Transition into Post-Secondary Life for the student with Brain Injury
Katherine A. Kimes, Ed.D., CBIS
ABI Education Services, LLC
President
KKimes@ABI-EdServices.com
www.ABI-EdServices.com
Understanding Brain Injury
The terminology surrounding traumatic brain injury (TBI) can be quite confusing, especially for school professionals who have limited knowledge in this area. This is why IDEA (2004) states that an IEP team should include a member that has knowledge or special expertise regarding the child’s disability and can interpret the instructional implication of the evaluation results to appropriately accommodate a student in public education.
To get a better understanding how TBI can drastically impact a child’s education, school professionals need to have a general understanding of the terminology behind this disability. All traumatic brain injuries (TBI) are acquired brain injuries (ABI), but not all acquired brain injuries are traumatic. Non-traumatic brain injuries occur from internal body occurrences.
An ABI implies that an individual has “experienced normal growth and development from conception through birth, until sustaining an insult to the brain” and results in an impairment in typical brain function (Savage & Wolcott, 1995, p. 146). A traumatic brain injury (TBI), which falls under the category of ABI, is defined as an acquired injury caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both.
The Centers for Disease Control describes TBI as “an important public health problem” (2013, ¶ 1). A traumatic brain injury (TBI) occurs every 15 seconds (CDC, 2013). TBI occurs at a greater rate than spinal cord injuries, HIV/AIDS and breast cancer (BIA, March 2001). It has been estimated that 1.7 million individuals in the U.S. sustain a traumatic brain injury (TBI) annually (CDC, 2013). Every year 795,000 individuals acquire a non-traumatic injury (CDC, 2013).
For the purposes of this article the term “brain injury” will be used as an umbrella term that refers to both ABI and TBI. Most, if not all brain injuries, whether non-traumatic or traumatic, can adversely effects a student’s life. The impairments resulting from brain injuries are not only limited to motor deficits. The cognitive impairments that can result include, but are not limited to, communication, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior (i.e., behavioral or emotional problems), physical functions, information processing and speech (Clark, 1996).
Understanding the Transition Needs of Students
Advances in medical technology have decreased mortality and morbidity rates and have increased the number of individuals surviving brain injuries. Those at highest risk of inquiring a brain injury are children 0-4 and adolescents 15-19 (Langlois, Rutlan-Brown & Thomas, 2004). These number directly correspond to students in primary and secondary education. Unfortunately, few school professionals understand what types of supports and services need to be provided to these students as they transition into post-secondary life. As a result, youths are caught between two basic transitional problems: 1) the transition from ‘normalcy’ to disability and 2) the transition from adolescence to adulthood.
Many students are limited in their post-secondary options because school professionals have a limited knowledge about brain injury and do not know how to appropriately accommodate these students. These students are often tracked into lower level courses and not given the chance to compete with peers. Many youths get lost in the public education system (Wehman, 1996). These students are not given the opportunity nor option to make transition/career/post-secondary decisions related to their future endeavors. This is unfortunate because effective post-secondary options can be an ideal stepping stone to help improve students’ cognitive and social deficits (Kimes, 2003).
Barriers in Transition Planning
For a long time, the focus of transition into post-secondary life was just thought to be employment oriented. Andrew Halpern (1985) questioned the prevailing idea that employment was the primary outcome of transition services. Harpen expanded the definition of transition services to include social inclusion, personal relationships, and happiness. Therefore, the role of transition planning should also emphasize a student’s successful integration into society and access to emotional support.
While much research has been done in regard to the transition of students with learning disabilities into post-secondary life, little research has been done on the post-secondary transition of students with brain injury. Past research has identified various barriers to the transition process for students with learning disabilities, which are also applicable to students with brain injury. These barriers can range from the level of parent involvement and the level of emotional support, limited opportunities, and limited life skill training to help pepare the student for life after high school. However, due to the multi-faceted and individualized impairments of brain injury combined with the prevailing lack of information about this disability, students with brain injury can be at a greater disadvantage.
It is important to prepare the student with brain injury for life after high school because two prominent areas of difficulty include social and behavioral adjustment (Clark, 1996). These barriers have the potential to interfere with a student’s later success (Clark, 1996). Psychosocial factors of mental status and social support are strongly correlated to a student’s perceived quality of life after brain injury (Chase, Colantonio, Ratcliff, Stead-man-Pare, Vernich, 2001). Unfortunately schools seldom focus on the quality of life of a student when developing a transition plan because many education professionals do not believe that they have much, if any, control over a student’s social and behavioral adjustment.
