TBI TRANSITION, RESEARCH AND THE OREGON TBI TEAM

Bonnie Todis, PhDCenter on Brain Injury Research and Training

cbirt.org

Overview What we know about the transition

experiences of students with TBI. What we know about transition in

general. What do we do with this knowledge? What does this have to do with you? What do you think?

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Research on Outcomes after Childhood TBI Most of this research has been

conducted by doctors and neuropsychologists.

Why would they do this research?

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What these studies look like Participants recruited from medical files Usually one follow up data point in

adulthood Rarely look at school factors

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What these studies didn’t tell us What are the transition experiences of

young adults with TBI? How do employment, etc. fluctuate over

time? What factors lead to different outcomes?

Special ed? Family support? Community Supports Demographics (age, severity, sex)

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National Transition Longitudinal Study (NTLS) 10-year study of transition outcomes Funded by OSEP 11,000 students 12 disability categories NTLS1 did not include students with TBI NTLS2 included youth who were 13-19 in 2000 Data collected in 2003 on 28% out of school

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NTLS: Employment

Series10

10

20

30

40

50

60

70General Youth

Average across all disabili-ties

TBI Youth

PSO Youth

TBI Adult

%

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NTLS: Post-secondary Education

Series10

10

20

30

40

50

60

General YouthAverage across all disabilitiesTBI YouthPSO Youth

%

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NTLS: Living with Parents

Series10

10

20

30

40

50

60

70

80

90

General YouthAverage across all disabilitiesTBI YouthPSO Youth

%

POST-SECONDARY OUTCOMES

PROJECT(PSO)

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Project PSO 8-year study of transition outcomes Funded by OSEP and NIDRR 90 students in Oregon and Washington Recruited at exit from high school Rolling recruitment over 2-3 years

School districts VR

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Employment Outcomes Ages 19-25

Age 19(n = 54)

20(n = 74)

21(n = 85)

22(n = 86)

23(n = 84)

24(n = 75)

25(n = 55)

Employment 20 (37) 36 (49) 44 (52) 42 (49) 37 (44) 35 (47) 33 (60)

Male 17 (46) 23 (49) 34 (60) 34 (59) 29 (52) 26 (54) 26 (74)

Female 3 (18) 13 (48) 10 (36) 8 (29) 8 (29) 9 (33) 7 (35)

<20 hrs/week 11 (55) 18 (53) 13 (32) 14 (35) 11 (31) 10 (30) 9 (29)

≥20 hrs/week 9 (45) 16 (47) 28 (68) 26 (65) 25 (69) 23 (70) 22 (71)

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Post-Secondary Employment Outcomes 19-25

Age in Years0

10203040506070

19 20 21 22 23 24 25

Perc

ent E

mpl

oyed

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Closer Look:Employment at Age 25 60% employed

74% of males, 35% of females

Hours per week Mean 21-30 No one worked more than 30 hrs per week

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Employment Outcomes by Gender

19 20 21 22 23 24 250

10

20

30

40

50

60

70

80

MalesFemales

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Employment at Age 25 Wages

Mean $8.22 per hour No difference between males and females

Type of Job 81.3% in menial, unskilled, or semi-skilled

categories The rest in skilled (11.3%) clerical/sales (5%)

or technicians (2.5%) None in the top 3 categories

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Comparison with Typical PeersEMPLOYMENT

RATEWAGES

PER WEEKHOURS

PER WEEK

TYPE OF JOB

PSO Sample 60%

$161-232 (male)$124-418 (female)

25.5 hrs

57%menial/unskilled

0%management/pro

Typical Young Adults

68%$485 (male)$418 (female)

35.8 hrs

36%menial/unskilled19%management/pro

• Bureau of Labor Statistics of the U.S. Department of Labor, January 19, 2007

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Factors Predicting Employment Hierarchical Linear Modeling Results

Family SES: Those with higher SES were less likely to be employed at the beginning of the study, more likely to be employed over time

For every unit change in SES there was a 3.3% increase in the odds of employment and a .7% increase in the rate of change in employment over time.

