Mental Health

Mind, Body and Sport: Potential barriers to accessing mental health services

By Ken Chew and Ron Thompson

Over the past decade, research and reports from university counseling centers have suggested that students are generally using mental health services at a much higher rate. They are displaying higher levels of distress and psychopathology, and their overall coping and adaptive skills are not as well developed as in prior generations.  

Research has repeatedly demonstrated that having access to mental health services has a number of positive benefits, which include reduced risk for behavioral problems and suicide and better overall academic outcomes, including better grades, higher retention rates, and reduced overall liability for the colleges and universities. Further, students who use counseling services generally have higher graduation rates than students who never seek counseling.  

Historically, the perception has been that student-athletes are more well-adjusted than non-athletes and are therefore less likely to struggle with mental health concerns at the same level. Further, studies have shown that participation in sport at the high school level and before acts as a protective factor that leads to more pro-social behavior.  

Nevertheless, as students-athletes move into the collegiate environment, they become at increased risk for issues related to alcohol abuse, aggression, injury and other negative behaviors. More and more, mental health professionals and individuals who regularly work with college-level student-athletes are acknowledging that they may actually be at greater risk for mental health concerns because they have the same risk factors as non-athletes, while also dealing with the pressures related to sport participation. Despite these additional stressors, student-athletes continue to use mental health services at a much lower rate than non-athletes.

Because student-athletes are often perceived as being higher functioning and have a variety of resources available to them to be successful both academically and athletically, it can be difficult to recognize when these individuals are distressed versus just having a bad day. As a result, it’s often not until performance drops or there are recognizable behavioral problems that there is even an awareness that the student-athlete may be struggling. However, that initial recognition and getting the student access to a mental health professional may be challenging because of a variety of barriers that limit or prevent access.

In an effort to improve student-athlete use of mental health services, it’s important to briefly discuss some of the barriers that may make access challenging. These generally fall into three fairly broad categories:  

  • Student variables
  • Barriers associated with service provision
  • A general misunderstanding of the difference between mental health counseling and mental health performance

Student variables

The most common student-related factors that may affect entry into or follow-up in counseling include the stigma around counseling, a desire for a quick fix rather than wanting to go through the process of counseling, fear of change, resistance related to feeling as if they are being made to go versus choosing for themselves, embarrassment, limited time, uncertainty of why they’re being referred, and confusion about what counseling is.  

Of these, the most noteworthy is the stigma related to counseling, which is common to both student-athletes and non-athletes. In fact, stigma is often perceived as the most significant factor preventing people from seeking counseling or being referred.

This especially holds true for student-athletes who may be taught from an early age that they need to persevere and push through pain or discomfort to be successful. The concept of being “mentally tough” actually conflicts with the very concept of counseling, which may require opening up to another person about any perceived weaknesses or things that the individual may be struggling with.  

Nevertheless, it’s important to note that the stigma associated with counseling has been lessening over the past decade, and students in general are seeking services at much higher rates than in the past. In fact, approximately 1 in 4 young adults between 18 and 24 are dealing with some form of mental illness; and it’s estimated that approximately one-third of students entering colleges and universities at this time are coming in with some prior counseling experience or having been on medication for a diagnosed mental health condition.  

Source of service provision and culture

Barriers related to service provision and culture are sometimes the most difficult to navigate because there are so many potential variables that may have an impact, many of which may have developed over time or may be related to institutional structure. Two of these potential barriers in particular are source of service provision, and historical/cultural barriers.  

With regard to the source of service provision, there are currently three major ways that mental health services are provided to student-athletes: (1) counseling centers, (2) positions within athletics, whether dedicated or shared with counseling, and (3) outside consultants. All of these have benefits and barriers.  

Counseling centers. The most common source of mental health service provision to both student-athletes and non-athletes comes from university counseling centers. The benefits of counseling centers are that they typically offer a variety of specialties or service providers, an increased level of privacy, and independence from pressure from athletics administration. Also, counselors are able to easily consult with each other on difficult cases.  

Despite these benefits, the biggest limit is the fact that most counseling centers don’t have psychologists who are trained specifically to work with student-athletes or are aware of sport culture. Additionally, access to services may be slow or difficult during busy times of the year, and there may be pushback from centers that believe that student-athletes are given preferential treatment. Also, hours of availability are often limited, and communication issues between counseling centers and athletics may limit referral. Unfortunately, at many institutions, there has been a historical rift between counseling services and athletics that only has served to add to the challenge of getting student-athletes proper counseling.  

Positions within athletics. Over the past decade, more universities have been moving to a model in which athletics has a dedicated in-house psychologist or a shared position with a counseling center. These positions provide greater flexibility in terms of overall access, and having a person familiar to the department increases use as well as referral.  

Additional benefits may include reduced concerns about higher-profile athletes being identified as being in counseling, consistency of treatment with the sports medicine team, increased availability to consult with or provide training to coaches and athletics administration. Having an in-house person also allows for greater awareness of the culture around athletics at a particular institution, which may be useful in helping student-athletes adjust or work through related pressures.  

Though the benefits may seem great, there are a number of challenges with these positions as well. These may include limited professional support, a high level of demands on a single clinician, limited resources, potential pressures from athletics administration or sports medicine, and professional resentment from other clinicians on campus who may not fully understand the position.  

Also, there can be confusion over whether the student-athlete is being referred for psychological counseling, which centers on helping people who are struggling with personal or mental health concerns and helping them get back to a normal or healthier level of functioning, or sport psychology/mental performance services, which focus on developing optimal performance in relatively well-adjusted individuals.  

Outside consultants. The third method of service provision is the outside consultant who comes in on a part-time basis. The primary benefit of this kind of position is that the athletics department can hire a person with a dedicated specialty to work with their student-athletes on an identified issue or set of issues.  

These arrangements can range from a set amount of contracted time within athletics to see multiple athletes and teams or be limited to seeing a select number of student-athletes for specialized treatment in a private practice setting. For many institutions, having an outside consultant can save on cost and allows for a greater control over access to services.  

Nevertheless, these positions continue to pose as a barrier because access to services is only as available as what athletics contracts; services may be limited based on the specialty of the provider; there may be confusion as to whom the client is; these positions may be less stable over time; and there may be pressures for the consultant to focus more on higher-profile or revenue-producing sports.

With regard to historical and cultural barriers, these are generally more long-standing and persist because of a shared resistance by all involved entities to change. Further, these variables generally overlap with some of the previously mentioned barriers. These may include the prior history between athletics and mental health services, uncertainty about what the other does, general misperceptions from the mental health side about athletics and student-athletes, appropriateness of referral, and issues related to the control and exchange of information, which may include confidentiality and privacy.  

When combined with the previously mentioned barriers associated with stigma, ease and speed of access, limited availability of qualified professional, and confusion about who the client is, it’s not hard to see why working relationships between counseling and athletics may have a history of challenges.  

Future directions

As noted earlier, access to psychological services has positive benefits for the individual as well as the institution. This holds true for athletics as well. Reducing barriers that may prevent student-athletes from receiving mental health services can actually strengthen athletics programs by:

  • Reducing behavioral concerns that may impact team dynamics.
  • Helping prevent or moderate significant drops in academic or athletics performance.
  • Reducing risk and liability associated with mental health concerns.
  • Serving as an additional support for students in need.
  • Improving overall student wellness.
  • Taking pressure off coaches, athletic trainers and other administrators in working with student-athletes who may be in distress.
  • Helping students to enhance functioning in multiple areas of their lives, including athletics performance.

To reduce these barriers and to receive the previously mentioned benefits, we encourage the following best-practice guidelines for athletics departments and university counseling services that can make a difference going forward.

  1. Have a discussion between athletics and counseling services as to the source and structure of mental health services on campus. This should ideally include sports medicine or athletic training, as these individuals have regular contact with student-athletes and are more aware of their personal and mental health needs. The purpose of this meeting should not be to create a specialized service for student-athletes but rather to identify what is available and ways to make referral easier and more user-friendly on both sides.  
  2. Recognize that student-athletes are a specific population with an emphasis on bringing in licensed psychologists with competence in sport or counseling of athletes. Having clinicians aware of the sport culture could ease the referral process, reduce stigma, and start the process of healing any cultural rifts between athletics and counseling.  
  3. Present mental health services to student-athletes as part of the overall sports medicine package and included in any resource guides directed to student-athletes. Being made aware of psychological services, increasing their visibility, and having them normalized early on will serve to reduce stigma and ease referral.  
  4. Make sure coaches and athletics administrators learn the difference between mental health counseling versus mental performance referral to cut down on any confusion with referral.  
  5. Identify a person within athletics or sports medicine whose role includes overseeing the emotional well-being of student-athletes. This individual would help facilitate referral, establish a collaborative relationship with campus and community resources, help create opportunities for counseling and athletics to cross-educate the other as to services and structure, and work with counseling to reduce any barriers that may arise.

Ken Chew has been the director of the Indiana State University Student Counseling Center since 2007. He also serves as director of training for the Counseling Center. Chew received his doctorate from the Virginia Consortium Program in Clinical Psychology in 2001 and completed his undergraduate work at Jamestown College, where he majored in psychology with a minor in fine art. His professional interests include the counseling of athletes, performance enhancement, drug and alcohol issues, multicultural counseling, facilitation of professional and personal development training, and outreach programming. 

Ron Thompson is a consulting psychologist for the Indiana University, Bloomington, Department of Athletics and co-director of the Victory Program at McCallum Place, which offers a specialized eating disorder treatment staff to meet the unique needs of athletes. Thompson has served as a consultant on eating disorders to the NCAA and on the female athlete triad with the International Olympic Committee Medical Commission. He can be reached at rthomps2@sbcglobal.net.

Mind, Body and Sport: Interpersonal violence and the student-athlete population

By Lydia Bell and Mary Wilfert

Sexual assault, harassment, bullying and hazing – these serious interpersonal injuries to an individual’s sense of safety and well-being find their way into athletics departments from the culture at large, tainting the experience of student-athletes.  

When an event unfolds on campus, it can cast a shadow on a university’s reputation as a safe place for emerging adults to explore who they will become and how they will contribute to society. As educators, we have an understanding of some of the underlying factors that may increase the risk of interpersonal violence for students-athletes and students at large.

The challenge before us is to examine components of the athletics culture, including issues around masculinity, encouraging aggression, group-think, bystander effect, homophobia and gender discrimination, that may contribute to violence, and to identify ways to mitigate the impacts of these factors on behavior.

As we consider education and prevention, it’s important to note that many aspects of the student-athlete experience provide opportunities to reinforce positive behaviors and outcomes, including the influence of coach as mentor, the support found in being part of a team, and leadership roles and skill development integrated in competitive play.

We do not have the data to indicate whether student-athletes experience more violence than their non-athlete peers, nor if the athletics culture by nature increases the risk of interpersonal violence. However, violence precursors, such as aggression and control, are part of the athletics culture, and “group-think,” which is embedded in team play, may allow some behaviors to go unchallenged.

Though most men on campus and on athletics teams are not involved in perpetrating violence, most interpersonal violence is perpetrated by men, and occurs more often within the context of group behaviors, and these can include fraternities and athletics teams. It is imperative that we take a critical look at these precursors and assess in what manner and to what extent they need to be tempered to reduce the potential they may exacerbate the behaviors of those with a predisposition to become violent.   

Our data sources include the 2012 NCAA Social Environments Study and the 2008-12 iterations of the National College Health Assessment*. The Social Environments Study features a representative sample of more than 20,000 male and female student-athletes across Divisions I, II and III. The survey included items assessing campus environment, entitlement and aggression, social relationships and help-seeking behaviors, and character education and intervention.

The National College Health Assessment, a comprehensive survey covering issues including substance use, sexual behavior, physical health, weight, personal

safety, violence, and mental health and well-being, is offered through the American College Health Association and administered in either the spring or fall term. Varsity student-athletes were identified upon indicating that they had participated in organized, varsity, college athletics within the last 12 months. All other participants constituted the non-athlete comparison group.

Aggression in athletics

In his 2010 book “Anger Management in Sport,” sport psychologist Mitch Abrams identified two forms of aggression, which he termed as instrumental and reactive. Instrumental aggression is behavior defined by actively, forcefully pursuing one’s goal, where harm to others may be a potential result of the action, but would never be a primary goal.

