IEP and Program Development for TBI
Contents:
- General Information
- Accommodations
- Special considerations when writing an IEP for a student with a TBI
- IEP development for physical issues
- IEP development for cognitive issues
- IEP development for social and emotional issues
- Assistive Technology
- Related Tools
General Information
To qualify for special education, a student must meet both criteria:
- Eligible for special education services (e.g., traumatic brain injury)
- Need specially designed instruction (teaching that is specially designed for the student)
The team writes the Individualized Educational Plan (IEP) after a student is found eligible for Special Education. The IEP is an agreement between the school district and the parents of a student who qualifies for special education.
Accommodations
These are tools or strategies used to give a student access to education, e.g., more time on a test; books on tape; peer note taker; etc.
- If a student only needs accommodations a 504 plan is needed, rather than an IEP.
- Students with TBI may need specially designed instruction to learn to successfully use and manage their accommodations. A list of accommodations for high school and elementary school may be found in the Guided IEP.
Special considerations when writing an individualized program for a student with a TBI
Students with TBI have a common experience: their lives were different before the brain injury. After the injury, many struggle to rediscover and redefine their identities. This process occurs as they are going to school, trying to relearn old material and learn new material.
- Creating specially designed instruction and a program that is specific to each student requires a team.
Suggestion: Because there are so many issues to consider, it is easy to over look an area of need in the IEP. A Guided IEP is in the Related Tools section of this page.
Students with TBI often need multiple IEP meetings during the first years after their injury, because of rapid changes in their physical, cognitive, academic and social performance. It is helpful to plan to have at least 4–6 meetings per year.
- This allows the team to change the IEP as the student acquires new skills and/or if new needs arise.
- The parents, teacher, special education teacher and district representative are key participants in IEP meetings. It is also important to include specialists in the meetings; such as a speech and language pathologist, school psychologist, physical therapist, occupational therapist, and nurses who serve the school.
- It is also important to invite staff and/or include information from the hospital, private therapy or any rehabilitation services the student may have had or is currently receiving.
IEP development for physical issues
Physical issues are often addressed first upon the student’s reentry to school from the hospital. When there are extensive and multiple physical needs, it can be challenging for school staff to also address the student’s cognitive needs. Common complications from a TBI are fatigue, headaches/pain, orthopedic impairments, vertigo, loss of bowel and bladder control, seizures, nausea, loss of range of motion in arms and/or legs, eating and swallowing difficulties and side effects of necessary medications.
- Involve the physical therapist, occupational therapist and nurse in writing this part of the student’s IEP goals.
- Consider a feeding protocol if needed (training along with a written plan of instruction and guidelines on feeding student who needs assistance or safety precautions for eating and swallowing).
Suggestion: Build in training for anyone who may be helping the student eat. These plans are usually written by a feeding team which typically includes a speech and language pathologist, occupational therapist and nurse. If a student has a feeding protocol written at the hospital, review it, and (if found appropriate) train the school staff who will be feeding the student. While getting input from the parents and family is highly desirable, it is inappropriate to expect parents to train staff on feeding.
- Address the use of adaptive devices such as specialized pencils, cups, spoons, etc.
- Suggestion: Include training for the student as well as any staff who assist the student. Work with the occupational therapist to develop appropriate information and resources for adaptive devices.
- Include any help needed with mobility in the IEP. Students who are learning to use a walker or wheel chair may need help with stability or may become fatigued when walking a distance.
Suggestion: The physical therapist usually designs this program and can train others to implement it.
- Design a plan for medication management for students who take medications during the school day.
- Students using medications with side effects that impact functioning at school will also benefit from a medication plan. For example, specific training may be needed for students with ongoing medication such as a baclofen pump (used internally to administer medication for contracted muscles).
Suggestion: Ask the nurse to help with training and writing IEP goals.
- Students with seizures will need to have a seizure protocol. This is a set of established guidelines that help the staff know exactly what to do if the student has a seizure. Seizure protocols are needed for a student who has any history of seizures, whether they occurred at home or at school.
