Secondary School Athletic Trainers Research Articles

Exploring Secondary School Athletic Trainers’ Perspectives in Managing Mental Health Situations

Background: Most people believe that student–athletes experience fewer difficulties related to mental health than non-sport participants. However, several studies have shown high depression levels or emotional difficulties in adolescent athletes. Most secondary school students have access to athletic trainers in their schools. Secondary school athletic trainers (SSATs) are medical professionals who can provide health care for student–athletes, and they could be appropriate supporters in providing mental health management in secondary schools. However, there are no studies that have addressed their preparedness and confidence level to manage potential risk factors and mental health disorders. This study aims to ascertain preparedness and confidence levels from SSATs’ perspectives in handling mental health disorders using a survey based on the mental health management guidelines and consensus statement. Methods: This is a cross-sectional study design. The research team created an online survey questionnaire based on the National Athletic Trainers’ Association (NATA) Mental Health Guidelines for Secondary School and Interassociation Recommendation: A Consensus Statement. Utilizing the NATA Research Survey Service, the online survey was emailed to SSATs who self-categorized as secondary school athletic trainers in the NATA membership system. (n = 171, 65% completion rate). SPSS was used to analyze the survey data. Result: This study found that 29.2% of SSATs reported they have policies or guidelines regarding mental health disorders management for minors. The most frequent policy was mandatory reporting in cases in which an individual is being abused or neglected (80.5%). The highest confidence area was aligned with the most frequent policy. The least frequent policy was considering unique stressors and triggers with student–athletes to recognize the potential mechanisms that may cause a mental illness or exacerbate an existing mental illness (58.5%). Even though the least frequent policy was not aligned with the least confidence area, it was the second lowest confidence level. This study identified significant differences between two different employment structures: school-based employment and hospital-based employment structures. Policies were more common in school-based employment than in hospital-based employment structures. Conclusion: This study demonstrated the gap between organizational and individual preparation. The majority of SSATs respondents expressed moderate to high confidence in their ability to manage mental health disorders, despite the lack of mental health policies or procedures in their secondary schools. This study recommends that SSATs create guidelines or procedures in the areas where they are least confident and prepared to offer mental health management for minor student–athletes. They can use the interassociation recommendations and the NATA guidelines for mental health care to close the gap.

Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions.

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. Cross-sectional study. Online survey. National Athletic Trainers' Association SSATs (6.7% response rate). Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.

Secondary School Athletic Trainers' Experiences Managing Workplace Organizational- Professional Conflict.

Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must be mitigated, yet little research has determined how ATs manage conflicts with stakeholders. To explore ATs' experiences with OPC in the secondary school setting. Qualitative study. Telephone interviews. 16 ATs (9 females, 7 males; age = 43±11 years; years certified = 17±9; years in their current positions = 9±6). We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts, and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach. Four themes emerged: effective communication, professional relationships, stakeholder education and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. OPC was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines post-injury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC. Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.

Secondary School Athletic Trainers' Perceptions of How Youth Sport Specialization Impacts Workload.

Youth sport specialization is a growing trend in youth sports and is associated with an increased risk of injuries and burnout. However, it is unknown how sport specialization is perceived to be affecting the working environment of secondary school athletic trainers (ATs). The purpose of this paper is to describe how ATs perceive youth sport specialization impacting their workload and whether they perceive it to impact patient safety. ATs will perceive that youth sport specialization impacts their workload and could impact patient safety. A sequential, explanatory mixed methods design with 2 phases: (1) cross-sectional surveys and (2) individual interviews. Level 3. A total of 487 secondary school ATs completed the online survey (access rate, 8.4%; completion rate, 85.4%). The survey consisted of Likert questions and included sections about aspects of workload impacted by specialization, impacts on patient safety, demographics. Ten participants were selected to complete a semi-structured interview via video conference. Approximately two-thirds of ATs perceive that sport specialization impacts their workload. (Somewhat, 38.6%; Quite a bit, 25.5%; A great deal, 5.5%) Attempts to reduce or modify patient activity and a patient's time for rehabilitation were the highest rated aspects of workload impacted by sport specialization. Approximately 30% ATs (29.9%) perceive that sport specialization impacts their workload to where it may influence patient safety (Somewhat, 21.6%; Quite a bit, 6.4%; A great deal, 1.9%). Three themes and subsequent subthemes were identified from the qualitative interviews: (1) current youth sport expectations, (2) conflict between school and club sports, and (3) AT job impacts. Secondary school ATs perceive their workload to be negatively impacted by youth sport specialization and some believe it may impact patient safety. Youth sport specialization is impacting youth sport stakeholders, including ATs, in a variety of ways.

