USING TECHNOLOGY TO HELP STUDENTS WITH TBI TRANSITION FROM COLLEGE TO EMPLOYMENT

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USING TECHNOLOGY TO HELP

STUDENTS WITH TBI TRANSITION

FROM COLLEGE TO EMPLOYMENT

Anne Leopold, MSc

39th Annual Brain Injury Rehabilitation Conference, Williamsburg

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PROJECT CAREER

Anne Leopold, MSc

Philip Rumrill, Jr., PhD, CRC Eileen Elias, MEd,

Karen Jacobs, EdD, OTR/L, CPE, FAOTA, Deborah Hendricks, EdD,

Elaine Sampson, MS, CRC Amanda Nardone, BS,

Callista Stauffer, MEd Hui Chen

United States Department of Education

Office of Special Education and Rehabilitation Services

National Institute on Disability and Rehabilitation Research (NIDRR) #H133A130066

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Outcomes for Individuals with TBI

• Devastating impact on the individual, family, and society

– Limitation in communication, cognitive, and emotional domains often remain

– Disparities in academic & employment outcomes

– Lower grades and higher dropout rates

– Difficulty attainting and keeping employment

 62% employed at time of injury; 31% employed 2 years after injury

 75% lose their jobs within 90 days if do not have adequate supports

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What can we do

Identifying the problem and

applying what we know –

best

practices …

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Identifying the Problem

•

Two of the most prominent barriers reported by

college students with TBI are (a) limited access to

supports to help them overcome cognitive and

academic limitations and (b) lack of career-related

services to prepare them for the world of work

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Best Practices

from the Assistive

Technology Field

• Assistive technology (AT)

– Generally defined internationally as: any item, piece of equipment or product systems, whether acquired commercially, off the shelf, modified or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities.

• Cognitive Support Technologies (CTS)

– a class of AT designed to help with cognitive functioning - memory, attention, concentration, planning, etc.

Scherer MJ. (2012). Assistive Technologies and Other Supports for People with Brain Impairment. New York: Springer

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Cognitive Support Technologies

• Specialized vs Universal

Universal devices are used by individuals with and without disabilities. They are becoming less expensive, more advanced, easier to use, and don’t stigmatize the

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Best Practices

from Vocational

Rehabilitation

• Case Management

• Individualized plan for employment

• Vocational goals and services to achieve goal

• Comprehensive services, including: information and referral, assessments, counseling and guidance,

physical restoration, vocational training or other post-secondary education, job search, job placement and job coaching, supported employment.

• Develop relationships with employers

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NIDRR – Project Career

Development of an Interprofessional Demonstration

to Support the Transition of Students with TBI from

Postsecondary Education to Employment

Cognitive Support Technologies

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What

 5 Years (2013-2018)

 150 civilian and military students with TBI attending 2-and 4-year undergraduate institutions, including:

and institutions in proximity to the three universities

 Continuous quality improvement driven by regular process and impact evaluation

 Regular Advisory Board Meetings to share lessons

learned and obtain feedback for addressing challenges

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Who

Project Career Team

Philip Rumrill, Jr., PhD, CRC

Project Director, Kent State University

Callista Stauffer, MEd

Technology and Employment Coordinator, Kent State University

Eileen Elias, MEd

Assessment and Technology Manager, JBS International

Anne Leopold, MSc

Assessment and Technology Expert, JBS International

Karen Jacobs, EdD, OTR/L Site Manager, Boston University

Amande Nardone, LCSW

Technology and Employment Coordinator, Boston University

Deborah Hendricks, EdD

Site Manager, West Virginia University

Elaine Sampson, MS, CRC

Subject Matter Experts

Marcia Scherer, PhD, MPH, FACRM Assistive Technology Training

Consultant, University of Rochester Physical Medicine and Rehabilitation

Joseph Cannelongo, MA, LPC, CRC Vocational Services Consultant, Advocare Incorporated

Brian McMahon, PhD, CRC, CCM, NCC External Evaluator,

Virginia Commonwealth University Medical Center

Advisory Board Members

Allie Murie, Robert Fraser, Marilyn

Spivack, Matthew Turk, Theresa Rankin, Rick Briggs, Valerie Fletcher, & John Kemp

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How

Comprehensive Assessment and Planning

Matching Person and Technology and Vocational Needs

Training and TA for

CST use

Mentoring Internships Accommodations Seminar/Webinar

Post-Graduation Support

Cognitive Support Technology iPad and Apps

Case Management Individualized Services &

Supports

Technology and Employment Coordinator

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Experiences with Technologies Assessment of Functional Need Objective Need Knowledge and Information Expectations of Benefit Personal Preferences and Priorities Person with

