How Well Are Schools Following the NCAA's Concussion Policy?

10-24-14 NCAA football
Arkansas Razorbacks running back Jonathan Williams (32) scores a touchdown in front of Alabama Crimson Tide defensive back Cyrus Jones (5) at Donald W. Reynolds Razorback Stadium in Fayetteville, AR, Oct 11, 2014. Nelson Chenault/USA TODAY Sports/Reuters

Member schools of the National Collegiate Athletic Association (NCAA) could do a better job of protecting their student athletes from concussions, according to a new report published online Tuesday by the Journal of Sports Medicine.

The study, headed by Christine Baugh, a doctoral candidate in Harvard's Program in Health Policy, surveyed schools to determine how well they were implementing the concussion management policy the NCAA established in 2010. It is the first report of its kind in the four years since the policy was first put in place.

"As scientific evidence supporting the seriousness of both the short- and long-term effects of concussion grows, so too does the need to ensure that athletes' brains are protected," the authors of the study write.

In April 2010, after holding a summit on the topic, the NCAA established its concussion management policy, which required every member school to create a concussion management plan to be put in place for the 2010-2011 academic year.

The NCAA outlined some basic tenets the schools' plans would have to follow.

These include a requirement that any student who shows "signs, symptoms or behaviors consistent with a concussion from practice or competition" be removed from activity and evaluated by a health care provider. If diagnosed with a concussion, the student cannot return to sports activity that day, and only team physicians or their designees can subsequently give medical clearance for "return to play".

Students must also go through an educational process each year to learn about the signs and symptoms of concussions and acknowledge their responsibility to report such signs and symptoms to the school's medical staff.

Baugh and her team sent out emails to coaches, sports medicine clinicians, and compliance administrators at all NCAA member institutions—a total of more than 30,000 individuals—asking them to complete a survey about the school's and their own demographic characteristics, the school's concussion management policy and implementation, and their views on how the school was dealing with concussions. The researchers promised individual and school-wide responses would be kept confidential. At least one person replied from 907 of the 1,066 schools.

Most of those surveyed (roughly 92 percent) indicated that their school had a concussion management plan in place when asked to answer yes, no, or unsure, though different respondents at the same school sometimes gave conflicting answers.

"For stakeholders to follow an institution's concussion management plan—or to have confidence that other stakeholders are following the plan—they must first know that it exists," the report says, emphasizing the need for improved communication among athletics staff, school administration, and any others involved.

The report found the educational component of the NCAA's guidelines to be most lacking. Based on the responses, only about 70 percent of schools had an "annual process for educating athletes about concussions". And even among those that did, the thoroughness varied greatly, with some only providing a one-page handout.

Despite the fact that less than three-quarters of schools provided information to their student athletes about recognizing concussion symptoms, roughly 91 percent of those who responded to the survey said the student athletes at their school were required to acknowledge their role in reporting such symptoms. The study's authors found this concerning, as schools put responsibility on students without providing them the proper education.

The research also revealed some confusion among respondents about who has the last word on return to play decisions, with a minority of those surveyed indicating a coach or athlete could make the final call on RTP.

The report puts part of the onus of improvement on schools that have failed to develop a plan or to implement their plan fully. But part of the responsibility, the authors write, also falls on the NCAA.

"As written, the NCAA Concussion Policy only requires the presence of a plan and not that the plan is actually implemented," the authors write. "Perhaps the most important next step is for the NCAA to revise the language of its concussion policy to reflect the necessity of plan implementation."

The NCAA released new concussion guidelines this year with what the authors of the study call "a voluntary set of best practices" which include making their concussion management plans publicly available. But these are only recommendations that schools can choose to follow or ignore, building on a policy that was never designed to be enforced.

"The legislation was specifically written to require institutions to have a plan and describe what minimum components had to be part of the plan," Chris Strobel, the NCAA's director of enforcement, wrote in an email in October 2010. The email is one of hundreds of documents released as part of a lawsuit former college athletes brought against the NCAA.

The 2010 policy was not, Strobel wrote, "about enforcing whether or not they were following their plan—except for those isolated circumstances of systemic or blatant violations."

But NCAA Chief Medical Officer Brian Hainline sings a different tune, according to a statement emailed to Newsweek:

In my work with our member schools, I have found the vast majority of them have implemented concussion plans and practices and are deeply committed to keeping student-athletes safe. As research continues to improve our understanding of concussion, the NCAA will continue work with our membership to improve concussion management. Specific to education efforts, we will launch a $4 million educational grand challenge – as part of the $30 million initiative we launched earlier this year with the Department of Defense – on Nov. 6 to improve concussion reporting and management. Both the lead co-authors of this paper are participating in the launch activities.