Perspectives in Teaching Elementary Students with Acquired Brain Injury

77 Pages·2017·0.64 MB·English

by  Hedellaine Valentin

PERSPECTIVES IN TEACHING STUDENTS WITH ABI

Grey Matter: Perspectives in Teaching Elementary Students
with Acquired Brain Injury in Ontario

By

Hedellaine Bosque Valentin

A research paper submitted in conformity with the requirements
For the degree of Master of Teaching
Department of Curriculum, Teaching and Learning
Ontario Institute for Studies in Education of the University of Toronto

Copyright by Hedellaine Bosque Valentin, April 2017
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 2

Abstract
As a result of the uncategorized status of acquired brain injury (ABI) as an exceptionality under
the Ontario Education Act (1990), students with ABI are provided minimal support in the school
setting. The literature reviewed revealed interventions to be a consistent area of research, and that
there exists a discrepancy in the field which reflects the lack of evidence-based research exploring
ABI as a recognized exceptionality. The study assumed a qualitative research approach and
collected data through semi-structured interviews with two elementary teacher participants from
Ontario schools. The study addressed the primary research question: What are the challenges
facing teachers who teach and support students with ABI? Key findings that emerged from this
research study include teachers’ knowledge on ABI, the demands of the classroom, the absence of
specific ABI protocols, and the quality of support from the home-school-community network.
Recommendations are provided based on implications influenced by the key findings. If teachers
are to establish equitable classrooms, they must be prepared with knowledge relevant to the
realities of the classroom in order to be genuine ambassadors of equity in education for all.
Keywords: acquired brain injury (ABI), special education, exceptionalities
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 3

Acknowledgements
I would like to acknowledge those who have supported me throughout this journey. I
would like to thank God for the grace of this opportunity and for the strength to have persevered
through this process and see it to the end. I would also like to express my gratitude to my
Research Advisor, Dr. Hilary Inwood, my Research Professor, Dr. Victorina Baxan, as well as
all my professors at OISE. With your guidance, I have been able to achieve far beyond the goals
I have set for myself and can truly say that I am proud of the work I have accomplished here -
you have encouraged me to keep dreaming. To my interview participants, I would like to express
my heartfelt thanks to you for your openness in sharing your experiences - you have enriched my
research greatly. To my awesome cohort at the Master of Teaching program, I am overwhelmed
with gratitude for the friendship and kindness you have shown me these past two years - I will
cherish these moments often. I would like to express my deepest gratitude to my parents, my
family, and my friends. Your constant love and support have sustained me through my trials, and
I am forever grateful for you all. Finally, to the love of my life, Stephen - I am blessed to have
you by my side and I am grateful for your endless support and encouragement, now and always.
You embolden and inspire me to work hard every day - thank you for always believing in me!
I dedicate this in memory of my beloved sister, Kae Anne Valentin, and my dear cousin
Andrea Mariano. You are forever in my heart.
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 4

Table of Contents
Abstract ............................................................................................................................................2
Acknowledgements ..........................................................................................................................3

Chapter 1: Introduction ...................................................................................................................6
1.0 Research Context ...........................................................................................................6
1.1 Research Problem ..........................................................................................................8
1.2 Purpose of the Study ......................................................................................................9
1.3 Research Questions ........................................................................................................9
1.4 Preview of Methodology..............................................................................................10
1.5 Background of the Researcher .....................................................................................10
1.6 Overview of the Study .................................................................................................12

Chapter 2: Literature Review ........................................................................................................14
2.0 Areas of Literature Reviewed ......................................................................................14
2.1 What is Acquired Brain Injury (ABI)? ........................................................................16
2.2 Implications to Students with ABI ...............................................................................17
2.2.1 Health ...........................................................................................................18
2.2.2 Cognitive impairments ..................................................................................18
2.2.3 Communication, sensory and perceptual impairments .................................20

2.2.4 Behavioural and emotional implications to student with ABI ......................20
2.2.5 Other influencing factors to recovery ...........................................................21
2.3 Impact on School Policies and Procedures ..................................................................22
2.3.1 Assessments .................................................................................................22
2.3.2 Developing Individual Educational Plans (IEPs) .........................................22
2.3.3 Interventions and strategies...........................................................................23
2.4 Challenges Facing Teachers ........................................................................................24
2.4.1 Lack of training and preparation ...................................................................24
2.4.2 Growing demands of the classroom ..............................................................24
2.4.3 Absence of standards ....................................................................................25
2.4.4 Lack of resources ..........................................................................................25
2.5 A New Category of Exceptionality in Ontario ............................................................25
2.6 Summary ......................................................................................................................26

Chapter 3: Research Methodology ................................................................................................28
3.0 Introduction to the Chapter ..........................................................................................28
3.1 Research Approach and Procedures.............................................................................28
3.2 Instruments of Data Collection ....................................................................................30
3.3 Participants ...................................................................................................................34
3.3.1 Sampling criteria ...........................................................................................34
3.3.2 Participant recruitment ..................................................................................35
3.3.3 Participant biographies..................................................................................36
3.4 Data Analysis ...............................................................................................................37
3.5 Ethical Review Procedures ..........................................................................................38
3.6 Methodological Limitations and Strengths ..................................................................39
3.7 Conclusion ...................................................................................................................40
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 5

