I’m Good Enough, I’m Smart Enough and Doggone it, I know TBI

Judy L. Dettmer

303-866-4085

judy.dettmer@state.co.us

School Realities:

No school person/program owns TBI:Case manager does not follow TBIProgram does not follow TBI

Myth of Rehab Center for TBI students:School IS the Rehab Center

Shades of grey!

YOU ARE THE EXPERTS!

De-mystify TBI – eligibility is binary.

But assessment and treatment of TBI is many shades of grey, red, blue, green…

TBI assessment protocol and a TBI intervention protocol – within your creative reach!

Basic premises

Proper Intervention is grounded in a Good Assessment – comprehensive, multi-layered

Focus of intervention is on teaching positive replacement behaviors and skills instead of looking at deficits

Requires active and continuous teaching on the part of adults

Not linear, not circular – it’s spiral

MONITORMONITOREvaluate Response Evaluate Response

to Interventionto Intervention

PLANPLANIdentifyIdentify Strengths, Strengths, Concerns, Concerns, & Outcomes& Outcomes

TEACHTEACHAssign & Implement a Assign & Implement a

Research-based InterventionResearch-based Intervention

ADJUST ADJUST Analyze & Interpret Analyze & Interpret

DataData

Universal Instruction & Problem Solving ModelUniversal Instruction & Problem Solving Model

Data D

riven

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Broad Overview of Issues & Strategies

Hallmarks of Brain Injury

Fatigue Executive Function

* Speed of Processing

* Memory

* Attention

* Organization/Planning

* Social Emotional

Strategies for Addressing Fatigue

Encourage the student to take rest breaks Be aware that medications a student is taking and

time of day they take them can contribute to fatigue Recognize signs when student is overloaded or

fatigued. Avoid presenting them with new tasks or information

School day may need to be altered or shortened to accommodate fatigue

Strategies for Addressing Speed of Processing

Give the student instructions one at a time, make them clear and concise

Provide appropriate “wait time” for the student to formulate a response to questions asked of him/her

Strategies for Addressing Speed of Processing

Eliminate timed tests

Avoid situations requiring multi-tasking

When giving instructions, check for comprehension. Have the student verbalize the instruction as well as demonstrate that he/she understands

Strategies for Addressing Memory

Regularly summarize information with the student as it is being given, especially critical in regards to new learning

Give instructions in written, verbal and visual format when possible

Call on the student with a brain injury first so that they do not forget their responses and are then able to focus on others responses

Strategies for Addressing Memory

Develop checklists/picture schedules with the student that he/she can use to help remember daily schedules, routines, etc.

Consistency and time are important, especially when introducing a new strategy

Allow the student time to put into practice what was just learned to reinforce learning/memory

Modify test format to reduce need for total memory recall, e.g. multiple choice

Strategies for Addressing Attention

Provide the student with an uncluttered environment

Eliminate as many auditory and visual distractions as possible

Eliminate as many interruptions as possible

Strategies for Addressing Attention

Assign tasks that do not require a lot of divided attention

Break task down into manageable steps based on the individual’s attention span

Provide the student with clear expectations for what he/she is supposed to accomplish during the activity time

Strategies for Addressing Organization/Planning

Assist student with cleaning out desks/locker on a routine basis

Develop checklists with the student that he/she can use to help remember daily schedule, routines etc.

Help student organize notebooks by using dividers, colored folders, portfolio containers etc.

Strategies for Addressing Organization/Planning

Help student develop and organize a “Homework Only” folder and check it with him/her at the beginning of each class

Check student’s planner at the end of the day (elementary) or each class (secondary) to ensure that they have written their homework assignments completely and accurately. Have the teacher initial the page so the parents know the planner is correct.

Strategies for Addressing Social/Emotional Concerns

Provide a framework for structure in social situations (e.g., invite a friend over for a specific period of time to do a specific activity)

Smal group settings are usually better for a student with a brain injury

Use peer buddies as mentors

Help the student identify what activities they may enjoy following a brain injury

Provide the student with direct and clear feedback

Most Importantly!

Do not assume that the student has the ability to take responsibility for the organizational aspects of his/her education

Each person with a brain injury is an individual and therefore a strategy you try with one person may not work with the next

Become familiar with the beauty of trial and error but give significant time for a strategy to take hold

Tools for Interventions

LearNet Colorado Kids with BI BrainSTARS What Works Clearing House Casel Cherry Creek School District BEG, BORROW and STEAL!

LEARNet Problem-Solving SystemMark Ylvisaker, Ph.D.

1. Clear statement of the problem in simple, everyday behavioral terms

2. Brainstorm possible explanations: Medical Cognitive Self-regulation Behavioral Emotional

LearNet

3. Systematic exploration of possible explanations

4. Planning (well thought out and evidence-based) interventions and support

Additional considerations: Collaboration Context On-going process

WWW.cokidswithbraininjury.org

Identification and Intervention Protocol Best practices for identification Best practices for assessment Best practices for interventions

Monk Video

BrainSTARS

Introduction to Brain Injury

Brain Injury and Development

Problem Solving Index

Evidence-Based or Research-Based Intervention:

What Works Clearinghouse

www.whatworksclearinghouse.org CASEL – Collaborative for Academic, Social

and Emotional Learning www.casel.org Cherry Creek School District, Colorado Wiki

www.ccsdrti.pbworks.com

CASEL 5 domains:

Self Awareness Social Awareness Self Management Relationship Skills Responsible Decision Making

Cherry Creek School District Wiki

Systematic Review of Evidence Based or Best Practices

Listing of practices endorsed by CCSD Description of area of need and

corresponding intervention

Progress-Monitor

Prioritize only 1 to 2 behaviorsWrite SMART goalsDetermine a baselineDetermine an aimlineDetermine a time-frame

Examples of behavior plans and progress-monitoring:InterventioncentralChart DogExcel

SMART GOALS

SMART Goals –

Specific

Measurable

Attainable

Realistic

Time-limited

“I do, we do, you do”

Progress-Monitoring

A Spiral

If intervention is working, wean back and insert more natural supports

If intervention is not working: evaluate, brainstorm, and adjust

If intervention works, wait and it will morph

Now Repeat After Me….

“I’m good enough,

I’m smart enough

and doggone it…

I know TBI”!

Questions?

The End!