Title Line 1 Title Line 2
Return to Learn Fall 2014 Webinar Series:
Students (K-12) with Concussion Educational Impacts, Return to School Progression, & Symptom Based Accommodations Brenda Eagan Brown, M.Ed., CBIS
Brenda Eagan Brown, MEd, CBIS BrainSTEPS Program Coordinator The BrainSTEPS Program [email protected]
October 1, 2014
www.brainsteps.net
www.brainsteps.net
The webinars in this concussion series were created to build the capacity of teachers working with students who return to the classroom following concussion. This series does not replace the official PA BrainSTEPS Return to Learn (RTL) Concussion Management Team (CMT) Training. Attendance during this webinar does not denote CMT formation or BrainSTEPS Team Membership. This webinar is for educational purposes only. If your Pennsylvania school district is interested in forming a Concussion Management Team for academic & symptom management, please register your CMT at www.brainsteps.net and online training information will be sent to you.
www.brainsteps.net
If you have questions during the webinar, feel free to email them to me at: [email protected] We are not taking questions during the webinar This webinar is being recorded and will be available online in one month at www.pattan.net and also at www.brainsteps.net
www.brainsteps.net
Safe Kids Worldwide 1 child every 3 minutes sustained a concussion
Concussions in Pennsylvania: Annually, approx. 22,000 children & adolescents sustain concussions.
47% of these concussions were in children ages 12 -15 U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) - 2013
www.brainsteps.net
www.brainsteps.net
1
Following a CONCUSSION, there are actual METABOLIC CHEMICAL CHANGES that take place in the brain.
www.brainsteps.net
Brain injury can occur even if there is NO loss of consciousness
www.brainsteps.net
More than 90% of concussions DO NOT involve loss of consciousness.
Memories of events BEFORE & AFTER the concussion are MORE accurate assessments of SEVERITY than loss of consciousness.
www.brainsteps.net
www.brainsteps.net
The majority of students should recover within the first 3-4 weeks, many in the first 7-10 days.
A child’s brain is not fully developed until the early to mid-20s. www.brainsteps.net
www.brainsteps.net
2
Signs and Symptoms of Concussion
Prolonged Concussion: Indicators that student’s concussion will most likely take 1 month or more recover? (UPMC in Pittsburgh, 2012)
1. Fogginess 2. Vomiting 3. Dizziness
CDC, 2014 www.brainsteps.net
www.brainsteps.net
What teachers may observe: • • • • • •
www.brainsteps.net
What teachers may observe: • • • • •
Behavior changes Confusion More emotional than usual More frustrated than normal Unable to cope with stress
www.brainsteps.net
Multi-tasking difficulty More forgetful Slowed thinking & processing Answers questions slowly Word-finding problems Difficulty handling new situations
www.brainsteps.net
What teachers may observe: • Drifting off in class • Difficulty focusing on material, especially more difficult material • Cannot keep focused for a sustained period • Restlessness • Reports of “foggy” feeling
www.brainsteps.net
3
Physical & Cognitive REST is crucial ACUTELY.
Keep in mind 2 Phases of Recovery:
1. The ACUTE Phase 2. The REHAB Phase
www.brainsteps.net
www.brainsteps.net
Too little rest:
= prolonged recovery
School Re-Entry Progression
Too much rest:
= physical deconditioning = social isolation www.brainsteps.net
Return to Learn (RTL) While it is true that an athlete must be 100% symptom-free before Return to Play, they do NOT need to be 100% symptom-free to RTL.
www.brainsteps.net
Students Should Not Push Through Symptoms While Recovering • exacerbates symptoms • prolongs recovery time Majerske, C., et al. 2008
www.brainsteps.net
www.brainsteps.net
4
Need for Rest After Concussion: High levels of cognitive activity
=
Longer recovery from concussion
School Concussion Management
1. Return to Learn 2. Return to PLAY
(Brown et al., , 2014)
www.brainsteps.net
When Students Should Return to Sports
www.brainsteps.net
Acutely- Upon Return to School – Across the Board (length of time needed varies) 1. No note taking 2. Reduce all in class work to 50% 3. No tests, quizzes, standardized tests, or homework 4. Scheduled rest breaks 5. Excuse from all classes/activities that may be overstimulating (light/noise)
Halstead, M.E., McAvoy, K., Devore, C.D., Carl, R., Lee, M., Logan, K. Returning to learning following a concussion. Pediatrics 2013;132(5):948-957.