Chapter 4: Findings .......................................................................................................................41
4.0 Introduction to the Chapter .........................................................................................41
4.1 Lack of ABI Training for Teachers Results in a Lack of Confidence in Teachers
and Diminishes Their Preparedness in Teaching and Supporting Students with ABI ......42
4.2 The Demands of the Classroom Limit Teachers from Establishing Effective
Strategies in Teaching and Supporting Students with ABI ...............................................44
4.3 Absence of a Set of Standards and Policies in Carrying Out Accommodations for
Students with ABI. .............................................................................................................46
4.3.1 In-school team meetings and IPRC meetings ...............................................47
4.3.2 Individual Educational Plans (IEPs) .............................................................47
4.3.3 Documentation of ABI and seeking extra supports ......................................49
4.4 Inadequate Support from Home-School-Community Network Presents Challenges in
Meeting the Needs of Students with ABI. .........................................................................51
4.5 Additional Challenges in the Classroom......................................................................53
4.6 Summary ......................................................................................................................55

Chapter 5: Implications .................................................................................................................57
5.0 Introduction to the Chapter .........................................................................................57
5.1 Overview of Key Findings and Their Significance .....................................................57
5.2 Implications..................................................................................................................60
5.2.1 Broad: The identification of ABI as a legal exceptionality .........................60
5.2.2 Narrow: Professional identity and practice ..................................................61
5.3 Recommendations ........................................................................................................63
5.3.1 Ontario Ministry of Education ......................................................................63
5.3.2 Ontario school boards and educational institutions. ....................................64
5.3.3 Healthcare professionals ...............................................................................65
5.3.4 Community agencies and organizations. .....................................................66
5.3.5 Families and friends. ....................................................................................66
5.4 Areas for Further Research ..........................................................................................67
5.5 Concluding Comments ................................................................................................68

References ......................................................................................................................................70
Appendices .....................................................................................................................................74
Appendix A: Letter of Consent for Interview ....................................................................74
Appendix B: Interview Questions .....................................................................................76
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 6

Chapter 1: Introduction
1.0 Research Context
Students sustaining an acquired brain injury (ABI) pose a distinct and challenging
situation to the Ontario school system. An ABI can be defined as being any type of injury
causing temporary or permanent damage to the brain after birth (Bennett et al., 2004) and mostly
refers to injury caused by trauma, such as a fall, motor vehicle accident, or severe sports impact.
ABI can also occur as a result of near drowning, suffocation, infections like encephalitis and
meningitis, tumors, strokes, and other vascular accidents, toxicity and metabolic disorders
(Savage, 1997; Garcia et al., 1998; Bennett et al., 2004).
In Ontario, students with ABI lack support in educational programming that aims to meet
curriculum expectations and standards. This lack of support is driven by an absence of explicit
identification of ABI as an exceptionality by the Ontario Education Act (1990). Amendments
were made under this act in 1980 to specify the provisions that govern special education
programming throughout Ontario school boards (Ontario Ministry of Education, 2012). Bill 82,
as the amendments are commonly known, outlines five specific categories when identifying a
student as exceptional: behaviour, communication (autism, deaf, hard of hearing, language
impairment, speech impairment, learning disabilities), physical (physical disabilities, blind/low
vision), intellectual (gifted, mild intellectual delay, developmental delay), or multiple. Students
whose abilities align with any of the five categories are provided supports in special education
programming; ABI does not fall within any of the categories or subcategories defined (Bennett et
al., 2003).
Without being overtly acknowledged as a student with exceptionalities, students with
ABI are often assessed improperly and classified as having a learning disability or other
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 7

exceptionality (Bennett et al., 2004). Brock University and the OBIA (2003) offer their
perspective on this issue by stating that these are markedly distinct from one another, although
similarities run consistent and parallel between these two conditions. The two differ quite
distinguishably by the onset of each of the conditions. This difference alone should warrant the
support of strategies and teaching practices specific to ABI, to be employed by teachers. Though
differences may be subtle, the idiosyncratic nature of ABI and its ever-changing characteristic
distinguishes it from other conditions. It is pertinent that teachers are aware of the complex
medical and health needs of students with ABI, and that, since the brain is a living organ, it is
possible that new symptoms may appear even years after the injury (Bennett et al., 2003). Zinga
et al. (2005) assert that the diagnosis of children who sustain an ABI is “more unpredictable than
that of adults as the interruption of the nervous system’s development can have a profound
effect, …[where] severe injuries can result in good outcomes while apparent mild injuries can
result in poor outcomes” (p. 3).
Many students with ABI are confronted with challenges and barriers to achieving success
in the classroom. Among these challenges are barriers are the insufficient amount of training
opportunities and support for teachers around ABI, as well as the lack of funding provided for
students with ABI (Zinga et al., 2005). According to Educating Educators About ABI (2003),
“many of the strategies and teaching practices used with students who have learning disabilities
(LD) [are also] effective when used with students who have an ABI, it is often the case that
particular strategies […] can cause great frustration with students who have sustained an ABI”
(p. 59); and, the inattention to this difference may be detrimental to the learning experience of
the student with ABI (Brock University and the OBIA, 2003). Although students with ABI may
seem to benefit from strategies and resources provided, their needs demand a more
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 8

