The Components of Effective Service Coordination for the Brain Injured Student in the Primary and Secondary Educational Setting.
Abstract
This document discusses the policy issue of service coordination and students with TBI in the public school system. It argues for policy changes at both the national, state, and local levels. A legislative, historical context of brain injury is presented to explain how federal laws have impacted the education of these students over the past decades. The problem of service coordination is identified in relationship to appropriate services delivery or a lack there of. Next, four barriers are discussed in relationship to effective service coordination. The case study of Valerie is examined in relationship to the format for effective service coordination and from there various related services are identified. The document ends with a discussion of four recommendations to help facilitate systemic change at the policy level that will help to enhance the overall service coordination for students with brain injury.
Introduction
In the 1970s, 90% of all brain-injury patients died as a result of their injuries. While the mortality rate of traumatic brain injury (TBI) has decreased, the incident rate of TBI has increased. Due to the continual advances in medical technology more and more children and adolescents are able to survive injuries to their brains. However, brain injury is still the leading cause of death and disability in children and adolescents in the United States. Students, who are afflicted with TBI, must continue to live, cope, develop, and flourish with the residual effects associated with the injury.
Unfortunately, the multidimensional problems of brain injury can affect the ‘normal’ or ‘typical’ development of children and adolescents and therefore, these problems are likely to compound at the primary and secondary school levels without proper service coordination. Segregation into separate schools for students with disabilities is typically seen as promoting the quality of life and meeting the needs of these ‘special’ students rather than seen as being isolating and prejudicial. Rather than segregating this population of students into special education schools, it is essential that these students’ needs are validated and they are allowed to attend public school in accordance with IDEA. Unfortunately, however, many teachers and educational professionals do not understand the particular services and needs that are often associated with students with TBI nor are they aware of how to successful implement or coordinate services that will fulfill their specialized needs in order to provide access to FAPE (as provided under the law).
The coordination of services for students with TBI at the primary and secondary levels could be greatly improved. This paper will explore several barriers associated with delivery of services for students with brain injury, including (1) educators’ and professionals’ lack of familiarity with the components of injury and understanding of the components that allow for the recovery of brain function, (2) the unique circumstances of brain injury, (3) successful coordination and implementation of special support and related services, and (4) the availability of funds to successfully implement service delivery.
Historical Context
Legislative History
Section 504 of the Rehabilitation Act, which was passed in 1973, prohibits discrimination to students with disabilities in employment, education, and all aspects of delivery of services and program access. This law requires school accessibility and the provision of reasonable accommodations. This act guarantees students with TBI to participate in programs provided by agencies receiving federal funds. The purpose of Section 504 was to ensure that there is no discrimination, whether intentional, or unintentional, against persons with disabilities in the public schools. Unfortunately, in 1972, most schools and school districts were not adhering to educating students with disabilities and most, if not all of these students were being shut out of schools and denied appropriate services.
It wasn’t until the passing of the Education for all Handicapped Children Act, P.L. 94-142, in 1975 that all public schools were required to provide a free and appropriate public education (FAPE) to all students between the ages of 3-21 regardless of disability. This law specifically protects students’ with TBI rights in four fundamental ways. These include the right to provide: (1) an appropriate education at tax-payers expenses, (2) an Individualized Education Plan (IEP) that records the student’s educational needs, (3) education in the least restrictive environment (LRE), and (4) protection of student, parent, or guardian rights to a due process hearing.
On July 26, 1990 President George H.W. Bush signed into law the Americans with Disabilities Act (ADA). It was the world’s first comprehensive civil rights law for people with disabilities. This law prohibits discrimination against individuals with disabilities in the realm of: (1) education, (2) pubic services, (3) public accommodations, and (4) telecommunications. The ADA mimics that of Section 504 of the Rehabilitation Act in language and objective. The only difference is that the ADA provides global access and addresses non-discrimination not only in schools, but also the workplace and the community at large.