www.brainsteps.net
A word about Medical Homebound & Homebound Instruction • Keeping a student out of school for too long can be harmful – Socially, Emotionally, Academically
• Something is usually missing: – – – –
6. Excuse from PE, recess, all physical activity
www.brainsteps.net
ONE or the OTHER rule New Learning Missed Work
return to school plan academic accommodations staff wasn’t trained to understand concussion fluid, consistent communication between home/school/medical
www.brainsteps.net
www.brainsteps.net
5
For students enrolled in a Career and Technical Center (CTC) Return to Tech vs Return to School
Educational Accommodations
A Career and Technical Education (CTE) provides unique environmental and academic challenges for the concussed student Need to Be Separate Decisions
www.brainsteps.net
Academic Accommodation Decisions Educational accommodation selection is the responsibility of the School Team. Medical academic accommodation suggestions are only RECOMMENDATIONS that the school team should take into consideration.
www.brainsteps.net
Helping the concussed student remain in school while recovering.
The school team needs to make the final decision for accommodation implementation based on collected academic data, symptom data, etc.
www.brainsteps.net
www.brainsteps.net
Cognitive fatigue and headaches For students who linger, striking a balance between the need for rest and keeping up with academic content is the biggest struggle.
www.brainsteps.net
• 50% of workload is commonly recommended during recovery
• Assignments (homework/classwork) should not be repetitious.
www.brainsteps.net
6
Cognitive fatigue and headaches Cued Recall is better than Random Retrieval. Alleviate brain fatigue by using:
• Rest Breaks • Removal from Cafeteria ?
www.brainsteps.net
Cognitive fatigue and headaches • Chunking Assignments
www.brainsteps.net
Cognitive Fatigue & headaches • Timeline for work - fatigue
• Water bottle • Extra time
• Don’t just say “Do what you can”
• Timelines to plan
www.brainsteps.net
Cognitive fatigue & headaches
Testing • Acutely tests and quizzes should be delayed (especially standardized tests) • Gradually re-introduce testing, preferably 1 test/quiz per day, as tolerated
www.brainsteps.net
Sensitivity to Light & Noise • Sunglasses, hat • Face student away from bright lights • Remove from over-stimulating classes • Early dismissal • Headphones or ear buds
• Testing in a separate, quiet room
www.brainsteps.net
www.brainsteps.net
www.brainsteps.net
7
Social/Emotional
Dizziness
Early on-
• Allow extra time to get to class avoid crowded hallways • Walk with a peer/peer carry books • Elevator key instead of stairs
www.brainsteps.net
Later on–
www.brainsteps.net
Social/Emotional Develop an emotional support plan with the student
Educational Frameworks to Safeguard Persistent/Prolonged/Protracted Concussions
• Identify an adult • Identify a student
www.brainsteps.net
Prolonged Concussion Recovery • PCS
• Students should work to his/her symptom threshold = REST, RECOVER, RETURN to Activity
www.brainsteps.net
www.brainsteps.net
Prolonged Concussion Recovery • • • • • •
Physical Therapy Speech Therapy (cognitive rehab) Vestibular Therapy Vision Therapy Medications Counseling
www.brainsteps.net
8
Academic Supports After Concussion
Informal Supports 100% Formal Supports 10-20%
If a student experiences lasting effects that impact learning (school
evaluation must first take place):
Concussion
504 Plan
IEP
INTENSIVE Very, very few
www.brainsteps.net
www.brainsteps.net
Who is Eligible for a 504? Not Special Education – 504 Plan/504 Service Agreement
www.brainsteps.net
o The
physical or mental impairment must impact at least 1 of 13 listed major life activities (Dr. Perry Zirkel, 2010): 1. Seeing
8.
