Introduction

Every parent, high school teacher and guidance counselor knows the storms and challenges of adolescence. The choices that all teenagers face about life after high school are at the same time exciting and confusing. Is it college or work, living at home or moving out, dating or getting married? These are not easy choices and each carries responsibilities and consequences.

This can be an especially difficult and confusing time for the adolescent with a brain injury since many expectations and hopes may need to be reexamined. This article discusses how the special education program can help prepare the student for this transition to adulthood, the barriers commonly encountered and strategies for work-training programs. For the student who wants to work after high school, acquiring specific job skills is essential. Finding a job after high school is just the first step, with the greater challenge being the development of a vocational career plan that provides income as well as opportunities in the future.

Laws that Help

The Individuals with Disabilities Education Act (IDEA) has an important requirement that is called “transition planning.” This means that the individualized education program (IEP) for any student who is receiving special education must start to plan for his/her transition to adulthood by age 14. The law recognizes that this is a complex process and gives the school two years to develop the transition plan, but it clearly states that it must be implemented when the student turns 16, allowing the student several years or more of special services prior to graduation. Although this transition plan is different for every student, it is built on educational goals and programs that will define what the student will be able to do, be based on the goals and choices of the student and prepare him/her for adulthood.

Goals for high school students can be as varied as vocational training or trade school, college or continuing education, supported employment, competitive employment and/or setting up an independent living program. Establishing linkages with agencies outside the school often is necessary to build an adult service system. Too often, parents and students wait until after graduation to apply to agencies for vocational rehabilitation services, housing programs and/or community services. The result often is a long delay between graduation and getting services in the adult system. There is another federal law that parents, students and educators can use to “get things moving” while the student is still in school. The Carl Perkins Vocational Act provides vocational education for students with disabilities and specifically stresses the importance of coordinating vocational planning with the IEP. This means involving public agencies, such as state vocational rehabilitation programs, while the student is still in school.

Barriers Facing Adolescents with Brain Injury

Everyone has a role to play in this process—the student, the family, the educator and employers in the community. By anticipating common barriers, strategies can be developed to address them.

Student’s perspective

The age when the student is injured affects his/her readiness and ability to change expectations and develop new goals. For the student who is injured as a child, there is time for parents to become familiar with the special education system and evaluate the possible impact of the injury upon their child’s future abilities as an adult. For the student who is injured midway through high school, time is not a luxury. At the same time that the brain is in the early stages of recovery, choices must be made about school courses and programs, often without a clear prognosis. If the brain injury has altered the student’s self-awareness and ability to accurately assess strengths and needs, this process is even harder. Finally, the desire to graduate with peers compels many students to take the diploma that also ends eligibility for special education.

Family’s perspective

For many families who are still in the midst of the emotional trauma of brain injury, negotiating special education services can become an additional stress that often is confusing and frustrating. Many families are unaware of the requirement for transition planning and need to be educated by school staff or advocates about its importance.

Parents may not share the same vision of what is possible for their child’s future, or parents may agree on what they think is “realistic” but school staff may disagree and attribute it to “denial” by the family. These differences may become sources of conflict during the IEP process. Remember that the focus of the transition plan is the student; do not allow conflicts to undermine the process.

Community’s perspective

In general, employers and the community often are unfamiliar with brain injury and may misinterpret cognitive changes as mental retardation and behavioral changes as mental illness. As students prepare to leave the educational system, they must be prepared to challenge and overcome the biases and stereotypes about disability they are likely to encounter. Whether a disability is visible or not has a major impact upon the public’s perception and reaction to the individual.

Learn from Others

Special education programs have a great deal of experience with students with disabilities and have helped many make the difficult transition from school to work. Whether a congenital condition, chronic illness or traumatic injury causes the disability, there are generic skills that all students must develop if they are to become successful workers. These skills are the core of an effective school to work program and include: self awareness, attendance and punctuality, personal appearance, good worker character traits, communication skills, interactions with supervisors and co-workers, filling out work-related forms, job seeking skills, budgeting and money management.

The success of a transition plan requires that everyone—the student, parents and the educational team—agree on the goals. To be effective, any work-training program must include strategies that address the generic skills already listed, as well as strategies that consider the cognitive and behavioral changes that can result from a brain injury. When developing a school to work program for a student with a brain injury, there are some unique considerations for the educational team, including:

• Effects of fatigue on work performance
  
• Setting up structure and consistency in work environment
  
• Cueing systems for memory and organization
  
• Reducing distractions
  
• Avoiding overstimulation
  
• Monitoring behavior
  
• Pacing work
  
• Switching tasks
  
  

Begin with orienting or introducing the student to what has to be done, the materials needed to get the job done, expected appearance and dress and any special requirements. Give the student specific expectations about the amount of work expected in a given time period. Focus on required behavior in work setting, including:

• Paying attention to work
  
• Completing tasks with accuracy
  
• Following a routine
  
• Retaining directions over time
  
• Responding appropriately to redirection or feedback
  
• Changing from one activity to another
  
• Accepting changes in established routines
  
• Willingness to redo tasks when necessary
  
• Initiation in the absence of directions
  
• Ability to work independently without supervision
  
• Checking quality of work
  
• Appropriate use of work materials
  
• Use of appropriate language
  
• Separation of personal and work issues
  
  

Whenever difficulties and obstacles are encountered, it is critical to develop a plan to ensure that staff consistently addresses those behaviors. Provide ongoing observation during training to note physical, cognitive and social difficulties. Either adjust the job to fit the student or help the student develop compensatory strategies.

When teaching a new task, keep it specific and simple, demonstrate, monitor and repeat the task until the student can do it independently. It is important to train for one task at a time until the student has accomplished it, since many students with brain injuries have difficulties switching tasks or handling multiple tasks. Collect data to track the student’s performance and identify needs that may require additional training or compensatory systems.

It is important to give the student with a brain injury specific feedback daily, not general praise or criticism. This feedback becomes part of the information loop to the educational team so that needed revisions to goals and objectives can be included in the transition plan under the IEP. Finally but most importantly, treat students as workers and not children. This is essential to prepare them for employment in the community, whether it is supported or competitive employment.

Marilyn Lash, MSW, chairs BIA’s Special Interest Group on Children and Adolescents with Brain Injury.