Evaluation of the Implementation of the New York State (NYS) Concussion Management and Awareness Act

Rochester Institute of Technology RIT Scholar Works Theses 5-2018 Evaluation of the Implementation of the New York State (NYS) Concussion Management and Awareness Act Elise Wilcocks ekw7318@rit.edu Follow this and additional works at: https://scholarworks.rit.edu/theses Recommended Citation Wilcocks, Elise, "Evaluation of the Implementation of the New York State (NYS) Concussion Management and Awareness Act" (2018) Thesis Rochester Institute of Technology Accessed from This Thesis is brought to you for free and open access by RIT Scholar Works It has been accepted for inclusion in Theses by an authorized administrator of RIT Scholar Works For more information, please contact ritscholarworks@rit.edu Evaluation of the Implementation of the New York State (NYS) Concussion Management and Awareness Act By Elise Wilcocks A Thesis Submitted in partial fulfillment of the requirements for the degree of Master of Science in Science, Technology, and Public Policy Department of Public Policy College of Liberal Arts Rochester Institute of Technology Rochester, NY May 2018 Evaluation of the Implementation of the New York State (NYS) Concussion Management and Awareness Act By: ELISE WILCOCKS Masters of Science, Science, Technology and Public Policy Thesis Submitted in Partial Fulfillment of the Graduation Requirements for the College of Liberal Arts/Public Policy Program at ROCHESTER INSTITUTE OF TECHNOLOGY Rochester, New York May 2018 Submitted by: Elise Wilcocks Signature Date Dr Sandra Rothenberg/Department Chair, Thesis Advisor Public Policy/Rochester Institute of Technology Signature Date Dr Qing Miao/Professor, Thesis Committee Public Policy/Rochester Institute of Technology Signature Date Dr David Borkholder/Professor, Thesis Committee Microsystems Engineering/Rochester Institute of Technology Signature Date Dr Franz Foltz/Graduate Director Public Policy/Rochester Institute of Technology Signature Date Accepted by: Signature Page Abstract Since the 1990s, sports-related concussions have become a public health concern in the youth and adolescent athlete population After some professional athletes revealed that their retirement was connected to concussions, public awareness of concussions and identifying the need to protect these high school athletes emerged Between 2009 and 2013, all 50 states in the U.S passed a state concussion management policy modeled after the Lystedt Act In July 2012, the New York State (NYS) Concussion Management and Awareness Act went into effect for all students in public and charter schools, with most schools applying their policies to interscholastic sports This policy - a mixture of requirements and guidelines - is aimed toward raising awareness and providing students a consistent recovery process However, the guidelines NYS provides school districts leaves room for variation in implementation across districts This variation in implementation is called policy translation: the creation and modification of the NYS guidelines to fit each schools’ needs While some of the variation might help accommodate differences among schools, other variation may negatively impact policy effectiveness The focus of this thesis is understanding the degree and cause of variations in implementation across high school boundaries Additionally, implications for future policy developments will be discussed Acknowledgements I would like to thank my thesis committee members for helping me throughout this process A special thank you goes out to my faculty advisor, Dr Sandra Rothenberg She has helped and supported me from day one when I joined the program years ago Thank you, Sandy, it has been a great experience working with you and all your support has been much appreciated I would also like to thank the RIT Biomedical Engineering department for providing me this opportunity to conduct my own research in a topic I’ve been passionate about for years Lastly, a huge thank you goes out to Caitlin, Dakota, and especially, my mom and dad! Thank you to you all for listening to me at times when I needed you the most You all helped motivate me throughout this journey Table of Contents Signature Page Abstract .2 Acknowledgements Table of Contents .4 Figures & Tables List of Abbreviations Introduction 1.1 Background: A Public Health Concern 1.2 Sports-Related Concussion State Policies 11 Literature Review 15 2.1 Knowledge and Education 19 2.2 Location and Availability of Resources 20 2.3 Policy Structure 22 2.4 Communication and Coordination 23 2.5 