Concentrating
2. Hearing
9.
Sleeping
3. Walking
10. Eating
4. Learning
11. Bowel functions
5. Breathing
12. Bladder functions
6. Reading
13. Digestive functions
www.brainsteps.net
“a person with a disability as any person who has a physical or mental impairment that substantially limits one or more major life activities*, has a record of such impairment, or is regarded as having such impairment.”
www.brainsteps.net
Section 504 of the Rehabilitation Act:
7. Thinking
504 Regulation 34 C.F.R. 104.3(j-l):
There needs to be a plan in place that all teachers implement across the board.
Don’t rely on the student to request accommodations “as needed” www.brainsteps.net
9
Journal of School Nursing Article (Legal issues of 504 Plans, IEPS, IHPs after Concussion)
Special Education
April 2015 Publication www.brainsteps.net
(Available online now)
Special Education Classification
Traumatic Brain Injury - (TBI)
www.brainsteps.net
Fear of Faking Symptoms? Does not occur often District guidelines can be established
Traumatic Brain Injury was added into the Special Education Law (IDEA) in 1990 as a specific category requiring specialized understanding. www.brainsteps.net
Public Law 101-476 [34 Code of Federal Regulations §300.7(c)(12)]
Caution advised when limiting school activities
www.brainsteps.net
The BrainSTEPS Program Created by: PA Department of Health in 2007
Pennsylvania’s Statewide
Brain Injury School Consulting Program * BrainSTEPS provides consultation & training for students who sustain all severities of brain injuries acquired anytime after birth
Unique partnership for funding:
PA Department of Health PA Department of Education, Bureau of Special Education via the PaTTAN network
Implemented by:
Brain Injury Association of Pennsylvania
www.brainsteps.net
www.brainsteps.net
10
• 31 BrainSTEPS Teams cover the state of Pennsylvania • 300+ Brain Injury school consultants – Educational professionals – Medical & Rehab professionals – Family members www.brainsteps.net
• • • • • • • • • • • • •
BrainSTEPS team
Communication with family member Communication with school Consultation Consultation with student Activities Records review Consultation: strategies Consultation w/ medical professionals Consultation educational plan Training of educators and support staff Classroom and peer education Information sharing among team Demonstration of interventions Observations/evaluations of student Participation in IEP and 504 meetings
www.brainsteps.net
Students Referred to BrainSTEPS
BrainSTEPS Teams monitor students annually until graduation.
nonTBI
11%
TBI Severities TBI 89%
Moderate & Severe
23% CONCUSSIONS
77%
www.brainsteps.net
www.brainsteps.net
Common Student Concussion Scenario
Pennsylvania’s Statewide Return to Learn Concussion Management Team (CMT) Model www.brainsteps.net
1. 2. 3. 4. 5.
