Assisting Students with a Concussion
Notification:
•
•
School is notified of suspected head injury (via Athletic Director, parent, teacher, etc)
Information is given to School's Concussion Contact (counselor - determined by principal)
Planning: (completed by Concussion Contact)
•
Email sent immediately to parent(s), teacher, and nurse. Include others (psychologist, coach, etc) as needed
o Assigns Case Manager
o Asks teachers to note needed accommodations/modifications
o Informs of suspected/diagnosed head injury
o Lists recommendations from physician if available
o Includes symptoms for parent(s) and teachers to watch for
o Gives directions to contact counselor with questions/concerns
Plans of Care:
•
If after two weeks, the student is still experiencing difficulties due to the concussion, develop an Academic Plan of Care via a face to face meeting with teacher(s),
parent(s), counselor. Include others (student, psychologist, coach, etc) as needed and appropriate.
• During the “recovery phase” (1-3 weeks following the concussion) the nurse will follow up to determine if a medical plan is needed.
Roles and responsibilities
Parent
•Provide medical
documentation to
nurse/school counselor
•Participate in development
of Academic and/or Medical
Plans of Care
•Provide updates from
doctors as needed
•Notify School Counselor of
any changes in behavior of
student
Nurse
•Contact parent
•Provide CDC information
•Complete nursing
assessment
•Coordinate development
and follow-up of Medical
Plan of Care with:
•Parent(s)
•Student
•Doctor
•Others (teachers, etc) as
needed
Counselor
•Coordinate development
and follow-up of Academic
Plan of Care with:
•Teacher(s)
•Parent(s)
•Student
•Nurse (if medical
clarification is needed)
•Others (psychologist,
coach) as needed
*Medical Plan of Care:
•
A document outlining the accommodations and modifications a student may need to
address medical symptoms while recovering from a concussion.
Academic Plan of Care:
•
A document outlining the accommodations and modifications a student may need to
address academic difficulties while recovering from a concussion.
•
This plan is reviewed as often as necessary, but at least every 6 weeks. If an Academic Plan
of Care has been in place for six months, and the student still demonstrates academic needs,
refer to an IEP team for DEC 1.
Revised 3-2015
Coaches,
Athletic Trainers (HS),
Sport Safety Technicins (MS)
Psychologist
Teachers
•Participate in development
of Academic and/or Medical
Plans of Care as requested
•Participate in development
of Academic and/or Medical
Plans of Care
•Follow Concussion
Notification Process and
Return to Play protocols
•Notify school psychology
TBI Assessment Team as
needed
•Provide accommodations as
outlined in Academic and/or
Medical Plans of Care
•Participate in development
of Academic and/or Medical
Plans of Care as requested
•Notify School Counselor of
any changes in
behavior/academic progress
of student
•
This plan is reviewed as often as necessary, but at least weekly.
•
•
If the need for an IEP is ruled out, the team may refer the student to the 504 Coordinator.
Please note that if state testing accommodations are needed, use the transitory impairment
procedure.
For students with current 504/IEP plans, the plans are not amended until a student
demonstrates a significant need in direct relation to the head injury.
•
Example email
Dear parent(s), teachers, nurse, et al:
We were notified today via [parent report, the Athletic Director, a doctor’s note, etc] that StudentName has a suspected/diagnosed concussion.
Most young people will recover completely from a single concussion within three weeks. Some students take longer to recover than others. Having all involved
school staff carefully monitor a student for potential difficulties in the weeks after a concussion is very important. Please watch for the following symptoms,
and report them to the counselor as you see them.
Physical
Thinking (Cognitive)
Behavioral or Emotional
Headaches
Slowed thinking
Irritability or grouchiness
Sick to stomach or vomiting
Trouble paying attention
Easily upset or frustrated
Dizziness or balance problems
Difficulty remembering
Nervousness
Low energy or being run
d
Trouble with vision/seeing
Acting like "in a fog
Sadness
Easily confused
Acting without thinking
Bothered by light or noise
School performance worsens
Any other personality change
Please make a note of accommodations/modifications your student has need of over the next two weeks. Knowing what the student has needed during the
initial two weeks will be helpful if an Academic Plan of Care is developed.
[If student has been seen by doctor]
StudentName has been seen by Dr. SoandSo. They have recommended the following:
List of recommended modifications/accommodations provided by the physician
Please contact me/case manager with any questions or concerns. The case manager is
I will follow up with all parties no later than (Date two weeks out).
Sincerely,
School Counselor
Revised 3-2015
.
Concussion Plan of Care: Academic
Name:____________________________________________ DOB:________________ School:______________________________ Year :___________
Start Date:__________________ Review Date(s)_________________________________________________ __________ End Date:_______________
Teachers:________________________________________________________ __________________________________________________________
Diagnosis: Brain Injury secondary to Concussion
Name of Physician: ___________________________________________________________
Description: A concussion is a type of traumatic brain injury, or 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 fall or a blow to the body that causes the head and brain to move quickly back and forth. A loss of consciousness
does NOT have to occur to have a concussion.