The TBI Act of 1996, P.L. 104-266, was introduced to the Senate by Orrin Hatch (R-UT) and was intended to amend the Public Service Act to provide for the expansion and improvement of TBI programs. The main objective of this Act was to appropriate funding for studies and research on TBI. As a result of this law, states have been able to expand therapeutic service capacity to include information and referral services, service coordination, rehabilitation and other services that are deemed necessary. The goal of therapeutic intervention study is to have individuals with brain injury return to work, school, and home ultimately to avoid institutionalization.
Before President William J. Clinton signed into law the Individuals with Disabilities Education Act (IDEA) on June 4, 1997 the expectations of students with disabilities were still falling short, despite the passing of the aforementioned laws. Too many students with disabilities were still dropping out of schools, and as a result these students found it difficult to find jobs. Eventually many drop outs ended up in the criminal justice system. In addition, the girls with disabilities who dropped out were becoming unwed mothers at an accelerated rate than their nondisabled peers. These female dropouts were therefore, excluded from curriculum assignments and assessments, which also resulted in their decreased level of performance.
Since the passing of IDEA, students with disabilities have been provided with the opportunity for involvement in the general education curriculum. Parents have also become more involved in their child’s eligibility and placement decisions. IDEA has encouraged greater expectations for students with disabilities. IDEA not only recognizes TBI as a special education category, bust it has also provided access to special education services. Along with entitlement to special education services, students are eligible for service coordination, i.e., rehabilitative services (i.e., occupational, physical, and speech-language therapies, etc.), which are to be provided in school.
There are two main distinctions between Section 504 of the Rehabilitation Act and IDEA. Section 504 of the Rehabilitation Act is a civil rights statue that prohibits discrimination of students on the basis of handicap, while IDEA is a federal grant program that authorizes federal funds to states to assist in the delivery of special education and related services.
Identifying the Problem
There are various problems that can be associated to a student’s academic, cognitive, behavioral, emotional, and psychosocial functioning after brain injury. Students with TBI are unique. This is the reason why it is essential to have proper cognitive assessment after a student sustains a TBI. It helps to determine the least restrictive educational placement and helps to establish referral(s) for appropriate services. However, despite the acknowledgement of the importance of proper placement and coordinated services, multiple problems can still exist that can inhibit a student’s successful reintegration into the school system. In order for these students to receive services, they must, first and foremost, be classified as TBI. Correct identification enables these students access to the range of services that are designed specifically to meet their individual needs to ultimately improve their quality of life.
Students with brain injury have basic needs and similarities that are often associated with other disability groups and therefore, often require similar services. However, students with TBI also have problems that are unique and specialized to their disability. It is important, therefore, not to lump these students into the general supports and services received by students with other disabilities.
This requires that students with TBI are appropriately evaluated. It is important that these evaluation procedures and disability differences are addressed within the school system. These include, but are not limited to: (1) access to appropriate services, (2) a higher elevation of the standard of care, and (3) access to services provided by professionals knowledgeable in the area of TBI.
Often these students need both medical and non-medical services. However, due to varying circumstances, sometimes these services are not available or difficult to obtain and coordinate due to fragmented system of delivered services or financial barriers. Unfortunately, many school districts face very real problems in meeting the federal responsibility of coordinating services for students with brain injury. Many schools seldom provide an appropriate or least restrictive learning environment for these students because, as previously mentioned, they lack the knowledge and understanding of the effects of TBI on students’ cognitive abilities. This can be especially detrimental to a child or adolescent’s recovery process. As a result, students are either placed at an inappropriate grade levels or in inappropriate classroom environments. In order to overcome these barriers school districts need to learn how to effectively coordinate services for the student with brain injury.
Need for Service Coordination
The IEP is a communication tool between educators, service providers, parents, and the student. It identifies and addresses the most appropriate and least restrictive educational environment for the student. Along with developing an IEP, the team should also identify and coordinate related services that are geared towards maximizing the benefits of a student’s education. These services, as defined either defined in the IEP or developed using other communication tools such as the Individual Service Plan (ISP) or the Individual Transition Plan (ITP). These various plans are to be used in conjunction with a student’s IEP to coordinate the student’s successful participation in and transition within the learning process. It also includes related services that are geared towards maximizing the benefits of a student’s education. These services, as defined in the IEP, are to be coordinated to help the student successfully participate in and transition within the learning process.
