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Examining Implementation of the Massachusetts Act Relative to Safety Regulations for School Athletic Programs (Sessions Laws: Chapter 166 of the Acts of 2010): A Multiple-case Study

Background/Purpose: Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. Fifty states have adopted legislation addressing the problem of sports-related concussions among youth-athletes. In 2010, Massachusetts adopted legislation based on Washington State’s Lystedt Law, enacting state-wide requirements for high school athletic programs. This study explored how the legislation has been implemented within Massachusetts schools and school-districts and identified factors influential to local implementation. Methods: A qualitative multiple-case study approach was utilized. US Census data concerning the household median income and population size of the school-district’s representative town(s) were used to purposively recruit cases. Semi-structured interviews with a breadth of school-district actors in the Commonwealth of Massachusetts and archival records associated with participating schools were used for analysis. Interview data were analyzed using a conventional content analysis approach. Written documents were subjected to an archival analysis. Results: 19 participants from 5 schools were interviewed. Interviewed school personnel included 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Eight case-level themes related to how the regulation was implemented were identified, and 6 influential factors related to the regulation’s implementation emerged. All participating cases decided to utilize neurocognitive baseline testing programs to assist in diagnosing concussions. Cases also decided to place the decision making authority of removal-from-play and return-to-play situations in the hands of athletic trainers. Primary care physicians were expected to provide medical clearance for concussed student athletes. Funding and man-power emerged as a threat to schools’ ability to implement the regulation with high fidelity. Conclusions: At the local level, provisions of the Massachusetts regulation were implemented with high fidelity. However, differences and similarities regarding local-level implementation decisions existed across cases. Conducting the study qualitatively allowed the study to obtain rich detail and identify implementation decisions made within cases. However, the knowledge generated may not be generalizable to other school districts or other states. The study’s findings speak to the variability often found when implementation is relegated to the local-level.