TBI TARC is supported by contract number 

HHSP233201500119I from the U.S. Administration for 

Community Living, Department of Health and Human 

Services, Washington, D.C. 20201

TBI Tuesdays

Return to Learn: Equal Access to 

Education for Students with 

Brain Injury

March 23, 2021
Welcome to Today’s TBI Tuesday Session

Thom Campbell

TBI Team Lead

Thom.Campbell@acl.hhs.gov

2
Webinar Logistics

• Participants will be in listen-only mode during the 

webinar. Please use the chat feature in Zoom to post 

questions and communicate with the hosts. 

• During specific times in the webinar, we will have 

opportunity to respond to questions that have been 

entered into chat.

• The webinar will be live captioned in English.

• The webinar will also have an American Sign 

Language (ASL) interpreter.

• This live webinar includes polls and evaluation 

questions. Please be prepared to interact during 

polling times. 

3
Feedback and Follow-Up

• After the webinar, you can send follow-up questions 

and feedback to tbitarc@hsri.org

(Please note: This email address will not be monitored 

during the webinar.)

• A recording, including a pdf version of the slides, will 

be available on the ACL website (acl.gov)

4
Who’s Here?

“In what role(s) do you self-identify? Select all that apply.”

1. Person with a traumatic brain injury 

(TBI) or other disability

2. Family member or friend of

a person with a TBI or other 

disability 

3. Self-advocate / advocate

4. Peer-specialist / peer-mentor

5. Social worker, counselor, or care 

manager

6. Researcher / analyst

7. Service provider organization 

employee

8. Government employee 

(federal, state, tribal, or municipal)

5
What we 

will 

cover

Part 1
What we 

will 

cover

Part 2
Meet Our ACL State Speakers

Julie Myers, 

MPH

Public Health 

Program Administer

Pennsylvania 

Department of 

Health

Karen McAvoy, 

PsyD

Clinical and School 

Psychologist

REAP and Get 

Schooled on 

Concussions

Dr. Brenda 

Eagan-Johnson

Program Director

BrainSTEPS

Hillary 

McClain Teears

Clinical Instructor

University of 

Pittsburgh School 

of Dental Medicine

David Kracke, 

JD

Brain Injury 

Advocate/Coordinator

Center on Brain 

Injury Research 

and Training

8
OVERVIEW: 

RETURN TO LEARN WORKGROUP

9
Terminology

• Return to Play –covers all activities 

related to school athletics reentry 

(should include sports and sports-related 

clubs and activities, gym class, and 

recess)

• Return to Learn –covers all activities 

related to academic school reentry 

• Return to School – umbrella term that 

encompasses both return to play and 

return to learn; covers all activities 

related to school reentry

10
Overview

• Participating States: Missouri, Oregon, Pennsylvania, 

Utah

• Purpose: To provide mentorship in 

Return to Learn and to develop 

Return to Learn products

• Products:

• Return to Learn Workforce Competencies • Return to Learn Toolkit 

11
Sample Products 

(slide 1 of 4)

BrainSTEPS (Strategies Teaching Educators, Parents, and Students)

Return to Learn After Concussion: 

Recommended Protocol

brainsteps.net/_orbs/about/BrainSTEPS.RTL.CMT.Pr

otocol.11.2017.pdf

12
Sample Products 

(slide 2 of 4)

Sample Products from Toolkit

Get Schooled on Concussion: 

Points of Vulnerability 

Available for download at 

getschooledonconcussions.com

13
Sample Products 

(slide 3 of 4)

Sample Products from Toolkit

Traumatic Brain Injury Classroom Tips for 

Teachers

cdc.gov/headsup/pdfs/schools/tbi_classroom

_tips_for_teachers-a.pdf

14
Sample Products 

(slide 4 of 4)

Sample Products from Toolkit

Draft: Webinar Sharing Form

15
POLICY AND BEST PRACTICES 

IN RETURN TO LEARN
R*E*A*P

Owner of R*E*A*P & Partner with NASHIA on 

R*E*A*P: Remove/Reduce*Educate*Adjust/

Accommodate/Pace

Co-Owner of GetSchooledOnConcussions.com

Karen@GetSchooledOnConcussions.com

303-818-8765

All rights reserved: © GetSchooledOnConcussions.com 17
Best Practices 

Return to Learn (RTL)

Citation: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 

18
National Organizations 

National Organizations who endorse the 13 Return to 

Learn consensus statements

National Organization

American Academy of Pediatric Neuropsychology

American Medical Society for Sports Medicine

Brain Injury Association of America

Defense and Veteran’s Brain Injury Center

High School RIO: Reporting Information Online

National Athletic Trainers’ Association

National Association of School Nurses

National Association of School Psychologists

National Association of State Head Injury Administrations

National Federation of State High School Associations

North American Brain Injury Society

Unites States Brain Injury Alliance

National Organizations who took part in 

the Delphi Process: Reached consensus on 

the 13 statements and gave support

American Academy of Pediatrics 

American Physical Therapy Association

American Academy of Neurology 

All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 19
Thirteen Consensus Statements

All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 20
Cognitive Rest

1. Students recovering from a concussion often need an initial period of 

relatively greater cognitive and physical rest, the timing and specific nature of 

which will vary from student to student. 