Reactive aggression or hostile aggression is related to anger, and is behavior that has harming another as a primary goal. Abrams also notes that anger, in and of itself, if not necessarily negative, is an emotion like any other, and does not have to lead to violence.  

In some cases, anger may enhance athletics performance as it prompts a physiological response of increased muscle strength. However, slower cognitive processing, and decreased fine motor skills are also part of that physiological response, which could hamper athletes, depending on the sport.

It is important to keep these differences in mind when viewing the data regarding aggression both on and off the field for student-athletes, as not all aggressive behavior is linked to interpersonal violence.

The 2012 NCAA Social Environments Study examined both athletics aggression and general aggression. Responses indicated that more than a third of males and a quarter of females have been trained to be aggressive in competition and believe that aggression is key to being a good athlete (see the table at the top of the following page).

Additionally, 45 percent of men and 29 percent of women are willing to do whatever it takes to win, and more than a fifth of men indicate that winning is more important than good sportsmanship. It is important to note that these numbers are nearly identical across divisions, with the exception that Division I males agree that they would do whatever it takes to win at slightly higher rates than those in Divisions II and III.

Athletics aggression among NCAA student-athletes

% Agree/Strongly Agree that… Men Women
I’ve been trained to compete with aggression. 42% 25%
Being fiercely aggressive during competition is a key to being a good athlete. 40% 23%
During a competition I would do whatever it takes to win. 45% 29%
Winning is more important to me than good sportsmanship. 21% 5%
I perform better in competition if angry. 26% 14%
If an athlete is fouled hard, he/she is justified in retaliating physically. 15% 5%

The data also reveal that being athletically aggressive may be entwined with unethical decision-making. In determining whether an athlete is justified in retaliating physically when fouled hard, we find that when a student-athlete indicates that he or she has been trained to compete with aggression, he or she is three to four times more likely to agree that the retaliation is justified.

For example, only 2 percent of women not trained to be athletically aggressive agreed that retaliation was acceptable, as compared with 11 percent of the women who were trained to be aggressive. Among men, 7 percent of those not trained to be athletically aggressive agreed that retaliation was acceptable, as compared with a quarter of the men trained to be aggressive.

In examining aggressive behavior off the field, males indicated higher levels of physical aggression than females, which is consistent with existing research on aggression. In most cases, men agreed to these items at twice the rate of women, with the exception of the question asking if they exhibited irritation when frustrated, with nearly one in five men and women agreeing to the item. Additionally, some of these items specifically ask about violent behavior resulting from anger, indicative of reactive aggression.

Aggrssion measures for NCAA student-athletes

% Agree/Strongly Agree that… Men Women
I have trouble controlling my temper. 13% 7%
Some of my friends think I get angry easily. 13% 7%
When frustrated, I let my irritation show. 17% 18%
Given enough provocation, I may hit another person. 19% 6%
I have become so mad that I have broken things. 19% 8%

While these data do not allow us to determine whether general aggression predicts aggression on the field, a relationship between the two scales is clear. Males prone to general aggressive behavior were far more likely to agree that winning was more important than good sportsmanship (64 percent vs. 20 percent), and aggressive females were six times more likely to agree (30 percent vs. 5 percent) that winning was more important than good sportsmanship.

Additionally, as we do not have a nationally representative sample of non-athletes responding to these questions, we do not know if the rates of off-field aggression for student-athletes is any higher or lower than their non-athlete peers.

The influence of alcohol

The role alcohol plays as a factor in violence and sexual assault has been well documented. At least 50 percent of college student sexual assaults are associated with alcohol use.

The NCHA survey data provided insight on negative behaviors attributed to alcohol consumption, which include engaging in regrettable actions, memory loss, police encounters, unprotected sex, physical injury to self or others, and suicidal thoughts.

Behaviors as a consequence of alcohol consumption (Figure 5A)

  Males Females
As a consequence of drinking, have you… Athlete Non-athlete Athlete Non-athlete
Done something you later regretted 33% 27% 33% 28%
Forgot where you were/what you did 32% 27% 30% 24%
Got in trouble with the police 6% 5% 3% 3%
Had sex without giving consent 2% 1% 2% 2%
Had sex without getting consent 1% 1% 0% 0%
Had unprotected sex 19% 13% 14% 12%
Physically injured self 16% 15% 14% 13%
Physically injured another person 5% 3% 2% 1%
Seriously considered suicide 1% 2% 1% 1%

Percentages represent the percent of respondents in each group that answered “yes” to each survey item. The other choices were “No” and “N/A, I don’t drink.” Approximately 20 percent of male and female student-athletes reported not drinking, so if one was to compare only the behaviors of those who drink, the respondents who say “yes” to experiencing these consequences are higher in number. For example, of the nearly 5,500 male student-athletes who reported that they consume alcohol, 24 percent reported that they had had unprotected sex as a consequence of drinking.

As the table indicates, male and female student-athletes report higher rates of alcohol-related regrettable actions and memory loss than their non-athlete peers. The high-profile nature of the student-athlete role, coupled with the pressure to serve as role models, may in part explain this higher rate of regrettable actions.

However, the higher rates of memory loss may indicate higher rates of excessive drinking among the student-athlete population.

The other statistic that bears further consideration is that more than one in 10 students overall reported engaging in unprotected sex related to alcohol consumption, and that this number jumped to nearly one in five among male student-athletes.

Additionally, student-athletes and non-athletes attributed alcohol consumption to incidences of physical violence and sex without consent, reinforcing the role alcohol can play in interpersonal violence.  

Sexual violence

The NCHA survey also gathered data about experiences of sexual violence within the past year. The accompanying table contrasts rates of sexual violence by sex and compares student-athletes with non-athlete populations.

Experiences with sexual violence (Figure 5B)

  Males Females
Within the past 12 months… Athlete Non-athlete Athlete Non-athlete
Sexually touched without consent 4.6%* 3.5% 9.1% 8.5%
Sexual penetration attempted without consent 1.2%* 0.9% 4.0% 3.6%
Sexually penetrated without consent 0.9%* 0.6% 2.1% 2.1%
Sexually abusive relationship 1.0% 0.9% 2.0% 2.1%

As indicated in the table, the percent of student-athletes and non-athletes in self-reported sexually abusive relationships was not significantly different. However, male student-athletes experienced some form of sexual assault at rates significantly (p<.01) higher than their non-athlete peers, and female students overall experienced sexual violence at rates twice that of men, across all categories.   

The data also revealed that lesbian, gay, bisexual and transgender (LGBT) students, independent of sex or athlete status, experienced significantly higher rates of sexual assault within the past 12 months than those who did not identify as LGBT. Such data serve as a reminder that sexual assault prevention training is applicable to both male and female student-athletes, and bring our attention to the need for additional focus on this topic among those athletes who identify as LGBT.

Mental health implications of sexual violence

NCHA survey participants were asked a series of questions about their mental health status within the past 30 days. To understand the mental health implications of sexual assault, the mental health responses of participants who indicated experiencing any sort of sexual assault (touched, attempted penetration, penetrated without consent) within the past 12 months were compared with those who had not experienced any of these conditions.  

The data revealed that for both athletes and non-athletes, males and females who self-reported experiences of sexual assault were significantly more likely to experience hopelessness, mental exhaustion, depression or suicidal thoughts; struggle academically; find it hard to handle intimate relationships; and experience sleep issues.  

However, student-athletes – both those who have experienced sexual assault and those who have not – appear to experience each of these conditions, with the exception of academic struggles, at lower rates than non-athletes. It is important to note that among both male and female student-athletes, those who indicated experiences of sexual assault within the past 12 months were three times more likely to have had recent suicidal thoughts than those who did not (13 percent vs. 4 percent for women, and 12 percent vs. 4 percent for men). (See Figures 5C and 5D)

Hazing and bullying

Hazing has been a topic of discussion for many years, and research has shown that the student-athlete population may be particularly vulnerable when first joining their teams.

The 1999 Alfred University hazing study of college athletics shed light on this topic when it revealed that upon joining their team, more than two-thirds of college student-athletes had experienced humiliating hazing, and half were required to participate in alcohol-related hazing.  

Male responses to mental health items (Figure 5C)

  Male Non-athletes Male Athletes
  No sexual abuse Sex abuse in past 12 mo. No sexual abuse Sex abuse in past 12 mo.
Felt hopeless within last 30 days 22% 33%* 17% 32%*
Felt exhausted (not from activity) within last 30 days 57% 66%* 47% 61%*
Felt so depressed it was hard to function within last 30 days 13% 24%* 10% 23%*
Seriously considered suicide within last 12 months 6% 14%* 4% 12%*
Diagnosed with depression within last 12 months 12% 20%* 8% 12%*
Difficult to handle academics within last 12 months 19% 32%* 35% 51%*
Hard to handle intimate relationships within last 12 months 28% 48%* 27% 48%*
Sleep issues within last 12 months 22% 35%* 18% 32%*

Female responses to mental health items (Figure 5D)

  Female Non-athletes Female Athletes
  No sexual abuse Sex abuse in past 12 mo. No sexual abuse Sex abuse in past 12 mo.
Felt hopeless within last 30 days 27% 40%* 23% 36%*
Felt exhausted (not from activity) within last 30 days 71% 81%* 65% 74%*
Felt so depressed it was hard to function within last 30 days 16% 29%* 12% 22%*
Seriously considered suicide within last 12 months 6% 16%* 4% 13%*
Diagnosed with depression within last 12 months 18% 29%* 13% 19%*
Difficult to handle academics within last 12 months 48% 62%* 43% 59%*
Hard to handle intimate relationships within last 12 months 33% 59%* 31% 55%*
Sleep issues within last 12 months 25% 41%* 20% 34%*

The prevalence of hazing in sport – despite harsher penalties and intensive prevention efforts – has been attributed in part to group-think and masculinity in sport. Athletics teams are like a family and become extremely close, allowing for forgiveness or ignorance of negative situations.

Student-athletes are especially vulnerable to group-think when they are isolated from outside opinions, when they are in homogenous groups, when they are expected to be obedient to “superiors,” and when there are no clear rules for decision-making.

Masculinity can also play a role in hazing, as the definition of being a “real man” can encourage hazing as a practice to prove that one can be physically and emotionally tough.  

Despite increased attention on this topic and stricter enforcement of anti-bullying codes of conduct, the University of Maine’s National Hazing Study (2008) found that more than 55 percent of college students involved in clubs, teams or Greek organizations have been subject to hazing, and more than 25 percent of club advisers or coaches were aware that this behavior was occurring.

Such discouraging data reinforce the need for continued anti-hazing programming for student-athletes, in addition to programming tailored specifically for coaches who may be able to prevent such actions at the outset.

The Maine Collaborative is currently conducting pilot programs on a number of NCAA campuses, engaging multi-departmental cross campus working groups, to test effective comprehensive prevention programs. As a supporter of this effort, the NCAA will receive and share findings to the membership on how best to decrease the risk of hazing.

Cyberbullying

An Indiana State University study in 2011 defined cyberbullying as using technology, such as social networking, text messaging or instant messaging, to harass others with harmful text or images or intentionally isolate another from a social group. The study found that almost 22 percent of college students reported being cyberbullied, 38 percent of students knew someone who had been cyberbullied, and almost 9 percent reported cyberbullying someone else.

Prevalence of cyberbullying

% Agree/Strongly Agree with the following Men Women
White Black Latino Other White Black Latina Other
I sometimes receive negative or threatening messages from fans via social networking sites. 9 17 12 11 3 6 3 4

 

The rise in cyberbullying is not limited to college students, and has received increased attention and in some cases local and state-level law adoption designed to mitigate this behavior among the K-12 population.

Among the student-athlete population, concerns about cyberbullying are not limited to peer-to-peer interactions. The 2012 NCAA Social Environments Study revealed that coaches have begun to encourage student-athletes to interact with fans via social media. While many reported positive interactions, some also noted receiving negative or threatening messages. (See Figure 5E)  

Of particular concern is black student-athletes who reported receiving negative or threatening messages at twice the rate of white student-athletes. Although approximately 80 percent of student-athletes noted that their coaches or others in athletics talk to them about responsible use of social media, departments may also want to consider how to help student-athletes address negative or threatening messages from fans.

Hazing and bullying, both in traditional forms and online, exist in the absence of strong leadership and direction, when groups are allowed to operate in secrecy and without supervision. These groups are more likely to deviate from social norms of conduct when coaches and administrators take a “hands-off” position, and when there are not clear policies or they are not consistently enforced.  

