Drs. Melissa McCart and Sondra Marshall are experts in the field of Traumatic Brain Injury (TBI) and the implications of a TBI on learning. Sondra Marshall, PhD, is a Licensed Psychologist with St. Charles Health System in Bend, Oregon. Melissa McCart, Ed.D, is a national and international speaker and author on the topic of brain injury and return to school following injury. Both are involved with CBIRT, the Center on Brain Injury Research and Training.Â
Today we discussed TBI in young children and the possibleÂ implications on future learning. We also talked about how students with TBI are different than students with learning disabilities and how they need to be treated as such. Dr. McCart and Dr. Marshall shared their insights on the importance of collaboration between home and school and how educators can learn more about Traumatic Brain Injury through the impressive amount of resources available through Return to School.Â
Sondra Marshall, PhD, is a Licensed Psychologist with St. Charles Health System in Bend, Oregon. She has been involved with the Oregon Concussion and Awareness Management Program since 2007, working with team members in the development of return to play and return to learn protocols post concussion. Dr. Marshall also worked with Drs. Ann Glang and Melissa McCart and the team from the Center of Brain Injury Research and Training at the University of Oregon on Brain 101, a research project that looked at concussion management in the high school setting. Finally, Dr. Marshall is working with the CBIRT team on a CDC awarded Return To Learn after TBI grant that specifically assess the concussion program Dr. Marshall and colleagues established in their community.
Melissa McCart, Ed.D, is a national and international speaker and author on the topic of brain injury and return to school following injury. She earned her doctorate in Educational Methodology, Policy and Leadership, her M.S. in behavioral disorders and applied behavior analysis, and her administratorâ€™s licenses from the University of Oregonâ€™s nationally ranked College of Education. She has worked extensively with at-risk children and families as a behavior specialist, behavior consultant and special education teacher. She is currently the director of the Oregon TBI Teams and works in the field of TBI research at the Center on Brain Injury Research and Training (CBIRT) at the University of Oregon. Prior to joining the CBIRT team, Melissa spent 7 years as a school administrator, 2 years as a behavioral consultant, and 8 years as a special education teacher to students with emotional/behavioral disorders. Melissa currently is a member of the National Collaborative on Childhood Brain Injury and serves on the Return to Learn, Policy, Common Data Elements and Community of Practice Committees.
Traumatic Brain Injury and Learning
Transcribed by Natalie Zhu
[ Introduction music plays ]
Welcome to the SENIA Happy Hour, where you get 1 hour of learning in less than thirty minutes.
|Lori: Today I speak with Drs. Melissa McCart and Sondra Marshall, who are experts in the field of traumatic brain injury, or TBI, and the implications of – uh – TBI on learning. Dr. Sondra Marshall is a licensed psychologist with St. Charles Health Systems in Bend, Oregon. And Dr. Melissa McCarthy is a national and international speaker and author on the topic of brain injury and return to school following injury. Both are involved with CBIRT or C, B, I, R, T, the Center on Brain Injury Research and Training.Â
Today we discuss TBI in young children and the possible implications on future learning. We also talked about how students with TBI are different than students with learning disabilities, and how they needed to be treated as such in the classroom. Dr. McCart andÂ
Dr. Marshall shared their insights on the importance of collaboration between home and school and how educators can learn more about traumatic brain injury through the impressive amount of resources available through returntoschool.org. I really hope you enjoy this conversation. I know I learned incredible amounts of good information. And now on to the show.
Hello Drs. Marshall and McCart, and welcome to the podcast.
Dr. Marshall: Nice to be here, thank you.
Dr. McCart: Thanks for having us.
