'Return to play' doesn't necessarily mean 'return to learn'
By Shasta Kearns Moore
Call it a jog-a-thon, a fun run or — as in the case of Hillsboro's Patterson Elementary School — a Panther Dash. Whatever it's named, an elementary school's annual fall fundraiser isn't supposed to end in tears.
But that's what happened Sept. 28 when Stephanie Shimp-Taylor's 6-year-old son Westen was accidentally pushed to the ground in a crush of eager runners.
"His little face bounced off the asphalt," said the Hillsboro mother of four. "He suffered a really severe concussion."
Fortunately, Shimp-Taylor, who was at the school that day, got her son medical care right away.
Unfortunately, although school officials initially seemed open to work with her to ease her son's return to school, Shimp-Taylor said the district's lack of preparation set them up for a fight.
"The relationship is definitely changing," she said. "I had to threaten getting lawyers and everything — and now we're at the point where that might be necessary to ensure that he gets the support that he needs."
Nearly a decade ago, Oregon led the nation in passing a return-to-play law that governs when a student athlete is safe to practice and compete on the playing field following a concussion. But the state hasn't required anything to ensure student athletes — or any other child with a concussion — are ready for the classroom following their injury, nor that the classroom is ready for them.
David Kracke, an attorney who helped lobby for Oregon's return-to-play law in 2009, says current law already protects students' rights to have medical needs considered in their classroom following any injury, including a concussion. But he agrees that it's time to expand the state's focus beyond "return to play" and help concussed students "return to learn."
"I don't think we necessarily need legislation to make this happen," said Kracke, who now works at the Eugene-based Center for Brain Injury Research and Training (CBIRT). "But without question, we need leadership from the highest levels of administration in this state."
A course few know about
Shimp-Taylor says her Hillsboro school offered her son a safety plan — a list of accommodations for his medical needs — but not until Nov. 16, seven weeks after the concussion occurred.
"I feel like the safety plan should have been in place the moment he came back to school," she said, adding that the interventions seemed to be largely dictated by her and her doctors. "I feel like there should be protocol in place in how to handle head injuries in elementary school with these kids."
In fact, there is. But only a few dozen of the state's thousands of educators know about it.
CBIRT — the place where Kracke works and the state's lead agency on traumatic brain injury response — last year released "In the Classroom After Concussion." The 10-hour online professional development course is free to Oregon educators and teaches them about what to do for a concussed student.
But few educators have heard about the course.
In response to questions about its return-to-learn practices, Hillsboro School District spokeswoman Elizabeth Graser confirmed that Hillsboro does not use "In the Classroom."
However, Hillsboro does use other CBIRT resources — particularly for high school student athletes. The district also offers resources to teachers on head injuries on its website.
But much as Shimp-Taylor experienced, the district's method relies heavily on doctor and parent guidance for educational accommodations.
Graser said parents are given paperwork for them and their doctor to fill out on what accommodations are needed. And, she added, school nurses tend to be involved when a school hears about a head injury and play a role in making sure the parents and school staff have a plan.
But the materials the Hillsboro district has on concussion management applies to student athletes covered by the return-to-play law, not younger children and non-athletes like Shimp-Taylor's son.
Asking the Oregon Department of Education yielded little information on what should happen academically for students who have suffered concussions. ODE Education Specialist Jeremy Wells said concussions might fall under special-education provisions, such as an Individual Education Program (IEP) or a 504 plan. But Wells, to whom Clackamas County school districts come to for advice, said each district determines how it wants to approach a concussion.
"For all of our 197 school districts, we operate under local control," he said.
Education plans left to schools
School districts, in turn, largely leave their response to treating non-sport brain injuries up to individual schools, principals and teachers.
"There really isn't any law that requires anything before going back to learn," said Sasha Grenier, ODE's sexual health and school nurse specialist.
While some district staffers might reach for IEPs and 504s, they are slow processes designed for youth who have long-term needs or permanent disabilities.
"With a concussed student, however, that student needs immediate accommodations and they need it for one to four weeks, or three to eight weeks," Kracke said.
The state's hands-off approach to preparing concussed students for the classroom is a sharp contrast from the state laws governing when student athletes can return to athletic activities.
And, it comes even though the ODE is paying the CBIRT to teach educators a specific protocol: "In the Classroom After Concussion."
Melissa McCart , CBIRT's Oregon traumatic brain injury education coordinator, said the online training has not been heavily accessed.
"There's not a ton of people," McCart said. "It's whoever is interested in it. We don't have any requirements to do it."
A public records request revealed that "In the Classroom" has had 141 users. That could change. In 2019, CBIRT plans to market the course nationally.
Whether a new law is needed to govern students' return to the classroom is a matter of debate. Most researchers — including those at CBIRT — are reluctant to impose another unfunded mandate on teachers, but they do think there should be a way to get return-to-learn information into more of the hands that need it.
Kracke said he expects to see an administrative solution by the end of the three-year federal grant that employs him at CBIRT.
"We are figuring out what direction our solutions are going to go," he said.
Kracke agrees that the crux of the issue appears to be that not enough districts know about the free resource that CBIRT developed, which is particularly unfortunate, he said, because with a concussion, "we don't have the luxury of time."
Oregon is widely recognized to be a leader in the small, interconnected world of concussion and brain injury education management.
CBIRT received $600,000 in federal funding due to its expertise and the leadership needed to make "In the Classroom" a model program for other states.
The long, slow rollout of the training is in part due to the need to collect scientific evidence that it works to teach people what they need to know.
A few other states haven't wanted to wait. Colorado and Pennsylvania, for example, have been teaching a return-to-learn model for years.
Called "Get Schooled on Concussion," their return-to-learn resources are free, open to everyone online, and integrate with an action plan that's not only for school staff — like "In the Classroom" — but also parents and medical personnel.
That interdisciplinary action plan is called REAP, which gets its name from its four steps of concussion management: Remove/reduce, educate, adjust/accommodate and pace.
REAP is the brainchild of Dr. Karen McAvoy, a small, cheerful woman whose professional life changed dramatically one day in September 2004.
That was the day 15-year-old Jake Snakenberg died from second-impact syndrome — a second concussion too soon after his first. McAvoy was the psychologist at Snakenberg's Colorado high school.
With one foot in the education world and one foot in the medical world, she spent years afterward developing and codifying concussion management plans that could coordinate efforts between all of the people in a young person's life.
Snakenberg suffered his concussions on the football field, but, as Hillsboro mom Shimp-Taylor found out, concussions can happen anywhere and to children much younger than those covered by Oregon's return-to-play laws.
For families at schools that don't have good return-to-learn protocols in place, much of the burden of coordinating post-concussion care falls to parents like Shimp-Taylor.
"Things are not going as well as I had hoped," she said of her son's return to first grade. "It's quite the hassle. I'm constantly having to update (the school) with new doctor's notes about his ongoing recovery."