One major responsibility for a Superintendent of Schools is risk management. The passing of the New Jersey Concussion Law motivated districts to develop a policy for concussion as mandated by the Law. While some districts adapted the Model Policy developed by the New Jersey Department of Education, others turned to insurance companies in New Jersey specialized in the drafting of new school policies. While most districts in New Jersey are in compliance with the Law, how many have taken concussion issues beyond the risk management aspect and considered developing a comprehensive concussion policy that establishes clear procedures and protocols for school personnel?
Accountability for compliance with the law is not mandated aside from the NJ Department of Education’s Quality Single Accountability Continuum (QSAC) currently utilized to evaluate and monitor public school districts. Please consider how you rate the importance of a comprehensive concussion policy that includes clear procedures and protocols for all school personnel.
As concussion is an ever evolving field it is important to consider if your school’s policy is evolving also.
Parents will most likely ask their child’s teachers any questions they may have about the district’s concussion policy. Depending on the answer, the next step is to ask the school principal so it is important for principals to be well informed and ready to answer concussion policy questions not only from parents but also from their teachers.
After reading through the district policy, principals may have a few questions of their own.
- Principals may want to consider an annual inservice for staff addressing the current understanding of concussion and the school district’s concussion protocol and official policy.
- A school principal might also suggest a similar workshop for parent-teach organizations.
Directors of Athletics
Considering that the New Jersey Concussion Law focuses on interscholastic sports it is reasonable to think that the majority of administrative responsibilities relative to concussion fall to Directors of Athletics. Implementation of the district’s concussion policy involves gathering accurate information, delegating concussion-related tasks, and developing methods to manage paperwork relative to concussion. The additional administrative work may seem overwhelming; however, this effort is worthwhile considering the protection it provides to secure the safety and future of young athletes.
Some history might help to clear things up.
Shortly after the New Jersey Concussion Law was passed in December 2010 concussion moved to the forefront of interscholastic discussions among School Principals, Vice Principals, Directors of Athletics, Athletic Trainers, Coaches and School Nurses. There were many questions; there was confusion, misunderstanding, speculation and some erroneous information.
But where did it all begin?
In 2006, in Washington State, a young athlete, Zackery Lystedt, was injured in a junior high school football game. The injury is described as second impact syndrome. Zackery had sustained multiple concussions in previous sports events, and when he took another hit that fateful day a sequence of events occurred in his brain resulting in severe brain injury and lifelong disability. Zachery’s parents began a campaign to raise awareness about the seriousness of concussion. The Centers for Disease Control and Prevention came on board, materials were developed and the Seattle Seahawks became involved with support from the NFL and USA Football. Washington State passed the Lystedt Law on May 16, 2009. The rest, as they say, is history, with almost every state in the United States having passed a concussion law to help prevent such tragedies from ever happening again.
Meanwhile, back in 2001 the first of four international conferences on concussion was held. Experts from all over the world had met to address concussions in sports and their concerns that many concussions were undiagnosed; athletes played their sport while still experiencing concussion symptoms; concussions were being dismissed as minor injuries; new studies about athletes and concussions showed that a new approach to concussion management was necessary. Since the first conference in Prague in 2001 information has been revised (Prague 2004, Zurich 2008, Zurich 2012), updated and enhanced to result in the consensus among concussion experts as it stands today.
And that brings us to today when we are still attempting to unravel all of the complex issues that surround concussion management.
There are many questions about concussion; here are a few:
- Which professionals are included in “clinicians trained in the identification and management of concussion”?
- What is the appropriate amount of time an athlete should be kept out of sports after a concussion?
- Is concussion different in younger children compared to adolescents?
- Should a student be kept home from school for months if symptoms do not resolve?
- How many concussions are too many concussions?
The answers to these questions and many more are being researched by experts in neuroimaging, medicine, neuropsychology, public health, and other related fields. Solutions are being sought through biomechanics, rules for play, engineering, education and more.
It All Leads To This
It leads us to wanting to learn accurate information and passing it on to our network of contacts. Athletic trainers are talking to their Directors; Teachers are talking to their school nurses; School Principals are asking questions of their Superintendents of Schools. There is currently enough valid information available for leaders to make decisions that will best support the safety of students as it relates to concussion management through development of concussion policies that are comprehensive and provide the best risk management possible. The word of the day is caution.
The New Jersey Concussion Law and Model Policy
Generally the Law applies to all public and nonpublic schools in New Jersey and applies to student-athletes in grades K – 12 who play interscholastic sports.
The Model Policy provides some statements that particularly address return-to-play following a concussion. In addition, any youth sports team organization (one or more sports teams organized pursuant to a nonprofit or similar charter or which are members teams in a league organized by or affiliated with a county or municipal recreation department) that operates on school grounds must also sign a statement of compliance with that school district or nonpublic school’s policies for the management of concussions and other head injuries.
The basic mandates established by the New Jersey Concussion Law and Model Policy are:
- Student athletes must be immediately removed from sports competition when a concussion is suspected and are unable to return to play on the same day.
- A Medical Evaluation and written clearance by a physician or other licensed health care provider trained in the evaluation and management of concussion required before being allowed back to sports activity.
- Student athletes must complete the Graduated Return To Play as outlined in the 2008 Zurich Consensus Statement before returning to full participation in interscholastic sports.
- Athletic trainers, coaches, and school physicians must take an interscholastic athletic head injury safety training program.
- School districts must provide a fact sheet to be signed by parents and athletes in order to participate in interscholastic sports.
- School physicians, athletic trainers, school nurses and coaches must complete an Athletic Head Injury Safety Training Program.
- Sports clubs using school district property are required to sign a statement of compliance with the school district’s concussion policy.
- Athletic trainers are mandated to complete continuing education specifically on concussion each year.
Should my district mandate baseline testing?
The term “baseline testing” typically refers to a brief neurocognitive computerized test that is taken in order to provide information about how an individual performs certain cognitive functions. Some of the computerized programs test for attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving, and reaction time; individual programs have specific differences. When an individual has a baseline available for these functions, if an event happens and a concussion is suspected a re-test can be taken (not immediately following the event) and the software program will compare the scores from the baseline test to the scores from the re-test. There are numerous baseline testing software companies that make baseline testing available to individuals, teams and other groups.
Baseline testing is just one tool to assist physicians in diagnosing a concussion and making safe return-to-play decisions. It is not mandated in New Jersey that student-athletes take a baseline test. A baseline test and subsequent re-tests are not necessary to monitor the progress of recovery from a concussion; however, many clinicians use them because of additional information they may provide to assist with return to play decisions and academic accommodations. Baseline testing is useful because it is the only objective tool available to clinicians who treat and manage concussions.
Is my School District doing enough to ensure the well-being of our students?
Some things to consider:
- Children who do not play sports and sustain a concussion are not addressed in the New Jersey Concussion Law or the model policy; however, these concussions need to be taken just as seriously.
- School districts can choose to provide guidelines for elementary and middle schools to follow in the event that a concussion occurs to a student outside of interscholastic sports.
- It would be optimal to include physical education teachers in interscholastic head injury training because of the contact sports they facilitate daily, and the risk of students sustaining a concussion during gym time. In addition, many students with concussion return to school with gym restrictions, because of the risk of contact sports and sustaining a second concussion making it imperative for the physical education teacher to be on the same page as other staff.
- Including a requirement for teachers to attend trainings in concussion will reinforce the relationship between concussion and cognition, academic accommodations, and physical activity restrictions that are typically necessary following a concussion.