The Other 60 Percent

A teen’s death prompts schools to improve concussion management

It was a hot August afternoon and football practice was just getting underway at Cherokee Trail High School in Aurora. Amid the gruff calls of assistant coaches and the smack of colliding shoulder pads came Coach Monte Thelen’s matter-of-fact voice at the end of each play, “Stay up, stay up, stay up!”

Football players at Cherokee Trail High School take part in a “thud” practice as an assistant coach looks on.

It was a half-pads “thud” practice and he wanted players to stay on their feet.

“We’re trying to limit the number of times players hit the ground with each other,” said Thelen. “We didn’t do that 10 years ago. I’m not even certain we did that eight years ago.”

This kind of safeguard is just one of many measures that has been employed over the last several years to help prevent an invisible and potentially life-threatening injury: concussions. In the Cherry Creek school district, where Cherokee Trail is located, the issue resonates with particular intensity because it is where Jake Snakenberg, a Grandview High School freshman, was playing football in 2004 when he took a routine hit and died of “Second Impact Syndrome” the next day.

Along with increasing awareness about concussions in the NFL and at the collegiate level, the 14-year-old’s death helped change the way youth concussions are handled in Colorado, giving rise to the Jake Snakenberg Youth Concussion Act, which took effect Jan 1, 2012.

The death of an athlete may be the most frightening consequence of concussions, but memory problems, concentration problems and other temporary cognitive deficits are more common outcomes. So while coaches and other advocates of good concussion management certainly want to prevent lethal “second hits,” they also want to ensure that concussed students have an efficient recovery so they can function in the classroom.

“It’s not just about return to play. It’s not just about sports,” said Karen McAvoy, director of the four-year-old Center for Concussion at Rocky Mountain Hospital for Children “You cannot return to play until you have 100 percent returned to learn.”

While experts agree that “Jake’s Law” has improved concussion management practices, they say that the state’s school districts and even its doctors do not always approach concussion management in a uniform way.

In Colorado, there is no statewide database on the number of youth concussions, sports-related or otherwise. However, national studies suggest that high school athletes sustain an estimated 136,000-300,000 concussions per year and the numbers have steadily increased. A 2011 study in the American Journal of Sports Medicine found that concussion rates in high school athletics increased by 16 percent annually from the 1997-1998 school year to the 2007-2008 year. The same study found that the most concussions occurred in football, followed by girls soccer.

Concussion resources

Impact of Jake’s Law

Jake’s Law, which applies to students 11-18 in school, club or recreational sports, requires that students suspected of sustaining a concussion be removed immediately from practice or games. In addition, students must be cleared by a doctor or other health care provider before returning to play. Finally, the law requires coaches to take annual trainings on the signs of concussion.

McAvoy said the legislation also helped emphasize the medical side of the concussion equation. Prior to the legislation, families were under no legal obligation to get kids suspected of sustaining concussions during sports checked by a doctor, and some chose not to, she said. With its return-to-play medical clearance provision, the law changed that.

“Through all of this the thread that you see is the culture change,” said McAvoy, who was a school psychologist at Grandview High School when Snakenberg died.

McAvoy said districts like Cherry Creek, Jeffco and Dougco have been at the forefront when it comes to developing effective concussion management programs.

Dr. Danny Mistry, chair of the Concussion Task Force in Grand Junction, said that despite a dramatic increase in awareness because of Snakenberg’s death and his namesake law, youth concussion management practices vary widely around Colorado. Although there are exceptions, he said, the east side of the state is generally ahead of the west side.

“It varies because of resources and education,” said Mistry, who practices at Western Orthopedics and Sports Medicine in Grand Junction, and who is a primary care team physician for Colorado Mesa University and the Colorado Rockies, as well as a team physician for USA Swimming.

In communities where concussion management is lagging, it may be due to both health care providers and the school system.  For example, Mistry said, some doctors may not see many youth athletes and may not be aware of the latest protocol for concussion management. In addition, school districts often can’t afford widespread staff training on concussions.

Like others experts, Mistry and McAvoy emphasize that student concussions must be managed by a team including athletic staff, parents, health care providers and teachers, who can often provide critical feedback about how a concussed student is functioning in the classroom.

Mistry said he hopes the National Institutes of Health or state departments of education will eventually set aside money to educate schools on concussion management.