Lori: Well, for a bit of background, I was speaking with Tracey Ellis, whoâ€™s one of our friends at SENIA International and sheâ€™s from International Diagnostic Solutions, IDS, and sheâ€™s a long time friend & sponsor of SENIA. We were discussing traumatic brain injury or TBI and the effect it may have on learning. She was telling me that the area of the injury affects different areas of learning, and that just ended up in this long discussion, and she finally said â€œYou know, you need to talk to [chuckles] Dr. Marshall.â€ And Dr. Marshall, you in turn said â€œYou know,Â [chuckles] you need to talk with Dr. McCart.â€Â
So, thank you both for joining us. First of all, can you tell us a bit about your backgrounds and then Iâ€™d love to jump into TBI and learning.
Dr. McCart: Go ahead, Sondra.
Dr. Marshall: Alright, my name is Sondra Marshall and I am a licensed psychologist â€“ but my journey has been anything but just landing in Psychology. I actually started off as a French teacher in Vermont and then became a guidance counselor and a school psychologist, so I had deep roots in the world of education. But through my doctorate program my focus was on pediatric traumatic brain injury and developed a specialty in neuropsychology.Â
So that is just a passion of mine â€“ and working with students with traumatic brain injury, but it basically generalized into neural developmental conditions, and I live now in Bend, Orego,Â where I’m the clinic director of a program called PEDAL â€“ which is the Program of Evaluation Development and Learning, and we provide comprehensive evaluations for students across neurological and neurodevelopmental conditions â€“ but one of my passions has been working with the University of Oregon and the centers for brain injury training in research, [corrects herself] research and training, and developing a concussion protocol for students in our community. But it’s really grown to being looked at as a national model â€“ and Iâ€™ll let Dr McCart talk about that.
Dr. McCart: Okay, youâ€™re making me write things down [laughs]. So, Iâ€™m Dr. Melissa McCart, and I have worked in education in some way since I was seventeen years old. It was my first real job. I was a one-on-one assistant for a student with autism when I was seventeen and it just kind of fed my desire to be a special ed teacher, so I was a special ed teacher for a long time, and then I was a behavior consultant â€“ so I would travel around and help people with kids who are having a hard time. After that I was a school administrator and I was at a very kinda high SCS school and I really, after eight years of doing that, missed the kids that were in special ed and those families, and so I started looking around and landed on the Center for Brain Injury Research and Training, and became the director of the Oregon TBI teams through them.Â
I also do TBI research for schools. I do a lot of work and education training for teachers, for school psychologists, [inaudible], that kind of thing. Currently, I am very involved in policy and legislation. Over the course of this work I have come to realize that we can change things for the better or more people that way and so I put a lot of energy into that as well.Â
What Sondra was talking about is that we actually are studying the Central Oregon return to school model through a large grant from the CDC â€“ Center for Disease Control to look at that as a replicable model that we can put out to other, other states, other areas, about how to do it the right way. And so Central Oregon and Sondra and the team she works with are currently considered a national leader in this work, and so we have a long history together â€“ Sondra and I.
Lori: Thatâ€™s great, and then just another little piece. I happen to be from Central Oregon as well, and Sondra and I just found out we’re from the same hometown or the same town, so yeah!Â
I think it’s great that both of you have such a history in education. I know our listeners always appreciate someone who’s been there and been in the trenches, so to speak, and can help us understand more of how we can help our students and support our students, so â€“
Let me ask you about traumatic brain injury. Why does it matter, first of all, where the brain is injured in terms of future learning?
Dr. Marshall: That was a good question â€“ as a neuropsychologist, the evaluations that we do on students are really guided by brain behavior functioning. And while I’d like to say that we can, for example, take a particular area, for example, let’s say someone tells me that the child was hit on the left side of their brain. Localizing necessarily where the [pause] injury is and then relating that to the functional outcomes doesn’t always blend really nicely. So as much as we want to take, okay, left side of the brain, maybe thereâ€™s language involved, maybe there’s this involved, we know that when the brain gets injured there is this [pause] kind of process that goes on in the brain, that it might be, the functional outcomes might be much more diffused than just a localized place.Â
So that’s why evaluation â€“ the piece that I bring to the table â€“ is understanding the brain, the whole brain, the whole child, the social, emotional, behavioral, cognitive, memory, executive functioning â€“ understanding the whole child. And in the context of their family, and in the context of their community â€“ how the child is functioning, and then what needs to happen in all of those systems to support that childâ€™s progression back to school.Â
So that’s, thatâ€™s maybe a way of avoiding specifically your question, Lori, but I think it’s really important to say that we can’t just look at where the injury is and say â€œYes, we’re going to expect these kinds of problemsâ€.
