BrainSTEPS Return to School Concussion Management Teams (CMT) Brenda Eagan Brown, M.S.Ed., CBIS Program Coordinator

BrainSTEPS Brain Injury School Re-Entry Model Program

S S trategies T T eaching E E ducators P P arents S S tudents BrainSTEPS

The BrainSTEPS Program Funded by: 1. PA Department of Health 2. PA Department of Education Implemented by: 1. Brain Injury Association of Pennsylvania - Beginning our 5 th academic year

What is BrainSTEPS? Brain injury consulting teams available to families and schools throughout Pennsylvania. Teams are extensively trained in the educational needs of students returning to school following brain injury. Teams work with local school staff to develop educational programs, academic interventions, strategy implementation, and monitoring of students.

BrainSTEPS Encompasses Acquired Brain Injuries Traumatic Brain Injury (includes Concussions) Non-Traumatic Brain Injury (Any child who has a brain injury that occurs AFTER the birth process can be referred!)

BrainSTEPS Provides Services to: All public schools in PA All cyber charter schools in PA All cyber online schools in PA

30 BrainSTEPS Teams 27 Intermediate Unit teams & 3 large school district teams 300+ Active Team Members All Colored Areas = Trained BrainSTEPS Teams White = Intermediate Unit regions without BrainSTEPS teams

What BrainSTEPS Can Do: 1.Conduct observations of the student 2.Communicate with the LEA and medical professionals/physicians to ensure a smooth re- entry and ongoing communication through recovery. 3.Gather medical, rehabilitation, & educational reports to assist in making educational recommendations.

What BrainSTEPS Can Do: 4. Create & provide a training for the school on the educational impact of the student’s specific brain injury. Educate and support district staff & family. 5. Provide Peer Trainings, so peers understand how brain injury has impacted their classmate.

6. Consult on all aspects of the student’s educational plan & make recommendations to the district team. 7.Assist in transitioning a student from grade to grade or school to school by training new teachers

BrainSTEPS Teams monitor students annually until graduation.

Concussions in Pennsylvania: Annually, approx. 22,000 children ages 0-21 years sustain concussions.

Concussion: Incidence Centers for Disease Control: 3.8 million sports and recreation related concussions are estimated to occur in the United States each year.

Concussion: Definition A concussion is a type of TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth.

The majority will recover within the first 3-4 weeks. Until recovered, students should receive accommodations in all settings to promote cognitive rest.

There is no set timeline for concussion recovery Typically a child can fully recover from a concussion as long as their brain has had time to FULLY HEAL.

Concussion management within school: Communication MUST flow between: – School team – Physician – Family – Student – Coaches, & athletic department (if athlete) – BrainSTEPS team

Return to Learn 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 Return to Learn. S triking a balance between the need for rest while keeping up with academic content is the biggest struggle for districts and students.

LEA Concussion Management Is there a recommended protocol to help districts manage the Return to Academics for students with concussions? YES!

Concussion Management Team (CMT) CMT LEA or individual school building team(s) Symptom Monitor Academic Monitor

1 st week Post-Concussion: LEA CMT will: Share physician instructions provided by parents Share student symptoms and accommodations for classwork until all symptoms resolve Excuse student from PE, sports, and all physical activity until cleared Notify the athletic department and coach if student plays sports

1-4 Weeks Post-Concussion: LEA Symptom Monitor Academic Monitor Monitors academic progress/behaviors weekly with teachers CMT monitors student symptoms & academic progress CMT meets weekly to review & adjust accommodations, notifying relevant staff of any updates. Offers support and educational resources to parent/guardian Monitors symptoms 3-5 days per week via student interview

1-4 Weeks Post-Concussion: LEA Symptom Monitor Academic Monitor 1. Have student’s symptoms subsided? 2. Has student been cleared by a physician to return to full physical and cognitive activity? 3. Do teacher weekly reports display no academic or behavior concerns? If YES was answered for ALL 3 questions: LEA will formally conclude concussion accommodations. CMT monitoring will end. Concussion will be documented in student’s education file and student should return to full activity. If NO was answered to any 1 of the 3 questions: CMT continues to monitor student’s academics and symptoms until concussion resolves or student reaches 4 weeks post-concussion. At that time a referral to The BrainSTEPS Program is warranted.

