Tackling Concussions

Sydney Arsenault, Briana Bice, Olivia Frieden,

Caleigh McDaniel, Petra Morgan

12.12.2017

Prepared for the Winningham Foundation

HPEB 300 Section 002

 Program Rationale

Why is Preventing Concussions Important?

Based on a study conducted in 2016, in the past three years alone, 47 kids have died
playing football. Seventeen of those deaths were directly related to head injuries sustained during
practice or games (Gibbs, 2016). This isn’t just a problem on the national level, but these injuries
have also greatly impacted South Carolina. ​The South Carolina Department of Health and
Environmental Control (SCDHEC) states that the yearly impact of traumatic brain injuries
occurring in South Carolina result in, “1,117 deaths, 2,800 hospital discharges, and 11, 500
emergency department visits” (Department of Health and Environmental Control, 2017).
Most of the research and regulations regarding concussions in football has occurred at the
professional and college levels, where the spotlight is the brightest. However, there is a crucial
need for shifting the spotlight to our next generation where concussions are seen to leave serious
impacts. Concussions can have long-term, detrimental effects to one’s health, particularly in
adolescents. While most concussions that occur in youth athletes are “considered mild, they can
result in more serious impacts on a young developing brain and can result in functional
impairment with thinking, memory, emotional, or behavioral changes” (Adler, 2011, p. 722).
Upon seeing these eye-opening statistics, Tackling Concussions, recognized that something
needs to be done for our younger generation.
Upon further research, we learned that middle school football players, ages 10-13 were
greatly suffering. Youth sports often have ​“limited medical coverage, which often places
increased responsibility on coaches for addressing any medical issues that may arise. Therefore,
it is important that individuals involved in youth sports, coaches in particular, are aware of the
signs and symptoms of concussions and know how to respond if a concussion is suspected”
(Covassin, Elbin, & Sarmiento, 2012, p. 234).
From statistics such as these, Tackling Concussions realized that these alarming statistics
could be reduced if the coaches were better educated on how to recognize the signs and
symptoms of a concussion. Therefore, our program created a one day program that will improve
the education of concussions to coaches in order to ensure the health and safety of 10-13 year old
football players in Richland County.
 What Can Be Gained From Implementing This Program?

● Increase the number of reported concussions

● Provide examples and a better understanding of the proper/safe equipment
● Help coaches to recognize the signs and symptoms of concussions
● Change attitude towards concussions to help coaches recognize the severity
● Less injuries and visits to the Emergency Room

How Will We Sell Our Program?

In order to sell our program, we plan to advertise to coaches what they will gain from our one
day workshop. It is important that they recognize the importance of this topic and by sharing
statistics with them, it is our hope that they will be inspired to take action in helping us to make a
change. We will also provide incentives for our workshop including an equipment giveaway, a
gift card raffle, and Tackling Concussions gear. In addition, we will share the credentials of our
widely acclaimed speakers so the guests can see that we are bringing in some of the top
professionals in the field.

