Browsing by Author "Daunhauer, Lisa, committee member"
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Item Open Access A picture of traumatic brain injury identification policy in U.S. schools by state(Colorado State University. Libraries, 2015) Mathias, Kelsey, author; Sample, Pat L., advisor; Greene, David, committee member; Daunhauer, Lisa, committee memberThe Individuals with Disabilities Education Improvement Act of 2004 (IDEA, P.L. 108-446) gives definitions for each disability category and general eligibility criteria that apply to all of the disability categories. Each state is allowed by IDEA to have their own definitions for each category, and it is up to the individual states whether they require more specific guidelines for eligibility criteria or if they want to use what is written in the legislation. This study examines the definition and eligibility criteria each of the 50 states in the United States use specifically for the traumatic brain injury (TBI) disability category. In this nation-wide descriptive study, members of the Department of Education for each state were contacted either to verify definitions and eligibility criteria uncovered from existing documentation found through the National Association of State Head Injury Administrators and state Department of Education websites; update the data that were found; or provide data that were missing from the initial search. Results indicated that 45 states fit in the “federal definition category,” and 6 states fit in the “own definition category” for the TBI definitions. For eligibility criteria, 27 states fit in “medical identification,” 11 states fit in “discretion of IEP team,” and 12 states fit in the “no TBI specific criteria” category. Currently, all states identify less than 1% of students receiving special education services as having a TBI, with the exception of Massachusetts (5.11%). The findings of this study demonstrate the discontinuity within the states in the policies and procedures used to determine special education eligibility.Item Open Access An analysis on the experience of parenting for adults with autism spectrum disorder(Colorado State University. Libraries, 2022) Lee, Jonathan, author; Hepburn, Susan, advisor; Brown, Samantha, committee member; Daunhauer, Lisa, committee memberA paucity of research has been conducted into the unique experience of parents with autism spectrum disorder (ASD). This lack of scientific understanding about a parent's lived experience is an obstacle to developing effective psychotherapeutic approaches to parents who have identified awareness of characteristic features of ASD. In this study, we present a qualitative case study of two adults with ASD who are parents. Both parents participated in an extensive interview focused on several domains: impacts resulting from characteristics of ASD, life changes resulting from a diagnosis or recognition of characteristics, impacts on executive functioning related processes, experience as a parent prior to recognition of characteristics or a diagnosis, belief in parenting ability, and insight into recommendations for support. Findings highlighted three main themes: 1) a conscious choice in accepting change, 2) saturation of self, and 3) the necessity for clinicians to adopt a learner's mindset.Item Open Access Developmental trajectories of adaptive behavior in Autism Spectrum Disorder and Down syndrome(Colorado State University. Libraries, 2017) Gerlach-McDonald, Brianne, author; Hepburn, Susan, advisor; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Riggs, Nathaniel, committee member; Sample, Pat, committee memberThe increasing prevalence of developmental disabilities indicates a need for research and interventions for these populations. One growing area of interest is adaptive behavior or the functional skills individuals perform in their everyday lives, such as communication and daily living skills. Individuals with developmental disabilities with greater adaptive behavior skills experience a better quality of life in childhood and achieve better functional outcomes in adulthood (e.g., living independently). However, more research is needed to understand how adaptive behavior develops in childhood to identify critical time points for targeted interventions. The current study examined developmental trajectories of adaptive behavior across childhood in two developmental disabilities: Autism Spectrum Disorder(ASD) and Down syndrome (DS). This study examined secondary data obtained from a longitudinal study conducted at the University of Colorado Health Sciences Center between 1997 and 2007. The aim of this dissertation was to examine the extent to which individual differences in diagnostic status, maternal education, intellectual functioning, executive function, and autism symptoms predicted developmental trajectories of adaptive behavior. Examination of the predictors of developmental trajectories of adaptive behavior provided information regarding potential intervention targets to promote optimal adaptive behavior. This study used growth modeling techniques to compare two developmental