Recently, I have been getting a lot more questions from parents about what kinds of services they should reasonably expect from a public school in the event their child suffers a concussion, especially whether their children are entitled to academic accommodations, such as an Individual Education Plan (IEP) or 504 Plan.
As a former school psychologist, I feel these questions deserve an answer. While I am now in private practice, I worked for a public school system for 13 plus years. My former colleagues do an amazing job, often with limited resources, and with little of the recognition afforded other professions.
Recently, I made a presentation at a state conference entitled, "The Role of the School Psychologist in Managing Students with Sport- Related Concussions." Given the increased focus on concussions in the national media, I had expected more to attend than the dozen or so who showed up. For a state like Florida, with the 5th and 6th largest school districts in the US, that doesn't bode well for parents, students, or educators. Now I see why there is an education gap about concussions!
So, all that being said, my goal in this article is to provide a basic outline of what parents should reasonably be able to expect from their public school system, with they key words in that sentence being "should" and "reasonably."
Even before we get to that question, let's step back a bit to talk about risk reduction. Nearly every state in the country now has a youth sports concussion safety law. The complexity, extent of proactivity, and financial support available for these statutes, however, varies from state to state. So I will try to provide a best case scenario for what I think is the LEAST that should be done each year in preparation for the school year.
Every fall, sometimes even before classes begin, student-athletes begin the pre-season preparation for their chosen sports. In most states, that preparation not only includes a thorough sports physical (these days called pre-participation physical evaluations or PPEs), but also a baseline neurocognitive assessment. It may even include a classroom-type presentation on the signs and symptoms of concussion and the student-athlete's responsibility to report them to coaches, parents and certified athletic trainers (AT). There may also be a parent orientation (hopefully) that covers the same information, although this is not always the case.
In my children's district, parents are instructed to watch a 20-30 minute video on a closed circuit cable channel, the same video shown in the school for the student-athletes. There is no formal human interaction to discuss this important topic and for parents to ask questions and dispel myths. [These are opportunities #1 & #2 for school psychologists; see list below]
Most, if not all, public schools normally engage in a few days of professional development for teachers, staff, and other school support personnel prior to the start of classes. [#3] Have the classroom teachers in your district been shown what to look for, not only in their student-athletes, but also in any of the children they serve across ALL grades?
For this case, we are assuming that the student has suffered a traumatic brain injury that has required him/her to be removed from competition and to get "return-to-play" clearance from a physician. Using the student-athlete's baseline data, the school psychologist should look for areas of impairment (e.g., verbal memory, visual memory, reaction time, etc.) [#4]. The parents and student-athlete (if possible) should meet with relevant school personnel (504 committee) to make the determination of what is needed by the student-athlete to access an "Appropriate Education" as defined by federal law. Based on the athlete's symptom presentation/profile and physician assessment it has to be determined if the student has a "physical and/or mental impairment that results in a substantial limitation " in the student's ability to perform up to the "average" level of the general population.
So what is an "appropriate education" as defined by Section 504 of the Americans with Disabilities Act? Section 504 regulations define the provisions of an "appropriate education" as "the provision of regular or special education and related aids and services" that are:
- Designed to meet individual education needs of handicapped persons as adequately as the needs of non-handicapped persons are met, and
- Based upon adherence to procedures that satisfy the requirements of: (a) C.F.R. 104.34 (educational setting in the least restrictive environment); (b) C.F.R. 104.35 (evaluation and placement procedures); and (c) C.F.R. 104.36 (procedural safeguards with respect to actions regarding the identification, evaluation, or educational placement of persons who, because of handicap, need or are believed to need special instruction or related services)." [C.F.R. 104.33]
Assessment -- Refers to the gathering of data from a variety of sources, such as achievement records/ scores, grade reports, teacher observation comments, discipline and attendance records, the cumulative record, and/or medical records provided by parents, etc.)
Educational Placement -- Refers to the application of the Section 504 Plan in the general education setting.
Supplementary Aids and Services -- Refers to the actual accommodations determined in the student's Section 504 Plan.
Accommodations refer to the special arrangements used in the general education classroom to provide access to the curriculum/program that do not change the course expectations and/or content of the curriculum/program. (Examples of accommodations: sitting in the front of the room, being provided with extended time for testing, providing a student with highlighted critical text, or providing use of a calculator.)
Psychologist as liason
In determining what accommodations a concussed student-athlete needs, a school psychologist is, and should be, the liaison between all parties involved (physician, teachers, coaches, athletic trainer, and student-athlete). They have the training and expertise, and are the most qualified to coordinate the services required by the student-athlete. Parents facing the daunting task of assisting their son or daughter in their re-integration into an academic setting ("return to learn") should feel comfortable in contacting the school psychologist to ask for assistance.
School psychologists can provide guidance, education, consultation, and/or expertise at all of the following points along the student-athlete prevention-management continuum:
#1 - Monitor the student-athletes during the administration of the baseline assessment and provide the awareness training they need.
#2 - Provide feedback to parents on their child's performance on the baseline assessment, present educational component to parents at pre-season concussion safety meeting.
#3 - Spend at least one half-day in professional development training of ALL classroom personnel on "what a concussion will look like in the classroom," and "what they can do ACADEMICALLY for those children who have suffered a concussion."
#4 Data interpretation and recommendations for the student-athlete.
Alberto Gamarra, Ph.D., NCSP, is a school psychologist, parent, coach, and former athlete now in private practice in Weston, Florida. He has worked with children and adolescents for over 15 years. In 2011, Dr. Gamarra founded Saving Young Minds, Inc. a 501(c)(3) non-profit organization working to increase sports-related concussion awareness in underserved communities.