Student returns to school to Learn School mayReturn not implement accommodations Symptoms flare Concussion Management Student pushes through Teams (CMTs) can symptoms alleviate these Student waits for medical appointment 2 issues & Continues potentially promote weeks away. pushing through symptoms. faster student recovery 6. At appointment, Dr. may place student on homebound rest for period of time because at this point, symptoms are so severe. www.brainsteps.net
11
Return to Learn BrainSTEPS Concussion Management Team (CMT) Model
Concussion Management Team (CMT)
CMT 1. Academic Monitor 2. Symptom Monitor
– CMTs consist of 2 monitors • Academic Monitor (School Psych, Guidance Counselor) Symptom Monitor (School Nurse)
– 700+ Return to School Concussion Teams across the state of PA since Jan. 2013 www.brainsteps.net
Utilizes the Return to Learn Concussion Electronic Toolkit
Academic Monitoring Tool 1 page 1 side Teachers Fill Out Classwork, Homework, Tests, Assignments, Behaviors
Symptom Monitoring Tool 1 page 1 side Student Fills Out Symptom Severity Rating Scale
www.brainsteps.net
Concussion Management Team
CMT Model Provides Pennsylvania School Districts: 1. Structure Concussion Return to Learn Protocol
2 person CMT does NOT take the place of the
“Interdisciplinary Team”
(Educational, Medical/Rehab, Parent, Student)
The CMT serves as the “Concussion Coordinators” *CMTs are the Data Collectors & Information Gatherers www.brainsteps.net
2. Online Return to Learn Training
Best Practices for managing concussions in the classroom
3. Tracking student progress
Concussion Academic & Symptom Monitoring Toolkit
www.brainsteps.net
PA’s Layered Statewide Educational Infrastructure for Concussion Return to Learn
CMT Monitoring Student Concussion
www.brainsteps.net
@ School level 700+ Concussion Management Teams for Return to Learn
BrainSTEPS Support begins 4 weeks post @ Intermediate Unit level 31 Regional Consulting Teams
At 4 weeks post concussion: Students are referred to BrainSTEPS & A Concussion (mTBI) Brain Injury Supports Framework is created
www.brainsteps.net
12
PA Students who should be referred to your regional Intermediate Unit BrainSTEPS Team Type of Student Acquired Brain Injury
When to Refer a Student to BrainSTEPS
Brain injury occurring anytime AFTER birth
4 weeks post concussion unless student has a history of any of the following then refer sooner: • Prior concussions • Migraines • Learning, attention or emotional disabilities, sleep disorders
New Moderate TBI, Severe TBI, Non-TBI
As soon as injury occurs, the sooner you refer the better. Don’t wait for the student to experience educational impacts/bad grades. Refer early to prevent issues.
Acquired Brain Injuries (TBI or non-TBI) that occurred in the past
If the student is experiencing educational impacts from an earlier brain injury, make a referral.
BrainSTEPS Teams are not CMTs • 29 educational Intermediate Units across Pennsylvania & 2 School Districts • Consultation & Training for all severities of Acquired Brain Injuries
CMTs are not BrainSTEPS Teams • 700+ across Pennsylvania based in school districts • Taught to manage concussions (only) for the initial 4 weeks prior to making a BrainSTEPS referral
www.brainsteps.net
www.brainsteps.net
Concussion
www.brainsteps.net
The Centers for Disease Control (CDC) & Prevention document:
www.brainsteps.net
S. Davies, B. Eagan Brown, G. Gioia, A. Glang, K. McAvoy
http://www.cdc.gov/concussion/pdf/TBI_Classr oom_Tips_for_Teachers-a.pdf
Concussion Management Team Registration www.brainsteps.net
www.brainsteps.net
PaTTAN: www.pattan.net Available for download at:
TBI added as an “Educational Initiative” in 2012
www.brainsteps.net
Available to order in bulk at: www.pattan.net
www.brainsteps.net
www.brainsteps.net
13
BrainSTEPS 2014
*Webinars will be archived at www.pattan.net & www.brainsteps.net The BrainSTEPS Program, PA Department of Health & PA Department of Education invite your PA school to form & train a
Return to Learn Concussion Management Team (CMT) Join the 700+ Return to Learn Concussion Management Teams that have formed in PA school districts within the last 1.5 years
Return to Learn Concussion Series Wednesday, September 10, 2014 Medical Management of Concussion 3:30—5:00pm Gerard Gioia, PhD
Wednesday, October 1, 2014 School Impacts, Return to School Progression, Symptom Based Accommodations 3:30—5:00pm Brenda Eagan Brown, MEd, CBIS
Wednesday, November 5, 2014 Vision Issues Impacting Academics 3:30—4:30pm Nathan Steinhafel, M.S., O.D., F.A.A.O
Wednesday, November 12, 2014
Vestibular Issues Impacting Academics 3:30—4:30pm Lenore Herget, PT, DPT, MEd
December 18, 2014
To register:
www.brainsteps.net www.brainsteps.net
Wednesday, October 22, 2014: Legal Dimensions for Schools 3:30—5:00pm Perry Zirkel, PhD, JD, LLM
Supporting Emotional & Mental Health of Students with Protracted Recovery 3:30—5:00pm David Brent, MD
. www.brainsteps.ne t
14
Students (K-12) with Concussion Educational Impacts, Return to School Progression, & Symptom Based Accommodations Brenda Eagan Brown, M.Ed., CBIS
Brenda Eagan Brown, MEd, CBIS BrainSTEPS Program Coordinator The BrainSTEPS Program [email protected]
October 1, 2014
www.brainsteps.net
www.brainsteps.net
The webinars in this concussion series were created to build the capacity of teachers working with students who return to the classroom following concussion. This series does not replace the official PA BrainSTEPS Return to Learn (RTL) Concussion Management Team (CMT) Training. Attendance during this webinar does not denote CMT formation or BrainSTEPS Team Membership. This webinar is for educational purposes only. If your Pennsylvania school district is interested in forming a Concussion Management Team for academic & symptom management, please register your CMT at www.brainsteps.net and online training information will be sent to you.