2. An estimated 70% of students recover from a concussion in 28 days with a 

gradual reduction of symptoms. This supports a gradual return to social and 

cognitive activity at home and school over the first 4 weeks of recovery. The 

speed of re-introduction will vary and must be individualized. 

3. Numerous positive social and emotional benefits are gained by being at 

school, even during recovery from a concussion. Unless contraindicated by a 

serious medical complication, a student with a concussion should return to 

school/learn even before symptoms are 100% resolved, provided the student 

can manage fluctuating symptoms and the school concussion management 

team has received education and resources to support the student in the 

educational setting

21 All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 
Concussion Management Team 

Composition 

4. A concussion management team should include representatives from school 

academic, school physical/health services, medical, and family/student 

domains who work collaboratively to develop and adjust an individualized 

Return to Learn plan. 

5. A family is advised to seek out medical evaluation, specifically a timely 

medical evaluation, treatment, and clearance for each concussion 

(regardless of the age of the student or the mechanism of injury).

6. Academic adjustments written into the Return to Learn plan are best 

overseen and directed by school professionals with dedicated expertise and 

knowledge of educational law, policy, and curriculum, guiding a collaborative 

Return to Learn process among the members of the concussion 

management team. 

22 All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 
Progress Monitoring

7. Progress monitoring should include symptom monitoring, no less than one 

time per week. 

8. Progress monitoring should include academic monitoring, no less than one 

time per week. 

23 All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 
Ascending Levels of 

Academic Support 

9. Schools have existing educational safeguards to support all students who 

struggle academically, medically, psychologically, and socially at school. 

Concussion can be included and managed using the existing educational 

safeguards. 

10. Schools should provide increasing tiers of academic support for students with 

concussions that do not resolve in a typical timeframe. 

11. Schools may apply their existing tiers of support for students with concussion 

and need not delay community or postpone academic supports while 

awaiting community health care input if medical input is not timely or 

available. 

24 All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 
Neuropsychological Testing 

12.Data from a neuropsychological evaluation is not required 

but can be helpful, should be considered, and may be 

incorporated into a Return to Learn plan if available. 

70% of students with a 

concussion resolve 

within 28 days

All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 25
Return to Learn Legislation 

13. Existing educational safeguards exist for students. 

They are prompt, flexible, and systematic for all concussed 

student athletes and non-athletes with academic needs. 

Return to Learn can be robust, widespread, systematized, and 

sustainable if embedded into existing educational frameworks.

All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 26
Cognitive Rest (Return to School)

1. Students recovering from a concussion often need an initial period of 

relatively greater cognitive and physical rest, the timing and specific nature of 

which will vary from student to student. 

2. An estimated 70% of students recover from a concussion in 28 days with a 

gradual reduction of symptoms. This supports a gradual return to social and 

cognitive activity at home and school over the first 4 weeks of recovery. The 

speed of re-introduction will vary and must be individualized. 

3. Numerous positive social and emotional benefits are gained by being at 

school, even during recovery from a concussion. Unless contraindicated by a 

serious medical complication, a student with a concussion should return to 

school/learn even before symptoms are 100% resolved, provided the student 

can manage fluctuating symptoms and the school concussion management 

team has received education and resources to support the student in the 

educational setting

Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 All rights reserved: © GetSchooledOnConcussions.com 27
Clinical Report from AAP on RTL

... as symptoms become tolerable, short-lived, and/or amenable to rest and intervention, 

the student may return to school, often with the use of supplemental academic adjustments. 

There is NO RTL 

without first a 

successful Return to 

School

Source: Halstead ME, McAvoy K, Devore, CD et al. Clinical Report, Returning to 

Learning Following a Concussion, 2013, http://www.ksno.org/wpcontent/uploads/2014/05/rettolearn.pdf

28
Return to School vs. Return to Learn

Return to School (RTS) 

Defined as:

• The process of the student physically walking 

back into a school setting. The decision to send a 

child to school on any given day is directed by the 

parent, often with input from a healthcare 

provider and is dependent upon the student’s 

ability to manage symptoms well enough to be 

physically and cognitively present in the 

classroom to listen and learn.

• Audience = parents and healthcare professionals

Return to Learn (RTL) 

Defined as:

• The process by which educators help students with 

concussion maximize learning while minimizing 

symptom flare-ups. A successful RTL plan is 

directed by educators, especially general education 

teachers, who have knowledge and skill in 

differentiated instruction to meet the needs of all 

students regardless of medical, psychological, 

learning, behavioral or social conditions. 

• Audience = Educators, primarily general 

education/classroom teachers

Permission granted by REAP©

29
Return to School & RTL are different audiences 

that require different messages

R2S audience = Parent & HCP RTL audience = Teachers and 

Related Service Providers

Barriers:

• Requires educatorspecific language 

and materials 

• If the majority of recovery is within 

the first 28 days, materials need to 

be specific to classroom teachers 

to empower them to direct RTL 

themselves, immediately, nimbly, 

flexibly and independently!

