Analysis of States' Barriers to and Progress Toward Implementation of Health and Safety Policies for Secondary School Athletics.

CONTEXT: Implementation of health and safety best practices for the leading causes of sudden death and catastrophic injury has been shown to mitigate risk. However, to our knowledge, no authors have examined progress toward health and safety policy implementation at the state level. OBJECTIVE: To investigate the progress made by state secondary school leaders in developing and implementing health and safety policies (ie, exertional heat stroke, sudden cardiac arrest, concussion, emergency action plans) and to explore perceived barriers to and strategies for implementation. DESIGN: Mixed-methods study. SETTING: State high school athletics associations and sports medicine advisory committees. PATIENTS OR OTHER PARTICIPANTS: Collaborative Solutions for Safety in Sport meeting attendees participated in this study. Thirty-five state leaders (current role experience = 8 ± 6 years) completed the survey. Ten of the 35 participated in follow-up interviews. DATA COLLECTION AND ANALYSIS: A survey assessing progress on health and safety policy implementation was administered. Respondents indicated whether their state had implemented a policy, made progress without implementation, or made no progress. We conducted follow-up telephone interviews so they could expand on the survey responses. The data were analyzed using descriptive statistics and the general inductive approach. RESULTS: A total of 89% of respondents reported their states made progress on or implemented health and safety policies during the 2015-2016 academic year. Barriers to policy implementation included cost, a lack of understanding regarding policies versus recommendations, the content and value of policy change, and a false sense of security. Strategies for implementation included varying approaches to change, education of all constituents, and collaborative relationships among key stakeholders. CONCLUSIONS: Although a majority of respondents reported progress in implementing health and safety policies in their states, perceived barriers pointed to the need for the continued education of state leaders in charge of developing and implementing health and safety policies. Despite these barriers, collaboration among key stakeholders is crucial to successful implementation of best-practice policies in secondary school athletics.

Gaining Access to Providing Medical Care to Male Sport Teams: The Female Athletic Trainer Perspective.

CONTEXT: Female athletic trainers (ATs) can face barriers to employment within the profession. Although there is evidence for an increasing percentage of women in athletic training, the portion providing medical care to male sport teams within the professional sport and collegiate settings continues to be small. OBJECTIVE: To investigate the experiences of female ATs when seeking employment with male sport teams within the Division I setting. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association (NCAA) Division I. PATIENTS OR OTHER PARTICIPANTS: A total of 15 NCAA Division I female ATs providing medical care to a male sport team participated in our study. Their mean age was 33 ± 9 years, and they had a mean of 11 ± 9 years of overall clinical experience. DATA COLLECTION AND ANALYSIS: All participants completed one-on-one phone interviews, which were recorded and transcribed. Analysis of the data followed thematic analysis using a phenomenologic approach. Credibility was established through credibility checks, peer review, and researcher triangulation. RESULTS: Factors that played a role in women gaining employment with male sport teams were (1) preexisting professional relationships, (2) prior experience with a male sport, and (3) perseverance. Participants in our study were most attracted to their current positions because of (1) the environment of the collegiate setting and (2) the location of the university. CONCLUSIONS: Job access for female ATs in this study was not viewed as a challenge. Familiarity through previous connections with the university and staff and commitment to career goals helped these women obtain the positions they held. The desire to work in male sports was not a primary contributing factor to the decision-making process. Progress continues for women in athletic training, as evidenced by the reported ease of job access with male sport teams.

Athletic Trainer Services in Public and Private Secondary Schools.

CONTEXT: The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored. OBJECTIVE: To compare the level of AT services in public and private secondary schools. DESIGN: Concurrent mixed-methods study. SETTING: Public and private secondary schools in the United States. PATIENTS OR OTHER PARTICIPANTS: A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private). MAIN OUTCOME MEASURE(S): School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis. RESULTS: A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators. CONCLUSIONS: Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector.

Athletic Trainer Services in US Private Secondary Schools.

CONTEXT: Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. OBJECTIVE: To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs. DESIGN: Concurrent mixed-methods study. SETTING: Private secondary schools in the United States. PATIENTS OR OTHER PARTICIPANTS: Of 5414 private secondary schools, 2044 (38%) responded to the survey. MAIN OUTCOME MEASURE(S): School administrators responded to the survey via telephone or e-mail. This instrument was previously used in a study examining AT services among public secondary schools. Descriptive statistics provided national data. Open-ended questions were evaluated through content analysis. RESULTS: Of the 2044 schools that responded, 58% (1176/2044) offered AT services, including 28% (574/2040) full time, 25% (501/2042) part time, 4% (78/1918) per diem, and 20% (409/2042) from a hospital or clinic. A total of 84% (281 285/336 165) of athletes had access to AT services. Larger private secondary schools were more likely to have AT services available. Barriers to providing AT services in the private sector were budgetary constraints, school size and sports, and lack of awareness of the role of an AT. CONCLUSIONS: More than half of the surveyed private secondary schools in the United States had AT services available; however, only 28% had a full-time AT. This demonstrates the need for increased medical coverage to provide athletes in this setting the appropriate level of care. Budgetary concerns, size of the school and sport offerings, and lack of awareness of the role of the AT continued to be barriers in the secondary school setting.