Lori: No, no, that makes sense and thank you for clarifying that. And, so to take it a little bit further, just as a special educator myself and have, through time, I mean through 25 years reading report after report, you know, when you read the parent history, quite often there’s one little sentence in there that will just stand out. Like â€œJanie fell out of the car when she was 6 months old but it was, you know, nothing needed to happen afterwardsâ€, or â€œso and so fell out of a tree when he was 4â€, or [chuckles] another child was sitting in their car seat on the table and the car seat fell off the table.Â
So these things are always mentioned but then there doesn’t seem to be any correlation thing when it comes to their future learning â€“ I mean, they’re just mentioned. So I’ve always been curious about this because I read them and then I always have that question of â€“ well could that have, could it have been something? So I guess [chuckle], I guess just thatâ€™s a long way of asking â€“ can seemingly small accidents as children have lasting impacts on their learning?
Dr. Marshall: Melissa, this is right up your alley!
Dr. McCart: It is, this is something we actually are dealing with a lot in Oregon right now and putting a lot of emphasis on in terms of training. So we know of the years of childhood, so say birth to 20 or 18, the most frequently injured age group is that, are those little kids. Theyâ€™re even higher than teenagers â€“ which always everybody says has the highest group â€“ but they’re not, theyâ€™re second to our, our very young, who experience a lot of falls, like you were talking about.Â
And so what we’re seeing is kids who maybe had an injury when they were six months, like one I’m dealing with right now, or three, and they don’t seem to have any issues. But then all of a sudden they go to school and we start to see things that look like there may be ADHD or learning difficulty or to be more explicit â€“ some executive function issues, sometimes it looks like forms of autism and if we are careful we can trace that back to injuries and be looking at things like developmental directories prior to the injury â€“ were they on a path that was normal at that point? And then after the injury maybe things slow down and change.
So long answer to say yes, that can happen and we are trying to come up with ways to help students get access to services and families get access to services in those specific situations.Â
Sondra, do you have anything to add to that?
Dr. Marshall: You know, I think I just really appreciate Lori raising this question about the importance of history and really probing more around history. As an evaluator, we can’t necessarily always make correlation â€“ like â€œOh yeah, that’s the reason why this child might be having problems,â€,Â but it certainly is a risk, and the work that Melissa is doing in terms of really advocating for â€“ [addressing Dr. McCart] do you want to talk about the credible history components?
Dr. McCart: So as a special educator, Lori, I’m sure you know that in the United States most states require â€“ for a student to be eligible for TBI under IDEA and special ed â€“ a medical statement. In Oregon we recently revised our Oregon administrative rules to include an alternative to that called the â€œcredible history interviewâ€. So say you have a child who was injured young and we never had a medical evaluation. We could do an interview with the parents, who is a credible person, and do a developmental history and gather information that way to make a child eligible for special education under TBI. So we’ve really been trying to create alternatives for difficult situations and accessing services.
Lori: Hm, well you give me pause, because of course, you know everyone who listens to this podcast [laughs] knows that I have a child with special needs and so I imagine that there’s a lot of parents that are listening to this right now quickly going back in their history to see â€œHm, could it have been that fall?â€ [laughs] So little bit of stress there â€“ I guess a good follow-up question would be â€“ so they have that credible history, what would a good next step for parents be? Any thoughts on that?
Dr. McCart: If they suspect that a past fall or past injury has maybe impacted their childâ€™s learning?
