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Mind Matters Challenge Executive Statements

The NCAA-DoD Mind Matters Challenge, part of the NCAA and U.S. Department of Defense Grand Alliance partnership, is an education and research grand challenge aimed at changing important concussion safety behaviors.

Overall Goal.

Increase early and honest symptom reporting post-concussion by developing effective approaches to intervention (e.g., education). To achieve this goal, it was first necessary to understand the factors that drive non-disclosure of concussion symptoms and the critical components of effective approaches to promote concussion disclosure.

Outputs of the Mind Matters Challenge.

Eight institutions were funded under the 3-year Mind Matters Research Challenge and six institutions under the 1-year Education Challenge, with one team receiving continued funding for an additional 2 years. To date, 24 published manuscripts in academic journals have resulted from the work of these groups, and 23 manuscripts are currently under peer review. To synthesize the emergent results of these groups and other contemporary research on concussion disclosure, a formal consensus process was undertaken in concert with the final Mind Matters Challenge meeting. Mind Matters grantees, in partnership with campus and military stakeholders, developed and refined actionable recommendations for institutions, aimed at increasing early and honest care-seeking for suspected concussions.

Process for Consensus Building.

The Delphi method allows for an efficient, unbiased approach to aggregating expert opinion to reach consensus. Each of the nine investigator groups contributed one to three foundational statements. Investigator-generated statements were synthesized into non-overlapping and actionable recommendations. Participants, all of whom were considered experts in their field based on their research and publications, voted on each statement in terms of its utility and feasibility, and provided open-ended written feedback. Statements meeting a priori quantitative thresholds for consensus were retained, and others were edited based on qualitative participant feedback. This process continued for three rounds and resulted in 17 statements addressing five domains: (1) content of concussion education for athletes/service members; (2) dissemination of concussion education for athletes/ service members; (3) other stakeholder concussion education; (4) team-level processes; and (5) organizational processes. The following consensus statements will be used as the springboard for the development of subsequent educational resources, peer-reviewed publications and future research studies.

Domain 1: Content of concussion education for athletes and military service members

Provide athletes/service members with education that addresses:

  1. The potential dilemma individuals face when deciding to disclose a concussion (e.g., tradeoffs, concerns about what might happen next, knowing how to report, etc.);
  2. Short-term benefits of early concussion symptom disclosure (e.g., athletic, academic, occupational);
  3. What is known about possible long-term manifestations of concussion and head injury;
  4. Concussion-related misperceptions (e.g. population-specific knowledge gaps);
  5. Site-specific information regarding institutional concussion resources and policies.

Domain 2: Dissemination of concussion education

  1. Actively collaborate with organizational stakeholders (including coaches/commanders, primary health care providers, student-athletes/service members, military chain of command) to select concussion education approaches that are engaging, interactive, and that foster discussion.
  2. Share messaging about concussion symptom disclosure on a regular basis and in a variety of ways (e.g., formal education, informal conversation, posters).
  3. Integrate messaging about the importance of complete concussion symptom disclosure throughout the recovery process.

Domain 3: Concussion education for other stakeholders

  1. Provide coaches/leaders in the military chain of command with evidence-based concussion education that is aimed at supporting student-athletes/service members in concussion symptom disclosure.
  2. Provide sports medicine/front line medical staff with strategies about how to engage coaches/ leaders in the military chain of command in supporting student-athletes/service members in concussion symptom disclosure.
  3. Provide easily accessible information to parents/guardians of student-athletes/service members about how to support athlete/service member concussion symptom disclosure.
  4. Provide easily accessible information to other key site-specific stakeholders (e.g., student-life administrators, faculty athletic representatives, leadership, chain of command) about how to support student-athlete/service member concussion symptom disclosure. 

Domain 4: Team- and unit-level processes

  1. Provide student-athletes/service members with education that addresses the role they can play in encouraging peers to disclose possible concussion symptoms (e.g., share evidence-based bystander education programming).
  2. Provide opportunity for team/unit members and coaches/leaders to discuss and establish team values that are supportive of concussion symptom disclosure.

Domain 5: Organizational processes

  1. Actively collaborate with organizational stakeholders (including coaches/leaders in the military chain of command, primary health care providers, student-athletes/service members) to identify and address organizational barriers to concussion symptom disclosure. 
  2. Evaluate the effectiveness of institutionally selected concussion education approaches in changing athlete/service member concussion symptom disclosure behavior.
  3. Communicate in a deliberate manner institutional values that emphasize safety and its importance in athletic performance/military readiness.

Closing comments and next steps. The NCAA-DoD Mind Matters Grand Challenge has already had a major global impact in the understanding of concussion disclosure through the publication of 24 peer reviewed manuscripts, with many more forthcoming. The results of these investigations provide guidance for athletics departments and service academies about how to develop and maintain a culture that supports concussion disclosure. They also provide the foundation for an augmented research agenda on this topic. One emergent theme was the need for consistent data collection across sites using valid and reliable measures in understanding the impact of different approaches that have been used to support concussion disclosure.