Qualitative Evaluation of High School Implementation Strategies for Youth Sports Concussion Laws

Abstract

Context: All 50 states and the District of Columbia have enacted laws governing concussion management and education. These concussion laws, featuring common tenets regarding removal from play, return to play, and concussion education, have shaped school and district policies. Objective: To evaluate the strategies commonly used to implement concussion laws at the school and district levels, as reported by certified athletic trainers (ATs). Design: Qualitative study. Setting: High schools. Patients or Other Participants: We interviewed 64 ATs from high schools (1 per school) participating in High School Reporting Information Online. Data Collection and Analysis: Interviews were conducted with participants between April and October 2015 regarding implementation of the 3 core tenets of concussion laws. Research team members independently evaluated the interview transcripts and field notes to identify common themes in implementation strategies. Results: Of the 64 schools represented, 90.6% were public schools, 89.1% sponsored more than 15 sports, and all schools employed at least 1 AT and had a written concussion policy. Four commonly used strategies to implement removal from play were reliance on coaches, immediate response, referral and guidance after injury, and notification of key individuals. Use of assessment or baseline tests, communication among parties involved, reliance on AT assessments, and return-to-learn policies were 4 frequent strategies to implement return to play. Finally, 3 major implementation strategies to effectuate concussion education were use of existing educational tools, timing of education, and concussion training for school professionals. Conclusions: Although concussion laws were passed at different times and varied in content across states, common themes in implementation strategies emerged across jurisdictions. The identification of strategic approaches to implementation will help ensure proper concussion management and education, reducing negative health outcomes among youths with concussions.

A comparison of US and Scotland youth soccer coaches’ legal consciousness regarding concussion safety regulations

“…identified improved implementation may include defining roles of key individuals, promoting education, creating awareness, and facilitating effective communication. 21 Further efforts should stress disseminating these common implementation strategies and practices to a broader range of clubs and schools in both the U.S. and Scotland. 21 Legislation without effective implementation strategies may not be the answer, particularly in Scotland.…”

“…Effective implementation of concussion laws requires multiple stakeholders using various existing resources. 21 Studies involving nationwide samples suggest that concussion laws are having an impact, but more research is needed to fully understand the true effects of their implementation. 17 Researchers should evaluate which statutory provisions have the desired impact focusing not only on the letter of the law, but on how individual jurisdictions operationalize the law.…”

“…Critics of the U.S. concussion laws recognize uncertainty regarding the law’s implementation and evaluation. 18,21 Without litigation as a vehicle for accountability, and given the vast majority of statutes do not mandate concussion reporting, anecdotal evidence that the laws are promoting more effective concussion management policies is challenging to validate. 17 Despite such uncertainty, following the enactment of this legislation, studies demonstrated an increase in key stakeholders’ awareness and knowledge regarding SRC, the rate of reporting, and in concussion-related healthcare utilization among children.…”

A Mixed Methods Approach to Identifying Administration Issues Pertinent in Interscholastic Sports

“…Post-concussion protocols include an individualized treatment plan involving return to play, serial patient monitoring, neuropsychological testing featuring the Sport Concussion Assessment Tool, and follow-up visits (Granitto & Norton, 2018). Davies et al (2018) conducted a qualitative study with 64 athletic trainers to evaluate concussion protocols. Results indicated that assessment or baseline tests, communication among involved parties, reliance on athletic trainer assessments, and return-to-learn policies are the four tenets of successful protocols (Davies et al, 2018).…”

“…Davies et al (2018) conducted a qualitative study with 64 athletic trainers to evaluate concussion protocols. Results indicated that assessment or baseline tests, communication among involved parties, reliance on athletic trainer assessments, and return-to-learn policies are the four tenets of successful protocols (Davies et al, 2018). Athletic trainers responded that baseline tests involved Immediate Post-Concussion Assessment and Cognitive Testing (imPACT), immediate communication with parents is especially important, and that returnto-play requires a 48-hour symptom-free period (Davies et al, 2018).…”