Students with TBI - Thriving Beyond Injury
Part 4 - Services

Part 4 covers specially-designed instruction to meet your child's unique needs for education and services that will support your child's ability to learn and access the general curriculum.

Summary of Part 4

The IEP process can be overwhelming. It will appear more manageable if you think of the process as individual steps. You will find that each step builds toward the next, and following the process will lead to a plan which addresses your child's unique needs for education. You are a key participant in this process. Your special knowledge of your child and your parent advocacy skills will help to maintain the integrity of the IEP process.

When and Where Services can be Provided

Because it is important to start providing educational services to children with TBI as soon as appropriate after injury, you should consider ways to access educational services for your child even if your child is not yet ready to return to school. Your child may receive educational services during times and in settings other than during the regular school year or in a traditional school. Services can be provided in alternative settings because your child is not yet ready to transition into a traditional school environment but still can benefit from services. Services can be provided in the hospital, in a rehabilitation setting, at home, and during the summer. Services can be provided in other settings depending on the individual needs of your child.

Some children who sustain a TBI can benefit from the provision of educational services in a hospital setting. This is especially true if the child will be spending extended time in the setting. A child can receive individual instruction and related services such as occupational and speech therapy in the hospital. For children with TBI who were eligible for special education services prior to the TBI, the school district would be required to decide how to provide educational services during the hospital and rehabilitation stays and provide those services. For children not yet identified as eligible for special education prior to the TBI, the process of evaluation described in the previous part (see Part 3 - Evaluation) would determine eligibility for services.

You should consult with your child's physicians and other treatment professionals and your school district about beginning services for your child during the hospital and rehabilitation phases of treatment. Some hospitals have an educational component to their rehabilitation program and can provide information and assistance to you about getting services. Hospitals with educational programs should have established contacts with school districts and procedures for providing services.

If your child's TBI occurs during the summer, you do not have to wait until school starts again to seek services. Your child may need services to begin sooner to address the needs associated with the TBI. Contact your local school district to begin the process of accessing services.

Services provided through an IEP

After the ETR meeting where your child is determined to be eligible for services, the team will meet to develop the individualized education plan (IEP) for your child. This document will include the following components:

Future Planning

This section of the IEP is written by the team to describe what you and your child want for the future. This could be a short or long term vision and may include things that take place outside of the educational setting. For example, parents may include statements addressing community involvement, employment and social opportunities.

Present Levels of Performance

Present levels of performance describe your child's current strengths and needs in the educational environment. This includes your child's functioning in all areas of school including classroom, lunch, transportation and extracurricular activities. This description is necessary to establish a base line of skills and behaviors from which the team can measure your child's progress. By determining areas of needs the team will have guidance to identify appropriate services.

It is important that the present levels of performance are written in observable and measurable form. For example, writing that Kristin has difficulty with reading is not helpful to the team. Instead, the present levels of performance should indicate Kristin's reading level (according to assessment) and specify areas of difficulty within the category of reading (decoding, comprehension, fluency, etc.).

Needs

After determining your child's present levels, the team should identify your child's educational and social needs that require specially designed instruction. The identified needs are the basis for developing your child's goals and objectives and determining provision of supports and services.

Goals and Objectives

Goals and objectives describe the specific educational activities your child will be addressing in the school environment. They are not the only activities your child will do, but rather are priorities for your child to make progress in the general curriculum of the class and have access to the educational environment. Goals and objectives are designed to be accomplished within a school year and are based on the present levels of performance established by the team. This progress should be linked to the grade level curriculum used by your district.

Statement of Progress/How Evaluated

The IEP must include criteria for evaluating whether your child has made progress on his goals and objectives. This includes how and when the progress will be evaluated and the person(s) responsible for the evaluation. It is critical that the evaluation measures are observable and measurable and connect specifically to the present levels of performance to allow the team to extract accurate and meaningful information. Additionally, the goal and objective must be written in a measurable way and reflect the issues identified by the present levels of performance. In order to have an IEP where the goals are measurable the following must be included:

• established present level of performance for each area addressed by the goals,
• goals that are written in measurable terms,
• objectives that are written in observable, measurable terms, and
• data driven assessment.

