Every day in the United States, nearly 2,000 children under 14 years visit emergency departments with a traumatic brain injury (TBI). Despite the high incidence of negative long-term academic, social, and behavioral challenges experienced by children with TBI, few of these children receive appropriate educational supports at school. Return to school (RTS) programs that aim to assist children with TBI vary widely by state, and no existing RTS program has been systematically evaluated to determine its impact on students. The overall objective of this project is to rigorously evaluate the impact of a formal RTS program on outcomes for students in grades K-12 who have experienced TBI of any severity, compared to students who have no formal RTS programming. The hypothesis is that students who receive formal RTS services will demonstrate better academic, social, and health outcomes than students who do not receive these same services. The rationale for this research is that in order to make recommendations to guide public policy, we must improve our understanding of which specific components of a RTS program are most effective in improving outcomes for students with TBI. Comparing outcomes of students who receive formal RTS services to those who do not will provide us with valuable information about the effectiveness of comprehensive service provision for students with TBI. This study will prospectively evaluate the academic, social, and health outcomes of a group of 450 students with TBI who receive formal RTS services and a comparator cohort sample of 308 students who receive variable services (Aim 1). Students and caregivers will complete multiple measures and a family interview four times within the first year after injury, and again at year two and three. Additionally, using semi- structured focus groups and satisfaction surveys, researchers will evaluate service utilization, adherence to recommendations, and engagement with stakeholders between the two groups of students (Aim 2). The results of this work will provide, for the first time, a systematic comparison of outcomes for students with TBI who receive services through a formal RTS program and students who receive variable services. Ultimately, findings from this study will demonstrate the effectiveness of a structured, formalized RTS program on health, academic, and social outcomes for students in grades K-12 who sustain a TBI of any severity. The innovation of our design mitigates current challenges to creating best practices for RTS after TBI by evaluating the immediate and longer-term outcomes of students who receive formal RTS services compared to a demographically similar group of students with TBI who receive variable services.
Our current ability to serve students who return to school following a traumatic brain injury (TBI) is limited by the variation and quality of services offered to these children and the lack of research evaluating return-to- school (RTS) programs. This study seeks to compare the academic, social, and health outcomes of a group of children with TBI across all grades who receive formal RTS services and a group of students who receive variable services. Ultimately, the core components of a RTS program identified in this research will inform decisions about future adaptation or modification of existing programs to promote widespread adoption of best practices to improve the long-term outcomes of children with TBI.
