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

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.