Source: © CDC All rights reserved: © GetSchooledOnConcussions.com

30
Concussion Management Team 

Composition 

4. A concussion management team should include representatives from 

school academic, school physical/health services, medical, and 

family/student domains who work collaboratively to develop and adjust an 

individualized Return to Learn plan. 

5. A family is advised to seek out medical evaluation, specifically a timely 

medical evaluation, treatment, and clearance for each concussion 

(regardless of the age of the student or the mechanism of injury).

6. Academic adjustments written into the Return to Learn plan are best 

overseen and directed by school professionals with dedicated 

expertise and knowledge of educational law, policy, and curriculum, 

guiding a collaborative Return to Learn process among the members of 

the concussion management team. 

All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 31
REAP:

 An Inter-disciplinary Team approach that sets the stage that 

every team has an equal & important role 

 A great jumping off point – a way to get all teams to the table

 All team roles are spelled out and understood by all other teams

 RTP & RTL

 Color coded

All rights reserved: © REAP 32
REAPconcussion.com (slide 1 of 2)

States that have customized REAP:

1. NASHIA

2. Colorado

3. Colorado 2013 version translated 

into Spanish

4. New York

5. Florida

6. New Jersey

7. Washington

8. Nebraska

9. Iowa

10. Alabama

11. North Dakota

12. Wyoming

13. South Carolina

14. West Virginia

15. Hawaii

16. Rhode Island

17. Arkansas

All rights reserved: © REAP 33
REAPconcussion.com (slide 2 of 2)

34

nashia.org

All rights reserved: © REAP
Concussion management is more than 

Return to Play legislation for athletes!

All students must 

return to school 

and return to 

learn even if they 

do not return to 

play 

Permission granted from GetSchooledOnConcussions.com©

35
RTL cannot be ROBUST or SUSTAINABLE if 

predicated on sports &/or medical direction 

All rights reserved: © GetSchooledOnConcussions.com 36
1 2 3 4

7. Monitoring Progress monitoring should include symptom monitoring, no less 

than one time per week. 

8. Progress monitoring should include academic monitoring, no less 

than one time per week. 

Source: © GetSchooledOnConcussions.com & Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for essential elements in © REAP returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 
Ascending Levels of Academic Support 

Multi-Tier System of Support (MTSS) or

Response to Intervention (RTI)

9. Schools have existing educational safeguards to support all students who 

struggle academically, medically, psychologically, and socially at school. 

Concussion can be included and managed using the existing educational 

safeguards. MTSS or RTI

10. Schools should provide increasing tiers of academic support for students with 

concussions that do not resolve in a typical timeframe. MTSS or RTI

11. Schools may apply their existing tiers of support for students with concussion 

and need not delay community or postpone academic supports while 

awaiting community health care input if medical input is not timely or 

available. 

40+% of students receive concussion in non-sports related mechanism; 

not under RTP Legislation Source: Myers RK, Eagan-Brown BL, Conway AT, et al. Examining a statewide educational consulting program 

for pediatric brain injury. Clin Pediatr. 2017;57(6):645-655. 

All rights reserved: © GetSchooledOnConcussions.com Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for 

essential elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 38
MTSS OR RTI

If research says 70% of students (between the ages of 5 years and 18 years) will 

recover from a concussion within 28 days, then ... 

Return to Learn supports need to be quick, nimble and fall within the purview of 

general education classroom teachers to apply and lift supports as they see fit 

Source: Permission granted from GetSchooledOnConcussions.com© 39
School-Based and 

School-Directed RTL

All rights reserved: © GetSchooledOnConcussions.com

40
GetSchooledOnConcussions.com

41
RTL Educational Resources

42
3 Common Effects of Concussion in the 

classroom... in this order!

All rights reserved: © GetSchooledOnConcussions.com 43
What the teacher hears... GetSchooledOnConcussions speaks the 

language of the classroom teacher

Student attends school (with 

some symptoms but I can 

make them comfortable in 

the classroom) to hear 

instruction

What work is reasonable 

given they don’t feel 100% 

and what can they learn and 

produce during this 

recovery? 

How can I assess them, give 

them a grade and check their 

mastery in order to advance 

to next level? 

I have students with ADHD that have slow processing speed; I have 

students with LD that have memory issues ... I can handle concussions!

All rights reserved: © GetSchooledOnConcussions.com

44
Teacher Acute Concussion Tool (slide 1 of 4)

 TACT for Teacher Training and/or “just-in-time” training

 30+ Tip Sheets available for download

 Videos available for download

45
Teacher Acute Concussion Tool (slide 2 of 4) 

 The TACT questions take less 

than 5 minutes to complete

 Elementary school teachers –

answer 7 questions with 

student in mind

 Middle/high school teachers 

– answer 8 questions with 

student in mind

 Teachers are asked to answer 

“how,” “what” and “when” 

you teach & “how much 

reading or computer” you 

use in their lessons

46
Teacher Acute Concussion Tool (slide 3 of 4)

 Within minutes, an email will 

appear in each teacher’s inbox. 