There are many levels of transition that affect students with TBI after injury. An important, initial transition period is the transition from hospital or rehabilitation facility to school. Therefore, establishing coordinated services for a student’s successful reentry is essential. It sets the tone for what is to come.
Unfortunately, however, there is often a level of disconnect between transition from medical facilities to reintegration into school systems as a result of lack of coordination of services within the school system. If there is not already a system within the school to help facilitate the student’s transition processes, the reentry process and educational experiences for the students with brain injury can turn into a no win situation. Unsuccessful reintegration will ultimately compound already existing problems. Not only are these students faced with the transitioning into school, but they also have to transition from a life of ability to a life of disability.
The problems that result because of a brain injury often encompass cognitive limitations. These impairments can include, but are not limited to: memory loss, concentration problems, processing abstract information, information retrieval problems, impaired planning, initiating, and inability to follow-through. Teachers and education professionals need to understand how to appropriately accommodate students with brain injury because these students typically do not have capacity to be their own advocate. They do not understand what services are needed. Typically, the child can experience lasting physical and sensory disabilities, along with behavioral, psychosocial and emotional impairments, which will only get worse rather than better over time without proper intervention. This is why appropriate service coordination is important to the child’s well being.
Barriers in Service Coordination
There are many barriers that are involved in coordinating services in the public school system for students with TBI just as there are many roles within the system that facilitate these barriers. It is important that as soon as a student is admitted into a health care facility, the school should be notified to prepare for the student’s transition into school. This allows the school to prepare for the child’s reintegration process. This process begins with an educational assessment to formulate an IEP in order to understand and frame the extent of related services the student will need.
IDEA requires that a multidisciplinary team perform an evaluation of a student to determine whether or not s/he qualifies for special education and related services. Various parties take part in this process and can include: the representative who supervises special education and related service professional, teachers, parents, student (when appropriate), the evaluator, and the service coordinator. It is important that the service coordinator not only is knowledgeable concerning the repercussions of TBI, but s/he also needs to be knowledgeable of the history of that particular student.
Developing an IEP for a student with brain injury is a complicated process. Various parties participate (as listed above) in service coordination process. The main problem that often arises is the joint effort of effectively coordinate services. As more and more people participate in this process, personal conflicts arise and compound already volital issues. While there are various conflicting roles within the process of service coordination, three important roles are identified: Administrative, Instructive, and Parental. Each role will be discussed in relationship to how it can directly hinder and ultimately interfere with the successful coordination of services in relationship to brain injury.
Administrator’s Role
The quality of education and services a school provides is contingent on the proactive role of the administrator and what issues s/he deems important. School administrators can help to facilitate the education of students with TBI and can help to change the direction of special education service delivery. Unfortunately, many, if not most, administrators are not aware of the TBI epidemic and as a result do not have a basic understanding of the mechanisms of brain injury and the residual effects it can have on a student, which hinders the overall service coordination process. This can be detrimental to the student’s future.
When confronted with the TBI crisis as existing within their school system, administrators are reluctant to address the issue because many times they are poorly informed. However, another reason is more economically oriented. Reluctance can be based on the lack of available funds to properly coordinate services. Even though state educational agencies are responsible for assuming the costs of related services that are provided through public education, to a school with limited resources, providing related services is often unrealistic. Students with TBI, who are eligible for related services, typically drain these school’s resources and existing monetary funds. They can be an enormous fiscal obligation.
IDEA legally mandates that schools are now required to allocate the necessary funds for related services. However, if service coordination is to be successfully developed and implemented, administrative support at the state and local levels is essential because administrative officials dictate the funding of teacher training and development. Without administrator support, the successful education of a student with brain injury can ultimately be an uphill battle.
Teacher’s Role
Similar to the barrier of lack of administrator’s awareness surrounding the TBI epidemic, special and general education teachers, also know little, if anything, about the repercussions of TBI. Therefore, they do not know how to appropriately educate these students because they have not received proper training in this area. They are unaware of what services, supports, and accommodations are essential to educating these students. Although there is no standard practice that will work as a best practice 100% of the time, teachers during their college education need to learn how to teach students with brain injury. They need to understand that just as needs differ from student to student, individual support and services will likewise differ for the student with brain injury when compared to other disabilities.