The NCAA Hazing Prevention Handbook recommends actions that administrators, coaches, team captains and athletes can take to ensure an athletics environment that speaks clearly to discourage hazing and that provides positive opportunities to enhance team building and bonding.

The NCAA Social Environments Study revealed that when faced with concerns over hazing and bullying, nearly 30 percent of student-athletes turn first to their parents for advice, support or assistance. While many would turn to teammates or coaches, parents were the most consistent first choice across the sample.

This was particularly true for freshmen, as nearly 40 percent indicated a desire to turn to parents first. As such, athletics departments may consider sharing information about hazing and bullying prevention and campus resources with parents so they can assist their children if approached about this topic.

Various efforts have recognized that effective hazing prevention requires collaboration across campus to assure clear and consistent hazing policies, and targeted educational programming to address the unique cultural elements for various student groups. The NCAA published the Hazing Prevention Handbook (www.NCAA.org/ssi), which provides examples of hazing prevention policy and education, and specific guidance for athletics administrators, coaches and student-athletes.  

Athletics departments can join the broader campus effort to address hazing through www.HazingPrevention.org, which sponsors the annual Hazing Prevention Week (http://www.hazingprevention.org/programs/national-hazing-prevention-week) the third week of September, providing resources that support hazing prevention at the campus level.  

Participation with campus colleagues working to decrease hazing in student groups will facilitate the athletics effort to assure team environments are free of hazing activities.  

Additionally, best-practice models in effective hazing prevention are under development through the National Collaborative for Hazing Research and Prevention (http://umaine.edu/hazingresearch), a multiyear pilot project to build an evidence base to better understand how to change the campus culture in order to reduce the risk of hazing for any one student.  

Intervention and character education

The 2012 NCAA Social Environments Study included items regarding participants’ willingness to intervene in a range of situations that could lead to aggressive or violent behavior. As the accompanying table reveals, the rates of intervention vary widely depending on the situation, and men and women appear willing to intervene at significantly different rates depending on context.

Likelihood of intervention

% Likely/Extremely Likely to do the following Men Women
Step in to stop a fight if someone threatens a teammate 82% 74%
Walk away from a confrontation 58% 74%
Get in a fight if the situation calls for it 50% 19%
Confront a teammate if he/she is treating a partner inappropriately 59% 47%
Intervene in a situation if it could lead to inappropriate sexual behavior 63% 71%

Understanding the considerations students weigh when deciding whether to intervene is useful when designing future training or having relevant discussions about intervention behavior.  

Participants’ responses reveal that there is a range of incentives and drawbacks to intervention that come into play when deciding whether to act. Overall, a large majority of student-athletes felt that they had a duty, at least in some cases, to act in a way that kept others safe. Additionally, many, especially females, agreed that they liked to think of themselves as helpers.

When considering drawbacks, fears of physical harm, angering teammates, and being perceived as over-reacting, often play a role in deciding whether to step in. Perhaps most concerning is that for 37 percent of males and 29 percent of females, intervening is at times perceived as just too much trouble.

Considerations regarding intervention

% who Agree/Strongly Agree with the following statement about deciding whether to help someone in trouble.
Incentives Men Women
All community members play a role in keeping people safe 78% 85%
I like thinking of myself as a helper 58% 89%
Teammates will look up to me if I intervene 59% 47%
Drawbacks    
I could get physically hurt by intervening 45% 40%
Intervening might make my teammates angry with me 43% 41%
People might think I’m overreacting to the situation 40% 37%
Sometimes it’s just too much trouble to intervene 37% 29%
I could get in trouble if I intervene 37% 32%

Character education

The Social Environments Study also included items that asked both about the types of training and character education student-athletes were receiving from their coaches, and also in what areas they would like more discussion or information.

Character education provided to and sought by student-athletes

Coach/athletics department education topic: Men Women
Discussed Want more Discussed Want more
Conducting self appropriately on campus and in community 90% 29%  (#2) 94% 31%  (#3)
Drinking/substance use 87% 25%  (#3) 93% 32%  (#2)
Diffusing/avoiding confrontations 83% 22% 79% 26%
Speaking up when you see things around you that aren’t right 80% 35%  (#1) 77% 47%  (#1)
Appropriate treatment of members of the opposite sex 80% 16% 66% 19%
Hazing/bullying 78% 16% 74% 20%
Relationship violence 67% 13% 54% 18%

More than any other topic, student-athletes want their coach or athletics department to talk about what to do when they see something around them that is not right. This is the No. 1 request across divisions, for both men and women. Student-athletes are seeking empowerment and want to build their skills in bystander intervention.

The second- and third-most requested topics were conducting one’s self appropriately on campus and in the community, and drinking and substance use. Approximately one in three men and women request more information about personal conduct, while women seek information about drinking and substance use at higher rates (32 percent) than men (25 percent). (See Figure 5H)

Coach implications for intervention

In examining character education and intervention, it is important to note some very interesting analyses a colleague at the Harvard School of Public Health has been doing with these data.

Looking specifically at predicting male student-athletes’ willingness to intervene in situations of partner mistreatment or inappropriate sexual behavior, it has been found that having a coach who talks to student-athletes about treating members of the opposite sex appropriately, relationship violence, and speaking up when things are not right, is both directly and indirectly significantly related to their willingness to intervene in both situations.

It is clear that a coach’s messages matter and can play a role in these behaviors. These analyses will be published soon and made available to NCAA members through the NCAA.org/research website.

Future directions

Interpersonal violence in the forms of sexual assault, harassment, hazing and bullying are under intense scrutiny as higher education is held accountable to provide safe environments for student life and learning. Included in this federal oversight are recommendations for education, prevention and response, identifying environmental strategies and bystander intervention training as best practices.  

A critical best practice for athletics administrators is to partner with higher education associations and experts in the field to advance our understanding of the causes and impact of interpersonal violence, and even more importantly to engage in effective prevention practices.

NASPA, the organization for Student Affairs Professionals in Higher Education, is working to identify campus practices that support healthy interpersonal relationships and that deter interpersonal violence. Athletics administrators and educators are encouraged to join in campus efforts, to meet their duties as members of the higher education community, and to address these issues in a true team effort. The NCAA is currently compiling a best-practice handbook on interpersonal violence prevention and response, to be published in the spring of 2014.

Athletics administrators and student-athletes alike are called upon to exert leadership and to model appropriate behavior, as they wear the mantle of high-profile representatives of the university community. Recent federal actions – namely the Dear Colleague Letter of Title IX, and the Campus Sexual Violence Elimination Act or SaVE Act administered under the Clery Act – have increased the duty to achieve compliance in prevention, education, and response to any violent incident. Athletics departments are equally responsible to ensure staff and students are provided resources to intervene and respond to acts of interpersonal violence.  

Current data tell us that a large number of student-athletes have been trained to compete with aggression, and that some, particularly males, exhibit aggressive behaviors off the field as well. Additionally, both male and female student-athletes are victims of sexual assault or relationship violence while on campus. Sexual assault can pose serious threats to an individual’s mental health. Those who have experienced sexual assault are significantly more likely to experience hopelessness, mental exhaustion, depression or suicidal thoughts; to struggle academically; to find it hard to handle intimate relationships; and to experience sleep issues.  

While these data shed light on some of the mental health outcomes related to sexual assault, we also want to bring attention to sexual assault and relationship violence prevention and bystander intervention.

The promise of bystander intervention training is an exciting and welcome strategy, engaging and empowering students to intervene safely and effectively when they see a friend or teammate in distress or at risk for experiencing interpersonal violence in the form of sexual assault/harassment and hazing/bullying.  

The 2012 NCAA Social Environments Study revealed that a surprising number of student-athletes appear to be reluctant to intervene in instances of relationship violence or inappropriate sexual behavior. However, more than a third of male student-athletes and half of female

student-athletes note that they would like to talk more about speaking up when they see things that aren’t right.

Many student-athletes are seeking the means to be empowered to act, and understanding their rationale for deciding when to intervene may assist us in developing programming that can directly address the perceived drawbacks to intervention.   

Sexual assault education of student-athletes and coaches is required in the U.S. Department of Education’s Title IX Dear Colleague Letter (http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201104.pdf). Bystander intervention training is a defined strategy and expectation offered in the 2013 Campus Sexual Violence Education or SaVE Act (http://clerycenter.org/campus-sexual-violence-elimination-save-act) administered through the Clery Act and enforced by the Department of Education, requiring campus compliance in education, prevention and response.  

The Step UP! Bystander Intervention Program (www.stepupprogram.org), which the NCAA supports, provides facilitator-friendly training materials to conduct training with student-athletes and other student groups to help overcome the bystander effect, addressing attitudinal impediments to timely intervention and providing real skill building to safely and effectively intervene when a friend or teammate is at risk.

Athletics departments can expect to be scrutinized and expected to step up and join the campus effort to create safe and healthy learning environments for all students. Athletics administrators are in position to influence the lives of so many, and through this guidance provide a unique opportunity to assist student-athletes to experience what it truly means to be a teammate on and off the field.

Note: The NCAA issued to member schools a new handbook that illustrates the responsibility athletics departments have in collaborating with other campus leaders to fight sexual assault and interpersonal violence. Titled “Addressing Sexual Assault and Interpersonal Violence: Athletics’ Role in Support of Healthy and Safe Campuses,” the handbook was created to help athletics departments partner to change the culture surrounding this issue. The NCAA Executive Committee also issued a statement on sexual violence. To read the statement and to view more information on the issue, visit www.NCAA.org/ssi.

Lydia Bell is the associate director of research for academic performance at the NCAA. Bell assists in all aspects of development and analysis of research on current and former student-athlete academic performance and well-being. Prior to joining the NCAA, she was an assistant professor of practice and director of Project SOAR in the Center for the Study of Higher Education at the University of Arizona. She received her Ph.D. in language, reading and culture and M.A. in higher education from Arizona, and an A.B. in government and legal studies and sociology from Bowdoin College.

Mary Wilfert is an associate director in the NCAA Sport Science Institute. Since 1999, she has administered the NCAA drug-education and drug-testing programs and worked to promote policies and develop resources for student-athlete healthy life choices. She serves as primary liaison to the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, the governing body charged with providing leadership on health and safety recommendations to the NCAA membership. Wilfert has worked in the health education field for more than 30 years to empower individuals to make informed choices for lifelong health and success.

*American College Health Association. American College Health Association-National College Health Assessment, Fall 2008, Spring 2009, Fall 2009, Spring 2010, Fall 2010, Spring 2011, Fall 2011, Fall 2012 ACHA-NCHA II, ACHA-NCHA llb]. Hanover, MD: American College Health Association; (2013-10-31).

 

Mind, Body and Sport: The haunting legacy of abuse

By Cindy Miller Aron

As previous chapters have pointed out, student-athletes may be an at-risk population for developing psychiatric symptoms. But individuals with abuse histories can be at even higher risk, given the likelihood of greater emotional vulnerability.  

The highly functional exterior of athletes often belies psychological fragility. Individuals with histories of abuse can lack the emotional resilience to cope with the ordinary acclimation to college life, let alone the extraordinary demands made upon student-athletes.

The legacy of abuse operates on a preconscious level. There is an individual’s obvious response to an athletics experience, and then there is what lies underneath. It is the preconscious, underlying areas of loss/sadness that compounds the intensity of what occurred.

The individual experiences his or her frustrations or disappointments as greater than the reality of what transpired. The student-athlete loses his or her ability to distinguish how he or she feels from what actually happened. Battling the persistence of these feelings results in an inefficient use of psychological energy. As a result, depletion can occur rapidly. Soon the student-athlete is emotionally running on empty. This is when psychiatric symptoms present.

Individuals with a history of sexual/physical/emotional abuse can suffer from post-traumatic stress disorder, which is a psychological reaction to experiencing a highly stressful event or series of events, outside the normal range of human experience. The disorder is characterized by depression, anxiety, flashbacks, intrusive thoughts and nightmares, among others. The demands of college athletics create an area ripe with “triggers” for the affected student-athletes.

Individuals with abuse histories have an extraordinary sensitivity to boundary violations or perceived boundary violations. A seemingly benign exchange can provoke a flood of effect with debilitating results. These responses can be confusing to the individual as well as teammates and other athletics department personnel. The student-athlete can begin to be labeled as “hot-headed,” “overly emotional,” “an over-reactor,” “too sensitive” and so on. These kinds of dismissive responses trivialize what is a deeper-seated struggle for an individual that bears attention.

