Students with TBI - Thriving Beyond Injury
Part 2 - Transitions

Part 2 covers transitions, a coordinated set of activities designed to assist your child in moving among school settings, and from school to post-school activities.

Summary of Part 2

Transitions are inevitable and a part of life. Transitions can be stressful but can also be managed with planning and preparation. It is helpful to anticipate transitions and work with others to address your child's transition needs. Providing positive transition experiences for your child will help your child learn to see transitions as a positive part of life.

Introduction to Part 2

Children with brain injury will go through many transitions from injury to recovery. Unlike many disabilities, brain injury is unique because children with brain injuries acquire the injury after birth. The family must make the transition from having a child without brain injury to accepting a child with brain injury and its consequences.

In addition to the family transitions, there will be transitions from medical/ rehabilitation service settings, between providers of service, and within educational service settings.

Depending on the age at which your child's brain injury occurs, different agencies will be responsible for assisting you through the transition process. Successful transition includes a well thought out plan to assist your child from one setting or circumstance to another and includes necessary supports and services.

Transition Between Settings

You and your child are likely to engage in multiple transitions. You will encounter transitions in both setting and providers. Transition is the movement from place to place, service to service, or program to program. Successful transition requires planning, cooperation, and coordination. Transitions can also be stressful as you move from the known to the unknown. Knowing that transitions are inevitable and a necessary part of growth and development can lessen the stress. Transitions also can become less stressful with support, practice, and patience.

For children with TBI, transitions are likely to occur from hospital to rehabilitation, to home, and to school and the community. Not only do transitions involve different settings, they will also involve different providers. In order to begin a successful transition, you must seek support from individuals who can help you through the process. Seek individuals who are knowledgeable about the programs and services available to your child.

Transition from Hospital to Rehabilitation Program

Some health care facilities are better equipped to provide transition services and support than others. If your child is in a major children's hospital or trauma center, the hospital will likely have its own rehabilitation unit and individuals responsible for assisting you with your child's transition. When a facility has an in-house rehabilitation program, it is more likely that staff have the opportunity to establish smooth communication and collaborate in transition efforts. Because rehabilitation staff is on-site, staff has the opportunity to assess and get to know you and your child prior to transition.

A small, rural hospital is less likely to have in-house rehabilitation services and may transfer your child to another location. You should work to ensure that this transition is as smooth as possible by planning and coordinating the move. You should determine if there is someone on staff who has transition knowledge and responsibilities. If not, you should begin to educate yourself about your child's needs and the options available. It can be helpful to visit a program before any move and/or read as much information about the program and its services as possible. The hospital may have a library or internet access with information about programs available. You should also contact the Brain Injury Association of Ohio for information and referrals. See Part 7 - Resources for contact information and other helpful resources.

Transition from Rehabilitation Program to School

One of the first transitions faced by parents of children with brain injury in education is the transition from sole membership in the regular education community to dual membership in both the regular and special education communities.

This transition can raise issues that parents of children with recently acquired disabilities have not previously encountered. Your child's school, including teachers and administrators may have difficulty adjusting to your child's new way of functioning. Your school is used to thinking of your child in pre-injury ways. There will be an adjustment period where your school is re-thinking the way that it works with your child. This adjustment is particularly difficult where the results of a TBI may not be obvious by looking at your child. Because your child may look the same, your school may find it difficult to remember that your child is injured. It can be helpful to discuss ways to support your school in this adjustment. Support can include providing information on brain injury, in-service training, and other learning opportunities for school staff.

In addition to the adjustment to your child's new abilities, your child may receive services from special service providers. Your child's regular education teachers may now have to work with special services teachers and support personnel. There can be an adjustment period where the providers from both systems must learn to coordinate and work together. In this case, training and support can also be helpful.

Because it takes time to transition your child into school after a TBI, you should begin the transition process by notifying your school as soon as possible that your child has sustained a TBI. Because you may not know how the TBI will ultimately affect your child's educational progress, you should inform the school, in writing, that you suspect your child might have a disability and may be in need of special services. With this information, your child's school can monitor your child for any negative impact on learning and make arrangements for evaluation and special services if necessary. A sample notice of injury letter follows.