Documentation 24 2.6 Research Question 25 2.6.1 Motivation for Thesis 27 Methods 28 3.1 Description of High Schools 29 3.2 Data Acquisition 30 3.3 Data Processing 32 Results 33 4.1 Background: NYS Concussion Management and Awareness Act 33 4.1.1 The Policy Audience 33 4.1.2 Elements of the Act 34 4.2 Written Policy 37 4.3 Written Policy Components 40 4.4 CMT Members 42 4.5 Implementation 44 4.5.1 Stage 1: Pre-season Activities 44 4.5.2 Stage 2: Before RTP 47 Stage 3: RTP and RTL 49 4.5.3 4.6 Summary 50 Analysis 54 5.1 Resources 54 5.2 Stakeholder Involvement, Knowledge, Education, and Attitude 57 5.2.1 Coaches 58 5.2.2 Parents 60 5.2.3 Students 61 5.2.4 Guidance Counselors and Teachers 62 5.2.5 Athletic Trainers and Other Team Leaders 64 5.3 Stakeholder Communication and Coordination 65 5.4 Framing of the Issue 67 5.5 Documentation 70 5.6 Type of School 71 Discussion 73 6.1 Implications 77 Policy Implications 77 6.1.1 6.1.1.1 Clarify and Broaden the Policy Goals 77 6.1.1.2 Make the NYS Act a Funded Mandate 78 6.1.1.3 Require a Written Policy 78 6.1.1.4 Expand the First NYS Requirement 79 6.1.1.5 Require RTP and RTL protocols 80 6.1.1.6 Clarify how to Accommodate Sports Team Mergers 80 6.1.1.7 Provide More Details on Administering Education to Stakeholders 80 Implications for Schools 81 6.1.2 6.1.2.1 Include Preventative Techniques in Education 81 6.1.2.2 Have a Sideline Evaluation Tool(s) 81 6.1.2.3 Educate Students in the Classroom 82 6.1.2.4 Use Active Learning Methods to Enforce Stakeholder Education 82 6.1.2.5 Create Detailed RTL Protocols 83 6.1.2.6 Be More Creative when Forming the School Policy 83 6.2 6.2.1 Limitations and Implications for Future Research 84 Limitations 84 Implications for Future Research 85 6.2.2 6.2.2.1 Who is Interviewed 85 6.2.2.2 The Sample Size of the Participants 87 6.2.2.3 Additional Studies of Focus 88 6.3 Conclusions 90 References 92 Appendix: Interview Details 100 Figures & Tables Table List of Abbreviations………………………………………………… …………… Table Summary of Papers Reviewed…………………………………….…………… …16 Table Factors Identified in the Studies………………………………………….…………18 Figure Policy Translation Model……………………………………………… …………26 Figure Comparative Case Matrix Framework…………………………… …… .…29 Table Summary of High Schools…………………………………………….… …… …30 Table Summary of Participants…………………………………………….……… … 31 Figure General Process Prior to the NYS Act…………………………………………… 34 Figure General Process After the NYS Act …………………………………………… 35 Table The Schools’ Documents…………………………………………… ………… …37 Table The Written Components in Each Schools’ Concussion Management Policy……40 Table The Schools’ Concussion Management Team (CMT) Members… ………… …42 Figure The Three Stages of the Concussion Management Process.……………… …….44 Table Coach Education During the Pre-Season………………………….…………… 45 Table 10 Differences in School Districts’ Pre-Season Meetings…………… …………… 45 Table 11 Additional Student Education Tactics……………………………… … ……… 46 Figure Stage Process.…………………………………….…………………………….….47 Table 12 How Stakeholder Involvement Helps or Hinders Implementation………….… 58 List of Abbreviations Table describes the various abbreviations and acronyms that are used throughout the thesis Table List of Abbreviations Abbreviation AD AT CDC CMT HIPPA IRB NCAA NCIPC NFL NHL NP NYS NYSCSH NYSPHSAA PCP PE RTL RTP SCAT SES SIS SN TBI WNY Meaning Athletic Director Athletic Trainer Centers for Disease Control Concussion Management Team Health Insurance Portability and Accountability Act “Privacy Rule” Institutional Review Board National Collegiate Athletic Association National Center for Injury Prevention and Control National Football League National Hockey League Nurse Practitioner New York State New York State Center for School Health New York State Public High School Athletic Association Primary Care Physician Physical Education Return to Learn Return to Play Sport Concussion Assessment Tool Socioeconomic Status Second-Impact Syndrome School Nurse Traumatic Brain Injury Western New York .. .Evaluation of the Implementation of the New York State (NYS) Concussion Management and Awareness Act By Elise Wilcocks A Thesis Submitted in partial fulfillment of the requirements for the. .. Implementation of the New York State (NYS) Concussion Management and Awareness Act By: ELISE WILCOCKS Masters of Science, Science, Technology and Public Policy Thesis Submitted in Partial Fulfillment of the. .. 2016) With the NFL, the CDC, and other stakeholders’ support of the Washington policy, the Lystedt law became the concussion management policy that all of the other states modeled their policies