Concussions can result in a constellation of physical, cognitive, emotional, and sleep-related symptoms that affect students\u27 wellness and performance at school. This study examined the number of concussion cases consulted on by a sample of Ohio school psychologists across two years.
Results indicated very little involvement with students who sustained concussions, with the majority of school psychologist respondents indicating that they consulted on zero cases. Suggestions for increasing school psychologists\u27 involvement with concussion cases are provided, including serving as concussion team leaders, tracking students\u27 symptoms and accommodations, and training others in their school community about concussion recognition and response

Davies, Susan C.

English

University of Dayton

University of DaytoneCommonsCounselor Education and Human Services FacultyPublicationsDepartment of Counselor Education and HumanServicesSummer 2015Ohio School Psychologists' Involvement withConcussion CasesSusan C. DaviesUniversity of Dayton, sdavies1@udayton.eduFollow this and additional works at: https://ecommons.udayton.edu/edc_fac_pubPart of the Counselor Education Commons, Educational Administration and SupervisionCommons, Educational Assessment, Evaluation, and Research Commons, Educational LeadershipCommons, Educational Psychology Commons, and the Higher Education CommonsThis Article is brought to you for free and open access by the Department of Counselor Education and Human Services at eCommons. It has beenaccepted for inclusion in Counselor Education and Human Services Faculty Publications by an authorized administrator of eCommons. For moreinformation, please contact frice1@udayton.edu, mschlangen1@udayton.edu.eCommons CitationDavies, Susan C., "Ohio School Psychologists' Involvement with Concussion Cases" (2015). Counselor Education and Human ServicesFaculty Publications. 51.https://ecommons.udayton.edu/edc_fac_pub/51Putting Pieces Together for Ohio Students Ohio School Psychologists' Involvement with Concussion Cases Susan C. Davies, Ed. D., NCS? Assistant Professor and Program Coordinator University of Dayton sdavies1 @notes.udayton.edu III this issue ... Concussions can result in a constella~ t ion of physical, cognitive, emotional, and sleep-related symptoms that affect students' wellness and performance at school. This study examined the number of concussion cases consulted on by a sample of Ohio school psychologists across two years. Results indicated very little involvement with students who sustained concussions, with the majority of school psychologist respondents indicating that they consulted on zero cases. Suggestions for increasing school psychologists' involvement with concussion cases are provided, includ-ing serving as concussion team leaders, tracking students' symptoms and accom-modations, and training others in their school community about concussion rec-ognition and response. Presidential Message .. ...... ....• .. .. . ... 3 Are School Psychologists at Risk? .. .. 9 Strategies for Student Success .. . ..... 14 OSPA Spring Conference .... .... 18 A Peek Into Our Past.. .. ........ . .. .......... 24 Involvement with Concussion Cases: Data from Ohio School Psychologists A concussion is caused by a direct blow or jolt to the head, face, neck or body that causes the head and brain to shift rapidly back and forth, resulting in a short-term impairment of neurological function (Centers for Disease Control and Prevention [CDC], 2014). Considerable media attention over the past several years initially focused on concussions sustained by adult athletes or war veterans, but more recent conversa-tion has turned the spotlight on concus-sions in youth sports. This shift in attention is important because concussions are more likely to be sustained by children and adolescents than by adults (Buzzini & Guskiewicz, 2006). One beneficial result Continued on page 6 Fall Conference Preview .. . .......... .. 30 Fall Conference Brochure ..... . .... Center Legislative Lowdown .34 Committee Reports .. . .42 Regional Affiliate Reports ..... .46 I I Involvement with Concussion Cases continued from page cover page Susan C. Davies, Ed.D., NCSP Assistant Professor and Program Coordinator University of Dayton sclavies1@notes.udayton.edu The Ohio School Psychologisr - VQlume 59, Number 3; SUmmey 2015 Table 1 Concussion Symptoms Category Physical Cognitive Emotional Sleep-Related of this youth-centered focus is the cre-ation of return-to-play guidelines to bet-ter determine when student athletes can safely return to practice and games (Sady, Vaughan, & Gioia, 2011). However, we cannot limit attention to just student athletes, While many concussions are sports-related, students also sustain concussion from recreational play, mo-tor