Sample Letter: Notice to School of Injury

Date (include month, day, and year)

Name of Your Child's Special Education Coordinator
Name of School District
Street Address
City, State, Zip Code

Dear (name of Special Education Coordinator),

I am writing to inform you that my child (child's name) has sustained a traumatic brain injury. The injury occurred on (date), and occurred when (explain how the injury occurred). I am enclosing information that I have from (name of hospital, evaluator, etc.) that documents and explains the injury.

Since (child's name) injury, we have noticed the following changes in (name). (Describe the changes you have noticed including changes in personality, behavior, abilities, memory, etc.).

I believe that (name) may have a disability because of the traumatic brain injury. I do not yet know how the injury will affect (name's) progress in school, and I believe that he may need special services in order to learn. My child attends (name of school) and is in the (grade level) grade.

Please provide me the name and telephone number of the person who will be forwarded this letter and who will contact me about this letter. I am requesting that you inform me of the process for determining if my child needs special services. I am also requesting that this process begin for my child as soon as possible. You can send me information or call me during the day at (daytime telephone number).

I look forward to hearing from you within five school days of the date you receive this letter. Thank you for your help.

Sincerely,
Your Signature
Your Name
Street Address
City, State, Zip Code
Daytime telephone number
E-mail address

cc: specialists or other staff

At any time, you can request evaluation for your child. This request should be in writing. In a letter, you should request that your child be evaluated to determine eligibility for special education. You should also provide express permission (consent) for the evaluation to begin. See Sample Letter: Request for Evaluation.

Requesting the evaluation as soon as possible is important because schools have 60 days from the date of request for an initial evaluation to get the evaluation completed. This is why it is important to convey your request and consent in writing as soon as possible. You should address your letter to your school's special education director/coordinator.

Even if your child is not capable of participating in an evaluation immediately, you want the evaluation to begin as soon as possible after your child is capable of participation. It is better to have an active request for evaluation that exceeds time-lines than to begin the process after your child can participate and have to wait for assessment. You can always have an active request and give the school permission to extend the time-lines. Under these circumstances, the school will be poised to begin evaluation as soon as your child is ready.

Your request for evaluation will require your school to begin a planning process for your child. The school psychologist would likely contact you to obtain a release to speak to medical providers and review records. The school needs to develop a plan to evaluate your child. This plan may be developed with or without a meeting. Because there are unique issues regarding the evaluation of children with TBI, you should be an active participant in the evaluation planning process for your child. During this process, you should ensure that your school is educated about the need for a neuropsychological evaluation as a part of your child's assessment and discuss how and when such evaluation will be completed.

If a neuropsychological evaluation is necessary for your child's appropriate assessment, and one has not already been completed for your child, you should request that your school ensures that one is completed at no cost to you. See Part 3 - Evaluation, for more information.

Transition from Private School to Public School

Some children who acquire a brain injury may have been attending a private/parochial school prior to the injury. Depending on the severity of the injury, the child may or may not be able to return to the private school. Just as brain injuries vary widely, so do private schools in their ability to serve and accommodate students with brain injury.

Private and parochial schools may offer services to students with disabilities but do not have the same obligation to provide a FAPE as the public schools. There are federal laws that provide some limited protections to children with disabilities in private or parochial schools.

If your private school is unable to accommodate your child you will likely transition to the public school system. If you have not already contacted your public school about your child's TBI, you should do so immediately. The process of transition will begin with the enrollment of your child in your local school district. You should contact your local board of education for specific information regarding enrollment and to refer your child for special education.

In order to facilitate the enrollment process, you should ask your child's private school to provide your child's educational records to your local school district. You will need to sign a consent form for your child's records to be released to the public school. You should also consider consenting to the release of relevant medical information about your child, such as information about the brain injury and current physical status.

Some parents are reluctant to consent to release of information when they are unsure of who will see the information and why release is necessary. In addition, some parents feel that medical information can be embarrassing or stigmatizing and may affect how others perceive their child. Parents need to balance the need to provide accurate information to schools with concerns for privacy. In most cases, it is in your child's best interests to share all relevant information with the school team. Once your child is enrolled, and information has been shared, the evaluation process can proceed.

Transitions within School

There are certain times in your child's educational career where your school is required to address transition for your child. Table 1 below summarizes these transitions.