The TACT delivers RTL guidance 

via email ... face-to-face training 

not required; advanced training 

not required

 Email is customized based upon 

teacher’s answers on the TACT 

that will give ideas and attached 

Tip Sheets on how to adapt in 

each classroom when a student 

with a concussion returns to the 

classroom... 

47
Teacher Acute Concussion Tool (slide 4 of 4)

 Classroom RTL guidance 

continues automatically, via 

follow-up emails, for 3 additional 

week...including additional Tip 

Sheets

All rights reserved: © GetSchooledOnConcussions.com

48
RTL Teacher Empowerment in 2 ways...

Whole Staff Teacher Training

GetSchooledOnConcussions video 

(15 minutes)

+

TACT (5 minutes)

Train your whole staff on RTL 

in 20 minutes 

And/

Or

“Just-in-Time” Training

When a student with a concussion 

comes to the attention of the school –

Send link to all teachers of that student 

to complete TACT “just-in-time” 

Get 4 weeks of email guidance again 

around particular student – AT THE 

TIME of the concussion

49
Participating States

All rights reserved: © GetSchooledOnConcussions.com

50
School-Based and School-Directed RTL

Does your RTL resource check the boxes?:

 Is it geared toward educators (RTL), not parents or HCP’s (return 

to school)

 Does it allow independence from sports & medical direction? 

 Does it fit into a MTSS or RTI model?

 Is there specific language to Tier 1 classroom teachers?

 Is there specific language to Tier 2 Related Service Providers?

 Is the emphasis on immediate support in Universal Tier 1? 

 Is delivery of guidance to teachers easy, quick, relevant?

 Is training to classroom teachers sustainable?

 Is there an inter-disciplinary team approach?

 Is there symptom progress-monitoring?

 Is there academic progress-monitoring?

 Is RTL school-based and school-directed?

 Is it applicable to athletes and non-athletes?

 Is it applicable to those who do not seek out 

medical evaluation or treatment?

 Is it applicable to all grades?

REAPconcussion.com

COKidswithbraininjury.com

GetSchooledOnConcussions.com

• Protracted 

Recovery

• 504 Plans

All rights reserved: © GetSchooledOnConcussions.com 51
Return to Learn Legislation

13.Existing educational safeguards exist for students. They are 

prompt, flexible, and systematic for all concussed student athletes 

and non-athletes with academic needs. Return to Learn can be 

robust, widespread, systematized, and sustainable if 

embedded into existing educational frameworks. 

Questions?

Karen McAvoy, PsyD

Karen@GetSchooledOnConcussions.com

Source: McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for essential 

All rights reserved: © GetSchooledOnConcussions.com elements in returning to learn following a concussion. J Sch Health. 2020; DOI: 10.1111/josh.12949 52
ACADEMIC SUPPORTS FOR STUDENTS AFTER BRAIN 

INJURY PARTICIPATING IN ONLINE LEARNING
Presented by...

Dr. Brenda Eagan-Johnson 

BrainSTEPS Project Director

eagan-johnson@biapa.org 

724.944.6542

www.brainsteps.net
Objectives

• We will discuss the BrainSTEPS Program

• How students can be academically supported during 

online learning based on their individual signs & 

symptoms of brain injury.

55
Overview of BrainSTEPS (slide 1 of 2)

Created in PA by:

PA Department of Health – 2007

Unique funding partnership:

PA Department of Health;

PA Department of Education, Bureau of Special Education

Implemented by: 

Regional educational Intermediate Units

Under direction from: 

Brain Injury Association of Pennsylvania

Adopted the BrainSTEPS Model in 2016: 

Colorado Dept of Ed

56
Overview of BrainSTEPS (slide 2 of 2)

• Support for students with ALL Types

& Severities of Acquired Brain Injury

• 10% nonTBI

• 10% TBI moderate/severe

• 80% concussions

• 30 BrainSTEPS Brain Injury Consulting Teams cover the state of 

Pennsylvania

• 300+ Brain Injury Consultants 

• Educational professionals 

• Medical & Rehab professionals

• Family members

57
BrainSTEPS Premise

If brain injury related educational supports:

✔Are immediately frontloaded upon return to school,

✔ Include validated instructional practices,

✔ Are monitored (phased out, continued, or increased) over time.

Students with Brain Injury:

✔Will receive appropriate levels of support based on need/changing 

needs over time, 

✔Not experience academic failure,

✔Remain in school & graduate.

58
COVID-19, Online Learning, & ABI

Common student difficulties after 

brain injury during online learning 

(but not all!): 

• Visual scanning

• Searching/scanning for visual information 

• Visual attention

• Mentally focusing on what is on the screen 

• Visual memory

• Difficulty recognizing, encoding, recalling visual information 

• Cognitive fatigue

• A decrease in cognitive energy that occurs from focusing on 

sustained cognitive demands (e.g., schoolwork, learning), 

independent of sleepiness.