vehicle collisions, fights, and abuse (Kozlowski, Leddy, Tomita, Bergen, & Willer, 2007). Youth with concussions from a variety of sources may return to school while still symptomatic, and they typically require adjustments to the school environ-ment while their brains heal. Unfortunately, most school personnel are not trained to understand the signs, symptoms, or ef-fects of concussion, nor do they know how to accommodate these students. Concussion symptoms are generally cat-egorized as physical, cognitive, emotional, or sleep-related (see Table 1; CDC, 2014). Such symptoms vary depending on the type and severity of the injury, as well as on certain preexisting conditions, such as a history of migraines or mental health Symptoms Headache, nausea, vomiting, balance problems, visual problems, fatigue, sen-sitivity to light and/or noise, and a dazed or stunned appearance Feeling mentally "foggy," feeling slowed down, having difficulty concentrating, having difficulty remembering things, forgetting recently learned information, experiencing confusion about recent events, responding slowly, and repeating questions Irritability, sadness, increased emotional-ity, and anxiety Drowsiness and changes in sleep pat-terns such as difficulty falling asleep, increased sleep, and/ or decreased sleep problems. (See Table 1) While student athletes should have !lQ symptoms and be cleared by a medi-5 cal professional before returning to play, students can return to school while their symptoms are still mild. However, they should do so only as long as appropriate adjustments are made to the educational environment. Post-concussion students may need academic, behavioral, or mental health support in order to be successful upon their return to school. This might include a shortened school day, extended deadlines for exams and assignments, modifications to exams and assignments, preferential seating, and a copy of class notes or the provision of a note-taker, to name a few. Such supports may be part of a 504 plan or part of a more informal plan of temporary adjustments (i.e., a "medical plan") that are monitored during the recov-ery period. If concussed students do not receive physical and cognitive rest, symp-toms can flare and recovery can take lon-ger. Ideally, these supports are facilitated by a school team that includes the child's parents, the school psychologist, the ContinUed on page 6 6 Involvement with Concussion Cases continued from page 5 school nurse, teachers, an administrator, and any relevant athletic personnel. Such a team can ensure a consistent response, documentation of progress, clear commu-nication between home and school, and general support for the injured student. Assessment of academic and behavioral needs, development of accommoda-tions, monitoring the progress of inter-ventions, leading a school-based team, and consulting with families and medi-cal professionals are all part of a school psychologist's repertoire of skills. Clearly, students with concussions would benefit from all of these services upon return to school. Lewandowski and Rieger (2009) estimated that in a high school of 1,000 students anywhere from 5-10 students likely experience concussions each year. While the National Association of School Psychologist (NASP) recommends a ra-tio of one school psychologist for every 1,000 students, the national median ratio is 1 :1500 (fhomas, 2000); therefore, we might expect typical school psychologists to have perhaps 8-15 students in their buildings sustain concussions each year. However, there is currently a lack of re-search on the actual numbers of concus-sion cases consulted on by school psy-chologists each year. This study involved a brief survey to collect such data in Ohio. Method Participants A survey inquiring about involvement with concussion cases was sent to a random sample of 100 school psychologists in southwestern Ohio. Data from respon-dents who did not answer all questions were excluded. Forty-seven usable re-sponses were submitted, yielding a re-sponse rate of 47%. Respondents represented a fairly even Table 2 Years Practicing as a School Psychologist (Excluding Internship) Number of Years N 1-3 Years 11 4-6 Years 11 7-10 Years 6 10-20 Years 11 More than 20 Years 7 More than 20 Years Table 3 District Demographics Category N Rural 8 Urban 10 Suburban 26 Not Working as a School Psychologist 2 Table 4 Number of Students Served in All Buildings Number of Students N Less than 500 Students 4 500-1000 Students 10 1001-1500 Students 13 1501-2000 Students 11 More than 2000 Students 7 Not Working as a School Psychologist 2 Table 5 Percentage 23% 23% 13% 23% 15% 2% Percentage 17% 21% 55% 4% Percentage 9% 21% 28% 23% 15% 4% Number of Concussion Cases Consulted on During the 2013-14 School Year Number of Cases o 2 3 Not Working as a School Psychologist Did Not Respond N 30 7 6 2 Percentage 64% 15% 13% 2% 4% 2% The Ohio School Psychologisf - I'ofltml! 