Problem
Accommodations
Responsible Party
Activity
(Physical/visual/motor integration)
 Balance problems
 Difficulty completing written work
 Difficulty copying from the board
 Dizziness
 Fatigue
 Headaches
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Allow rest breaks as requested by student
Class withdrawal
Extended time on tests and/or projects
Limit classwork/ homework assignments
Limit exposure to projectors/computers/television
Limit reading assignments and/or allow use of audiobooks
Modified schedule /day
No PE or recess until cleared by physician
Provide teacher notes and/or study guides
Staff member to assist student as needed with ambulation
Other:
Teacher/Counselor/Student
Sensory
(Sound sensitivity/Light sensitivity/Vision)
 Dehydration
 Double/Blurry vision
 Headaches
 Lights from projectors, computers, etc that
may trigger headaches
 Ringing in ears
 Sound defensiveness
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Allow rest breaks as requested by student
Allow student to wear sunglasses/hat (provided by
parent/guardian)
Allow water bottle in class (provided by parent/guardian)
Extended time on tests and/or projects
Limit classwork/ homework assignments
Limit exposure to projectors/computers/television
Limit reading assignments and/or allow use of audiobooks
Provide alternative printed materials (e.g., large print
materials, colored paper)
Provide seating to facilitate vision
Other:
Teacher/Counselor/Student
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Concussion Plan of Care: Academic
Name:____________________________________________ DOB:________________ School:________________________ Year :___________
Emotional
 Anxiety
 Irritability
 Sadness
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Cognitive
(Thinking/Processing/Memory)
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Confusion if too much information is
presented at once, or too quickly
Difficulty concentrating
Difficulty filling out forms/worksheets
Difficulty following complex multi-step
directions
Difficulty paying attention for long periods
of time
Difficulty processing information in order
to understand what others are saying
Feeling sluggish, hazy, foggy, or groggy
Headaches
Problems remembering or learning new
information
Reads slowly or has difficulty reading
material in complex formats or with small
print
Slow to answer questions
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Allow rest breaks as requested by student
Allow student to meet with counselor/psychologist as
needed
Referral to Alliance Behavioral Health if difficulties persist
Other:
Teacher/Counselor/Student
Allow extra time for student to process/visually inspect and
comprehend/respond to information
Allow rest breaks as requested by student
Allow student to use extended breaks (holidays) for makeup work completion rather than adding it on to current
study requirements
Limit classwork/homework assignments
Limit exposure to projectors/computers/television
Limit reading assignments and/or allow use of audiobooks
Partial/modified day/schedule
Provide both spoken and written
Instructions/directions
Provide repetition of material/instructions
Provide teacher notes and/or study guides
Provide testing modifications
o Allow extended time on tests and/or projects
o Allow student to mark in book for testing
o Grade averaging in lieu of quizzes
o No classroom or standardized testing until cleared
by physician
o Open book/notes for quizzes/tests
o Stagger test schedule (One test per day)
o Test in recognition format (T/F or multiple choice)
Reduce amount of new material to be memorized by
student
Other:
Teacher/Counselor/Student
Counselor Signature: __________________________________________________________ Date :____________________________________
Parent Signature: _____________________________________________________________ Date :____________________________________
NORTH CAROLINA STATE BOARD OF EDUCATION
Policy Manual
Policy Identification
Priority: Healthy Responsible Students
Category:
Policy ID Number: New Policy HRS-D-000
Policy Title: Return-to-Learn After Concussion
Current Policy Date:
Other Historical Information:
Statutory Reference: GS 115C-12(12)
Administrative Procedures Act (APA) Reference Number and Category:
Concussion Monitoring: Return to Learn
(a)
Each Local Education Agency (LEA) and charter school must develop a plan for
addressing the needs of students preschool through twelfth grade suffering concussions.
The plan must include:
1) guidelines for removal of a student from physical and mental activity when there is
suspicion of concussion;
2) a notification procedure to education staff regarding removal from learn or play;
3) expectations regarding annual medical care update from parents, medical care
plan/school accommodations in the event of concussion; and
4) delineation of requirements for safe return-to-learn or play following concussion.
(b)
In accordance with the LEA or c harter school plan, each school must appoint a team of
people responsible for identifying the return-to-learn or play needs of a student who has
suffered a concussion. This team may include the student, student’s parent, the principal,
school nurse, school counselor, school psychologist, or other appropriate designated
professional.
(c)
Each LEA and charter school must provide information and staff development on an
annual basis to all teachers and other school personnel in order to support and assist
students who have sustained a concussion in accordance with their learning and
behavioral needs. This annual training should include information on concussion and
other brain injuries, with a particular focus on return-to-learn issues and concerns.
(d)
Each LEA and charter school will include in its annual student health history and
emergency medical information update a question related to any head injury/concussion
the student may have incurred during the past year.
This plan shall be implemented at the beginning of the 2016-2017 academic school year.
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