4 weeks Post-Concussion: BrainSTEPS CMT makes a referral to the BrainSTEPS Team Referrals can be made earlier if the student’s symptoms are not progressively getting better or if student has had multiple concussions in past BrainSTEPS: offers concussion training to school staff CMT: Sets up meeting to create BrainSTEPS Brain Injury Support Framework. School team, CMT, BrainSTEPS, parent/guardian & student are invited. Copies of monitoring tools from CMT will be shared with BrainSTEPS prior to meeting. BrainSTEPS Brain Injury Support Framework is created with input from all parties. Schedule follow up meeting in 1 month to review. CMT provides copies of BrainSTEPS Brain Injury Support Framework to relevant staff, parents/guardian. CMT continues to monitor student.

4-8 Weeks Post-Concussion: LEA For those students who need ongoing accommodations Academic Monitor Symptom Monitor Continues to monitor academic progress/behaviors weekly with teachers CMT monitors student symptoms & academic progress CMT continues to meet weekly to review & adjust accommodations, notifying relevant staff of any updates. Continues to monitor symptoms 3-5 days per week via student interview

4-8 weeks Post-Concussion Key Questions CMT must discuss during weekly CMT meeting : 1. Have student’s symptoms subsided? 2. Has student been cleared by a physician to return to full physical and cognitive activity? 3. Do teacher weekly reports display no academic or behavioral concerns? If the answer is YES to all 3…

4 – 8 weeks Post-Concussion 1. LEA should formally conclude the accommodations set forth in the Brain Injury Supports Framework. 2. CMT & BrainSTEPS monitoring will end. 3. Concussion will be documented in student’s educational file and student will return to full activity If YES to all 3…

4 – 8 weeks Post-Concussion Key Questions CMT must discuss during weekly CMT meeting: 1. Have student’s symptoms subsided? 2. Has student been cleared by a physician to return to full physical and cognitive activity? 3. Do teacher weekly reports display no academic or behavioral concerns? If the answer was NO to any 1 question…

4 – 8 weeks Post-Concussion 1. BrainSTEPS, CMT and the school team should continue to monitor symptoms and accommodate the student until symptoms resolve. 2. Discussion should take place as to whether an evaluation should be conducted by LEA to determine need for more formal intensive accommodations/modifications. 3. If a referral for a multipurpose evaluation is not deemed necessary, then continued monitoring by the CMT and monthly review of the Brain Injury Support Framework in partnership with BrainSTEPS will continue. If NO to any 1…

Concussion Management Team(s) (CMTs) will be Trained for FREE: BrainSTEPS Concussion Return to School Videoconference Training January 15, :00 am-12:00 pm If they are registered at

How to Establish and Register Your Concussion Management Team(s): 1.LEAs should identify 2 individuals per district or per school building (preferred). LEAs may also choose to have one CMT per grade (i.e., 9 th, 10 th, 11 th, 12 th ). o Academic Monitor o Symptom Monitor 2.LEAs are to register each CMT by clicking the link at By registering each CMT, they will receive information on the upcoming CMT training. 3. BrainSTEPS will support students at 4 weeks post concussion and continually offer update training and resources to the CMTs.

Register Your Concussion Management Team(s) ASAP:

The Jan. 15, 2013 training objectives : Pediatric concussions and concussion etiology Concussion impact on classroom performance Strategies to reduce student symptom severity and promote recovery Matching of accommodations to specific symptoms How to fully implement the BrainSTEPS Concussion Return to School Protocol Specific responsibilities that the Academic Monitor and Symptom Monitor hold while serving on the CMT

Teacher’s Desk Reference: Concussion This will be IN PRINT & Available from PaTTAN KOP shortly!

BrainSTEPS Concussion/ mTBI Return to School Protocol This will be in print & available from KOP PaTTAN shortly!

BrainSTEPS Concussion Return to School Protocol FLOW CHART

Instructions for Administrators regarding how to establish & register Concussion Management Teams (CMT)

For More Information on the BrainSTEPS Program For more information – please contact: Brenda Eagan Brown, M.S.Ed., CBIS Program Coordinator BrainSTEPS - Brain Injury School Re-Entry Program Brain Injury Association of Pennsylvania Phone: To Register: