Caring for the Collegiate Athlete A Team Approach

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Caring for the Collegiate AthleteA Team Approach

• Shannon Courtney MA,ATC
• Kurt Dallow, MD, FACSM
• Carrie Hertweck, Psy.D.

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Objectives

• Review current model at University of Northern
  Colorado for interscholastic athlete health care
• Identify possible ventures between University
  Health Centers, Athletic Departments, and
  Counseling Centers

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Trivia Question

• What early football offensive formation led to
  the formation of the NCAA?

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Trivia Question Answer

• The Flying Wedge

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NCAA

• The game's rugged nature, typified by mass
  formations and gang tackling, resulted in
  numerous injuries and deaths and prompted many
  institutions to discontinue the sport. Others
  urged that football be reformed or abolished from
  intercollegiate athletics.
• President Theodore Roosevelt summoned college
  athletics leaders to two White House conferences
  to encourage such reforms. In early December
  1905, Chancellor Henry M. MacCracken of New York
  University convened a meeting of 13 institutions
  to initiate changes in football playing rules. At
  a subsequent meeting December 28 in New York
  City, the Intercollegiate Athletic Association of
  the United States (IAAUS) was founded by 62
  members.
• NCAA celebrates its centennial anniversary this
  year.

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Case 1

• 18 yo freshman swimmer presents to the training
  room for evaluation of possible eating disorder
• PE, review of PMed HX, and interview suspicious
  for anorexia nervosa with purging
• Outpatient counseling, medications,
  disqualification from swim team
• 2.5 years later-institutionalized repeatedly with
  severe anorexia nervosa, ? Survival.

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Case 2

• 21 yo WBB player presents with L posterior back
  pain, and dyspnea
• Evaluation- training room by ATC-referral to team
  physician- subsequent referral to SHC. FNP
  evaluated-referred to hospital for testing
• Dx- pulmonary infarct on CT angiogram
• 3-6 mo warfarin rx, 2006 WBB play is over.

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University of Northern Colorado Athletics

• Big Sky Conference
• Div I Athletics Program (FB Div I-AA)
• 19 Intercollegiate athletic programs
• 450-500 student athletes
• 7 Certified Athletic Trainers

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Training Room
Student Health Center
Counseling Center
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Training Room

• Medical staff-4 orthopedists, 2 primary care
  sports physicians, and 1 primary care sports
  medicine fellow.
• Visits Tuesdays AM, Thursday PM, and in the
  offices as needed.
• Documentation- word processing, signed off by the
  provider
• Radiology available digitally in the training
  room
• Services provided on a gratis basis. Surgery
  generates professional fees

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UNC SHC

• 2 physicians, 5 part-time FNPs, part time PT, 1
  RN and 2 MAs, pharmacy outlet
• 6000 Visits/year 2006- begun billing 3rd party
  insurance, 3rd party Rx plans 11/06
• Physicians are primary care sports medicine
  trained nurse practitioners are family medicine
  or womens health trained
• Services-acute care, health maintenance,
  vaccinations

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UNC Counseling Center

• Counseling Center Staff on Team
• Carrie Hertweck, Psy.D. and
• Kim Wilcox, M.A.
• Services we provide
• Guaranteed free intake
• Help in process of assessing for an eating
  disorder
• If appropriate, provide personal counseling.
  Otherwise, will help student athlete find mental
  health services in community
• Consult and collaborate with other team members
  in the treatment of the student athlete to
  provide comprehensive care

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Common Mental Health Issues Among Collegiate
Athletes

• Participation in collegiate sports can often be
  a protective factor for student athletes. Some
  research has supported the idea that student
  athletes can be less prone to low self-esteem,
  social isolation, depression, and anxiety than
  their non-athlete peers.

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Reasons

• Association between exercise and positive mental
  health
• Friendships gained from teammates
• Greater self-esteem and short-term improvement in
  mood, due to increase in serotonin levels,
  norepinephrine, and opiod levels
• (Donohue et al., 2004)

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However

• Participation in collegiate sports can also have
  a negative impact on a student athletes mental,
  emotional, and social health. Some research
  indicates
• Increased risk for developing an eating disorder,
  especially among white female student athletes.
• (Johnson et al., 2004)

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Risks cont.

• Increased levels of depressive symptoms, social
  anxiety, and feeling less supported by peers.
• Dissatisfaction with college experience because
  of feeling less integrated with campus
  experiences and activities.
• (Storch et al., 2005)
• Greater levels of anxiety due to time management
  demands.

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• Anecdotally, I have seen an increase in
  problematic peer relationships amongst student
  athletes due to the vast amounts of time they
  spend with teammates in practice, training,
  playing, traveling, and living in the same
  residence halls and often the same rooms.

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What Counseling Services Can Do to Help the
Student Athlete

• Provide personal counseling (individual and
  group)
• Performance Enhancement Services
• Short- or long-term consultation with specific
  teams or teammates
• Consultation and/or training for coaches,
  trainers, and other athletic department staff on
  mental health issues
• Provide outreach programs for student athletes

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Factors Influencing the Student Athletes
Decision to Seek Counseling Services

• 10 of American College Student Athletes are
  dealing with issues significant enough to warrant
  the need for psychological services as a result
  of their role as a student and athlete (Watson,
  2006, p. 35).
• Yet, counseling services remain underutilized by
  this population.

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Factors influencing help seeking behavior Cont.

• Time-management demands
• Stereo-types of student athletes being
  privileged, pampered, lazy, out-of-control, and
  primarily motivated to attend school for the sole
  purpose of participating in their sport
• Typically raised in an environment that stresses
  importance of self-reliance and resiliency
• Importance of team over personal well-being
• Resistance to counseling from athletic department
  personnel
• Caution by university administration to not offer
  additional support services to student athletes
  for fear of violating NCAA rules and regulations
• (Watson, 2006).

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Intercollegiate Athletic InsuranceShannon
Courtney MA., ATCAthletic Training Program
DirectorAssistant Athletic Trainer University of
Northern Colorado
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• University of Northern Colorado Athletics
• Big Sky Conference
• Div I Athletics Program (FB Div I-AA)
• 19 Intercollegiate athletic programs
• 450-500 student athletes
• 7 Certified Athletic Trainers

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• Athletic Training Educational Program
• Nationally accredited by the Commission on
  Accreditation of Athletic Training Education
• Longest accredited educational program in the
  state of Colorado (1 of 5)
• 30 athletic training students in the clinical
  program
• As certified athletic trainers we are under the
  supervision and direction of our Medical Director
  and Team Physicians
• Work directly with our athletic programs
• Responsible for the evaluation, treatment,
  prevention, education to our athletic teams and
  their injuries
• First line of injury prevention and treatment on
  the field

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• Partnership with
• UNC counseling center
• Provides support to student athletes and
  education to our athletic department
• NCMC support the athletic training room
• Provide diagnostic viewing
• Student Health Center
• Pre-season physicals
• Work directly with student athletes
• North Colorado Sports Medicine
• See student athletes in clinic
• Educational area for our athletic training
  students
• Physicians visit the UNC athletic training room
• Area high schools
• Athletic training students gain experience by
  assisting certified athletic trainers at the high
  school

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Intercollegiate Athletic Insurance

• August 2006
• NCAA passed legislation that required all member
  institutions to certify that insurance exists to
  cover athletically related injuries, through it
  does not have the require schools pay for the
  insurance

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• Athletes expect to be covered 100 while
  participating for the institution
• Recruiting advantage
• Member institutions that cannot afford to pay to
  cover their student athletes
• Most student health insurance policies do not
  cover athletic injuries

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• NCAA provides catastrophic insurance up to 20
  million in a lifetime for student athletes,
  coaches, managers, athletic trainers, who are
  catastrophically injured during qualifying play
  or practice, travel or activities related to
  their practice or participation

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• Catastrophic Insurance policy
• Deductibles have gone from 25.000 to 50,000 and
  currently is at 75,000
• As a University we have to provide insurance to
  cover up to 75,000
• Since 1995 the NCAA has processed an average of
  4 catastrophic claims each year
• Cheerleading was a major contributor

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• At UNC student athletes must show proof of
  insurance coverage (that covers intercollegiate
  athletics) prior to participating in practices or
  competition.

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Coverage for Student Athletes

• Self Insured
• Institutions hope that the amount that they pay
  out for medical costs will be less than what they
  would pay in insurance premiums

• Advantages
• Potential savings
• Simplified claims process
• Flexibility
• Disadvantages
• High risk for large claims
• Risk of bankrupting funds
• Institutional tied up

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• Primary Coverage
• Medical or accident insurance that begins to pay
  for covered medical expenses as soon as the
  institution pays the deductible
• Parents insurance is not used

• Sense of responsibility for paying all the
  medical bills
• Large percentage of uninsured athletes
• Simplified and accelerated claims process
• Large cost for the university
• Less than 1 use this coverage

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• Secondary Insurance Coverage
• Excess insurance
• Policy that pays for covered medical expenses
  only after all other insurance policies,
  including their personal (or parents) insurance
  policy has reached its limit
• Spreads the risk and costs out.

• Advantages
• Less costly
• Shared responsibility
• Promotes cost controls
• Disadvantage
• Longer claim process
• Requires more communication
• Labor intensive claims process

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• Cost History for UNC
• Year Premium Ded. Claims Paid
• 01-02 48,000 2,500 21,800
• 02-03 48,000 2,500 131,000
• 03-04 54,000 2,500 30,000
• 04-05 117,000 2,500 est. 35,000
• 05-06 117,000 2,500 est. 30,000
• 06-07 63,000 2,500 ?????

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• Average cost for a football claim
• 1,278.04

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• How to reduce your cost???
• Insure that all student athletes have primary
  insurance (NCAA rule- 06)
• Negotiate discounts with providers
• (Insurance only costs)
• Work with team physicians, and visits to the
  athletic training room or health center
• Negotiate riders to the student insurance, know
  what their coverage's are will it help your
  cause

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• Work with local insurance agents be careful not
  to violate NCAA rules
• Communication
• Documentation and record keeping
• Work with local insurance agents be careful
  not to violate NCAA rules
• Communication
• Documentation and record keeping

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New Directions

• Vaccination clinics for student athletes
• Addition of psychologist to the scheduled team
  physcian meetings?
• Closer collaboration with SHC and Counseling
  Center?

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Discussion
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Thanks!
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Intercollegiate Athletic Insurance
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• Athletic Training Educational Program
• Nationally accredited by the Commission on
  Accreditation of Athletic Training Education
• Longest accredited educational program in the
  state of Colorado (1 of 5)
• 30 athletic training students in the clinical
  program
• Work directly with our athletic programs
• First line of injury prevention and treatment on
  the field

46

• Partnership with
• UNC counseling center
• Provides support to student athletes and
  education to our athletic department
• NCMC support the athletic training room
• Provide diagnostic viewing
• Student Health Center
• Pre-season physicals
• Work directly with student athletes
• North Colorado Sports Medicine
• See student athletes in clinic
• Educational area for our athletic training
  students
• Physicians visit the UNC athletic training room
• Area high schools
• Athletic training students gain experience by
  assisting certified athletic trainers at the high
  school

47

• Athletes expect to be covered 100 while
  participating for the institution
• Recruiting advantage
• Member institutions that cannot afford to pay to
  cover their student athletes
• Most student health insurance policies do not
  cover athletic injuries

48
Intercollegiate Athletic Insurance

• August 2006
• NCAA passed legislation that required all member
  institutions to certify that insurance exists to
  cover athletically related injuries, through it
  does not have the require schools pay for the
  insurance

49

• All student athletes must show proof of insurance
  coverage (that covers intercollegiate athletics)
  prior to participating in practices or
  competition.

50

• NCAA provides catastrophic insurance up to 20
  million in a lifetime for student athletes,
  coaches, managers, athletic trainers, who are
  catastrophically injured during qualifying play
  or practice, travel or activities related to
  their practice or participation

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• Catastrophic Insurance policy
• Deductibles have gone from 25.000 to 50,000 and
  currently is at 75,000
• Since 1995 the NCAA has processed an average of
  4 catastrophic claims each year

52
Coverage for Student Athletes

• Self Insured
• Institutions hope that the amount that they pay
  out for medical costs will be less than what they
  would pay in insurance premiums

• Advantages
• Potential savings
• Simplified claims process
• Flexibility
• Disadvantages
• High risk for large claims
• Risk of bankrupting funds
• Institutional tied up

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NCAA Requirements
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Integration of Services

• Psychologist at team physician meetings?
• More integration with Counseling Center and
  Health Center
• Move training room over to SHC?

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References

• Donohue, B., Covassin, T., Lancer, K., Dickens,
  Y., Miller, A., Hash, A., Genet, J. (2004).
  Examination of Psychiatric Symptoms in Student
  Athletes. Journal of General Psychology, 131
  (1), 29-35.
• Johnson, C., Crosby, R., Engel, S., Mitchell,
  J., Powers, P., Wittrock, D. Wonderlich, S.
  (2004). Gender, ethnicity, self-esteem and
  disordered eating among college athletes. Eating
  Behaviors, 5 (2), 147-156.
• Storch, E., Storch, J., Killiany, E., Roberti,
  J. (2005). Self-Reported Psychopathology in
  Athletes A Comparison of Intercollegiate
  Student-Athletes and Non-Athletes. Journal of
  Sport Behavior, 28 (1), 86-98.
• Watson, J. (2006). Student-Athletes and
  Counseling Factors Influencing the Decision to
  Seek Counseling Services. College Student
  Journal, 40 (1), 35-42.

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Thank You
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Objectives

• Review current model at University of Northern
  Colorado for interscholastic athlete health care
• Identify possible ventures between University
  Health Centers, Athletic Departments, and
  Counseling Centers

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University of Northern Colorado

• Approx 450 interscholastic athletes, with 19
  sports.
• Recent move to Division 1-AA status
• Teaching program for athletic trainers
• Student Health Center run under a partnership
  between Banner Health Systems and UNC
• UNC Counseling Center funded through student
  fees/?

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Training Room

• Medical staff-4 orthopedists, 2 primary care
  sports physicians, and 1 primary care sports
  medicine fellow.
• Visits Tuesdays AM, Thursday PM, and in the
  offices as needed.
• Documentation- word processing, signed off by the
  provider
• Radiology available digitally in the training
  room

61
UNC SHC

• 2 physicians, 5 part-time FNPs, part time PT, 1
  RN and 2 MAs, pharmacy outlet
• _____ Visits/year begun billing 3rd party
  insurance, 3rd party Rx plans.
• Physicians are primary care sports medicine
  trained nurse practitioners are family medicine
  or womens health trained

62
UNC Counseling Center

• Staff
• Psy.D
• L.P.C.s
• Visits
• Group
• individual

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UNC Training Room

• 6 certified ATCs, ____ student athletic training
  students
• ____ visits per year
• Modalities- whirlpool, electrical stimulation,
  phonophorsesis, stretching, soft tissue massage.

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Counseling Services for the Student Athlete

• Presented By
• Carrie Hertweck, Psy.D.
• UNC Counseling Center,
• Staff Psychologist

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University of Northern Colorado

• Teaching program for athletic trainers
• Student Health Center run under a partnership
  between Banner Health Systems and UNC
• UNC Counseling Center funded through student
  fees/visits.

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