BrainSTEPS Concussion Return to School Protocol for Schools
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The document provides a protocol for schools to follow when a student returns to school after sustaining a concussion. It recommends designating a Concussion Management Team to monitor the student's symptoms and academic performance for the initial 4 weeks post-concussion. If symptoms persist after 4 weeks, the team should refer the student to BrainSTEPS for assistance developing accommodations. BrainSTEPS will then work with the team, student, and parents to create an individualized support plan and continue monitoring symptoms and performance until the concussion fully resolves.
BrainSTEPS Concussion Return to School Protocol for Schools
- 1. Returning to School After Concussion: Recommended Protocol
- 2. Return to School Protocol: Purpose BrainSTEPS can: A concussion is a mild form of traumatic brain Assist with implementation of the Return injury (mTBI), caused by a bump, blow, or to School Protocol jolt to the head, which can induce an altered state, including physical and cognitive abilities. Train staff at the district, school or It may or may not include loss of conscious- classroom level on the effects of ness; however, typically, there is no loss of concussion consciousness. Concussion is a functional rather than a structural disturbance that may Provide consultation to school personnel and need short-term or long-term management. In parents for referred students at 4 weeks the hours and days post-concussion, metabolic post-concussion, or earlier if needed chemical changes take place within the brain Provide symptom specific educational at the cellular level, resulting in physical, cog- accommodations utilizing the Brain Injury nitive, and/or emotional symptoms. Activities Supports Framework associated with academics can significantly increase symptoms, even when the student has Assist in ongoing monitoring of symptoms and begun to recover. Total cognitive and physical accommodations until the concussion resolves rest is typically recommended for the first sev- eral days to weeks. The effects of a concussion Facilitate communication between family, may linger for several months to a year or student, medical, and educational entities more. All students who experience a concussion should The purpose of this Return to School Protocol is be medically evaluated and should follow the to assist local educational agencies (LEAs) in treatment recommended by a medical profes- understanding the importance of monitoring sional with experience in managing concussions. a student’s return to academics following a concussion. The Return to School Protocol is LEAs utilizing this voluntary Return to School voluntary and may be used at the discretion of Protocol are asked to designate two individuals the LEA. A referral to the BrainSTEPS Program at either the district or individual school building should be made if a student is 4 weeks post- level who will agree to monitor the student and concussion and is still experiencing symptoms, the resulting educational impact on the student or if the student’s classroom performance or after the concussion. These two individuals will attendance has been impacted. Referrals to serve as the Concussion Management Team BrainSTEPS can be made earlier if: (CMT). The CMT is comprised of individuals who can serve as the Academic Monitor and A student has a concussion that is not the Symptom Monitor. Together, the CMT will progressively resolving during the first few promote information flow between the school weeks, or team, family, student, and physician. A student has a history of any of the following “concussion modifiers”: Initial 4 Weeks Post-Concussion: LEA Responsibilities • Past concussion(s) 1. The LEA learns that a student has sustained • Migraine headaches a concussion. • Depression or other mental health 2. The Concussion Management Team (CMT) issues is notified. • Attention deficit hyperactivity disorder 3. The CMT notifies the student’s educators, (ADHD) alerting them of the concussion and the • A learning disability student’s need for rest and academic accommodations. The CMT will: • Sleep disorders 2
- 3. • Share the physician’s instructions with heal faster than cognitive symptoms relevant school staff, as well as recom- (e.g., attention, memory, concentration) mendations provided by the parents 7. It is recommended that the CMT offer • Include the student’s specific symptoms, support and educational resources to the along with adjustments/accommodations student’s parents. One such resource is: to alleviate exacerbating symptoms The Centers for Disease Control • Notify the coach, the athletic and Prevention: www.cdc.gov director, and the athletic trainer, (Type “concussion” in the search box.) if the student is an athlete • Provide notification to appropriate At 4 Weeks Post-Concussion: school staff that the student should be BrainSTEPS Referral excused from physical education class, sports, and physical activity during 1. If the student remains symptomatic and/or recess until cleared there has been a notable change in student performance or attendance, the Concussion 4. The CMT’s Symptom Monitor will utilize Management Team (CMT) will initiate a the BrainSTEPS Student Symptom Severity formal referral to the BrainSTEPS Program Monitoring Checklist to monitor the student’s by visiting the BrainSTEPS website physical, thinking/remembering, and (www.brainsteps.net) to locate the correct emotional symptoms. Symptoms should be consulting team by county. monitored via student interview 3 to 5 days per week for the first 2 weeks, and then 2 2. BrainSTEPS will conduct student specific to 3 days per week during weeks 3 and 4. concussion training for relevant school staff, parents/guardians, and student. 