59
Online Learning Challenges

My daughter has a horrible time 

with online school. She has to simultaneously 

navigate the school’s course website, 

Dropbox, the online course schedule, & then Zoom for 

group projects. Throw in having to figure out how to 

open a word documents to type notes, download 

power point slide handouts, print them out, remember 

where all the microphone & video camera buttons are, 

quickly mute and unmute herself to speak, & make sure 

she is still participating enough in online chats 

for class participation grades in every class is just too 

much after a brain injury! 

- Parent

60
In-School In-Person Learning Environment

Teachers implemented academic supports

“Removing the physical presence of a teacher to 

guide & support learners can have an impact on 

how students learn, especially those with learning 

disabilities.”

Carnahan, C., & Fulton, L. (2013). Virtually forgotten: Special education students in cyber schools.

TechTrends, 57(4), 46-52.

61
Virtual Learning Environment

Parents/Family are now responsible for 

monitoring/cueing/reinforcing (if needed)

1. What are the supports schools typically provide to students after 

brain injury?

2. How can those supports be adjusted to fit online learning needs of 

students? 

3. How can parents learn about these supports?

62
Brain Injury & Virtual Learning 

(slide 1 of 2)

The physical activity & cognitive 

demands of attending in-person school 

can trigger symptoms (lights, sounds, 

movements). 

However: 

At home, students have more control 

over environmental symptom triggers. 

63
Brain Injury & Virtual Learning 

(slide 2 of 2)

Online learning may result in increased cognitive 

fatigue due to screen time.

– Quick brain breaks can be beneficial.

– Schedule breaks automatically into the day.

– Student can use a timer. 

– Discourage daytime napping. 

64
In Person vs. Online Learning: 

Flexibility

Flexible Scheduling at Home:

• Half day versus full day

• Rearranging courses to a time when student is more alert can 

be difficult if a class is only offered in-person 1 time per day

• Online provides much more flexibility for all coursework, 

repeating classes, credit recovery courses, etc.

65
Brain Injury & Virtual Learning 

(slide 1 of 5)

Online learning may decrease student mental health issues. 

Positives: For some students 

when home & online, more focused 

effort can go toward learning rather 

than exerting cognitive effort worrying 

about school bullies or other school-related 

anxieties. 

66
Brain Injury & Virtual Learning 

(slide 2 of 5)

• Ensure parents, school counselor, school psychologist are 

aware of red flag signs to look for regarding depression, 

anxiety, suicidal ideation...

• School staff can use screening tools virtually

• School staff can schedule private online sessions or phone 

calls to frequently check in with the student post-brain injury 

• Keep in regular communication with parents

67
Brain Injury & Virtual Learning 

(slide 3 of 5)

• Online learning may be difficult due to active brain injury 

signs & symptoms during synchronous real-time 

discussions & question/answer periods via chat feature 

due to (for example) the physical process of typing or 

slowed mental processing. 

• Asynchronous activities may be best during the initial 

days of recovery.

68
Brain Injury & Virtual Learning 

(slide 4 of 5)

• Teachers can provide questions prior to being asked so 

the student can prepare an answer & have it typed out or 

written out before virtual class begins.

• The student can use their computer microphone to speak 

the answer instead of typing, or the student can use 

text-to-speech software. 

• Teachers should provide checks for understanding & 

regular reinforcement of new concepts. Don’t rely on the 

student to tell you they don’t understand.

69
Brain Injury & Virtual Learning 

(slide 5 of 5)

• For new key learning content, teachers may be willing to 

pre-record a parent lesson or meet directly with the 

parent to pre-teach them the skill, so the parent who 

assists their child at home can be better prepared for that 

day’s online lesson. 

• Teachers may also be able to record their online class 

sessions so the student can review repeatedly, as needed.

70
Online Learning Supports 

After Brain Injury (slide 1 of 2)

Use Worked Examples

• Step by Step Cueing System

• Extremely beneficial to all students, regardless if they have 

experienced effects from a brain injury

 Scaffolding process

 Reduces cognitive load for working memory

 Efficient for students learning a new task or how to solve a problem

71
Online Learning Supports 

After Brain Injury (slide 2 of 2)

Virtual self-advocacy skills –

Encourage students to ask themselves the following questions 

each day when participating in online learning:

1. Do I understand what I just learned? If not...

+

2. How can I contact the teacher for help? 

Role play the question/answers with them.

72
Clean Desktop

73
Disorganized Desktop

74
Help the student organize 

his or her computer 

desktop screen. 

• Most students have never been taught how to organize 

documents on a computer.

– Where to save a file. How to create a folder. Where the folder 

should be located.

• An organized desktop & computer filing storage system is 

something that needs to be taught to all students

– How to use & organize folders, files, tags, etc. 

