TBI Transition, Research and the Oregon TBI Team

1. TBI Transition,Research andthe Oregon TBI Team Bonnie Todis, PhD Center on Brain Injury Research and Training

2. Overview • What we know about the transition experiences of students with TBI. • What we know about transition in general. • What do we do with this knowledge? • What does this have to do with you? • What do you think?

3. Research on Outcomes after Childhood TBI • Most of this research has been conducted by doctors and neuropsychologists. • Why would they do this research?

4. What these studies look like • Participants recruited from medical files • Usually one follow up data point in adulthood • Rarely look at school factors

5. What these studies didn’t tell us • What are the transition experiences of young adults with TBI? • How do employment, etc. fluctuate over time? • What factors lead to different outcomes? • Special ed? • Family support? • Community Supports • Demographics (age, severity, sex)

6. National Transition Longitudinal Study (NTLS) • 10-year study of transition outcomes • Funded by OSEP • 11,000 students • 12 disability categories • NTLS1 did not include students with TBI • NTLS2 included youth who were 13-19 in 2000 • Data collected in 2003 on 28% out of school

7. NTLS: Employment %

8. NTLS: Post-secondary Education %

9. NTLS: Living with Parents %

10. POST-SECONDARY OUTCOMESPROJECT(PSO)

11. Project PSO • 8-year study of transition outcomes • Funded by OSEP and NIDRR • 90 students in Oregon and Washington • Recruited at exit from high school • Rolling recruitment over 2-3 years • School districts • VR

12. Employment Outcomes Ages 19-25

13. Post-Secondary Employment Outcomes 19-25

14. Closer Look:Employment at Age 25 • 60% employed • 74% of males, • 35% of females • Hours per week • Mean 21-30 • No one worked more than 30 hrs per week

15. Employment Outcomes by Gender

16. Employment at Age 25 • Wages • Mean $8.22 per hour • No difference between males and females • Type of Job • 81.3% in menial, unskilled, or semi-skilled categories • The rest in skilled (11.3%) clerical/sales (5%) or technicians (2.5%) • None in the top 3 categories

17. Comparison with Typical Peers • Bureau of Labor Statistics of the U.S. Department of Labor, January 19, 2007

18. Factors Predicting Employment • Hierarchical Linear Modeling Results • Family SES: Those with higher SES were less likely to be employed at the beginning of the study, more likely to be employed over time • For every unit change in SES there was a 3.3% increase in the odds of employment and a .7% increase in the rate of change in employment over time.

19. Factors That Impact Employment Work Category by Sex and Age at Injury Over Time Job Category by Sex and Age at Injury Clerical, sales Later age) Skilled manual labor Earlier age Avg age Females Later age Semi-skilled Earlier age Avg age Males Unskilled work Menial service

20. Factors That Impact Employment Wages Over Time by Age at Injury and Severity Later injury Severe Mild/Moderate Early injury Later injury Bonnie Todis, Ph.D. Center on Brain Injury Research and Training Early injury

21. Factors That Impact Employment Hours Worked per Week Severity: M/M work > # Hrs. Gender: Males> #hrs. For both genders: Earlier age at injury = work fewer hours/week 21 – 30hr later later Hours Per Week 16-20hr Injured earlier Injured earlier Males Males Females 11-15hr Females Mild/Mod Severe Severity

22. Factors That Impact Employment Job Happiness by Severity and Age at Injury Very Happy Early age Severe Avgage Later age Happy Early age Mild/ Moderate Avgage Later age Unhappy

23. POST SECONDARY EDUCATION

24. Post-SecondaryEducation OutcomesAges 19-25 n(%)

25. Post-Secondary Education Outcomes Ages 19-25

26. Comparison with Peers • Non disabled young adults 18-25 46% enrollment (Pew 2007) 54% female (2005) • NLTS2 45% reported continuing to postsecondary ed within 4 years of leaving high school. • 32% community colleges • 23% vocational/tech • 14% 4-year

27. Factors That Affect Enrollment • Higher family SES, shorter time to enrollment • Females more likely to enroll • Those injured later were more likely to enroll. For every year increase in age at injury there was a 12.3% increase in likelihood of enrollment.

28. Independent Living Outcomes Ages 19-25 n(%)

29. Post-SecondaryIndependent Living OutcomesAges 19-25

30. Comparison with Peers • Non-disabled peers 18-25 40% live with parents (Pew) • NLTS2 ages 17-21 25% have lived independently at some time since high school (65% of these lived in a college dorm or military housing).

31. Factors That Affect Ind. Living • Age at injury: Those injured earlier take longer to achieve independent living status. • For each year older at injury, there is a 12.7% increase in odds of achieving independent living.

32. Transition Practices

33. What We Know about Transition Practices • Transition has been mandated since the 80s • Lots of programs have been developed • Some programs have been evaluated • USDoE provided funding to identify and disseminate research-based transition practices NSTTAC

34. How E-B Practices Are Identified • Establish criteria for evidence of effectiveness • Classify practices as • Look at what you end up with

35. Taxonomy of Evidence-Based Practices • Student-focused planning • Involving student in IEP process • Self-Advocacy Strategy • Self-Directed IEP • Student development • Life skills • Self-advocacy • Employment skills • reading, math • Self-determination

36. Taxonomy of Evidence-Based Practices • Family Involvement • Training for parents about transition • Program structure • Community-based instruction • Extending services beyond high school • Check and Connect • Interagency collaboration

37. Caution! • Evidence is not strong • Effectiveness have not been established for students with TBI • Not included in most of the studies that were reviewed • Why? (Top secret story that you can’t tell anyone!)

38. What does this mean? • Knowing about transition outcomes for students with TBI • Knowing what transition practices are most effective • What is your next step as an educator?

39. What does this all mean? • We have a pretty good idea what kids with disabilities need to prepare for transition • We’re pretty sure kids with TBI need these things, too • The things that work for other kids may need to be tweaked for kids with TBI

40. Outcomes so far…. • Transition toolkit • Transition Web Project • IES Proposal

41. Transition Website Project • History • NIDRR Development Project • 2011-2014 • Three stages • Development • Pilot testing • Evaluation

42. Transition Web Project

43. What does this have to do with you? • Participatory Action Research • Involve the people who are the stakeholder in the research in every phase of the research process • Stakeholders • Students with TBI • Educators • Family members

44. PAR Activities • Predevelopment • Qualitative findings from PSO • What were transition services like? • What was difficult for educators? Parents? Kids? • What worked? • Where were the gaps in knowledge? Practice?

45. PAR Activities • Development • Focus groups • Interviews • Participant observations

46. PAR Activities • Pilot test phase • Usability tests • Advisory board

47. PAR Activities • Evaluation • Field test intervention • Complete pre-post measures • Focus groups • Dissemination • Presentations • Help with articles • Implementing evidence-based practices*******

48. PAR Activities for Team Memberson T-Web • Predevelopment • Focus group • Development • usability • Evaluation • Treatment/Non-treatment

49. Focus-Group/Discussion

50. Speaking of Research Opportunities • cbiRt • Current projects • TATE • STEP*** • Family Web • Transition Web *** • MCH *** • TEAM ***