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

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