Implementation of the 2010 Massachusetts Act Relative to Safety Regulations for School Athletic Programs: A Multiple-Case Study

Background/Purpose: Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. 50 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 implementation of the legislation within Massachusetts schools.

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 school-employed actors associated with the regulation’s implementation and archival records associated with participating schools were used for analysis.   Interview data was subjected to a conventional content analysis. An archival analysis of written documents was conducted and informed interview questions.

Results: 19 participants from 5 schools were interviewed. Interviewed school personnel includes 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Identified themes associated with how the regulation has been implemented within local school districts will be discussed.

Conclusions: While major components of the Massachusetts regulations were implemented with a high level of fidelity differences and similarities regarding local-level implementation decisions existed across cases. Conducting the study qualitatively helped to identify implementation decisions made within cases. However, the knowledge generated may not be generalizable to other school-districts or other states.  Findings speak to the variability often found when implementation is relegated to the local-level.