Less than benign exchanges, in the form of harsh coaching behavior, create a different set of challenges for those with abuse histories. The familiarity of mistreatment may allow a greater degree of tolerance than for individuals with no abuse history. However, this is not without emotional cost.  

The individual can quickly experience a shrinking sense of self and self-worth, which over time compromises the individual’s ability to manage these exchanges. The student-athlete likely begins to experience increased frustration, distortion in thinking, unrealistic performance expectations and self-deprecating statements.

Coaching feedback can intensify arousal, causing further emotional distress in the individual. The person begins to feel worthless, and helpless about having any impact on the circumstance, which then can lapse into hopelessness. Images of failure loom large, compounded by feelings of embarrassment, self-loathing and the potent affect of shame.

It is common for individuals with abuse histories to experience inappropriate guilt, meaning the assumption of greater responsibility for what transpired than is reasonable. This is the result of the masterful way in which abusers can project responsibility for their actions onto the victim. The abused individual experiences a mistake or disappointment as a crime of sorts for which they need to be punished.

Errors/mistakes are inherent in performance-based endeavors. An athlete can experience a relentless feeling of responsibility for such a metaphoric crime, triggered by a game error or dismal performance. This burden of failure, which “demands punishment,” deploys more assaults on the individual’s self-esteem and sense of his or her own character, further eroding the individual’s effective stability.

Somatic complaints, without medical explanation, are a psychiatric symptom that is split off from the origin in internal distress. These are often manifestations of depression. These can present as pregame nausea, chronic aches/pains, headache and so on.  

Depression/anxiety can come in many disguises, such as psychomotor agitation, balking, hitting a hurdle, cramping and tight muscles. Additional disguises involve psychomotor retardation, inability to pass a fitness test, missing balls/shots and fumbling, to name a few. Somatic complaints bear further exploration. The preconscious conflicts of those with abuse histories can be a primary driver of such concerns.

Student-athletes are especially vulnerable to losses in physical functioning through injury, which removes them from the athletics activity. Considerable research – described in some detail in Chapter 4 of this publication – has been done on this issue outlining predictable post-injury adjustment/depression. For student-athletes, an injury can become a significant life stressor. It not only prevents participation in their sport and with their team, it affects self-image and status on the team. The inability to participate in practice creates increased social isolation, all of which exacerbates their emotional response to injury.  

Individuals with abuse histories can suffer more acute psychiatric symptoms in response to injury as a result of an already compromised sense of self, tolerance for stress, frustration and emotional distress.

Individuals with histories of abuse are also at a higher risk for developing eating disorders. It is estimated that 30 percent of individuals who develop eating disorders have abuse histories. Once again, student-athletes are already an at-risk population for developing eating disorders (see Ron Thompson’s article in Chapter 3). Combine this with an abuse history, and the preponderance of this psychiatric condition comes as no surprise.

An injury or incident can derail a student-athlete, causing a psychological free fall. Some of the warning signs are reckless behavior, such as careless sexual encounters, smoking pot, drinking and irritability, which can translate into fighting. Reckless behaviors are efforts to manage intolerable feelings, and are but temporary solutions that inevitably exacerbate the circumstance at best and can land individuals in considerable trouble at the worst.

The free fall can result in destructive thoughts, such as suicidal ideation, suicide attempts and other forms of self-harm. Student-athletes lose their capacity to manage unacceptable and intolerable feelings, trapping themselves in a black hole of despair.

Student-athletes competing at the collegiate level are at a confluence of circumstances, with limited preparation for the magnitude of the pressures they will encounter. Student-athletes with histories of abuse are subjected to an unusual combination of internal and external pressures that place them at risk for emotional compromise and struggle.

This can be mitigated with keen recognition of the signs of psychiatric distress, combined with early intervention and treatment.

Cindy Miller Aron is a licensed clinical social worker and certified group psychotherapist providing outpatient mental health services, including the assessment, and treatment of depression, anxiety, adjustment disorders, traumatic loss, with specializations in group therapy, late adolescence, sports psychology, supervision and consultation. She is a fellow in the American Group Psychotherapy Association and is the founding president of the Oregon Group Psychotherapy Society. Aron is also a member of the Association of Applied Sports Psychology.

Mind, Body and Sport: Harassment and discrimination – LGBTQ student-athletes

By Susan Rankin and Genevieve Weber

Perhaps nowhere is the expression “the only constant is change” more evident than in higher education. The experiences of college students, including student-athletes, are ever changing, which means that faculty, staff, coaches and administrators have to recognize and act on these changes or they will quickly find themselves left behind.

Those of us who work with students who identify within the queer-spectrum (bisexual, gay, lesbian, queer, pansexual, same-gender loving, etc.) or the trans-spectrum (androgynous, gender-nonconforming, gender-queer, transfeminine, transmasculine, transgender, etc.) can attest to the extensive changes that members of these groups have experienced just in the last decade.

The settings of college campuses have improved for queer-spectrum and trans-spectrum students over the years; yet, when research examines the experiences of queer-spectrum and trans-spectrum students, one group – student-athletes – is routinely absent from studies.

One of the biggest changes has been the age at which students disclose their sexual identity. From the 1970s through 1990s, it was commonplace for queer-spectrum individuals who were planning on attending college, especially if the college was away from home, to wait until they were on campus and had developed new friends before they disclosed their identity. This disclosure is colloquially known as “coming out.”

In some cases, the students were not delaying disclosure, but simply did not recognize themselves as lesbian, gay, bisexual and queer (LGBQ) until they met others like themselves and were in a more supportive environment. Today, with a growing number of gay-straight alliances in middle and high schools, the availability of online resources and (for student-athletes) the rising number of professional athletes who are “coming out,” students more readily understand themselves to be attracted to others of the same sex/gender and often come out in high school and, increasingly, in middle school.

Although there has been an increased focus in the professional literature on the experiences and perceptions of queer-spectrum and trans-spectrum college students, there is limited research examining sexual identity and transgender identity in intercollegiate athletics.

In this section, we offer a review of the influence of campus climate on the well-being of queer-spectrum and trans-spectrum college students, including those who identify as student-athletes. We summarize a large amount of empirical and conceptual research related to the collegiate experiences and perceptions of queer-spectrum and trans-spectrum non-athletes in the absence of student- athlete-focused research. This is based on the assumption that the unique stress related to sexual and gender identity development influences both queer-spectrum and trans-spectrum student-athletes and non-athletes alike.

Campus climate within athletics

Historically, athletics programs on college or university campuses might be sources of specific concerns for queer-spectrum and trans-spectrum students. Studies have shown that despite the diversity of ethnicity, socioeconomic status, geographic background and even sexual orientation, coaches, administrators and student-athletes nonetheless often exhibit heterosexist and homophobic attitudes.

One study of five Division I campuses in fact explored how athletics teams respond to diversity, including race, gender, socioeconomic level, geographic region and sexual orientation. The authors noted that “questions about sexual orientation brought about the most highly charged responses.” Many also denied that LGBT individuals were members of their teams or expressed negative reactions to the idea of having LGBT team members. The overall message from the findings was that hostility toward gay men and lesbians exists on nearly all teams and at all the case study sites.

In one of the first studies to comprehensively explore the perceptions and experiences of student-athletes with regard to campus climate, we developed and tested the Student-Athlete Climate Conceptual Frame, which suggests that individual and institutional characteristics directly influence both how student-athletes experience climate and a variety of educational outcomes unique to student-athletes. At the same time, student-athletes’ experiences of climate can also influence these educational outcomes.

The findings offered that climate significantly affects lesbian, gay, bisexual, transgender and queer (LGBTQ) student-athletes’ academic and athletics outcomes. LGBTQ student-athletes generally experience and perceive a more negative climate than their heterosexual peers. These negative experiences with climate adversely influence their athletics identities and reports of academic success. Although sexual identity is not a direct predictor of academic success or athletics identity, the way LGBTQ student-athletes experience the climate significantly influences both.

Thirty years of research underscore the disproportionately higher rates of depressive symptoms, substance use/abuse, suicidal ideation and suicide attempts among queer-spectrum and trans-spectrum youth.

Experiences with harassment place queer-spectrum and trans-spectrum individuals at high risk for alcohol and drug use/abuse, and previous studies have noted that binge drinking is more prevalent among LGB college students than their heterosexual counterparts and that there is a relationship between psychological distress and alcohol use for LGB college students.

Other studies found that sexual-minority college students were more likely to experience and witness incivility (disrespectful behaviors) and hostility (overt violence), and personal incivility and witnessing hostility were associated with greater odds of problematic drinking. These studies and others generally conclude that experiences with minority stress place LGB individuals at high risk for adverse mental health outcomes, including alcohol and drug use/abuse.

The social stigma and discrimination associated with LGBTQ identities are contributing factors to the elevated rates of depression and suicide as well. Discrimination at the individual level (hostility, harassment, bullying and physical violence) and institutional level (laws and public policies) have been identified as risk factors for depression, social isolation and hopelessness, which in turn place LGBTQ people at risk for contemplating suicide.

Among college students, extant studies also indicate that sexual minorities are at increased risk for poorer mental health, including suicide attempts. LGB students have been found to be more depressed, lonely, and had fewer reasons for living compared with heterosexual students.

How athletics departments can help

While many of the experiences of LGBTQ student- athletes are similar to the general population, there are several ways in which their lives are very different from their heterosexual peers. Overall, “in-house” harassment, or harassment experienced at practice or similar athletics-related events, whether intentional or not, is the most prevalent kind experienced by our respondents. It follows, therefore, that athletics departments have the power to improve the collegiate experiences of all student-athletes through cooperation with athletics personnel, student- athletes and faculty members at their institutions.

However, to effectively address the experiences of LGBTQ student-athletes in particular, it behooves athletics personnel to look beyond the obvious and attend to the myriad ways in which LGBTQ student-athletes encounter discrimination and harassment as they strive to achieve both academic and athletics success as well as overall well-being in college.

We propose the following best practices for creating positive campus climates for queer-spectrum and trans-spectrum student-athletes.

The power of language. First, we encourage the use of language that extends beyond the binaries in all of the following recommended potential best practices. Many individuals do not fit the socially constructed definitions of gender identity, sexual identity and gender expression. Language instills and reinforces cultural values, thereby helping to maintain social hierarchies. While definitions facilitate discussion and the sharing of information, terminology remains subject to both cultural contexts and individual interpretation. As a result, the terminology that people use to describe themselves and their communities is often not universally accepted by everyone within these communities.

Therefore, it is recommended that we value the voices of those within our campus communities and use language that reflects their unique experiences. It is important for athletics personnel to familiarize themselves with the language offered in the beginning of this article with respect to LGBTQ communities. Using inclusive language provides a sense of safety for LGBTQ student-athletes.

Finally, the frequent use of derogatory language such as “faggot,” “that’s so gay,” or “dyke” are common sources of harassment experienced by LGBTQ student- athletes. Language is powerful and has a significant impact on LGBTQ student-athlete success. To create a more inclusive environment, we encourage athletics personnel to respond quickly to end the use of derogatory language aimed at LQBTQ student-athletes.

Offer a visible and supportive presence. There are multiple venues where intercollegiate athletics can offer a visible and supportive presence. This serves two goals: (1) It lets the LGBTQ community know that intercollegiate athletics at your institution is knowledgeable of the issues/concerns facing the LGBTQ community and stands as an ally in the fight against anti-LGBTQ bias, and (2) It provides an environment for LGBTQ student-athletes and athletics personnel to feel safe and supported in acknowledging their sexual and/or gender identities.

  • Create an athletics department or individual team videos (PSAs) that show your support of LGBTQ people and student-athletes. New York University (http://www.youtu.be/MriTHFvYZVc) and the University of North Carolina, Chapel Hill, (http://www.youtu.be/e4TJqZXk12A) have developed videos to give you an example.
  • Support LGBTQ events on your campus (for example, National Coming Out Day; Day of Silence, LGBTQ Pride Week) by encouraging student-athletes and athletics personnel to attend the events. Just standing in solidarity alongside LGBTQ students and allies will speak volumes with regard to your support and may encourage them to attend more athletics events. If your institution has an LGBT Resource Center, they can provide a calendar of events. For a list of LGBTQ Resource Centers or other support services available on your campus, go to the Consortium of Higher Education Lesbian Gay Bisexual Transgender Resource Professionals home page at www.lgbtcampus.org.

