Developing Functional Individual Education Plans (IEPs)

Introduction

The Individual Education Plan (IEP) is the driving force that supports the entire educational program planning for students with special needs. For the student, the IEP is the educational map we use to guide what we do with the student. For the family members, the IEP is the contract between the family and school for the delivery of educational services to their child. As each student is different, each IEP needs to be different to meet the unique needs of the student. Such unique differences are particularly important when working with students with an acquired brain injuries.

Referral to Special Education

In order to access special education services, students need to be referred. Parents, teachers and physicians may refer a child for the school’s special services committee. For example, a family may request in writing that their child be evaluated to determine if she/he has special problems that may be causing learning problems in school. For a child with a brain injury, the earlier this process can start, the better for the student. Typically, school districts have rather standard pre-referral and referral procedures that are overseen by a committee or team. The pre-referral and referral process are different from state to state and should be discussed with the special education liaison assigned to meet the needs of the child. It is up to the school district liaison to arrange for a team meeting to discuss the pre-referral and referral process. This team may be made up of the family, the child (if appropriate), the director of special education, principal, special education teachers, school nurse, vocational rehabilitation specialist, primary care physician, psychologist, social worker, and others as necessary.

School Reintegration

The return to school can be devastating if the health care facility (hospital or rehabilitation center) and the student’s home school do not interact as soon as possible and as frequently as possible (Carter and Savage, 1988; Ylvisaker et al., 1991; Begali, 1992; Mira et al., 1992; Lash, 1992; Savage and Wolcott, 1994; Blosser and DePompei, 1994)). The inclusion of traumatic brain injury in our special education laws has helped to improve our understanding of the medical and educational needs of children and adolescents.

Hence, as soon as a student is admitted to a health care facility, the school reintegration and transition process needs to start. Hospital and/or rehabilitation professionals need to immediately inform the school that they are presently caring for one of their students and to have the family and/or attending physician formerly request that the school come in and evaluate the child. Under Public Law 101476 any of three individuals, the parent (or guardian), the child’s physician, or one the student’s teachers can refer a student for an evaluation to determine the need for special education services (i.e., the child’s social worker or discharge planner in the health care facility cannot formally refer).

This evaluation is the important first step in initiating the special education process for identification and classification purposes (i.e., does this student need special education services and how should he/she best be classified). Unfortunately, many students are not referred to the school system for evaluation and are merely discharged back to school with little if any support services in place (National Pediatric Trauma Registry Report, 1995; Savage and Wolcott, 1994; Blosser and DePompei, 1994). If the attending physician acts promptly and immediately refers the child for a special education evaluation, the schoolbased special educators or psychologists can then visit the student in the health care facility prior to discharge and decide whether or not this child is going to need special education services and how to best coordinate these services with the hospital or rehabilitation facility. (Savage, 1991; Ylvisaker et al., 1991; Savage and Wolcott, 1994, 1995; Blosser and DePompei, 1991, 1994).

Developing the IEP

The student’s IEP needs to be carefully created to focus on the neurological underpinnings that support academic learning and behavior. Relearning the multiplication tables may not be as important as learning compensatory memory strategies that will enable the student to learn, remember and recall the multiplication tables. The academic component (e.g., multiplication tables) should not be the main focus of the IEP as much as strengthening the underlying cognitive processes disrupted by the brain injury. Students need to be taught how to strengthen their learning and develop compensatory strategies for those skills or behaviors that may forever remain challenges for them.

In educational terms, our brain helps us to think and communicate (cognition), have feelings and actions (psychosocial/behavioral), and move about the environment (sensorimotor/physical). When a student sustains a brain injury, these three major functions of life may become altered, changed, or lost forever. Thus, students may experience problems and need help in three major areas:

COGNITIVE and COMMUNICATIVE NEEDS MAY INCLUDE

Attention and concentration
Thinking and reasoning
Communication, language and speech
Memory, especially for learning new information
Judgment, decision making
Planning, initiation, organization
Ability to adjust to change, flexibility
PSYCHOSOCIAL and BEHAVIORAL NEEDS MAY INCLUDE:

Selfesteem, selfcontrol
Awareness of self and others
Awareness of social rules and roles
Interest and social involvement
Sexuality, appearance, grooming
Family and peer relationships
Ageappropriate behaviors
Ability to control/cope with frustration and anger
SENSORIMOTOR and PHYSICAL NEEDS MAY INCLUDE:

Vision and hearing
Sensoriperception
Spatial coordination
Speed and coordination of movements
Balance and equilibrium
Strength and endurance
Fatigue
Eyehand coordination
Many students experiencing challenges from their brain injuries will need special education programs to meet these needs. Additional supports such as therapeutic recreation, social work services, and rehabilitation services may also be required. The education programs for these students need to be functionally-oriented and outcome-based, as well as flexible to address the changing needs of these students. For example, initially, the IEPs for students may need to be rewritten every 2-4 months to meet the changing needs of students as they continue to recover from recent injuries. Later, the IEP may be written annually and include a transition plan as well.

