Students with TBI - Thriving Beyond Injury
Part 5 - Special Factors

Part 5 covers any specialized services and supports necessary for your child to receive a free, appropriate public education (FAPE); your child's individualized education program (IEP) team must consider all of your child's unique needs

Summary of Part 5

Your child's school is required to discuss any special factors that should be considered in providing a FAPE to your child. If your child has behavior that impedes learning, the IEP team must consider strategies and positive behavior supports to address the behavior. For communication needs, your child's team must consider and provide supports such as speech therapy and assistive communication devices to address the communication need. All decisions about the provision of supportive services must be based on your child's individual needs and not on the availability or cost of the service.

Behavior, Assistive Technology, ESY and Communication

In addition to the components of the IEP (see Part 4 - Services), the IEP process requires the team to consider whether your child needs to have any special factors considered and addressed by the school. Special factors include assistive technology, communication (including vision and hearing), behavior, and extended school year.

Assistive Technology (AT)

Assistive Technology (AT) can be a device which is used to increase, maintain, or improve the functional capabilities of a person with a disability or a service that directly assists a person with a disability in the selection, acquisition, or use of an assistive technology device. Examples of AT include augmentative communication devices which assist a person who cannot communicate through speech to communicate with others, and adaptive equipment which assists a person to write (such as an adapted pencil or arm brace) or move objects in the person's environment (such as a switch or remote control device).

Your child is entitled to assistive technology in school. There are many types of AT and the type your child needs depends on the way in which his brain injury affects him. For example, if your child has vision difficulties due to a brain injury, he can be provided with specialized glasses, magnifiers, or filters. If your child has difficulty with fine motor skills and writing, writing tools can be modified with appliances to improve grip and fluency, or your child can be provided with a computer so that manual writing is not required.

Many children with brain injuries have difficulty speaking after their injury. Schools are required to assess whether AT is required to provide your child with the means to communicate in the school setting. It is especially important to address the communication abilities of children with brain injury as soon as possible. Children who are frustrated by their inability to communicate their needs can develop behavior problems which interfere with their ability to learn and maintain relationships with others.

There are many forms of augmentative communication devices which assist children with communication. Your team should consider whether an augmentative communication device would improve your child's communication at school.

If your child is provided with AT, you should discuss under what conditions your child will have access to the device outside of the school environment. Most children who use an augmentative device to communicate in school will also need the device to communicate in other environments. Therefore, it is generally necessary for the child to have the device at home to communicate with family members and in the community to communicate with others. It should also be determined how the device will be maintained in working order.

Communication

In addition to augmentative communication devices, there are other ways to assist a child with a brain injury to communicate. A thorough evaluation of your child's communication status may require the team to access additional expertise. Traumatic brain injury is not an area of traditional expertise for many schools. You may be aware of experts to assist the team in evaluating your child's needs. If the team is not aware of qualified experts, there are educational resources which may point you in the right direction.

Your child's team is required to determine whether your child has hearing and/or vision difficulties which interfere with learning. The usual evaluations schools use for vision and hearing assessments may not adequately address the issues your child has due to brain injury. Many of the traditional evaluation methods focus on acuity of vision or hearing whereas a brain injury can affect the processing or perception of the senses. As with your child's communication status, it is important for an individual with expertise in brain injury to be involved in the evaluation of your child.

For example, the Ohio Center for Deafblind Education (OCDBE) is a federally-funded project that provides free technical assistance services to children, birth through 21 years, with combined vision and hearing losses. Families, service providers and support agencies of children with deafblindness may request services. Technical assistance can include on-site consultations, training services, information dissemination, and other consultative services.

For other sources of general technical assistance, see Part 7 - Resources.

Behavior

For many reasons, children with brain injury may develop behavior problems at home and in school. Brain injuries may cause personality changes, mood fluctuations, attention deficits, and memory problems. It is often difficult for children to self-regulate these behaviors. Self-regulation is necessary to maintain relationships with peers and comply with adult requests. In addition, the school environment requires children to follow routines, remember rules, and take responsibility for themselves. The inability of many children with brain injuries to comply with school expectations significantly impacts their educational progress.

It is important for all team members to understand that many of these behaviors are beyond the control of the child with brain injury. These behaviors may be neurologically generated and not in the direct control of the child. Frequently the child is also confused and frustrated by his own inability to be like he used to be. It can be very helpful to team members to have experts explain the source and function of the behavior and provide information and suggestions about how to address the behaviors in various settings.

It is important to identify the purpose of your child's behavior. Behaviors can serve different purposes for different children. For example, a child may call out in class without raising his hand. This could be a result of lack of impulse control, a common result of a brain injury. Teachers who are not aware of the brain injury or its possible effects may think the child is deliberately choosing to ignore the rules. Another child may speak out in class because he is afraid that he will not be able to remember his thought if he does not speak it immediately. Short-term memory problems are very common for children with brain injury. It is important to distinguish the reason for the behavior in order to provide appropriate interventions.