59. NltmbD' J: $1tJ 7 Table 6 Number of Concussion Cases Consulted on During the 2012-13 School Year sian cases school psychologists in Ohio consult on during the school year. School psychologists who responded to the sur-vey worked in districts of varying sizes and demographics. Results indicated that school psychologists have very little-if any-involvement with students who have sustained concussions. Number of Cases o 2 3 Not Working as a School Psychologist Did Not Respond N 27 8 2 6 3 distribution of experience, ranging from 1-3 years to more than 20 years (see Table 2). The majority (55%) worked in suburban districts, 21 % worked in urban districts, and 17% worked in rural districts (see Table 3). The number of students served in each respondent's buildings varied (see Table 4). Survey The survey in this study was distributed to the sample of potential participants via email.using Google Forms. The first three questions asked the participants' number of years in practice, district demograph-ics, and number of students served . The next questions asked about how many concussion cases they consulted on dur-ing the previous two school years. If they did provide consultation on students with concussions, respondents were asked to provide a brief open-ended response of what the consultation entailed . Results Results indicated that the majority of respondents (64%) consulted on zero concussion cases last school year (2013-14); 15% consulted on one case, 13% consulted on two cases, and only one re-spondent consulted on three cases. Of the 47 respondents, 4% were not working as school psychologists last year. During the previous school year (2012-13), the num-bers were similar; 57% of respondents consulted on zero cases, 17% consulted on one case, 4% consulted on two cases, The Ohio School Plych%gis{ - Volume J9 . . \ umber J: Summer 201 J Percentage 57% 17% 4% 2% 13% 6% and again, only one respondent consulted on three cases. Nineteen percent were either not working as school psycholo-gists during the previous year or di d not work in the same building both years. No respondents indicated they consulted on more than three cases either year. While firm conclusions cannot be drawn from this study-the participant pool was limited to school psychologists in the southwestern quadrant of Ohio, and the total number of respondents was relatively small-it appears that school psycholo-gists are not being called upon to help stu-dents who have sustained concussions. It is possible that students with concus-sions are primarily cared for by parents, who may simply send an email notifying Participants who provided consultation on teachers about the incident, together concussion cases were asked to briefly describe what they did. The majority of respondents described consulting with parents, teachers, nurses, and adminis-trators to implement accommodations per physician recommendations. Such accommodations included a shortened school day, reduced expectations without grade penalty, extended time for work, postponement of tests, provision of a quiet setting with dim lights for completion of work, and so forth. Several of the an-swers indicated the school psychologist's involvement included reviewing medical documentation to determine 504 eligibility. Participants also described discussing the effects of concussions with school staff and setting up team meetings to share in-formation. Two participants completed an evaluation for special education eligibility. Another administered an IQ test to look for changes from previous testing , particularly in the area of short-term memory and pro-cessing speed . Discussion The purpose of th is brief survey was to determine the average number of concus-with instructions to "keep an eye on her" or "have him sit out of gym class today." However, if other school staff members (i.e. , school psychologist, nurse, admin-istrator) are not notified, then a fonmal record of injury is not made. Such records are crucial pieces of information if a stu-dent experiences significant problems post-injury or sustains a second concus-sion at a later date. Further, tracking of specific accommodations is unlikely, which can lead to an inconsistent, ineffec-tive response. Responses to the open-ended question regarding what school psychologists did for the concussion cases indicated that school psychologists were able to apply their existing skill sets to this population of students. Specifically, they addressed con-sultation, assessment, creation of accom-modation plans, and writing of 504 plans, when appropriate. Two of the respondents indicated that their involvement with con-cussion