There is little empirical evidence that addresses the “best practices” in transition planning. However, some recommended practices for enhancing the social inclusion of youths with disabilities in postsecondary settings include: individual, peer or contextual interventions. These interventions can range from teaching disabled students how to build self-awareness, self-esteem, and social skills to how to educate those without disabilities on those with disabilities, i.e., brain injury (Chadsey, J. and Shelden, D., 1998). The focus needs to shift to how to build an inclusive post-secondary environment that integrates students with disabilities with students without disabilities, both academically and socially.
Post-Secondary Options
It is important to keep in mind that every brain injury is different and impairments vary from student to student. As such, the implications of brain injury will affect each student’s education differently. No two brain injuries are ever alike. Therefore, no two students’ transition into or options for post-secondary life will be the same.
However, based on a student’s ability/academic level, the choices of post-secondary options are as numerous as they are for any student without a brain injury. Students can move directly into the workforce or go on to vocational training or attend a university or college. However, what needs to be given primary consideration is the ability level and personal goals of the student.
Individual Transition Plan (ITP)
For students with brain injury, who receive special education services in public schools, an individual transition plan (ITP) needs to be developed at age 14. If the injury is acquired after 14 years of age, an ITP needs to be developed as soon as the student returns to school. An Individualized Transition Plan (ITP) is a curriculum tool that can prepare and guide students for life after high school.
An ITP is a person-centered process and is based on a student’s individual needs. A transitional plan needs to take into consideration many factors such as: the student’s pre-accident ability and grade level, the severity of injury and the implications of the brain injury on the student. In addition, factors such as disability, emotional functioning, family support and available community resources also need to be considered. Because the ITP is a person-centerd process, the life goals of the individual student need to be taken into consideration when developing the transition plan.
The ITP is an outcome-oriented process that promotes movement from school to post-school activities. These activities can include, but are not limited to: postsecondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, self-sufficiency and community participation. An effective ITP is developed focusing on what the student will be doing post-graducation, while addressing independent living goals. It is also key to consider the level of emotional support the student has in making the transition. The level of emotional support and self-determination can play a big factor in whether or not a post-secondary transition will be successful.
Transition planning is a complicated process and the components of that transition need to be clearly addressed in the student’s Individual Transition Plan (ITP). For the student with brain injury, the emphasis should be placed building academic, functional and social inclusion. IDEA (2004) says schools should provide “effective transition services to promote successful post-school employment or education is an important measure of accountability for children with disabilities” [§2651(14)]. The development and implementation of the ITP should include coordination of services that will help to support the post-secondary transition of these students (IDEA, 2004).
Transition from high school into post-secondary life for a student with brain injury can be a very confusing experience. As such, different students will need different levels of support. Some students may need extra help and preparation, while others may need very little guidance. Therefore, it is important to work directly with the student and to involve the parents in the process because they know their child the best. Collaboration is important, especially because the ITP is a component of the IEP process.
The Process of Transition Planning
Questions should be addressed with the student to help determine the best post-secondary option(s). Although these steps my be time-consuming, this personal oversight is needed to help determine viable post-secondary goals. It can be overwhelming for a student to think about or even consider his/her future goals since acquiring the injury. Both students with and without disabilities are often unequipped to make post-secondary choices even after graduating from high school (Super, 1990). Therefore, individualized support needs to be provided by the school system through the Individual Education Plan (IEP) and the Individual Transition Plan (ITP). Schools and school professionals need to be knowledgeable to provide students with brain injury appropriate support and service, those services which are guaranteed under IDEA (Kimes, 2013).
Make it a priority to schedule meetings with the student and brainstorm possible post-secondary options. Get the student thinking about his/her future. The following questions are a starting point to help develop a comprehensive Individual Transition Plan (ITP).
The first question to be addressed is: what is the percentage of the student’s impairment that is the result from the brain injury? What are his/her limitations? Are they cognitive, psychosocial, interpersonal or psychomotor? Is the student aware of his/her disability and/or limitations? Does s/he possess self-determination to move beyond these limitations?
