Implementing Return to Play:
Learning from the Experiences of Early Implementers
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In May 2009, the State of Washington passed the “Zackery Lystedt Law” to address concussion management in youth athletics. The Washington law was the first state law to require a “removal and clearance for Return to Play” among youth athletes. Between 2009 and 2012, 42 additional states and the District of Columbia passed similar laws.
In order to assess the implementation of Return to Play laws, the National Center for Injury Prevention and Control (NCIPC) conducted a case study evaluation on the Return to Play implementation efforts in two states: Washington and Massachusetts. These two states were selected because they were both early adopters of Return to Play and because their laws varied on several important dimensions, including the role of the health department and other stakeholder groups. The evaluation was designed to assess implementation efforts, including related challenges and successes in implementation.
Return to Play laws include a variety of different components that can be complicated to implement, such as removal from play, collection of concussion histories, required training for different stakeholders, etc. Additionally, Return to Play laws do not always provide specific guidance on how each of the components of the laws should be carried out. Some laws identify a specific entity, such as a state agency, to develop regulations and other laws are less specific. As a result, implementers are sometimes required to make decisions after the law has passed that can have an impact on successful implementation. Thoroughly considering the logistics of implementation and engaging in a robust planning process can help increase the consistency and quality of implementation.
Based on the experiences of the stakeholders interviewed in Massachusetts and Washington, there are a number of key considerations for the implementation of Return to Play. The guide presents considerations, as well as lessons learned from state stakeholders and potential barriers to implementation, in the following areas:
- Stakeholder Roles and Responsibilities
- Implementation Requirements
- Knowledge and Awareness
- Medical Clearance
- Supporting and Monitoring Implementation
- Planning Ahead to Evaluate the Impact of Return to Play
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