75
BrainSTEPS Online Learning 

Supports

1. 37-minute BrainSTEPS Brain Injury, Online Learning 

Supports for School Staff: 

youtube.com/watch?v=kVioDG2nW0E

2. BrainSTEPS Guidance Document with suggestions for online 

brain injury academic supports: tinyurl.com/covidmtbi

3. Accompanying video that supports the document: 

youtu.be/uNeLVNypQEo

76
Brainsteps.net

77

www.brainsteps.net
Pennsylvania

Pennsylvania

Brenda Eagan-Johnson, Ed.D., CBIST

BrainSTEPS Project Director

Phone: 724-944-6542

Email: eagan-johnson@biapa.org

78
HILLARY 

MCCLAIN 

& 

DECLAN
DECLAN’S 

STORY

80
WE CAME TO SWIM BEFORE EAR TUBE SURGERY
AUGUST 11, 2016

A DAY WE WILL NEVER FORGET
NEXT SEVERAL WEEKS AT 

CHILDREN’S HOSPITAL
REHAB AT CHILDREN’S HOME –

APPROX. 6 WEEKS
DECLAN

Then:

• Age 3 (8/11/2016)

• Craniectomy

• Cranioplasty

• Severe TBI
He is well aware of 

these scars

•We grow our hair out to cover 

these up

86
Declan’s School Experience Post-TBI
DECLAN’S 

RETURN TO SCHOOL 

POST-TBI

• Age 5

• Kindergarten

• Public School in Southwestern PA

• Issues for Declan at school

• Impulsiveness

• Teacher’s inability to teach him

• Seizures at school

• Frequent dizziness due to meds
• Frequent EEGs 

• Headaches

• Seizures

• Emotional

• Blurry vision

• Noise sensitivity

• Side effects of 

medicine

POST-TBI 

ONGOING 

ISSUES
LIMITED ACTIVITIES
FREQUENT 

OCCURRENCES

• Unpredictable

• Hospital stays

• Ambulance calls

• Occurs often at school

• Causes him to miss school

• Causes parent to miss work
DECLAN SLIDES

Another day of

not feeling well...

This is his life...
-FALLING AT SCHOOL FROM BEING DIZZY

-SEIZURES IN THE MIDDLE OF KARATE
TEAM

• Declan and I got connected to BrainSTEPS through 

a referral from the school

• BrainSTEPS helped:

• Organize all of our facts;

• Teach the teachers how to help Declan learn;

• Stay on top of the teachers;

• Advocate for services for him:

• Talk to text features

• Push for more services

• Stay on top of IEP

• Natalie and Brenda attend every school meeting;

• She has no problem telling the team they are wrong,

• Advocated for services that would be beneficial for 

him not hold him back (as the school was suggesting)
QUOTE FROM HILLARY

Declan would not have made it as far as he has without 

the guidance and expertise of Brenda and Natalie. There 

has been many times where I am so overwhelmed, 

I can’t hold myself together. I have been blessed to have 

a team that never gave up on him like everyone else has. 

I can’t thank my BrainSTEPS team enough.
FIRST DAY OF 2ND GRADE
WE DO HAVE SOME 

SPECIAL MOMENTS...
QUESTIONS
BREAK

Up Next: • Facilitated Discussion 

–

To Legislate or Not to 

Legislate

• Open Discussion / 

Questions and Answers

99
Future TBI Sessions

March 30, 2021, 1:00 – 4:00pm (ET) 

"Justice for All: Serving Individuals with Brain Injury 

Across the Justice System." Register for the session. 

April 6, 2021, 1:00 - 4:00pm (ET)

"Maximizing the Effectiveness of Advisory Boards Through 

Full Participation." Register for the session.

100
TO LEGISLATE OR NOT TO LEGISLATE?
Table 3 Change from baseline helmet use in studies 

evaluating the effectiveness of legislation on helmet use in 

cyclists

Karkhaneh, M., Kalenga, J. C., Hagel, B. E., & Rowe, B. H. (2006). Effectiveness of bicycle helmet legislation to increase helmet use: a systematic review. Injury 

prevention : journal of the International Society for Child and Adolescent Injury Prevention, 12(2), 76–82. https://doi.org/10.1136/ip.2005.010942
“ Helmet 

Legislation Legislation increased helmet use 

among cyclists, particularly younger 

age groups and those with low 

pre‐intervention helmet wearing 

proportions. These results support 

legislative interventions in populations 

without helmet legislation.1

1. Karkhaneh, M., Kalenga, J. C., Hagel, B. E., & Rowe, B. H. (2006). 

Effectiveness of bicycle helmet legislation to increase helmet use: a systematic 

review. Injury prevention : journal of the International Society for Child and 

Adolescent Injury Prevention, 12(2), 76–82. 

https://doi.org/10.1136/ip.2005.010942 103
Implementation of Max’s Law in 

Oregon High Schools

104
Max’s Law Mandates

105
Percentage of Sample High Schools that 

Require and Implement Max’s Law Protocols

106
Why do we need legislation?

Max’s Law’s return to play mandates 

have been nearly universally 

implemented in Oregon high schools.

Without a return to school mandate, 

only 21% of schools surveyed had an 

active concussion management team.

Oregon Health Authority. (2019). Implementation of Max’s Law in Oregon High Schools: Results from a Survey of High School Athletic Directors.

107
Oregon HB 4140 (2020)

• Broad support from variety of stakeholders

• Effective date January 1, 2021

• Requires the Oregon Department of 

Education to develop a form for public 

education programs to use when students 

have been diagnosed with concussion or 

other brain injury

• This form facilitates schools in providing 

immediate, appropriate accommodations for 

students with brain injury

108
Return to Learn: 

To Legislate or Not to Legislate?