disabilities. Participants included 77 children with ASD and 24 children with DS who were assessed in toddlerhood (ages 1-3 years), preschool (ages 4-6), and during the school years (ages 7-10). Parents completed a demographic questionnaire and interviews of adaptive behavior (Vineland Adaptive Behavior Scales; Sparrow, Balla, & Cicchetti, 1984), and autism symptoms (Autism Diagnostic Interview-Revised; Lord, Rutter, & LeCouteur, 1994). Child participants completed standardized developmental testing (Mullens Scales of Early Learning; Mullen, 1995), an executive function task measuring cognitive flexibility and working memory (Spatial Reversal; Kaufmann, Leckman, & Ort, 1989), and a semi-structured play-based assessment of autism symptoms (Autism Diagnostic Observation Schedule; Lord, Rutter, DiLavore, & Risi, 1999). Growth models were specified for developmental trajectories of communication, daily living skills, and socialization as measured by the Vineland Adaptive Behavior Scales. Diagnostic status, maternal education, intellectual functioning, executive function, and autism symptoms were added as predictors. Children with ASD and DS made gains in their adaptive behavior skills from toddlerhood to middle childhood but had significantly delayed scores compared to children in the standardization sample. The best fitting models of communication and socialization indicated significant linear and quadratic growth, and the best fitting model of daily living skills indicated significant linear growth. Diagnostic status was a significant predictor of initial starting states of communication and socialization in toddlerhood, but not daily living skills. Diagnostic status was a significant predictor of linear and quadratic slopes of communication. Maternal education was a significant predictor of initial starting states of socialization in toddlerhood in both groups. Mental age in toddlerhood was a significant predictor of initial starting states in toddlerhood for communication, daily living skills, and socialization in both groups. Mental age was a significant predictor of linear slopes of communication, daily living skills, and socialization, and quadratic slopes for communication and socialization in both groups. These findings provide implications for intervention; many existing manualized early intervention treatments do not explicitly target adaptive behavior. Implications for available programs are discussed, followed by recommendations for targeting adaptive behavior and expanding research efforts to promote these skills in children with ASD and DS.Item Open Access Exploring foster and adoptive parent stressors and resources: a mixed method study(Colorado State University. Libraries, 2019) Polly-Almanza, Abby Audrey, author; Barrett, Karen, advisor; Daunhauer, Lisa, committee member; Orsi, Rebecca, committee memberAt any given time over half a million children are in foster care and over 50,000 of these children are adopted each year in the United States. The majority of these children have been exposed to trauma. Parents may not have the resources needed to effectively parent their foster/adoptive children and the experience of parenting a child with a significant trauma history may be stressful. In the current study, we conducted 8 focus groups with 25 foster and adoptive families to learn more about the relationship between child behavior and parenting stress and whether resources moderate this relationship. Secondly, we explored parent resources through qualitative analysis. Results indicated emotion symptoms and conduct problems respectively, resources, and their interaction significantly predicted total parenting stress. Moreover, both emotion symptoms and conduct problems variables significantly predicted total parenting stress but these effects were not moderated by support. Parents reported trainings and social support were generally helpful but that other supports such as respite, positive relationships with schools, and helpful professionals were important. Parents expressed frustration over a lack of resources after initial foster parent training or adoption, negative interactions with professionals, and judgement from friends and family. The current study suggests a need for larger studies on the types of support that would be most helpful to this population, as well as how support fits into the space between child behavior and parent stress in, order to create effective interventions for this population.Item Open Access Factor analysis of the Brain Check Survey(Colorado State University. Libraries, 2013) Pickle, Sarah, author; Sample, Pat, advisor; Greene, David, advisor; Daunhauer, Lisa, committee memberChildren who have a traumatic brain injury (TBI) are under-identified and lack appropriate educational supports to help them achieve their academic goals. Because TBI can greatly impact a child's ability to succeed at school, there is a need for a convenient and effective way to screen for TBI in students who are struggling in school so they can obtain appropriate school-based services. The purpose of this study was to work toward