iii-1 module iii ______________________________________________________ returning to school

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III-1 Module III ______________________________________________________ Returning To School

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Page 1: III-1 Module III ______________________________________________________ Returning To School

III-1

Module III______________________________________________________

Returning To School

Page 2: 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

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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

Page 4: III-1 Module III ______________________________________________________ Returning To School

III-4

Transition to School______________________________________________________

• Preparing for transition to school begins at the time of injury

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III-5

Transition to School______________________________________________________

• What can the medical facility do?

• What can the educational facility do?

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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

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III-7

Three Stages of School Re-entry Planning______________________________________________________

• At the time of injury

• During the hospital/rehabilitation stay

• Prior to discharge

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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

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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

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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

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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

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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

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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

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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

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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?

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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.

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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

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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

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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

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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

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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?

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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

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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

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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

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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)

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III-26

Designate a case manager_______________________________________________________

• It is best practice to appoint a case manager who coordinates communication among IEP team members

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III-27

What types of problems can the school anticipate?_______________________________________________________

•Serena

•Monty

•Mike

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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

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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)

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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

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III-31

Sensory/Perceptual Problems______________________________________________________

• Visual deficits– field cuts

– tracking (moving and stationary objects)

– spatial relationships

– double vision (diplopia)

• Neglect

• Auditory deficits

• Tactile deficits

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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

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III-33

Executive Functions______________________________________________________

• Planning, prioritizing, sequencing, self-monitoring, self-correcting, inhibiting, initiating, controlling or altering behavior

(Savage & Wolcott, 1995, p. 150)

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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

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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

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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

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III-37

Behavioral Problems ______________________________________________________

• Deficits (all types) may lead to challenging behaviors– non-compliance

– aggression

– confrontational behavior

– lack of initiative

– withdrawal

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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

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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

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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

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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

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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

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III-43

Evaluation of students with TBI_______________________________________________________

Two purposes:

• Identification of a student as a student with a disability

• Program planning

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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?

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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

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III-46

Challenges to Evaluation for Programming______________________________________________________

• What factors make evaluation of the programming needs of students with TBI challenging?

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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

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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

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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

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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

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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?

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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)

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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

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III-54

What does Wisconsin law require in evaluations for special education?______________________________________________________

• See Chapter 115.782 on pages 54a and 54b

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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

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III-56

End of Module III