Develop inclusive policies. Policies that explicitly welcome LGBTQ student-athletes, coaches and athletics personnel powerfully express the commitment of an athletics department and, based on the results of this project, will add to team success (winning!). Individuals will be more likely to be open about their sexual identity or gender identity when they know that the institution is supportive. When individuals do not have to expend energy hiding aspects of their identity, they are able to focus on team and individual goals.

Our recommendations include:

  • Develop/enforce inclusive policies. If your institution does not have a nondiscrimination policy inclusive of actual or perceived sexual identity, gender identity, and gender expression, you can work with senior administrators to adopt one.
  • Develop fair and consistent enforcement (consequences) for incidents related to the inclusive nondiscrimination policies.
  • Prohibit homophobic, transphobic, and heterosexist behavior and language by fans at athletics events.
  • Include sexual identity and gender identity in the athletics department’s student-athlete handbook.
  • Include sexual identity and gender identity in the Student-Athlete Advisory Committee (SAAC) publications.
  • Extend health insurance coverage to athletics personnel’s same-gender partners/spouses.
    • If the institution does offer health insurance coverage, “gross up” wages for employees who enroll for these benefits to cover the added tax burden from the imputed value of the benefit that appears as income for the employee.
    • If the institution cannot offer health insurance coverage to employees’ same-gender partners/spouses, offer cash compensation to employees to purchase their own health insurance for same-gender partners/spouses.
  • Include sexual identity and gender identity issues and concerns or representations of people with various sexual identities and gender identities in the following:
    • Application for student-athlete financial aid/athletics grants-in-aid
    • Student-athlete health intake forms
    • Alumni materials/publications
  • Offer students who identify outside the gender binary the ability to self-identify their gender identity/gender expression, if they choose, on standard forms. For example:
    • Application for admission
    • Application for housing
    • Student health intake form
  • Provide appropriate health care for transgender student-athletes.

Increase awareness of LGBTQ issues and concerns. Since LGBTQ and non-LGBTQ individuals are socialized into a homophobic and heterosexist society, athletics community members need the space to question and examine unfounded attitudes and beliefs.

Acknowledging the contributions of LGBTQ former athletes/coaches in the sports arena is important to fully integrate LGBTQ concerns and experiences into the athletics community. The omission of such topics from athletics “de-historicizes” LGBTQ experiences and paints a false picture of the world in which we live. We offer the following potential best practices for consideration:

  • Provide the 2013 Champions of Respect: Inclusion of LGBTQ Student-Athletes and Staff in NCAA Programs to all athletics personnel. A copy of the publication is available at www.NCAA.org/lgbtq.
  • Integrate LGBTQ issues and concerns into the Challenging Athletes’ Minds for Personal Success (CHAMPS)/Life Skills Program for student-athletes.
  • Integrate LGBTQ issues into existing courses for student-athletes. For example:
    • First-year student-athlete class (first-year seminar)
    • Student-athlete leadership development courses
    • Athletic Directors Leadership Institutes
  • Integrate LGBTQ issues and concerns into existing professional development programs. For example:
    • National Association of Collegiate Directors of Athletics (NACDA) Management/Leadership Institute
    • NACDA Sports Management Institute
    • NCAA Women Coaches Academy (WCA)
    • NCAA Achieving Coaches Excellence Program (ACE)
    • NCAA Career in Sports Forum (Forum)
    • NCAA Diversity Education Workshops
    • NCAA Emerging Leaders Seminar
  • Include programs that incorporate topics regarding sexual identity and gender identity in all new athletics personnel orientations.
  • Promote the use of inclusive language in all athletics venues (playing fields, locker rooms, training rooms, etc.).
  • Create a pamphlet with examples of heterosexist assumptions and language with suggested alternatives.
  • Provide course credit to LGBTQ student-athletes for participating in peer education initiatives (Straight Talks, Speakers Bureaus, etc.).
  • Offer programming to discuss multiple identities of LGBTQ people (LGBTQ Latinos/Latinas, international LGBTQ people, LGBTQ people with disabilities, LGBTQ Muslims, etc.).
  • Offer resources about LGBTQ people and the intersections of their sexual identity and gender identity with their religious and/or spiritual needs (Unity Fellowship for Students, Gays for Christ, etc.).
  • Acknowledge the different ways that LGBTQ student-athletes experience harassment. Take steps to improve their perceptions of climate (for example, athletics department responses to acts of anti-LGBTQ bias incidents).

Respond appropriately to anti-LGBTQ incidents/bias. As long as anti-LGBTQ bias persists in athletics, LGBTQ student-athletes and athletics personnel will need to feel safe and supported by their departments when acts of anti-LGBTQ intolerance occur. LGBTQ student-athletes and athletics personnel should be able to speak and act without fear of homophobic reprisal.

  • Offer a clear and visible procedure for reporting LGBTQ-related bias incidents.
  • Develop a bias incident and hate crime reporting system for LGBTQ concerns that includes the following:
    • Bias incident team
    • Methods for supporting the victim
    • Outreach for prevention of future incidents
    • Protocol for reporting hate crimes and bias incidents

Offer comprehensive counseling and health care. The literature suggests that LGBTQ people who experienced both ambient and personal heterosexist harassment had the lowest overall well-being as compared with respondents who experienced only ambient heterosexist harassment and those who did not experience any heterosexist harassment.

Given that our results indicate many LGBTQ student- athletes experience heterosexist climates, the need for counseling support is evident. Further, more students are “coming out” as transgender in intercollegiate athletics. Although this growing population has unique needs related to physical and mental health care, most colleges and universities offer little or no support for this population.

We recommend the following best practices for addressing the counseling and health care needs of LGBTQ student-athletes:

  • Offer support for student-athletes in the process of acknowledging and disclosing their sexual identity and for other concerns with one’s sexual identity.
  • Offer counseling services that support LGBTQ people, with a staff that knows and understands LGBTQ student-athletes’ needs and experiences.
  • Provide training for team physicians, athletic trainers and other medical staff to increase their awareness of and sensitivity to LGBTQ people’s health care needs.
  • Actively distribute condoms and LGBTQ-inclusive information on HIV/STD services and resources.
  • Offer a student health insurance policy that covers ongoing counseling services for transgender students who need such counseling, as consistent with the World Professional Association for Transgender Health’s (WPATH) Standards of Care.
  • Offer a student health insurance policy that covers the initiation and maintenance of hormone replacement therapy for transgender students who need such therapy, as consistent with the World Professional Association for Transgender Health’s (WPATH) Standards of Care.
  • Offer a student health insurance policy that covers gender confirmation (“sex reassignment”) surgeries, including mastectomy and chest reconstruction, breast augmentation, complete hysterectomy, genital reconstruction and related procedures, for transgender students who need such surgeries, as consistent with the World Professional Association for Transgender Health’s (WPATH) Standards of Care.

Increase awareness of transgender issues and concerns. In 2010, the NCAA reported that its national office received 30 inquiries in the previous two years about how colleges should “deal with transgender athletes.” Those numbers, NCAA officials offered, could increase, given that more people than in the past are identifying themselves as transgender, more are doing so at younger ages than in the past, and a growing number of colleges have anti-bias policies that cover gender identity.

A report titled, “On the Team: Equal Opportunity for Transgender Student-Athletes,” argued that in this environment, the lack of a national standard is unfair both to transgender students and to all student-athletes. The report divides its recommendations for colleges into two categories of transgender students: those who are undergoing hormone treatments and those who are not, and the report notes that many people who identify as transgender do not take medical steps.

For those undergoing hormone treatments, the report recommends that a male-to-female transgender student-athlete should be able to participate on a men’s team but should complete one year of hormone treatments before competing on a women’s team.

The report recommends that a female-to-male transgender student-athlete who is taking prescribed testosterone should be allowed to compete on a men’s team but must seek an exemption to NCAA rules barring the use of testosterone.

For those not undergoing hormone treatments, the report recommends that transgender students should have the option of competing on the teams consistent with sex assigned at birth, female-to-male students be allowed to participate on either the men’s or women’s team, but that male-to-female transgender students not be permitted to compete on women’s teams.

In 2011, the NCAA clarified its policies on transgender student-athletes. The new policy, which embraced the suggestions in the 2010 report from the National Center on Lesbian Rights and the Women’s Sports Foundation, ensures that student-athletes are allowed to participate on male or female teams, so long as they adhere to two key rules. The policy required no new legislation but rather clarified two pieces of existing legislation regarding banned substances – namely, testosterone – and a team’s official “status,” determined by the gender of its players.

  • Provide the publication “On the Team: Equal Opportunity for Transgender Student-Athletes” for all athletics personnel. A copy of the publication is available at http://www.nclrights.org/wp-content/uploads/ 2013/07/TransgenderStudentAthleteReport.pdf
  • Provide the 2011 NCAA Policy on Transgender Inclusion to all athletics personnel. The policy is aimed at allowing student-athletes to participate in competition in accordance with their gender identity while maintaining the relative balance of competitive equity among sports teams. The policy will allow transgender student-athletes to participate in sex-separated sports activities so long as the student-athletes’ use of hormone therapy is consistent with the NCAA policies and current medical standards, which state:
    • A trans-male (female to male) student-athlete who has received a medical exception for treatment with testosterone for gender transition may compete on a men’s team but is no longer eligible to compete on a women’s team without changing the team status to a mixed team. A mixed team is eligible only for men’s championships.
    • A trans-female (male to female) student-athlete being treated with testosterone suppression medication for gender transition may continue to compete on a men’s team but may not compete on a women’s team without changing it to a mixed-team status until completing one calendar year of documented testosterone-suppression treatment.
  • Provide the resources offered by the NCAA to all athletics personnel that includes:
    • Inclusion of Transgender Student-Athletes resource book.
    • A CD that contains the resource book and a slide presentation to educate administrators and student-athletes.
    • A 30-minute video that discusses transgender issues.
  • Increase the awareness of student-athletes regarding transgender student-athletes and policies in the NCAA.

Further recommendations for future research and promising best practices are offered in recent studies by Beemyn and Rankin (2011), Marine (2011) and Rankin et al. (2010).

Other recommended resources include the Campus Pride Friendly Campus Index (http://www.campuspride index.org/), Promising Practices for Inclusion of Gender Identity/Gender Expression in Higher Education (http://www.campuspride.org/tools/promising-practices-for-inclusion-of-ge...), and the Consortium for LGBT Professionals in Higher Education Architect (http://www.lgbtcampus.org/architect).

Susan Rankin is a research associate in the Center for the Study of Higher Education and associate professor of education in the College Student Affairs Program at Pennsylvania State University. Rankin earned her B.S. from Montclair State University in 1978, an M.S. in exercise physiology from Penn State in 1981, and a Ph.D. in higher education administration in 1994, also from Penn State. Before moving into her current position, Rankin served for 17 years as the head softball coach and a lecturer in kinesiology at Penn State. She has presented and published widely on the impact of sexism, racism and heterosexism in the academy and in intercollegiate athletics.

Genevieve Weber is an associate professor in the School of Health and Human Services at Hofstra. She is also a licensed mental health counselor in the state of New York with a specialization in substance abuse counseling. Weber teaches a variety of courses related to the training of professional counselors, includes group counseling, multicultural counseling, psychopathology, and psychopharmacology and treatment planning. In her research and professional presentations, she focuses on the impact of homophobia and heterosexism on the lives of lesbian, gay, bisexual and transgender (LGBT) individuals, with particular attention to the relationship between homophobia, internalized homophobia, and substance abuse among LGBT people.

Mind, Body and Sport: Harassment and discrimination – ethnic minorities

By Terrie Williams

While previous sections of this publication talked at length about common stressors on student-athlete mental health because of the unique position these students are in as athletes, cultural factors exist that complicate those stressors even further for under-represented student- athlete populations.

As a woman of color and someone who has experienced her own clinical depression, I am acutely aware of the challenges and stigma facing blacks when trying to address mental health issues. And as a trained licensed clinical social worker, I’ve had the great opportunity to engage with the National Alliance on Mental Illness, the Substance Abuse and Mental Health Services Administration, and other mental health organizations that have allowed me to create mental health advocacy campaigns for the black community. 

