BrainSTARS: A Model Program for Children and Adolescents with Acquired Brain Injury

Jeanne E. Dise-Lewis, Ph.D., Associate Professor, Departments of Rehabilitation Medicine and

Psychiatry

The ProblemBrain

InjuryNeurodevelopm

ental Deficits

Metacognitive Weaknesses

Attention Processing SpeedOrganization Self-Regulation

Executive Functions

Behavior ProblemsHas Temper Tantrums Has Poor Frustration Tolerance

Has Messy Handwriting Doesn’t Follow Directions Looks “Blank” Fights With Others Fails Tests Can’t Keep Up With Peers

Specific Learning

Difficulties Reading New Learning

Note-taking Expressive LanguageSocial Skills Test-taking Problem

Solving Long-Rang Projects

Educates about Brain Injury

Teaches approaches to interventions

Links observable problems to neurodevelopmental deficits

Recommends specific interventions for neurodevelopmental deficits

Supports a student’s team through 3 scheduled follow-up consultations at school

BrainSTARS Model Program

Outcomes

Better Teamwork With Parents

I can better support families as they progress through post-injury period

I will be able to offer specific strategies to parents

Talk to parents regarding stages and ABI symptoms

Helped me understand what parents are going through

I can help as a mentor now Helped me to communicate with parents

I will be better prepared to assist families in my work

Use daily picture schedule as parent feedback form

Open communication - parent/teacher/ special staff

I will be more aware to ask parents about any head trauma

Effective strategies for improving communication with parents

Able to understand parent and teacher miscommunication better

A Developmental Understanding

All children with ABI are affected differently, depending on age

Understanding how ABI affects different levels of development

Even though an injury was in preschool, problems can show up later

Injury will present itself through various other stages of development

The child's age when he had the brain injury plays a huge role

How an ABI affects the developmental stages

The disruptions you see depend on when a brain injury happens

Brain injury affects you depending on your developmental stage

Effects of ABI may be varied over time

Be more aware of age, developmental demands and strategies

Better Teacher Morale

Encouraged me to have more patience It helps to have more knowledge

Better understanding when I get an unexpected response

I'm glad to know I am not doing harm through repetition

A relief to get EXCELLENT interventions, very practical and usable

I have more at my disposal to identify why kids struggle with learning

A new way of looking at my work Reinforces what we are doing

I feel better able to consider ABI on initial evaluations

Supports my existing knowledge

It helps to have strategies I can be much more in-tune with my kids

Remember to be patient - with the child and myself

This helped me single out particular weaknesses

Take a look at students I serve with at new "eye"

I have interventions to apply, strategies to try

I feel better able to support incoming middle-schoolers with ABI

I have many more options for intervention now

Change my expectations Reduced my stress

Better Teamwork Within School

Share information with staff at my elementary school

Check with all members of the team about their views

I will spend time with the staff in developing a better program

Be able to help staff figure out practical things to do with a child

Share this information with my faculty, for starters

Ask more questions at Child Resource Team Meetings

I have more information to share with teachers regarding ABI

Give my college students more information than I had before

I will have more information to share with regular educators

It's a team effort to help students with head injury

Share information with team members

Mentor teammates more effectively

Share ideas with teachers on things to try in the classroom

I'll be able to talk more directly with teachers, re: child's needs

I shall press for more evaluation of specific children

I will be more effective with other teachers

Education About Brain Injury

Be more aware of brain injury when doing health histories

Stronger understanding of brain injury and how it affects learning

Realizing the cumulative effects of ABI New learning is most often affected by ABI

Look for specific differences to separate ABI from LD or ADHD

Ask about head injuries when some of the characteristics are evident

Different approach is needed for kids with ABI

How relevant brain injury is to special education

Dispelling the idea that children bounce back from brain injury

Appreciation for the long term (long life) effects of ABI

Expect decreased processing speed How under-diagnosed brain injury is

I know specific behaviors that will alert me to ABI being a possibility

I have a better understanding of how ABI affects a child's function

Clearer understanding of effects of ABI Ask more specific questions about mild ABI

Evaluate ADD and ADHD students as possible ABIs

Some LD kids may really be ABI and need different accommodations

Even though an injury was in preschool, problems can still show

What ABI is and how to treat students with ABI

Improved Educator Skills

Restructure thinking and approach to some of my kids

I will have a clearer understanding of brain injury and it's symptoms

I understand differences between LD & ABI Help student develop strategies rather than telling him how to do a task

I have more information to offer I will focus teaching on specific situations

I'll be more aware of how I give directions I will teach strategies for generalization

I am going to change how I give instructions

Be able to identify these students

Consider ABI qualifiers when looking at kids in special education

Consider possible brain injury more than I have historically

Help design more appropriate interventions for behavior difficulties

Allocate more planning and thought to organize student's day

I have more knowledge about my students I will be sure to give demonstrations as well as directions

I wonder if kids who are struggling have had a head injury

I can see how cognitive problems cause behavior problems

How to change the environment to help meet child's needs

Teach strategy which can be generalized in other situations

Improved Understanding Of Child

Look at some of my students in a different way

Be more responsive to "fatigue” issue

Understand why these kids behave as they do

Understand better where they are emotionally

Understand effect of brain injury on organization and irritability

Makes me wonder/think about my students in a different way

See students through a different perceptual filter

Help teacher and parents understand these kids better

A reminder to focus on feelings Assist in transitions more

Pay more attention to physical factors than we do

Increase my tolerance for students with history of ABI

I will have a better understanding of the child's struggles in school

Understanding mental inflexibility; it is not just stubbornness

Concrete ideas about how my students may be affected

Recognize need for more time for processing

Need to advocate for more specific interventions for the child with ABI

Have a better understanding of what some of the behaviors mean

Have more appropriate expectations for children with ABI

Understand child's difficulty learning new information

Classroom Strategies

Establish visual cues for classroom routines

Practice and repeat instructions

Provide more concrete explanations/directions

Use visual daily planners - even with older children

Prepare materials needed for lesson Make more visual aids

Focus on developing specific strategies for kids

Give more visual cues when working on assignments

Make directions short and concrete Repeat directions and don't rush

Allow for breaks Shorten directions

Use daily picture schedule as parent feedback form

Provide more structure in the learning environment

Maximize hands-on learning opportunities

Use environmental strategies in classroom

Minimize verbal directions and explanations

Break down tasks into smaller pieces

Simplify directions to major points instead of elaborating

Take the child where he/she is and build structure up from there

To date, more than 50 children and their parent/school teams have been BrainSTARS Model Participants. We plan to work with an additional 50 teams

this year.

BrainSTARS is a U.S. Department of Education Model Demonstration Grant Project, Funded by OSEP(Grant # H324M990060)