Dr. McCart: If they’re not already identified by the school, as a parent I would go to the school and ask for an evaluation of your childâ€™s present level of performance. If I suspected a brain injury, I would also be seeking out someone like Sondra to, to look at the, kind of, potential for impact to learning â€“ you know, what does the studentâ€™s executive function look like, that kind of thing.Â Often schools, though they try, are not as equipped as a person like Sondra to go and look at some of that more nuanced, detailed information.Â
Dr. Marshall: I think that’s great. I want to back up and I certainly don’t want to alarm parents. [Lori laughs] You know because kids are made to bump their heads as they’re learning to do things like walk and run, and I mean we all can think about the bruises and the falls that our children took and think â€œOh my gosh is that the reasonâ€. And we all want to point to something to make sense of why a child is functioning the way they are.Â
So I don’t want to alarm parents, but when things, maybe, when there’s a change in function, so if a child’s had an injury and there’s a change in functioning and things just aren’t connecting from one point of time to the next point of time â€“ because, because I think kind of even bringing it into, you know, traumatic brain injury is on a continuum, so everything from a concussion â€“ which is a mild traumatic brain injury â€“ to a more severe significant brain injury thatâ€™s required hospitalization, thatâ€™s maybe required some level of significant medical intervention right, those are all brain injuries. But all brain injuries don’t necessarily mean that a child is going to have learning and or functional problems.
So again, us parents, we are quick to beat ourselves up about things and want to explain why our child is not doing what we want â€“ basically, letâ€™s get right down to it. [Lori laughs] But at the end of the day I just want to assure parents that, that, that fall, that bump for the tenth time, you know, on that step is not the reason why necessarily.
Dr. McCart: Yeah I know depending on what literature you read, somewhere between 80 and 90% of all concussions or brain injuries fully recover, and so you know we can live without the fear right now.
Lori: Right, yeah I was gonna say otherwise everyoneâ€™s going to wrap their kids up in bubble wrap or wear helmets.Â
Dr. McCart: What we need to watch for are those kids that don’t recover and how can we provide support for them, and how can we track kids when they do have an injury so we can be sure to be aware of the ones that donâ€™t recover fully so we can help them.
Lori: Thank you. For teachers, as far as they’re concerned, they’re reading along in the child’s IP or past history report, and they come along that, is that information something that a teacher should follow up with families about? What type of recommendations would you have for teachers?
Dr. McCart: I would say if you come across something in a report or in a child’s file, it would probably be significant enough at that point that somebody mentioned it to even get in the file. And so I might ask about it â€“ you know, â€œI saw in your childâ€™s file that they experienced a fall from a tree. How are they doing? Are they recovering?â€. You know, that kind of thing.
Dr. Marshall: Lori, were you referencing not only what teachers should do if they read about it? Because I mean, for the meat of the work that CBIRT has done and what we’re doing with them is, what do you do if you have a child with a traumatic brain injury in school? [Lori: Mhm.] That’s where it becomes messy and complicated. And there’s no one pathway but I think that’s where CBIRT is a leader in, really, creating pathways. So I didn’t know if you were going to get into that or if that was also what you were referencingÂ
Lori: Yeah, well please go ahead and tell us more about that. What exactly is CBIRT â€“ what do they do and how do they support?
Dr. McCart: CBIRT is a center at the University of Oregon, as a research center, and one of our biggest, most important things that we do, is take research to practice. So I focus on schools, we have other folks working there that focus on the adult populations, but in terms of what your listeners are interested in â€“ probably school.