Students with TBI seldom ever experience the same residual impairments of other students with TBI. No two brain injuries are ever alike. Problems can range from physical, cognitive, behavioral, emotional to psychosocial deficits. All these deficits in there own right are debilitating, however, when they are experienced simultaneously, they can be overwhelming. For example, teachers often interpret a student’s behavioral deficits as defiance, noncompliance or anger and inaccurately interpret his/her behavioral repercussions as a conduct disorder or EBD. Unfortunately, this typically translates into the student being placed in an inappropriate educational setting and receiving inappropriate behavioral supports, which can be as debilitating to a student’s recovery as receiving inappropriate academic supports.
Parental Role
Parents know their child the best. However, parents are not always the most practical advocate for their child when coordinating services within the school system. The first reason is that they are often still in crisis mode months even years after their child’s injury and can be in need of services themselves. Parents are not only faced with their child’s new cognitive, social, and behavioral limitations, but the child oftentimes has new sense of self and a new role within the family dynamic. It can take time for parents to absorb and accept the problems now faced by their child, which often makes them not the best advocate for their child’s needs and service coordination.
Another barrier is that parents may not be aware of what services and supports are available out in the community or what related service would be most beneficial to their child. In addition, the relationship between the school system and parents can likewise be a barrier. The development processes can become an emotionally charged environment. The parents can play an either passive or aggressive role, or they can ultimately obstruct the processes by refusing services.
As the three previous discussions indicate, there are important roles administrators, teachers, and parents can take within the service development process, which can either facilitate or hinder a student’s program planning and service coordination.
Academia’s Role Revisited
As previously discussed, common barrier among academic roles is lack of awareness. Lack of awareness of the repercussions of TBI on a student can translate into an ineffective education plan because often schools are unwilling to integrate these students into either the general or special education curriculum. This unfortunately, translates into the fourth barrier known as segregation. Many education professionals, because of their unfamiliarity with TBI, believe that the best placement for these students, those who require special education and coordinated services, is in a private, special education school setting. This belief, however, is based on the misunderstanding of the medical condition know as brain injury and how it can affect or alter the education of students in relationship to their recovery.
The segregation of children with TBI into special education schools is somewhat reminiscent of the era when children were segregated into separate schools based on the color of their skin. That was in the 1950s and even half a century later, educators are still having the same segregation discussion, only this time from a new perspective. Unfortunately, society still separates the haves from the have nots, the ‘normal’ from the ‘abnormal’, which ultimately translates into segregating the abled from the disabled.
While some education professionals believe that FAPE means the right to segregate students with brain injury from the rest of the student population, it fundamentally goes against FAPE and it’s principle of LRE. The student with brain injury needs to be educated in the least restrictive environment and LRE does not always mean that the student needs to be locked away in a separate school, shielded off from his/her peers. Separate in any form, is not equal.
Proponents for segregation of students with brain injury into special education schools are inferring that students with TBI do not have a right to be educated with their peers (even if the decision is made with best intentions). These advocates for segregation believe that public schools are not the best place for educating students with brain injury because they believe that special, segregated schools will provide a better education and will be more prolific in improving the student’s cognitive, social, and mental development in order to facilitate their well being.
Case Study: Valerie
On January 15, 1990 Valerie, a 16 year old sophomore in high school, was on her way to her after school job at Murphy’s Mart. She was running late because she had just stopped to visit her friend, who lived across the street from the strip mall. She crossed at the green, however, she crossed against the light. Her hair flew in her face and she didn’t see the approaching car. She ran out in front of the 40mph vehicle and her body flipped over the car. She landed on the highway, causing her head to hit against the pavement. She immediately went into coma.
She was taken via ambulance to a local trauma hospital. She underwent a craniotomy and a shunt was inserted to relieve pressure from her swelling brain. She was placed in the ICU. An MRI showed damage sustained in the frontal and temporal lobes. She regained consciousness on the 5th day and was then transferred to a rehabilitation facility for approximately a month.
