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.

From an early age, and throughout their athletic career, athletes are under pressure from parents, teammates, and coaches to play hurt, develop a belief that playing with concussion symptoms – at the risk to their own health – is not only acceptable, but expected; and are criticized, penalized, and ostracized if they do not abide by these team and cultural norms.

Up to now 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.

Unfortunately, for a variety of reasons, such education hasn’t worked to change athletes’ concussion reporting behavior.  Even though most 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 – or, in the parlance of American football, a new game plan – is clearly needed, one which recognizes that:

• chronic under-reporting is not the result of an athlete’s lack of knowledge of concussion symptoms and the health risks of continuing to play with such symptoms, but stems from an athlete’s belief that they would be letting their team down and hurting the team’s chances of winning by reporting; and
• the best way to increase the rate at which athletes report concussion symptoms, either their own or their teammates, may be for coaches, athletes, parents, medical staff, and even fans, to work as a team to change reporting behavior by changing reporting attitudes and team norms. 

The #TeamUp4ConcussionSafety program, developed by SmartTeams™ with a Mind Matters grant from the National Collegiate Athletic Association and Department of Defense, and with additional support from our sponsors and underwriters, is designed to increase reporting by athletes of concussion symptoms by engaging coaches, athletes, medical staff, and parents 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, not just that game, but over the course of the season, and an athlete’s career, and should be viewed as a behavior valued by every team.

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 first understand how much they know about concussions, and about their current attitudes towards and beliefs about symptom reporting.

To find out what coaches, athletes, athletic trainers, and parents know about concussions, and, more importantly, whether they view concussion symptom reporting in a positive or negative light, every stakeholder will be asked to complete a series of short quizzes.

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 gapes, coaches, parents, and athletes will be encouraged as 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 in detail 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 improving concussion safety requires a team effort, we believe that 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

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 safe 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 by maintaining open lines of communication and an ongoing dialog about concussion safety between and among coaches, athletes, medical staff, and parents.

Do’s and Don’ts

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

• athletes who do honestly and immediately self-report concussion symptoms, and encourage teammates to do the same are not letting their 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;
• athletes who do honestly and immediately self-report concussion symptoms, and encourage teammates to do the same, – are being good teammates
• athletes who don’t honestly and immediately report concussion symptoms put their health and those of their teammates at risk; and
• 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.