Disability Assessment ofPredisposition

Subjective Need, incl. • Task worthiness • AT use worthiness Follow-Up Use Realization of benefit Enhanced performance of activities Enhanced participation Subjective well-being

Personal Factors Support

Decision-Making & Selection

Device Comparison & Trial use •Device ratings •Desired device modifications •Training needs/desires •Written plan Provider

• Social and Economic Priorities

• Legislation & Laws

• Attitudes of Family/Friends & Key Others

• Support from Family/Friends & Key Others

• Availability of Products

• Affordability of Products

• Availability of appropriate professionals

• Opportunities and services

Matching Person and Technology

(MPT) Model

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Service and Support Delivery

-the iPad

• MPT Assessment to identify

students’ needs and preferences as well as past and current

experiences with technology

• Individualized technology training and technical assistance for iPad use

– TATE: Training Assistive

Technology in the Environment Toolkit

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Apps as CSTs

Attention/Memory

• AudioNote

• Notability

• Voice Dream Reader

Emotion/Stress • Calm • Breath2Relax Planning/Organization • Planner Plus • iThoughts • 30/30 • Week Calendar Reminders • Due • Alarmed

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Outcomes After 1 ½ Years

• 56 Participants

– 7 dropped out

– 5 graduated and are still receiving services

• Age range: 18-52 (Mean=27)

• Military: 25% Gender Male (58.9%) Female (41.1%) Race/Ethnicity Caucasian/White (87.5%) African American/Black (7.1%) Hispanic/Latino (7.1%)

American Indian/Alaska Native (3.6%) Other (3.6%)

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Outcomes continued

Year Freshman (33.9%) Sophomore (19.6%) Junior (12.5%) Senior (25%) Other (8.9%)

• Full time students: 66%

Cause of TBI

Motor Vehicle Accident (37.5%) Combat/IED (16.1%)

Sports (16.1%) Fall (14.3%)

Assault/Gun Shot (7.1%) Other (8.9%)

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Trends to date…

•

After 6 months, participants have more

positive perspectives on technology and more

positive overall experiences with current

technology uses.

•

After 6 months, participants indicate

preferences for being more active and social,

and being more positive and independent.

•

After 6 months, participants indicate greater

satisfaction overall.

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Experiences to date…

Project Challenges Time Resistant to Suggestions /Support Barriers for using CST Time Frustration Barriers to Obtaining Empoyment Difficulties finding resources/not knowing how to get there Lack of direction Lack of understanding/ awareness for requirements Cognitive Challenges Memory Attention/ Focus/ Concentration Processing Other Challenges Living situation Loss Finances Physical Challenges Seizures/ migraines/ headaches Sleep Vision Positive Outcomes Actions taken by participant Benefits from Apps Improvement in emotions/ mood Obtained employment School performance Mentor Psychological Challenges Anxiety/ Depression/ Stress Frustration Irritability/ Agitation Services and Supports* Search for fiinancial aid/ scholarship General counseling Help with health insurance

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Insight from a participant

“I think the mentoring part of Project Career has been the most beneficial thing for me. Even though I have work experience and I've been in the Marines, I really did not know much about the field of computer science or anyone currently working in the field. My mentor talked with me on the phone for over two hours the first time and as a result, I completely changed the classes I'm taking this summer to better fit what I actually want to do for a career. If it wasn't for him, I would have wasted a lot of time on programming classes that wouldn't have ultimately helped me that much. I really encourage some of the younger students who may be more hesitant to work with an experienced mentor. My mentor has so much experience and has had a lot of

different jobs so I feel like I'm learning a lot from him and now have a better sense of what I want to do.”

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Lessons Learned

• Students may experience a variety of challenges and may have multiple responsibilities (e.g., school, work, family,

disability) – it is essential to meet the students where they are at.

• Students often seek help for maneuvering administrative tasks (e.g., registering for classes, completing financial aid

application), writing resumes and cover letters, applying for graduate school, and learning to use Excel, Word, and

PowerPoint.

• Students benefit greatly from mentoring relationships and

internships/paid work. Many of them have not had a job since before their injury. It helps them build confidence and specific job skills.

• The strength of the program is that students, for the first time, receive a lot of individualized attention.

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Questions & Thoughts

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Contact Information

Anne Leopold, MSc

Research Analyst / Project Manager

240-645-4135

–TATE: Training Assistive