1. Returning to School After Concussion:
Recommended Protocol

2. Return to School Protocol: Purpose BrainSTEPS can:
A concussion is a mild form of traumatic brain  Assist with implementation of the Return
injury (mTBI), caused by a bump, blow, or to School Protocol
jolt to the head, which can induce an altered
state, including physical and cognitive abilities.  Train staff at the district, school or
It may or may not include loss of conscious- classroom level on the effects of
ness; however, typically, there is no loss of concussion
consciousness. Concussion is a functional
rather than a structural disturbance that may  Provide consultation to school personnel and
need short-term or long-term management. In parents for referred students at 4 weeks
the hours and days post-concussion, metabolic post-concussion, or earlier if needed
chemical changes take place within the brain  Provide symptom specific educational
at the cellular level, resulting in physical, cog- accommodations utilizing the Brain Injury
nitive, and/or emotional symptoms. Activities Supports Framework
associated with academics can significantly
increase symptoms, even when the student has Assist in ongoing monitoring of symptoms and

begun to recover. Total cognitive and physical accommodations until the concussion resolves
rest is typically recommended for the first sev-
eral days to weeks. The effects of a concussion  Facilitate communication between family,
may linger for several months to a year or student, medical, and educational entities
more.
All students who experience a concussion should
The purpose of this Return to School Protocol is be medically evaluated and should follow the
to assist local educational agencies (LEAs) in treatment recommended by a medical profes-
understanding the importance of monitoring sional with experience in managing concussions.
a student’s return to academics following a
concussion. The Return to School Protocol is LEAs utilizing this voluntary Return to School
voluntary and may be used at the discretion of Protocol are asked to designate two individuals
the LEA. A referral to the BrainSTEPS Program at either the district or individual school building
should be made if a student is 4 weeks post- level who will agree to monitor the student and
concussion and is still experiencing symptoms, the resulting educational impact on the student
or if the student’s classroom performance or after the concussion. These two individuals will
attendance has been impacted. Referrals to serve as the Concussion Management Team
BrainSTEPS can be made earlier if: (CMT). The CMT is comprised of individuals
who can serve as the Academic Monitor and
 A student has a concussion that is not the Symptom Monitor. Together, the CMT will
progressively resolving during the first few promote information flow between the school
weeks, or team, family, student, and physician.
 A student has a history of any of the
following “concussion modifiers”: Initial 4 Weeks Post-Concussion:
LEA Responsibilities
• Past concussion(s)
1. The LEA learns that a student has sustained
• Migraine headaches a concussion.
• Depression or other mental health 2. The Concussion Management Team (CMT)
issues is notified.
• Attention deficit hyperactivity disorder 3. The CMT notifies the student’s educators,
(ADHD) alerting them of the concussion and the
• A learning disability student’s need for rest and academic
accommodations. The CMT will:
• Sleep disorders
2