Policies, Procedures, and Confidence in Managing Pregnancy Among Secondary School Athletic Trainers

Adolescent pregnancy rates are higher in the United States than in other developed countries. Clear policies and procedures are necessary for managing pregnancy in the secondary school setting. This study aimed to determine if athletic trainers had a policy for, and their confidence in, managing pregnant athletes in the secondary school setting. Sixteen percent of the participants have previously managed adolescent pregnancy, yet only 4% had a policy. Athletic trainers with pregnancy policies and procedures or previous experience managing pregnancy reported greater confidence in managing pregnancy in adolescent athletes. Participants were only “slightly confident” in managing pregnant adolescent athletes.

Perceptions of Self-Care and Work–Life Balance Among Secondary School Athletic Trainers

The athletic training research agenda identifies a need for exploration on strategies for improved work–life balance. One unexplored area is self-care practices used to maintain work–life balance. Fourteen (six males, eight females) athletic trainers employed in the secondary school setting participated in a qualitative research study. All interviews were recorded, transcribed, and analyzed using an inductive approach as prescribed by phenomenological approach. Data saturation guided recruitment and peer review and intercoder reliability was used for credibility. Secondary school athletic trainers are engaging in self-care practices regularly and connect those activities to their work–life balance. Self-care practices are designed to create “me time” and are geared toward physical and social self-care activities. In addition, our results address the interchangeable thoughts of self-care practices, stress relief, and work–life balance.

Perceived Stress as an Indicator of Work–Family Conflict and Burnout Among Secondary School Athletic Trainers

Burnout and work–family conflict (WFC) are stressors faced by secondary school athletic trainers, however, the concept of perceived stress and its relationship to burnout or WFC is not well understood. The purpose of this study was to investigate perceived stress’ relationship with burnout and WFC. Participants reported a WFC score of 40.36 (±15.63), low burnout (40.1 ± 16.28), and moderate stress (15.99 ± 7.02). Perceived stress predicted WFC, but not burnout (b = 1.13, t572 = 14.132, p ≤ .001). One’s level of perceived stress impacts WFC, which indicates higher stress will equal greater work–family conflict.

Secondary School Athletic Trainers' Strategies and Barriers to Overuse Injury Treatment in Adolescent Athletes.

Studies have illustrated that overuse injuries occur in adolescent athletes more often than previously reported. The general purpose of this study was to provide a thorough report of secondary school athletic trainers encounters, practices, and perceptions of overuse injury in adolescent athletes. Cross-sectional. An anonymous online questionnaire was distributed via email to athletic trainers in the secondary school setting. The questionnaire was sent to participants during the summer of 2021 and 430 participants (highest educational degree earned: master's degree = 66%) completed the survey. Various survey methods were used to evaluate athletic trainers (1)demographics, (2)estimations about what percentage of injuries evaluated and treated were classified as overuse, (3)methods for treating overuse injuries, (4)confidence in treating overuse injuries and the complete implementation of their treatment plan, (5)perceptions of various barriers to treating overuse injuries, and (6)perception as to why patients did not want to reduce activity to treat their overuse injuries. Participants reported that about half of all evaluations and treatments in a year were overuse injuries and they were "fairly" or "completely" confident (90%) in their ability to treat these injuries. The most common treatments cited were stretching (91%) and reducing activity (90%). Only 61% of participants were "fairly" or "completely" confident in the complete implementation of their treatment plan. Participants believed that patients' reluctance to reduce sport activities (82% "moderate" or "extreme" barrier) was the most significant barrier to treatment. Participants cited athletes' avoidance of missing games as the most common reason athletes were reluctant to reduce sporting activity. Participants felt confident in treating overuse injuries yet faced significant barriers in treating these injuries. Clinicians should be prepared to have conversations about the importance of reducing sporting activity to allow proper healing for overuse injuries in adolescent athletes.

