TBI and Transition

Lauren Lindstrom, University of Oregon

Robin Harwick, Center for Brain Injury Research and

Training

Session Overview

Youth with TBIYouth with TBI

TransWeb ProjectTransWeb Project

Focus Group: Focus Group: what what are the current are the current needs?needs?

Wrap-up & Wrap-up & ResourcesResources

What’s Unique about TBI?Sudden onset. Sudden onset.

Half of all childhood TBIs occur between Half of all childhood TBIs occur between ages 14-19 ages 14-19

By high school, students with early By high school, students with early injuries are different from students with injuries are different from students with later injurieslater injuries

Parents and students cling to pre-injury Parents and students cling to pre-injury post-secondary planspost-secondary plans

Learning challenges are uniqueLearning challenges are unique

What do we know?Transition Outcomes

PSO project: 89 PSO project: 89 students with TBI in students with TBI in Washington and OregonWashington and Oregon

Tracked for up to 6 Tracked for up to 6 years: 18-25years: 18-25

EmploymentEmploymentPost-secondary Post-secondary educationeducationCommunity integrationCommunity integration

Going to College: Youth with TBI

Non disabled young adults 18-25 = 46% enrollment

Youth with TBI = 45% enrollment (within 4 years of leaving high school)

32% community colleges

23% vocational/tech

14% 4-year

Only 17% remained in college one year after high school

Factors That Affect Enrollment

Higher family SES, shorter time to Higher family SES, shorter time to enrollmentenrollment

Females more likely to enrollFemales more likely to enroll

Those injured later were more likely to Those injured later were more likely to enroll. For every year increase in age at enroll. For every year increase in age at injury there was a 12.3% increase in injury there was a 12.3% increase in likelihood of enrollment. likelihood of enrollment.

Post-secondary outcomes

Important qualitative finding of PSO: Important qualitative finding of PSO:

Students injured later (in high school) Students injured later (in high school) tend to follow their pre-injury transition tend to follow their pre-injury transition plans.plans.

Often go to college where they are likely Often go to college where they are likely to struggle and fail.to struggle and fail.

Parents and teachers support this Parents and teachers support this because they don’t know what else to do. because they don’t know what else to do. And because they hope it works out. And because they hope it works out.

What about employment?

EMPLOYMENT RATE

WAGESPER WEEK

HOURS PER

WEEK TYPE OF JOB

PSO Sample

60%

$161-232 (male)$124-418 (female)

25.5 hrs

57% menial/unskilled0% management/pro

Typical Young Adults

68%$485 (male)$418 (female)

35.8 hrs

36% menial/unskilled19% management/pro

• Bureau of Labor Statistics of the U.S. Department of Labor, January 19, 2007

Closer Look:Employment at Age 25

60% employed

74% of males35% of females

Hours per week

Mean 21-30No one worked more than 30 hrs per week

What this means for Transition

Some of the strategies you use with other students may Some of the strategies you use with other students may need to be modified to address these challengesneed to be modified to address these challenges

Awareness of strengths and challengesAwareness of strengths and challenges

Planning, remembering, initiating, following throughPlanning, remembering, initiating, following through

Managing impulsivity, inertia, rages, frustrationManaging impulsivity, inertia, rages, frustration

Speech/communication impairment Speech/communication impairment

Reading/responding to social cues Reading/responding to social cues

What this means for transition

Working with the family may be challengingWorking with the family may be challenging

May be be protective (this child almost died)May be be protective (this child almost died)

May assume rapid post-injury recovery rate will continue May assume rapid post-injury recovery rate will continue until full recoveryuntil full recovery

May expect school to focus on recovery rather than May expect school to focus on recovery rather than maximizing educationmaximizing education

Trans Web ProjectWhy do we need this?

Students with TBI have poor transition Students with TBI have poor transition outcomesoutcomes

Several aspects of TBI are challenging for Several aspects of TBI are challenging for educators and employerseducators and employers

Because TBI is considered “low incidence” Because TBI is considered “low incidence” most educators aren’t trainedmost educators aren’t trained

Because of sudden on-set, most parents aren’t Because of sudden on-set, most parents aren’t prepared for transitionprepared for transition

Transition Web Project

Student Student componentcomponent

Parent Parent ComponentComponent

Teacher Teacher componentcomponent

What do you think?Focus Group

Wrap-up/Resources

TBI TeamsTBI Teams

TBI ToolkitTBI Toolkit

cbirt.orgcbirt.org

TBI Toolkit ExamplesTransition Strategy TBI Challenge & Adaptation

Learning in context-teach competencies a student will need in the contexts that they will need to use them

•Many students with brain injury look “normal” and it is easy to overestimate skills and abilities until the individual performs in the desired setting. •Learning in context helps employers and students understand what is easy or hard for the student and how to adapt to help the student be successful.

Self Awareness-most transition age students are working to discover who they are and what they will do in life

•Students with TBI are often discovering skills and abilities (and needs and deficits) as they are healing and maturing .•Students with TBI often need to actively work on self awareness as they create a new understanding of themselves, their abilities, strengths and challenges following the brain injury.

TBI Toolkit Examples

Transition Strategy TBI Challenge & Adaptation

Family Involvement- a predictor of school and transition success for at risk youth

As with the youth him or herself, many families are adjusting to life after the brain injury. Especially true for recent injuries.

Person Centered Transition Plans

•Students with TBI may need several explicit plans over time that change as the student changes and adapts to the student’s new understanding of him or herself. •Helping students with unrealistic goals; use their explicit plans to reflect on abilities, gain self awareness, self determination and self advocacy while evaluating their steps toward personal goals.

TBI Toolkit ExamplesTransition Strategy TBI Challenge & Adaptation

Mentorship/Coaching •Students with TBI are often unaware of their own limitations or create information to fill gaps in memory or knowledge (confabulation). •It is important for mentors to understand the reason for this behavior and not attribute it to lying or being intentionally misleading.

Initiation and Motivation •Many students with TBI demonstrate neurologically-based initiation impairments that are the direct result of their injuries. •A student may be unaware that difficulty starting new tasks is a challenge and need a plan to begin work on a task or set of tasks. •For students with limited motivation, use routine to replace internal motivation and create a sense of success.