And I put it in the chat so you can share it out â€“ the new CBIRT website â€“ which is called returntoschool.org, and there is online training on that site for educators, anybody in any country, and you can utilize it. It is ten lessons on all things brain injury for educators. We provide rules, webinars â€“ we do multiple webinars that are about an hour long each. Sondra has done one for us on assessment. We do â€“ what else â€“ we do conferences, in fact if you go to returntoschool.org, under â€œschools: there are sample IEP goals for students with brain injuries, because one of my biggest pet peeves is pulling out an IEP for a student with brain injuries and arranging… all it is is reading and math. So there’s lots of ideas about executive function, kind of, deficits that need specially-designed instruction.Â
Trying to think what we do â€“ training is all over the place. We used to be in-person, now theyâ€™re online. Hopefully they will be back in person soon. [pause] And we do research on best practices for students and teachers. Sondra, do you [inaudible] â€“
Dr. Marshall: I want to punctuate something you said because, I mean, I think we’re so passionate about this because I think people think â€œOh it’s a brain injury but they have a learning problemâ€, so they treat the child as if they just have a learning disability. Or, they had a brain injury and maybe they act like a child with ADHD and they’re kind of hyperactive and inattentive and impulsive, so they treat the child like they have ADHD. But these kids are very different and on any given day they might be functioning differently and the needs of the family are also different and the needs in the classroom are going to be different.Â
And so we really want to emphasize that these kids can be very complicated and that’s why you know, having knowledge, education, creating pathways for kids from the hospital and back into the school, and having, kind of, collaboration and having paperwork to support teachers, you know, how do they deal with the social, emotional, behavioral learning attention needs of a student in the classroom â€“ they are not necessarily like all the other kids that they’ve dealt with. They are very different and so that’s where I think, you know, I just want to take this opportunity that there are such great resources available.Â
Dr. McCart: Yeah so â€“ that made me think of one of the other things on there â€“ thereâ€™s two more things on this website. Theyâ€™re called research matters and we take research articles that are often complicated and very long and turn them into what do teachers need to know out of it â€“ and so it’s a bulleted list of all this research, [Lori: Nice.] and then we also do one page guides for all things for brain injury â€“ so things like â€œWhat are some strategies for success for a short-term memoryâ€ or for social interaction or whatever subject. Thereâ€™s about 50 of them, that are PDFs, that can be sent out, shared, printed any of that stuff. So I mean basically we just try to get as much information out as possible to educators.
Lori: Yeah â€“ I mean it sounds comprehensive and so informative, and I love the bulleted points [chuckles] because we all know our teachers right now, especially during COVID, are so exhausted anyways, but having those suggestions for them is essential. So when weâ€™re thinking about our students with TBI, you mentioned that their, profiles, that they might act like they have ADHD or it might look like autism. So what I think I hear you saying is it’s the brain injury that’s causing these behaviors or actions versus an actual ADHD diagnosis or autism. Is that what I heard?
Dr. Marshall: Yes I mean, Iâ€™ll take a, I’ll just step in and just say, for example, let’s say a student had a brain injury, prior to which they were able-bodied, they were neurotypical, they didn’t require any medications and the additional support. And post-injury they’re having focus problems, maybe they’re impulsive, they say things without thinking, theyâ€™re struggling now with learning. That child needs a, number one, they weren’t born like that so it’s a systems change for that child, that family. And then also, I donâ€™t know, the metaphor that we used is kind of like swiss cheese â€“ on any given day they might not be like that, just depending on how neurons are firing and where they’re at with their sleep hygiene and stress levels – unless you got depression and anxiety, which we’re learning are great mediators to being able to function. Thatâ€™s an area that we’re really looking at in kids with concussions as well, kind of the role that sleep, depression, anxiety are playing on the recovery profile of these students.
So, so â€“ that’s why it’s so important to not just lump them into â€œOh well we know ADHD kids so we’ll just set them up like a child with ADHDâ€.
Lori: And what, this may be difficult to answer, off the cuff, but what would be one way of working with them differently than you would with a child with ADHD, you would say?
