Tag: children

Traumatic Brain Injury in Youth

Posted on by Nicol Walsh

A Brief Overview

  • A traumatic brain injury (TBI) is an injury that affects how the brain works.
  • Approximately 1.7 million people receive traumatic brain injuries every year. Of children 0-19 years old, TBI results in 631,146 trips to the emergency room annually, 35,994 hospitalizations, and nearly 6,169 deaths.
  • Children have the highest rate of emergency department visits for traumatic brain (TBI) injury of all age groups. TBI affects children differently than adults.
  • Although TBI is quite common, many medical and education professionals may not realize that some difficulties can be caused by a childhood TBI. Often, students with TBI are thought to have a learning disability, emotional disturbance, or an intellectual disability. As a result, they may not receive the type of educational help and support really needed.
  • Students with TBI who are not eligible for special education might be eligible for a Section 504 plan.
  • TBI is a category of eligibility for special education under the Individuals with Disabilities Education Act (IDEA) and the Washington State Administrative Code (WAC)
  • Washington law requires evaluation referrals in writing. The state provides a form for referrals, downloadable from a website page titled, Making a Referral for Special Education. The person making the referral can use the form or any other format for their written request.
  • PAVE provides a Sample Letter to Request Evaluation.

Full Article

A traumatic brain injury (TBI) is an injury that affects how the brain works. TBI can affect people of all ages and backgrounds. The exact definition of TBI, according to special education law, is referenced later. This injury can change how the person thinks, behaves, and moves. A traumatic brain injury can also change how a student learns and behaves in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:

  • thinking and reasoning,
  • understanding words,
  • remembering things,
  • paying attention,
  • solving problems,
  • thinking abstractly,
  • talking,
  • behaving,
  • walking and other physical activities,
  • seeing and/or hearing, and
  • learning.

The term TBI is not used for a person who is born with a brain injury or for brain injuries that happen during birth.

How is TBI Defined?

The definition of TBI below comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.

IDEA’s Definition of TBI

The Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as

“…an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.8(c)(12)]

Washington State’s Definition of TBI

“Traumatic brain injury means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” (WAC 392-172A-01035)

What Are the Signs of Traumatic Brain Injury?

The signs of brain injury can be quite different depending on where the brain is injured and how severely. Students with TBI may have one or more difficulties, including:

Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.

Difficulties with thinking: Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, students with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a brief time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.

Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Students with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A student with TBI may not have all the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it is hard to predict how an individual will recover from the injury. Early and ongoing help can make an enormous difference in how the student recovers. This help can include physical or occupational therapy, counseling, and special education.

It is also important to know that, as children and youth grow and develop, parents and teachers may notice new problems. This is because, as young people grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for them to learn new skills that come with getting older. Sometimes families and teachers may not even realize that the student’s difficulty comes from the earlier injury.

How to Access Support

If a student is having a tough time at school and has a known or suspected disability, the school evaluates to see if the student qualifies for special education. A student is protected in their right to be evaluated by the Child Find Mandate, which is part of the federal Individuals with Disabilities Education Act (IDEA). if they do have a disability and, because of the disability, need special services under IDEA. These services can include:

Early Supports for Infants and Toddlers (ESIT): A system of family centered services to support infants and toddlers with disabilities (before their 3rd birthday).

Special education and related services: Services available through the public school system for school-aged children and youth, including preschoolers (ages 3-21). It is important to remember that the IEP is intended to be flexible. It can be changed as the family, school, and the student learns more about what support and services are needed at school.

If the student is not eligible for special education, a Section 504 Plan may help. Under Section 504, students with disabilities can access the accommodations, aids, and services they need to access and benefit from education. It also protects students from discrimination based on disability.

When students with TBI return to school, their educational and emotional needs are often quite different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes which may result in mental and/or behavioral health needs. The student’s family, friends, and teachers also recall what the student was like before the injury. These and other people in the student’s life may have trouble changing or adjusting their expectations of the student. Therefore, it is important to plan carefully for the return to school.

