Community‐Engaged Approach to the Development and Implementation of a Student‐Centered Return to Learn Care Plan After Concussion

Abstract

BACKGROUND: Current return to learn (RTL) after concussion guidelines lack specificity for individualized student care, limiting potential for adoption and implementation. We used a community-engaged research framework to develop and evaluate the implementation of a student-centered care plan that assists school personnel in facilitating RTL. METHODS: We used best-practice RTL guidelines and input from administrators and medical experts to iteratively develop a flexible student-centered care plan. Thirteen schools participated. Coding completion of care plans indicated feasibility and fidelity; interviews with RTL coordinators indicated acceptability. RESULTS: The care plan includes educational materials, symptom checklists, and guidelines for classroom adjustments linked to student symptoms. Care plans were initiated for 24 (70.6%) of 34 students with concussions, indicating feasibility. Fidelity was high, with the following subsections completed: Action Checklist (90%), Symptom Evaluation (91%), Temporary Adjustment Recommendations (95%). Qualitative analysis of interviews suggested care plans were acceptable and facilitate consistent communication, prioritization of individual needs of students, and increased ability to delegate tasks to other school staff. CONCLUSIONS: Implementation of a student-centered, individually tailored care plan for RTL is feasible and acceptable in public high schools. Future research should examine how to expediently initiate student-centered concussion care plans after diagnosis to optimize recovery.

Concussion symptoms and temporary accommodations using a student-centered return to learn care plan

“…This study aimed to better understand concussion symptoms and need for temporary accommodations. Using a four week school-based student centered RTL care plan (Conrick et al, 2020), we found that: 1) many students who reported a concussion to school had a history of prior concussion and depression, 2) most students experienced concussion symptoms beyond two weeks, 3) students in the long symptom duration group had more symptoms and more severe symptoms during the first week of reporting compared to students whose symptoms resolved within 1-2 weeks from RTL care plan start, 4) RTL coordinators recommended corresponding temporary accommodations for reported symptoms across all domains in the majority of cases, and 5) RTL coordinators least often recommended corresponding accommodations for sleep symptoms. In combination, these data collected and provided by school staff suggest that students who reported concussion symptoms to schools needed and received many student-centered temporary accommodations.…”

“…Students who were diagnosed with concussion by a health care provider and reported it to the school, regardless of whether the concussion took place at school or elsewhere, were eligible to receive the RTL care plan by the school. Feasibility and acceptability of the RTL care plan by 13 public high schools were previously reported (Conrick et al, 2020). Five of these 13 Seattle public high schools detailed information on symptoms and corresponding temporary accommodations.…”

“…There is also little known about whether implementing an RTL protocol with individualized temporary school accommodations for students can affect concussion symptom recovery. Using a community-engaged research approach, we recently developed an RTL care plan for all students with concussion that had high overall implementation fidelity (70.6%), feasibility, and acceptability in 13 public high schools (Conrick et al, 2020). In this study, we examined concussion symptoms and temporary accommodations during school use of a symptom based studentcentered RTL care plan.…”

Factors Related to Concussion Knowledge, Attitudes, and Reporting Behaviors in US High School Athletes: A Systematic Review

“…Given the current national spotlight on student health during the coronavirus pandemic, educators have an opportunity to push forward an agenda focused on improving SRC protocols. Therefore, the following specific recommendations are offered for student health educators based on the findings of this systematic review: Use established, current, research‐based concussion education guidelines, such as the CDC's Heads Up 13 ; Investigate alternative delivery methods, such as electronic or app‐based media, to entice adolescents to actively participate in concussion education; Develop educational interventions designed specifically for at‐risk populations, including girls, programs without athletic trainers, and athletes whose primary language is not English 50 ; Incorporate concussion prevention into health education class curricula as a method of reaching all students 54 ; Actively involve parents in concussion education through school functions, community programs, and social media; Ensure all schools (public and private) develop concussion surveillance protocols to track incidents and help prevent secondary concussions in athletes that are still recovering 55 ; Utilize school nurses as a resource in managing the treatment course and advocating for the appropriate restrictions required for recovery; Individualize RTP and/or return‐to‐learn (RTL) plans based on an athlete's injury and recovery progression, in collaboration with medical systems 56,57 ; Advocate for state Departments of Education to endorse appropriate and researched RTL and RTP protocols with demonstrated successful outcomes 58 …”

Care Coordination for Children with Special Health Care Needs: A Scoping Review to Inform Strategies for Students with Traumatic Brain Injuries

“…Strong coordination of care that includes the educational setting as a key partner can help ensure efficient and effective services, including an adaptation of the learning environment in a way that accommodates physical, cognitive, and emotional needs 27 . This includes coordinating with school‐based‐related service providers who are allied health professionals, such as speech pathologists, occupational therapists, and physical therapists 28 . Although there is expert opinion literature on improving educational services for children with TBIs, 29‐31 as well as a small number of studies examining issues related to hospital‐school transition and school reintegration, 32‐34 few empirical studies specifically examine care coordination between medical and educational providers for students with TBIs.…”