Contact and collision sports at all levels are characterized by what some call a “culture of resistance” by athletes to honest self-reporting of concussion symptoms, with as many as 60% of concussions, and nine in ten “bell-ringer” events (which could be concussions) going unreported.

Up to now nearly all concussion education has focused almost exclusively on teaching athletes, coaches, and parents about the signs and symptoms of concussion and the health risks of concussion and repetitive head trauma.

The problem is that such education hasn’t really worked.  Even though more and more athletes now recognize that continuing to play while concussed puts their health at risk, a majority continue to hide concussion symptoms in order to keep playing.

A new approach, a new game plan, is needed, one which accounts for the fact that, while some of the reasons athletes do not immediately report concussion symptoms do have to do with a  lack of knowledge about concussion symptoms, a belief by athletes that symptoms aren’t serious enough to report, or that they can continue to play without putting their health at additional risk, there are five additional reasons for hiding concussion symptoms:

1.  not wanting to disappoint coaches, teammates, parents, and fans by coming out of the game;
2.  pressure from coaches, teammates, parents, and fans to continue playing after a hard hit;
3.  a belief that coaches, teammates, parents, and fans expect them to play injured;
4.  a fear that reporting concussion symptoms will have negative consequences, such as loss of playing time or position as a starter, or having their toughness questioned; and/or
5. a belief that, even if they have a positive attitude toward concussion symptom reporting, that attitude is not shared by the coach, teammates, parents, and fans.

The Team Up For Concussion Safety program developed by SmartTeams™ under a Mind Matters grant from the National Collegiate Athletic Association and Department of Defense, is designed to increase reporting by athletes of concussion symptoms by engaging coaches, athletes, medical staff, and parents as a team in a season-long program which emphasizes that immediate reporting of concussion symptoms by athletes not only reduces the risk of further injury – or, in rare cases, even death – but is actually helps the athlete and their team perform better, just that game, but over the course of the season and of an athlete’s career.

In other words, we believe, based on recent research, that more athletes will report concussion symptoms, and encourage their teammates to report, if an environment, a sports culture, can be created in which athletes:

1. understand that they will not be disappointing coaches, teammates, parents, and fans if they come out of a game or practice when they are experiencing symptoms to be evaluated for concussion;
2. are not pressured by coaches, teammates, parents, and fans to continue playing after a hard hit;
3. do not believe that coaches, teammates, parents, and fans expect them to play injured;
4. do not worry that reporting concussion symptoms will have negative consequences, such as loss of playing time or position as a starter, or having their toughness questioned; and/or
5. share with the coach, teammates, parents, and fans a positive attitude toward concussion symptom reporting.

Here’s how parents can help.

Five Steps

The SmartTeams™ #TeamUp4ConcussionSafety program consists of five steps:

1. Testing Knowledge and Attitudes

The rate at which student-athletes immediately and honestly report experiencing concussion symptoms, both their own and their teammates, will only begin to increase if all stakeholders, including parents, first understand how much they know about concussions, and about their current attitudes towards and beliefs about symptom reporting.

To find out what you know as a parent about concussions, and, more importantly, whether you view concussion symptom reporting in a positive or negative light, parents will be asked to complete a series of short quizzes.

• Do You Know The Concussion Basics?
• Do You Know The Signs and Symptoms of Concussion?
• Parents: Does Your Child’s Concussion Safety Or Winning Come First?

2. Completing a Concussion Safety Course

While knowledge and awareness of concussion has increased substantially over the sixteen years that MomsTEAM/SmartTeams™ and others, particularly the CDC, have been engaged in concussion education, research shows that there are still important gaps that need to be filled.

To fill in those gaps, parents are asked in  Step Two in the #TeamUp4ConcussionSafety program to continue learning about concussions by:

• taking an online concussion education course;
• watching The Smartest Team documentary (streaming free on this website); and
• learning more about best concussion safety practices and the latest in head injury research by accessing our extensive library of concussion articles and videos.

3. Attending a Concussion Safety Meeting

Because studies show that one-off concussion education isn’t enough to change concussion symptom reporting behavior, Step Three in the SmartTeam™ #TeamUp4 ConcussionSafety™ game plan calls for coaches, athletes, athletic trainers, team doctors (and, at the youth and high school level, parents) to attend a mandatory concussion safety meeting before every sports season to learn about the importance of immediate concussion symptom reporting, not just in minimizing the risks concussions pose to an athlete’s short- and long-term health, but in increasing the chances for individual and team success.  

4. Taking A Concussion Safety Pledge

Anecdotal evidence from NCAA Division I football programs suggests that the signing by athletes of pledges acknowledging their responsibility to report concussion symptoms increases the rate of reporting by athletes, both of their own symptoms and those of teammates.  Because we believe that improving concussion safety requires a team effort, all those with a stake in concussion safety should sign pledges, not just athletes.  

Step Four of our new concussion safety game plan calls for athletes, coaches, parents, and medical staff to demonstrate in a tangible way their commitment to creating a culture in which immediate reporting of concussion symptoms by athletes is a valued team behavior and the sign of a good teammate by signing a concussion safety pledge at or shortly after the pre-season concussion safety meeting, 

5. Staying Involved/Sharing Successes

Because prevailing attitudes towards concussion symptom reporting and reporting behavior are deeply entrenched in our sports culture, coaches, athletes, athletic trainers, team doctors, and parents are encouraged to continue working over the course of the sports season to create and maintain an environment in which athletes feel comfortable in immediately reporting concussion symptoms (both their own and their teammates) by sharing and reinforcing positive messages about the importance of immediate concussion symptom reporting via social media (we encourage sharing success stories and positive messages @SmartTeams on Twitter  and on our #TeamUp4ConcussionSafety Facebook page), and by maintaining open lines of communication and an ongoing dialog about concussion safety among and between coaches, athletes, medical staff, and parents.

Four goals

The goals of the SmartTeams™ “Teaming Up For Concussion Safety” program are to teach coaches, players, and parents that:

1. athletes who do honestly and immediately self-report concussion symptoms, and encourage teammates to do the same are not letting their coach, teammates, parents, and fans down, but are helping the team’s chances of success, not just in a particular game but over the course of the season;
2. athletes who do honestly and immediately self-report concussion symptoms, and encourage teammates to do the same, are being good teammates
3. athletes who don’t honestly and immediately report concussion symptoms put their health and those of their teammates at risk; and
4. athletes who don’t honestly and immediately report concussion symptoms can hurt their own performance and their team’s.

With consistent messaging and constant reinforcement of the value of immediate concussion reporting in achieving individual and team performance goals, we believe that, not only will attitudes and beliefs about concussion reporting begin to change, but concussion reporting behavior will start to change as well, and that, over time, the culture of resistance to concussion symptom reporting will be replaced by a culture of concussion safety.