ROCKINGHAM CO PUBLIC SCHOOLS
School-Based Concussion Management
VIRGINIA DEPARTMENT OF EDUCATION
TBI SUMMER TRAINING
JULY 19, 2017
REBECCA R. HILL-SHIFFLETT
The Simple Facts
- Brain injury and concussion can happened to anyone, not just athletes
- Schools are taking a more active role in the "return-to-learn" process for concussed students
- A multi-disciplinary approach for recovery is the most effective
ROCKINGHAM CO PUBLIC SCHOOLS
RCPS Multi-Disciplinary Approach
- Parent and Student
- School Personnel
- Physicians/Medical Personnel
The Beginning 2011-12
- Shenandoah Valley Regional Program provided TBI Training December 6, 2011
- RCPS participants included Nurses, Athletic Trainers, Coaches, Activities Director and Central Office
- Division Goals
- Expand awareness, education, and training by June 2012
- Develop comprehensive division plan to pilot by June 2013
ROCKINGHAM CO PUBLIC SCHOOLS
Team Structure and Responsibilities
| Central Office Leadership | School-Based CMT | Division Task Force |
|---|---|---|
| Participants Director of Pupil Personnel Services Director of Secondary Education Director Physical Ed RCPS TBI Liaison |
Participants School Nurses Symptom Monitor (Nurse) Academic Monitor Athletic Trainers PE Teachers Student Study Multidisciplinary team Chairpersons |
Participants Community Health Leaders RCPS TBI Liaison •Parents •Teachers •Athletic Trainers •Sentara RMH •Physicians |
| Responsibilities Appoint TBI Task Force Communicate with Principals Oversee school based protocol |
Responsibilities Each team member has a specific role in monitoring the individual Return-to-Learn protocol based on student needs |
Responsibilities Participate in training June 19, 2012 Increase knowledge base Develop RCPS Division Goals for TBI Create a referral form Plan training and education |
ROCKINGHAM CO PUBLIC SCHOOLS
The Beginning...Division Task Force Training
AGENDA - June 2012
- 9:00 Welcome and Introductions
- 9:15-10:15 Michelle Witt, Director Crossroads to Brain Injury Recovery, Inc. Overview - Traumatic Brain Injury
- 10:15-11:15 Implementing Accommodations in the School Setting - Sara Tonizzo, Partnership for People with Disabilities
- 11:15- Noon Begin Brainstorming for RCPS Procedures - Sara Tonizzo
- Noon-1:00 PM Lunch on your own
- 1:00-3:00 Team Work Session - RCPS TBI Procedures
ROCKINGHAM CO PUBLIC SCHOOLS
Traumatic Brain Injury School-Based Response Process Initial DRAFT
Gate Keeper for Referrals: School Nurse
- Complete TBI Report Form
- Obtain consent to exchange information with physician
- Email to teachers
- Reporting Forms sent to teachers
- Email to teachers
- Reporting Forms sent to teachers
- Assess
Outcomes
- Referral is terminated
- Assess
- Referral to TBI Intervention Team (Student Assistant Program (SAP), ASSIST or Student Study Team)
- Follow-up time line established
- Access
- Referral is terminated
- Referral for 504 OR
- Referral for evaluation for Special Education
ROCKINGHAM CO PUBLIC SCHOOLS
Goals for Implementation
| Need/Goal | Participants | Resources Needed | Projected Time Line | Who |
|---|---|---|---|---|
| Establish a "Gate Keeper' at each school School Based TBI Teams |
School Nurse Administrator Nurse Guidance Counselor Student |
Documentation Consent to Exchange Information Reporting Form Contact List Training |
Begin Pilot Implementation for 2012-2013 after training Begin Pilot Implementation for 2012-2013 after training |
School Nurse School Nurse and TBI Teams Study/504/SAP Athletic Trainers |
| Training | Principals School Nurses |
CO Support | August 9, 2012 August 14, 2012 |
CO Staff RN's, Chuck Wenger |
| Student Study | Chairs | August 17, 2012 | CO Staff | |
| Open to All Staff | November 6, 2012 | Michelle Witt Sara Tonizzo |
ROCKINGHAM CO PUBLIC SCHOOLS
Accomplishments in 2012-13
- TBI/Concussion Link posted on RCPS web site
- Draft flow chart and forms are developed to document and monitor TBI/Concussions
- Nurses Met
- Discussed process
- Tweaked forms
- Added forms for communicating with teachers
- All forms posted on our web site
ROCKINGHAM CO PUBLIC SCHOOLS
Sentara RMH Orthopedics and Sports Medicine and Rockingham County Public Schools
SENTARA
ROCKINGHAM CO PUBLIC SCHOOLS
RMH Medical Center
Sentara RMH Partnership
- Dr. Tom Weber began working with RCPS Athletic trainers in April 2011
- This partnership has added estimated $85,000 to the RCPS athletic program
- Sentara RMH was awarded a $25,000 grant in 2012-2013 to support concussion diagn0sis and management in RCPS
