While the media frenzy focuses on the physical risks of concussion, there is also growing concern about the academic repercussions for students who sustain the injury. We do not currently have a uniform evidence-based approach for optimally returning a student back to learning activities after a concussion. We also do not understand how the diverse consequences of a concussion may affect academic self-efficacy and performance. The purpose of this study is to explore the effects a concussion may have on college students who are navigating the return to learn (RTL) process. This research aims to inform whether there are measureable deficits in academic self-efficacy using the previously validated and abridged survey measure, the Self-Efficacy of Learning Form (SELF-A). Time of injury during the academic semester is also considered, as we hypothesize greater healing should negate the concussion's effects on the measure of self-efficacy. In addition, the research explores students' experiences with RTL using a semi-structured interview approach. The results suggest that college students who suffer a concussion during an academic semester have lower measures of academic self-efficacy compared to a control group of their peers. In addition, results show that students are returning to learn while still suffering from the effects of their concussion. This study found no significant correlation between the healing time of a concussion and the scores on the SELF-A. The interviews served to underscore the diverse myriad physical and psychological challenges a student faces, as well as the precarious variance in RTL strategies. This study highlights the challenges that students face while they RTL following a concussion, and begs the investigation of whether better RTL practices can help mitigate the negative effects. It underscores the necessity for further research, evidence-based medical care, instructor accommodations, and institutional policies to support students' safe RTL and ability to perform at their maximal academic potential.

Concussion is an injury that disproportionately affects children and adolescents and has the potential to negatively impact school performance. Currently, a significant proportion of youth with concussion go unreported due to a lack of effective concussion surveillance procedures. Additionally, many individuals who have daily contact with youth (e.g., parents, teachers) lack training in how to assess or manage a concussion. Schools may be the ideal setting to address both of these problems as they have a high level of access to students and employ personnel (e.g., school psychologists, nurses, social workers, counselors) with experience in assessment and intervention. What is not known is how to best design a school-based concussion management (SBCM) procedure in order to facilitate concussion surveillance and management. Accordingly, the overall purpose of this study was to identify and describe factors (i.e., provider implementation characteristics, concussion referral communication) which may inform the design and implementation of SBCM programming. Examining the relationship between relevant SBCM outcomes and factors associated with strong school programming may help build the foundation for future SBCM procedures. Factors that influence program fidelity and outcomes are called school programming implementation characteristics and they reside at multiple levels (i.e., community, school, climate, program, provider) and are positively related to successful outcomes across varied programming. This exploratory study which utilized secondary analysis of existing data focused on the provider level with the primary aim of identifying and describing student services personnel (SSP; n = 144) implementation characteristics. Indicators of provider implementation characteristics consisted of their beliefs, training, and experiences in order to quantify how these characteristics predict perceptions of the impact of concussion on academics, perception of current informal procedures, and the number of students with concussions served. The independent variables primarily under investigation in this study (role, career experience, recent concussion experience, and training subscale) align with empirically supported personnel implementation characteristics. The second aim of this study was to explore pre-existing communication patterns between SSP utilizing the independent variable referral source. It is of note that the school district from which the data were collected had no formal SBCM programming; therefore, all SSP implementation characteristics examined were viewed as baseline characteristics. Results indicated that as all SSP groups (i.e., school psychologists, nurses, counselors, social workers) perceive a need for SBCM as indicated by dissatisfaction with current procedures and agreement that concussion can negatively impact student performance. Although all groups indicated that they did not believe current concussion procedures to be effective, school psychologists and nurses reported the highest levels of dissatisfaction Additionally, nurses were found to have the highest levels of training in concussion assessment and management, and received significantly more concussion referrals per year when compare to the other SSP. These findings suggest that nurses may be effective in delivering concussion related service and establishing effective concussion surveillance procedures. Although more research is needed, this study represents the first step in bridging the gap between experimental concussion research and the successful delivery of these innovations through SBCM programming in order to help students recover from a concussion.

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