Changing Behaviors On Concussion Treatment Through “Chalk Talk”

The "4 Steps To Public Behavior Change"  by Jim Grunig, Harold Mendelsohn, Brenda Darvin,  Max McCombs and other behavior change specialists laid out a path of action that has been used with great success by such efforts as Mothers Against Drunk Driving (MADD), smoking cessation programs and others.  Now it has been applied to the problem of concussions and learning. 

The Brain Injury Association of NH (BIANH), in cooperation with the Geisel School of Medicine at Dartmouth College and the Bureau of Developmental Services (BDS), has developed a pilot program called “Chalk Talk” for returning students with concussions to the classroom with the same care taken that they would use to return them to the playing field.

For the past 3 years, BIANH representatives have worked with Concussion Management Teams at 9 high schools and two middle schools to establish a protocol that involves baseline testing before a concussion occurs, and careful monitoring to ease them back into their academic schedule to allow the brain time to recover.

“Instead of sending the student home for 2 weeks, where the temptation to watch TV and use electronics is high, the student recovers under the careful guidance of a team of school professionals.  This may include time out of the classroom in a specially designed location to address issues of fatigue or sensitivities to light or sound,” says Lynne Fleming, Program Coordinator. “It’s a team approach, and the school nurse, athletic trainer, teachers, parents, guidance counselors and Dartmouth Hitchcock’s pediatric neuropsychologists are all evaluating the student’s progress.  They are monitored and given a reduced work load, so they are only sent back to a full schedule of classes when they are ready.”

In addition to comparing post-concussion data with baseline data, parents, teachers and nurses are asked to complete forms to evaluate the student’s progress on a daily basis.  “Having the expertise of a trained pediatric neuropsychologist is key,” says Steve Wade, Executive Director.  “We were fortunate to receive a 5-year ACL (Administrators for Community Living) grant, much of which is used to pay the pediatric neuropsychologists for consulting to the education team.”

In 2012, NH Governor John Lynch signed SB402, otherwise known as “return to play” legislation.  This bill gave schools clear guidelines on returning a student to the playing field after they had sustained a concussion.  Now the BIANH is considering legislation for RLT or “return to learn” to take the protocols developed in Chalk Talk one step further.  “There are 7 states out there with Return to Learn legislation,” says Executive Director Steve Wade, “and we are in the process of studying how it has been implemented elsewhere.  We plan to talk with opinion leaders on the topic of brain injury here in NH about the merits of similar legislation here.”

So the 4 steps to public behavior change,  was ideal for successfully asking for Return to Learn legislation.

The 4 Steps In Action:

Step 1 developed a coalition campaign to educate the public that a concussion is a brain injury and it is critical not to overtax the brain while it is in recovery mode.  This involves identifying opinion leaders on the topic, getting them to recognize the problem and how they could be affected, and giving them opportunities to address the problem (by serving on concussion team task forces, advocating the proper treatment of concussed students, advocating legislation etc.).

Step 2, enforcement, or establishing laws or guidelines that would mandate the behavior change –is where Return to Learn legislation would come in .

Step 3, engineering, or enacting a structural change to work around the situation is what  BIANH has done with the creation of the Chalk Talk program and system for evaluating progress.

Step 4,  social reinforcement –is where the behavior becomes a socially-acceptable norm, and social rewards and punishment take over the job of enforcing it.  Ideally, in the future, every school will have a protocol for returning a student to the classroom after a concussion.   Just as we have learned we need to protect the developing brain from re-injury on the playing field, we now know we need to reduce cognitive demands in the classroom in order to give the brain time to heal.