sustain a traumatic brain injury (mild, moderate, or severe) Source: The Brain Injury Association of Pennsylvania, 2008

12. Infants Accidental Dropping Physical Abuse Toddlers Falls Vehicular Accidents Preschoolers Falls Vehicular Accidents Physical Abuse Elementary School Children Vehicular Accidents Bicycle Accidents Falls Recreational Injuries Adolescents Vehicular Accidents Sports Injuries Assault Causes of Traumatic Brain Injury

13. Causes of Acquired Brain Injury • Post Cancer Treatment • Toxic Substances • Infections • Aneurysms • Stroke • Anoxia (i.e. choking, respiratory / heart conditions)

14. Brain injury can occur even if there is no loss of consciousness.

15. A Concussion is a Traumatic Brain Injury!

16. Concussions in Pennsylvania: Annually, approx. 22,000children ages 0-21 years suffer concussions

17. A Child’s Brain • Underdeveloped – the younger the child, the less developed is their brain • Easily Injured – infant’s neck is weak • New skills build on ESTABLISHED skills over time • Brain injury interrupts skill development, and can prevent new skills from developing

18. Important Developmental Stages • Child’s stage of development when injury happened • Child’s stage of development NOW

19. Pre-Existing Conditions & TBI • Children with pre-existing behavioral weaknesses are much more likely to have a TBI. • Effects of TBI will compound and add to pre-existing learning, behavioral or psychological problems, such as: • Dyslexia • ADHD • Paranoia • Depression

20. Effects of Brain Injuryon Children

21. Examples of Physical Effects • Headaches • Changes in speech & language • Stamina/weakness • Difficulty with balance • Seizures • Sensory changes Taste Smell Hearing Vision

22. Cognitive Effects Executive Function Challenges: • Attend or concentrate • Initiate, organize, or complete tasks • Sequence, generalize, or plan • Flexibility of thinking, reasoning, or problem solving • Working memory

23. Cognitive Effects Metacognitive Challenges: • Abstract thinking • Information processing (slowed speed) • Judgment or perception • Long-term or short-term memory

24. Cognitive Effects Related Challenges: • Confabulation • Ability to acquire or retain new information • Inconsistent and unpredictable learning rate

25. Social, Emotional,Behavioral Issues • Distractibility • Impulsivity • Irritability • Aggression • Motivation & Initiation • Depression • Lack of Social Judgment • Denial/Lack of Self-Awareness • Rigidity/Inflexibility • Low Frustration Tolerance

26. Instructional Strategies to Consider • Classroom rules & expectations should be well structured and explicitly taught • Instruction should contain repetition & feedback • Avoid multi-step instructions if possible From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

27. Instructional Strategies to Consider • Supplement verbal instructions with writing and modeling • Provide ample time to process, complete tasks, and respond • Assist the student in keeping his/her materials and schedule organized From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

28. Instructional Strategies to Consider • Teach compensatory strategies for test-taking, note-taking, reading materials, etc. • Try external aids such as lists, diaries, computers, calculators • Videotape the student’s progress in class to provide feedback and show progress From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

29. Modifications to Consider • Consider scheduling adjustments, i.e. breaks, study hall, eliminating non-core classes, etc. • Assist the student in changing classes • Introduce student gradually, i.e. small group • Need for supervision • Consider ESY, homebound services, instruction in the home, or tutoring for summer months From: TBI Inservice Training Module, Janet Siantz Tyler, PhD., Kansas Dept. of Education, TBI Project

30. BrainSTEPS Partnerships in our Region • Discharge Info from: • Children’s Hospital Pittsburgh • Children’s Institute Pittsburgh

31. Pennsylvania’s BrainSTEPS Programis Considered a National Model for Brain Injury School Re-Entry! BrainSTEPS received the Award of Excellence for Programs & Services December 2008, from the national Brain Injury Association of America

33. For More Information on the BrainSTEPS Program Contact: Jamie Moder, MHPE, CHES Adapted Recreational Education Consultant Allegheny Intermediate Unit 412-394-5822 jamie.moder@aiu3.net Brenda Eagan Brown, M.S.Ed., CBIS BrainSTEPS Program Coordinator Brain Injury School Re-Entry Program Brain Injury Association of Pennsylvania 724-944-6542 eaganbrown@biapa.org www.brainsteps.net

34. REFERENCES Chapman SB. Neurocognitive stall: a paradox in long term recovery from pediatric brain injury. Brain Injury Professional, 3(4): 10-13, 2007. Kennedy, M. & Krause, M., University of Minnesota, Symposium on Disability Studies & Inclusive Education, July 23, 2010 ppt presentation Savage RC. The Child’s Brain – Injury and Development, Lash and Associates Publishing, Wake Forest, NC, 1999. Savage, Ronald C. “The utilization of allostatic load theory to predict long term deficits in children/adolescents with TBI” presented at North American Brain Injury Society conference. October, 2007. www.nabis.org. Todis B. & Glang, A. (2008).  Redefining success: Results of a qualitative study of post-secondary transition outcomes for youth with traumatic brain injury. Journal of Head Trauma Rehabilitation, 23(4), 252-263. http://www.ncbi.nlm.nih.gov/pubmed/18650769