While she was at the rehabilitation facility, Valerie regained the ability to walk, talk (although now she talked in a slurred, deliberate voice), feed, and dress herself. Her cognitive therapist noticed some deficits in her inhibition and behavioral tendencies. She often had emotional outbursts at the rehabilitation staff, swearing, and yelling.
Valerie’s history shows that prior to her accident, Valerie was in the accelerated program with a high IQ. However, her mother explained that Valerie never felt the need to study because the school work came easy to her. She made A’s without having to apply herself. Despite her above-average grades, she was notorious for her bad judgment and behavior. It all started her freshman year in high school when she was 15. At a party, she became intoxicated and had sex with a popular, senior boy. During her freshman year, she was arrested for shoplifting in Kaufmann’s Department Store; had parties at her parents’ house and had sex with her boyfriend in her bedroom with her parents sleeping in the next room.
Upon discharge from the rehabilitation facility, Valerie underwent cognitive assessment to determine her educational placement. The results showed that she had average intellectual abilities. She was to reenter school at the 10th grade level during the spring semester of 1990.
Services to Be Coordinated
Related Services
IDEA defines related services as including transportation, developmental, corrective, and other supportive services, which includes speech-language pathology, audiology, psychological services, physical and occupational therapy, recreation therapy, social work services, and medical and individual and family counseling services (i.e., rehabilitation counseling) to help a student receive full benefit of special education services. Related service professionals work with not only the student, but can also work with the family through community resources.
Therefore, constant communication is key to ensure effective and appropriate service delivery. Coordinated services are to underscore what is in the best interest of the student. Therefore, services need to be coordinated in the education setting through a team approach that is not isolated from the student’s educational goals.
A services coordinator, a person who is knowledgeable about TBI, is an essential part of the IEP team because s/he will have complete access to the student’s records in order to determine the student's specific needs and what services need to be coordination. A service coordinator develops the student’s Individualized Service Plan (ISP). Related services vary from student to student depending on the effects of their injury and should be listed in a student’s IEP. The service coordinator is an important part of the IEP team because s/he can share their special expertise in relation to the student’s specialized needs and how their professional services can appropriately address the needs of the student. These related services can include, but are not limited to the following therapies and services:
Occupational Therapy (OT). OT is geared towards enhancing a student’s ability to function within his/her educational program. Activities are geared towards improving fine motor skills such as writing, using scissors, or sitting effectively in class. OT is geared towards those activities and functions used in daily life.
Physical Therapy (PT). PT can increases muscle strength, range of motion, mobility, and endurance. The optimum goal of PT is to enhance and develop the physical potential of the student in order to maximize his/her independence.
Speech-Language Therapy. The speech therapist diagnoses disorders of fluency, language, articulation, voice, and oral-pharyngeal function. The speech and language services offered can either be geared towards building restorative, augmentative, and alternative communication systems or towards helping students improve existing language and cognitive skill deficits. The speech therapist screens, identifies, assesses a student’s need.
Psychological Services. The school psychologist or school counselor must administer these services. It is important, however, that s/he is familiar with TBI so that the services provide are appropriate and specialized. The goal of the psychologist is to gather information from a variety of sources such as tests, teachers, and parents and this information is then interpreted. The psychologist collects information to become more familiar with the student’s needs in order to develop an appropriate program.
Medical Services. These services can only be defined by a licensed physician. They include diagnostic treatment only and do not include direct or ongoing treatment.
Social Health Services. Either a qualified school nurse or a specifically trained nonmedical staff must administer these services to the student. Duties include: feeding, cleaning, catheterizations, suctioning, administering medications, planning safety in school, and classroom care.
Transportation Services. Schools must provide travel to and from school and between schools, and in and around the school buildings for the student with TBI. Also if specialized equipment is needed for transporting students, it also should be provided by the school system.
Counseling Services. The job of the school counselor is to help the student develop career awareness. The goal of the counselor is to help improve the student’s self-understanding and improve behavior output. The counselor can and often works in conjunction with the school psychologist when providing services.
