216 Practice Issues in School Neuropsychology

BEST PRACTICES IN SCHOOL REENTRY

Obviously, a great deal of variance and differences in neuropsychological I sequelae across the conditions are covered in this chapter, with additional I variance within each condition. Additionally, these conditions may yield I more generalized impairment, or more specific impairment in cases where I neurological impact is more localized. However, due to the complexity Л many cognitive processes, even localized damage may impact many neuro-1 cognitive tasks, which involve multiple areas of the brain. Nonetheless, I some general guidelines appear to be applicable in most cases when a chilfl reenters school after experiencing an illness or injury that impacts neuro-1 cognitive functioning:

• If feasible, a school neuropsychologist should meet with medical per­ sonnel who have been providing the most recent care for the student Medical records should be obtained and reviewed to evaluate the severity of illness /injury and to determine whether there are indications of specific neurological dysfunction or if the impact was fairly general­ ized. Any delineated cognitive or behavioral residuals should be noted. I If any objective assessments of function have been completed, those I records should be specifically reviewed. Prior school records may be I provided to medical and psychological personnel providing acute care I and/or initial rehabilitation for the child or adolescent for information about pretreatment or injury performance.

• The school neuropsychologist should gather as much information as possible about the student's functioning prior to the illness or injure If the child has previously received special or remedial services, those associated educational and psychological records will be useful. If the child has been typically developing, any general evaluations of] academic or cognitive skills will be useful. It may be helpful for the] teachers and/or parents to complete rating scales or checklists to describe the child's functioning prior to the illness or injury. The Behavior I Rating Inventory of Executive Functioning (BRIEF) (Gioia, Isquith, Guy,M Kenworthy, 2000) or the Neuropsychological Processing Concerns Checklist I for School-age Children and Youth (Miller, 2007) would be useful for this! type of evaluation.

• The school neuropsychologist should meet with the parents to gain their perspective on residual problems and to establish a home-school col-j laborative relationship for planning reentry.

• If the child is still considered to be in an "acute" phase of the injury or illness, a full neuropsychological battery is probably not indicated at this point. The school neuropsychologist may complete some brief assess­ ments to establish current baselines of neurocognitive status.

School Reentry for Children Recovering from Neurological Conditions 217

• The school neuropsychologist should consult with receiving teachers to provide an overview of any deficits at initial reentry and to describe the potential educational impacts and needed accommodations for initial reentry. These accommodations might include shortened school days, alternative modes of testing, note-takers, and development of a consist­ent routine. Specific training and/or information may need to be pro­vided to teachers and other school personnel.

• After the child has been in school for a few days (five to ten days), it may be useful for the teacher to complete one of the checklists used to evaluate pre-illness/injury status, and also for baseline comparisons.

• Many children may experience social-emotional residuals and/or spe­ cific behavioral residuals related to their condition. It may be useful for the school neuropsychologist to meet with the child's peers, within the limits of confidentiality, to discuss some of the associated changes in the student. Additionally, it may be beneficial to plan specific activities for the social reintegration of the student.

• Depending on the apparent needs of the child, the school neuro­psychologist along with other educational personnel may initiate the process for either a 504 plan or for possible disability for special education services under either Traumatic Brain Injury (TBI) or Other Health Impaired (OHI). Individual 504 plans typically are for more mild disabilities and conditions with minimal educational impact and can be implemented on a shorter-term basis. The 504 plan also requires less formal assessment and involves accommodations within the educational program and setting rather than in the direct provision of services. If there appears to be longer term or more significant residual educational impact of the injury or illness, the student may be referred for evaluation and services under Other Health Impaired (OHI) or Traumatic Brain Injury (TBI) special education categories. While the residuals of different conditions may be similar and both are "acquired" to some extent, the specific classification appears related to the basis of the residuals; (i.e., illness vs. injury).

• Related to the initiation of consideration for accommodations or educa­tional services, a full comprehensive neuropsychological battery may be useful at this point. As discussed previously, a full battery may not be indicated in cases where the child's neurological status is not fully stabilized or is still considered to be in an acute or recovery phase. Partial batteries may be indicated in these cases. A full battery may also not be indicated in two other situations. First, if there appears to be minimal neurocognitive or educationally relevant residuals, a full bat­tery may not be warranted. This does not mean that some accommo­dations and/or psychosocial supports are not provided, but it may be