Perceived Knowledge and Confidence of Social Determinants of Health in College and Secondary School Athletic Trainers

For most athletes, their athletic trainer is the healthcare provider with whom they interact the most while for others, ATs are the only health care professionals they interact with. It is crucial that ATs can assess and implement strategies that account for SDH in athletes. The purpose of this study was to explore the relationship between the number of years certified as an athletic trainer in the college and secondary school settings and perceived knowledge of factors and confidence in the implementation of interventions to address social determinants of health (SDH) when treating patients.

The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting.

Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.

The Role of Title 1 Secondary School Athletic Trainers in the Primary and Patient-Centered Care of Low Socioeconomic Adolescents.

Athletic trainers (ATs) provide regular encounters with a healthcare provider for many Title 1 student-athletes with healthcare access and quality barriers. Thus, they are uniquely positioned to serve as a student-athletes' first point of contact for general medical concerns. This study aimed to describe ATs' experiences providing primary care for Title 1 student-athletes. This qualitative design employing an interpretative phenomenological analysis (IPA) approach used in-depth, virtual focus groups to examine the experiences of ATs practicing at Title 1 secondary schools. The findings reveal that ATs were called upon to evaluate, treat, and, when necessary, refer student-athletes with general medical conditions. However, Title 1 ATs encountered numerous complex social determinants of health (SDoH) preventing efficient and effective referral to specialty healthcare providers. Thus, ATs ultimately felt their most important roles in the primary care of low socioeconomic adolescents were as caregivers who mitigated avoidable healthcare barriers in addition to coordinators of integrated care that assisted student-athletes and their families with navigating the healthcare system. Title I ATs need to be aware of the SDoH affecting their student-athletes and the ability of those SDoH to affect health outcomes as well as overall student-athlete health and well-being.

Secondary School Athletic Trainers' Knowledge of Growth Spurts and Growth Measurement Methods

Context As youth sport participation grows, athletic trainers (ATs) continue to be important health care providers in managing growth-related injuries. Objective To examine secondary school ATs' reported knowledge on diagnosing and treating growth-related injuries and reported confidence for determining growth status and to report methods secondary school ATs use to determine patient growth status. Design Cross-sectional. Setting An online questionnaire was distributed to secondary school ATs in the United States. Data collection occurred in the summer of 2021 over a 6-week period. Patients or Other Participants A total of 430 secondary school ATs (highest degree earned: master's degree = 66%). Main Outcome Measures The questionnaire contained secondary school ATs' confidence in determining if an athlete was going through a growth spurt, level of knowledge on diagnosing and treating growth-related injuries, methods secondary school ATs use to determine growth status in their athletes, and demographics. Results Most secondary school ATs believed that growth spurts affected sport-related injury risk (88%); however, only 37% of secondary school ATs were fairly or completely confident in their ability to determine if an athlete was going through a growth spurt. For those 37% of secondary school ATs, 89% of them used history or observation over time, but no formal method, for determining growth status of their patients. Patient self-assessed Tanner stages (32%) and clinical evaluation of Tanner stages (28%) were the next most used methods for assessing growth. Conclusions In accord with Domain I of athletic training, secondary school ATs could benefit from improved knowledge on how to measure and manage growth in their patient population. To aid education in this area, future researchers should focus on assessing barriers secondary school ATs face in implementing methods for measuring growth and exploring secondary school ATs' knowledge levels on risk management programs for youth athletes going through growth spurts.