Pennsylvania’s Experience

Dr. Brenda Eagan-Johnson

BrainSTEPS Project Director

eagan-johnson@biapa.org

724.944.6542

www.brainsteps.net

109
Published in

Network for 

Public Health Law, 

2015

(slide 1 of 2)

110
Published in Network For Public Health 

Law, 2015

(slide 2 of 2)

111
Return to Learn 

Concussion Management Team (RTL CMT)

• Ancillary BrainSTEPS Model to build school internal capacity 

to manage concussions for initial 4-6 weeks

*Trained over 3,000 RTL CMTs since 2013

112
Return to Learn Process of 

Support for Concussion

113
BrainSTEPS: RTL CMT Training

• 5.5 hour, asynchronous, online, interactive 7-module course

• 3 resource tools are provided to CMTs to implement the protocol:

1. State Department of Education endorsed

BrainSTEPS: Return to Learn Concussion 

Protocol

2. Protocol Implementation Checklist

3. Concussion RTL Monitoring Toolkit

114
RTL CMT Training Site

115
Published in Pediatrics, 2016 

(slide 1 of 2)

Halstead ME, McAvoy K, Eagan-Brown B. (2016) Expanding concussion laws not 

necessary for return to learning after concussion. Pediatrics, 138(6):e20163194

116
Published in Pediatrics, 2016 

(slide 2 of 2)

Why?

• Educational support frameworks currently exist to aid students with 

medical disabilities who rise to the level of more intensive intervention.

Instead: 

• Educate general education teachers about concussions, specifically 

on how to make short-term academic adjustments in the general 

education classroom to impact the majority of students with 

concussions that resolve within several weeks.

• Although it is true that legislation comes with an increase in public 

awareness, for RTL it may be more appropriate to use time and 

funding to enhance existing educational resources. 

117
Published in Journal of School Health, 2020 

1st National Concussion Return to Learn Consensus (slide 1 of 4) 

118
Published in Journal of School Health, 2020 

1st National Concussion Return to Learn Consensus (slide 2 of 4) 

The PROS of enacting Return to Learn legislation include:

1. Increased awareness of concussion & resulting learning impacts 

among among educators

2. Potentially improved and more consistent communication among 

school, family, and health care providers who serve on the 

concussion management team

3. Higher school accountability for RTL academic supports at school

119
Published in Journal of School Health, 2020 

1st National Concussion Return to Learn Consensus (slide 3 of 4) 

The drawbacks of enacting RTL legislation:

1. May be interpreted to apply only to sports-related concussions if 

Return to Learn language is written into current or existing Return to 

Play legislation;

2. Does not provide the ability to direct specific Return to Learn 

guidelines toward school districts which exert local control;

3. Does not account for the varying needs and resources of districts;

120
Published in Journal of School Health, 2020 

1st National Concussion Return to Learn Consensus (slide 4 of 4) 

The DRAWBACKS of enacting RTL legislation:

4. May not be necessary in light of already existing federal educational 

laws requiring districts to support all students regardless of medical 

diagnosis (even temporary);

5. Does not include funding for school personnel training; and

6. Could increase the potential for litigation.

121
In Conclusion

 Schools are required by federal law to 

support struggling students.

 Although RTL legislation may help align all 

schools within a state into doing something to 

create a plan for RTL concussion management, 

the biggest missing piece continues to be 

(typically) a lack of funding for training to meet 

the requirements of the legislation.

 To change the culture and function of a school 

infrastructure, it requires more than just 

legislation. It requires a commitment to training.

122
OPEN DISCUSSION
Real-Time Evaluation Questions 

• Please take a moment to respond to these seven evaluation 

questions to help us deliver high-quality TBI TARC webinars

• If you have suggestions on how we might improve TBI TARC 

webinars, or if you have ideas or requests for future webinar topics, 

please send us a note at TBITARC@hsri.org

124
Future TBI Sessions

March 30, 2021, 1:00 – 4:00pm (ET) 

"Justice for All: Serving Individuals with Brain Injury 

Across the Justice System." Register for the session. 

April 6, 2021, 1:00 - 4:00pm (ET)

"Maximizing the Effectiveness of Advisory Boards Through 

Full Participation." Register for the session.

125
The Traumatic Brain Injury Technical Assistance and Resources Center (TBI TARC) is an 

initiative from the Administration for Community Living that helps TBI State Partnership 

Program grantees promote access to integrated, coordinated services and supports for 

people who have sustained a TBI, their families, and their caregivers. The Center also 

provides a variety of resources to non-grantee states, people affected by brain injury, 

policymakers, and providers.

Thank You.

126
MEET THE PRESENTERS
Julie Myers, MPH

Public Health Program Administer

Pennsylvania Department of Health

julimyers@pa.gov

Julie Myers, MPH is the Program Administrator for the Bureau of Family Health's Traumatic Brain 

Injury programs. She is involved in several grant projects involving education and training for TBI, 

school reentry, and neuroresource facilitation. She serves on the Board Logistics and Support Team 

for Pennsylvania's Traumatic Brain Injury Advisory Board. She is a graduate of Penn State College of 

Medicine with a master of public health in Health Systems Organization and Policy. 