Dr. McCart: I think in a school situation part of it is knowing, right, so that that is a TBI versus ADHD. With ADHD youâ€™re looking specifically at executive function disorder. With a â€“ with a child with a brain injury, they’re recovering and so the accommodations or modifications or instruction that you need for most of the students have to change rapidly and frequently as the student is changing rapidly and frequently.Â
Whereas with ADHD you know, you often, I mean, you can work with them, but what you see is what you get, more or less, that is a child who has that disorder. With brain injury you have to evaluate it just constantly and I think that is the thing a lot of educators miss. We’re so used to our regular special education [pause] timelines, you know we do the evaluation every 3 years, we do the IEP once a year and then we don’t think about it too much until then because we just do what we do, right. But with a kid with a brain injury we’re looking at, you know, frequent, frequent assessment and changing of plans.
Lori: I see.
Dr. Marshall: And Iâ€™ll add onto that â€“ maybe there are some, kind of, co-occurring issues, so maybe there’s more memory based issues associated with that injury too. So what are the interventions that we’re going to set up to support that child â€“ because they also have some kind of occurring issues related to the injury.
Lori: Got it, thank you.
Dr. McCart: Or even a physical injury. Oftentimes when they come back to school they have a physical injury they’re dealing with as well, so you have to accommodate that as well.
Lori: Well, I do want to switch gears to your work on concussions, because what you’re doing is [pause] is very important. When you’re working with people who have had a concussion, you want to ensure schools use the proper protocols when there is a suspected concussion, but also for when they’re returning to school, right. Tell us more about your work on that.
Dr. Marshall: Go ahead Melissa, and Iâ€™ll pad around it.
Dr. McCart: Are you talking about the difference between return to play and return to school? Like sports versus return to school? Or â€“
Lori: Yeah, letâ€™s go ahead and talk about your return to play with sports – why is that so essential? I know in a lot of our international schools we do have set protocols in place. I was a coach, and as a coach we need to take courses on how to recognize a concussion and ensure that our students weren’t playing when they were injured. But give us a brief history of why this is important.
Dr. McCart: Well, mostly it’s because if somebody’s injured we don’t want them to go back into play and get another injury. And we know that in that timeline of recovery they are significantlyÂ more likely to get another injury if they’re playing, so we want to avoid that. But also not just brain injuries right â€“ so if they have a brain injury, they’re much more likely to, say theyâ€™re a soccer player, maybe get a knee injury because their balance might be a little off or you know some other type of injury, so we definitely don’t want that to happen. And ultimately our kids are students first, right, so we want to protect the developing brain and make sure that they can be a successful student before theyâ€™re athletes. [pause] So I mean that’s it in a nutshell from my end, I donâ€™t know if Sondra has anything.
Dr. Marshall: I think that’s great! I mean I think you know, just in the evolution, what was it â€“ 2007? 2008, Washington was the first state that passed the return to play law, Oregon was right on its heels and really, you know, the focus was initially on returning to play. And now there’s legislation coming on board just reminding us that, like Melissa said, the first thing that kids have to do is return to the classroom.
And I think one thing is because, that we really didn’t highlight, and we all know this, is a brain injury is an invisible injury. We don’t see it on the outside so what we see is a student who looks able-bodied, who looks like they’re fine, and we then develop expectations around that when really they’re not. And we know that the brain is going through this huge growth â€“ developmental growth period in high school especially, and we really need to protect its potential.Â
So itâ€™s, you know, the pendulum has swung, everything from, you know, take them off and put them in a closet and let the brain heal, to realizing that that’s not the great thing and again letting research be a better guide and how do we develop systems to really help that student get back into school safely, return to school safely and then get back into play while preserving their sense of self-efficacy, self-esteem, kind of, and their mental health, because we know that that also plays a part in that.
Dr. McCart: Yeah, and you know like, the thing I always like to say is, we have an obligation to these students who most are going to recover, right, to not let an injury that is likely to be temporary alter the trajectory of their life. Those kids that need temporary accommodations â€“ we have a responsibility to make sure that they get those and that they’re able to move forward into adulthood unhindered.