knowledgeable and focused approach due to the complex nature of acquired brain injury (Zinga,
2005).
Another common barrier to receiving appropriate supports for students with ABI is
funding. Zinga et al. (2005) report that when school boards in the province of Ontario were
required to form an Identification, Placement, and Review Committee (IPRC) procedure in order
to identify students as exceptional, they were limited to the five specific categories of
exceptionality outlined in the Education Amendment Act (1980): behaviour, communication,
physical, intellectual, or multiple. It seems that ABI does not fit these recognized categories, and
the inclusion of ABI within these categories may challenge, and even weaken, the policy`s
efficacy in delivering services to those students who may be eligible to access them (Zinga et al.,
2005).
These are but a number of such discrepancies that may occur in schools throughout
Ontario where students with ABI encounter barriers to having their needs met in the classroom.
If teachers are expected to develop equitable classrooms, the Ontario Ministry of Education must
be diligent in laying the proper foundations in order for teachers and other educators to meet
these expectations and be ambassadors of equity and accessibility in education for all.
1.1 Research Problem
An examination of the literature on the topic of students with ABI reveals that the matter
has been discussed for decades. Significant themes in the literature include the implications of
ABI for students, the influencing factors for recovery of these students, the impact on teachers
regarding programming for ABI students and the challenges teachers face in implementing these
programs (Zinga et al., 2005). However, it is apparent that Canadian research, specifically the
studies grounded in the Ontario school system, have yet to influence the advancement of current
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 9

legislation that governs special education programming for students with ABI. This analysis of
Zinga et al. (2005) also presents incongruences with the eligibility of students with ABI for
services to support their educational needs, and notes that there is a lack of evidence-based
research exploring ABI as a categorical exceptionality in the province of Ontario. The movement
towards inclusion of students with exceptionalities in the Ontario public school system seems to
be a gradual process. It has promoted changes in curriculum and instruction; but still requires
significant development in the roles of teaching professionals and school personnel.
1.2 Purpose of the Study
The research found in this study explored teachers’ experience in working and supporting
students with ABI at two Ontario schools, including public elementary classrooms and
classrooms with some degree of special education programming, whether integrated or
specialized. It investigated the impact of the approaches and strategies in place at schools for
students with ABI. Beginning with an analysis of the current literature on the nature of ABI and
the process of reintegration of students with ABI into schools, and then an examination of the
responses from teacher interviews, I will present the perspectives of teachers in teaching and
supporting students with ABI. This investigation will focus on the educational background and
training of teachers, their preparedness in meeting the needs of students with ABI in the
classroom, the strategies and practices they use to meet the needs of students with ABI-
especially in regards to the IPRC process and other protocols, and their challenges in delivering
the curriculum to students with ABI.
1.3 Research Questions
The primary question guiding my research pertains to the experiences of teachers and
their practices: What are the challenges facing teachers who teach and support students with
PERSPECTIVES IN TEACHING STUDENTS WITH ABI 10

ABI? Secondary questions were as follows: What special education training is provided to
Ontario teachers and educators to prepare them in teaching and supporting students with ABI?
How prepared do teachers feel in meeting the needs of students with exceptionalities, especially
students with ABI? What are the instructional strategies and practices employed by teachers in
elementary schools who educate students with ABI? and, How do the instructional strategies and
practices employed by teachers in elementary schools meet the needs of students with ABI?
1.4 Preview of Methodology
The study assumed a qualitative research approach, and underlying perspectives that
align with the general views of Creswell (2007) whose works “[model] reflexivity, or self-
awareness” (p. 12). Other works that have helped to develop my perspective of qualitative
research inquiry include Hoepfl (1997), Turner (2010), Tracy (2010), Bogdan and Biklen (2006),
Denzin and Lincoln (2000), Marshall (1996), and Golafshani (2003). The instrument selected for
data collection was a semi-structured, face-to-face interview that was conducted with teachers as
research participants. A teacher participating in this study had to be a teacher in an Ontario
elementary or secondary school with experience in teaching students with ABI and had to have
worked with other school personnel throughout these experiences. The data collected was
transcribed, coded by themes and topics, sorted and categorized. The findings of this study will
be presented in Chapter Four and areas of further research will be outlined in Chapter Five, the
conclusion to the study.
1.5 Background of the Researcher
The motivation to pursue a career in education stems from my commitment to serve
others, my advocacy for equity and accessibility, and my experience in working with
differently-abled populations in the community. Thus, this topic is quite significant for me. My