Social Work Services. Social workers address the welfare of the student in life, home, community, and school environments. It is important that social worker has direct contact and interacts with both the student and his/her family because the social worker needs to understand how the family dynamics and home environment influences the student’s in school learning and behavioral patterns.
Parent Counseling Training. This is an important related service that is often not a focus after a child’s injury. It addresses the needs of the parents and the role they play in understanding their child’s disability and development. This service has many benefits. While it directly serves the parent, it also indirectly benefits the student with brain injury because it helps the parent learn how to cope, care, and interact with their child in relation to their specialized needs.
Recreation Therapy. This therapy focuses on teaching a student how to use leisure and recreation time constructively. It helps to improve social skills, physical, cognitive and language development, and coordination.
Assistive Technology Devices and Services. Assistive devices and services can be utilized to help a student receive the maximum benefit of his/her education. If a student is unable to fully function in school, assistive devices and services help the student to discover ‘new’ ways to interact with his/her environment. It can help to give them a sense of independence. It is the school district’s responsibility to train students on how to correctly use the devises and access these services.
Artistic/Cultural Therapy. These types of therapies, such as dance, movement, music, and art, provide students with a means of self-expression and opportunities to express creativity and control.
Transition Services. An Individual Transition Plan (ITP) is a curriculum tool that can help guide students with brain injury. It is based on a student’s individual needs. The ITP is a document that helps the student set and achieve goals. It shapes what s/he will accomplish once finished with high school. The ITP can change depending on the student’s interests. It promotes movement from school to post-school activities. This process should begin at age 14 and be readdressed at 16.
The fourteen above-mentioned categories of related services are by no means exhaustive. What service best suits the student depends on his/her level of functioning and personal needs. Related services help to facilitate and coordinate an overall, comprehensive system of care for students with TBI.
Case Study: Valerie (continued)
Before returning to school, Valerie’s parents meet with her IEP team to discuss Valerie’s placement to determine what services need to be coordinated in order to help her reintegration into school. This initial meeting includes: the service coordinator, the person who can interpret academic evaluation results, Valerie’s parents, the school system representative, i.e. principle, or school superintendent, special and general education teachers, transition service specialist, and any one else who has special expertise about Valerie, i.e. an advocate.
The service coordinator, parents, and advocate know through conversations with the rehabilitation staff and reviewing documents from the rehabilitation facility what related services are specific to Valerie’s needs. Therefore, the services coordinator has already written Valerie’s ISP (with the consent of her parents). Since Valerie’s related service professionals have already been identified, they too help to make up the IEP team.
Since this is the first meeting of IEP team, Valerie is not included in the decision making. Due to her combative interpersonal interaction thus far and inappropriate behavior, it is decided that she should not participate in the IEP development process. She lacks the ability to be her own advocate and make decisions in her best interest. However, as her recovery progresses and the more self-awareness and flexibility she achieves, the more likely she will become an active participant in her IEP development process.
It is important that Valerie have an ITP because she is 16 years old. Once she has become reaccustomed with school, the transition specialist will work with Valerie. The ITP process will include career exploration activities. This will help make Valarie aware of the choices that are available to her beyond high school and help to clarify her future goals.
As the transition specialist recommends, as documented in the ITP, Valerie will begin attending school for half days the first week in order to gradually accustom her to the transition back to school. Once she has been reacclimated, as determined by her academic scores and rehabilitation evaluations, the IEP team decides that it is in Valerie best interest to take Math, English, Biology with lab, and a computer coarse. Her day will be rounded out by the coordination of her related services, which include physical and occupational therapies (to substitute for gym class), speech-language therapy, and psychological services to help assist in reducing her aggressive and inappropriate interpersonal behaviors.
Valerie will be attending general education Math and English, but will have a special education professional to provide her with assistive services. It has been decided that she will take 10th grade biology with lab and although the lab is geared towards a buddy partner system, Valerie also will have a special education professional assisting her to help with her lab projects. To round off the academic day she will be taking computer course without an assistant.
Because both Valerie’s parents work full time and they will not be able to pick Valerie up after school and transportation needs to be provided. The IEP team, along with the service coordinator, decides that she will ride the special education bus to and from school.
