Welcome to the TBI-HELP Live Chat
Topic Summary:
This will be a discussion of educational issues for children
who have sustained an ABI. Issues range from the first steps in returning a recovering youngster to school after ABI, to creating a
supportive environment in the school, and planning for a youngster's long-term educational needs.
[19:00:38] Mod: Good evening! Tonight we are very happy to have Dr. Paul Berger-Gross, Director of Traumatic Brain Injury Program at St. Mary's Hospital for Children. His topic for this evening is "The Educational and Special Needs of Brain Injured Children." Welcome Dr. Berger-Gross!
[19:01:15] Mod: What kind of services can the school offer my child?
[19:02:55] Paul Berger-Gross, Ph.D.: The school can offer a variety of services and
accommodations. They can provide Speech, Occupational and Physical Therapy. Counseling services may be provided. Also alterations like
un-timed tests. The school may have access to regional specialists in TBI/ABI, technical expertise, and other services.
[19:04:46] Mod: Rail: How soon after a TBI should I consider the School system as an option for my child? What are the criteria for that step relative to the process of recovery?
[19:05:04] Paul Berger-Gross, Ph.D.: The how soon question is a complicated one, I would like to hear your particulars. The child must be stable medically prior to entering school again, but even that may not be necessary for home instruction.
[19:06:34] Mod: Rail: Are there any special forms or filings that I need to do with the School District to guarantee by child the best possible resources-and are there any costs to our family?
[19:07:23] Paul Berger-Gross, Ph.D.: In the hospital we evaluate a child's ability to handle the "noise" of attending school, soon after they begin to interact with the world, Gently increasing their time in school. The school is not required to provide the best possible resources, though that is what a parent should try to access. The only cost to a family is when the resources you deem necessary are not provide by the school. You can go to CSE, administrative review and impartial hearing to try to get more or better
[19:10:55] Mod: Rail: Is there much guidance for Home Instruction for TBI recovering children?
[19:11:54] Paul Berger-Gross, Ph.D.: Not sure what you mean by guidance. Home instructors are not likely to know any more than any other "regular" teacher about TBI. But, you can access system experts to work with the home instructors on that. For example, in NYC there is a group TBI=TAP that can assist any school system personnel.
[19:14:23] Mod: Do I have a choice of classes and schools for my child?
[19:16:32] Paul Berger-Gross, Ph.D.: In general, your local placement person will provide a class placement. You would have a chance to see and accept or reject it. At that point, you could ask for other choices. By the book, you do not have free reign to select classes and schools. But, if you know of specific places that suit a child, you can influence the process. As far as I know there is no specific curriculum for home instruction for ABI. However, there are a great number of resources for educators (see e.g., books by Ylvisaker, Savage, others) on teaching to ABI kids. For Home Instruction, I would assume you have an unready child. I would still emphasize cognitive skills. Readiness to be in a classroom. And reduce the number of "course areas" to be studied.
[19:19:39] Mod: Rail: Are there specific "school based" educational programs for TBI/ABI?
[19:20:50] Paul Berger-Gross, Ph.D.: While TBI has IDEA status as an educational disability, there are not many public school classrooms designed with
TBI in mind. A few localities provide specialized classrooms or specialized consultation to their schools. There are of course, private schools that are specialized for TBI education (e.g., Crotched Mountain, May School, etc.).
[19:22:15] Mod: Rail: How different- across States are the options for "in school" assistance for the ABI child?
[19:24:28] Paul Berger-Gross, Ph.D.: The differences can be huge. But, just here in NY, my home state, the localities differ tremendously. One local county has a specialized tbi team that maintains a regional program and consultation to the local schools (Westchester). NYC has a consultation group, but no specific tbi teachers or classes. Some upstate NY areas can not provide basic special education supports in the area of OT and PT.
[19:25:40] Mod: Rail: How old is 'too old' for inserting the ABI patient back into the school system for additional experience and learning--Is
there a specific age difference that is rejected by the school district?
[19:27:02] Paul Berger-Gross, Ph.D.: Here in NY, if a youngster has graduated from High School, they can not be reinserted into school (according to the principal of my school). But, you have until a child is 21 otherwise to demand schooling for a youngster.
[19:28:00] Mod: What happens with college?
[19:29:46] Paul Berger-Gross, Ph.D.: So many colleges have offices that support individuals with disabilities now. For a decent student there should be a good selection of schools that will provide tutoring, mentoring, reduced
class loads, note taking, etc. The transition to college is important for all the other ways a youngster may lose supports other than those just mentioned.
