1. cbirt. org Bonnie Todis, Ph.D. Center on Brain Injury Research and Training STEP: S tudent T ransition and re- E ntry P rogram

2. cbirt. org www.TBIFocus.org Rehabilitation Research and Training Center on Interventions for Children and Youth with Traumatic Brain Injury

3. cbirt. org Partners Cincinnati Children’s Hospital Medical Center Nationwide Children’s Hospital Rainbow Babies & Children’s Hospital MetroHealth, Cleveland The Children’s Hospital, Denver Center on Brain Injury Research and Training Tufts University University of Oregon

4. cbirt. org Ann Glang, Ph.D. Bonnie Todis, Ph.D Deborah Ettel, Ph.D. Center on Brain Injury Research and Training

5. cbirt. org David “The accident happened when David was in first grade. He was in the hospital for just 3 days. He was unconscious for just a few hours. We were so, so lucky! Nobody from the hospital contacted the school, but we thought that was ok. We knew David was going to be just fine in a couple of weeks.”

6. cbirt. org David “The teachers say David is fantastic, such a joy. A little slow. But that’s David now. They don’t know David as any way else.” ~David’s mother

7. cbirt. org David “I don’t know if the information about his brain injury got passed along to the 2nd grade teacher. It’s in his cumulative file, but I don’t know if anyone reads those.” ~David’s mother

8. cbirt. org David “Eventually I found out about the accident, but I had no training in TBI. It was tough…I wanted to push him, but I didn’t want him to get frustrated and shut down.” ~David’s teacher

9. cbirt. org “As educators, we don’t have a handle on this disability” ~Oregon special education administrator

10. cbirt. org Importance of Hospital-School Transition Special education is the ticket to rehabilitation in school

11. cbirt. org Challenges There is a lack of understanding of TBI in the school setting Parents and educators have different perspectives and have a difficult time working together There is no systematic method for connecting children and their families with services within the school and community following TBI.

12. cbirt. org Back to School Study (US Department of Education, Grant # H324C010113) Purpose: Document hospital-school transition experience of children with TBI N = 56 Inclusion criteria: 24 hour hospitalization 76% of children had severe TBI Glang, Todis, Thomas et al., 2008

13. cbirt. org Back to School Study Findings Key factors related to provision of formal special education or 504 services: injury severity hospital-school transition services

14. cbirt. org Improving the link between hospital and school

15. cbirt. org STEP model Grounded in experience of families and of hospital and school personnel in five states Focus groups with hospital rehabilitation personnel, administrators, social workers Interviews and observations with parents, teachers, school administrators, support personnel

16. cbirt. org STEP (Student Transition and re-Entry) model State Department of Education (DOE) provides a single point of contact for all hospitals to call DOE informs trained regional liaison Regional liaison informs the school offers resources to family and school

17. cbirt. org STEP ongoing support School staff access training and support as needed Parents can contact the liaison at any time Progress of students is tracked by DOE annually

18. cbirt. org R4 R3 R6 R1 R2 R7 R5 R8

19. cbirt. org Key elements of STEP Facilitates Special Education identification of students with TBI—especially those not discharged from rehabilitation Provides user-friendly resources to families and schools Tracks kids through school so TBI is not “forgotten”

20. cbirt. org STEP Evaluation Randomized controlled trial Sites in Ohio, Colorado, Oregon 5 hospitals, 3 Depts. Of Education Current N = 55 (rolling enrollment; total sample = 140)

21. cbirt. org Sample Children/youth ages 5-19 who: Are enrolled in school Sustain TBI Are hospitalized at least overnight One Parent Two Teachers

22. cbirt. org Study Design: RCT Student assigned to STEP or usual care Parent and 1-2 teachers complete baseline measures Reassessment at one year T0 in hospital, T1 at 30 days post-injury, T2 at 1 year post- injury T2 now coming in

23. cbirt. org Measures ParentsTechers State/Trait Anxiety Index Brain Injury Partners measures of advocacy skill Child Behavior Checklist (CBCL, aka Achenbach) CASP – Child & Adolescent Scale of Participation CASE – Child & Adolescent Scale of Environment Brief BRIEF (24 questions) STEP measures of parent concerns/services needed/provided/satisfaction Demographics-including experience/training Teacher Knowledge STEP measures of teacher concerns/services needed/provided/satisfaction BRIEF (full) CBCL SSBS – School Social Behavior Scales (Scale A)

24. cbirt. org Preliminary Findings Measures (reported here) Parent survey School records

25. cbirt. org Sample: Age at Injury Mean age: 11.8 years (SD =3.8 yrs) Range: 5 – 17 years

26. cbirt. org Severity of Injury N = 55

27. cbirt. org Student Grade N = 55

28. cbirt. org Received inpatient rehabilitation services? N = 55

29. cbirt. org Special Education Services

30. cbirt. org Results by TX Condition No statistically significant differences between outcomes for STEP vs. Usual Care Example: parent satisfaction satisfied or very satisfied Usual care: 78%, STEP: 84%

31. cbirt. org Does the effect of STEP depend upon whether or not the student had rehabilitation services? Control for rehabilitation services status

32. cbirt. org Tx effects controlling for rehabilitation services status Procedures: Sample divided by Rehab (28) vs. No Rehab (27) Each group contained tx & control

33. cbirt. org % Participants with IEP at Time 2 N = 55

34. cbirt. org Parent Satisfaction with IEP Time 2

35. cbirt. org Services Students in STEP received more support services across domains than students in Usual Care condition: Academic47% vs. 18% Speech/Language24% vs. 9% Social behavioral 24% vs. 0% Medical 18% vs. 9%

36. cbirt. org Parent Overall Satisfaction at Time 2

37. cbirt. org Big Picture When they returned to school, children/youth who received inpatient rehabilitation received similar services in school setting across treatment condition

38. cbirt. org Big Picture For children/youth who did not receive rehabilitation, those in STEP showed better results compared with Usual Care Were more likely to be identified for special education Received more support services Parents found school staff more helpful Parents expressed more satisfaction with IEPs and with overall services

39. cbirt. org Positive Features of STEP model Makes modest demands on hospitals, school systems, and parents Affordable Flexible/Adaptable Sustainable

40. cbirt. org Next Steps on STEP Continue data analyses Teacher measures One-year student outcome measures One-year follow-up study Funded by OH Emergency Medical Services (Dr. Keith Yeates lead investigator) One additional data point: T3 18-24 months post-recruitment Includes participants in OH, OR, and CO Dissemination of the model to local and regional hospitals, other states

41. cbirt. org Contact me Bonnie Todis, PhD Center on Brain Injury Research and Training Teaching Research Institute Western Oregon University www.cbirt.org todisb@cbirt.org