Background All 50 states and the District of Columbia in the United States enacted laws between 2009 and 2014 governing concussion management and education. These concussion laws, featuring common tenets regarding removal from play, return to play, and concussion education, have shaped school policies.

Objective To evaluate strategies commonly used to implement concussion laws at high schools in the United States, and to discuss these strategies in an international context. Methods: We interviewed 71 high school athletic directors (ADs) or certified athletic trainers (ATs) (one per school) who were the most involved in their school’s policy. These participants, selected from a nationally representative sample, were asked about their schools’ implementation of the three core tenets of concussion laws. Research team members independently evaluated the interview transcripts and field notes to identify common themes in implementation strategies.

Findings Of the 71 schools represented, 91.5% were public schools, 88.8% had more than 15 sports, and all schools employed at least one AT and had a written concussion policy. Four commonly used strategies to implement ‘removal from play’ were identified, including reliance on coaches, immediate response, referral and guidance after injury, and notification of key individuals. Use of assessment or baseline tests, communication among parties involved, reliance on AT assessments, and return-to-learn policies were four common strategies to implement ‘return to play’. Finally, three major implementation strategies to effectuate ‘concussion education’ were use of existing educational tools, timing of education, and concussion training for school professionals.

Conclusion While concussions laws were enacted at different times and varied in content across the United States, common themes in implementation strategies emerged across jurisdictions. The identification of strategic approaches to implementation can have implications for proper concussion management and education, both in the United States and internationally to reducing negative health outcomes among concussed youth.