establishing construct validity for the Brain Check Survey (BCS), which is a parent-report questionnaire intended to help school personnel screen for possible TBI in students. The BCS can act as a starting point in the process of qualifying students for Special Education, a 504 Plan, or Response to Intervention assistance. In five different school districts in Colorado, parents completed the BCS for their child who was recruited from one of three groups: has identified TBI, is currently receiving special education services for diagnosed specific learning disabilities, or is considered typically developing. Construct validity was tested using multiple factor analyses: 1) all participants combined (typically developing, traumatic brain injury, and specific learning disability), 2) elementary, middle, and high school level categories of all participants, and 3) all ages from the typically developing group only. These factor analyses confirmed the two-factor construct of the BCS that measures student Symptoms and Behaviors. The analysis also gave insight into two distinct aspects of behaviors that the instrument is measuring: Cognitive Processing and Behavior Control. The positive findings from this factor analysis study suggest that the BCS has strong construct validity and can be effective in screening students for possible TBI.Item Open Access Foundations of early planning in Down syndrome(Colorado State University. Libraries, 2017) Will, Elizabeth Anne, author; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Coatsworth, James Doug, committee member; Henry, Kimberly, committee memberGoal-directed behavior, or planning is critical for academic and daily outcomes, and an area of distinct challenge in Down syndrome. This study examined early foundations of object-related planning in toddlers (N=38) with Down syndrome. Motor abilities, visual attention, and motor cognition were tested as predictors of two planning outcomes in DS: object-related problem solving and functional object use. In addition, a potential developmental cascade from motor abilities to object-related problem solving was also tested. Results revealed that motor abilities are an important developmental foundation for both types of object-related planning outcomes. Results also revealed differences in the contribution of visual attention and motor cognition to object-related planning outcomes. Findings also provided support for a potential developmental cascade between motor abilities and planning outcomes. Collective results from this study contribute to the understanding of early development within Down syndrome, and therefore provide implications for the development of early, targeted intervention.Item Open Access Foundations of executive function in Down syndrome(Colorado State University. Libraries, 2020) Schworer, Emily, author; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Hepburn, Susan, committee member; Knight, Andrew, committee memberThough early features of infant cognition are predictive of executive function (EF) in typically developing (TD) children, there is little information regarding the developmental origins of EF in Down syndrome (DS). The current study compared the performance of infants with DS and TD controls on four foundational EF dimensions: attention shifting, sustained attention, early planning, and processing speed, and examined the relationship between EF foundations at Time 1 and subsequent EF performance at Time 2 (6 months later). Participants were 58 infants with DS, M chronological age = 11.32 months, SD = 3.50; M developmental age = 7.93 months, SD = 2.79, and 48 TD infants, M chronological age = 7.76, SD = 3.22; M developmental age = 7.75 months, SD = 3.52. Results showed that infants with DS shifted their attention more slowly, looked for longer durations at objects, and demonstrated a longer latency to contact objects when compared to TD infants at Time 1. The association between early planning and chronological age differed by group at Time 1 as well. Attention shifting at Time 1 significantly predicted EF performance at Time 2 in the DS group. This study provides evidence that an early atypical presentation of EF precursors is detectable during infancy in DS and is predictive of subsequent EF performance. These findings will facilitate the identification of areas of early cognitive risk in DS and inform future interventions.Item Open Access Infant exploration and childhood action planning in children with Down syndrome(Colorado State University. Libraries, 2023) Van Deusen, Kaylyn, author; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Prince, Mark, committee memberChildren with Down syndrome (DS) are predisposed to delays across domains of development and there is a dearth of information on longitudinal associations across early childhood that would help to characterize skill acquisition. Executive functions (EFs) are the thinking and problem-solving skills that direct behavior to achieve goals. Planning is a subconstruct of EF that is an area of relative challenge for children with DS in middle childhood and adolescence. This investigation