Concussion education perceptions among secondary school athletic trainers

ABSTRACT Purpose Describe concussion education perceptions among secondary school athletic trainers and determine the relationship between education program characteristics and perceived effectiveness. Methods Two hundred and three participants completed at least one survey item (age = 35.2 ± 9.4 years; male = 27.6%). We used descriptive statistics to describe concussion education characteristics and point out biserial correlations to determine if relationships existed between concussion education characteristics and perceived effectiveness. Results The most frequently used mandated concussion education programs were informational handouts created by the state interscholastic association, the Centers for Disease Control and Prevention’s (CDC) Heads Up materials, and the National Federation of State High School Athletic Association’s materials. The CDC’s Heads Up materials, handouts created by the state interscholastic association, and in-person presentations created by respondents were the most frequent concussion educational programs utilized by respondents who indicated no specific program mandated. Educational programs that were engaging increased perceived effectiveness (n = 131, rpb = 0.31,p < 0.001). Conclusions Our results highlight that materials created by state interscholastic association and the CDC’s Heads Up program among others are utilized to satisfy mandates and are perceived to be moderately effective, especially when perceived to be engaging. These results can help guide future studies to examine specific educational tools and administration strategies to determine effectiveness on concussion disclosure.

Practices and Perceptions of Family-Centered Care: A Cross-Sectional Survey of Secondary School Athletic Trainers

Family-centered care (FCC) includes collaboration between families and healthcare providers, the creation of flexible policies, and the family taking an active role in the delivery of care. Secondary school athletic trainers provide care for underage patients in school-based health systems, making them responsible for maintaining communication with parents, guardians, and/or caregivers. This cross-sectional survey investigated the extent to which athletic trainers (n = 205) include aspects of FCC in their daily secondary school clinical practice (current practices = CP) and whether they believe that aspect of care is necessary for FCC to be provided in athletic training (perceived necessary = PN) in their everyday practice using the Family-Centered Care Questionnaire-Revised tool. The total mean score for the CP scale (mean = 26.83 ± 4.36) was significantly lower (p ≤ 0.01) than the PN scale (mean = 35.33 ± 4.17). All FCC subscales compared between CP and PN were significantly different (p ≤ 0.01), with each being of higher importance than CP in athletic training. Data analysis revealed four themes related to enhancing FCC in secondary schools: limited education and resources, staffing and space concerns, non-technical skills, and social determinants of health. Attention should be placed on developing resources and interventions for secondary school athletic trainers to collaboratively work with children and their support systems.

Burnout in Secondary School Athletic Trainers, Part II: Correlations With Substance Use

Burnout has been associated with increased energy drink consumption and increased occurrence of binge drinking of alcohol in collegiate athletic trainers (ATs), but this has not been examined in ATs in other work settings. The purpose of this study was to examine the relationship between burnout and use of various substances in secondary school ATs. Statistical analyses found a significant direct relationship between emotional exhaustion and energy drink consumption, but no other findings were statistically significant. These findings suggest that other factors besides burnout are contributing to a high rate of binge drinking of alcohol in secondary school ATs.

Burnout in Secondary School Athletic Trainers, Part I: Correlations With Situational Variables

Burnout is a psychological syndrome that is found at higher rates in health care professionals, including athletic trainers. Situational variables such as social support, salary, work–family conflict, and workload have been associated with burnout in collegiate athletic trainers. The purpose of this study was to see whether such relationships exist within a sample of secondary school athletic trainers. Analyses suggest that increases in work–family conflict and decreases in social support were significantly correlated with increased burnout in our sample. These findings suggest that modification of work–life balance and support network are more important in combating burnout than modification of workload or salary.