Tips for Families and Caregivers

  • Learn about TBI. The more you know, the more you can help yourself and your student.
  • Work with the medical team to understand your loved one’s injury and treatment plan. Ask questions. Share what you know or think. Make suggestions.
  • Keep track of your loved one’s treatment. A 3-ring binder or a box can help you store this history. As your youth recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or place it in a box.
  • Plan for your student’s return to school after the injury. Contact the school. Ask the principal about an evaluation for special education or a Section 504 plan. You may also consider asking the medical team to share information with the school.
  • Talk to other families whose loved ones have TBI.
  • Stay connected with your student’s teacher. Tell the teacher about how your student is doing at home. Ask how your student is doing in school.
  • Sometimes students who do not qualify for the IEP will qualify for accommodations and other support through a Section 504 Plan. PAVE has an article about Section 504, which provides an individual with protections throughout the lifespan.
  • Protections against bullying and discriminatory discipline are aspects of Section 504. Watch PAVE’s video, Behavioral Health and School: Key Information for Families.

Help from PAVE

PAVE’s Parent Training and Information (PTI) team provides 1:1 support and additional resources. Click Get Help or Call 1-800-5PARENT (572-7368) and select extension 115, English or Spanish available, to leave a dedicated message.

For information, help during a crisis, emotional support, and referrals:  

  • Suicide Prevention Lifeline (1-800-273-TALK): After July 16, 2022, call 988.
  • Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.
  • TeenLink (1-866-833-6546; 6pm-10pm PST)
  • Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide.

Further information on TBI:  

Family Support

  • PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.
  • Department of Health and Human Services (DSHS) has a link to Washington TBI Support Groups.
  • Brain Injury Association of America works to create a better future through brain injury prevention, research, education, and advocacy.
  • Brain Injury Alliance of Washington is dedicated to improving the quality of life for people who have sustained a brain injury and their families by providing services such as information resources, legislative advocacy, public awareness campaigns, and support groups.

Parent to Parent (P2P) Connects Caregivers Statewide for Support

Posted on by Nicol Walsh

A Brief Overview

Full Article

Family caregivers for children with disabilities and special healthcare needs may feel isolated or uncertain about where to seek help for their children and themselves. A place for support is Parent to Parent (P2P), a network that connects families to trained parent volunteers who have experienced a similar journey with their own children. In addition to resources and information, parents share personal support and encouragement.

Families new to the disability world can find preliminary information and request help right away by filling out a short form on a website page designed just for them, hosted by The Arc of Washington: Getting Started/Contact Us…Welcome to our World.

The first P2P program started in Nebraska in 1971. Programs started in Washington State in 1980. A national P2P network was established in 2003 to provide technical support to the statewide networks, with a goal to reach all 50 states. P2P USA provides an historical timeline.

Washington has a network of P2P programs that serve every corner of the state. The Arc provides support to the regional programs and links them to national P2P resources. Families can go to arcwa.org to find a list of P2P coordinators, organized by region and listed under the counties served.

¿Hablas español? Para más información y hacer referidos, llama a su condado abajo: Coordinadores de Enlance Hispano.

Families can request a parent match 

When reaching out to the local P2P network, families can request a “parent match.” P2P leaders will locate a helping parent volunteer who has a similar lived experience and help the families get connected. From there, a supportive relationship can develop, where empathy, hope, and strength are shared.

Helping Parents cannot provide all answers, but they share insight, solidarity, and role modeling. They also share the joy and pride they’ve experienced while watching their child grow and achieve. A phrase commonly shared is: “I know, and I understand.”

In keeping with evidence-based practices promoted by national and state P2P organizations, the helping parent volunteers are training following a specific process and all personal information is kept confidential.

P2P services are free and include:

  • Emotional support for family caregivers of children with special needs
  • Referrals for community resources
  • Information sharing about disabilities and medical conditions
  • Family matching with trained helping parents
  • Social and recreational events
  • Training for parents who would like to become helping parent volunteers
  • Disability awareness and community outreach

Someone to listen and understand

Washington’s statewide P2P is funded by The Arc of Washington State, the Developmental Disabilities Administration (DDA), and the Department of Health/Children with Special Health Care Needs. Individual county programs receive funding from host agencies, county DDA offices, the United Way, local grants, private donations, and more.