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Factors That Impact Employment

1.00

2.00

3.00

4.00

5.00

Type

of w

ork

cate

gory

hig

h=pr

ofes

sion

al

Work category by time sex age at injury

0 1.00 2.00 3.00 4.00

TIME

SEX = 0,AGEINJ3 = -5.985SEX = 0,AGEINJ3 = 2.897SEX = 0,AGEINJ3 = 5.119SEX = 1,AGEINJ3 = -5.985SEX = 1,AGEINJ3 = 2.897SEX = 1,AGEINJ3 = 5.119

Later age)

Earlier age

Later age

Earlier age

Avg age

Avg age

Males

Females

Work Category by Sex and Age at Injury Over Time

Skilled manual labor

Clerical, sales

Semi-skilled

Unskilled work

Menial service

Job Category by Sex and Age at Injury

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5.94

7.20

8.46

9.72

10.98

Wag

es

Wages ov er time by age at injury and sev erity

1.00 3.50 6.00 8.50 11.00

Time

AGEINJ3 = -5.985,SEVERE = 0AGEINJ3 = -5.985,SEVERE = 1AGEINJ3 = 5.119,SEVERE = 0AGEINJ3 = 5.119,SEVERE = 1

Bonnie Todis, Ph.D.Center on Brain Injury Research and Training

Factors That Impact Employment

Early injury

Later injury

Wages Over Time by Age at Injury and Severity

Later injury

Severe

Mild/Moderate

Early injury

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0.00 1.001.72

2.32

2.91

3.50

4.09

SEVERE

Q2A

9A1

hours worked per week

SEX = 0,AGEINJ3 = -5.985SEX = 0,AGEINJ3 = 2.560SEX = 0,AGEINJ3 = 5.119SEX = 1,AGEINJ3 = -5.985SEX = 1,AGEINJ3 = 2.560SEX = 1,AGEINJ3 = 5.119

Factors That Impact Employment

Severity

Hours Worked per WeekIn

jured

ea

rlier

later

Severity: M/M work > # Hrs.

Gender: Males> #hrs.

For both genders: Earlier age at injury = work fewer hours/week

Females

Males

Females

Males

Injur

ed

earlie

rlat

er

SevereMild/Mod

21 – 30hr

11-15hr

Hou

rs P

er W

eek

16-20hr

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-8.00 -6.00 -4.00 -2.00 02.80

2.98

3.17

3.35

3.54

time

how

hap

py a

re y

ou

AGEINJ3 = -4.211,SEVERE = 0AGEINJ3 = -4.211,SEVERE = 1AGEINJ3 = 2.575,SEVERE = 0AGEINJ3 = 2.575,SEVERE = 1AGEINJ3 = 4.296,SEVERE = 0AGEINJ3 = 4.296,SEVERE = 1

Factors That Impact Employment

Later age

Later age

Early age

Avg age

Early age

Severe

Mild/Moderate

Job Happiness by Severity and Age at Injury

Avg age

Happy

Very Happy

Unhappy

POST SECONDARY EDUCATION

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Post-SecondaryEducation OutcomesAges 19-25 n(%)

Age 19(n = 54)

20(n = 74)

21(n = 85)

22(n = 86)

23(n = 84)

24(n = 75)

25(n = 55)

Education 15 (28) 26 (35) 34 (40) 22 (26) 26 (31) 18 (24) 14 (25)

Male 7 (19) 17 (36) 20 (35) 11 (19) 15 (27) 7 (15) 6 (17)

Female 8 (47) 9 (33) 14 (50) 11 (39) 11 (39) 11 (41) 8 (40)

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Post-Secondary Education Outcomes

Ages 19-25

NondisabledPSO Sample

0204060

Comparison with typical young adults ages 18-25 (Pew Research Center,

2007)

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Comparison with Peers Non disabled young adults 18-25 46%

enrollment (Pew 2007) 54% female (2005) NLTS2 45% reported continuing to

postsecondary ed within 4 years of leaving high school. 32% community colleges 23% vocational/tech 14% 4-year

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Factors That Affect Enrollment Higher family SES, shorter time to

enrollment Females more likely to enroll Those injured later were more likely to

enroll. For every year increase in age at injury there was a 12.3% increase in likelihood of enrollment.

