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Nationwide Children's Hospital Sports Medicine wants you to understand the impact concussions can have on a student's ability to learn. You can help reduce the likelihood of a child suffering permanent damage to his or her academic record by using this guide to help you create and implement an academic concussion management plan.
Concussions are brain injuries that may affect a student’s ability to learn. Because every brain and every student are different, every concussion is different. Some students may not miss any school and may need no more accommodations than someone who has suffered a minor illness. Others may have months of enduring symptoms that can significantly impact their academic performance. Mental and physical rest are essential to concussion recovery. If not properly managed from the time of initial injury, recovery time can be extended and damage to the students’ academic records can result. Therefore, it is essential to have a communication and management plan in place that helps concussed students heal while continuing their education.
Concussions are both a medical and educational issue. Any accommodations created by the school are based on an educational need that happens to be caused by a medical issue. Assessing problems with learning and school performance (and making changes to a student’s learning plan) are not medical decisions, but are academic decisions. Therefore, it is completely appropriate for the school to address learning difficulties caused by a concussion.
Creating an Academic Concussion Management Plan focuses on creating an effective communication plan to manage concussed students in the school setting. If you have not already, please familiarize yourself with An Educator’s Guide to Concussions in the Classroom before continuing on in this document. Concussions in the Classroom explains what a concussion is, why and how concussions may affect students, and how to make temporary academic accommodations to help these students recover. This baseline knowledge is critical to understanding and implementing an academic concussion management plan; therefore, it is highly encouraged that all educators in your school system read and understand this information.
Many people are vested in a student’s education, especially when a health condition affects his or her ability to learn. Those involved can be grouped into four categories:
For the student and family to receive the best care, all of the teams must communicate effectively both amongst themselves and with the family.
Each team member will have responsibilities to perform when managing a concussed student. The table below provides an overview of these duties. Remember, because school systems vary, your school may not have all of these team members. The responsibilities of missing team members may need to be assigned to others.
Coach/Physical Education Teacher
The responsibilities of the team members overlap to some extent. Therefore, a clear line of communication must be
built so that information is effectively and succinctly transferred among all parties.
The basic academic concussion management process begins with identifying the injury and notifying the Concussion Management Leader (CML) of the injury, so the process can begin. When the student returns to school, a needs assessment must be performed to determine the student’s medical and academic problems. Once the needs are established, a plan with accommodations can be created and disseminated to teachers and coaches. The basic framework of the process will be explained here, followed by two examples of potential role assignments for team members. Then, each step in the process will be defined in further detail.
Below, two models for concussion management are presented. Both models involve the Concussion Management Leader (CML). This person serves as the central communicator for all parties and oversees the process through the duration of the plan. In the first variation, the two-leader model uses the expertise of people on each of the medical and academic teams to split the assessment duties, with one leader also performing CML duties. In the second variation, called the one-leader model, the CML is the central communicator and may need to perform both the medical and academic assessments.
The team members chosen for leadership positions should be self-motivated, willing to learn, and be strong communicators. They should familiarize themselves with concussion management, and most importantly, be on the school campus most days. An evaluation of the workloads of potential leaders should be done prior to implementation of the plan to ensure they will be able to perform these special positions adequately.
The Two-Leader Model works best for schools that have enough resources for duties to be divided amongst those with expertise in certain areas. A Medical Leader (ML) will assess medical needs, whereas an Academic Leader (AL) will assess the academic needs. Either of these leaders can also serve as the CML, or they may share the CML duties. The key to making this model work is constant communication between the ML and AL and a clear delineation of the other responsibilities in the process.
Recommended team members for the Medical Leader: School nurse, athletic trainer, administrator
Recommended team members for Academic Leader: Guidance counselor, teacher, school psychologist, administrator
with the guidance counselor serving as CML and AL and the school nurse serving as ML:
The One-Leader Model works best for schools that do not have a full-time school nurse or guidance counselor or
lack the resources to split the medical and academic duties. In this model, the CML must be prepared to make both a
simple medical assessment (in the absence of qualified medical personnel) and an academic assessment (in the absence
of qualified academic personnel). If needed, the CML can be trained for these duties by the appropriate personnel, and
maintain communication with them throughout the management process. Choosing the appropriate person as the
CML is the key to making this model work.
Recommended team members for this job: School nurse, guidance counselor, administrator, school psychologist with a willing administrator serving as the CML and consulting with other team members:
STEP 1: Concussion is reported to the CML as soon as possible.