examined the foundations of planning in DS between infant exploration behavior and emerging childhood planning. METHODS: Forty-six children with DS and their parents participated in two waves of data collection. Infants' first visit was held between 9 and 17 months (M = 12.76 months; SD = 2.16) for Wave 1 and the second research visit was when children were 3 to 7 years old (M = 5.03 years; SD = 0.80) for Wave 2. RESULTS: No significant predictive link was found between infant exploration and early childhood planning. No significant findings emerged between biomedical status and childhood planning. CONCLUSION: Results of this investigation did not identify a predictive link between infancy and early childhood planning. The current study was among the first longitudinal analyses examining development in early childhood for children with DS. Future work should further characterize the heterogeneity observed in children with DS to tailor intervention supports to emerging planning skills.Item Open Access Multimodal agents for cooperative interaction(Colorado State University. Libraries, 2020) Strout, Joseph J., author; Beveridge, Ross, advisor; Ortega, Francisco, committee member; Daunhauer, Lisa, committee memberEmbodied virtual agents offer the potential to interact with a computer in a more natural manner, similar to how we interact with other people. To reach this potential requires multimodal interaction, including both speech and gesture. This project builds on earlier work at Colorado State University and Brandeis University on just such a multimodal system, referred to as Diana. I designed and developed a new software architecture to directly address some of the difficulties of the earlier system, particularly with regard to asynchronous communication, e.g., interrupting the agent after it has begun to act. Various other enhancements were made to the agent systems, including the model itself, as well as speech recognition, speech synthesis, motor control, and gaze control. Further refactoring and new code were developed to achieve software engineering goals that are not outwardly visible, but no less important: decoupling, testability, improved networking, and independence from a particular agent model. This work, combined with the effort of others in the lab, has produced a "version 2'' Diana system that is well positioned to serve the lab's research needs in the future. In addition, in order to pursue new research opportunities related to developmental and intervention science, a "Faelyn Fox'' agent was developed. This is a different model, with a simplified cognitive architecture, and a system for defining an experimental protocol (for example, a toy-sorting task) based on Unity's visual state machine editor. This version too lays a solid foundation for future research.Item Open Access Parent-mediated interventions for infants with Down syndrome(Colorado State University. Libraries, 2020) Swanson, Molly, author; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Sample, Pat, committee memberParent-mediated interventions (PMIs) are becoming increasingly popular but the parents' role as the administrator of the intervention, specifically the parental fidelity to an intervention protocol (PF) has yet to be standardized. Early syndrome specific PMIs can influence many domains of development for infants with Down syndrome (DS); however, the impact of PMIs on object exploration for infants with DS has yet to be tested. The current study examined the impact of parental fidelity to a PMI protocol on object exploration skills in infants with DS. The sample for this study consisted of 37 infants (M=7.04, SD=2.44) infants from 4 to 18 months with a confirmed case of trisomy 21. Infants in the intervention group (n=19) received the Sticky Mittens intervention and infants in the alternative group (n=18) received the 'object dance' activity. Parents were asked to fill out a parent logs to track their PF. Multiple regressions revealed that increased parental fidelity resulted in more infant swats and reach attempts from pre to post-intervention for the intervention condition, but not the control condition. The findings from this study indicate the unique role that parental fidelity plays in explaining intervention effects or a lack of intervention effects in PMIs. The implications for parental fidelity in PMIs are discussed.Item Open Access Parenting behavior and executive function in children with Down syndrome(Colorado State University. Libraries, 2017) Schworer, Emily, author; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Sample, Pat, committee memberParenting behaviors have an important influence on child development, and recent work has demonstrated the specific effects of parenting on the development of executive function (EF) abilities. Although these associations have been examined in typically developing children, the relationship between parent-child interaction and EF abilities has yet to be examined in dyads where the child has a diagnosis of Down syndrome (DS). The current study examined the differences in parenting behaviors between DS