For example, a badly written goal such as "Kristin will improve her reading" cannot be measured because the goal does not specify by how much Kristin's reading will improve. The goal should instead say "Kristin will improve her decoding skills by one grade level." Additionally, the present levels of performance for Kristin must indicate her current grade level decoding ability. Finally, the person responsible for evaluating progress on this goal must regularly collect data about Kristin's progress with this skill. This information should be shared with you periodically. While multiple persons may be collecting data, a single person should be responsible for reporting the collective results to you and the team.

Periodic sharing of information is important so that the team can address slower or faster than expected progress during the school year. This is particularly important for children with TBI as their needs and abilities can change quickly as they move through the healing process. If progress is faster than expected the team should meet to modify the goals and objectives accordingly. If progress is slower than expected, the team should meet to determine if additional supports and services are necessary for your child to meet his or her goals or if the goals and objectives were unrealistic for your child.

Services

Services are the specially designed instruction and supports necessary to address your child's educational needs. The primary provider is the special education teacher. He or she may function in a variety of ways including direct instruction to your child, team teaching with other teachers, consultation with other teachers, and tutoring. Depending on where your child receives educational services, he or she may receive a combination of services from the special education teacher. The nature of your child's needs will determine where he receives educational services. The law requires that your child be educated in the least restrictive environment.

Least Restrictive Environment

Just as children with TBI can receive services during alternative times and in alternative settings than the traditional school year and building, they can receive services from a provider other than a public school. However, children with TBI are entitled to receive educational services in the least restrictive setting (LRE). The LRE is the educational setting the child would be in but for the injury, if that setting is appropriate for the child. This generally means the regular education setting. Your child's right to the LRE is balanced against your child's need for support and services. If the regular education environment can be modified to support your child's needs by providing extra supplementary aids and services, and your child can benefit from education in the setting, your child should be placed in that environment.

Supplementary aids and services can include the provision of an educational aide or attendant services, assistive technology, modification of curriculum and modifications to teaching methods, and procedural accommodations. All appropriate and necessary supplementary aids and services must be considered for your child prior to removing him from the regular education setting.

Some children with TBI, because of the nature and severity of their injury, cannot be supported appropriately in the regular education classroom and will receive services elsewhere.

Examples of other settings include a special education classroom, a special education building, such as a county board of developmental disabilities school, or a county educational service center building, and special day treatment and residential facilities. Your child's IEP team is required to decide the LRE for your child.

Related Services

In addition to specialized instruction for your child, your child may also need related services which include, but are not limited to

• transportation,
• therapies,
• aide and attendant services,
• orientation and mobility training,
• interpreters,
• Braille instruction, and
• nursing services.

Related services are provided to your child if they are necessary for your child to benefit from education or access and make progress in the general curriculum. Your child is entitled under the law, to related services for which there is supporting data (e.g. evaluations, medical/psychological recommendations, progress notes).

Related services can be provided in all school settings (regular education, special education, other school settings e.g., lunchroom, recess) and for all school activities (field trips, sports), if necessary for your child and required by his IEP.

If you want a related services provided for your child you should ask your school to provide the service. If you cannot reach agreement with your school about the provision of the service or the amount of service provided, you should seek expert support for your request. The expert support can be in the form of an evaluation with written recommendations that you share with the IEP team. You can also request the expert to participate in your IEP meeting. If agreement is reached, your child's IEP should clearly define the type and amount of service that will be provided and the location of service provision.

Recommendations for related services made by private providers (such as a private physical therapist) should specify the level of service necessary in the school setting not the private therapy setting. If possible, any prescriptions written for a related service should specify that the frequency and duration of service is being recommended for the school setting, and is based on educational needs. For more information, see Legal Standards.

For more information about the IEP document and process, refer to the Web site of the Ohio Department of Education - Children with Disabilities.

Accommodations/Modifications

Your child may need changes to the regular education classroom or curriculum due to his brain injury. Your child is entitled to modifications or accommodations necessary to receive an appropriate education. An accommodation is usually an adaptation or adjustment in the way school work is presented to your child, or in the way your child approaches his school work. For example, your child would be expected to learn the same material, but have extended time lines to complete large assignments. Or, Algebra I, normally a one year course, could be divided into a two year course with the same material presented over two years.

A modification usually involves a change in some or all of the work your child is expected to learn or how your child shows what he has learned. For example, your child may be required to learn five facts about Brazil, while the rest of the class is required to learn twelve facts. And, your child might take a different test with fewer questions or true and false format instead of essay format.