www.brainsteps.net
If you have questions during the webinar, feel free to email them to me at: [email protected] We are not taking questions during the webinar This webinar is being recorded and will be available online in one month at www.pattan.net and also at www.brainsteps.net
www.brainsteps.net
Safe Kids Worldwide 1 child every 3 minutes sustained a concussion
Concussions in Pennsylvania: Annually, approx. 22,000 children & adolescents sustain concussions.
47% of these concussions were in children ages 12 -15 U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) - 2013
www.brainsteps.net
www.brainsteps.net
1
Following a CONCUSSION, there are actual METABOLIC CHEMICAL CHANGES that take place in the brain.
www.brainsteps.net
Brain injury can occur even if there is NO loss of consciousness
www.brainsteps.net
More than 90% of concussions DO NOT involve loss of consciousness.
Memories of events BEFORE & AFTER the concussion are MORE accurate assessments of SEVERITY than loss of consciousness.
www.brainsteps.net
www.brainsteps.net
The majority of students should recover within the first 3-4 weeks, many in the first 7-10 days.
A child’s brain is not fully developed until the early to mid-20s. www.brainsteps.net
www.brainsteps.net
2
Signs and Symptoms of Concussion
Prolonged Concussion: Indicators that student’s concussion will most likely take 1 month or more recover? (UPMC in Pittsburgh, 2012)
1. Fogginess 2. Vomiting 3. Dizziness
CDC, 2014 www.brainsteps.net
www.brainsteps.net
What teachers may observe: • • • • • •
www.brainsteps.net
What teachers may observe: • • • • •
Behavior changes Confusion More emotional than usual More frustrated than normal Unable to cope with stress
www.brainsteps.net
Multi-tasking difficulty More forgetful Slowed thinking & processing Answers questions slowly Word-finding problems Difficulty handling new situations
www.brainsteps.net
What teachers may observe: • Drifting off in class • Difficulty focusing on material, especially more difficult material • Cannot keep focused for a sustained period • Restlessness • Reports of “foggy” feeling
www.brainsteps.net
3
Physical & Cognitive REST is crucial ACUTELY.
Keep in mind 2 Phases of Recovery:
1. The ACUTE Phase 2. The REHAB Phase
www.brainsteps.net
www.brainsteps.net
Too little rest:
= prolonged recovery
School Re-Entry Progression
Too much rest:
= physical deconditioning = social isolation www.brainsteps.net
Return to Learn (RTL) While it is true that an athlete must be 100% symptom-free before Return to Play, they do NOT need to be 100% symptom-free to RTL.
www.brainsteps.net
Students Should Not Push Through Symptoms While Recovering • exacerbates symptoms • prolongs recovery time Majerske, C., et al. 2008
www.brainsteps.net
www.brainsteps.net
4
Need for Rest After Concussion: High levels of cognitive activity
=
Longer recovery from concussion
School Concussion Management
1. Return to Learn 2. Return to PLAY
(Brown et al., , 2014)
www.brainsteps.net
When Students Should Return to Sports
www.brainsteps.net
Acutely- Upon Return to School – Across the Board (length of time needed varies) 1. No note taking 2. Reduce all in class work to 50% 3. No tests, quizzes, standardized tests, or homework 4. Scheduled rest breaks 5. Excuse from all classes/activities that may be overstimulating (light/noise)
Halstead, M.E., McAvoy, K., Devore, C.D., Carl, R., Lee, M., Logan, K. Returning to learning following a concussion. Pediatrics 2013;132(5):948-957.
