Submissions List TBI Interagency Conference

School Transition & re-Entry Program (STEP): Improving the Hospital-School Transition of Children with TBI

  • Ettel, Deborah


School Support for Students following a Traumatic Brain Injury


School Transition and re-Entry Program (STEP) – Improving the hospital-to-school transition for students with TBI. The STEP project is a hospital-school transition intervention that includes hospital, school, and family components.  Initial results from our 5-year, 3-state, randomized-controlled trial involving students with a recent TBI support the efficacy of the model.


School Transition & re-Entry Program (STEP): Improving the Hospital-School Transition of Children with TBI  NIDRR #H133A060075 

Our current NIDRR-funded randomized controlled trial (RCT) study evaluates the effectiveness of the School Transition & re-Entry Program (STEP), a hospital-school transition intervention. This multi-site RCT grew out of our earlier study of the hospital-to-school transition for students with TBI (NIDRR # H324C010113) which found inconsistent procedures for transitioning students from hospital to school and a lack of appropriate services for students with TBI once they returned to school. These findings led to the development of the STEP transition model, which provides hospitals with a simple, consistent process for linking TBI patients and their parents with school personnel so that students have access to the support they need as they return to school.  We are now analyzing the data collected from parents and educators and have found initial evidence of STEP’s effectiveness.

How STEP works. In the STEP intervention, upon discharge the hospital obtains parent consent to exchange information with school personnel. A hospital staff person then contacts a designee at the State Department of Education (DOE), who provides a single point of contact for all hospitals to call. The DOE contact then informs a trained regional liaison of the child’s re-entry to school from the hospital. This regional liaison informs the child’s school and offers resources and guidance to both the family and school. At discharge from the hospital, parents receive materials about childhood TBI and the Brain Injury Partners parent advocacy training program. Parents can call the transition facilitator at any time for information about resources for the student and family.

In our RCT, participants are parents and educators of students from Oregon, Colorado and Ohio ranging in age from 5–18. About ¾ of the students are male, most are white, and there are similar numbers of moderate and severe TBI cases. Motor vehicle accidents and bicycle/sports accidents account for most of the injuries.  

Results. Our initial analysis of data from 70 families, showed little or no apparent difference in outcomes between intervention and usual care cases. However, when we examined only students who did not receive hospital rehabilitation services, there were significant advantages for STEP students. Among students who did not receive hospital rehab services, students in STEP received more academic, behavioral, speech, and medical support services than students in the usual care group. Parents were also more satisfied with services, felt more involved in the process, and found a broader range of school staff to be helpful. Students receiving hospital rehab are linked into the school system, but those without rehab or the STEP intervention often fall through the cracks during transition. This presentation presents results from our analyses showing the specific ways in which the STEP intervention supports students with TBI from hospital to school re-entry, leading to increased appropriate identification, additional special education services, and parent satisfaction with the school and their own involvement.