cases entailed completing evalu-ations for special education. Rarely are concussions so severe that special educa-Continued on page 8 8 Involvement with Concussion Cases continued (rom page 7 tion is required, so these two cases likely involved more significant brain injuries. This study suggests that school psycholo-gists have little involvement with a popula-tion of students who could greatly benefit from our work. More training is necessary in order to increase school psychologists' Future research might examine the stu-dent outcome when the school psycholo-gist is designated as the point person on a school-based concussion management team. More information is also needed about the efficacy of return-to-academics programs intended to support students who have sustained concussions. Finally, it would be helpful to collect classroom data (e.g., time on-task, work completion) on students with concussions to evalu-ate efficacy of specific accommodations Susan C. Davies, Ed. D., NCSP, is an associate professor and the co-ordinator of the school psychology program at the University of Dayton. Her research and professional interests include school services for students who have sustained TBls and the de-. velopment of intercultural competence ~hrOUgh international education. knowledge about the signs, symptoms, and across time. appropriate accommodations for students who have sustained concussions. However, practitioners do not need to develop an entirely new skill sent in mder to assist students who have sustained concussions. References Rather, they can apply existing skills, in-cluding facilitating meetings; following the problem-solving process; tracking interven-tions; and collaborating with families, ath-letic staff, and medical personnel. School psychologists can also conduct t rainings for their school staff and com-munity members about concussion rec-ognition and response, advertising in the process that they are the individuals in the schools who can serve as point persons on a concussion management team, who can consult on a student's progressive return to academics, and who can track the ac-commodations that are put in place. This can be a novel and welcome population of students on the school psychologist's caseload; since 80% of students with con· cussions return to baseline levels of per-formance within just a few weeks (Collins, Lovell, Iverson, Ide, & Maroon, 2006), it can be particularly gratifying for a school psychologist to see students improve so significantly over a short period of time. In contrast, failing to put appropriate supports into place can put injured students at seri-ous risk for prolonged symptoms. Further, sustaining a second concussion before the first has resolved itself can lead to perma-nent disability or, in very rare cases, death (Byard & Vink, 2009). Buzzini, S. R., & Guskiewicz, K. M. (2006). Sport-related concussion in the young athlete. Current Opinion in Pediatrics, 18, 376-382 . doi: 10.1097/01. mop.0000236385.26284.ec Byard, R. w., & Vink, R. (2009). The second impact syndrome. Forensic Science, Medicine, and Pathology, 5,36-38. Centers for Disease Control and Prevention. (2013). Concussion and mild TBI. Retriev. from http://www.cdc.govl concussionlindex.html Collins, M. w., Lovell, M. R. , Iverson, G. L. , Ide, T. , & Maroon, J. (2006). Examining concussion rates and return to play in high school football players wearing nev helmet technology: A three-year prospective cohort study. Neurosurgery, 58(2) 275-286. Frollo, J. (2014). See where your state stands on concussion law. Retrieved from: http://usafootbal l.comlnewslfeatured-articles/see-where-your-state-stands-concussion-law Kozlowski, K. F., Leddy, J. J. , Tomita, M., Bergen, A., & Willer, B. S. (2007). Use of the ICECI and ICD-10 E·coding structures to evaluate causes of head injury and concussion from sport and recreation participation in a school population. NeuroRehabilitation, 22, 191-198. Lewandowski, L. J., & Rieger, B. (2009). The role of a school psychologist in concussion. Journal of Applied School Psychology, 25, 95-110. doi: 10.1 080/15377900802484547 Sady, M. D. , Vaughan, C. G., & Gioia, G. (2011). School and the concussed youth: Recommendations for concussion education and management. Physical Medicine & Rehabilitation Clinics of North America, 22, 701-719. Thomas, A. (2000). School psychology 2000: What is average? NASP Communique, 28(8). Retrieved from: http://www.nasponline.org/publications/cq/ cq288sp201 aspx Tht Ohio School P~ych()lo8i.s{ - Volume 59, NrJmbe,. 3: Summ 

Ohio School Psychologists\u27 Involvement with Concussion Cases

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Ohio School Psychologists\u27 Involvement with Concussion Cases

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