iii-1 module iii ______________________________________________________ returning to school
TRANSCRIPT
III-1
Module III______________________________________________________
Returning To School
III-2
Module III Goal ______________________________________________________
• To provide information that will facilitate the successful return of students with TBI to their schools
III-3
Module III Learning Outcomes______________________________________________________
• At the end of this module you will:– Understand the responsibilities of hospital and
school in school re-entry planning – Be familiar with the IEP team process for students
with TBI– Recognize common problems of students with TBI – Be able to plan an evaluation of a student with TBI
III-4
Transition to School______________________________________________________
• Preparing for transition to school begins at the time of injury
III-5
Transition to School______________________________________________________
• What can the medical facility do?
• What can the educational facility do?
III-6
School Re-entry Planning:Whose responsibility is it?_______________________________________________________
• Responsibilities of school staff and medical staff shift over time
• Medical staff: assumes leadership for patient care in the hospital
• Educational staff: takes more responsibility for school planning as needs are known and discharge nears
• The family is involved throughout
III-7
Three Stages of School Re-entry Planning______________________________________________________
• At the time of injury
• During the hospital/rehabilitation stay
• Prior to discharge
III-8
Strategies for the Medical Facility______________________________________________________
• At the time of the injury– Identify a medical contact person (e.g., care
coordinator or social worker)
• During hospitalization– Provide updates on progress and needs
– Arrange for hospital visits for school staff
– Educate family and school staff
– Refer for special education if need is suspected
III-9
Strategies for the Medical Facility (cont.)______________________________________________________
• Prior to discharge– Inform family and school of discharge date
– Provide discharge summary
– Participate in IEP team if possible
– Establish and communicate follow-up and reevaluation schedule
III-10
Re-entry Strategies for Schools______________________________________________________
• At the time of the injury– As soon as you know a student has been
injured, designate a school contact person to receive and provide information
– Identify the medical contact person
III-11
Role of the School Contact Person______________________________________________________
• Be a support to the family
• Get appropriate releases signed to share information
• Gather information from hospital personnel as it becomes available
• Inform others (such as teachers, peers, and siblings’ teachers) as needed
III-12
Re-entry Strategies for Schools (cont.)______________________________________________________
• During hospitalization– Obtain parent’s permission to
release/receive information
– Request updates from medical contact
– Visit student in the hospital
– Share information with school staff
III-13
Re-entry Strategies for Schools (cont.)_______________________________________________________
• During hospitalization (cont.)– Refer for special education if appropriate
– Educate parents about special education process
– Arrange for staff training
III-14
Re-entry Strategies for Schools (cont.)______________________________________________________
• Prior to discharge– Obtain current hospital records
– Complete IEP team process before discharge, if possible, but within statutory timeframes.
– Collaborate with medical facility to obtain consultation and in-service training
III-15
Strategies For Successful School Re-entry of Students With TBI_______________________________________________________
• Summary of strategies used by medical and school facilities appears on pages 15a-15b.
• Which strategies have participants used?
• Are there other strategies participants have found helpful in the transition from hospital to school?
III-16
Transition to School Checklist_______________________________________________________
• The Transition to School Checklist is designed to help school personnel monitor completion of transition activities
• Please refer to the Checklist on page 16a.
III-17
Transitions also include______________________________________________________
• Transitions between classes
• Transition to new schools
• Transition to post school settings
• Other students
• See Transition Checklist on p. 17a
III-18
The IEP Team Process_______________________________________________________
1. Refer the student to the LEA
2. Identify IEP Team members
3. Evaluate the student’s eligibility and determine needs
4. Develop the IEP
5. Offer placement
III-19
1. Refer the student to the LEA______________________________________________________
• In moderate and severe brain injuries referrals usually occur while the student is hospitalized
• As soon as you suspect a student is a child with a disability, inform the parent of your intent to refer, and refer in writing to the LEA
III-20
2. Identify IEP team members_______________________________________________________
• The IEP Team must include members designated in Chapter 115.78
• These requirements are reproduced on the next page of your manual
• Others with special expertise or knowledge may be included at the discretion of parent or school
III-21
2. Identify IEP Team Members (cont.)______________________________________________________
• Who would you want on Serena’s IEP team?
