Strategies to Address Unmet Needs and Facilitate Return to Learn Guideline Adoption Following Concussion

Lyons, Vivian H.; Moore, Megan; Guiney, Roxanne; Ayyagari, Rajiv C; Thompson, Leah L.; Rivara, Frederick P.; Fleming, Robin; Crawley, Deborah; Harper, Dawn; Vavilala, Monica S.

doi:10.1111/josh.12510

Cited by 44 publications

(52 citation statements)

References 28 publications

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“…Lyons et al report on RTL services in Washington state from a survey of community members from 144 rural and urban schools, and identified our unmet needs as follows: (1) current lack of school policies, (2) barriers to providing/receiving accommodations, (3) variability in communication patterns, and (4) recommendations shared by all stakeholders. 47 A checklist was developed consisting of readiness, implementation, and evaluation stages of RTL implementation for public schools statewide.…”

Section: Concussion Prevention and Return To Playmentioning

confidence: 99%

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Yue

Upadhyayula

Avalos

et al. 2020

JNRP

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Background Mild-traumatic brain injury (mTBI) and concussions cause significant morbidity. To date, synthesis of specific health care disparities and gaps in care for rural mTBI/concussion patients remains needed. Methods A comprehensive literature search was performed using PubMed database for English articles with keywords "rural" and ("concussion" or "mild traumatic brain injury") from 1991 to 2019. Eighteen articles focusing on rural epidemiology (n = 5), management/cost (n = 5), military (n = 2), and concussion prevention/return to play (n = 6) were included. Results mTBI/concussion incidence was higher in rural compared with urban areas. Compared with urban patients, rural patients were at increased risk for vehicular injuries, lifetime number of concussions, admissions for observation without neuroimaging, and injury-related costs. Rural patients were less likely to utilize ambulatory and mental health services following mTBI/concussion. Rural secondary schools had decreased access to certified personnel for concussion evaluation, and decreased use of standardized assessment instruments/neurocognitive testing. While school coaches were aware of return-to-play laws, mTBI/concussion education rates for athletes and parents were suboptimal in both settings. Rural veterans were at increased risk for postconcussive symptoms and posttraumatic stress. Telemedicine in rural/low-resource areas is an emerging tool for rapid evaluation, triage, and follow-up. Conclusions Rural patients are at unique risk for mTBI/concussions and health care costs. Barriers to care include lower socioeconomic status, longer distances to regional medical center, and decreased availability of neuroimaging and consultants. Due to socioeconomic and distance barriers, rural schools are less able to recruit personnel certified for concussion evaluation. Telemedicine is an emerging tool for remote triage and evaluation. AbstractKeywords ► concussion ► epidemiology ► health disparity ► mild-traumatic brain injury ► rural ► prevention ► return to play

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Section: Concussion Prevention and Return To Playmentioning

confidence: 99%

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Yue

Upadhyayula

Avalos

et al. 2020

JNRP

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“…Stakeholders include the family, health care practitioners, athletic personnel, and school personnel . Within the school system setting, school administrators and teachers are critical stakeholders tasked with implementing the RTL process . Teachers are responsible for following school policies and providing education in a manner conducive to student learning and academic success .…”

mentioning

confidence: 99%

“…7,17,18 Within the school system setting, school administrators and teachers are critical stakeholders tasked with implementing the RTL process. 19 Teachers are responsible for following school policies and providing education in a manner conducive to student learning and academic success. 7 Because of their role as educators and close daily interactions with students, teachers are uniquely positioned to recognize and monitor daily changes in a student's academic performance, demeanor, and behavior, 16 and consequently implement effective RTL protocols.…”

mentioning

confidence: 99%

Schoolteachers' and Administrators' Perceptions of Concussion Management and Implementation of Return‐to‐Learn Guideline

Romm

Ambegaonkar

Caswell

et al. 2018

Journal of School Health

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BACKGROUND Concussions are a public health concern and concussion management in school requires a team approach. We examined schoolteachers' and administrators' perceptions of concussions, management, and implementation of return‐to‐learn (RTL) guidelines. METHODS We audio‐recorded and transcribed semistructured interviews with teachers (N = 16) and administrators (N = 6) from a public school system. We analyzed data using an analytic induction and constant comparison approach. RESULTS Two themes emerged: different understanding, and school context. Participants with no sport coaching experience were less familiar with concussions than those who coached a sport. Participants with personal experience with concussions were more sympathetic toward concussed students' needs. Teachers expressed feeling ill‐equipped to implement RTL guidelines without specific instructions in the complex school environment. However, school administrators had minimal understanding of teacher‐described challenges. CONCLUSIONS Teachers and administrators recognize that concussions are a health concern, but differ in their perceptions of concussions, management, and implementation of RTL guidelines. Personal experiences mediate individual perceptions about concussions. The daily realities of a school environment complicate teachers' capacity to implement RTL guidelines. Conversely, school administrators did not express awareness of any challenges with concussion management. To best facilitate students' recovery schools should include all stakeholders when devising concussion management policies.

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“…For example, health educators need to assist schools with developing return‐to‐learn policies to support student‐athletes with their post‐concussion learning needs. Health educators also need to facilitate training opportunities for parents, faculty, staff, and administrators to better support student‐athletes as they transition back to school after sustaining a concussion Advocate for evidence‐based diagnosis and treatment methods for concussion. Advocate for the presence of athletic trainers, especially in urban schools where a disparity exists …”

Section: Implications For School Healthmentioning

confidence: 99%

Concussion! Friday Night Lights and Informed Consent—A Commentary

DeBarr

Pettit

2019

Journal of School Health

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Strategies to Address Unmet Needs and Facilitate Return to Learn Guideline Adoption Following Concussion

Abstract: Washington State children have unmet needs upon returning to public schools after concussion. The student-centered RTL model and checklist for implementing RTL guidelines can help schools provide timely RTL services following concussion.

Cited by 44 publications

References 28 publications

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Schoolteachers' and Administrators' Perceptions of Concussion Management and Implementation of Return‐to‐Learn Guideline

Concussion! Friday Night Lights and Informed Consent—A Commentary

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