How Common is TBI in Children in Pennsylvania? In Pennsylvania each year 4,000 children & adolescents were HOSPITALIZED. The BrainSTEPS Program

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1 How Common is TBI in Children in Pennsylvania? Assists students, schools, families in Pennsylvania following acquired brain injury Brenda Eagan Brown, M.Ed., CBIS BrainSTEPS Program Coordinator Each year, approximately 26,000 children (ages 0-14) in Pennsylvania sustain a traumatic brain injury (mild, moderate, or severe) Source: The Brain Injury Association of Pennsylvania, 2008 In Pennsylvania each year 4,000 children & adolescents were HOSPITALIZED with TBI Source: The Pennsylvania Department of Health, DOES NOT INCLUDE EMERGENCY ROOM VISITS. The return to school can be devastating if the health care facility (hospital or rehabilitation center) and the child's home school do not interact as soon as possible and as frequently as possible Carter and Savage, 1988; Ylvisaker et al., 1991; Begali, 1992; Mira et al.,1992; Lash, 1992 Retrieved Jan. 21, 2013 from School Re-Entry: School may be the only rehabilitation facility (per se) available to many children and adolescents Low teacher-pupil ratios are highly desirable (e.g., 1:1) The BrainSTEPS Program Created by: PA Department of Health in 2007 Unique partnership for funding: PA Department of Health PA Department of Education, Bureau of Special Education via the PaTTAN network Implemented by: Brain Injury Association of Pennsylvania 1

2 The BrainSTEPS Program Brain injury consulting teams available to families and schools throughout Pennsylvania. Teams are extensively trained in the educational needs of students returning to school following brain injury. BrainSTEPS Assists Students with All Acquired Brain Injuries Traumatic Brain Injury (includes Concussions) Non-Traumatic Brain Injury * Any child who has a brain injury that occurs AFTER the birth process can be referred to BrainSTEPS BrainSTEPS Teams 31 BrainSTEPS teams cover PA 29 are based out of the educational Intermediate Units and 2 larger districts 300+ active, trained BrainSTEPS consultants Educational professionals Medical professionals Rehabilitation professionals Staff from community facilities Staff from government agencies University faculty Family members BrainSTEPS PA Hospital & Rehabilitation Team Members Children s Hospital of Philadelphia Lehigh Valley Hospital Beechwood NeuroRehab St. Vincent s Medical Center The Barber Institute Geisinger Medical Center Good Shepherd Rehabilitation The Children s Institute of Pittsburgh Acadia Rehabilitation, Inc. Nemours/A.I. dupont Hospital for Children (Delaware) Mainline Rehabilitation Reading Hospital Schuylkill Rehabilitation What BrainSTEPS Teams Do: Prepare the student for return to school Communicate with the district & medical, & rehab professionals Gather medical, rehab, & educational reports/evaluations to assist in making educational recommendations Conduct student observations What BrainSTEPS Teams Do: Provide peer, parent and school training o Individual to student needs for school teams o General for district wide in-service trainings Consult on all aspects of the student s educational plan & make recommendations to the district team Assist in transitioning a student from grade to grade or school to school by training new teachers 2

3 What BrainSTEPS Teams Do: Serve as a consistent point of contact for students Monitor all referred students annually until graduation. Offer families support, education and connections to community resources o BrainSTEPS Student Care Binders Continually update their brain injury expertise by attending mandatory BrainSTEPS trainings, obtaining CBIS certification, and participate in other brain injury training opportunities BrainSTEPS Database Communication with family Communication with school Consultation with student Records review Consultation: strategies Consultation w/ medical professionals Consultation educational plan Training of educators and support staff Classroom and peer education Information sharing among team Demonstration of interventions Observations/evaluations of student Participation in IEP and 504 meetings BrainSTEPS team member Consultation Activities BrainSTEPS Referrals Physician 12% Hospital 5% IU 4% Rehab 8% Types of Student Brain Injury Diagnoses nontbi 11% Moderate& Severe 23% TBI Severities Family 21% Advocate 4% School 46% TBI 89% CONCUSSION Mild Traumatic Brain Injury 77% 3

4 Type of Student Acquired Brain Injury Brain injury occurring anytime after birth Concussion Mild Traumatic Brain Injury (TBI) New Moderate TBI, Severe TBI, Non-TBI Acquired Brain Injuries (TBI or non-tbi) that occurred in the past When to Refer a Student to BrainSTEPS 4 weeks post concussion unless student has a history of any of the following then refer sooner: Prior concussions Migraines Learning, attention or emotional disabilities, sleep disorders As soon as injury occurs, the sooner you refer the better. Don t wait for the student to experience educational impacts/bad grades. Refer early to prevent issues. If the student is experiencing educational impacts from the earlier brain injury, make a referral. Pennsylvania s Statewide Return to Learn Concussion Management Team (CMT) Model PA s Layered Statewide Infrastructure for Concussion Return to School Students Should Not Participate in Activities with High Cognitive Demand While Symptomatic Student Concussion CMT School level 730 Concussion Management Teams for Return to School 1 st layer BrainSTEPS Support begins 4 weeks Intermediate Unit level 31 Regional Consulting Teams 2 nd layer exacerbates symptoms prolongs recovery time *Front load accommodations Brown, N., et al. 2014; Majerske, C., et al Return to School BrainSTEPS Concussion Management Team (CMT) Project CMTs consist of 2 monitors Academic Monitor (School Psych, Guidance Counselor) Symptom Monitor (School Nurse) 730 Return to School Concussion Teams across the state of PA since Jan Common Student Concussion Scenario 1. Student returns to school District based Concussion 2. School doesn t implement accommodations 3. Symptoms flare Management 4. Teams Student pushes (CMTs) through can alleviate symptoms these 5. This goes on for a few weeks, because student is issues waiting & for promote medical appt. faster student 6. Dr. may then (several recovery weeks later) place student on homebound rest for period of time because at this point, symptoms are so severe. 4

5 Concussion Management Team Available for download at: 2 person CMT does NOT take the place of the Interdisciplinary Team (Educational, Medical/Rehab, Parent, Student) The CMT serves as the Concussion Coordinators *CMT are the Concussion Coordinators, Data Collectors, & Information Gatherers Available to order in bulk at: CMT Model Provides Districts: 1. Structure Concussion Return to School Protocol 2. Training Best Practices for managing concussions in the classroom 3. Tracking student progress Concussion Academic & Symptom Monitoring Tools The Centers for Disease Control (CDC) & Prevention document: S. Davies, B. Eagan Brown, G. Gioia, A. Glang, K. McAvoy oom_tips_for_teachers-a.pdf 5

6 Brenda Eagan Brown, M.Ed., CBIS BrainSTEPS State Coordinator Phone: Website: 6