PABI Plan - The Sarah Jane Brain Project

gains, development of spoken language, and social skills development in young adults 10-15
years following their acquired brain injury event.
Severe needs post PA/TBI. Individuals who have had severe TBIs need comprehensive and
expert medical care, which anticipates and treats the particular sequalae of acquired brain injury
on the body systems as the individual ages in adulthood. It is very difficult to find adult PCPs
and specialty physicians who feel willing and competent to take on the myriad of unknown and
potentially very complex outcomes of ABI on a physical system that was traumatized during a
crucial period of development. Even in environments that have rich and long standing histories
of providing medical care for both adults with acquired brain injuries and children with acquired
brain injuries, it is difficult to find physicians who are willing to accept an individual with an
acquired brain injury in childhood or adolescence to serve as a PCP for that individual as an
adult. As a result, the pediatric rehabilitation physicians and therapists continue to follow their
patients into their twenties and thirties.
School to Work
The scaffolding is in place to support the transition from school to post secondary education or
work through the IEP process, mandated district based school transition programs, and
partnerships between the Department of Education and the Division of Vocational Rehabilitation
in many states. These transition programs have been well articulated and mandated to begin no
later than age 14. They effectively bridge the entire transition into adult life through Job
Accommodation Network programs, the Division of Vocational Rehabilitation Workforce
Centers, and college Learning Disabilities Student Centers. Model programs such as the Schoolto-Work
Alliance Program seamlessly bridge the transition by beginning in middle school with
interest inventories, prevocational coursework, and life skills curriculum embedded completely
in the public school building. As the student enters high school, the balance in the program
shifts to include more outside the school placements, with part day spent in the work place and
part day in the public school classroom. Finally, after graduation from public school at age 21,
supportive programs in the Division of Vocational Rehabilitation continue to provide specialized
counseling, follow-up, coaching, and other assistance through age 25.
While the comprehensive services and seamless transition appears on paper in every district,
these programs are marked by extreme variability in the quality of services provided. One school
district’s transition program may be pertinent, comprehensive, and prepare the student well for
development of realistic goals as well as the skills needed to get and keep a job, while another
district may fail in this regard. In some states outcome evaluation of the adequacy of the
transition program is being taken very seriously and indicators of success (for example, Indicator
13 evaluating the implementation of the transition services program for all student who have
IEPs and Indicator 14 providing for follow-up of functional outcomes of the graduates of this
transition program) are being reviewed. Some of the early data on outcomes and efficacy of this
program suggest very strongly that children are not being prepared adequately in terms of
emotion regulation, executive functions, and management of frustration. They appear to be
equally successful with their non-special education peers in terms of landing a job but they have
a great difficulty keeping the jobs that they acquire. Investigation of the specific ingredients of
school transition programs that are effective, as demonstrated by high proportion of students
working five years after graduation from public school, is clearly warranted.
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