www.brainsteps.net
A word about Medical Homebound & Homebound Instruction • Keeping a student out of school for too long can be harmful – Socially, Emotionally, Academically
• Something is usually missing: – – – –
6. Excuse from PE, recess, all physical activity
www.brainsteps.net
ONE or the OTHER rule New Learning Missed Work
return to school plan academic accommodations staff wasn’t trained to understand concussion fluid, consistent communication between home/school/medical
www.brainsteps.net
www.brainsteps.net
5
For students enrolled in a Career and Technical Center (CTC) Return to Tech vs Return to School
Educational Accommodations
A Career and Technical Education (CTE) provides unique environmental and academic challenges for the concussed student Need to Be Separate Decisions
www.brainsteps.net
Academic Accommodation Decisions Educational accommodation selection is the responsibility of the School Team. Medical academic accommodation suggestions are only RECOMMENDATIONS that the school team should take into consideration.
www.brainsteps.net
Helping the concussed student remain in school while recovering.
The school team needs to make the final decision for accommodation implementation based on collected academic data, symptom data, etc.
www.brainsteps.net
www.brainsteps.net
Cognitive fatigue and headaches For students who linger, striking a balance between the need for rest and keeping up with academic content is the biggest struggle.
www.brainsteps.net
• 50% of workload is commonly recommended during recovery
• Assignments (homework/classwork) should not be repetitious.
www.brainsteps.net
6
Cognitive fatigue and headaches Cued Recall is better than Random Retrieval. Alleviate brain fatigue by using:
• Rest Breaks • Removal from Cafeteria ?
www.brainsteps.net
Cognitive fatigue and headaches • Chunking Assignments
www.brainsteps.net
Cognitive Fatigue & headaches • Timeline for work - fatigue
• Water bottle • Extra time
• Don’t just say “Do what you can”
• Timelines to plan
www.brainsteps.net
Cognitive fatigue & headaches
Testing • Acutely tests and quizzes should be delayed (especially standardized tests) • Gradually re-introduce testing, preferably 1 test/quiz per day, as tolerated
www.brainsteps.net
Sensitivity to Light & Noise • Sunglasses, hat • Face student away from bright lights • Remove from over-stimulating classes • Early dismissal • Headphones or ear buds
• Testing in a separate, quiet room
www.brainsteps.net
www.brainsteps.net
www.brainsteps.net
7
Social/Emotional
Dizziness
Early on-
• Allow extra time to get to class avoid crowded hallways • Walk with a peer/peer carry books • Elevator key instead of stairs
www.brainsteps.net
Later on–
www.brainsteps.net
Social/Emotional Develop an emotional support plan with the student
Educational Frameworks to Safeguard Persistent/Prolonged/Protracted Concussions
• Identify an adult • Identify a student
www.brainsteps.net
Prolonged Concussion Recovery • PCS
• Students should work to his/her symptom threshold = REST, RECOVER, RETURN to Activity
www.brainsteps.net
www.brainsteps.net
Prolonged Concussion Recovery • • • • • •
Physical Therapy Speech Therapy (cognitive rehab) Vestibular Therapy Vision Therapy Medications Counseling
www.brainsteps.net
8
Academic Supports After Concussion
Informal Supports 100% Formal Supports 10-20%
If a student experiences lasting effects that impact learning (school
evaluation must first take place):
Concussion
504 Plan
IEP
INTENSIVE Very, very few
www.brainsteps.net
www.brainsteps.net
Who is Eligible for a 504? Not Special Education – 504 Plan/504 Service Agreement
www.brainsteps.net
o The
physical or mental impairment must impact at least 1 of 13 listed major life activities (Dr. Perry Zirkel, 2010): 1. Seeing
8.
