Protect the head

Falling soccer goal raises questions about how schools handle concussions

PHOTO: kizzzbeth

Eighth-grader Mia Leff was jogging around the soccer field during PE class at Denver’s Skinner Middle School when it happened. As she passed one of the soccer goals last March 13, a gust of wind blew it over.

It hit her on the shoulder, knocked her to the ground and came to rest on her head. It took at least four students to pull the metal frame off her, said her mother Suzanne Leff.

“It was a pretty strong blow,” Leff said. “She was clearly disoriented. She couldn’t remember where she was, what had happened.”

Suzanne Leff became more alarmed by something her daughter said during the car ride to  Children’s Hospital’s emergency clinic. Mia described having back pain “where my wings are.” The strange comment underscored the fact that Mia may have been walking and talking, but something wasn’t right.

It turned out Mia had a severe concussion, which led to a referral to a concussion clinic and weeks of recuperation. As is often the case with concussion sufferers, Mia appeared outwardly normal soon after the incident. Some of her teachers reported that she was a bit quieter than usual, but there was more to it.

She had headaches, blurry vision, light sensitivity, fatigue and trouble concentrating. While preparing for an annual Shakespeare performance in which she’d often played multiple parts with ease, memorizing lines proved so difficult that she barely managed a minor role.

As Mia got better—she’s now a healthy ninth-grader–her parents decided to dig deeper into the district’s concussion training requirements and its system for securing soccer goal posts. What they found was both encouraging and disheartening.

On the plus side was the district’s eventual decision to replace more than 150 mobile soccer goals, including the ones at Skinner, with new tip-resistant, anchoring models. The bad news was that the district’s concussion protocol—a system for handling such injuries and helping students return to school and sports–was absent from the district’s website and routine staff training.

“The protocol looks really great on paper,” said Suzanne Leff.

But when she asked whether school-level staff are advised about the protocol, the district’s Deputy General Counsel Michael J. Hickman replied in an e-mail, “It’s my understanding there is no district-wide implementation.”

That, Leff said, “explains why the school didn’t have a copy of it and there was no understanding of what needed to be done [when Mia returned to school.]”

Sports rules the roost

Experts say many educators lack awareness about “return-to-learn” practices because concussions have long been considered a low-incidence injury that mostly happened in sports. In other words, it’s been the domain of coaches and trainers, not teachers and principals.

Concussion resources

Karen McAvoy, director of the Center for Concussion at Rocky Mountain Hospital for Children, said the first priority for many school districts is to comply with the law, and most states’ concussion laws focus exclusively on the sports side of the equation—requiring things like annual coach training and doctor clearance before kids return to play. That’s the case in Colorado, which passed the Jake Snakenberg Youth Concussion Act in 2012.

“Nowhere in there does it say, ‘You will support them academically at school,’” said McAvoy, author of a highly regarded concussion management protocol called REAP.

The language also leaves out the many children and youth who sustain concussions outside of sports, in car accidents, bike or skateboard crashes or playground mishaps.

“I am not surprised that grade schools and middle schools are not necessarily up to speed,” said R. Dawn Comstock, associate professor of epidemiology at the Colorado School of Public Health.

That’s not where the focus or funding has been as the concussion field has evolved over the last five to eight years, she said. Plus, the question of how schools address concussions gets more complicated because not every family reports suspected concussions and common symptoms of concussion can mirror other conditions.

“This isn’t like a kid who shows up on crutches and in a cast,” said Comstock. “Concussions are a silent injury, particularly for the junior high school or high school age.”

Comstock, who runs the RIO surveillance system that tracks sports-related injuries at the high school level, said finding the sweet spot on concussion awareness can be tough for schools when they have so many other things, including a long list of student health issues, to address.

“One of the problems is providing training to every single educator….it’s expensive,” she said.

McAvoy said while concussion management practice very widely among schools, some districts are ahead of the curve. She cited Jeffco, Dougco, Cherry Creek, Boulder and Mesa County Valley 51,  as districts that have taken advantage of the free resources available, include her trainings, the REAP booklet, and downloadable concussion guidelines from the Colorado Department of Education.

In Denver Public Schools, academic personnel haven’t pursued concussion training or resources with the same vigor that the athletic staff has, she said.

“Their athletics and academics seem separate.”

Still, she’s hopeful that one outcome of Mia’s injury might be to galvanize district leaders around increased concussion awareness and training.

“I think it needs to have enough administrative support to be a districtwide kind of effort”

The slow journey back

When Mia returned to Skinner after her concussion, her parents were persistent about arranging a gradual re-entry to the academic rigors of school. At first, Suzanne Leff contacted the principal and each teacher individually, but eventually a school liaison coordinated communication between teachers and the Leffs.

For weeks, Mia received a number of accommodations. She was excused from TCAP testing as well as non-critical homework assignments. Because she couldn’t tolerate looking at screens, her teachers made print-outs or otherwise modified computer-based assignments.

She used the school elevator because her balance was off and ate lunch in the principal’s office or another quiet place to avoid the hubbub in the cafeteria. She was also allowed to leave classes early so she could navigate the hallways in relative calm. Friends were enlisted to carry her books.

