Background to the research

• Paediatric TBI has been shown to impact on educational attainment through deficits in memory, attention, planning, language and behavioural control. These deficits not only pose a problem for the child in attempting to gain an education but also for educators who must make allowances for that child in their teaching. While researchers have demonstrated the importance of a supportive school environment on a successful return to education, few studies have explored the understanding of educational professionals around paediatric brain injury. Given the influential role educators play in the lives of children, they represent a key figure in return to school life following injury. The purpose of this study was to investigate this topic in a population of UK educational professionals.

Research Approach

• Following a trial, the CM-TBI survey was posted to all educational establishments in NI. The study explored four independent variables: knowledge, experience, training and school type. One representative from each school was asked to complete and return the questionnaire; 388 questionnaires were returned, giving a response rate of 32%.

Main Findings

• The majority of respondents were principals, who had more than 21 years of experience in the teaching profession.
• One hundred and sixty-three participants reported that they knew someone who had acquired a brain injury, whilst 100 stated that they had personally taught a child who had a brain injury. Of these 100, 16 stated that they had received some training.
• Small, specialist schools reported the lowest number of pupils (n=12), with larger post-primary schools reporting the greatest number of students (n=1710). Some schools reported that they had no pupils with SEN, whilst one school had 415 students on their SEN register. Participants in the study were responsible for a total of 115,723 pupils, 15,748 of whom had SEN.
• In relation to the 40 items in the CM-TBI, participants tended to express greater confidence in their response to false items, with 35.5% and 26.6% disagreeing and strongly disagreeing, respectively. This is compared to 33.5% of participants agreeing with the true items and 11.8% strongly agreeing. However, many participants expressed a lack of knowledge about both the true (40.4%) and false (30.3%) questions.
• Within the domain of brain injury sequelae, 83.5% of respondents disagreed or said they didn't know if it was common for children with brain injuries to be easily angered. When asked whether children who are knocked unconscious wake up quickly with no lasting effects, 26% of respondents disagreed, 44% didn't know and 30% agreed.
• Within the domain of recovery, 98.8% disagreed or said they didn't know that children who had one brain injury were more likely to have a second. When asked if a second blow to the head could aid in memory recall, 29.1% said they didn't know, but 69.4% disagreed.
• There was a statistically significant difference on CM-TBI score between educational professionals who knew someone with a brain injury and those who did not. Those who knew someone with a brain injury were, on average, 5-points higher on the scale than those who had no knowledge.
• There was a statistically significant difference between teachers who had taught a childhood survivor of brain injury and those who had not. Teachers who had personally taught a child with a brain injury were, on average, 4-points higher on the CM-TBI than those who had no such experience. Participants who knew someone with a brain injury or who had taught a child with brain injury scored higher on the domains of seatbelts/prevention, brain damage, brain injury sequelae, amnesia, recovery and rehabilitation. Participants who had no such experience or knowledge scored higher on the domain of unconsciousness.
• No statistically significant difference was found between school types on the total score of the CMTBI or in relation to those who had received training, compared to those who had not.
• There were statistically significant, positive associations between total score and number of pupils and number of pupils with SEN. Participants whose schools had more pupils tended to score higher on the CM-TBI.

Conclusions

• In line with previous research findings, this work showed that knowing someone with a brain injury led to increased understanding of the condition among educators. As predicted, the work suggested that educators who had taught a child with brain injury would exhibit a greater understanding of the condition than those who had no such professional experience. These findings are in contrast with some previous research. However, greater experience has been shown to influence the attitudes individuals hold towards people with mental health problems in both positive and negative directions. Also, educators who knew children with brain injuries sought out information on the condition in order to meet the needs of their pupils. These individuals had not received any formal training during their education, which is consistent with a finding from the only other piece of research to explore this topic.
• Given that the prevalence of paediatric TBI has been estimated at 280/100 000, it is surprising that more educators did not have experience of or know a child with a brain injury. In addition, as the majority had more than 21 years experience in the teaching profession, it may have been expected that many more educators would have encountered children with brain injuries. It is likely that many schools are not informed about the occurrence of a brain injury or that information is not being forwarded to the correct individual.
• Reasons are suggested for the lack of a statistically significant difference between participants who had received training in childhood brain injury and those who had not. These included possible different interpretations of the term 'training'. Findings seemed to indicate that training in brain injury for teachers is organised in a reactive vs pro-active manner. The needs of childhood survivors of brain injury would be better identified (and met) were teachers and schools more proactive in questioning parents about events (e.g. infections, accidents, etc.) that might have an impact on a child's learning. Continuous professional development regarding brain injury would also enable teachers to remain abreast of the emerging evidence base regarding rehabilitation.
• It is likely that participants from larger schools have more resources and so were able to dedicate time to learning about brain injury. The statutory obligation on schools to identify and meet the special education needs of children suggests that all schools should be aware of the occurrence of paediatric brain injury. However, it is possible that the school may only be aware that a need exists and not that it has arisen as the result of a brain injury. The current research suggests that educators are not well informed about the prevalence or consequences of paediatric brain injury. The lack of understanding demonstrated may mean that such deficits are not taken into account on return to school, which may put these pupils at increased risk.
• Limitations and future directions are discussed, such as additions of further items to improve the strength of individual domains. Also, testing a larger sample, across time, would provide data on reliability, while conducting a confirmatory factor analysis would add to its validity.
• The current study limited its sample to principals, pastoral care teachers and SENCOs, due to the increased likelihood that they would have encountered a child with brain injury. However, given that every teacher has a pastoral care remit, it would have been interesting to explore the understanding of all teachers in the region. Future studies could employ email or internet-based surveys which would significantly reduce costs and enable the participation of educators with diverse experience.
• Educators exert great influence on the lives of children and play a crucial role in return to school following brain injury. This research has shown that many misconceptions exist in their understanding of the condition which is likely to adversely impact on the treatment of children under their care. Clearly, work must be undertaken to raise the profile of paediatric brain injury among educators and increase the understanding of its consequences, both in general and in relation to educational outcomes. Whilst a number of educational interventions targeted at return to school have been developed, few of these have been rigorously evaluated. Given the findings of the current work, there is a need to develop and test targeted interventions to educate members of the teaching profession on paediatric brain injury.