The following comments focus on the work my colleague, Yolanda Brooks, and I have done over the past decade with black male athletes. To be sure, there are some commonalities in the experiences of black male athletes and the experiences of men and women from other racial and ethnic minority groups – and in the experiences of student-athletes from socioeconomically disadvantaged backgrounds, across all races and ethnicities. In my work with black male athletes, I have seen many struggle with socioeconomic barriers and remnants of a racist system that continues to plague many in this community. It is critical that athletics administrators and others working with minority and socioeconomically disadvantaged

student-athletes gain an appreciation for their unique experiences and backgrounds. 

To be a black man in our society often means to experience overt violence and subtle forms of racism. It may mean being stopped and frisked, racially profiled and made to feel insecure about the complexion of one’s skin. It may mean feeling pressure to not appear threatening to others for fear of being further harassed by police. Even in the absence of overt discrimination and racial violence, black men are too often aware that discrimination and violence are possible. Having to be constantly on guard has real physiologic consequences.

The young, developing black male may have experienced family violence and an absentee father. In some families, as a coping mechanism, black men are taught to cut off their feelings and normalize horrific events that happen to them personally or to people they know. What happens to the child and/or adult who watches a relative – or anyone – be killed in front of him and then has to go about his normal routine?

Another cultural factor that can negatively affect a young, developing black male is an adherence to hip-hop culture, which is heavily influenced by street culture and may define “ownership” of women and money as a means to feel valuable in place of authentic self-esteem. Within these settings, a maturing black male may learn or interpret that in order to be considered a man, one never discusses his feelings. It becomes safer to lash out in anger than to let on to the hurt within. The bruised ego, pride and self-loathing eventually manifest into a stoic demeanor that sabotages any chance of meaningful and intimate relationships.

In a number of instances, as young black student-

athletes were developing, parents altered the family lifestyle (changed/left jobs, moved to another city, etc.) so that the most talented child would have the best opportunity to succeed in his/her sport. This could mean playing for the best elite team (which is expensive) or getting the coveted college athletics scholarship.

But if the student-athlete is underperforming, loses passion for the sport or wants to develop a more balanced lifestyle (engaging in social behaviors of a typical adolescent athlete versus the insulated, isolated, intense, laser-focused, all-consuming lifestyle of elite sports), there may be strong pushback from the support network – especially those who’ve sacrificed or have made a strong investment in the student-athlete. They aren’t allowed to quit even if they wanted to, as there has been too much invested in that student-athlete – too much is at stake.

When they arrive at college, many black student-athletes experience an additional set of stressors. These can include a feeling of isolation from the majority and from dominant social-cultural aspects of college life, the absence of supportive social networks outside of sports, academic struggles (and in some instances, barriers) created by socioeconomic challenges. 

In environments where there are sociocultural differences, some black student-athletes may struggle to transition and fit in. This may overwhelm an already stressed individual. Student-athletes – particularly those in high-profile sports – are not new to high-pressure situations. However, if stretched beyond their capacity to manage, they may find themselves struggling to adjust to the demands of their life situation regardless of talent, potential or sport.

These stressors can leave the student-athlete overwhelmed and vulnerable to developing stress-related symptoms, mental disorders such as clinical depression and anxiety, or even at higher risk to incur a career-threatening injury. As a group, blacks tend not to seek help for psychological problems – and student-athletes are even less likely to do so in fear of appearing weak and vulnerable.

Managing all of these stressors and pressures can challenge the strongest adult; however, for a college student- athlete (who is still growing and developing mentally and physically), such demands can quickly overwhelm and lead to serious mental and behavioral problems. Reactionary high-risk behaviors (substance abuse, sexual promiscuity, illegal activity, etc.) may emerge along with avoidance and detachment from support networks.

To effectively address this issue, there need to be outreach strategies embedded systemically in collaborative athletics and health programs in order to identify, enhance and encourage these student-athletes to access support – and if warranted, intervention – before sliding down the slippery slope of stressed to distressed to depressed.

 

Mind, Body and Sport: Risk factors in the sport environment

By Emily Kroshus

Many mental health disorders are at least partially rooted in genetic biological predispositions (genetic vulnerability). However, genetic vulnerability is not destiny – environmental stressors and resources play a critical role in whether individual vulnerabilities turn into burdensome health conditions. By environment, we mean all of the factors outside the individual, ranging from their interactions with people close to them, to institutional policies and programs, to the broader culture within which they live, learn and play.

Collegiate student-athletes face many of the same mental health risk factors as their non-athlete peers, but their roles as student-athletes both expose them to additional environmental risk factors and offer protective resources to help mitigate those factors.

The environmental risks can take the form of direct stressors (for example, time demands, performance pressures, coaching style); interactions with others in their environment that encourage risk behaviors and discourage individuals from seeking help; harassment and discrimination related to personal characteristics such as race/ethnicity or sexual orientation; and exposure to interpersonal or sexual violence.  

The protective factors can include prevention and screening programs, and interactions with others that encourage individuals to seek help.  

These risk and protective factors are introduced briefly below, and then discussed in greater detail later in the chapter in essays from leading clinicians.   

Sport-related stressors

Stress is not inherently bad. In fact, in many cases it is a healthy part of growth. However, if it is chronic or inadequately managed, it can result in negative health outcomes either directly or through unhealthy coping behaviors (such as substance abuse).  

Interactions, resources, policies, programs and cultural attitudes in the sport environment have the potential to reduce the presence of stressors and to help student-athletes deal effectively with them.  

Time demands are a frequent source of stress for student-athletes. Many student-athletes spend more than 30 hours per week on their sport, with extensive in-season travel and early morning practices that limit sleep. Managing both sport and academic demands often results in elevated stress, inadequate sleep, and an inability to participate in other extracurricular or leisure activities that help promote overall well-being. Because of the physical demands on their sport, many student-athletes need more sleep than the average college student. Individuals with adequate sleep also respond more effectively to stressors as they arise. Research has indicated that sleep is critical for mental acuity, sport performance and injury prevention.

Another frequent source of stress is pressure to perform athletically. Some of this pressure is self-imposed. When sport is central to identity, so is sport performance. Pressure often comes from outside sources, most critically from coaches. Coaching style plays a role. When coaches use an ego/performance-centered motivational climate (as compared with a skills-mastery motivational climate), student-athletes tend to experience greater anxiety and distress, and are at elevated risk of negative outcomes, including burnout and disordered eating.

Institutional policies matter, too. Athletics scholarships put a dollar value on athletics performance, and policies related to scholarship reductions heighten performance-related pressure for student-athletes, particularly those with financial need. Interactions with parents, peers and fans can put a premium on athletics performance and a microscope on failure to perform athletically. The growing use of social media allows alumni and other fans to interact with student-athletes directly, and can have the result of exacerbating this pressure.

Normative behaviors

Interactions with teammates can be a source of risk – or protection. Adolescents and young adults often place a high value on peer approval and in looking and acting like their peers. For student-athletes, this often means teammates. The stronger the group’s identity and cohesion, the more important individuals tend to find conforming to the group’s norms.  

Sports teams often have extremely high group identity and cohesion. When some teammates model unhealthy behaviors, such as disordered eating or substance use, other teammates are at elevated risk of adopting those behaviors. Whether exposure to or experimentation with these types of unhealthy behaviors results in an individual progressing to a clinically diagnosable mental health disorder depends in part on his or her underlying genetic vulnerability. However, environment matters a great deal.  

Another way in which teammates and others in the sport environment can influence mental well-being is in the extent to which mental health issues and help-seeking are stigmatized or encouraged. If teammates and coaches stigmatize mental health conditions or encourage a culture of toughness and not admitting weakness, symptomatic or at-risk individuals will be less likely to disclose their mental health conditions or seek help. Conversely, teammates who don’t stigmatize disclosure of mental health conditions and who encourage help-seeking can be powerful positive forces. Coaches can play a critical role in serving as a resource for student-athletes who want to discuss mental health issues, and in encouraging or discouraging help-seeking for these issues.  

Harassment and discrimination

Minority populations, including racial/ethnic minorities and sexual minorities, often experience negative mental health outcomes connected to their experiences with harassment and discrimination. While some sport environments may be fully inclusive of all minority groups, others are not. Additionally, while the sport environment is a critical one for student-athletes, it is not the only environment in which they function. Even when a sport environment is fully inclusive, student-athletes from minority populations who are stigmatized or who experience more overt forms of harm such as verbal harassment and violence in nonsport environments can experience negative health consequences. For example, sexual minority college students tend to experience more anxiety and mood disorders, engage in more frequent suicidal ideation, and make more suicide attempts than their heterosexual peers.

The Minority Stress Model has helped explain this difference. Acute and chronic stressors – including violence and harassment and the fear of violence and harassment occurring – as well as internalized stigma lead to physiologic responses, such as elevated cortisol levels. These physiologic processes can have direct bodily harm. They can also increase the risk of maladaptive coping behaviors such as substance abuse.

In addition to ensuring that sport environments are free of harassment and discrimination of minority populations, coaches, clinicians and others who interact with student-athletes need to be aware that individuals of minority status may be shouldering a heavy load from their experience functioning outside the sport environment. In some cases, it may be appropriate to engage resources to help athletes cope with these external sources of stress, or at the very least to function in a supportive and understanding role.

Interpersonal violence

Experiencing interpersonal violence, particularly sexual violence, can have lasting mental health consequences. Recent evidence from the National Collegiate Health Association indicates that nearly 10 percent of female college students have been sexually touched without their consent during the past 12 months, with no significant differences between athletes and non-athletes.  

Sexual minority students – both male and female, athlete and non-athlete – experienced significantly higher rates of sexual assault within the past 12 months than those who did not identify as lesbian, gay, bisexual or transgender. Individuals who self-reported experiences of sexual assault were significantly more likely to struggle academically, find it hard to handle intimate relationships, and experience hopelessness, mental exhaustion, sleep issues, depression and suicidal thoughts.

Interpersonal violence, including hazing and bullying, may be elevated in certain sport environments. While being a student-athlete does not increase risk of experiencing sexual violence, student-athletes who experience sexual violence or other forms of interpersonal violence in any settings bring these experiences and the resultant mental health consequences back with them to the sport environment. Consequently, individuals in the sport environment need to be aware of the resources available to student-athletes so that they can manage the mental health consequences that often result from experiencing these forms of violence. Individuals in the sport environment can also play an important role in encouraging victims of violence to report their experience and in supporting them emotionally in this process.

*  *  *  *

The sport environment matters for both risk and prevention of mental health disorders. Unique stressors often accompany the experience of being a student-athlete. Resources in the sport environment can potentially mitigate stressors and encourage help-seeking for individuals who are experiencing mental health disorders or who are at risk of these disorders.

Student-athletes benefit from being part of the sport family – with teammates and coaches who see them on a daily basis. Whereas many students transitioning to college run the risk of being isolated and not finding a supportive community, college student-athletes often have a built-in community from the moment they step foot on campus.

Student-athletes are often used to working with a team of multidisciplinary health care professionals to facilitate optimal health and sport performance. Coaches, athletic trainers and teammates can reinforce to symptomatic individuals that mental health professionals are just one more piece of this equation.  

Student-athletes are also used to adhering to routines and dealing with aversive conditions rehabilitating injuries – and receiving support from teammates and coaches during this process. The process of recovery from mental health disorders can in some cases be similarly onerous – and social support matters a great deal here, too.

Drawing on the experience of recovering from other health- and performance-impacting injuries in the sport environment can help more positively frame mental health-related treatment-seeking and adherence for the symptomatic individual.   

While the sport environment presents numerous risk factors for student-athlete mental health, it can also play an important role in prevention and wellness. Reducing unnecessary sources of stress and stigma in the sport environment, increasing access to resources to help mitigate stress, and encouraging help-seeking for mental health disorders are all critical ways in which the sport environment can function to improve mental well-being among student-athletes.

Emily Kroshus is a Postdoctoral Research Fellow at the Harvard School of Public Health and the NCAA Sport Science Institute. She received her doctoral degree from Harvard School of Public Health in the department of social and behavioral sciences, with a concentration in health communication. As an undergraduate at Princeton, Kroshus was a three-time NCAA Division I All-American in cross country and track and field.

Mind, Body and Sport: Student-athletes in transition

By Penny Semaia

It’s been 10 years since I last strapped on a helmet and played the game that has done so much for me. Yet, I still have this bond with football that seems to never go away. It’s almost like a sixth sense that pops up when someone mentions the game. When I’m watching a Pitt game at Heinz Field, it’s as if each play is in slow motion. I see every block. I can predict certain movements. Sometimes, I catch myself lifting my arm up as if I was the one shedding a block. I laugh when I think about it. I laugh even harder when I see my old teammates do the same thing. It’s a reflection of our past and what we were – student-athletes.

