In the past decade, every state in the country has put laws on the books to try and reduce the risk of concussions caused by sports in high schools. Many schools then put their own concussion and concussion response policies on the books. But there are roadblocks in the final stretch—ensuring that those policies are followed, by coaches, parents, students, and athletic trainers.
In a new study, published in the Journal of Adolescent Health, a team of researchers interviewed 64 athletic trainers in high schools around the country about the barriers that stand in the way of successfully implementing these concussion programs. “Just passing the law does not implement it,” says study author Ginger Yang, associate professor of pediatrics at Nationwide Children’s Hospital and an epidemiologist at the Ohio State University College of Public Health.
State laws around concussions have three major goals: ensuring that students, coaches, and parents are provided with concussion education; verifying that any student with concussion symptoms is immediately removed from a game; and requiring that students with concussions see a health professional who can confirm they are healthy enough to start participating in sports again.
Carving out time for concussion education, the study found, was one significant barrier, as was the quality of the educational materials available. In addition, the information was typically only available in English. “These schools serve large populations where the families were not native English speakers,” Yang says.
Athletic trainers said that students often don’t report their symptoms, and that parents and coaches don’t like when kids are removed from play. “Just the old school thinking…‘Well back when I played we played through this’. I hear that a lot [from parents and coaches],” one trainer said in a study interview.
Access to healthcare is also important: Kids who don’t have insurance might not be able to see a doctor about a concussion, and get their clearance to return to play, Yang says. “The school doesn’t have control over that.”
Most of the identified barriers were consistent with those seen in other studies, says Stephanie Morain, assistant professor in the Center for Medical Ethics and Health Policy at the Baylor College of Medicine, who has also done work in this space. The fact that schools are facing some challenges is understandable, she says, given that concussion laws went into effect quickly. “In some sense, it’s not surprising to see a lag,” she says. “Some states were really learning as they went.” In some places, legislators didn’t speak with athletic trainers, schools, or other stakeholders before putting laws in place—causing some frustration and confusion.
Changing the culture around sports—and removing some of the tough-it-out attitude that can stop kids from reporting problems—also takes time. “It requires a big cultural shift and buy-in,” Morain says. “That’s always the challenge.” She says she would like to see major figures in sports like football lead by example, and talk about why it’s important to take concussions seriously. “If they said, your long term success in the game will be better if you sit this one out when you need to.”
Impressing the importance of these changes on parents and coaches is likely an important way to try and close these noted gaps, Yang says. Along with identifying solutions, the next steps will be to collect data to understand the difference in injury rates and outcomes between schools that are implementing these policies and those that are struggling to do so.
“These are important questions,” Morain says. “One of the really important things to understand is what happens in this transition between getting the law on the books and implementing the law on the street.”