Needs Assessment:
Health Problem:
The public health issue that we are addressing is the prevention of concussions in youth
sports. According to the Centers for Disease Control (CDC, 2017b), a concussion is “​a type of
traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the
body that causes the head and brain to move rapidly back and forth. This sudden movement can
cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and
sometimes stretching and damaging brain c​ells” (CDC, 2017b).​ ​ Concussions can have
long-term, detrimental effects to one’s health, especially in adolescents.
We are focusing on adolescents not only because concussion prevention should begin at a
young age, but also because of the large scope of concussions among young athletes. In fact,
“most sports-related and recreation-related concussions seen in emergency departments each
year (65%) occur among youth aged 5 to 18 years,” (Adler, 2011, p. 722). There is potential for
lasting side effects with traumatic brain injuries (TBIs) like concussions. These effects include
memory loss, difficulty communicating, and an increased risk for developing diseases like
Alzheimer’s and Parkinson’s (CDC, 2017b). The more concussions a person has, the more
at-risk they are for these side effects. This is worrying because researchers have found that an
athlete with a previous concussion is more likely to sustain a second concussion and more severe
repercussions in the same season as the initial injury (Collins, 2002).
Recently popular media, have shed light on the consequences of concussions on
professional athletes, and the lifelong effects they have on an athlete’s overall wellbeing. It is
important that safety precautions are established during an athlete’s youth so that they do not
sustain serious, long-lasting side-effects from a concussion.
Populations Affected:
The issue of concussions is important to athletes and parents everywhere. It is important
because it is incredibly prevalent among young athletes, especially football players, soccer
players, and boxers. It has been reported that, “An estimated 300,000 sport-related traumatic
brain injuries, predominantly concussions, occur annually in the United States” (Gessel, 2007,
para.1). Prevacus, a company that specializes in concussion treatment research, reports that
people who play high school football are more likely to sustain a concussion than in any other
sport (Prevacus, 2017). Unfortunately, a lot of concussions go undiagnosed because of the lack
of trained professionals, like athletic trainers, available to detect them (Prevacus, 2017). It can be
assumed that a lot of athletes have sustained initial concussions and continued to play without
recovery time, increasing the likelihood that they will receive another concussion. In short, the
issue of concussions should be important to athletes because of the potential life-changing effects
that they can cause and the likelihood of repetitive injury.

Target Population Demographics:

We are focusing our target group by age specifically and gender not by race or ethnicity.
We find that it would be best for us to focus our prevention plan on children from the ages of
10-13 because of a study that showed how emergency room visits have doubled for kids ages
10-13 in the past decade (Stats on Concussions, 2013). Therefore, we are proposing an injury
prevention plan that will target younger (middle school aged) male children playing football. We
further chose to use the Richland county area and middle schools in this county to provide
training for their coaches in a way to affect them.

Risk Factors for Population:

a. Behaviors/factors related to behaviors:
● Students underreporting concussions in fear of looking weak, losing their position in the
game, or disappointing teammates/coaches (Sarmiento, Donnell, & Hoffman, 2017).
● Failure to recognize that the resolution of symptoms does not establish that it is safe to
return to play. Returning too soon further increases the risk (Bachynski & Goldberg,
2014).
● Children and some adolescents are unable to understand and consent to the particular
risks that come with playing contact sports ​(Bachynski & Goldberg, 2014).
● Parents, coaches, and players are not being educated on the symptoms of a concussion
(Bachynski & Goldberg, 2014).
● Players having improper attitude toward concussions and not understanding the severity
(Sarmiento, Donnell, & Hoffman, 2017).
● Other sports participation increases risk of concussion (Emery & Meeuwisse, 2006).
● Helmet, fit, age and type (Greenhill et al., 2016).
*Parent’s attitude toward concussions and preventative/screening measures. At young ages
such as 10-13 years old, parent’s heavily influence their children’s thinking and perceptions. If a
parent fails to recognize the severity of concussions, it is likely that their child will have a similar
mentality.
b. Environmental risk factor
● Insufficient protective equipment. While helmets are effective in preventing other types
of head injuries, such as skull fractures or intracranial hemorrhage, they are not designed
to prevent TBI ​(Bachynski & Goldberg, 2014).
*Economic status might impact your ability to invest in proper protective equipment, and
access to medical resources.
c. Predisposing risk factors that cannot be changed
● Ages 10-13 are at the highest risk because children have weaker necks and developing
brains ​(Bachynski & Goldberg, 2014).
● Size disparities that are common between children of the same age ​(Bachynski &
Goldberg, 2014).
● Previous TBI (Emery & Meeuwisse, 2006).

>>>>>(PUT IN A FOOTNOTE EXPLAINING *)

* These were ideas formulated by the planning group and founding members of Tackling
Concussions

Target Population Input:

Our Steering/ Planning Committee will include:

● Representative from the Winningham Foundation
● Representative from the National Alliance for Youth Sports (NAYS)
● Representative from Brain Injury Research Institute (BIRI)
● Football coaches
● Parents of 10-13 year olds who play football
● Professional athletes(influencers) who have had concussions -- maybe still deal with
symptoms
● Trauma doctor or Neurologist
● Athletic trainer
Since children 10-13 are still considered to be minors and are so heavily influenced by the adult
role models in their lives, we plan to include parents of families in our target area and coaches
from schools in the area. We have chosen not to include children of this age group in our
planning committee due to the fact that our program is to work on their safety and that is largely
controlled by the behaviors that their guardians teach and instruct.