[19:30:48] Mod: rail: Are there "Trade
Schools" that have opened up to ABI individuals? Given the limits of the ABI survivor is this an option for few or many?
[19:32:36] Paul Berger-Gross, Ph.D.: I would like to shake the hand of whoever asked the Trade School Q. If a child has terribly reduced memory, just how many history and science facts is that child going to retain. They can, however learn procedures (routines). If they can physically do it, they can learn complex routines and can develop interesting career options. But, few American schools support this for ABI's or other Special Ed kids.
[19:33:34] Mod: Rail: How often are children "locked" into pre-abstract reasoning if the ABI is before the 5th grade?
[19:35:14] Paul Berger-Gross, Ph.D.: Despite Piaget and "stage theory" many 9, 10, and 11 year olds do a perfectly good job of categorizing, generalizing and abstracting. Still, some don't and injury can prevent them from ever acquiring. By the same token, children and adults with severe injuries often lose that abstractive ability after ABI. There are centers that provide vocational training for the disabled run by many organizations. But, I do not know of specific TBI training centers. Does anyone else?
[19:37:41] Mod: Rail: Given a Piagetian training - I had to ask that question.
[19:38:48] Mod: What advice would you give to a college student who is experiencing mild cognitive deficits?
[19:40:20] Paul Berger-Gross, Ph.D.: I think that the most important advice for taking on your own cognitive weaknesses, is to obtain a clear idea of what they are. Then produce a "game plan" for avoiding them, minimizing them, or overcoming them where you ANTICIPATE they will occur.
[19:41:30] Mod: susan: how often are IEP's revised to take
progress into consideration? If you don't like the determination where can you get a child advocate from?
[19:42:34] Paul Berger-Gross, Ph.D.: The IEP can be revisited and updated fairly frequently. This is something I try to make families aware of as they deal with the early more rapid recovery period with ABI. There are different organizations that provide advocacy support around the country. In NY, Resource for Children with Special Needs can help with identifying resources. Advocates for Children can support legal challenges to your school district.
[19:45:00] Mod: Susan: Do these programs also focus on community re-entry? Often these types of programs are in a very sheltered environment?
[19:46:43] Paul Berger-Gross, Ph.D.: While every inpatient rehab and private TBI school will try to serve community reentry, they can only do so much. There are some resources to assist community based young adults. In NY state there is a neurobehavioral consultation group with Tim Feeney and Mark Ylvisaker that travel the state to help in difficult situations.
[19:47:43] Mod: Susan: Which may include therapy?
[19:49:34] Paul Berger-Gross, Ph.D.: The public schools provide counselors and sometimes (infrequently lately) psychologist or SW therapists. The level of therapy does not usually reach the level of intensity of an outpatient mental health center. Private special education, funded by the Public Schools sometimes includes psychiatric oversight and significantly more intense therapy.
[19:51:45] Mod: What type of intervention is available for pre-K children with ABI?
[19:54:20] Paul Berger-Gross, Ph.D.: There are 3 age-based systems of special education. For school age children SPED is accessed via the CSE. For those up to 3 years, Early Intervention (EI) reviews needs and selects services. Which are often provided in home by therapists and
developmental teachers. Between 3 and Kg, children obtain services through CPSE. These services can be home based or school based. CPSE services can be as small as one unit of a speech therapist per week, or full day of therapeutic preschool.
[19:54:41] Mod: Susan: How far out of your district can one usually go to receive the needed services? If day services are not available for the deficit can you petition for private school?
[19:56:53] Paul Berger-Gross, Ph.D.: Because of a lack of specific resources in NYC, we send a number of children to a neighboring county (Westchester) to
participate in their program. If you can prove an unmet need, you can get the school system to fund out-of-state residential therapeutic schooling. Usually, a child has to "fail" several placements or be dangerous to get that funding.
[19:58:20] Mod: Susan: Since pre-K and K are not mandatory in NY is it hard to do this with these young children?
[19:58:50] Paul Berger-Gross, Ph.D.: No, it is not particularly difficult to win approval of pre-school age
children's' special education. The evaluation process is similar to that for CSE, but a lot less reading, writing and arithmetic!
[19:59:39] Mod: I see that our time is almost up. I would like to thank Dr. Paul Berger-Gross for providing us with a very informative chat session tonight. I would also like to thank our audience for participating. Good night and stay safe!
[20:00:08] Paul Berger-Gross, Ph.D.: You are quite welcome. Good night.