Today, I work in student-athlete development at the University of Pittsburgh, where I earned my degree and played football. Although it’s been a long time since I played, I’ve transitioned out of my sport in my own way, yet am still connected to it through work and play.

However, not everyone is as fortunate as I am, in the sense that I’m still connected to my sport and alma mater on a daily basis. For much of the 10 years that I’ve been out of uniform, I’ve witnessed many of my student-athletes go through their own transition of taking off their jersey for the last time. For some, it was seamless; they were able to move on to the next phase of their life and not look back. For others, it was the day they wanted to avoid the most; the day they realized they are no longer athletes. Their commitment to their sport had been their identity for as long as they remembered. Now, their identity is a question mark.

As professionals working in student-athlete development, it is our duty to help our student-athletes gain the knowledge and skills to prepare for life after sport. In the area of identity and life transitions, this is one of the most difficult and time-sensitive topics. There is a fine balance to helping student-athletes understand the importance of focusing on their current situation while also preparing them for the next stage. I believe that one of the most important steps in helping student-athletes successfully navigate this transition starts with establishing a strong baseline relationship with them. Programs and resources are important, but in my experience, they are most effective when delivered with what I like to call a human touch.

For example, a student-athlete walked into my office, sat down and stared at me. She said, “Penny, I can’t believe this is it. It’s over. I’m done with track.”

Knowing this student-athlete, I knew she had a great job lined up and was prepared. Yet, she was so caught up in her athletics career ending. My immediate response was, “How do you feel?” She answered, “Well, I don’t know. I’m just … I don’t know.”

I’m sure this sounds familiar. It’s the end of the academic year. We get the trickling-in of seniors who just want to chat, and the conversation somehow always flows into the end of their athletics career. I always anticipate going into this topic with seniors. We’ve been talking about it since day one.

This is where the human touch is most important. The key is taking all of the programs and services that we deliver and narrowing them down to the individual level. It’s also about understanding our student-athletes as individuals and knowing that they are all unique.

For example, just because two student-athletes may compete in the same sport and are from the same region, or even the same family, we cannot assume that we will serve them in a similar way as individuals. The groundwork to all of our programs and services relies on the human touch approach.

The initial phase of this happens by developing:

Positive and trusting relationships. When student-athletes trust us, they will approach us for anything – especially when they need help facing the end of their athletics careers. One thing that has helped me gain trust is taking the time to really listen – that has allowed me to get to know student-athletes as individuals. The information gained through listening, no matter the topic, is often vital for future conversations. I always take notes after my meetings with student-athletes, no matter how insignificant it seems at the time (such as noting a pet’s name). I know that this information can be useful when I need to communicate with them in the future. The more our student-athletes know that we are interested in them, the more they will begin to trust us.

Once this is established, we can have real conversations about their future long before the end of their athletics career is imminent. To quote Theodore Roosevelt, “People don’t care how much you know until they know how much you care.” It’s when our student-athletes know that we care enough about them that they will open up.

Instances in which our student-athletes will need support are career-ending injuries, end of eligibility, and stressors in play (not playing at the same level or up to their or their coaches’ expectations). The relationships we build when our student-athletes are under the least amount of stress can help us identify the times when their behaviors are out of character. This is where our gauge of our student-athletes is both a benefit and vital to helping provide the necessary care for them.

Exercise patience. We need to know and understand that athletics is a big deal for our student-athletes. They wouldn’t be participating if it wasn’t! This came up for me early in my career while I was trying to help a young football player.

This young man did not play at all before his senior year. Following his senior season, during which he got in a few times, he still wanted to focus on working out and postpone finding a career. I was trying to help him focus on moving on. In my mind, he was a long shot and he didn’t even see that. I wanted him to know and understand this, so I took the “keeping it real” approach of providing statistics of student-athletes who play professionally, horror stories and anything else that revealed the odds that this was not a viable path for him. The more I tried to talk to him, the more he didn’t want to hear me.

This was very frustrating for me. Everything led to a standstill in our progression. It wasn’t until I heard someone say, “Who are we to shatter a kid’s dream?” that I reevaluated my train of thought. They were right. Who was I to tell this young man he shouldn’t pursue his dreams? That really stuck with me.

Since that experience, I’ve shifted my approach and have focused on the idea of Life Beyond Sport. Instead of saying, “move on,” my approach is “prepare for when the day comes.” Helping our student-athletes learn how to balance their preparation is tough, especially when they’ve been told to focus on their athletics for so long. We have to help them realign their objectives and dig deeper into understanding what they want most out of life and how they will get there.  

Maintain the educator role. One last bit of advice I’d have for anyone working in our field is to maintain the educator role. Being in a position where we are on the front lines – working directly with student-athletes daily, I’ve learned that I can’t be the answer for everything. Instead, when student-athletes approach me, I want to engage them in the learning process as much as possible instead of just spoon-feeding them the answers. Our focus should be on helping them learn how to figure things out, helping them identify the necessary resources, or just simply pointing them in the right direction.

Far too often we are looked at as the “go-to office” that solves all of the issues. As nice as that is, it can stir up misinterpretations of what our mission is and what we do. For example, if a sophomore gymnast enters our office and is looking for a summer job and then we provide the individual with a person’s name and phone number to call for a job, are we truly helping that gymnast? By the time their senior year comes around, they will have the same expectations of our services and think that we will just hand them a career. For that office staff, the pressure is often to help serve this student-athlete as quickly as possible.

Instead, our approach should be focused on the process. We should help point them to the resources (such as career services) that can help them develop skills to search for a job and learn about the types of careers that they may want to pursue after graduation. We can support them in this process, but they must be active participants for it to be effective. We cannot be the answer to everything, but we can be a great resource to help point our student-athletes in the right direction. For some student-athletes, this will include referral to a mental health professional.   

Foster trust. For us to effectively help our student-athletes transition to life beyond sports, a foundation of trust must be laid. We cannot simply rely on programs and lectures to have the type of impact necessary. The stronger the relationship, the more likely our student-athletes will understand and accept the services we are providing and the recommendations we are making.

This is where our role becomes a key factor for our athletics departments. I understand that not everyone has one role. Many of us share coaching, academic, or athletic training responsibilities – some have all three roles. No matter what hat we wear, when it comes to the health and well-being of our student-athletes, this should always be the top priority.

By implementing services with a human touch and keeping a focus on life beyond sport – no matter what the student-athlete’s athletics goals – our student-athletes will have the right type of support in their journey.

Penny Semaia is the senior associate athletics director of student life at the University of Pittsburgh. He oversees the Cathy and John Pelusi Family Life Skills Program, which prepares student-athletes for success for life after college by using academic, athletics and community resources. Semaia also serves as the president of Get Involved! Pittsburgh, a nonprofit organization focused on young professionals being active in their communities. Semaia was a four-year letter-winner for the Pitt football team from 2000 to 2003. He graduated with a degree in anthropology with related areas in sociology and theater. Semaia joined Pitt’s athletics department in 2005 as the career and life skills coordinator.

Mind, Body and Sport: Post-concussion syndrome

By David Coppel

Over the last decade, sport-related concussions have become an important focus within the general sports injury and sports medicine field. Clinical and research studies regarding this form/context of mild traumatic brain injury have increased geometrically as its position as a public health concern elevated and the Centers for Disease Control and Prevention (CDC) became involved.  

The CDC has compiled guidelines and resources for health care providers, coaches, parents and athletes regarding concussions. Great progress has been made in understanding and managing sport-related concussions, especially in terms of:

  • Incidence and prevalence of sport-related concussion at all levels of sports participation,
  • Delineating acute symptoms and sideline management,
  • Describing the general course of recovery for most athletes, and
  • Identifying risk factors or modifiers associated with prolonged recovery and/or persistent symptoms.  

Expert reviews of available scientific evidence have resulted in a series of consensus or position statements that have guided concussion definitions, evaluation, management and return-to-play guidelines.

The current definition of concussion is a brain injury involving a “complex pathophysiological process affecting the brain, induced by mechanical forces.” Concussion has a number of described features:

  • Concussion may be caused by either a direct blow to the head, face, neck or elsewhere on the body with impulsive force transmitted to the head.
  • Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously or may evolve over  minutes or hours.
  • Concussion may result in neuropathological changes, but the acute clinical changes largely reflect a functional disturbance rather than structural injury.
  • Concussion results in a graded set of clinical symptoms that may or may not involve a loss of consciousness, and resolution of clinical and cognitive symptoms typically follows a sequential course, with some cases having prolonged symptoms.

Diagnosing concussion may be complicated in some instances, as most do not involve a loss of consciousness or overt neurological signs, and impact on functioning can be quite mild and temporary. No consistent biomarkers or neuroradiological findings have been delineated, although the research continues in these areas.

The neuro-pathophysiology of sport-related concussion has been described in terms of changes in brain metabolism and evidence of temporary metabolic-based vulnerability to secondary injury. Typically, concussion events produce physical, cognitive and emotional/neurobehavioral symptoms that are generally most severe in the acute post-injury time frame (one to two days) and then reduce/resolve over subsequent days and weeks.  

Recent consensus guidelines indicate that 80-90 percent of concussions resolve in seven to 10 days, sometimes longer for children and adolescents. The diagnostic complexity emerges when symptoms are delayed or prolonged, or when symptoms are not specific to concussion, but instead are temporally related to the concussive event or experienced/perceived as having been brain-injury related. Due to the range of symptoms (physical, cognitive, emotional) and the individual factors influencing recovery, a multidisciplinary management approach is often indicated. Physicians, athletic trainers, neuropsychologists, academic advisers, physical therapists and clinical/sport psychologists all play roles in clarifying symptoms and providing support.

The strong desire and motivation of some athletes to return to play provides the opportunity for these motivational factors to be manifest in symptom reporting. Since tracking self-reported post-concussion symptoms over time (typically with checklists) is the main aspect of management, some athletes will minimize or report resolved symptoms in order to be seen as “symptom-free” and begin the return-to-play protocol or be cleared. Knowing the athlete and his or her baseline or pre-injury functioning can be crucial in evaluating post-injury symptom reports and presentations.

Acute sport-related concussion signs may include loss of consciousness, headache, dizziness and alteration of mental status (confusion or fogginess). Headache, nausea, fatigue, irritability, sleep disturbance and sensitivity to light and noise may continue over the next few days. Other symptoms seen on post-concussion symptom checklists include attention and concentration difficulties, slowed processing, distractibility, memory problems, slowed visual tracking or vision problems, balance disturbance, and anxiety or depressed mood. Typically, depressed mood or anxiety levels improve as the physical symptoms resolve, but it is important to assess and intervene if these emotional issues persist.

While most sport-related concussions (concussion symptoms) resolve over days and weeks (most within three weeks), a subset of sport-related concussion patients may not resolve in this expected time frame and have persistent post-concussion symptoms, or be seen as developing post-concussion syndrome/disorder. Diagnostically, according to the International Classification of Diseases, post-concussion syndrome occurs after a head trauma (which may include a loss of consciousness), and includes at least three of the following symptoms:

  • Headache
  • Dizziness
  • Fatigue
  • Irritability
  • Difficulty in concentration and performing mental tasks
  • Memory impairment
  • Insomnia
  • Reduced tolerance to stress, emotional excitement and alcohol.  

Symptoms of depression or anxiety resulting from loss of self-esteem or fear of permanent brain damage are seen as adding to the original symptoms.

Treatment/management of sport-related concussion is often based on self-reported symptoms, and these symptoms may reflect other conditions and/or factors not related to concussion, but more with post-traumatic stress disorder. Thus, based on the nonspecificity of symptoms, there is some controversy about the validity of a “post-concussion syndrome.” In general, when athletes continue to be significantly symptomatic (or worsen) beyond the three- to four-week recovery period, the symptoms could be more influenced by psychological factors than the original physiological factors associated with the acute injury.

Following a sport-related concussion, athletes are told initially to observe relative physical and cognitive rest. Reducing physical activity for an active student-athlete can be a difficult and stressful adjustment. A prescribed reduction in cognitive demands often involves reduced class time or assignments and is described by some as “cognitive or brain rest.” These restrictions and reductions appear appropriate in the initial week of recovery, but may become harmful later in recovery, as other stressors may emerge with falling behind in school (making up and keeping up demands upon return) and concern over training/conditioning effects.