Mission Statement, goals, objectives:

Mission Statement-
To help ensure the health and safety of 10-13 year old football players in Richland County, our
agency, Tackling Concussions, will improve the education of concussions to coaches, and
athletes involved in youth sports.
Goals-
Provide education in effort to…
● Increase reporting of concussions
● Expand knowledge of symptoms
● Provide an understanding of proper equipment
● Change attitudes toward concussions to increase understanding of the severity
● Increase awareness of available resources regarding concussions
● Improve coach and player to player accountability
Objectives-
Process-
● By November 1, 2017, Tackling Concussions will have met with all members of our
planning committee in order to discuss our mission statement and collaborate.
● By November 8th, 2017, Tackling Concussions will meet with football coaches who are
members of the planning committee in order to assess their prior knowledge of
concussions in effort to better prioritize our goals.
Learning-
● Program participants will be able to identify symptoms of concussions 85% of the time
when given a scenario of an injured player, so they will be able to recognize them in real
life situations by the end of the program.
● When the program is complete 10% or less of the participants will view reporting
concussions in a negative way, but as a means of protecting the players health for the
future.
Impact-
● Fourteen days after the completion of our “Tackling Concussions” program, 100% of
program participants who show any sign or possibility of concussions will not return to
play for the rest of the game and until they are cleared by a medical professional for at
least ten to fifteen weeks (avg. football season).
● By 2027, the amount of undetected concussions in male football players aged 10-13 in
Richland County will decrease by 75%.

Implementation/Intervention
THEORY BEHIND TACKLING CONCUSSIONS:

Tackling Concussions chose to use the Theory of Planned Behavior to frame the
interventions we will implement. Our group chose this theory because of its combination of
perceived control of a behavior, like detecting concussions, subjective norms (which address the
stigma surrounding mTBIs in sports), and attitudes towards a behavior, like doubting the
seriousness of repeated injury. Combining the first three facets of this theory leads to an intention
for behavioral change, which we hope will ultimately facilitate a behavior change. Researchers
have found that using the Theory of Planned Behavior in concussion education removes
demographics from the equation and focuses solely on the individual (a coach, for example) and
their behavioral control (the ability to detect and report a concussion) ; (Rigby, Vela, &
Housman, 2013). This theory holistically analyzes the problem of concussion detection and helps
to create a plan to adequately combat it.
Attitudes toward reporting concussions before our planned method for prevention are
typically negative and center around coaches, players, and parents of players believing in a lack
of severity regarding concussions. Changing these attitudes would require all parties, specifically
coaches, to be well-informed on symptoms and repercussions of concussions.
Current norms toward concussions include players not reporting their injuries properly to
their coaches or each other. An increase in coach education would presumably encourage them
to establish better networks for communication. These networks could support an environment
for accountability between players themselves and between players and coaches on injuries.
The current perceived behavioral control for coaches reporting concussions is high. Many
coaches believe that they have the skill set required to identify, report (if needed), and prevent
further concussions. In reality the number of repeated concussions and lack of reported
concussions, leading to repeat concussions, is too great. Our hope is to provide coaches with the
proper skill set and knowledge base to identify, report, and acknowledge the severity of repeat
concussions. This will presumably encourage them to become advocates for reporting
concussions at an increased rate.

THEORY OF PLANNED BEHAVIOR AS IT RELATES TO TACKLING

CONCUSSIONS
INTERVENTION STRATEGIES:

Objective Theory and Intervention Possible

Type construct Strategy Activities

1. Planned Health Education -Classes, seminars, and

Learning Behavior-Attitud Strategies workshops geared
towards informing
es toward the coaches
behavior -Panel discussions from
some members of our
steering committee
-Simulations so coaches
have the knowledge
to report concussions.