Suggestion: The school nurse is typically responsible for writing the seizure protocol and training staff on how to follow the protocol if/when the student has a seizure.
- Students with latex or other allergic reactions will also need protocols to address each set of procedures to follow. Identify any allergies and train staff in the use of the procedure for the specific student.
Suggestion: The school nurse is responsible for training in this area.
- Fatigue is often a result of a TBI and needs to be addressed to assist the student with effective functioning.
Suggestion: If fatigue is an ongoing issue for the student, consider shortening the school day or building in rest breaks.
IEP development for cognitive issues
Cognition is the use of effective thinking skills to solve problems, understand social situations, learn new material and recall previously learned information. Writing an IEP to help a student with cognitive concerns may seem confusing at first. It is important to address the problems the student is having in school as they appear in school. For example, organizational strategies, memory strategies, and study skills all help address cognitive issues a student might have after a TBI.
- When students are overwhelmed by information and input from multiple sources, they may respond by becoming confused or reacting with angry outbursts.
Suggestion: Give the student a quiet place to rest and regroup.
- Students often try to use old or familiar strategies that were successful prior to their injury, but these strategies may no longer be effective.
Suggestion: Develop goals which address the amount and type of instruction needed by the student to explore new learning and to identify effective study strategies.
- Executive functions are often damaged when a student has a TBI. These are the capacities that enable a student to successfully engage in independent, purposeful, self-serving behavior. These skills are vital for success across the curriculum and need to be taught and generalized across multiple settings, over time.
Suggestion: Ask how or if the student does something in order to better understand how executive skills are used. They are often overlooked but are essential for success in school and life.
- Executive functioning can differ drastically from overall cognitive functioning and is not well reflected in an overall IQ score. A student’s executive functions may be affected if there is:
- Less self control,
- Emotional ups and downs,
- Flattening of affect,
- Heightened tendency to get irritated or excited,
- Impulsive behavior and speech,
- Erratic carelessness,
- Rigidity or difficulty changing ideas,
- Difficulty shifting attention and behavior,
- Decline in personal grooming,
- Impaired capacity to initiate activity - even if it is something the student wants to do,
- Decreased or absent motivation,
- Difficulty with planning and carrying out sequences that lead to goal-directed behavior.
Difficulties with these skills are often mistaken as the student malingering, being lazy, acting spoiled, or being psychiatrically disturbed. Specific programs may need to address executive functioning skills in the IEP.
IEP development for social and emotional issues
It is important to address social and emotional issues as they occur in school. For students who have difficulty with self control or impulsive behavior, a functional behavioral analysis (FBA) and behavior plan should be included in the IEP.
- Because students who have had a TBI are not always able to accurately link the effects of their behavior to their actions, mentoring is often a successful component of a behavioral plan.
- Behavior plans that rely on rewards and consequences may be less effective when a student has a TBI. As is true of all students, assisting students to behave appropriately is always preferable to devising consequences to correct inappropriate behavior.
Suggestion: It may be more helpful for students to:
1. Pre-plan a situation.
2. Learn routines.
3. Be guided through an analysis of their choices and the consequences of their actions.
- TBI is unlike other disabilities because a student’s personality, abilities, goals, likes and dislikes must be rediscovered as abilities change after the injury.
- Difficulty with executive functions can lead to difficulty with social and emotional functioning. Depression is often part of adjusting to a TBI.
Suggestion: Counseling that is structured around goal setting and self awareness can be helpful.
Assistive technology and students with TBI
A comprehensive assistive technology (AT) evaluation can determine what AT tools might help the student. Some students with TBI need specially designed instruction to successfully learn, use, and become independent with accommodations that are technically advanced or require tutorials or support over time. Difficulty learning new material, memory problems and fatigue can make this even more challenging.
Related Tools
Written by:
Patricia Sublette, PhD.