dyads and dyads with TD children matched on non-verbal mental age. DS dyads (n= 44) and TD dyads (n=29) participated in the Parent-Child Challenge Task to assess behaviors of both the parent and child during a challenging problem-solving task. Parent directive and teaching behaviors were coded, along with child compliance and noncompliance. Child participants completed the pony/gator task, a laboratory measure of inhibition and working memory. Parents also completed the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P), a proxy-report measure of EF. Results showed a difference in parenting behavior between DS dyads and TD dyads. Frequencies of parenting behaviors in DS were also related to both the pony/gator laboratory measure and the Inhibitory Self-Control index raw scores on the BRIEF-P. The findings indicate a unique pattern of association between parent behaviors and EF in DS. The implications for parent training and intervention are discussed.Item Open Access Parenting strategies and child behavior in children with Down syndrome(Colorado State University. Libraries, 2014) Lopez, Amber, author; Fidler, Deborah, advisor; Daunhauer, Lisa, committee member; Lunkenheimer, Erika, committee member; Sample, Pat, committee memberThis study examined parent-child interactions in Down syndrome in the context of a collaborative puzzle task. Variables of interest included the parent dimensions of teaching and directives, and the child behaviors of compliance, persistence, and social engagement during a five-minute interaction. Based on previous research in the field of parenting and developmental disabilities, it was hypothesized that parents of children with Down syndrome would exhibit significantly more directive behavior than parents of typically developing children, and that the use of directives would be associated with higher levels of compliance and task persistence in children with Down syndrome. It was also hypothesized that children with Down syndrome would engage in higher levels of off-task behavior, such as social engagement with a parent, based on evidence of the over-use of social behaviors during challenging tasks in this population. Children with Down syndrome (N = 20) and mental-age matched typically developing children (N = 13), and their parents, were recorded during a five-minute problem-solving task. Parent and child behaviors were captured utilizing a modified version of Lunkenheimer's (2009) Dyadic Interaction Coding System. Results indicated that parents of children with Down syndrome demonstrated both significantly higher levels of directive behaviors and teaching behaviors in comparison to parents with typically developing children. Contrary to previous research, children with Down syndrome in this study were found to be significantly more compliant than their typically developing peers, and no significant differences emerged between the groups in terms of off-task, socially-related behavior. Additionally, this study examined the reciprocal nature of parent-child interactions using state lag sequential analyses. Results from these analyses demonstrated a higher probability of directive parenting behavior following child social engagement in the Down syndrome group as compared to the typically-developing group. Conversely, the lag sequential analyses demonstrated a higher probability of teaching parent behavior following social engagement in the typically-developing group as compared to the Down syndrome group. The likelihood for both teaching and directive parenting behavior following child noncompliance was also higher in the Down syndrome group as compared to the typically-developing group. The findings from this study demonstrate consistency with previous work that parents of children with Down syndrome are more directive than parents of typically developing children, and highlights the differing patterns of parenting behavior in both typically and atypically developing populations. The use of analyses to examine dyadic contingencies also provides new information regarding the strategies that parents employ with their children to promote on-task behavior, specifically in children with an intellectual disability. Lastly, this study contributes to the body of research on the behavioral phenotype of children with Down syndrome.Item Open Access Pediatric traumatic brain injury and educational identification: estimating injury severity using data from a TBI screening tool(Colorado State University. Libraries, 2013) Holzrichter, Sarah, author; Sample, Pat, advisor; Greene, David, committee member; Daunhauer, Lisa, committee memberTraumatic brain injury is a significant source of disability in children and its sequelae can significantly impact a child's academic abilities and school success. Only a small percentage of children who sustain a TBI, however, will receive academic supports specific to TBI, whether through an IEP, 504 plan, or Response to Intervention. The Brain Check Survey (BCS) is a parent-report screening tool designed to be used in educational settings to screen for past incidents that may have caused brain injuries as