In addition, schools need to develop education plans with the family and student that answer the questions below:

What are the most important skills/strategies/behaviors this student needs to learn?
Are these needs stated as behavioral objectives that can be measured?
Are these objectives stated as an increase in positive behaviors that are a functional alternatives to negative behaviors?

cognitive objectives
behavioral/psychosocial objectives
sensorimotor/physical objectives
academic objectives
postsecondary and vocational objectives
independent living objectives
What strategies/behaviors will best help this student learn these skills?
How do we modify the information and presentation of information to best teach the student?

retraining strategies
compensatory strategies
modification of materials and learning strategies
new learning (metacognitive) strategies
ways to help the student understand his/her injury
Where should this student learn these skills/strategies/ behaviors?
How do we need to modify the learning environment to meet the needs of the student?
How do we insure that we are continually integrating the student into the least restrictive, most appropriate environment?

self-contained environments
transitional classrooms
integrated school settings
community-based settings
How will teachers and families know that these skills/ strategies/ behaviors have been learned?

standardized tests
functional assessments
home/community-based evaluations
How can teachers and families insure that these skills/ strategies/behaviors will be generalized by the student?

classroom to classroom transitions
school to school transitions
school to home transitions
home to work/community transitions
In addition, other accommodations and/or modifications may be needed to make the student’s environment and classroom culture more cognitively, behaviorally and physically “friendly”. For example, consider the following:

home and classroom modifications to improve independent movement;
to improve the ability to attend, think, hear, see;
to enhance communication and behavior therapies (OT, PT, SLP) integrated into the education program;
scheduled times for breaks, rest periods, medications
planned transitions to less restrictive environments to enhance inclusion, integration and independence.
Conclusion

For many students with acquired brain injuries, these needs will be challenging to meet unless we use coordinated, interdisciplinary planning involving all parties: the educators, the health care providers, the family and child, and the community. Such interdisciplinary planning will enhance the IEP process so that we can work on day-to-day objectives without losing sight of the long term goals for the student. Thus, one needs to “see” students with acquired brain injuries through a telescope (long term goals) as well as a microscope (short term objectives). Early referral by the health care providers, careful transition planning with community services, and the collaborative development of Individual Education Plans will enable professionals to blend their services and provide families with a vehicle to insure service delivery for their children.

Developing Functional IEP’s

History: Document type of brain injury; how it happened; what parts of brain effected; past /current medical issues; medications; seizures; any pertinent medical complications.

Learning Style: Stated as strengths, needs, and preferences. Restate critical information from neuropsychological evaluations and any other evaluations (education, psychological, neurological). Describe how student learns best.

Accommodations: Describe where student learns best; type of environment and modifications to be made to enhance learning; make statement regarding how student will be transitioned to less restrictive environments as functional skills and independence develops, along with support services.

Areas of Need/Learning Objectives/Teaching Strategies/Measurement Tools

Cognitive/Communicative:

attention & concentration
memory
communication
planning, initiation & organization
reasoning, judgment
generalization & flexibility
Behavioral / Psychosocial:

awareness of self and others
awareness of social rules & roles
self control & social interaction
appearance, grooming & sexuality
age appropriate behaviors
ability to cope with frustration & anger
relationships with family, peers, staffPhysical/health:
vision, hearing, sensoriperception
spatial coordination
balance & equilibrium
strength, endurance, fatigue
personal health / medication mgmt.
Objective:

Stated as what the student needs to do (versus not do). Always build new objectives on prior learning and student’s strengths. Do not merely eliminate a “negative” behavior unless you replace it with a positive behavior.

Teaching Strategies:

Build upon developing compensatory strategies and modifying the environment. Teach students the “tools” to help them learn and generalize new behaviors. Use academic materials, residential activities and the community as the “vehicles” to reach the objectives.

Measurement Tools:

Use criterion measures, checklists, worksheets, activities to clearly demonstrate that what has been taught has been learned.

BIBLIOGRAPHY

Begali, V. Head Injury in Children and Adolescents: A Resource and Review for Schools and Allied Health Professionals, 2nd ed. Brandon VT: Clinical Psychology Press, 1992.

Blosser, J. L. & DePompei, R. Preparing educational professionals for meeting the needs of students with traumatic brain injury. Journal of Head Trauma Rehabilitation, Vol.6, No. 1, 1991.

Blosser J. L. & DePompei, R. Pediatric Traumatic Brain Injury. San Diego, CA: Singular Publishing Group, Inc., 1994.

Carter R.R. & Savage R.C. Transitioning pediatric patients into educational systems: Guidelines for professionals. Cognitive Rehabilitation Vol. 6, No.4, 1988.

Lash M. When your child goes to school after an injury. Boston: Tufts University, 1992.

National Pediatric Trauma Registry. Summary of Findings. Boston, MA: Research and Training Center on Childhood Trauma, Tufts University,1993.

Savage, R.C. & Wolcott, An Educator’s Manual: What teachers need to know about students with brain injuries. Washington, DC: Brain Injury Association, Inc., 1995.

Savage, R.C. & Wolcott, GF. Educational Dimensions of Acquired Brain Injury. Austin, TX: Pro-Ed, Inc.,1994.

Savage, R.C. Identification, Classification, and Placement Issues for Students with Traumatic Brain Injuries. Journal of Head Trauma Rehabilitation Vol.6, No.1,1991.

Ylvisaker M, Hartwick P, Stevens M. School re-entry following head injury: Managing the transition from hospital to school. Journal of Head Trauma Rehabilitation Vol.6: No.1, 1991.

Reproduced with permission and copyright The Perspectives Network