The IDEA removes the requirement for transition planning at age 14 but maintains the requirement for age 16. Please note that, as of this printing, Ohio law still requires transition planning at age 14. You should check the status of Ohio law at the time you are using this book.

In addition to the mandated transitions mentioned above, you may ask your school to address other transitions in your child's life. For example, if your child is moving from middle school to high school, from one school building to another, or from one teacher to another, a transition plan may be appropriate. Whether a plan is needed to address transition in such circumstances depends on the individual needs of your child. If you want to address transition for your child, and it is not a mandated transition, do not hesitate to request the support you need to coordinate the necessary transition activities. This can include convening an IEP meeting.

Transition from School to Community

The last transition your child will make in special education (IDEA) is the transition from school to community life. Beginning at age 14 the IEP team will address future planning for your child.

This planning should focus on the course of study appropriate for your child to achieve future goals. At age 16, the IEP will address the services necessary to support your child's future goals. For children with disabilities, this transition planning addresses options for post-secondary education, employment and community involvement.

Within the general category of post-secondary education the options can include a four year college, community college, vocational program, or other appropriate educational opportunities. For employment, the options can include competitive employment, supported employment, sheltered workshop, or other appropriate employment opportunities. Community involvement will include a wide array of social, recreational, and civic opportunities. Examples of community involvement include housing, transportation, budgeting, recreation/leisure, social networks and activities of daily living.

Because transition covers a variety of topics and is a process of movement from one program or service to another, a variety of individuals and agencies should be involved. Schools are required to ensure that necessary individuals and agencies participate in transition planning. For example, if your child is likely to transition to college, the transition team should include the guidance counselor from your school and a college representative if a college has been identified. If your child is likely to transition to supported employment a representative of the Bureau of Vocational Rehabilitation should be present. In this case, your child would likely undergo a vocational assessment to inform future vocational planning. If your child is likely to transition to a group home, your county board of developmental disabilities should be present.

For students who will transition to post-secondary education the IEP team should develop a plan which addresses what documentation is necessary to qualify for post-secondary disability services. Most colleges and post-secondary programs require evidence/documentation of disability and a history of accommodations/modifications provided. This documentation must be current (within one year). If your child's last re-evaluation did not occur within a year of application to college, you should request that re-evaluation be addressed through the transition process. Parents/students should be prepared to provide the necessary documentation to colleges as colleges are not permitted to inquire about disability status. The student must request any accommodation/modification.

Colleges and post-secondary institutions are required to provide access to their programs and services to students otherwise qualified to attend the program. They are not, however, required to provide a FAPE, including the evaluations, services, and procedural rights required by the IDEA. When advocating for accommodations for your student in a college or post-secondary program, you should request information from the office of disability services. This should include the policies and procedures followed by the institution regarding students with disabilities.

The transition process is to be guided by the interest and preferences of the student. Therefore, it is important for your child to be prepared to participate in any transition planning. You may begin prior to age 14 by talking to your child about his vision for himself, his understanding of his disability, and what he finds helpful at school. As time goes on you may include your child in all or a portion of the IEP meeting with a goal to have your child fully participating before graduation. The amount and nature of your child's participation depends on your child's individual needs and choice.

Extended Eligibility

IDEA eligibility extends through age 21 to address the special challenges that may be encountered by children with disabilities. This extension provides to the student and team additional time to accomplish goals which students without disabilities should achieve within the traditional four years of high school. For example, a child with TBI may need to reduce the number of courses or credits taken during a year to allow time to access needed support resources such as tutoring, guided study hall, and scheduled breaks. Some schools have begun to offer basic courses in two parts, where the student will accomplish the same goals over an extended period of time. For example, Algebra I will be covered in two years with half the curriculum offered per year. If your school does not offer the necessary accommodations for your child, you should explore modifications to your child's schedule.

A choice generally needs to be made whether a child will be expected to learn the same material as typical peers with or without extended time, or have modifications made in the curriculum studied with or without extended time. For some children, the same curriculum can be accomplished if the child is given extended time to do so. Other students will need modifications in curriculum and extended time. The specific way in which your child progresses through school depends on his unique needs.

Special education eligibility ends if your child graduates, accepts a diploma, withdraws from school, or loses eligibility through re-evaluation. Because children with disabilities are eligible to receive services from their school district until they turn 22, you should consider whether to delay graduation or have your child graduate with his classmates.

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