The nation’s first “Return to Play” law was passed in 2009 in the state of Washington in response to a devastating brain injury suffered by a 13-year-old youth football player. While all 50 states now have such laws addressing when student athletes return to sports after a concussion, a study in the December 2016 Pediatrics found that few have “Return to Learn” laws addressing when students with concussions should return to school.
The study, “Variations in State Laws Governing School Reintegration Following Concussion” found return to learn laws are present in only eight states, and these varied in scope, specificity and delineation of responsibility.
Nearly half of the laws were restricted to student-athletes, excluding students who sustained concussions through non-sport-related mechanisms. Although all eight state laws required the establishment of a return to learn protocol, only four included any standards for the content of the protocol, and these standards were often vague, with no specified mechanism to assess efficacy or outcomes. Both Virginia and Massachusetts mandate school accommodations as deemed appropriate by the injured student’s health care provider, for example, which study authors called a poor standard given existing variability in concussion knowledge among primary care providers. Nebraska’s law states only that a return to learn protocol has to “recognize” the potential need for accommodations and monitoring by school staff, providing no further details about management of these processes.
Of all the state laws, according to the University of Washington researchers, only Illinois’ specified an evidence-based standard consistent with CDC guidelines for return to learn protocol development. None of the laws provided guidance on management of students with persistent post-concussive symptoms or the timing of accommodation removal. Researchers concluded that although concussion is clinically understood as a complex pathophysiological injury with emotional, behavioral, cognitive, and physical dimensions, this understanding has not translated to multifaceted state guidelines for the return of injured youth to school and educational activities.
In an accompanying, solicited commentary, “Expanding Concussion Laws Not Necessary for Return to Learning Following Concussion,” Mark E. Halstead, MD, FAAP, and colleagues said that although increased public awareness is an immediate benefit of new legislation, return to learn legislation may not be sufficient. They recommend guidance from state departments of education to develop and implement return to learn practices, offering authentic training opportunities for educators, and assistance in creating policies and procedures to pair with existing return-to-play policies.