well as for behaviors and symptoms that may be related to a past TBI and that are impacting a specific student's school performance. In the state of Colorado, having a parent complete the BCS is one of the steps used to determine if a child has a "credible history" of brain injury that is necessary to qualify the child for services. As of yet, however, there are no guidelines given for how to interpret the portion of the BCS that inquires about past incidents that may have caused a brain injury. The purpose of this study was to develop a model for interpreting this portion of the BCS and for roughly estimating the severity of any of the student's past head-related injuries. An Injury-Severity Classification Model (ISCM) was developed and inter-rater reliability tested for its use. Data from completed BCS forms collected in five different Colorado school districts were used for analysis. Additionally, preliminary testing of the model's construct validity was conducted using the resulting severity groups and their presenting behaviors and symptoms as reported on the BCS. High inter-rater reliability was established for the ISCM and its utility was demonstrated for estimating past injury severity among students already identified as having sustained a TBI and receiving services, as well as among students currently receiving no special services. Recommendations are made for revisions of the Injury-Severity Classification Model (ISCM) and for future research.Item Open Access Pediatric traumatic brain injury: investigating factors associated with problematic behaviors(Colorado State University. Libraries, 2011) Darnell, Holly, author; Sample, Pat L., advisor; Daunhauer, Lisa, committee member; Stallones, Lorann, committee memberChildren with traumatic brain injury (TBI) are currently under-identified and under-served in the American school system. The present study investigated factors associated with problematic behaviors including gender, number of head injuries and reported symptoms. Parents of students in grade school (K-12) from three research groups (children with TBI, children with learning disabilities and typically developing children) rated their child's behaviors and symptoms, and provided an injury history using the Brain Check Survey. Contrary to current literature, in the present study boys were not found to have more severe behaviors than girls overall for the TBI group, but rather both genders were rated similarly on behaviors. Analysis between behaviors and number of injuries was not completed as the TBI sample lacked variability in the number of injuries sustained per child. More severe symptoms were correlated with more severe behaviors overall for all three groups, with the TBI group demonstrating the strongest associations and more severely rated behaviors overall. Occupational therapists should consider that girls with a TBI may exhibit behaviors as severe as boys when evaluating children in order to ensure a proper diagnosis. Symptoms associated with behaviors being exhibited in children also should be evaluated and treated, as such interventions may result in improved behaviors.Item Open Access Pediatric traumatic brain injury: understanding parent perceptions of their child and school-based supports and services(Colorado State University. Libraries, 2013) Terry, Erin, author; Sample, Pat L., advisor; Greene, David, committee member; Daunhauer, Lisa, committee memberTBI affects hundreds of thousands of children each year, having a profound impact on multiple areas of functioning including cognition, social interaction, learning, and behavior, and thereby directly influencing their school performance. Despite its high incidence and potentially severe consequences, TBI-related disability among children often goes unrecognized for what it is by caregivers, educators, and physicians. In this study, we focused on the qualitative data obtained in the parent-report Brain Check Survey related to students with identified TBI employing a phenomenological approach. Data from fifty-one parent completed BCS tools were analyzed to gain an understanding of parent perceptions of their child with TBI, including the child's TBI-related behaviors and symptoms; and the parents' perceptions of the child's school-based supports and services in relation to their TBI-related learning needs. Data analysis yielded four major themes that represented the qualitative content provided by parents on the BCS, namely parent response types, knowledge, services, and emerging topics. Parent experience varied depending on perceived supports and barriers, highlighting the need to include parents as a frequent and permanent participant in the preparation for and development of their child's educational plan. A key recommendation is that schools assist parents of children with TBI in gaining skills in advocacy and knowledge of educational entitlements as early as possible once their child is identified in the school as having a TBI. Parents need to be empowered early on to find their voice as advocates, helping to ensure that their child is able to participate and perform in