Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T07:52:09.433Z Has data issue: false hasContentIssue false

The Massachusetts School Sports Concussions Law: A Qualitative Study of Local Implementation Experiences

Published online by Cambridge University Press:  01 January 2021

Abstract

Background:

Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. In 2010, Massachusetts passed legislation aimed at addressing the issue of concussions in school athletics. We sought to understand local-level implementation decisions of the Massachusetts concussion law.

Methods:

A qualitative multiple-case study approach was utilized. Semi-structured interviews with school-employed actors associated with the law's implementation were used for analysis. Interview data were subjected to a conventional content analysis.

Results:

A total of 19 participants from 5 schools were interviewed. Schools were purposefully selected from communities varying in socioeconomic status and population. Participants included 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Eight themes emerged regarding specific ways schools have implemented the law. Six themes emerged regarding factors influencing implementation.

Conclusions:

All cases employ neurocognitive testing as a means to assess concussions, place decision-making authority in athletic trainers' hands, and use a 30-minute online video to disseminate concussion education. Employing athletic trainers could pose challenges to school districts with limited financial capacity, as financial assistance from the state is not provided under the law. The validity of neurocognitive testing and the effectiveness of online concussion training need further study. Cooperation from student athletes, their parents, and physicians is necessary for full implementation of the law.

Type
Independent Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Langlois, J. A., Rutland-Brown, W., and Wald, M. M., “The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview,” Journal of Head Trauma Rehabilitation 21, no. 5 (2006): 375378.Google Scholar
Institute of Medicine, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture (Washington, D.C.: National Academies Press, 2013).Google Scholar
Covassin, T., Elbin, R. J., Harris, W., and Parker, T. et al., “The Role of Age and Sex in Symptoms, Neurocognitive Performance, and Postural Stability in Athletes after Concussion,” American Journal of Sports Medicine 20, no. 10 (2012): 110.Google Scholar
Schulz, M. R., Marshall, S. W., and Mueller, F. O. et al., “Incidence and Risk Factors for Concussion in High School Athletes, North Carolina, 1996-1999,” American Journal of Epidemiology 160, no. 10 (2004): 937944.Google Scholar
Gessel, L. M., Fields, S. K., and Collins, C. L. et al, “Concussions among United States High School and Collegiate Athletes,” Journal of Athletic Training 42, no. 4 (2007): 495503.Google Scholar
See Schulz et al., supra note 4.Google Scholar
Gibson, T. B., Herring, S. A., and Kutcher, J. S. et al., “Analyzing the Effects of State Legislation on Health Utilization for Children with Concussion,” JAMA Pediatrics 169, no. 2 (2015): 163168Google Scholar
Lowrey, K. M. and Morain, S. R., “State Experiences Implementing Youth Sports Concussion Laws: Challenges, Successes, and Lessons for Evaluating Impact,” Journal of Law, Medicine & Ethics 42, no. 3 (2014): 290296.Google Scholar
See Gibson et al., supra note 7.Google Scholar
See Lowrey et al., supra note 8.Google Scholar
Baugh, C. M. and Shapiro, Z. E., “Concussions and Youth Football: Using a Public Health Law Framework to Head off a Potential Public Health Crisis,” Journal of Law and the Biosciences 2, no. 2 (2015): 449458.Google Scholar
Sports Concussion Policies and Laws, Centers for Disease Control and Prevention, “Implementing Return to Play: Learning from the Experiences of Early Implementers,” available at <http://www.cdc.gov/concussion/policies/rtp_implementation.html> (last visited June 22, 2016).+(last+visited+June+22,+2016).>Google Scholar