“We’re in the midst of an epidemic and we have to stem the tide,” he said.

Tools of the trade

Talk to high school coaches and athletic directors around the state and you’ll hear about a variety of tools in place for concussion prevention, identification and management. Often, they’ll note that changes were underway even before Jake’s Law took effect — they saw the direction the pendulum was swinging.

That swing may have started in 2009, when Washington passed the first in a flurry of state statutes on the issue, the Zackery Lystedt Youth Concussion Bill. Today, the District of Columbia and every state except Mississippi have some sort of youth concussion law.

In Colorado, concussion prevention and education efforts include switching to lower-contact drills, reducing the weekly number of full-contact drills, experimenting with protective equipment such as the “Guardian Caps” that fit over football helmets, giving coaches pocket-sized cards listing concussion symptoms and having players and their parents read and sign concussion information sheets.

The free REAP Project booklet from the Rocky Mountain Hospital for Children is used widely in Colorado. It has also been used in New York and Florida.

Many school districts also use a highly-regarded concussion management protocol written by McAvoy called REAP, which stands for Reduce, Educate, Accommodate, Pace. Contained in a colorful 11-page booklet available for free from Rocky Mountain Hospital for Children, the protocol emphasizes the team approach, the careful monitoring of physical, emotional and cognitive symptoms, and a graduated “return-to-play” that allows student athletes to ramp up physical activity over the course of several days.

As recommended in REAP, districts have increasingly addressed cognitive symptoms of concussions, such as mental fatigue and difficulty concentrating, by making accommodations in the classroom such as reduced note-taking or extra time on tests.

Mark Kanagy, assistant principal of Windsor High School and athletic director in Weld RE-4 School District, said this is true in his district. In some cases, the district has put in place a temporary 504 plan, which are normally used to accommodate students with disabilities, for a concussed student.

Some Colorado districts also use a computer-based test called ImPACT, which measure students’ neurocognitive function at a baseline level as sports seasons begin, and can be administered after a suspected concussion to help determine whether new deficits exist.

While experts caution that ImPACT tests aren’t foolproof, they say they can be one piece of the puzzle in determining whether students are affected by concussion. The test is used at about 100 Colorado middle and high schools, according to company officials.

Paul Cain, athletic director for Mesa County District 51, said his district pays about $1,000 a year to use ImPACT for students in football, soccer, lacrosse, basketball, baseball, softball, diving, and cheerleading, as well as for students in other sports whose parents have requested it.

Kanagy, assistant principal of Windsor High School and athletic director in Weld RE-4 School District, said ImPACT “makes things more quantifiable…It helps take some of the guesswork out of it.”

He said a student might feel fine and have no headaches or other symptoms after a concussion, but if the post-injury ImPACT test doesn’t align with the baseline test, it can indicate something is still wrong.

Still, not everyone thinks ImPACT is an ideal tool. They say that students packed in a computer lab taking the test may not earn reliable baseline scores because they are distracted or deliberately performing poorly. In addition, not all doctors know how to interpret the test.

McAvoy said most school districts never use ImPACT because of its cost. “And that’s okay,” he said. “ImPACT is not necessarily where I would put limited resources.”

Trickle down effect

As standards for concussion education and management among youth athletes have risen, advocates say non-sports concussions in youth are starting to get more notice as well. Those concussions may result from a car accident, a fall or a bicycle crash outside of school, which means school staff don’t always know about them right away, if at all.

The REAP Project booklet is dedicated to Jake Snakenberg, who died of “Second Impact Syndrome” in 2004.

“Our biggest issue is getting non-athletic concussions communicated to our schools,” said Cain. “As a community that’s the next thing we need to work on.”

It’s not unusual for non-athletic concussions to outnumber sports-related ones. During the 2011-12 school year, about 60 percent of 200 student concussions in District 51 were not sports related, said Mistry. At Cherokee Trail High School, there were 25 non-athletic concussions last year compared to 15 sports-related.

“Really it comes down to the responsibility of the parent, the responsibility of the child,” said Steve Carpenter, athletic director at Cherokee Trail.

While some families inform the school nurse about out-of-school head injuries and, in Cherry Creek district staff receive training on recognizing non-athletic concussions, Carpenter said, “Those are tricky ones.”

