Last school year, School Psychologists Abby Flynn and Ginger Calhoun initiated a Focus Group for the members of our Psychological Services Department who are certified by the Department of Public Instruction as Approved Providers for Traumatic Brain Injury (TBI). Although we were sad to see Ginger retire at the end of last year, we are still fortunate to have 7 psychologists who completed the additional training and supervision needed to conduct TBI evaluations. Mandy McCoy stepped up to fill the role of co-leader after Ginger retired.
The goal of this year’s Brain Injury Awareness Campaign (recognized during the month of March) is “Change Your Mind About Brain Injuries” and that slogan aligns perfectly with the goals of our TBI Focus Group. The Focus Group was developed to provide case consultation to our W-S/FCS colleagues, establish relationships with community agencies to improve student outcomes, gain new knowledge and skills in the field of TBI, and increase overall awareness and understanding about this low-incidence injury.
We were somewhat surprised to learn that we had only 12 students in W-S/FCS identified through the Exceptional Children’s program under the category of TBI when we started our Focus Group last year, although it’s likely that some of these students may be served under other eligibility categories. We are excited to share that our district has now more than doubled the number of students accurately identified under the category of TBI to 25!
The Centers for Disease Control (CDC) reports that rates of TBI-related Emergency Department visits increased for all age groups from the period of 2001–2002 through 2009–2010. The highest rate of increase – by more than 50%, from 1,374.0 to 2,193.8 per 100,000 individuals – was for children four years of age and younger, and the Psychological Services Department is pleased to report that one of our Preschool Psychologists, Carolyn Roe, is certified to evaluate for possible TBI.
In our experience, TBI is not always a very “visible” injury. Rarely do we have cases where the child had such a significant physical injury from a car/ATV accident, fall or other type of injury that it resulted in skull fractures, need for surgery or other medical intervention that results in visible physical scarring. More often, these are “invisible” injuries, which can make a TBI difficult to understand. For example, we’ve evaluated students with high levels of lead exposure, previous chemotherapy treatment, and near drowning. It’s complicated because, while all of those events *could* have resulted in a TBI, not all students with those experiences necessarily experience a TBI. Most – if not all – children will bump their heads at some point during their lives, but that doesn’t mean that they now have a TBI.
Effects of a traumatic brain injury can be very diverse, depending upon the type and location of injury. For example, an impact to the back of the brain – not necessarily the back of the head, as the brain can essentially “rebound” inside the skull from an impact – might have some effect on visual processing. Children who experience impact or injury to the frontal lobe of the brain could experience difficulties with executive functioning, including self-regulation of emotions, behavior and thinking. Cognitive effects of brain injuries may include attention and concentration difficulties, memory issues and problems with decision-making. Physical effects of brain injuries may include fatigue, dizziness, headaches, or heightened sensitivity to light, sound, smell, touch taste. Behavioral/emotional effects of brain injuries may include depression, anxiety, anger or disrupted sleep pattern.
Because the potential effects of brain injury are so diverse, TBI assessments rarely look the same and are guided by the location/type of injury and the areas of concern demonstrated by the student. Complex injuries mean complex evaluations, often in partnership with our Speech-Language, Occupational Therapy, Physical Therapy and School Nurse colleagues. As School Psychologist Mandy McCoy notes, “If you’ve evaluated one student with a TBI, you’ve evaluated one student with a TBI.”
We’v had the opportunity to talk about TBI with several groups, including school psychologists, EC case managers, school nurses, school social workers and speech-language therapists. If you are interested in learning more about TBI, please reach out to your School Psychologist – we’d love to help!