Developing the College Program for Students with Brain Injury
I was always interested in how you think about your thinking. Then I met a student on campus, and started to have coffee with her, and discovered she was really struggling in some areas of learning and campus life that I could probably have skills and knowledge to help her with. I started to look around and realized there were really no formal programs for students with brain injury while they were in college.
I think we all pretty much know that it’s difficult to get a large federal grant these days, so what I did instead was I went to our clinic director, and I asked him if we could provide clinical services through the clinic as speech pathologists — and he said yes, we could. Then I approached the department of vocational rehabilitation in Minnesota, and explained to them the coaching approach that we use with students, which is where we only meet with them once a week, and we really, explicitly instruct them to think about their thinking and think about their problem solving and taking care of some of these issues their having on campus themselves. And they agreed do set up a contract with us. That has allowed us to provide these services, then at the same time, those same individuals can either opt in to the research part of the program, which is basically the exact same except we get to collect data and save the data. Or they can opt out of it. It’s up to them.
What happened is, it’s generated just enough funds for us to keep the research arm of the lab going. We’ve been slowly collecting data on our students using this coaching approach. We have really good outcomes. Every student that has been through the program who has progressed to graduate has, indeed, graduated with good academic standing and gone on to get jobs. We’re really excited about that.
How do you measure student outcomes?
Our research model is one theoretically that supports people creating their own goals. There’s quite a bit in the research literature that uses something called “goal attainment scaling.” It’s a scaling technique where the client and the clinician can co-create or collaborate to create these goals.
This kind of research allows you as a researcher and a clinician to find out what the client wants to work on. It’s really very much student-centered or patient-centered outcome based. The goals are really the students’ goals. They are not necessarily goals that I as a speech-language pathologist would have sat and created all by myself for the client. We really collaborate together. Students share what their goals are, and we guide that goal selection using approaches like motivational interviewing. Or structured surveys, using interviewing off of the surveys. The approach is quite dynamic, it goes back and forth, it’s collaborative. By doing that, it helps the student learn how to self-regulate, because we’re modeling it for them.
One of the exciting things about this research is that it’s very outcome-based. If a student comes to us and says their goal for the semester is to get a B in English, we take that as a goal, and then we begin to deconstruct with the student how they’re going to get that B, and what they’re going to have to do, knowing their unique strengths and weaknesses cognitively, socially, and with time management.
I really think that the future is with identifying valid but ecological outcomes that families want and that patients want. I see us beginning to do that, we’re kind of in the early stages of it. But ten years from now, we’re going to have a much better understanding of how to do that, how to measure that, what’s valid, what’s important to the client, what’s important to the researcher. But we’re kind of in this grey zone right now. So it’s really exciting.
What advice do you have for researchers interested in outcomes research?
I think that in healthcare in particular, they want to see functional goals. They want to see how a resident in an assisted living center now requires less assistance, or less supervision. As speech pathologists, as researchers, we really need to figure out how to quantify that, and what that’s going to look like. I think something like goal attainment scaling, which is recognized in the rehabilitation literature, is probably one way that we can do that.
One thing that researchers can do, that they often don’t do, is consider the cost of not having the questions that they feel are important answered. We’re not very good at cost analysis — but even framing the question that way. What is the cost of not providing coaching support to an individual who looks like they could succeed in college, but don’t. Because the statistics right now are so poor that someone with brain injury who goes back to college has a 50% chance of dropping out in the first year.
When you think about the cost of coaching support, which may be provided once a week for a year and a half, and the outcome is graduation in five years, and has a job at the end of it, and has a team of individuals that can support that person, and that person now has strategies they can carry into their work life. As researchers, we don’t often think about those things, but we need to put it into our research questions.
What are the costs if we don’t get this question answered? That’s the question that comes out of my research, but other researchers can ask the same question and say, well what’s going to happen if we don’t understand this? Lay out what the costs would be. I think that’s really convincing. And I think that’s what will convince third-party payers and policy makers.