The Council for Exceptional Children published a research paper about P2P in 1999. Respondents to a national survey reported the following benefits from participating in P2P:

  • Someone to listen and understand (66 percent)
  • Disability information (63 percent)
  • Care for my child (58 percent
  • Ways to find services (54 percent)

Statewide, various agencies and family-led organizations host local P2P programs. An interactive map of Washington State provides an easy way to locate information in English and Spanish about a P2P program in your area.

Another way to begin is to contact the statewide P2P coordinator, Tracie Hoppis, by sending an email to: parent2parentwa@arcwa.org.

Respite Offers a Break for Caregivers and Those They Support

Posted on by Nicol Walsh

A Brief Overview

  • Respite offers a short-term break for caregivers and those they support. This article provides information and resources to get started seeking respite services.
  • Lifespan Respite Washington, a program of PAVE, provides vouchers with up to $1,000 per qualifying household, to fund respite care.
  • Pathways to Respite, an online booklet published by several Washington agencies, provides further guidance. The guidebook defines caregiver stress and explains why breaks are critical to everyone’s well-being.
  • The ARCH National Respite Network and Resource Center provides a free, downloadable 17-page guidebook, ABCs of Respite: A Consumer Guide for Family Caregivers. ARCH stands for Access to Respite Care and Help. The ARCH resource center also provides information and resources specific to Respite During COVID-19.
  • Veteran’s families may qualify for respite through the Program of Comprehensive Assistance for Family Caregivers (PCAFC), operated by the United States Department of Veterans Affairs. The final section of this article includes additional military-specific resources. NOTE: There are upcoming changes to this program. See the information at the Hidden Heroes website.

Full Article

Modern families come in many styles. Primary caregivers may be parents, and they might be other relatives (kinship providers), friends, or neighbors. “Care recipient” is a term for anyone who requires assistance for daily living. “Caregiver” refers to anyone who provides regular assistance to a child or adult with a chronic or disabling conditions.

Caregivers and care recipients develop unique rhythms and relationships. Sometimes, both need to press pause and reset. Pathways to Respite, an online booklet published by several Washington agencies, provides guidance about caregiver stress:

“Putting the needs of everyone else before your own may solve an immediate stress; however, in the long-term, it can lead to increased anxiety, frustration, overwhelming feelings, resentment, depression, burnout, and even illness. Whether you think of yourself as a caregiver or not, these are all signs of caregiver stress.”

Respite offers a short-term break for caregivers and those they support. Time apart can boost well-being for all: While caregivers temporarily shift their focus to self-care, care recipients have time to meet new people and explore new interests.

Finding an appropriate respite service and organizing payment can feel challenging. This article provides guidance to simplify the steps.

Check standards and safety measures

When researching a respite agency, caregivers can assess whether the agency meets standards and is following appropriate safety measures, especially during the COVID-19 pandemic.

Lifespan Respite Washington provides a checklist with questions to consider. Here are a few examples:

  • How are the workers selected and trained?
  • Can the respite worker administer medications or assist with medical tasks?
  • If the provider will be driving the care recipient, do they have a valid driver’s license?
  • How are emergencies and problems handled?
  • What safety measures are in place to protect against COVID-19?

Registered, publicly funded respite providers are required to meet certain standards and qualifications, including background checks and training. The public agency that pays for the service is responsible to track and share information about those procedures and quality measures. If respite is paid for by private medical or long-term care insurance, providers must meet the insurance company’s standards. Caregivers can ask an insurance company representative to explain the standards and how they are upheld.

The ARCH National Respite Network and Resource Center provides a free, downloadable 17-page guidebook, ABCs of Respite: A Consumer Guide for Family Caregivers. ARCH stands for Access to Respite Care and Help. The ARCH resource center also provides information and resources specific to Respite During COVID-19.

What respite services would be most helpful?

Respite includes a broad range of services. Some organizations offer short-term, overnight stays in their facilities and some provide daytime services. Some respite services are delivered into the home, including these examples:

  • personal hygiene care
  • meal preparation
  • light housekeeping
  • companionship, activities, or supervision

Community Living Connections (CLC) provides an online assessment to help caregivers figure out what type of help they may want or need. Washington State’s CLC is part of a national collaborative that includes the U.S. Department of Health and Human Services, the Veterans Administration, and the Centers for Medicare & Medicaid Services.