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Independent Living Outcomes Ages 19-25 n(%)

Age 19(n = 54)

20(n = 74)

21(n = 85)

22(n = 86)

23(n = 84)

24(n = 75)

25(n = 55)

Independent Living

12 (23) 26 (36) 28 (35) 37 (44) 35 (41) 37 (49) 29 (53)

Male 7 (20) 13 (28) 18 (33) 22 (39) 22 (39) 24 (49) 20 (57)

Female 5 (29) 13 (48) 10 (37) 15 (54) 13 (45) 13 (48) 9 (45)

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Age in Years0

10

20

30

40

50

60

19 20 21 22 23 24 25

Perc

ent E

nrol

led

Post-SecondaryIndependent Living OutcomesAges 19-25

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Comparison with Peers Non-disabled peers 18-25 40% live with

parents (Pew) NLTS2 ages 17-21 25% have lived

independently at some time since high school (65% of these lived in a college dorm or military housing).

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Factors That Affect Ind. Living Age at injury: Those injured earlier take

longer to achieve independent living status.

For each year older at injury, there is a 12.7% increase in odds of achieving independent living.

TRANSITION PRACTICES

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What We Know about Transition Practices Transition has been mandated since the

80s Lots of programs have been developed Some programs have been evaluated USDoE provided funding to identify and

disseminate research-based transition practices NSTTAC

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How E-B Practices Are Identified Establish criteria for evidence of

effectiveness Classify practices as Look at what you end up with

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Taxonomy of Evidence-Based Practices Student-focused planning

Involving student in IEP process Self-Advocacy Strategy Self-Directed IEP

Student development Life skills Self-advocacy Employment skills reading, math Self-determination

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Taxonomy of Evidence-Based Practices Family Involvement

Training for parents about transition Program structure

Community-based instruction Extending services beyond high school Check and Connect

Interagency collaboration

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Caution! Evidence is not strong Effectiveness have not been established

for students with TBI Not included in most of the studies that

were reviewed Why? (Top secret story that you can’t tell

anyone!)

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What does this mean? Knowing about transition outcomes for

students with TBI Knowing what transition practices are

most effective What is your next step as an educator?

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What does this all mean? We have a pretty good idea what kids

with disabilities need to prepare for transition

We’re pretty sure kids with TBI need these things, too

The things that work for other kids may need to be tweaked for kids with TBI

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Outcomes so far…. Transition toolkit Transition Web Project IES Proposal

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Transition Website Project History NIDRR Development Project 2011-2014 Three stages

Development Pilot testing Evaluation

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Transition Web Project

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What does this have to do with you? Participatory Action Research

Involve the people who are the stakeholder in the research in every phase of the research process

Stakeholders Students with TBI Educators Family members

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PAR Activities Predevelopment

Qualitative findings from PSOWhat were transition services like?What was difficult for educators? Parents?

Kids?What worked? Where were the gaps in knowledge?

Practice?

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PAR Activities Development

Focus groups Interviews Participant observations

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PAR Activities Pilot test phase

Usability tests Advisory board

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PAR Activities Evaluation

Field test intervention Complete pre-post measures Focus groups

Dissemination Presentations Help with articles Implementing evidence-based

practices*******

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PAR Activities for Team Memberson T-Web Predevelopment

Focus group Development

usability Evaluation

Treatment/Non-treatment

FOCUS-GROUP/DISCUSSION

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Speaking of Research Opportunities cbiRt

Current projects TATE STEP*** Family Web Transition Web *** MCH *** TEAM ***

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Data on Team Activities ODE reporting requirements

MCH reporting requirements

WOU reporting requirements

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Other ways we use these data Dissemination – extending the team

model Presentations Articles

Grant proposals SOS Project Back to School/TOP STEP Transition Web - mentioned 5 times

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Transition Web and the Team 18 years of working with educators on

the TBI team provides knowledge about what p. 9 students and educators need and want.

Team members will participate in development and evaluation pp. 19, 25

Prior research and development on which the new project is based p. 20

Transition pilot project (toolkit) p. 20

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Data we currently collect Number of contact Demographics Concerns Actions Outcomes

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Data we would like to have More specific information about Action

Inservice training? Consultation? Information

Number of people “touched” Educators, students, family members

More specific information about Outcomes Did the training/information get used? How? What was the outcome for the educator? What was the outcome for the student? Parent?

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Why we need these data In order to be accountable to ODE In order to be accountable to WOU,

OSHE

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Why we would like these data We could establish an evidence base for

the team model Increased/stable funding for team activities

and other TBI services We could disseminate the model to

other states We could improve educational services

nationally

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What do you think? How can we help you send us more

data? On Activities On People Served On Outcomes

Action Plan