These questions help to identify the student’s particular needs and determines possible post-secondary options. Possible choices can be whether to continue with his/her education at a university or college, vocational training or to move directly into the workforce or supported employment. The choices are very individualized and based on each student’s needs, wants and desires for the future. It’s important to help shape the student’s goals into attainable steps.
The second question is contingent upon the first. It provides the student with choices. If the student is cognitively able and wants to pursue education, the next question asks: what is the best choice of postsecondary education experience for the student? Should it be a 4-year college, 2-year college, community college or vocational training?
The next question that needs to be addressed involves the level of support and level of services the student needs to make the post-secondary experience successful. If the student goes directly to work, what type of accomodations will s/he need in the work setting? Should the student be referred to the Office of Vocational Rehabilitation? Does the student need assistance through supported employment?
When applying to college, university or vocational training, it is important to find out if needed academic and support services are offered by the school because special education services do not have to be provided by private colleges and universities, only public. If specialized support is offered, how extensive are the services? There are a variety of specialized supports a college or university can offer such as academic and personal support, counseling, testing services and academic advising. Does the school offer the types of accommodations the student is going to need? The appropriate level of accommodations offered should match the needs of the student.
Once it has been agreed that the student’s post-secondary option fits his/her needs, wants, desires and ability level, the next question should address independent living goal(s). What type of living arrangements will best suit the student? Where does the student want to live after high school? Should the student remain at home, live in an apartment, or can s/he live in a dormitory or off-campus housing?
Conclusion
Post-secondary transition planning for the student with brain injury is a complicated and complex process. No two transition plans will ever mimic each other and no two transition plans will ever yield the same results. Therefore, school professionals need to become knowledgeable about the implications of brain injury and how that information can be applied to a student’s transition into post-secondary life.
As this article has emphasized, transition planning is not a one-size-fits-all process. However, as long as school professionals are willing to learn about brain injury, the ITP is a tool that can help determine the most appropriate post-secondary placement. The goal is to build a collaborative environment to allow these students to prosper in their future endeavors. With your help and guidance, their choices can be unlimited. It is a starting point from which a better system of services can be offered to students with brain injury.
References
Brain Injury Association (BIA). (2001, March). TBI Incidence. Alexandria, VA: Brain Injury Association.
Centers for Disease Control. (2013). Traumatic Brain Injury. Retrieved September 23, 2013 from http://www.cdc.gov/TraumaticBrainInjury.
Chadsey, J. & Shelden, D. (1998). Moving Toward Social Inclusion in Employment and Postsecondary School Settings. In Chadsey, Janis G. and Rusch, Frank R. (Ed.), Beyond High School Transition From School To Work (pp.406-437). Belmont: ITP
Chase, S., Colantonio, A., Ratcliff, G., Steadman-Pare, D., Vernich, L. (2001). Factors Associated with Perceived Quality of Life Many Years After Traumatic Brain Injury. Journal of Head Trauma Rehabilitation 16(4), 330-42.
Clark, E. (1996). Children and Adolescents with Traumatic Brain Injury: Reintegration challenges in educational settings. Journal of Learning Disabilities, 29(5), 549-560.
Halpern, A. (1985). Transition: A look at the foundations. Exceptional Children, 51, 479-486.
Individuals with Disabilities Education Act of 2004, P.L 108-446, 20 USC §1400 et seq.
Kimes, K. (2003, June). The George Washington University’s Disability Support Services. “Teaching Students with Traumatic Brain Injury.”
Kimes, K. (2013, August/September). Behavior Management In School. Brain Injury Journey. 1(3), 28-29.
Langlos, J.A., Rutlan-Brown, W. & Thomas, K.E. (2004). Traumatic brain injury in the United States: emergency department visits, hospitalization, and deaths. Altanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Savage, R.C. & Wolcott, G.F. (Eds.). (1995). An educator’s manual: What educators need to know about students with brain injury. Washington, D.C.: Brain Injury Association, Inc.
Super, D.E. (1990). A life-span, life-space approach to career development. In D. Brown, L. Brooks & Associates (Eds.), Career choice and development: Applying contemporary theories into practice (2nd ed.). (pp. 197-261). San Franscisco: Jossey-Bass.
Wehman, P. (1996). Applications for Youths with Traumatic Brain Injury. Life Beyond the Classroom: Transition Strategies for Young People with Disabilities (pp.445-478). Baltimore: Paul H. Brookes Publishing Co.