Concentrating
2. Hearing
9.
Sleeping
3. Walking
10. Eating
4. Learning
11. Bowel functions
5. Breathing
12. Bladder functions
6. Reading
13. Digestive functions
www.brainsteps.net
“a person with a disability as any person who has a physical or mental impairment that substantially limits one or more major life activities*, has a record of such impairment, or is regarded as having such impairment.”
www.brainsteps.net
Section 504 of the Rehabilitation Act:
7. Thinking
504 Regulation 34 C.F.R. 104.3(j-l):
There needs to be a plan in place that all teachers implement across the board.
Don’t rely on the student to request accommodations “as needed” www.brainsteps.net
9
Journal of School Nursing Article (Legal issues of 504 Plans, IEPS, IHPs after Concussion)
Special Education
April 2015 Publication www.brainsteps.net
(Available online now)
Special Education Classification
Traumatic Brain Injury - (TBI)
www.brainsteps.net
Fear of Faking Symptoms? Does not occur often District guidelines can be established
Traumatic Brain Injury was added into the Special Education Law (IDEA) in 1990 as a specific category requiring specialized understanding. www.brainsteps.net
Public Law 101-476 [34 Code of Federal Regulations §300.7(c)(12)]
Caution advised when limiting school activities
www.brainsteps.net
The BrainSTEPS Program Created by: PA Department of Health in 2007
Pennsylvania’s Statewide
Brain Injury School Consulting Program * BrainSTEPS provides consultation & training for students who sustain all severities of brain injuries acquired anytime after birth
Unique partnership for funding:
PA Department of Health PA Department of Education, Bureau of Special Education via the PaTTAN network
Implemented by:
Brain Injury Association of Pennsylvania
www.brainsteps.net
www.brainsteps.net
10
• 31 BrainSTEPS Teams cover the state of Pennsylvania • 300+ Brain Injury school consultants – Educational professionals – Medical & Rehab professionals – Family members www.brainsteps.net
• • • • • • • • • • • • •
BrainSTEPS team
Communication with family member Communication with school Consultation Consultation with student Activities Records review Consultation: strategies Consultation w/ medical professionals Consultation educational plan Training of educators and support staff Classroom and peer education Information sharing among team Demonstration of interventions Observations/evaluations of student Participation in IEP and 504 meetings
www.brainsteps.net
Students Referred to BrainSTEPS
BrainSTEPS Teams monitor students annually until graduation.
nonTBI
11%
TBI Severities TBI 89%
Moderate & Severe
23% CONCUSSIONS
77%
www.brainsteps.net
www.brainsteps.net
Common Student Concussion Scenario
Pennsylvania’s Statewide Return to Learn Concussion Management Team (CMT) Model www.brainsteps.net
1. 2. 3. 4. 5.
Student returns to school to Learn School mayReturn not implement accommodations Symptoms flare Concussion Management Student pushes through Teams (CMTs) can symptoms alleviate these Student waits for medical appointment 2 issues & Continues potentially promote weeks away. pushing through symptoms. faster student recovery 6. At appointment, Dr. may place student on homebound rest for period of time because at this point, symptoms are so severe. www.brainsteps.net
11
Return to Learn BrainSTEPS Concussion Management Team (CMT) Model
Concussion Management Team (CMT)
CMT 1. Academic Monitor 2. Symptom Monitor
– CMTs consist of 2 monitors • Academic Monitor (School Psych, Guidance Counselor) Symptom Monitor (School Nurse)
– 700+ Return to School Concussion Teams across the state of PA since Jan. 2013 www.brainsteps.net
Utilizes the Return to Learn Concussion Electronic Toolkit
Academic Monitoring Tool 1 page 1 side Teachers Fill Out Classwork, Homework, Tests, Assignments, Behaviors
Symptom Monitoring Tool 1 page 1 side Student Fills Out Symptom Severity Rating Scale
www.brainsteps.net