McAvoy said while Jake’s Law exclusively addresses sports concussions in 11-18 year olds, concussion guidelines she co-wrote for the Colorado Department of Education, also address concussions sustained outside of sports and in students under 11.

Still, since parents aren’t required to seek medical advice for non-athletic concussions, it can be hard for school staff to know how to proceed, she said.

“When does a school feel comfortable releasing them back to recess, physical education and those kinds of things?”

making moves

In New York, a new focus on housing could also spur more diversity in schools

PHOTO: Christina Veiga/Chalkbeat
In 2016, the Community Education Council in Manhattan's District 3 approved a controversial school rezoning aimed in part at integrating schools.

On a recent morning in Brooklyn, principals, parents, and education leaders from across the state gathered to drill into the root causes of school segregation and develop plans to spur more diversity. Joining the discussion was someone unexpected: a representative from the state’s Fair and Equitable Housing Office.

“We want to see within your districts, what your challenges are, what your ideas are,” said Nadya Salcedo, the office’s director. “You can’t talk about integration and segregation without talking about housing.”

It is often taken as a given that schools are segregated because neighborhoods are. Yet the twin challenges of integrating where children live and learn are rarely tackled in tandem. In New York, two recent moves have the potential to address both.

The first: State education leaders who are working with local districts to craft school integration plans are also inviting housing officials to the table early on — and plan to include them throughout the process.

The second: In New York City, housing officials have launched a tiny pilot program to help low-income renters move into neighborhoods that offer more opportunities, defined partly by school performance. The initiative isn’t meant to tackle school segregation directly, but if it grows, it could result in more diverse classrooms.

Both are small and unconnected, involving officials from different agencies. Details about both the state and city efforts are scant, for now. But taken together, they suggest a new energy toward tackling housing issues that are often a barrier to more integrated schools.

“There have been some ripples of hope out there,” said Fred Freiberg, executive director of the Fair Housing Justice Center. “But we still have a long ways to go.”

The meeting in Brooklyn brought together school district leaders who have been armed with a state grant to help improve schools by integrating them. Now, housing officials have been looped into that work to brainstorm how to collaborate.

The housing department “is working to help desegregate communities,” spokeswoman Charni Sochet wrote in an email. “This includes working with our federal, State and local partners.”

Similarly, the city began its housing pilot this summer but didn’t share details until this week, when the Wall Street Journal profiled the program. The 45 families in the program’s first phase are getting assistance searching for a new home — including rent vouchers that are worth more in wealthier neighborhoods, financial counseling to help them afford a move, and support navigating the intimidating New York City housing market.

“The mayor’s education and housing plans take dead aim at achievement and economic gaps decades in the making,” Jaclyn Rothenberg, a city spokeswoman, wrote in an email. “All students benefit from diverse classrooms. Neighborhoods benefit from a diverse community.”

The pilot is striking given what Mayor Bill de Blasio has said about housing in the city in the past. When asked how he plans to tackle school segregation, he has often argued that the city’s power is limited because schools reflect entrenched housing patterns and private choices by families about where to live. “We cannot change the basic reality of housing in New York City,” he said in 2017.

Families with rental vouchers often find it difficult to move out of segregated neighborhoods where schools tend to struggle under the weight of concentrated poverty. The city’s pilot could tackle those issues.

“At least now I’ll have a chance to apply to some of these apartments,” one participant, the mother of a 10- and 12-year-old, told the Wall Street Journal. “I’m moving to a better school district, and nothing else matters.”

In places such as Baltimore, similar “mobility” programs have included a sharp focus on helping families move to areas with better schools, and making sure that students adjust well to their new classrooms. On a wide scale, such efforts could create more diverse neighborhoods and learning environments, since income tracks closely with race and ethnicity — and schools with high test scores are often filled with white students and those from more affluent families.

It could also have profound effects on how children perform academically and later in life. Moving to a neighborhood with lower poverty rates can boost college attendance and future earnings, according to some of the most influential research on the topic.

Montgomery County, Maryland offers another example, where the housing commission randomly assigned families to public housing instead of letting them choose where to live. There, children in public housing who went to “advantaged” schools in less impoverished neighborhoods did better in math and reading than their peers who lived in public housing but attended the district’s least-advantaged schools, according to a report by the Century Foundation, a progressive think tank.