his/her student learner role as effectively as possible.Item Open Access Program development of best practices for students with traumatic brain injury(Colorado State University. Libraries, 2014) Guttormsen, Elin, author; Sample, Pat, advisor; Greene, David, committee member; Daunhauer, Lisa, committee memberRationale: Recent changes in Colorado legislation have led to implementation of new procedures in identification and classification of students with traumatic brain injury (TBI). The purpose of this study was to chronicle the subsequent process of training school personnel in Colorado to increase their capacity to implement the new school-based identification, assessment, and intervention processes for students with TBI. Methods: The study employed an interpretive case study design. Data collection measures included documentation review, field observations, and interviews with key informants. Results: Three thematic and chronological phases emerged from data analysis: (1) identifying the need for program change, (2) increasing awareness through preliminary staff trainings, and (3) creating expertise through secondary staff trainings. Discussion: Emergent themes present in program development included professional development, staff leadership, and interdisciplinary collaboration, and are supported by theoretical research. This program development in Colorado can serve as a procedural guide for other states attempting to implement new best practices for students with TBI.Item Open Access Traumatic brain injury identification processes for school-aged children in rural Colorado school districts(Colorado State University. Libraries, 2016) Palmer, Maureen K., author; Sample, Pat L., advisor; Greene, David, committee member; Daunhauer, Lisa, committee memberRationale: Recent changes in Colorado legislation have led to the implementation of new procedures in identification and classification of students with traumatic brain injury (TBI). The purpose of this study was to highlight changes to TBI identification protocols and subsequent approbation of services in rural Colorado schools since the change in state requirements. Methods: The study employed a case study design. Data collection measures included focus groups and interviews with participants, field observations, transcription, coding and triangulation. Results: Six patterns emerged from data analysis which spoke to current TBI identification and service delivery protocols in schools: (1) geographic limitations (2) waves of administrative support, (3) low socioeconomic status, (4) fragmented communication, (5) school professionals' perceptions of TBI and (6) cultural attributes of the rural location. Discussion: Influential patterns present in rural districts lend insight into barriers to implementation of TBI identification and service delivery. Recommendations for improved service delivery in rural areas focus on increasing access of school personnel to professional development as well as state protocols that can facilitate communication between state and local education agencies. These findings in rural Colorado illuminate barriers to TBI service delivery and can be factors to consider for other states attempting to implement new best practices for students with TBI.Item Open Access Utility of the participation and environment measure for children and youth (PEM-CY) for programmatic assessment and intervention planning: a mixed methods study(Colorado State University. Libraries, 2013) Cliff, Anna Beth, author; Khetani, Mary, advisor; Schelly, Catherine, committee member; Daunhauer, Lisa, committee memberThe purpose of this mixed methods sequential explanatory study was to examine the utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for use by a community service agency, Adaptive Recreation Opportunities (ARO), for programmatic assessment and service planning to promote children's community participation. The study used two distinct, interactive phases, which included collection and analysis of quantitative data (Phase 1) and sequential collection and analysis of qualitative data (Phase 2) to determine if qualitative results could be used to further explain results from the quantitative phase. The first phase of the study (quan) included gathering PEM-CY data from 23 families who were receiving services from ARO to better understand patterns in children's community participation and environmental supports and barriers to participation in community activities. Results from Phase 1 were summarized into a report and used during Phase 2 (QUAL) to gather the perspectives of 7 ARO staff via semi-structured interviews. Phase two findings suggest that ARO staff perceived the PEM-CY to provide for a more comprehensive and detailed initial assessment process to identify individual and program-level needs. Providers were also able to delineate a core decisional process for leveraging PEM-CY results to develop an intervention plan with families. Future validation with parents and considerations for enabling collaborative and feasible uptake of the decisional process by parents and providers is discussed.