- Dr Weber oversees the scope of practice for RCPS athletic trainers and supervising RNs
Sentara RMH Orthopedics and Sports Medicine
- Helps maintain computerized electronic medical records
- ImPACT neurocognitive baseline testing purchased for all RCPS high schools and training provided to ATCs
- On-Site coverage for home high school football games
- Provides 24/7 physician on-call availability for consult on injured athletes ensured by Dr. Weber for consult with ATCs regarding injuries
Sentara RMH Orthopedics and Sports Medicine
- Sentara RMH Orthopedics and Sports Medicine serves as a liaison to other RMH departments to facilitate care
- Sports physicals are available
- Continuing education programs for sports medicine
- Conditioning and injury prevention program on-site to athletic teams prone to injury
Accomplishments in 2013-14
- Expanded partnership with Sentara RHM Orthopedics and Sports Medicine
- Sentara RMH funded training for BrainSTEPS Model - School-Based CMT
School-Based Concussion Management
- RCPS program modeled after BrainSTEPS
- Return to learn protocol
- Athletes and non-athletes are monitored
- Symptom Monitor (School Nurse)
- Monitors symptoms
- Academic Monitor
- Monitors adjustments and academic performance
- RCPS Protocol Flow Chart and Forms
School Nurse – Gatekeeper for Referrals
Nurse completes form CMT-1 Concussion Signs and Symptoms Checklist
- Nurse calls parent and sends a copy of form CMT-1 home
- If athlete, notifies Athletic Trainer
If student returns to school with symptoms or physician orders follow protocol
Student Comes to School with Symptoms or Physician Orders for Concussion Head Injury at School
- Nurse completes CMT-2 Student Concussion Symptom Monitoring Tool
- Nurse calls to inform the parent of CMT protocol and recommends student be seen by physician if they have not been seen
- Nurse sends CMT-3 Teacher Notification of Student Concussion to teachers and Academic Monitor.
- If student is an athlete, the Athletic Trainer is also notified.
- Nurse monitors two times per week using CMT-2
- Academic Monitor begins monitoring with CMT-4 Student Concussion Academic Monitoring Tool
- If student is an athlete, information is sent to the Athletic Trainer
- Parents are notified of progress
Week Three Check
- Progress is noted, no symptoms: Appropriate return to learn and return to play
- Symptoms Continue, No Progress:
- Contact Parent
- CMT makes referral to Student Study CMT -5 Recommendations to Address On-Going Symptoms
- Interventions may include a referral to Dr. Tom Weber Concussion Management Flow Chart
Implementation Time Line
- December 6, 2011: Shenandoah Valley Regional Program TBI Training
- June 19, 2012: Division Task Force TBI Training
- August 2012: Dissemination of pilot forms and flow chart
- March 21, 2013: TBI Team presents at VDOE TBI Training
- July 26, 2013: RCPS CO Staff met with RMH Sports Medicine- Concussion Clinic Staff
- August 1, 2013: RCPS TBI Team presents at VDOE TBI Training
- September 24, 2014: RCPS Memorandum of Agreement with RHM
- October 4, 2013: Division Training on BrainSTEPS model
- October 17, 2013: RCPS Supervising RNs met with Dr. Weber
- November 14, 2013: RNs met with Dr. Weber, RMH Staff and RCPS Athletic Trainers
- December 6, 2013: RNs met to revise flow chart and forms
- January 16, 2014: School-Based CMT’s met to review flow chart and and forms
- March 25, 2014: RNs met with Dr Tom Weber
Full Implementation 2014-15
- All schools continue to implement School-Based CMT model.
- Continued partnership with Sentara RMH for training, education and concussion management
- Feedback and Evaluation of pilot
- 2014-15 Focus
- Middle School Back to School Night August 2014
- Informational session for all school nurses August 2014
- Informational sessions at “Your Day at School”
Program Continuation and Evaluation 2017-18
- Summer session with Sentara RMH and RCPS leadership team
- August training for Nurses and Academic Monitors
- Quarterly Nurse Supervisors and Dr. Weber
Suggestions
Identify…
- What staff do you already have in place?
- What structures already exist to support return to learn?
- Who are your “experts”
- What supports exist in your community?
- Use available resources….but make it your own
Helpful Resources
- Brain Injury Association of Virginia
- Centers for Disease Control
- REAP
- Brain 101- The Concussion Playbook (ORCAS)
- BrainSTEPS
- www.rockingham.k12/va/us
Questions?