Concussion Management Team
CMT Model Provides Pennsylvania School Districts: 1. Structure Concussion Return to Learn Protocol
2 person CMT does NOT take the place of the
“Interdisciplinary Team”
(Educational, Medical/Rehab, Parent, Student)
The CMT serves as the “Concussion Coordinators” *CMTs are the Data Collectors & Information Gatherers www.brainsteps.net
2. Online Return to Learn Training
Best Practices for managing concussions in the classroom
3. Tracking student progress
Concussion Academic & Symptom Monitoring Toolkit
www.brainsteps.net
PA’s Layered Statewide Educational Infrastructure for Concussion Return to Learn
CMT Monitoring Student Concussion
www.brainsteps.net
@ School level 700+ Concussion Management Teams for Return to Learn
BrainSTEPS Support begins 4 weeks post @ Intermediate Unit level 31 Regional Consulting Teams
At 4 weeks post concussion: Students are referred to BrainSTEPS & A Concussion (mTBI) Brain Injury Supports Framework is created
www.brainsteps.net
12
PA Students who should be referred to your regional Intermediate Unit BrainSTEPS Team Type of Student Acquired Brain Injury
When to Refer a Student to BrainSTEPS
Brain injury occurring anytime AFTER birth
4 weeks post concussion unless student has a history of any of the following then refer sooner: • Prior concussions • Migraines • Learning, attention or emotional disabilities, sleep disorders
New Moderate TBI, Severe TBI, Non-TBI
As soon as injury occurs, the sooner you refer the better. Don’t wait for the student to experience educational impacts/bad grades. Refer early to prevent issues.
Acquired Brain Injuries (TBI or non-TBI) that occurred in the past
If the student is experiencing educational impacts from an earlier brain injury, make a referral.
BrainSTEPS Teams are not CMTs • 29 educational Intermediate Units across Pennsylvania & 2 School Districts • Consultation & Training for all severities of Acquired Brain Injuries
CMTs are not BrainSTEPS Teams • 700+ across Pennsylvania based in school districts • Taught to manage concussions (only) for the initial 4 weeks prior to making a BrainSTEPS referral
www.brainsteps.net
www.brainsteps.net
Concussion
www.brainsteps.net
The Centers for Disease Control (CDC) & Prevention document:
www.brainsteps.net
S. Davies, B. Eagan Brown, G. Gioia, A. Glang, K. McAvoy
http://www.cdc.gov/concussion/pdf/TBI_Classr oom_Tips_for_Teachers-a.pdf
Concussion Management Team Registration www.brainsteps.net
www.brainsteps.net
PaTTAN: www.pattan.net Available for download at:
TBI added as an “Educational Initiative” in 2012
www.brainsteps.net
Available to order in bulk at: www.pattan.net
www.brainsteps.net
www.brainsteps.net
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BrainSTEPS 2014
*Webinars will be archived at www.pattan.net & www.brainsteps.net The BrainSTEPS Program, PA Department of Health & PA Department of Education invite your PA school to form & train a
Return to Learn Concussion Management Team (CMT) Join the 700+ Return to Learn Concussion Management Teams that have formed in PA school districts within the last 1.5 years
Return to Learn Concussion Series Wednesday, September 10, 2014 Medical Management of Concussion 3:30—5:00pm Gerard Gioia, PhD
Wednesday, October 1, 2014 School Impacts, Return to School Progression, Symptom Based Accommodations 3:30—5:00pm Brenda Eagan Brown, MEd, CBIS
Wednesday, November 5, 2014 Vision Issues Impacting Academics 3:30—4:30pm Nathan Steinhafel, M.S., O.D., F.A.A.O
Wednesday, November 12, 2014
Vestibular Issues Impacting Academics 3:30—4:30pm Lenore Herget, PT, DPT, MEd
December 18, 2014
To register:
www.brainsteps.net www.brainsteps.net
Wednesday, October 22, 2014: Legal Dimensions for Schools 3:30—5:00pm Perry Zirkel, PhD, JD, LLM
Supporting Emotional & Mental Health of Students with Protracted Recovery 3:30—5:00pm David Brent, MD
. www.brainsteps.ne t
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