3. • Share the physician’s instructions with heal faster than cognitive symptoms
relevant school staff, as well as recom- (e.g., attention, memory, concentration)
mendations provided by the parents
7. It is recommended that the CMT offer
• Include the student’s specific symptoms, support and educational resources to the
along with adjustments/accommodations student’s parents. One such resource is:
to alleviate exacerbating symptoms
The Centers for Disease Control
• Notify the coach, the athletic and Prevention: www.cdc.gov
director, and the athletic trainer, (Type “concussion” in the search box.)
if the student is an athlete
• Provide notification to appropriate At 4 Weeks Post-Concussion:
school staff that the student should be BrainSTEPS Referral
excused from physical education class,
sports, and physical activity during 1. If the student remains symptomatic and/or
recess until cleared there has been a notable change in student
performance or attendance, the Concussion
4. The CMT’s Symptom Monitor will utilize Management Team (CMT) will initiate a
the BrainSTEPS Student Symptom Severity formal referral to the BrainSTEPS Program
Monitoring Checklist to monitor the student’s by visiting the BrainSTEPS website
physical, thinking/remembering, and (www.brainsteps.net) to locate the correct
emotional symptoms. Symptoms should be consulting team by county.
monitored via student interview 3 to 5 days
per week for the first 2 weeks, and then 2 2. BrainSTEPS will conduct student specific
to 3 days per week during weeks 3 and 4. concussion training for relevant school staff,
parents/guardians, and student.
5. The CMT’s Academic Monitor will monitor
the student’s weekly performance, both 3. The CMT will schedule a BrainSTEPS Brain
academically and behaviorally, by having all Injury Supports Framework meeting,
relevant teaching staff complete the BrainSTEPS including all relevant parties (school team,
Academic Monitoring Form at the conclusion parent/guardian,student,BrainSTEPS).
of each week until symptoms resolve.
4. BrainSTEPS will partner with the CMT, school
6. Weekly, the Academic Monitor and team, parent/guardian, and student to create
Symptom Monitor will meet to review an individualized BrainSTEPS Brain Injury
results of the Symptom Severity Monitoring Supports Framework during this meeting.
Checklist and the Academic Monitoring
• Results from all weekly BrainSTEPS
Tool, to determine whether further accom-
Academic Monitoring Tools collected by
modations should be made during the
the Academic Monitor to date will be
initial 4 weeks or if the concussion symp-
shared with BrainSTEPS prior to the
toms and impacts have resolved and CMT
meeting.
monitoring and accommodations are no
longer needed. Weekly results will be • Results from all weekly BrainSTEPS
shared with the student’s teachers, related Student Symptom Severity Monitoring
professionals, and parents/guardians. Checklists collected by the Symptom
Monitor to date and any physician
• Parents/guardians should be involved
medical instructions will be shared with
in providing input on symptoms
BrainSTEPS prior to the meeting.
occurring at home.
• During the initial BrainSTEPS Brain
• Accommodations for classwork should Injury Supports Meeting, a follow-up
be provided until all symptoms resolve. meeting within 1 month will be sched-
Physical symptoms (e.g., headache, uled to review, modify, continue, or
dizziness, light/noise sensitivity) may conclude accommodations.
continued . . . 3

4. • The Academic Monitor will provide a 2. If a referral for a multipurpose evaluation
final copy of the BrainSTEPS Brain is not deemed necessary, then continued
Injury Supports Framework to relevant monitoring by the CMT and monthly review
school staff and parents/guardians. of the Brain injury Support Framework, in
partnership with BrainSTEPS, will continue.
• If the student is receiving homebound
instruction, the BrainSTEPS Brain Injury 3. If further formal educational supports are
Supports Framework should be shared thought to be necessary, a referral for a
with the teachers assigning and provid- multipurpose evaluation should be made
ing homebound instruction. to the appropriate individual at the district
level.
5. The Symptom Monitor will continue to
monitor the student’s symptoms 2 to 3 days
per week using the BrainSTEPS Student 4-8 Weeks Post-Concussion if Symptoms
Symptom Severity Monitoring Checklist. The Resolve
Symptom Monitor will provide copies of the
Monitoring Checklist to BrainSTEPS prior to 1. BrainSTEPS will work with the Concussion
any formal review of the BrainSTEPS Brain Management Team (CMT), school team,
Injury Supports Framework. parent/guardian, and student to deter-
mine appropriate accommodations and
6. The Academic Monitor will continue to modifications until the symptoms impacting
monitor the student’s academics weekly education resolve. Resolution of symptoms
using the BrainSTEPS Academic Monitoring could take weeks, months, and in some
Tool. The Academic Monitor will provide cases symptoms may last a lifetime.
copies of the Academic Monitoring Tool to
BrainSTEPS prior to any formal review of 2. If the symptoms impacting education com-
the BrainSTEPS Brain Injury Supports pletely resolve, there should be a meeting
Framework. held by the LEA to conclude the implementa-
tion of the BrainSTEPS Brain Injury Supports
• The Academic Monitor will provide Framework or more formal accommodation
a final copy of the BrainSTEPS Brain agreement.
Injury Supports Framework to relevant
school staff and parents each time it is • CMT monitoring will conclude.
modified. • All relevant school staff, as well as
the student and the student’s parent/
4-8 Weeks Post-Concussion if Symptoms guardian will be notified by the LEA.
Persist 3. The LEA will ensure that the concussion has
1. If the student continues to be symptomatic, been noted in the student’s educational
the Concussion Management Team, record on file with the district.
BrainSTEPS, and school personnel should
consider whether the student’s academic For more information about BrainSTEPS
or behavioral needs warrant ongoing contact:
adjustments and accommodations, or if Brenda Eagan Brown, MSEd, CBIS,
an evaluation should be conducted by BrainSTEPS Program Coordinator
the LEA to determine the need for more Email: eaganbrown@biapa.org
formal intensive accommodations and/or Phone: 724-944-6542
modifications.
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