Washington’s Pathways to Respite booklet includes “fill-in-the-blanks” tools to help define needs, including the following example:

“I would like to take a break, but I am concerned that___________” and “If I had some time to myself, I would _____________.”

Pathways to Respite was developed by Informing Families, a resource of the Washington State Developmental Disabilities Council, in partnership with the Washington State Developmental Disabilities Administration, Aging & Long-Term Support Administration, and PAVE, which administers Lifespan Respite WA.

Determine payment to choose a provider

If a family will pay directly for respite services, providers are easily found online. Here are some suggestions to launch a search:

  • Adult Day Services Washington State
  • After-school programs children with special health care needs Washington State
  • In-home respite care Washington State

Another way to navigate the provider system is to connect to a website managed by SEIU 775:  The Service Employees International Union is comprised of independent service providers who have a collective bargaining agreement with Washington state’s Department of Social and Health Services (DSHS).

If a care recipient is eligible for respite through private medical insurance, the insurance company will list approved providers.

Publicly funded respite programs also provide lists of registered providers. Family caregivers who have respite funding through Medicaid or the Developmental Disabilities Administration (DDA) can use CarinaCare.com, an online tool to connect individuals with providers. A Who’s Who page describes provider credentials.

Vouchers are available from Lifespan Respite WA

Lifespan Respite WA provides information about how to apply for a voucher. Vouchers are “mini-grants” for unpaid caregivers supporting a family member, friend or neighbor who has a special need or condition. The vouchers, up to $1,000 per qualifying household, can be used with any of the registered Lifespan Respite Providers. 

To qualify, the caregiver or care recipient cannot be enrolled in a respite or Medicaid personal care program. (Exceptions are made for persons on a waiting list and not scheduled to get respite services within 30 days of applying for a Lifespan voucher.) Additionally, a caregiver must:

  • Be unpaid
  • Provide 40 or more hours a week of care
  • Not receive respite from any other program
  • Live in Washington State
  • Be unable to afford to pay privately for respite care

Who qualifies for free or low-cost respite care?

In Washington State, eligibility for free or low-cost respite services may depend on a person’s circumstances or the category of disability.

  • Seniors and Adults with Disabilities
    • Seniors 65 and older who meet functional and financial eligibility can receive a variety of services through Home and Community Services (HCS).
    • Unpaid caregivers of adults 55 and older who meet functional and financial eligibility can receive respite care and other needed support services like caregiver education, support groups, housework and errands and other services.
  • People with Developmental Disabilities (All Ages) and Children with Disabilities
    • Children and adults with developmental disabilities who meet eligibility criteria for Developmental Disabilities Administration (DDA) may be able to receive respite, personal care, assistive technology, community engagement support, and other services provided through Home and Community-Based Services and Community First Choice (CFC).
    • Children with disabilities who are not DDA eligible may still be able to receive CFC through DDA.

How to apply:

Foster care respite

Respite care is available for foster parents licensed by the Division of Licensed Resources (DLR), a Tribal agency, or a Child Placing Agency (CPA). Unlicensed relative caregivers or those determined to be “suitable person placements” also can receive respite, as can caregivers assigned by the Department of Children, Youth, and Families (DCYF) or a Washington Tribe. 

Child Specific Respite (CSR) is linked directly to the medical, behavioral, or special needs of an individual child. CSR authorizes respite relief to families providing care to a child placed by DCYF on a case-by-case basis, consistent with the written service plan for the child.

Veterans and Military Family Caregivers

Veteran’s families may qualify for respite through the Program of Comprehensive Assistance for Family Caregivers (PCAFC), operated by the United States Department of Veterans Affairs. PCAFC offers up to 30 hours of respite: Program options, eligibility and the application process are described in a downloadable booklet published Oct. 1, 2020.

The Elizabeth Dole Foundation and the U.S. Department of Veterans Affairs offer Respite Relief for Military and Veteran Caregivers, no-cost, short-term relief with the help of in-home care professionals. See Hidden Heroes for further information.