Staff members at Skinner were receptive and accommodating, but Suzanne Leff, an attorney, began to wonder what would happen to other students in Mia’s situation if they didn’t have vigilant advocates.

“If we hadn’t known how to advocate for our daughter, she would have been in a classroom flailing for weeks….We pressed hard with her teachers and principal.”

Scrap metal

While falling soccer goals are hardly a common cause of concussions, they are not unheard of either. Such tip-overs have caused dozens of serious injuries or deaths across the nation over the last thirty-five years, usually because children or teens were climbing or hanging on them.

In Mia’s case, the factors were windy conditions and the fact that the goal had been moved into place for a game that afternoon. Usually, it was stored off to the side, chained to a fence.

The Leffs are pleased with the district’s decision to replace 166 soccer goals with newer models. The replacement effort began earlier this fall with the replacement of 46 goals at a cost of $100,000. An additional 120 goals will be replaced before the start of the spring sports season.

Trena Deane, executive director of facility managment for DPS, said not every soccer goal in the district is being replaced. Some were judged safe by an action team that formed soon after Mia’s injury and assessed all the district’s goals.

The Leffs learned about the goal replacement project in early October, the same weekend that the first set of old goals were cut up for recycling.

Suzanne Leff said Mia was thrilled with the news, saying, “Oh my gosh, I’m so glad they’re doing that…So no one else has to go through what I had to.”

How are you feeling?

With plan to focus on teen health, Adams 12 school district opens new clinic

PHOTO: Jasleen_kaur/Creative Commons

The Adams 12 school district, Colorado’s sixth-largest, will open its first school-based health clinic this fall at Thornton High School.

The new clinic will offer routine physicals, sick care and mental health counseling to the 1,675 students at Thornton High as well as another 1,000 students who take classes at the district’s career and technical education center on the same campus.

By providing a convenient source of health care, particularly for low-income students, advocates say school-based health centers help prevent and address health problems that can impede learning.

Statewide, the number of school-based health centers has grown over the last decade — from 40 in 2007 to 59 this fall.

Despite the overall upward trend, not all school-based health centers survive. For example, the clinic at Jefferson Junior-Senior High School, a high poverty school in the Jeffco district, closed its doors last spring.

A district official there said the nonprofit organization providing the health services, which were available to Jefferson students and other local residents, decided to depart because district security logistics made it difficult to keep the clinic open during evening and weekend hours.

In Adams 12, planning for the new clinic began in 2015. A district committee chose Thornton High to house the health center because of the high level of poverty in that area and because the campus, which also houses the Bollman Technical Education Center, serves the largest number of high school students in the district.

District spokesman Kevin Denke said the decision to focus on a teenage population stems from the fact that adolescents tend to see doctors less often than younger students and may be starting to engage in risky behaviors, such as sexual activity, alcohol use or drug use.

The neighboring Boulder Valley school district also has a school-based health clinic in the works, though it’s not expected to open until the fall of 2019. That clinic, the district’s first, will be located at the Arapahoe Campus, which houses Arapahoe Ridge High School and the district’s career and technical education center.

District officials said the clinic was originally slated to open earlier, but the launch was pushed back to align with a planned remodel of the career and technical education space.

In the meantime, the district will expand a dental care program that’s gradually ramped up at the Arapahoe Campus. Begun four years ago as a basic screening program that referred kids with cavities and other problems to area dentists, the program last year provided cleanings, fluoride treatments and sealants to 42 students at Arapahoe Ridge and two other district high schools.

This year, the program will offer the same services, plus treatment for minor cavities, to students from all district high schools. The goal is to serve 250 students by the end of the year.

Fighting hunger

No more cheese sandwiches: Denver restores hot lunches for students in debt

Students at Denver's Fairmont ECE-8 have a choice of fruits and vegetables for lunch. (Denver Post file photo)

Denver students will start the year off with lunch debts paid off and a new promise that falling behind on lunch payments will not mean a cold “alternative” meal.

The district announced the change this week.

“We will feed every kid, every day,” Superintendent Tom Boasberg wrote. “We know hungry kids aren’t the best learners.”

In some districts, including DPS, students who fall behind on lunch payments may be given alternative meals such as a cheese sandwich, or graham crackers and milk.

Boasberg said all kids will get regular hot-lunch options while payment issues are resolved and the district works on a long-term strategy.

In the last school year, Denver students had accumulated a balance of more than $13,000. The debt would be higher if some schools had not set aside money to help students.

According to the district, schools paid for more than 37,700 meals during the 2016-17 year.

The district said that donations raised by students through a nonprofit called KidsGiving365, and by Shift Workspaces, founded by Grant Barnhill, a parent of an incoming DPS student, will cover all the outstanding lunch debt of students in the district.

In DPS, all students receive free breakfast. Students who qualify for free lunch based on family income do not make payments and do not accrue debt.

For 2017-18, a family of four must earn less than $31,980 to qualify for free lunch, or less than $45,510 to qualify for a reduced price lunch.

The announcement from DPS reminds families that the application for free or discounted lunch can be submitted throughout the year, and that students are eligible regardless of immigration status.