128
Karen McAvoy, PsyD

Clinical and School Psychologist

REAP and Get Schooled on Concussions

karen@getschooledonconcussions.com 

Karen McAvoy, PsyD, is dually credentialed as a clinical and school psychologist. Her career has 

spanned positions in Pediatric Psychology (with the Children’s Hospital Colorado and Rocky 

Mountain Hospital for Children) to positions in School Mental Health (with Cherry Creek School 

District and the Colorado Department of Education). Dr. McAvoy is the author of REAP 

(Remove/Reduce* Educate*Adjust/Accommodate and Pace) – a community-based interdisciplinary team approach to concussion management. She is also the co-founder and owner of 

GetSchooledOnConcussions.com, a website and training curriculum empowering educators to 

direct Return to Learn efforts for students with concussion at school. Currently, Dr. McAvoy 

continues to serve as a consultant to the Colorado Department of Education where she provides 

trainings to educators on the impact of neurologically-based disorders on learning and behavior. 

She also directs the Concussion and Neurological Health Center with Berkana Rehabilitation 

Institute in Ft Collins, Colorado. 129
Dr. Brenda Eagan-Johnson

Program Director

BrainSTEPS

eagan-johnson@biapa.org 

Dr. Brenda Eagan-Johnson, Ed.D., CBIST, has over two decades of experience in the field of pediatric brain injury, education, and 

neuro-developmental issues in children. Dr. Eagan-Johnson is instrumental in the creation, ongoing development, and daily oversight 

of the nationally recognized Pennsylvania statewide child and adolescent brain injury school consulting program, BrainSTEPS – Brain 

Injury School Re-Entry Consulting Program. She also serves as a consultant for a Centers for Disease Control and Prevention–funded 

study related to BrainSTEPS outcomes. Through her work, Dr. Eagan-Johnson regularly trains medical, rehabilitation, and school staff 

on the identification, symptoms, and educational treatment methods to improve cognitive, executive function, behavioral, social, and 

communication skills, as well as transition strategies, for students who sustain acquired brain injuries. 

Dr. Eagan-Johnson received her master’s degree in transition special education specializing in pediatric traumatic brain injury from 

George Washington University, where she has served as an adjunct instructor since 2015. She holds a doctor of education degree in 

Mind, Brain, and Teaching (educational neuroscience) from Johns Hopkins University. Dr. Eagan-Johnson has three teaching 

certifications and serves on three national advisory boards. Additionally, she has held a Certified Brain Injury Specialist certification 

since 2008. Dr. Eagan-Johnson is published in pediatric brain injury, regularly presents at the national and international levels, and has 

received multiple awards for her work. She was the co-lead for the first Concussion Return to Learn Consensus for the National 

Collaborative on Children’s Brain Injury, which is endorsed by 12 national organizations. Spearheading development and creation of 

Pennsylvania’s Return to Learn Concussion Management Team Model, now endorsed by two State Departments of Education, Dr. 

Eagan-Johnson has trained over 2,800 school-based concussion teams since 2013. Her brother sustained a severe TBI when they were

teenagers, which is where her passion in the field began. 130
Hillary McClain Teears

Clinical Instructor

University of Pittsburgh School of Dental Medicine

lhim28@pitt.edu 

Hillary McClain Teears is a clinical instructor in the Department of 

Periodontics and Preventive Dentistry at the University of Pittsburgh School of 

Dental Medicine. Ms. McClain Teears is a mother to 4 young boys, 2 biological 

and 2 stepsons, all of whom live with her and her husband full time. Her 

biological 8-year-old son is a survivor of a severe traumatic brain injury. She 

discusses her experiences with her son's school following his TBI and the 

valuable support she received from the BrainSTEPS Program.

131
David Kracke, JD

Brain Injury Advocate/Coordinator

Center on Brain Injury Research and Training

dkracke@cbirt.org 

Dave Kracke, JD, is the Oregon Brain Injury Advocate/Coordinator. David has been a member of the 

Oregon State Bar for 28 years. He has an extensive background working with private and public 

stakeholder groups in the realm of legislative and policy initiatives. He is a recognized legislative 

and policy expert in TBI. David served as a lead author and legislative advocate for the stakeholderinformed efforts to pass concussion-response education laws, including Oregon Revised Statute 

(ORS) 336.485, (“Max’s Law”), one of the nation’s first enacted laws establishing concussion 

protocols for concussed high school athletes and ORS 417.875, (“Jenna’s Law), a companion law to 

Max’s Law which provided statewide concussion protocols for all youth athletes in the state of 

Oregon regardless of league affiliation. In 2020, David and Melissa McCart from CBIRT led the 

successful effort to require immediate temporary academic accommodations for concussed 

students returning to school. 

David’s position at CBIRT is the first step toward establishing a permanent Brain Injury AdvocateCoordinator Director for the state of Oregon. 132