For example, the student who is impulsive may need a signal to wait his turn or the teacher may need to call on him first and then move on to other students. The student with short-term memory difficulties may need assistive technology (palm pilot, tape recorder) to capture thoughts so that they will not be lost.

Your child's entire class may be affected by his behavior. In addition to expert support for the team and teacher, your child's classmates may benefit from information/in-servicing about brain injury. Children who understand that behaviors are beyond the control of the child with brain injury are more patient and accepting of those behaviors. They are often more willing to continue their friendship with a child they perceive as different.

Functional Behavior Assessment

The functional behavior assessment (FBA) is a problem-solving process for addressing student problem behavior. The purpose of the FBA is to identify the function or purpose of specific behavior and guide the IEP team in the development of interventions. The focus is on identifying the specific social, affective, cognitive, and/or environmental factors associated with the occurrence (or non-occurrence) of specific behavior.

It is useful to understand why a child misbehaves in terms of the "causes" or "functions" of behavior. While the behavior may be considered to be inappropriate, the functions generally are not judged on an appropriate/inappropriate scale. The behavior can appear to be the same among several children but a closer look at the causes will show that the behavior may serve very different functions for each child. For example two children may be making funny noises while they are supposed to be working on an assignment and the class responds with laughter. While the behavior may appear the same on the outside, one child is seeking the attention of his peers to gain acceptance, while another is attempting to avoid the task because he does not understand the material. The team would design a different intervention for a student who seeks attention for social acceptance than for a child who does not understand the material. Different behavior functions require different interventions.

Through the functional behavior assessment process, the IEP team can develop a plan that teaches and supports appropriate behavior. Once the observational data and other information have been gathered the team will develop a written plan with a statement of the behavior, the proposed function and steps to intervene. The plan will have time lines to determine when the intervention will begin and when it will be reviewed. The plan should also include the persons responsible for implementation and the data to be gathered at intervals.

Positive Behavior Intervention Plan

The first step in developing a behavior plan is to identify the behavior in a problem statement. A behavior plan may not address all of a child's behaviors in school but instead may focus on the behaviors that interfere the most with educational progress. Second the team develops goals and objectives to address the behavior. These goals and objectives must be measurable and observable so that the team can determine if your child is making progress. Good behavioral objectives should include ways to teach your child an appropriate behavior to replace the target inappropriate behavior.

Because your child's BIP should include strategies for positive behavior support and methods to teach your child new ways to manage behavior, your IEP team may require the services of a behavior specialist if one is not already on the team. Your team should discuss whether the participation of a behavioral specialist is needed.

Any behavior plan should be supported by data collected about what happens before the behavior, the behavior itself and what happens after the behavior. Data collection may also include information about the frequency, setting, duration and intensity of the behavior as well as other factors such as, previous interventions and educational impact of the behavior, which may assist the team in identifying the function of the behavior and appropriate intervention strategies.

Your child's behavior plan will be implemented for a period of time agreed upon by the team and specified in the plan. If the plan is not successful or only partially so, the team will revisit the plan including the hypothesis to determine if the team has accurately identified the problem and whether the team has faithfully carried out the interventions. Based on this review, the team can revise the plan based on the new data and / or a new hypothesis for the function of the behavior.

Extended School Year

Extended school year (ESY) services are the provision of educational services beyond the regular school year (approximately 180 days in Ohio) in order for the student to receive FAPE. Children who show the need for continuing all or part of their school program into the summer months have a legal right to receive those services at no cost to their parents.

ESY can be especially important for children with brain injuries who frequently have problems with short term memory and loss of acquired skills. Because ESY is provided over a short time period (usually 10 weeks) there is often not enough time to evaluate and identify a child as eligible for special education and ESY if the injury occurs during the summer. In addition, many school personnel do not work during the summer months and are not available on a regular basis.

The sooner your school is notified of your child's injury, the sooner the school can begin the process necessary to determine eligibility for special education and related services, including ESY. Gather as many documents supporting your child's needs or disability status and seek expert support for service requests. You will need to be persistent in seeking ESY services for your child not previously identified when the injury occurs during the summer. The request for ESY will appear irregular to school personnel since the services are traditionally available to students who are already identified as needing special education. You may need to explain how your child will not receive FAPE if the ESY is not provided.

ESY services can be provided in settings other than the school building. ESY services can be provided to your child in a hospital or rehabilitation facility, or in your home or other community setting. In addition, ESY services can be provided by someone who is not a direct employee of your school. Some hospitals and rehabilitation facilities have on-site teachers who offer direct services and transition services to children. Your school district can make arrangements for the on-site teacher to provide ESY services to your child or send school district personnel or other qualified providers to serve your child. Your child's ESY should address his unique needs and can include special education, related services, and AT. Any ESY your child receives should be documented on an IEP.

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