• Who would you want on Monty’s IEP team?
III-22
3. Evaluate the student’s needs_______________________________________________________
• As part of the evaluation the IEP team:– Reviews existing evaluation data
• evaluations and information provided by parents
• previous interventions and their effects
• current classroom-based assessments and observations
• observations by teachers and related services providers
III-23
3. Evaluate the student’s needs (cont.)______________________________________________________
• After review of data the IEP team determines– if additional data are needed, and if so,
who should gather it
– if child has an impairment
– present levels of performance
– if child needs SE and related services
III-24
4. Develop the IEP______________________________________________________
• If the IEP team determines that the student has an impairment (TBI) and needs special education and related services, the team prepares the Individualized Education Program
III-25
5. Offer placement_______________________________________________________
• An educational placement is developed to implement the child’s IEP
• To the maximum extent appropriate, a child with a disability is educated with nondisabled children (Chapter 115.79)
III-26
Designate a case manager_______________________________________________________
• It is best practice to appoint a case manager who coordinates communication among IEP team members
III-27
What types of problems can the school anticipate?_______________________________________________________
•Serena
•Monty
•Mike
III-28
Common Problems of Students with TBI______________________________________________________
• Certain types of difficulties are common in students with TBI
• Anticipating these difficulties can facilitate successful re-entry to school
• Problems can be physical/medical, cognitive, sensory, motor, social, emotional, and behavioral
III-29
Physical/Medical Problems_______________________________________________________
• Problems– Seizures– Fatigue– Headaches– Swallowing/Eating– Self-care activities
• Medication issues (see p. 29a)• Is an Individualized Health Care Plan
(IHCP) needed? (see p. 29c-d)
III-30
Common Motor Problems______________________________________________________
• Apraxia• Ataxia• Coordination
problems• Paresis or
paralysis• Orthopedic
problems
• Spasticity
• Balance problems
• Impaired speed of movement
• Fatigue
• See p. 30a
III-31
Sensory/Perceptual Problems______________________________________________________
• Visual deficits– field cuts
– tracking (moving and stationary objects)
– spatial relationships
– double vision (diplopia)
• Neglect
• Auditory deficits
• Tactile deficits
III-32
Cognitive/Communication Problems_______________________________________________________
• Executive functions
• Memory
• Attention
• Concentration
• Information processing
• Sequencing
• Problem solving• Comprehension of
abstract language• Word retrieval• Expressive language
organization• Pragmatics
III-33
Executive Functions______________________________________________________
• Planning, prioritizing, sequencing, self-monitoring, self-correcting, inhibiting, initiating, controlling or altering behavior
(Savage & Wolcott, 1995, p. 150)
III-34
Cognitive/Communication Deficits_______________________________________________________
• See p. 34a for additional information regarding cognitive/communication problems
• See p. 34b for an example of Monty’s difficulties at school
III-35
Social-emotional Problems_______________________________________________________
• Irritability• Impulsivity• Disinhibition• Perseveration• Emotional Lability• Insensitivity to social
cues• Low frustration
tolerance
• Anxiety• Withdrawal• Egocentricity• Denial of deficit/lack
of insight• Depression• Peer conflict• Sexuality concerns• High risk behavior
III-36
Social-emotional Problems______________________________________________________________
• See p. 36a for descriptions of social-emotional deficits
• See p. 36b for an example of Serena’s difficulties at school
III-37
Behavioral Problems ______________________________________________________
• Deficits (all types) may lead to challenging behaviors– non-compliance
– aggression
– confrontational behavior
– lack of initiative
– withdrawal
III-38
Traumatic Brain Injury Checklist_______________________________________________________
• Orientation and Attention to Activity
• Starting, Changing, and Maintaining Activities
• Taking in and Retaining Information
• Language Comprehension and Expression
• Visual-Perceptual Processing
• Visual-Motor Skills
• Sequential Processing• Problem-Solving,
Reasoning, and Generalization
• Organization and Planning Skills
• Impulse or Self-Control• Social Adjustment and
Awareness• Emotional Adjustment• Sensorimotor Skills
III-39
Manifestations of TBI by Age__________________________________________________________
• Preschool– Irritability and crying– Temper tantrums– Frustration– Fearfulness– Disabilities become evident over time as
higher level skills are expected to develop
III-40
Manifestations of TBI by Age_________________________________________________________
• Elementary school– Difficulty with new learning– Short attention span and impulsivity– Frustration – Inappropriate social interactions– Disabilities become evident over time as
higher level skills are expected to develop
III-41
Manifestations of TBI by Age________________________________________________________
• Middle school and high school– Difficulty with new learning– Short attention span and impulsivity– Frustration over skill losses– Decreased social judgment– Risk-taking– Depression and anxiety– Sexuality concerns– Effects of earlier injury become evident
III-42
What happens as a result of these deficits and behaviors?_______________________________________________________
• Friends leave
• Families mourn
• Teachers are frustrated
• The student is at increased risk for isolation from peers, academic failure, depression, substance abuse, sexual behavior, delinquency, further TBI
III-43
Evaluation of students with TBI_______________________________________________________
Two purposes:
• Identification of a student as a student with a disability
• Program planning
III-44
Evaluation Planning______________________________________________________
• Where do you begin after a referral is made?