That result hews to a growing body of research that has found that students benefit from attending schools that are integrated by race and socioeconomic class.

How the city implements its pilot will matter if students and schools are to benefit most. Although some studies have found that housing programs can improve affected students’ academic performance, the effect can be modest and vary greatly depending on where families relocate and which schools their children attend.

New York City presents some additional challenges. With a vast system of school choice and programs that selectively sort students based on their past academic performance, students and neighborhoods aren’t as closely linked here as they are in other cities.

Recent research found New York City schools might be slightly less segregated if students actually stayed in their neighborhood schools. And simply living near a school does not guarantee access in cases where competitive entrance criteria are used to admit students — a process called screening that critics say contributes to segregation. School attendance boundaries can also separate students by race and class even when they live side by side, a dynamic exemplified by recent rezoning battles on the Upper West Side and in gentrifying Brooklyn neighborhoods.

In New York, the scale of the challenge is huge: The city has one of the most segregated school systems in the country, an ignominious superlative that also applies to neighborhoods. The politics of unraveling these issues can be explosive. Many advocates for both fair housing and more diverse schools caution that policies should work both ways, giving low-income families and people of color the chance to leave under-resourced schools and neighborhoods, while also boosting investments in classrooms and communities that have been historically neglected.

“It shouldn’t be an either-or,” said Freiberg, the Fair Housing Justice Center director. “You’re going to have to do both.”

Though conversations seem to just be getting started, integration advocates and housing experts are heartened by the small steps already taken.

“This is a dream come true for people in the housing world,” said Vicki Been, a former city housing official who is now faculty director at the New York University Furman Center. “We have always been looking for ways to get families into neighborhoods that have better schools, lower crimes, better job opportunities.”

Reema Amin contributed reporting. 

money matters

Haven’t heard of participatory budgeting? Voters approved it on Tuesday — and here’s how it can bring millions to New York City schools.

PHOTO: Christina Veiga/Chalkbeat
Sunset Park Prep Principal Jennifer Spalding, left, and Assistant Principal Lauren Scott, right, sit in the school auditorium, which was renovated with funds won through participatory budgeting.

When a city councilman told Laura Espinoza she could win thousands of dollars for her local schools through a process called participatory budgeting, the mother of four was skeptical it could be true.  

Then she thought about a recent experience volunteering in her daughter’s Sunset Park school, where she watched the deep disappointment of a boy who lost a class project on an outdated laptop that abruptly died.

Espinoza decided to put together a proposal, working with teachers and administrators, to fund technology upgrades for P.S. 24, as well as other schools in the district, including her son’s middle school at the time, Sunset Park Prep. She was amazed when her son’s assistant principal called to say their project had won a share of almost $700,000 to be divided among schools.

“I said, ‘Wow! That’s what we were able to do?’” Espinoza remembers.

More New York City parents could have similar experiences at their schools after voters on Tuesday passed a ballot referendum that calls for participatory budgeting to expand to every council district. It’s a concept many New Yorkers may never have heard of but allows everyday parents and even students to steer millions of dollars to their communities, including their schools.

As it stands now, council members choose to participate in the process, dedicating at least $1 million of their discretionary budgets for the public to spend. Residents gather ideas through a formal process, and the proposals are put to a vote. Children as young as 11, or those who are in at least the sixth grade, can cast ballots — as well as anyone else who lives in the district. Projects with the most votes get funded.

Participatory budgeting has been a lifeline for Sunset Park Prep, a school that serves mostly children from low-income families and is nestled on a few floors of a 100-year old building. Principal Jennifer Spalding estimates the process has pumped $1.8 million into her school over the past five years.

“There’s no single source of money I can think of that would replace that amount,” she said. “It’s allowed us to do projects I never thought would be possible.” 

Since her first foray into the process, Espinoza has dedicated countless hours to drum up ideas and voters to support projects for schools in her community. She’s not alone in council District 38, which is overseen by Councilman Carlos Menchaca. Spanning immigrant enclaves such as Sunset Park, Red Hook, and other Brooklyn neighborhoods, the district last year tallied the most votes for participatory budgeting projects.

