STEPHANIE:

Stephanie is a 9 -year-old female who sustained a traumatic brain injury when she was an unrestrained passenger in a motor vehicle accident.  She suffered a severe brain injury with depressed right occipital skull fracture, multiple right temporal lobe contusions, diffuse cerebral edema, subdural hematoma, and hydrocephalus.    Upon arrival to the emergency room, Stephanie required an emergency tracheostomy and underwent an emergency right-sided craniotomy to control intracranial pressure.  Her intensive care course was complicated by cerebrospinal fluid leak along the incision site, evacuation of a hematoma, placement of a left-sided frontal ventriculoperitoneal shunt because of increased size of ventricles, and replacement of bone flap.  Stephanie remained on the intensive care unit for approximately one month and was then transferred to the inpatient rehabilitation unit for three weeks.  Upon discharge from the hospital, Stephanie received daily outpatient speech, occupational, and physical therapies for two months until she returned to school in the fall. 

Prior to the accident, Stephanie was a 2nd grader and mid-year transfer student to a suburban elementary school.  Pre-injury developmental and medical history was unremarkable.  Stephanie’s parents denied any history of learning, language or behavioral problems prior to the injury although they reported math to be an area of weakness for Stephanie.  Additionally, they were considering retaining Stephanie in the 2^nd grade due to the mid-year transfer.  A review of Stephanie’s report card revealed B’s & C’s throughout 2^nd grade.   

Results of a cognitive/behavioral and academic assessment performed by the school psychologist prior to Stephanie’s return to school revealed the following: 

q       Current level of intellectual functioning in the mildly mentally impairment range, with a significant difference between verbal and performance ability;

q       Verbal ability is a relative strength while she is having significant difficulty with visually presented material secondary to a left visual field neglect (i.e., failure to respond to visual stimuli on the left side of the body);

q       Severe general memory deficit with difficulty remembering and recalling information presented both verbally and visually;

q       Adaptive functioning is in the borderline range and suggests loss of adaptive skills;

q       No behavior concerns were expressed at this time

q       Broad reading and writing skills in the low average range

q       Relative strength in basic academic skills with a relative weakness in her application of the skills;

q       Timed-tasks were significantly lower;

q       Broad math skills were significantly below average for her age;

q       Lower math and language arts applications were likely related to memory and mental organization skills which were significantly delayed 

Rather than being promoted to the 3^rd grade, the case conference committee determined that it was in Stephanie’s best interest to repeat the 2^nd grade.  The least restrictive environment was considered to be placement in the resource room for language arts and math in the morning and afternoon placement was with the general education classroom for nonacademic classes. 

Because of her mother’s concern about Stephanie being transported to school by bus, she selected to transport Stephanie to school herself.  

Stephanie was adjusting well to her return to school and progressing in her academic subjects in her resource room placement.  Approximately two months into the school year, the resource teacher noted a pattern of behaviors that concerned her:

q       Stephanie’s mother frequently brought her late to school

q       Stephanie was frequently absent from school with no phone call by mother

q       Stephanie’s homework was not being completed and papers were not being signed by parents

q       Stephanie would complain of a headache around mid-morning requiring a trip to the school nurse

q       Stephanie was refusing to complete independent worksheets

q       Stephanie was talking out in class

q       Stephanie is displaying difficulty concentrating on tasks

q       Stephanie was getting into verbal arguments with peers

q       Stephanie would throw papers on the floor when corrected by the teacher

q       Stephanie spent time alone during recess  

INSTRUCTIONAL EVALUATION: 

Write a short reflection paper (not more than 4 pages) that offers (1) implications for the classroom and Stephanie’s behavior based on the results of the school psychological assessment;  (2) suggestions for a functional behavioral assessment (FBA) that her teacher might employ to identify the circumstances that impact the presence or absence of these challenging behaviors; and (3) offer suggestions for an individualized behavioral intervention plan (BIP) to address Stephanie’s challenging behaviors and the environmental, cognitive and neurological factors that elicit the behaviors reported by the teacher.   

ASSESSMENT RUBRIC 

Proficient	Emerging	Novice	Unacceptable
Reflection paper accurately describes the relationship between brain injury and its impact on behavior.  The FBA suggests 6+ appropriate antecedent events and 6+ consequential events for the behavior described.  Offers 6+ appropriate intervention strategies for managing these behavior problems.	Reflection paper fairly accurately describes the relationship between brain injury and its impact on behavior.  The FBA includes 4-5 appropriate antecedent events and 4-5 consequential events for the behavior described.  Offers 4-5 appropriate intervention strategies for managing these behavior problems.	Reflection paper incompletely describes the relationship between brain injury and its impact on behavior.  The FBA includes 2-3 appropriate antecedent events and 2-3 consequential events for the behavior described. Offers 2-3 appropriate intervention strategies for managing these behavior problems.	Reflection paper does not describe the relationship between brain injury and its impact on behavior.  The FBA includes less than 2 appropriate antecedent events and less than 2 consequential events for the behavior described. Offers less than 2 appropriate intervention strategies for managing these behavior problems.
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