Lori: Right. It’s not worth it to play one extra basketball game or, or push them too far in school if they’re needing that time to rest and recover.
Dr. McCart: Or make them take the SAT [Lori: Yeah.] their college admittance relies on, while they’re in recovery.Â
Lori: And I like what you said, Sondra, about mental health. Iâ€™ve witnessed several high school students who have been impacted by a fairly serious concussion, and then go through a very deep period of depression, for sometimes years after. [Dr. Marshall and Dr. McCart: Yeah.]
When a student does return to school after a concussion, and you’ve mentioned briefly about this, why can’t it be back to business as usual? What does their brain need and what do teachers need to know?
Dr. McCart: [addressing Dr. Marshall] You wanna take on what the brain needs and Iâ€™ll take on the teachers?
Dr. Marshall: Okay, Iâ€™ll take on what the brain needs. I wish that were an easy question to answer, and I think the most important thing is, every brain is unique. Every student has a different set of vulnerabilities. So what one student needs isn’t necessarily going to be what someone else needs. So I think, number one, it’s not to assume that one student’s brain is going to require the same exact pathway as another student’s brain â€“ so being flexible.Â
Because we know that it’s going to be a combination of, you know, letting that brain rest and recover, but also keeping that brain in the game and that student connected to their social community. But it’s like â€“ if we were to take a broken arm and say â€“ â€œWell so what, you still have to use itâ€, then we probably hinder the recovery of that broken arm. So it’s just the journey of, you know, doing a little bit, taking breaks, doing a little bit, taking breaks, expanding its, you know, ability. Because I think one thing that’s important â€“Â the concussion will maybe be very nuanced and, you know, we’re learning more and more about what happens to the brain, but it’s really being framed up as a chemical reaction, so it’s not necessarily a structural injury as much as there’s this, kinda, cascade of a chemical reaction that is, kinda, pulling all the energy from that brain and making it hard for that brain to do the things that it naturally needs to do. So the brain keeps all of our systems and organs going, but it also doesn’t all of our thinking, and all of our, you know, all of our balance and motor stuff. And then, you know, all the, all the texting that kids are doing which doesn’t seem like it takes energy, but it really does. So it’s really a lot of education about teaching that student about what the brain is actually for.
I call my students who get concussions my brain ambassadors, right, because they have to educate the next group. And so itâ€™s a journey of recovery, a pathway to recovery, where we’re managing the energy input and output. So thatâ€™s part of what I do and then what teachers do â€“ they do the heavy lifting.Â
Dr. McCart: Yeah, I think the biggest thing that teachers need to know is to understand the impact of a mild concussion. I think the teachers and educators do a great job with our moderate to severe kids â€“ that is obvious that they’ve been injured. I think teachers have that pretty well dialed-in. It’s the kids that are the mild to moderate group that look like everything’s okay. [Lori: Right.] So understanding what the potential impact that might be. One of the biggest complaints we get is that â€œMy teacher doesn’t have any empathy towards me on this and they’re not providing temporary accommodations.â€ So basically that just comes down to educating educators about that. We assume that educators are there because they want to do the best they can by kids. So you never assume any of that is intentional, it’s just not knowing, so I think that is one piece.
I put in the chat, and you can share it with whoever you like, but we have a return-to-academics protocol after concussion that we like to pass out, and it, it basically shows moderated total return to the classroom. And it’s like: step 1 â€“ rest, step 2 â€“ light mental activities, step 3 â€“ part-time school, step 4Â â€“ part-time school with less supports, and then all the way to full-time school with supports and full-time school without supports. And so it kind of outlines how to graduate kids back in and when to progress them to the next, to the next steps, and I think having protocols and policies in place in school that teachers are educated about would make a massive difference in the life of the kids that are mild and moderate.
