School Transition & re-Entry Program (STEP)

Project Update

March 19, 2012

We have entered an exciting new phase in evaluating STEP—our multi-state randomized clinical trial (RCT) of our intervention meant to improve the transition from hospital back to school for students with TBI. Along with completing our original data collection, we have recently begun collecting follow-up data at approximately 18 months to 2 years post-injury to allow analysis of changes in student characteristics and needs over time and the schools’ response to those changes. This is possible, in part, through a CBIRT (Glang) subcontract with Dr. Yeates at Nationwide Children’s Hospital, Columbus, OH on an Ohio EMS/Trauma Research Grant to continue the data collection and complete analysis activities. This EMS grant funds the continued tracking and monitoring activities in Ohio. Where possible, we have extended our data collection for participants in other states as well through the original STEP grant.

 While we continue to collect data, we have begun an initial analysis of some the data obtained from about 70 parents at one month and one year post-injury. Very early reports appear to show that students in the STEP program benefitted from the hospital to school connection that was established through the program, compared with students who received usual care. We are careful not to interpret these early indicators as formal program effects, but we do feel positive about the trend of the results. We have had several opportunities to share information about how the STEP model works, and about the early results at the 2011 Federal Interagency Conference on TBI in Washington, DC (Glang, Todis, & Ettel) , the 2011 American Congress of Rehabilitation Medicine Annual Conference, in Atlanta, GA (Todis), a HRSA sponsored Summit on Children and Youth with TBI conference in March 2011, and through a new consensus paper on evidence-based interventions and common data elements for pediatric TBI research. We are looking forward to sharing results from completed data collection on the STEP model as soon as possible.

October 4, 2011

Continuation of data collection. In July 2011 Drs. Glang and Todis, along with Dr. Keith Yeates of Nationwide Children’s Hospital of Columbus, OH, received a grant from the Emergency Medical Services of Columbus to extend the data collection period for the STEP project in Columbus. The grant was funded for one year, provided funds to support surveying participant families one additional time approximately 18-24 months post recruitment in the program. This additional data collection will allow analysis of the changes in student characteristics and needs over time, and the responses of schools to these changes. This will also allow continued evaluation of the impact of the STEP program on student outcomes. IRB approval has been obtained for this continuation in Ohio as of October 4, 2011.

Given the continuation of data collection in Ohio, STEP investigators decided to continue data collection in the other STEP sites of Denver CO, and Portland, OR as well. At the study’s end, we will have survey information from participant families at hospital recruitment (near time of injury), at approximately one month post-injury, 12 months post-injury, and 18-24 months post-injury.

Prior summary information: Recruitment began in July 2008 to evaluate the effectiveness of the transition intervention in a multi-site randomized control trial. Children treated at four hospitals (Legacy Emanuel in Portland, Nationwide Children’s Hospital in Columbus, Cincinnati Children’s Hospital, and The Children’s Hospital in Denver) are randomly assigned to either the transition intervention or a usual care comparison group. Recruitment is closed at each hospital as of 3/31/2011.

130 families were recruited:

Oregon – Portland: 28 families

Colorado – Denver: 25 families

Ohio – Columbus: 52 families

Ohio – Cincinnati: 20 families

Ohio – Cleveland: 5 families

Subjects: Ages range fairly uniformly from 5–18, except for a large number of 16-year-olds. About ¾ of the subjects are male, and most are white. We have about equal numbers of moderate and severe TBI cases. Motor vehicle accidents and bicycle/sports accidents account for most of the injuries.

We currently have 59 families who have completed full data sets, and new survey data is being collected on a rolling basis, as data collections come due for individual families. We have started data analysis on the first 59 and presented our preliminary findings at the 2011 Federal Interagency Conference on Traumatic Brain Injury in Washington DC. On initial analysis, there appeared to be little or no difference in outcomes between intervention and usual care cases. However, when controlled for whether or not the student received hospital rehabilitation services, there was a significant improvement for STEP students.

Among students who did not receive hospital rehab services, students in STEP received more academic, behavioral, speech, and medical support services than students in the usual care group. Parents were also more satisfied with those services, felt more involved in the process, and found a broader range of school staff to be helpful.

We will continue to analyze data as they become available. Our next goal is to disseminate these findings nationally to promote the incorporation of a successful evidence-based intervention for the support of students with traumatic brain injury.

Upcoming goals: Once sufficient data are collected and analyzed, we plan to work to educate and engage other hospitals in how to successfully implement the STEP program. This may take the form of presentations to hospital emergency teams and leadership, and may involve members of the Oregon TBI Team and staff from currently participating hospitals.

July 6, 2011

An initial analysis of the first 55 sets of data showed little or no difference in outcomes between intervention and usual care cases. However, when controlled for whether or not the student received hospital rehabilitation services, there was a significant benefit to intervention over control subjects who did not also receive rehabilitation services from the hospital.

Among students who did not receive hospital rehab services, students in STEP received more academic, behavioral, speech, and medical support services than students in the usual care group. Parents were also more satisfied with those services, felt more involved in the process, and found a broader range of school staff to be helpful.

Further and more in depth data analysis will continue as more complete data sets are obtained.

April 11, 2011

We are currently evaluating the effectiveness of the transition model with 128 families in a multi-site randomized control trial. Children treated at five hospitals (Legacy Emanuel in Portland, The Children’s Hospital in Denver, Nationwide Children’s Hospital in Columbus, Cincinnati Children’s Hospital, and MetroHealth Medical Center in Cleveland) were randomly assigned to either the transition intervention or a usual care comparison group. Recruitment ended at each hospital on 1/31/2011. Parents and teachers in both groups complete surveys on the child’s academic functioning, behavior, and environment.

Preliminary data analysis indicates that those families who received the intervention protocol showed slightly less familial stress after one year, students were more likely to be identified for special educational services and received more services, parents were more satisfied with the services the students received, and parents felt more involved in the special educational process. Data analysis will continue as we receive more follow-up data. Final follow-up surveys are due in March 2012. A detailed multivariate analysis will be performed at that time.