Mass. Gen. Laws ch. 111, § 222 (2010)Google Scholar
See Lowrey and Morain, supra note 8.Google Scholar
Mello, M. M., “Making the Case for Laws That Improve Health: A Framework for Public Health Law Research,” Milbank Quarterly 88, no. 2 (2010): 169210.Google Scholar
See Baugh and Shapiro, supra note 12.Google Scholar
Coyne, T. I., “Sampling in Qualitative Research: Purposeful and Theortical Sampling; Merging or Clear Boundaries?” Journal of Advanced Nursing 26, no. 3 (1996): 623630.Google Scholar
“State and County Quickfacts: Massachusetts (2013, June 27),” available at <http://quickfacts.census.gov/qfd/states/25000.html> (last visited June 22, 2016).+(last+visited+June+22,+2016).>Google Scholar
Hsieh, F. H and Shannon, E. S., “Three Approaches to Qualitative Content Analysis,” Qualitative Health Research 15, no. 9 (2005): 12771288.Google Scholar
See Lowrey and Morain, supra note 8.Google Scholar
Pryor, R. R., Casa, D. J., and Vandermark, L. W. et al., “Athletic Training Services in Public Secondary Schools: A Benchmark Study,” Journal of Athletic Training 50, no 2. (2015): 156162.Google Scholar
Kerr, Z. Y., Lynall, R. C., and Mauntel, T. C. et al., “High School Football Injury Rates and Services by Athletic Trainer Employment Status,” Journal of Athletic Training 51, no. 1 (2016): 7073.Google Scholar
Alsalaheen, B., Stockdale, K., and Pechumer, D. et al, “Measurement Error in the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT): Systematic Review,” Journal of Head Trauma Rehabilitation (2015): Publish Ahead of Print June 17, 2016.CrossRefGoogle Scholar
Golding, D. et al., “Evaluating Risk Communication: Narrative vs. Technical Presentations of Information about Radon,” Risk Analysis 12, no. 1 (1992): 2735.Google Scholar
Mrazik, M., Dennison, C. R., and Brooks, B. L. et al., “A Qualitative Review of Sports Concussion Education: Prime Time for Evidence-Based Knowledge Translation,” British Journal of Sports Medicine 49, no. 24 (2015): 15481553.CrossRefGoogle Scholar
McDermott, K. A., “Incentives, Capacity, and Implementation: Evidence from Massachusetts Education Reform,” Journal of Public Administration Research and Theory 16, no. 1 (2004): 4565.Google Scholar
McCrea, M., Hammeke, T., and Olsen, G. et al., “Unreported Concussion in High School Football Players,” Clinical Journal of Sports Medicine 14, no. 1 (2004): 1317.Google Scholar
See McCrea et al., supra note 30a.Google Scholar
Chrisman, S. P, Quitiquit, C., and Rivara, F. P. et al., “Qualitative Study of Barriers to Concussive Symptom Reporting in High School Athletics,” Journal of Adolescent Health 52, no. 3 (2013): 330335.Google Scholar
Register-Mihalik, J. K., Guskiewicz, K. M., and Mcleod, T. C. Valovich et al., “Knowledge, Attitude, and Concussion-Reporting Behaviors among High School Athletes: A Preliminary Study,” Journal of Athletic Training 48, no. 5 (2013): 645653.Google Scholar
LaRoche, A. A., Nelson, L. D., and Connelly, P. K. et al., “Sport-Related Concussion Reporting and State Legislative Effects,” Clinical Journal of Sport Medicine 26, no. 1 (2016): 3339.Google Scholar
Shenouda, C., Hendrickson, P., and Davenport, K., “The Effects of Concussion Legislation One Year Later — What Have We Learned: A Descriptive Pilot Survey of Youth Soccer Player Associates,” PM & R 4, no. 6 (2012): 427-435 and S. P. Chris-man, M. A Schiff, and S. K. Chung et al., “Implementation of Concussion Legislation and Extent of Concussion Education for Athletes, Parents, and Coaches in Washington State,” American Journal of Sports Medicine 42, no. 5 (2014): 1190–1196.CrossRefGoogle Scholar
See Gibson et al., supra note 7.Google Scholar
See Mello, supra not 18.Google Scholar
See Kerr et al., supra 26.Google Scholar
See Golding et al., supra 28.Google Scholar