In addition to the determining after school transportation for Valerie, a social worker has discovered that Valerie will be without parental supervision for several hours after school and will be left under the supervision of her two younger brothers. Therefore, the social worker from the IEP team has arranged for Valerie to remain at school, attending recreation therapy, until one parent is off work to pick her up.
In addition to coordinating an after school plan, a social health worker has developed an in school safety plan. Therefore, Valerie will change classes ten minutes before the bell rings to prevent her from having to maneuver through the chaos of a hallway. As an added bonus, to help her socially reintegrate, a different friend will assist her in making the transition from one class to the next.
A psychological assessment determined that Valerie does not apply herself and she has oppositional tendencies, immaturity and a poor self-image. Her uninhibited behavior has only magnified since the injury. However, it is important to realize, as Valerie improves and becomes reaccustomed to school, her IEP, ISP, and ITP will all be reassessed and continually modified to suit her changing needs.
Discussion and Policy Recommendation
As this document indicates, resource and service delivery coordination are of high priority for school districts to facilitate a student’s transition into the school system. Students with TBI need a range of services that are designed to meet individual needs that can evolve and are allowed to change over time. Service delivery needs to be flexible. Because the public school system is the primary source of therapies and intervention for children and adolescents with brain injury, not only is it practical it to improve service coordination at this level, it is essential.
In order to improve successful service coordination for students with TBI, teachers, education professionals, and administrators need to be knowledgeable concerning how to appropriately teach these students and what services are to be coordinated in order to enhance their opportunities in education. Therefore, schools need to provide these professionals access to: continuing education programs; appropriate assessment techniques, and effective transition planning. Educational placement for students with brain injury should be designated in accordance with LRE and appropriate accommodations.
This document advocates for the following policy changes for service coordination within the public school system for students with TBI and is geared towards inspiring change in system policy. The first recommendation involves the desegregation of students with brain injury from isolated special education schools towards integration at the public school level. This recommendation is civil rights based. The primary reason these students are being segregated in a lack of awareness of the implications of brain injury. This first recommendation is closely linked to the second, which geared towards improving teacher quality by expanding awareness of how to educate and provide appropriate support services for students with brain injury. Both of these recommendations can be fulfilled through continuing education courses for not only teachers and administrators, but all education professionals. This will keep all groups current on the important issues associated with brain injury and will help to keep the educational channel of communication open. It is important, if not essential, that professionals who work with students with TBI are provided in-service and continuing education programs as it relates to the coordination of services.
For example, continuing educations workshops could be held in during the summer months when teachers are not in school and free from the day-to-day strains of maintaining a classroom schedule. To help minimize the costs of continuing education programs, schools could combine district resources and bring together experts in the field of brain injury and develop a statewide seminar for educational professionals that focus on training opportunities.
An example of a state that has taken initiative is Arizona. This state has developed a Governor’s Council on Spinal and Head Injuries with the philosophical belief that people with brain injury should have the opportunity to learn; be productive, and contribute to the community. Service coordination is an important aspect of this statewide service. Coordinators help families develop and ISP. The duties of an ISP team are: gathering information, determining appropriate assessments, identifying goals and services, and exploring funding resources. One such state development is, Education and Rehabilitation of Children with Traumatic Brain Injury, which is an 8-module course for educators. This educational program provides essential training opportunities combined with other important resources. Chapters in this module include: Introduction to TBI, Medical Aspects, Neuropsychological Assessment, Cognitive and Communication Problems, Focus on the Family, Transition to Home, School and Work, and Effective Therapies and School Strategies. Likewise, other states could easily adapt a similar model. It is very important for all educators, whether they are novices or veterans, to be current with the national, changing educational venue.
Likewise, the third policy recommendation is also closely linked with the first two. The third recommendation involves helping to change educators’ perceptions of students with TBI. What needs to change is the outrageous assumption that these students require accommodations that not realistic through the public school system. This third recommendation, which is contingent of the first two recommendations, has its roots in professionals’ lack of awareness of the implications of injury to the brain. This also forms the basis of the mistaken assumption that IEP process is a one size fits all system and any student with a disability that does not fit into the exact same mold as everyone else must be segregated. This philosophy believes that if a student requires extensive, coordinated, related services they need to be put into a special education school. Therefore, the underlying goals of my first three recommendations have their basis in facilitating awareness.