Many of those voters are school parents like Espinoza, who have turned to the process to fill resource gaps in their children’s classrooms — raising the kind of money that would be the envy of PTAs in more well-off schools but also challenging stereotypes about how involved immigrant parents and those of more modest means are in their neighborhood schools. Across the city, surveys show that participatory budget voters are more likely to be among the very poor, Hispanic, or come from communities who can’t participate in regular elections.  

“For me participatory budgeting, as a Hispanic, as an immigrant, as someone who feels like she doesn’t have a voice in this country, changed my life,” Espinoza said. “Though we can’t vote, though we can’t give money that families and professionals in Park Slope can, we can give something too — and it’s not a small thing. They are things that change the lives of children.”

Principal Jennifer Spalding speaks fondly of the century-old building that houses Sunset Park Prep middle school, which features long windows and soaring ceilings. But with age comes plenty of capital needs — and not always the kind that are a top priority in a city where the average school building was constructed in 1948.

Rich red curtains hang in the auditorium, where the sound system will soon get a makeover. The gym sports a shiny wood floor and freshly painted walls. In science classrooms, there are brand new cabinets and the sinks now work. A metal cart houses dozens of sleek MacBook Air laptops in a multimedia room stuffed with new tables and a smart board. All were paid for through participatory budgeting.

The process is especially important for schools like Spalding’s, where the parent organization is focused more on building community than raising dollars. The school relies on $3 tickets to dances to help fund field trips, while other nearby schools throw fancy galas and pull in hundreds of thousands of dollars. (A new city council bill will track those disparities by requiring the education department to collect and report PTA fundraising.)

For Spalding, the value of these badly-needed infusions goes beyond dollars. Students get their first taste of civic engagement by participating in voting during a school day. They feel a sense of empowerment when their school benefits. And they see the tangible benefits of their votes — and that they’re worth investing in.

“It adds so much value to our students’ lives,” she said. It sends a message that, “this is a place worth being, and a place of value.”

Not everyone supported expanding the process — at least not in the way the city ballot measure calls for. It creates a commission that would oversee voter initiatives, including a wider roll-out of participatory budgeting. A majority of members will be appointed by the mayor, prompting some to call the initiative an unnecessary expansion of mayoral power. Others have cautioned that participatory budgeting may not be as inclusive as it appears.

After seeing its power in his own district, Menchaca lent his support to the ballot initiative.

Before Menchaca was a city councilman, he worked in the Brooklyn borough president’s office managing capital projects. Though he saw many positive improvements being made, he was confounded by how opaque the process was, and how removed projects often seemed from what people really wanted. Then he became a city councilman.

“Participatory budgeting was like this ‘aha’ moment —  this eureka moment where it shifts the balance of power,” Menchaca said.

He made the process the centerpiece of how he does city business. When Menchaca meets a new constituent, he starts the conversation with participatory budgeting: “Do you have an idea about how to make your community better? Great,” he says.

His open invitation was met by organized and motivated parents who saw deep needs in local schools, but sometimes lacked the ability to give from their own pockets. Through countless public meetings, with steady translation services to reach the many Chinese and Spanish speakers in the district, parents were quickly won over.

“This was the first time parents had an idea for a concept and could fund it themselves,” Menchaca said.

Last year, more people voted for participatory budgeting projects than they did in the district’s primary election. Menchaca dedicated $2.5 million to the process last year — and often ends up spending most of his discretionary budget on other ideas that just missed the cut.

But the process is also a reminder of the scale of need that parents see in their neighborhood schools. It’s a challenge the district will have to overcome if a new school integration plan is to succeed. Approved in September, the plan changes the way students are admitted to middle schools in District 15, which overlaps Menchaca’s district. Advocates say the diversity push will have to go beyond attempts to simply move students around, and also to tackle inequities that continue to exist within individual schools.

While many in his district see participatory budgeting as a game-changer for schools, it can only go so far to fill resource gaps. The process only divvies up money for capital projects like building repairs and park renovations. It can’t pay for programming like an arts class or after-school robotics club or fund salaries for extra helpers in the classroom.

Those are the kinds of holes that Espinoza says will need to be filled if the district is to meet its integration goals. The city is dedicating $500,000 to implement the plan, part of which will go towards new resources for schools. Advocates also called for an analysis of available programming.

“We’ve been alleviated a little with these projects,” Espinoza said. “But more is needed”