Brain Injury and Schools: Overview of Best Practices

By Cindy Pahr, M.Ed., CBIST, and Brenda Eagan-Johnson, Ed.D., CBIST

Children and adolescents have a unique recovery profile after an acquired brain injury (ABI). ABI that occurs to the developing brain can impact cognitive, physical, behavioral, and language skills. Deficits in any area may increase in severity or emerge over the developmental years, requiring more intensive interventions. Therefore, it is important to continually monitor student progress.

By law, schools are required to respond to a student’s learning needs following ABI. However, there is a lack of ABI knowledge among school staff and parents. Additionally, parents may not inform school staff about the ABI, in an effort to return to normalcy. This makes identifying and understanding challenges at school difficult. However, medical rehabilitation teams can serve an instrumental role by encouraging parents to seek support at school sharing knowledge of newly acquired deficits with parents and school staff.

Offering parents guidance in accessing school-based support during this traumatic time is invaluable. Healthcare providers can inform parents to send a written request for intervention to the school. The physician’s diagnosis and resulting deficits should be included as an attachment. The letter triggers a school process to determine if the deficits impact learning. School interventions are commonly provided in the form of an Individualized Health Plan, a 504 Plan provided through general education, or an Individualized Education Plan (IEP), provided through special education. Special education evaluations may include the following: Psychological, Academic, Physical & Health Impairment, Speech, Occupational Therapy, Physical Therapy, and Adapted Physical Education.

Programs around the country are making strides in supporting students with ABI. San Diego Unified School District developed the Brain Injury Learning Center (BLIC) offering one-to-one intervention and evaluation for students with recent ABIs who are not ready to return to a large school or classroom setting after hospital discharge. The service providers and assessors are supported by a CBIST. Determination of qualification for an IEP or a 504 plan is made to support needs related to their ABI. When ready, the student returns to their home school or other appropriate setting. They and the school team receive services from a special education teacher credentialed in ABI.

At the statewide level, the BrainSTEPS Program was created in 2007, is funded by the Pennsylvania (PA) Department of Health and PA Department of Education, and is implemented by the Brain Injury Association of Pennsylvania. A Project Director (CBIST) oversees 30 teams of 250+ brain injury educational consultants and medical-rehabilitation providers. In 2022, the CBIS certification will be provided to BrainSTEPS team leaders to continue building professional capacity and networking opportunities at the state/national levels. In 2016, the Colorado Department of Education adopted BrainSTEPS. Currently, the Centers for Disease Control and Prevention is funding a 4-year, $2.2 million study to investigate BrainSTEPS student outcomes.

Universally, there is a need for more training for school staff to ensure appropriate supports are in place for students following ABI. Healthcare providers who inform and empower parents to request an evaluation for intervention before school reentry are critical to initiating the process for obtaining interventions. It is important to begin this process proactively, rather than waiting until the child begins to struggle at school.