Concussion Management Policy Implementation in High Schools: Examining Policy Through a Disproportionality Lens

Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation represent systematic disparities consistent with the disproportionality literature.

A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.

Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low implementation scores had a greater percentage of students who identified as African American/Black and nurses with less experience.

Findings highlight current disparities in the implementation of concussion management policies and support adoption of a disproportionality lens in this sphere.