The fourth recommendation is also associated with the third recommendation in that educators and administrators believe that the IEP process is a one size fits all system. Familiarity stems complacency. For students with TBI, the IEP team essentially needs to include: the administrator, service coordinator, parents, transition specialist, and related services professionals. Although these various roles may seem redundant and irrational to teachers, as it has been indicated throughout this document, every above-mentioned role is essential to the continued educational development of students with brain injury.
The fourth recommendation argues for the important role of the service coordinator. These individuals play an important role in the IEP, ITP, and ISP development processes. Not only is a service coordinator vital to orchestrate specialized student services, they are also the link to the parents to assist them in working effectively with the school system before, during, and after the transition process. The goal of an effective service coordinator is to unite all parties through encouraging positive relationships during the development processes.
They are to facilitate a partnership between the school system and parents in order to have all parties working together and not against each other. A qualified service coordinator also works with teachers and professionals to help them understand the principles surrounding TBI, the recovery process, the implications on the student’s education process, and the principles of service coordination. Not only is a coordinator a moderator, helping to extinguish polarizing views concerning a student’s abilities and capabilities, but the coordinator is the linkage or toolkit towards recognizing what community resources and services are available to help improve the student’s overall quality of life.
In addition to the above mentioned recommendation of the essential role of the service coordinator, the role of the administrator is equally important. S/he can to help foster a change in the school’s system policy through funding efforts. A personal change in attitude of an administrator will lead to a system change in policy. This change in policy will help to facilitate an attitude change among all educational professionals within that school system.
The fifth and final policy recommendation change does not stem from the individual or professional level, but rather is contingent upon our lawmakers. This recommendation is rooted in the source of funding. I believe that the government needs to allocate emergency money to specifically help schools coordinate the delivery of services to students with brain injury. For example, the government can earmark an annual percentage of the money given to each of the 50 states’ education departments in response to a school’s inability to properly fund service coordination for these students.
This governmental expenditure also leads to how the TBI Act needs to be reauthorized to address the educational dimensions of brain injury. The act needs to allocate funding for schools to coordinate services to help to facilitate students’ recoveries. The act currently focuses on studies and research in the area of brain injury. However, now the act needs to be defined further. It needs to focus on the educational dimension of students with brain injury. What needs to be authorized are educational parameters to expand and improve the coordination of services to students with TBI to increase these students’ overall quality of life and educational experiences.
Conclusion
The above mentioned policy change needs to begin with fundamental changes at the personal, local, and grass-roots levels. This will lead to lasting and complex structural and systemic changes at the state and governmental levels. These changes include, but are not limited to the five previously mentioned recommendations. Resources and service coordination in public education is of the highest priorities for the development of TBI system change. The above-mentioned recommendations mark the beginning of a cycle of fundamental systemic policy change. It is important that changes occur in the systemic delivery and service coordination for all students with brain injury.
As this document has discussed, students with brain injury need a range of coordinated services and supports that are unique and flexible to meet varying, individualized, and personalized needs. In addition, general awareness of the implications of TBI needs to be a priority at both the local and national level. Awareness programs need to be developed at the local level for education professionals, administrators, teachers, related service specialists, and families to help initiate school programs that focus on the education of these students. While students with brain injury share a commonality of service coordination with other disability groups, a prevalent difference is that services needs to be coordinated and provided by individuals who are knowledgeable in the area of TBI. It is only through awareness and the allocation of federal monetary funds that these students can be provided with appropriate, coordinated services and accommodations. Access to appropriate coordinated services is the stepping stone to facilitate students in their reentry into the school system after injury. Access to FAPE will provide these students access to educational and community resources, which will provide them with the skills needed to be productive members of society, which in turn will give them the potential to access future endeavors, which will ultimately provide opportunities that can elevate their overall quality of life.