2. Planned Community -Classes, seminars, and

Learning Behavior-Percei Mobilization workshops geared
towards informing
ved Behavioral Strategies Health coaches
Control Education -Panel discussions from
Strategies some members of our
steering committee
-Simulations so coaches
have the knowledge
to report concussions.
-Encourage coaches to
create a coalition with
the purpose of
empowering the
community to take part
in decreasing the high
concussion rate.
-Prepare and train
coaches to become
advocates for reporting
concussions in hope of
also empowering
parents and players.

3. Planned Social Support -​ ​Create “buddies” within

Environmental Behavior- Networks the team to increase
player to player
Subjective Norm “Other” accountability.
Coaches can set up
this system.
 - Create a social
network of coaches
from separate teams
who are members of
our planning
committee. This will
allow coaches to
share experiences,
information and
resources that they
have found
successful. This can
be achieved through
sharing emails or
social media.

KICKOFF:

Our team will kick off our program by holding a one day event for football coaches from
Richland county to equip them with the tools needed to ​increase reporting of concussions in their
area. Our goal with this event is to interact with our secondary population (richland county
football coaches), for us to properly impact our primary population (children from the ages of
10-13). This training will include information sessions from health professionals in hope that it
will expand the coaches’ knowledge about symptoms, provided understanding of proper
equipment, change attitudes toward and gain proper understanding of their severity, increase
awareness of available resources, as well as improve coach and player accountability. During
this training the coaches will be able to participate in simulation training to examine their
accuracy of identifying concussions and be able to apply their knowledge gained from the
training. This program event with also include both a pre-assessment and a post-assessment for
the coaches to evaluate the immediate effectiveness of the program. This event serving as the
kickoff for our program will help​ Tackling Concussions to further evaluate the needs and be
able to better monitor the progress of our program. ​Tackling Concussions will use and
expand on curriculum from CDC’s “Heads Up” program, as well as use additional
information that we have researched as the foundation for our program.
MATERIALS:

EQUIPMENT SUPPLIES

● Certified Helmets ● Refreshments: Lunch

● Printer ● Office materials: Paper, pens, staplers,
● Laptop Computers staples, post-its
● Projector ● Itineraries and information sheets
● Podium ● Incentives: Amazon gift cards
● Microphones ● Refreshments: Water and tea
● Notepads/pens
Personnel
30,000

Educators Full-time Health Education Specialist and 5,000

Physician who specializes in concussions (only
speaking at our one day program)

Administrative Staff Part-time Administrative staff member x 1 25,000

Space
0

Program Sessions School gym In-kind from

Alcorn Middle
School

Seating Tables and chairs In-kind from

Alcorn Middle
School

Equipment
4,485

Printer HP printer/copier/scanner 750

Laptop Computers Dell laptops x 4 3,000

Projector Portable video projector for presentation 200

Certified Helmets 3 helmets that vary, but are all certified so 500
coaches can learn about proper equipment
Podium 3.5 foot tall podium for speakers In-kind from
Alcorn Middle
School

Microphones Wireless microphones for speakers and for guests 35

to ask questions x2

Supplies
166,533

Refreshments PDQ box lunches x25 200

Office materials Paper, pens, staplers, staples, post-its 500

Itinerary Printed itineraries for guests/speakers x25 30

Incentives Hats and T-shirts x25 500

Incentives 350 certified Ridell helmets to give away for each 165,000
team.

Refreshments Water/Tea provided throughout the program

50

Notepads/Pens Notepads and pens for guests to take notes x25

200

Drawstring bags Drawstring bags to hold itinerary, notepads, and 40

informational brochures from guest speakers

Nametags Nametags for guests, volunteers, and speakers x25 15

TOTAL
$201,018
Gantt Chart in word doc bc formatting
Program Resources:

Tackling Concussions will use and expand on curriculum from CDC’s “Heads Up” program, as
well as use additional information that we have researched.

We also plan to use the information sheets listing concussion facts and warning signs from the
“Heads Up” program to hand out to coaches.

We plan on paying for the program through sponsors including the Winningham foundation,
Dick’s Sporting Goods, Gatorade, Under Armor, Clif Bars and Riddell (Football equipment
company).