Dr. Marshall: Oh my gosh, now, Melissa talks about that as if it’s easy to do â€“ and don’t forget we have a family system over here and parents who are activated because of everything, and so what we’ve learned in the â€“ well, you know I’ve been part of the TBI consultants for at least 20 years and then certainly in this world of concussion â€“ is it’s messy. And what weâ€™re, that’s what we’re trying to do in study, and Central Oregon is, what are the lessons learned, what are things that the components of such a program that are really going to set families, a student in the school, up for success, to successfully move a student back to school and then back to play. And it is, it’s a challenge.
Lori: Yeah. Yeah, it is and I love what you said about the empathy piece and also just the fact that the majority of teachers want what’s best for their students â€“ it’s usually just that they’re not educated in this particular field. We’ve seen it time and time again, right [laughs], with this type of thing, so I think your resources that you’re sharing or going to be so helpful for everyone. So I really appreciate that and I will definitely share those on our show notes.Â
I think we’re about ready to tie up for today, but if, if there was one question that you wished I would have asked you, what would that be?
Dr. Marshall: I mean for me maybe, you know â€“ what are you, are there, is there one or two things that, lessons learned with you guys doing this for so long that you would encourage other schools to think about and identify? I don’t know, Melissa, if there’s anything…Â
Lori: Well, why don’t you go ahead and answer that question [laughs] for me.
Dr. Marshall: I mean, I think two things, for me. I think one is that every school should have an identified point person to manage the students and be that point person for parents to contact and teachers to contact. Because when parents â€“ because they’re trying to do their best and listen to their child â€“ just reach out independently to teachers, there’s not a coordinated effort for that student, and within the system, and it gets, it is easy to have communications go awry so that’s number one. Number two is â€“ what is your system from the medical side back to the educational side, because that also can be a place where things get really messy and especially if the school is hesitant â€“ because these are kids who had medical injuries â€“ to then adjust protocols without a medical person being part of that conversation, but they don’t know how to bridge that gap between the medical and educational.Â
Like I think that’s one of the things that we have done really successfully â€“ we actually have an educational person who is allowed to float between the educational and medical side to help bring information back and forth so that there’s real collaboration.Â
Lori: Mhm. That’s great â€“ and between the families as well â€“ I like how you mentioned the family system, it’s so important. Thanks, so, Melissa?
Dr. McCart: I have two things. One is, as educators of high school students, we need to remember that these kids will not ask for help. [Lori: Hm, good point.] Most of them are not going to raise their hand and say â€œI had a concussion, please help meâ€ â€“ like the educators need to go to them and talk to them. The other thing is, is that educators can’t know everything â€“ it’s one of the hardest jobs there is, and expecting educators to know everything about everything is unrealistic, not fair, all of the above with that. And I think the takeaway for educators about concussion and brain injury is â€“ ask for help. Thereâ€™s resources available, there’s people all over the place who can provide assistance, CBIRTâ€™s always open to providing assistance, Sondraâ€™s always open to helping, so you know we all care about kids. So if you have kids that are needing support, make sure you ask.
Dr. Marshall: And I think I’m going to put in a shameless plug, and I know we’re not quite ready, Melissa, but we do have a side project we are developing â€“ a consulting arm where we are being positioned to help schools set up concussion pathways.Â
Lori: Well that’s fantastic. I’m really excited and as soon as you guys get that let us know so we can let everybody else know
Dr. McCart: It’ll be on the website so I’m sure.
Lori: Perfect. [Lori and Dr. McCart both laugh] Well, thank you so much for your time today. I know I’ve learned a lot and I know our listeners will be very appreciative of this.
Dr. Marshall: Wonderful, thank you so much it’s really nice to meet you
Dr. McCart: It’s been so fun, thank you.Â
Lori: Thanks for stopping in to our SENIA happy hour. Don’t forget to head over to SENIAinternational.org/podcast and check out our show notes from our discussion today. We at SENIA hope you are enjoying these podcasts. There’s so much to explore and we’re at the very beginning, so feel free to drop us a note and let us know what you’d like to hear more about during your next SENIA happy hour. Until then, cheers!