STEP 2: Contact student and family and meet with the student upon return to school.
STEP 3: Assess medical needs.
STEP 4: Assess academic needs.
STEP 5: Distribute accommodations to teachers in writing. Contact family (and if applicable, coach and athletic trainer) with relevant academic/medical updates and plan, as needed. Document as required.
STEP 6: Identify appropriate timeframe for re-assessment of needs, and using feedback from teams, re-start process at step 3 or 4.
In general, any information about a student’s health status and academic career is protected information under the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA), respectively. Be careful about what you say and to whom you say it. Make sure you cannot be overheard and only discuss what is absolutely necessary to manage the situation.
It may be advantageous for an administration to outline appropriate forms of communication in these types of circumstances. There are many ways to communicate a student’s status: through email, telephone or in person, each with unique advantages and disadvantages. Make sure your entire staff knows how to appropriately communicate when involved in this plan.
For more information about HIPAA, visit hhs.gov/ocr/privacy/hipaa/understanding/index.html. For more information about FERPA, visit www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html.
As with any type of communication within a group, there are a few things you can do to help the team succeed:
Occasionally, the situation will arise when a student cannot see a physician, cannot get an appointment for a week or more, or the physician note does not provide any academic accommodations. In these circumstances, it is advisable for the school to put their own academic management plan in place until more specific recommendations follow. Waiting to implement a plan could significantly compromise the student’s educational progress as well as his or her recovery.
The student’s parent or guardian (or the student, if over age 18) will need to fill out a Release of Medical Information (ROI), in order for the physician to be able to speak with school staff about the student’s medical care. If desired, the CML should request for the family to complete this documentation through their physician’s office.
Concussion symptoms are unfortunately subjective in nature, and therefore, make it difficult to know when a student
is lying. Students with medical documentation of their injury should be helped to the best of the school’s ability. How-
ever, communication among all team members will help to identify students who may be trying to “work the system.”
If a concern has arisen about the legitimacy of the student’s complaints, a meeting with all involved parties can be
held to discuss the situation and determine the appropriate course of action. In these instances, direct communication
between the CML and physician is very useful.
Documentation is very important, especially in cases of non-compliance. There may be situations where the student and/or family do not follow recommendations. In these cases, it is important to document the school’s efforts and to keep this documentation on file as directed by school policy. The initial conversation between the CML and student/family can help to ensure compliance and therefore should not be skipped.
In order to begin the return-to-play progression, the student-athlete should not have any symptoms for at least 24 hours, not be using medications to help with symptoms, and be attending school full time without any concussion- related academic accommodations. When it’s time to start the progression, there should be communication among the athletic, medical and academic teams to make sure the student is functioning fully in school before beginning his or her return to sports. Academics come first!
IEP and 504 Plans are legal documents that help to ensure a student’s educational needs are being met by the school system. These programs may be necessary for students with long-term issues resulting from their injuries. These programs may take extensive time and documentation to implement, and therefore, may not be able to help the student in the days or weeks immediately following the injury. Each school system should decide how these programs fit into their academic concussion management plan.
A history of certain pre-existing medical conditions and/or academic difficulties can make concussion diagnosis and
treatment even more challenging. Special considerations may be needed in the following circumstances:
Furthermore, students who have a history of poor attendance or those who are high achievers may need firm guidelines and good social support to ensure adherence to the management plan.
In all of these scenarios, direct collaboration with the health care provider may be helpful in differentiating concussion symptoms from other conditions, so that the best recovery plan for the student can be utilized.
Nationwide Children’s Hospital Sports Medicine provides a consultation service on this topic free of charge. The
length and content can be tailored to fit the specific needs of the group. Please call (614) 355-6000 for more information.
A PDF version of this document is also available for download.
We provide further educational resources, presentations and print materials on concussion management and other sports-related injuries and fitness well-being. Visit NationwideChildrens.org/Sports-Medicine or call (614) 355-6000.
The Concussion Clinic at Nationwide Children’s utilizes the expertise of Pediatric Sports Medicine and Physical Medicine and Rehabilitation specialists, along with neurologists, neurosurgeons, radiologists, neuropsychologists, physical therapists and athletic trainers, to best manage pediatric concussions.
We also offer baseline neurocognitive (concussion) testing to evaluate a healthy athlete’s decision-making ability, reaction time, attention and memory.
The Centers for Disease Control and Prevention provide informational materials about concussions for athletes, parents, coaches and teachers, including a free Heads Up! toolkit. Visit cdc.gov/concussion.
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