Secondary School Athletic Trainers’ Navigation of Patient Socioeconomic Status Challenges in Care: A Qualitative Study

Secondary school ATs (SSATs) are uniquely positioned healthcare providers at an optimal public health intersection where they can provide equitable healthcare to low socioeconomic status (SES) adolescents. SSATs face similar challenges to physicians in treating low SES patients, but their strategies may be different compared to other medical professions. However, the consequences of low SES population healthcare delivery by SSATs have not been explored. SSATs were asked to share what challenges, if any, they encounter with providing care for their low SES patients and what strategies they find most effective to overcome these challenges. Data were collected via semi-structured interviews and reflective field notes and analyzed using a four-step, interpretative phenomenological analysis (IPA) guided theme development. Data saturation was met, and the sample size aligned with other IPA studies. Trustworthiness was established with research triangulation and Yardley's four principles. Three interrelated themes emerged: (a) mechanisms for identifying SES, (b) the impact of SES on care, and (c) navigating SES challenges. SSATs described many strategies that were gained through their clinical experiences to overcome healthcare barriers. SSATs have the potential to decrease health disparities through their role as a liaison and advocates for their low SES patients.

Continuing Professional Development Using Infographics Improves the Familiarity of the Social Determinants of Health

Context Secondary school athletic trainers (ATs) may not be aware of health care delivery strategies for the social determinants of health (SDOH). Specifically, secondary school ATs have demonstrated the lowest knowledge and practice of the SDOH. Objective The purpose of this study was to determine whether infographics as a continuing professional development method changed patient-centered–care screening considerations and familiarities with the SDOH. Design Randomized controlled trial. Setting Online survey with infographic intervention. Patient or Other Participants In total, 34 participants in the intervention group and 46 participants in the control group were included for the analysis. Intervention(s) The intervention group received a different SDOH infographic weekly for 12 weeks. The control group did not receive any infographics. Main Outcome Measure(s) The survey asked participants to rate their patient-centered–care tasks, screening consideration, and familiarity with the SDOH. Results A significant change-score improvement was identified for the intervention group relative to providing whole-person health care (P = .024) and recognizing the SDOH (P ≤ .001). No statistical differences were noted for screening and practices between the groups. However, familiarity with screening for 4 SDOH areas improved for the intervention group, including access to primary care (P = .007), poverty (P = .048), environmental conditions (P = .036), and social cohesion (P = .025). Conclusion The ATs improved their familiarity with screening for some SDOH after engaging in professional development using infographics, but screening practices and considerations did not change over the course of the study.

Retention of Athletic Trainers in the Secondary School Setting

Research has explored factors related to retention of athletic trainers in collegiate settings but less is known about retention of athletic trainers in secondary school settings. This study aimed to investigate factors that increase retention of secondary school athletic trainers. Twenty-two secondary school athletic trainers (10 females and 12 males, length of employment 14.65 ± 5.01 years) participated in a semistructured video call interview with seven open-ended questions. A phenomenological approach revealed three themes and eight subthemes: (a) support (administration, partner athletic trainer, and non-work-related); (b) connections (impact on patients, school community, and wider community); and (c) security (financial and nonfinancial). Although participants acknowledged challenges, they identified aspects that positively influenced their retention.

Secondary School Athletic Trainers’ Perceived Confidence In Providing Independent Medical Care Within Differing Healthcare Delivery Models

Purpose: The aim of this study was to evaluate athletic trainers’ confidence and ability to deliver independent medical care in the secondary school setting. Methods: A cross-sectional survey design was used with open- and closed-ended questions using a tool that was modified from a previously validated tool used within the collegiate setting; the tool was adapted through content expert validation. Results: Athletic trainers perceived themselves as confident in providing independent medical care through the school district healthcare delivery model (n=109/121, 90%) more often than those functioning within the hospital/clinic outreach model (n=85/130, 65%). Conclusions: Despite not having nationalized legislation and having variable support structures in place, secondary school athletic trainers are confident in providing independent medical care even when their direct supervisor may not be a healthcare provider. This is contradictory to similar findings within the collegiate setting governed by National Collegiate Athletics Association legislation enforcing independent medical care.