• What do you need to know about the student to determine eligibility for special education and related services and to develop an IEP?
III-45
Information to Determine Needs_______________________________________________________
• TBI information• Information about areas of functioning
– Cognition and memory– Speech and language; communication– Sensory and perceptual abilities– Motor abilities– Psychosocial impairments– Physical functions/safety– Academic skills
III-46
Challenges to Evaluation for Programming______________________________________________________
• What factors make evaluation of the programming needs of students with TBI challenging?
III-47
Challenges to Evaluation for Programming: Student Factors______________________________________________________
• Rapidly changing skills (especially during first 6-12 months)
• Communication, physical, sensory, motor, emotional, and behavioral difficulties may interfere with assessment
• Uneven skill profile (some higher skills preserved with lower skills lost)
• Performance influenced by state and situation
• Problems may emerge later
III-48
Challenges to Evaluation for Programming: Other Factors______________________________________________________
• The family is probably in distress
• Initial assessment is probably conducted outside school in a setting unlike the classroom
• Much assessment information is needed from other professionals (who are busy)
• Medical reports may be difficult to interpret
• Assessment requires IEP team coordination and planning
III-49
What can be done to address these challenges?_______________________________________________________
• Use classroom data to inform instruction• Use observation, curriculum-based
measures, work samples, trial teaching• Assess across content, time, settings• Invite parents to provide information• Ask medical personnel for assistance• Plan team evaluations• Share information
III-50
Teamwork: The Family and the School Staff_____________________________________________________
• Parent(s) and educators work together
• Educators recognize and respect the expertise, values, and concerns of the family
• The family recognizes and respects the skills of educators
• Communication is frequent and honest
III-51
TBI Evaluation Planning:Group Activity______________________________________________________
• Refer to the TBI Evaluation Planning worksheet on pages 51a and b
• Monty and Serena have been referred for evaluation for special education. What do you know? What do you need to find out?
III-52
How Can I Gather Additional Information?_______________________________________________________
• Record review (school and medical)• Direct observation (school or hospital)• Student interview (if possible)• Teachers/service provider interviews• Criterion-referenced assessment• Curriculum-based assessment• Rating scales and checklists• Neuropsychological assessment (if available)
III-53
Test Interpretation: Cautions_______________________________________________________
• Standardized, norm-referenced measures– may not assess the full range of skills
– testing situation may mask deficits
– limited predictive validity
• Timed tasks– may reflect motor slowing, not ability
• Measures of prior knowledge– may not reveal difficulty with new learning
III-54
What does Wisconsin law require in evaluations for special education?______________________________________________________
• See Chapter 115.782 on pages 54a and 54b
III-55
Monty and Serena: Do they meet Wisconsin criteria for TBI?_______________________________________________________
• Acquired injury to the brain
• External physical force
• NOT congenital or birth trauma
• Partial functional disability or psychosocial impairment or both
• Impairments in one or more areas (listed in definition)
• Need special education/related services
III-56
End of Module III