Service Delivery in the Healthcare and Educational Systems for Children Following Traumatic Brain Injury: Gaps in Care

Abstract

Objective To provide a review of evidence and consensus-based description of healthcare and educational service delivery and related recommendations for children with traumatic brain injury. Methods Literature review and group discussion of best practices in management of children with traumatic brain injury (TBI) was performed to facilitate consensus-based recommendations from the American Congress on Rehabilitation Medicine’s Pediatric and Adolescent Task Force on Brain Injury. This group represented pediatric researchers in public health, medicine, psychology, rehabilitation, and education. Results Care for children with TBI in healthcare and educational systems is not well coordinated or integrated, resulting in increased risk for poor outcomes. Potential solutions include identifying at-risk children following TBI, evaluating their need for rehabilitation and transitional services, and improving utilization of educational services that support children across the lifespan. Conclusion Children with TBI are at risk for long-term consequences requiring management as well as monitoring following the injury. Current systems of care have challenges and inconsistencies leading to gaps in service delivery. Further efforts to improve knowledge of the long-term TBI effects in children, child and family needs, and identify best practices in pathways of care are essential for optimal care of children following TBI.

What Schools Need to Know about the Centers for Disease Control and Prevention's Guideline on Diagnosis/Management of Mild Traumatic Brain Injury in Children—A Commentary

“…Often, symptoms affect areas such as vision and cognition that can impact performance in school settings . This is a concern since the time spent in acute medical care is very short compared to the time children spend at school; consequently it is important for those in the school environment to be made aware of a child's mTBI . Previous reports have described a gap in communication between medical and educational settings for children with TBI .…”

“…This is a concern since the time spent in acute medical care is very short compared to the time children spend at school; consequently it is important for those in the school environment to be made aware of a child's mTBI . Previous reports have described a gap in communication between medical and educational settings for children with TBI . Thus, in order to support a child who returns to school, information about the child's injury should be provided to the school.…”

“…Within the school environment, a child with an mTBI may experience consequences of the injury that negatively impact learning and behavior. Recent reports indicate that many children with TBI require some form of academic support at school . Yet inconsistent communication between health care professionals, parents and school systems, coupled with parents' and educators' limited understanding of the possible effects of mTBI, often results in children with mTBI being under‐identified for the receipt of support services in school .…”

“…Recent reports indicate that many children with TBI require some form of academic support at school . Yet inconsistent communication between health care professionals, parents and school systems, coupled with parents' and educators' limited understanding of the possible effects of mTBI, often results in children with mTBI being under‐identified for the receipt of support services in school . Children are also unlikely to receive follow‐up in the health care system, particularly following mTBI, further increasing the likelihood that they will experience unmet educational needs .…”

An international perspective on educators’ perceptions of children with Traumatic Brain Injury

“…Therefore, children who might have ongoing physical, cognitive, or behavioral needs return home to families who are largely responsible for supporting them through the rehabilitation process, with little or no communication between medical providers and educators Haarbauer-Krupa et al, 2017). For many children with TBI, the primary service provider has become the school.…”