5. The CMT’s Academic Monitor will monitor the student’s weekly performance, both 3. The CMT will schedule a BrainSTEPS Brain academically and behaviorally, by having all Injury Supports Framework meeting, relevant teaching staff complete the BrainSTEPS including all relevant parties (school team, Academic Monitoring Form at the conclusion parent/guardian,student,BrainSTEPS). of each week until symptoms resolve. 4. BrainSTEPS will partner with the CMT, school 6. Weekly, the Academic Monitor and team, parent/guardian, and student to create Symptom Monitor will meet to review an individualized BrainSTEPS Brain Injury results of the Symptom Severity Monitoring Supports Framework during this meeting. Checklist and the Academic Monitoring • Results from all weekly BrainSTEPS Tool, to determine whether further accom- Academic Monitoring Tools collected by modations should be made during the the Academic Monitor to date will be initial 4 weeks or if the concussion symp- shared with BrainSTEPS prior to the toms and impacts have resolved and CMT meeting. monitoring and accommodations are no longer needed. Weekly results will be • Results from all weekly BrainSTEPS shared with the student’s teachers, related Student Symptom Severity Monitoring professionals, and parents/guardians. Checklists collected by the Symptom Monitor to date and any physician • Parents/guardians should be involved medical instructions will be shared with in providing input on symptoms BrainSTEPS prior to the meeting. occurring at home. • During the initial BrainSTEPS Brain • Accommodations for classwork should Injury Supports Meeting, a follow-up be provided until all symptoms resolve. meeting within 1 month will be sched- Physical symptoms (e.g., headache, uled to review, modify, continue, or dizziness, light/noise sensitivity) may conclude accommodations. continued . . . 3
- 4. • The Academic Monitor will provide a 2. If a referral for a multipurpose evaluation final copy of the BrainSTEPS Brain is not deemed necessary, then continued Injury Supports Framework to relevant monitoring by the CMT and monthly review school staff and parents/guardians. of the Brain injury Support Framework, in partnership with BrainSTEPS, will continue. • If the student is receiving homebound instruction, the BrainSTEPS Brain Injury 3. If further formal educational supports are Supports Framework should be shared thought to be necessary, a referral for a with the teachers assigning and provid- multipurpose evaluation should be made ing homebound instruction. to the appropriate individual at the district level. 5. The Symptom Monitor will continue to monitor the student’s symptoms 2 to 3 days per week using the BrainSTEPS Student 4-8 Weeks Post-Concussion if Symptoms Symptom Severity Monitoring Checklist. The Resolve Symptom Monitor will provide copies of the Monitoring Checklist to BrainSTEPS prior to 1. BrainSTEPS will work with the Concussion any formal review of the BrainSTEPS Brain Management Team (CMT), school team, Injury Supports Framework. parent/guardian, and student to deter- mine appropriate accommodations and 6. The Academic Monitor will continue to modifications until the symptoms impacting monitor the student’s academics weekly education resolve. Resolution of symptoms using the BrainSTEPS Academic Monitoring could take weeks, months, and in some Tool. The Academic Monitor will provide cases symptoms may last a lifetime. copies of the Academic Monitoring Tool to BrainSTEPS prior to any formal review of 2. If the symptoms impacting education com- the BrainSTEPS Brain Injury Supports pletely resolve, there should be a meeting Framework. held by the LEA to conclude the implementa- tion of the BrainSTEPS Brain Injury Supports • The Academic Monitor will provide Framework or more formal accommodation a final copy of the BrainSTEPS Brain agreement. Injury Supports Framework to relevant school staff and parents each time it is • CMT monitoring will conclude. modified. • All relevant school staff, as well as the student and the student’s parent/ 4-8 Weeks Post-Concussion if Symptoms guardian will be notified by the LEA. Persist 3. The LEA will ensure that the concussion has 1. If the student continues to be symptomatic, been noted in the student’s educational the Concussion Management Team, record on file with the district. BrainSTEPS, and school personnel should consider whether the student’s academic For more information about BrainSTEPS or behavioral needs warrant ongoing contact: adjustments and accommodations, or if Brenda Eagan Brown, MSEd, CBIS, an evaluation should be conducted by BrainSTEPS Program Coordinator the LEA to determine the need for more Email: eaganbrown@biapa.org formal intensive accommodations and/or Phone: 724-944-6542 modifications. 1/13