Personnel:
● Educators: Health Education Specialist and Physician who specializes in concussions
● Part-time Administrative staff member
● Volunteers to help with food, set up, take down
Space:
● Alcorn Middle School gym for program sessions - see Appendix C for memorandum of
agreement
● Tables and chairs
Equipment:
● Certified Helmets
● Printer
● Laptop Computers
● Projector
● Podium
● Microphones
● Chairs
● Tables
Supplies:
● Refreshments: Lunch
● Office materials: Paper, pens, staplers, staples, post-its
● Itineraries and information sheets
● Incentives
● Refreshments: Water and tea
● Notepads/pens
● Drawstring bags
 ● Nametags

Staff and Responsibilities:

Health Education Specialist: We will employ a Health Education Specialist and Physician who
specializes in Concussions to assist in writing the curriculum for Tackling Concussions and
presenting it the day of our educational event.

Part-time Administrative Staff Member: We will employ a part-time administrative staff member
to help plan the event and to be a liaison between the program planners and school officials and
coaches

Volunteers: Volunteers will be used to help set up and take down the event. They will also help
with distributing food and putting together informational packets and goodie bags.

Program Marketing

What kind of promotional tools will you use?

● Tackling Concussions will use ​digital communication​ and ​direct marketing​ as our
promotional tools. We will send personalized emails to coaches to invite them to our
education event and provide details about our program. We will continue to use email as
our primary form of digital communication to send updates and information about
Tackling concussions throughout the football season. At our educational even we will
invite coaches to join our Tackling concussions Facebook group to provide an online
forum for coaches to discuss concussions and ask any questions they may have. Members
from our program planning committee will also be in the group to provide answers as
well as additional information regarding the prevention of concussions.

Tackling Concussions will provide incentives to motivate Coaches to attend the event. We will
provide incentives such as:
● Certified helmets for entire team
● Dick’s Sporting Goods gift cards
● Free Promotional Items
○ T-shirts
○ Hats
○ “Heads Up” Posters for Coaches’ offices and in locker rooms
○ Drawstring goodie bags containing: Notepads, pens, Clif bars, Gatorade,
fact sheets from CDC’s “Heads Up” Program
Program Evaluation:

Tackling Concussions will employ an external evaluation service to monitor the

representation of priority stakeholders in the planning committee. The evaluators will also
determine if the information obtained in meetings with planning committee coaches and
members was implemented in the program.
Tackling Concussions’ goal is to increase the amount of detected concussions in athletes
by educating coaches and athletic trainers on concussion symptoms and signs. To assess the
completion of this goal, Tackling Concussions will offer examinations of the participants at the
end of the program that involve assessing their ability to detect concussion symptoms in real-life
scenarios. This examination will also contain a portion to review participant’s association of
concussion detection with protective health, as seen in Appendix B. This will evaluate the
effectiveness of the education and attitude toward concussion training part of the program.
Participants will also have the option to take a satisfaction survey created by Tackling
Concussions that will measure the relevance of the material and coach/athletic trainer program
satisfaction with likert scales and take suggestions for improvements, as seen in Appendix A.
To determine the effectiveness of the program in the long-term, Tackling Concussions
can annually compare quantitative data on detected concussions in the target, Richland County
middle schools, for 2017 through 2027. If, after five years, concussion detection is not
increasing, the planning committee will conduct focus groups in the target schools and modify
the identified problem of the program.

Evaluation Strategies

Objective Evaluation

Process Tackling Concussions will The program will employ an

accurately represent the
priority population and
involved stakeholders in the
program’s vision and
education portion.
external evaluation service to
monitor the representation of
the stakeholders and the
implementation of their
interests.

Impact Tackling Concussions’ goal is Tackling Concussions will

to increase the amount of
detected concussions in
athletes by educating coaches
and athletic trainers on
concussion symptoms and
signs.
offer examinations of the
participants at the end of the
program that involve
assessing their ability to
detect concussion symptoms.

Outcome By 2027, the amount of Tackling Concussions will

detected concussions in male annually compare quantitative
 football players aged 10-13 data on concussion rates in
will increase by 75%. the target, Richland County
middle school, for
2017-2027.

