@article{cbdf6c06e57d4ebc9e697e64915237c9,
title = "Return to Learn ECHO: Telementoring for School Personnel to Help Children Return to School and Learning After Mild Traumatic Brain Injury",
abstract = "BACKGROUND: Return to learn (RTL) after mild traumatic brain injury (mTBI) presents unique challenges for school professionals. A multidisciplinary team approach is necessary yet training school professionals is logistically difficult. This paper describes an innovative pilot RTL program and its evaluation. METHODS: Utilizing the telehealth/telementoring program Project ECHO{\textregistered} (Extension for Community Healthcare Outcomes), this study utilized a multidisciplinary team of subject matter experts to deliver five 1-hour sessions across 5 cohorts of school-based professionals (total of 133 participants). The evaluation used a mixed-methods approach of post-session and post-program participant surveys and post-program participant focus groups. RESULTS: Participants who completed a post-program survey reported statistically significant improvements in essential aspects of RTL knowledge and self-efficacy. This included improvements in how to manage a student with an mTBI (44.8% to 86.9%), benefits of early return to school for students following mTBI (31.8% to 86.9%), and the importance of written RTL policies/procedures (55.1% to 97.1%). CONCLUSIONS: This study demonstrates that RTL training via a telementoring approach may be a positive and effective way to train school-based professionals and improve knowledge and self-efficacy, especially when attending face-to-face trainings are difficult. This model has the potential to produce programmatic and systematic improvements for RTL education.",
keywords = "mild traumatic brain injury, project ECHO, return to learn, return to play, telementoring",
author = "Karen McAvoy and Mark Halstead and Linda Radecki and Amy Shah and Anjie Emanuel and Stephanie Domain and Jill Daugherty and Dana Waltzman",
note = "Funding Information: This project was supported by the Cooperative Agreement Number, NU38OT000282, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the faculty and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Funding Information: Many children who sustain a mild traumatic brain injury (mTBI) experience cognitive symptoms, including difficulty concentrating, following directions, or remembering, as a result of their injury.1,2 These symptoms, and the possibility that physical and mental exertion can aggravate symptoms,3,4 can consequently have an impact on a student's ability to learn and their performance in the classroom.5-7 Applying academic adjustments and accommodations for students who have sustained a mTBI, or concussion, has received significant attention over the last decade. Guidance from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) initially focused on appropriate return to play (RTP) and activity following an mTBI.8,9 However, in 2013, the AAP's Clinical Report on Returning to Learning following a Concussion highlighted the challenges that may exist in supporting students in the academic setting.10 This report offered recommendations for a multidisciplinary team concept that provides appropriate assistance to the student in the classroom while recovering from mTBI. Teachers, school nurses, principals, and athletic trainers all report barriers to providing adequate support for students following mTBI.11-14 These barriers include a lack of adequate training or mTBI knowledge, inadequate time to provide the recommended adjustments, lack of communication among members of the school RTL team as well as with health care providers, and lack of awareness of policies and protocols. In one survey, only 22.3% of teachers reported feeling very or extremely confident recognizing the signs and symptoms of mTBI, highlighting the fact that mTBI sometimes is thought of as an “invisible” injury.12 A study of school principals highlighted only 34% had received specific training on managing students with a mTBI.13 Furthermore, another study found that following a mTBI, communication between athletic trainers and school nurses occurred “often” or “always” 65% of the time, while communication between athletic trainers and teachers occurred “often” or “always” only 49% of the time.14School protocols for RTL are also lacking. Studies have reported a wide range in the percentage of schools (12–77%) who have an established protocol in place.11,14-16 To support school personnel in improving their understanding of mTBI and to educate about RTL procedure and protocol development, the researchers developed and implemented a pilot Project ECHO{\textregistered} (Extension for Community Health care Outcomes) program focused on RTL following mTBI (RTL ECHO). Project ECHO is an evidence-based telehealth/telementoring program that brings together communities of learners (eg, primary care providers, school administrators, home health aides) in a virtual setting, often in rural and underserved areas, with multidisciplinary subject matter experts.17 Didactic presentations and case-based discussions between faculty and participants emphasized an “all teach, all learn” approach. In 2019, a multidisciplinary faculty implemented RTL ECHO from January to March with 3 cohorts and October-December 2019 with 2 additional cohorts. The purpose of the pilot RTL ECHO evaluation was to explore school personnel's satisfaction, awareness of national guidelines and trainings, knowledge and self-efficacy, peer support, communication and partnerships, outcomes, and suggestions for program improvement. This paper reports on the development of the program and the evaluation that was conducted with the participants. Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.",
year = "2022",
month = dec,
doi = "10.1111/josh.13221",
language = "English",
volume = "92",
pages = "1194--1201",
journal = "Journal of School Health",
issn = "0022-4391",
number = "12",
}