Groundbreaking work on an evidence-based Return to Learn program

Dr. Monica Vavilala is an anesthesiologist and director of Harborview’s Injury Prevention and Research Center, based in Seattle. She and her team at Return to Learn Washington have created a pilot Return-to-Learn program, which, thanks to a grant from the CDC, they will implement and study at 24 public high schools across Washington State. Dr. Vavilala’s work with Return to Learn Washington, and more information about the pilot program can be found here. 

Throughout a brief phone interview, Dr. Vavilala graciously answered questions about the Return to Learn Washington program and its pilot study. 

Olivia Collis, a Concussion Alliance intern, interviewed Dr. Vavilala; the interview has been lightly edited for clarity and adapted for the Web by Srishti (Shelly) Seth.

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“Return to Learn,” Dr. Vavilala explained, “refers to the idea that students with a concussion should have attention paid to the pace and nature of how they return to academics.” Across the United States, the need for support and guidance when recovering from a concussion has already been partly acknowledged through Return to Play laws, which outline how to determine if athletes with a concussion can return to playing their sport. Washington was the first to implement such legislation, through the Zackery Lystedt Law.

“In Washington state,” Dr. Vavilala noted, “if you have active symptoms after having a concussion suffered through a sport or...a non-athletic-related injury, you cannot play in organized sports. That's state law.” But, she continued, “While all 50 U.S. states adopted Return to Play legislation, similar nationwide policy-level guidance does not exist to guide students to return to learn (RTL), and schools are held responsible for their own concussion management." As a result, “students don't have any way of knowing what they should be doing concerning the classroom and education.” The lack of legislation means that schools are responsible for determining the best course of action, and concussion accommodations vary widely from school to school. Dr. Vavilala said, “there are some students who are receiving no accommodations, some students who are receiving lots of accommodations, some students who are receiving accommodations late, some who are receiving them early, but never go back to the regular classroom.” Dr. Vavilala and her team at HIPRC were inspired to create Return to Learn Washington because of students’ unmet needs.

Concussion “can be associated with persistent symptoms such as headaches, sleepiness, drowsiness, exacerbation of anxiety, depression, feeling fatigued, and light sensitivity,” which can all interfere with academic performance. Dr. Vavilala says, “students with symptoms are not able to focus on learning the material that is taught to them in schools.” In 2015, Dr. Vavilala and numerous medical professionals surveyed return-to-learn practices and experiences, surveying staff and parents who collectively represented 144 public schools across Washington State. They identified several domains of unmet needs, and, with input from return-to-learn stakeholders, they expanded to include focus groups with key school staff, surveys of students with concussions & their parents, and engagement with the key stakeholders in Washington State concerning concussions and the school environment. Dr. Vavilala noted that “we learned from our constituents that students are struggling, parents are struggling, and we saw an opportunity to make a difference and make an impact.”

Dr. Vavilala and her team at the Harborview Injury Prevention and Research Center developed the Return to Learn Program, a student-centered care pathway, and plan to test its efficacy in 24 Washington state public high schools. The Return to Learn program is a means of educating the teachers, counselors, and professionals in schools to be equipped to best aid students in coming back to school and provide learning accommodations. Input from concussed students about how they are feeling in the school environment will help inform their Return to Learn experience and guide the accommodations that are implemented in their learning. 

Next, Dr. Vavilala answered questions regarding who can use the RTL protocol. She noted that “there are two efforts. The first is a randomized trial that we are currently conducting in Washington State public high schools that tests the Return to Learn program in their environments. The Return to Learn program is also available for use for schools that are not part of the program, but we are making that available at a cost.” Moreover, Dr. Vavilala and her team are very interested in potentially developing similar programs for middle or elementary schools, which do not currently exist.

Dr. Vavilala reflected, “we have a long history of researching the area of traumatic brain injury here at the center (Harborview), and so this was a good opportunity for us to make a difference.” When asked about her hopes for the future of the Return to Learn program, she said, “I hope that the Return to Learn program will be adopted across the state, and we will eventually work towards a Return to Learn law.”

For more information about Harborview Medical Center’s Injury Prevention and Research Center, visit http://depts.washington.edu/hiprc/. 

For more information about the Return to Learn Washington program, visit http://depts.washington.edu/hiprc/rtl/.