Active-duty military and Activated Reserve or National Guard family caregivers may be eligible for respite care through TRICARE, the military healthcare system. Here are resources for military family caregivers:

  • Respite care for primary caregivers of service members injured in the line of duty can be found on the TRICARE website.
  • Extended Care Health Option (ECHO) can be a respite resource for caregivers of non-military family members.
  • Some installations have respite funding available when the care recipient is enrolled in the Exceptional Family Member Program.
  • Coast Guard family caregivers have the Special Needs Program which may offer respite or funding for respite:
  • Coast Guard Mutual Assistance has Respite Care Grants available for eligible Coast Guard clients who have responsibility 24 hours per day to care for an ill or disabled family member who lives in the same household.

Census 2020: Submit Your Response to Ensure Schools and Other Programs get Funding

Posted on by Nicol Walsh

The United States Census collects information to figure out how to spend about $1.5 trillion each year. Communities get federal money based on how many people of various ages live there. Money for special education, foster care, children’s health insurance and many other programs is distributed more fairly when the federal government has an accurate count of people living in each community.

The federal government counts citizens only every 10 years, so communities where people are undercounted might not get the money they need for a full decade. According to Count All Kids, the 2010 U.S. Census missed more than 10 percent of children under age 5. Count All Kids provides materials to help families understand why submitting accurate information is important. If a two-year-old isn’t included as a household member, for example, the community will have less money for education, childcare, and other services until that child has a chance to be counted at age 12.

A one-minute YouTube video with Sesame Street characters is a family-friendly way to learn more about Census 2020. For another musical take on why an accurate count is critical, talk show host and comedienne Samantha Bee shared a song about the Census by Baltimore rapper TT The Artist on her stay-home version of the show, Full Frontal.

The National Association for Family, School and Community Engagement (NAFSCE) provides materials to help families understand how to complete their census forms and why their accurate response is important. A recorded webinar from March 30, 2020, is available on YouTube: The 2020 Census and Equity – Why It Matters and How You Can Help.

Minority communities suffer when children aren’t counted

NAFSCE notes that poor and racial minority communities tend to suffer most when families don’t count their children: “Young children had by far the highest net undercount of any age group in the 2010 census. Black and Hispanic children are missed at more than two times the rate of white children.”

Homes received Census forms in the mail this winter/early spring. The questions take about 10 minutes to answer and the responses can be filed online, by phone, or by mailing in a paper form.

In Washington, the Office of Financial Management oversees a Complete Count Committee to help the public access and submit forms to include all members of their family. The state’s website includes a map of legislative districts that are drawn based on Census data and other information about programs that are impacted by the numbers:

“For every 100 households missed in the 2020 Census count, the state could lose up to $5.8 million, which would affect the ability to support children, veterans, senior citizens and middle- and low-income families adequately. An accurate count of Washington’s communities will ensure the fair distribution of taxpayers’ funds and political representation.”

Household information is confidential

On pages that address questions and concerns of families, the Office of Financial Management includes information about confidentiality and privacy protections: 

“The Census Bureau collects data for statistical purposes only. It combines your responses with information from other households or businesses to produce statistics, which never identify your household, any person in your household, or your business. Your information is confidential. By law, the Census Bureau will never identify you individually.

“Title 13 of the U.S. Code protects the confidentiality of all your information and violating this law is a crime with severe penalties. In addition, other federal laws, including the Confidential Statistical Efficiency Act and the Privacy Act, reinforce these protections. The penalty for unlawful disclosure is a fine of up to $250,000 or imprisonment of up to 5 years, or both.”

Beware of scams: Use official forms from snail mail

CensusOutreach.org provides a timeline for 2020 reporting. Families receive notifications by mail and are encouraged to submit response by the end of April. The last day for households to self-respond online, by phone or by mail is July 31, 2020. The Census Bureau will not email or text people for the 2020 Census and encourages people to beware of scams: Do not open or respond to any links sent by email or text that reference the Census. Official forms come through U.S. Mail.

Hard to Count Maps 2020 provides an interactive map that shows how various states are doing in collecting census data and provides state-by-state details about return rates and where to go for further information. If online access is difficult, Washington families can contact the state Office of Financial Management by phone for more information: 360-902-0584.