Analysis of school traumatic brain injury policy content

Millions of children and teens are affected by sports- and recreation-related traumatic brain injuries (TBI) annually. To help reduce the effects of TBIs in youth sports, between 2009 and 2014, all 50 states and the District of Columbia enacted youth sports TBI laws. The laws generally include the following three main points:

  1. Education regarding TBI signs and symptoms, particularly for youth athletes, parents, and coaches;
  2. Removal from play following an actual or suspected TBI; and
  3. Written permission to return to play approved by a licensed health professional.

After these laws were put in place, several states had either a state agency and/or local school board create and distribute state TBI education requirements to schools. Many schools also worked to create, revise, and implement their own youth sports TBI policies. Prior studies examining the implementation of these laws at the state level have shown differences in the content and implementation of TBI laws across states, which could reduce the effectiveness of these laws. To date, no studies have examined the content and legal consistency of TBI policies at the school-level, which may directly affect how schools interpret, implement, and exercise their respective state’s TBI law.

To address this gap in the literature, this study analyzed the content of written high school TBI policies and examined the similarities and differences in these school-level policies in relation to the three main points of their respective state’s youth sports TBI law.

Main findings
Our findings showed that of the 71 high school TBI policies analyzed, nearly all (98.6%) required student-athletes to be seen by a licensed health professional before the athlete could return to play, most (83.1%) included removal from play requirements, and more than half (59.2%) required their school distributed written concussion information to student-athletes and their parents. We found that the language used in the high school TBI policies was quite different across the 71 schools with regard to policy enforcement (i.e. strictness of language), policy description (i.e. details of the policy requirements), and policy implementation specifications (i.e. specific steps for implementing the policy requirements).

Removal from play:
This study found that 83.1% (59) of policies included the removal from play piece. Of these, 89.8% (53/59) showed strong policy enforcement, using language such as “will,” “must,” or “shall” remove; but only 32.2% (19/59) percent clearly said who was responsible for removing the athlete from play.

Return to play:
All but one of the policies required athletes be cleared by a medical professional before return-to-play, but only 39.4% (28/71) of the policies specified that the medical professional had to be trained in the management of TBI.

Concussion education:
The biggest differences we found across school TBI policies were in the educational requirements specified by the policies. Only 33.8% of the school TBI policies required coaches to be trained in concussion recognition and management. Over half (59.2%) of the policies required TBI information sheets to be given to athletes and their parents, 49.3 and 39.4% of these required parents and student athletes to sign the information sheet, respectively.

This study is one of few studies to look at the implementation of youth sports TBI laws at the school-level.

Contribution to literature
This study provides insight into the translation of state-level youth sports TBI laws to school-level policies, and contributes to the scientific literature on the profile of TBI policies at the school-level. School TBI policies with stricter enforcement language and clear-cut implementation steps will help ensure the successful implementation of state TBI laws at the school-level.

Jingzhen Yang
Center for Injury Research and Policy
The Research Institute at Nationwide Children’s Hospital
Dept. of Pediatrics, College of Medicine, The Ohio State University
Dept. of Epidemiology, College of Public Health, The Ohio State University
700 Children’s Drive, RB3-WB5403, Columbus, Ohio 43205, USA


Consistency and Variation in School-Level Youth Sports Traumatic Brain Injury Policy Content.
Coxe K, Hamilton K, Harvey HH, Xiang J, Ramirez MR, Yang J
J Adolesc Health. 2018 Mar


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