APPENDICES

APPENDIX A
Tackling Concussions Satisfaction Survey
Thank you for giving us this opportunity to serve our athletes and protect their health. Please help us
improve by taking a few minutes to tell us about your experience.

1. How comfortable do you feel recognizing the symptoms of a concussion?

Not Comfortable Very Comfortable

1 2 3 4 5

2. What part of the seminar did you find most helpful?

3. Would you recommend this training to other leaders in school athletic programs?

4. What would you suggest to the planning committee to improve this seminar?
APPENDIX B
Tackling Concussions Evaluation

1. Circle all conditions that are signs of a concussion.

2. If diagnosed with a concussion, how long should an athlete be removed from play?
3. Does one concussion increase the risk for subsequent concussions?
4. How are baseline tests related to diagnosing a concussion?
5. What position sustains the highest percentage of concussions in football?
6. What are the four stages of recovering from a concussion?
7. Can coaches/athletic trainers clear an athlete for return to regular athletic activity?
8. What diseases/syndromes is an athlete at risk for in late adulthood if he sustains multiple
concussions in adolescence?
9. What factors delay recovery in an athlete?
10. What should coaches/athletic directors require before allowing athletes to return to practice/game
play?
APPENDIX C
Memorandum of Agreement

This Memorandum of Agreement is made on February 16, 2017 by and between Tackling Concussions,
1400 Greene Street, Columbia, SC 29225, and Alcorn Middle School, 5125 Fairfield Road, Columbia, SC
29203, for the purpose of achieving the various aims and objectives relating to implementing Tackling
Concussions’ ​Education Program (the Program).

WHEREAS Tackling Concussions and Alcorn Middle School desire to enter an agreement in which
Tackling Concussions and Alcorn Middle School will work together to implement the Program.

AND WHEREAS Tackling Concussions and Alcorn Middle School are desirous to enter into a
Memorandum of Agreement between them, setting out the working arrangements that each of the partners
agree to implement the Program.

Purpose
The purpose of this Memorandum is to provide the framework for any future binding contract regarding
the Education Program between Tackling Concussions and Alcorn Middle School.
Obligations of the Partners
The Partners acknowledge that no contractual relationship is created between them by this Memorandum,
but agree to work together in the true spirit of partnership to ensure that there is united leadership of the
Program and to demonstrate commitment to the Program by rendering us of the following resources.

Cooperation
The activities and service for the Program shall include, but are not limited to:

A. Resources to be rendered by Tackling Concussions include:

Donate all electronic resources used in the Program to Alcorn Middle School including, but not
limited to, one projector, one printer, four Dell laptop computers, and two wireless microphones.

B. Resources to be rendered by Alcorn Middle School include:

Host Tackling Concussions’ ​Education Program​ in school gym and allow access to podium,
tables, and chairs.

Confidentiality
Subject to sub-clause (2) below, each party shall treat all information received or obtained as strictly
confidential.
(i) required by the law of any relevant jurisdiction
(ii) the information has come into the public domain through no fault of that party; or
(iii) the other party has given prior written approval to the disclosure, provided that any such
information disclosed shall be disclosed only after consultation with and notice to the other party.

Term
The term of this agreement will be 1 year unless terminated sooner in accordance with the terms of this
agreement. Renewal of the agreement will be officially considered at the conclusion of the agreement.

Termination
Either party may terminate its donation of resources under this agreement if the other party breaches any
of the articles previously mentioned, giving 30 days notice with a clear account of the reasons for
termination. With mutual and written consent from both parties, the agreement can be terminated at
shorter notice.

No modification of the terms of this agreement shall be valid unless it is in writing and signed by both
parties.

Signatures of Party Representatives

If the terms of this Memorandum of Agreement are acceptable, please sign and date this agreement letter.

*INSERT SIGNATURE LINE******************

Key contact for Tackling Concussions Date

*INSERT SIGNATURE LINE******************

Key Contact for Alcorn Middle School Date

References

**Sending them all to Amy again to review

***GO THROUGH AND REMOVE UNUSED ONES
****ALPHABETIZE

https://thinkprogress.org/youth-football-concussion-crisis-f2fc701ca204/