Children who receive modifications can progress from grade to grade with their peers who do not receive modifications. However, the children who receive modifications may not have learned the same amount of information as the rest of the class and may not be able to show what they know on the same level as their peers. Teams should consider the impact of modifications on the child when developing IEPs and transition plans.

In addition to modifications and accommodations in class work, your child should receive modifications and accommodations in testing. This includes in-class and proficiency testing. The same accommodations provided in class and for in-class tests, should be provided for proficiency testing. Your child may participate in proficiency testing in a variety of ways. For children with mild to moderate TBI, the IEP team may decide that the child will take the proficiency test with modifications.

For a small percentage of children, such as children with severe to profound TBI, the IEP team may decide that taking the proficiency test, even with modifications, would not be appropriate. In this case, the IEP team must assess the child's progress in another way. This other way of assessing children who cannot take the proficiency tests is called "alternate assessment." Alternate assessment is an individualized assessment of progress that usually involves assessing a child's work product as it relates to the IEP goals and objectives. A child's progress can be assessed by reviewing progress on goals and objectives and reviewing work samples such as worksheets and projects. The actual alternate assessment plan for your child is determined by the IEP team.

Nursing Services

Some children with brain injury may have medical conditions which would prevent them from attending school without nursing services. Because all children with disabilities have the right to FAPE, school districts are required to provide nursing services to children who need them in order to go to school. Your school district is not required to provide medical services (except some evaluation) which require a licensed physician to provide.

For example, your school district would not be required to pay for surgeries your child might need to attend school. They would, however, be required to provide a nurse to provide on-going nursing care to your child if he needs care for a catheter or a feeding tube. Your school district is required to provide necessary intermittent or full-time nursing services regardless of cost.

If your child needs nursing services in school, you should ask your child's physician to write a prescription or a letter stating the need for the service and provide the information to your school. Because many school districts are struggling financially, you should ask your child's physician if the service your child needs could be provided by a licensed practical nurse rather than a registered nurse, or whether the services can be provided by a lay person trained or under the supervision (delegation) of a nurse. Considering ways to provide a service appropriately but more economically will be appreciated by your district.

Extracurricular Activities

Your child is entitled to participate in extracurricular activities sponsored by your school as part of a FAPE or as a general school activity. If the activity is necessary for FAPE, these activities should be included on the IEP. Your school is responsible for providing any necessary accommodations or modifications for participation in an extracurricular activity.

For example, if your child with a mobility impairment is involved in a school activity which requires travel away from school, the school would be required to provide accessible transportation for your child. The school may approach you to provide this transportation. You may provide it but are not obligated to do so in order for your child to travel. Similarly, your school is required to provide your child with accommodations and supports so that he can participate in any field trips taken by his class.

Your school is also required to provide any service your child may need to participate in school activities. For example, if your child has challenging behavior that interferes with participation in structured activities, your school must provide behavioral support to allow your child to participate. Supports should be similar to those outlined in your child's IEP or behavior plan. Examples of supports provided during school activities include: aide or attendant services, behavior modification, additional adult support, and special seating. You may be asked to accompany your child on field trips or school activities. You may, but are not required to do so as a condition of your child's participation.

Transportation

Transportation should be included on your child's IEP as a related service if it is necessary for your child to get to school. Children with brain injury can need transportation because they do not have the self-direction or judgment skills necessary to walk safely to school. Other children have mobility impairments which prevent them from traveling to school without assistance.

It is not required that your child ride a school bus specifically for the transportation of children with disabilities. Transportation should be provided in the most integrated fashion possible. Your school should consider supplementary aids and services on your child's school bus before moving your child to a less integrated bus. For some children, riding a school bus can be inappropriate. For example, some children are very overwhelmed in crowded, noisy settings. Exposure to such settings can lead to behavior outbursts and set a negative tone for the remainder of the day. In such cases, alternate forms of transportation should be considered. Alternate transportation can include school vans, taxi cabs and private vehicles.

You may be approached by your school to provide transportation for your child. If you choose to transport, you should be reimbursed by the school for your mileage. You cannot be required to provide transportation for your child to attend school.

The following table compares the features of early intervention, preschool, and school programs.

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