As student-athletes recover and are cleared, they begin a return-to-play protocol that incrementally increases the physical exertion level, and ultimately the risk of re-injury over days, leading to a return to full practice and participation. Student-athletes must complete each stage without emergence of symptoms. Similar “return to learn” approaches have been proposed for academic re-entry.  

Strong somatic focus, hyper-vigilance to symptoms, sleep disturbance (often due to mental activation or worry), general stress/rumination behaviors, or a pattern of maladaptive coping styles may also be factors associated with prolonged or persistent symptoms. Family or social network/support problems, which include negative/nonsupportive responses or reactions from teammates, coaches or other primary relationships can result in more emotionally based symptoms.

During sport-related concussion recovery, if significant mood swings, depressed mood, or increasing anxiety or panic symptoms arise, they are indicators for referral to clinical or counseling psychologist/sport psychologist or other health care providers with expertise in these management areas.

Most concussed student-athletes recover symptomatically relatively quickly and return to their sport and academic activities. However, some have persistent symptoms, or delayed symptom resolution, which often impacts their athletics, academic, social and emotional functioning.

In addition to the basic approach of monitoring symptoms over time, interventions aimed at sport-related concussion education, management of recovery expectancies, symptom attributions and addressing emotional issues have been positive factors in recovery from sport-related concussions.

Ideally, management and treatment of sport-related concussions should include opportunities to evaluate and address the psychological impact and emotional responses that can be activated in student-athletes in varying degrees. When student-athletes are unable to practice or train, or when they feel significant physical, cognitive or emotional vulnerability, they often perceive/feel challenges to their identity – particularly their athletics identity, self-esteem, and in some cases, their future plans or goals.

Discussion of sport-related concussion as an injury with varying degrees of concurrent neurophysiological and psychological components appears to be the most effective approach with student-athletes. It helps avoid concussion being seen with the false dichotomy of the athlete having physical or mental issues. Referrals to licensed health care providers or counseling centers can help the student-athlete deal with those challenges, as well as the fear of re-injury, and address potential concerns over long-term consequences of concussions.

David Coppel is a professor in the department of neurological surgery and the director of neuropsychological services and research at the University of Washington Sports Concussion Program. He is a clinical professor in both the department of psychiatry and behavioral sciences and the department of psychology at Washington, where he has provided clinical supervision to graduate students, psychology residents and postdoctoral fellows for more than two decades.  Since 1996, Coppel has been the consulting neuropsychologist and clinical/sport psychologist for the Seattle Seahawks. His work at the Sports Concussion Program continues his strong involvement in the evaluation of the cognitive and emotional aspects of sport concussion, research regarding the sports concussion recovery factors, and the role of neurocognitive factors such as attention, concentration and focus in sports performance.

Mind, Body and Sport: How being injured affects mental health

By Margot Putukian

Injuries, while hopefully infrequent, are often an unavoidable part of sport participation. While most injuries can be managed with little to no disruption in sport participation and other activities of daily living, some impose a substantial physical and mental burden. For some student-athletes, the psychological response to injury can trigger or unmask serious mental health issues such as depression, anxiety, disordered eating, and substance use or abuse.

When a student-athlete is injured, there is a normal emotional reaction that includes processing the medical information about the injury provided by the medical team, as well as coping emotionally with the injury.  

Those emotional responses include:

  • Sadness
  • Isolation
  • Irritation
  • Lack of motivation
  • Anger
  • Frustration
  • Changes in appetite
  • Sleep disturbance
  • Disengagement

How student-athletes respond to injury may differ, and there is no predictable sequence or reaction. The response to injury extends from the time immediately after injury through to the post-injury phase and then rehabilitation and ultimately with return to activity. For most injuries, the student-athlete is able to return to pre-injury levels of activity. In more serious cases, however, a student-athlete’s playing career may be at stake, and the health care provider should be prepared to address these issues. The team physician is ultimately responsible for the return-to-play decision, and addressing psychological issues is a significant component of this decision.

It’s important for athletic trainers and team physicians, as well as student-athletes, coaches and administrators, to understand that emotional reactions to injury are normal. However, problematic reactions are those that either do not resolve or worsen over time, or where the severity of symptoms seem excessive. Examples of problematic emotional reactions are in the accompanying table.

One problematic reaction is when injured student-athletes restrict their caloric intake because they feel that since they are injured, they “don’t deserve” to eat. Such a reaction can be a trigger for disordered eating. When a student-athlete is already at risk for disordered eating, this problematic reaction only heightens the likelihood these unhealthy behaviors will worsen.   

Another problematic response to injury is depression, which magnifies other responses and can also impact recovery. Depression in some student-athletes may also be related to performance failure. When student-athletes sustain significant injuries, such as knee injuries associated with time loss from sport, they can suffer both physically as well as emotionally with a decrease in their quality of life. When Olympic skier Picabo Street sustained significant leg and knee injuries in March 1998, she battled significant depression during her recovery. She stated: “I went all the way to rock bottom. I never thought I would ever experience anything like that in my life. It was a combination of the atrophying of my legs, the new scars, and feeling like a caged animal.” Street ultimately received treatment and returned to skiing before retiring.  

Kenny McKinley, a wide receiver for the Denver Broncos, was found dead of a self-inflicted gunshot wound in September 2010 after growing despondent following a knee injury. He had undergone surgery and was expected to be sidelined for the entire season. He had apparently made statements about being unsure what he’d do without football and began sharing thoughts of suicide.

These case examples demonstrate how injury can trigger significant depression and suicidal ideation.

Concussion is another injury that can be very challenging for student-athletes to handle emotionally. An injury like an ACL – while it poses a serious setback to the student-athlete – at least comes with a somewhat predictable timeline for rehabilitation and recovery. What makes concussion particularly difficult is that unlike most injuries, the timeline for recovery and return to play is unknown. With concussion, the initial period of treatment includes both cognitive and physical rest, which counters the rigorous exercise routine many student-athletes often depend on to handle stressors. Given the emotional and cognitive symptoms associated with concussion, student-athletes often struggle with their academic demands. In addition, compared with some injuries where a student-athlete is on crutches, in a sling, or obviously disabled in some way, with the concussed student-athlete, he or she “looks normal,” making it even more challenging to feel validated in being out of practice or play.

For the student-athlete with concussion, it is especially important – and difficult – to watch for problematic psychological responses to the injury. Some student-athletes experience emotional symptoms as a direct result of the brain trauma that can include feeling sad or irritable. If these symptoms don’t seem to be going away it is important to explore whether they might be related to a mental health issue such as depression and not directly to the injury itself. In some cases, the psychological reaction to the concussion – rather than the concussion itself – can be the trigger for the depression. When this is the case, simply waiting for the brain to recover isn’t enough: the depression also needs to be treated.

It is also important to be aware that with increasing media attention being paid to neurodegenerative diseases such as chronic traumatic encephalopathy (CTE) among professional athletes, some student-athletes might fear that even the mildest concussive injury will make them susceptible to these highly distressing outcomes. Though there is very little known about what causes CTE or what the true incidence of CTE is, the concern for possibly developing permanent neurodegenerative disease can be paralyzing. Athletic trainers and team physicians can help educate injured student-athletes about the known risks associated with concussions and can help them focus on managing the injury in the present. They should also be aware that student-athletes who are expressing a high level of anxiety could be experiencing a mental health condition that requires treatment by a mental health professional.

Seeking treatment

Injured student-athletes who are having a problematic psychological response to injury may be reticent to seek treatment. They may be afraid to reveal their symptoms, may see seeking counseling as a sign of weakness, may be accustomed to working through pain, may have a sense of entitlement and never had to struggle, and may not have developed healthy coping mechanisms to deal with failure. In addition, many student-athletes have not developed their identity outside of that as an athlete. Thus, if this role is threatened by injury or illness, they may experience a significant “loss.” Getting a student-athlete to consider treatment can be challenging (and it is complicated by privacy issues), so coaches, athletic trainers and team physicians as the support network for the student-athlete should work together to provide quality care.

As an athletic trainer or team physician, it’s important to be aware of common signs and symptoms for various mental health issues and understand the resources available to treat them. Those personnel also must do everything possible to “demystify” mental health issues and allow student-athletes to understand that symptoms of mental health issues are as important to recognize and treat as symptoms for other medical issues and musculoskeletal issues. Underscoring the availability of sports medicine staffs to provide for early referral and management of mental health issues is essential.

It’s also important for coaches, athletic trainers and team physicians to support injured student-athletes and do what they can to keep athletes involved and part of the team. This might include keeping student-athletes engaged, and at the same time encouraging them to seek help and not try to “tough their way through” situations that include mental health factors.

For coaches, one of the most powerful actions is to “give the student-athlete permission“ to seek treatment (see Mark Potter’s article in Chapter 1 emphasizing this notion). This is often incredibly helpful in encouraging student-athletes to seek care. Having programs available to educate student-athletes as well as sports medicine and administrative staffs regarding the resources available and the importance of collaborative programming helps provide appropriate care.

It is important to understand the mental health resources available on each campus and consider both early referral as well as establishing multidisciplinary teams that include athletic trainers, team physicians, psychologists, psychiatrists and other health care providers to provide care for mental health issues in student-athletes. If this can be incorporated into the overall goal of optimizing performance, along with nutrition and strength and conditioning, it may be better received by student-athletes and coaches, thereby increasing the compliance with management and treatment.

Given all that is known about mental health issues in athletes – and the role of injury and the barriers to treatment – the bar is raised in terms of what athletic trainers and team physicians can do in the future. Having a comprehensive plan in place to screen for, detect and manage student-athletes with problematic response to injury is an important first step.

Margot Putukian is the director of athletic medicine and head team physician at Princeton University, where she is also an assistant director of medical services at University Health Services. She has an academic appointment as an associate clinical professor at Rutgers Robert Wood Johnson Medical School. Putukian has a B.S. in biology from Yale University, where she participated in soccer and lacrosse, and an M.D. from Boston University. She completed her internship and residency in primary care internal medicine at Strong Memorial Hospital in Rochester, New York, and her fellowship in sports medicine at Michigan State University. Putukian is a past president of the American Medical Society for Sports Medicine. She currently works with US Soccer and US Lacrosse as a team physician, and several organizations advocating for health and safety issues, including the NCAA, the NFL, USA Football, the American College of Sports Medicine, US Soccer and US Lacrosse. She can be reached at putukian@princeton.edu.

Mind, Body and Sport: Education-impacting disabilities and the NCAA waiver process

By Marcia Ridpath

The population of students with disabilities is growing in the postsecondary setting. One of the reports provided by the U.S. Government Accountability Office (GAO) indicates that students with disabilities represented nearly 11 percent of all postsecondary students in 2008. This upward trend is reflected in the world of athletics as well.

In the NCAA waiver process, we have seen a steady increase in the number of student-athletes with disabilities, particularly those with diagnosed or suspected mental health disorders.

Athletic trainers often have a unique perspective because they work closely with student-athletes and can be one of the first to identify signs of a potential mental health impairment. When a student-athlete arrives on campus, he or she may not have a formally identified mental health concern; however, we often see difficulties develop as the student-athlete transitions to the collegiate environment.

Many student-athletes struggle both in and out of the classroom and find themselves in need of an academic waiver to establish or repair their athletics eligibility. Athletic trainers and other athletics department staff can often provide insightful documentation when an institution chooses to file a waiver on behalf of a student-athlete.

It is important that colleges and universities are aware of the NCAA’s definition of disability. We use the term “education-impacting disability” (EID) in Divisions I, II and III, in all types of waivers, and in related policy/procedures tied to disability. The definition is as follows:

“For academic eligibility purposes, the NCAA defines a disability as a current impairment that has a substantial educational impact on a student’s academic performance and requires accommodation.”

Following is a list of the various types of disabilities that typically surface in the waiver process. Learning disabilities/disorders, attention-deficit hyperactivity disorders and mental health disorders are the most prevalent impairments. Documentation often indicates that students present with more than one identified disorder.

  • Learning disabilities/disorders (LD)
  • Attention-deficit hyperactivity disorder (ADHD)
  • Mental health disorders
  • Medical conditions
  • Hearing impairment
  • Autism spectrum disorders (ASD)

Athletics department personnel are in a key position to observe the challenges and behaviors present in the lives of student-athletes, often on a daily basis. This is particularly true for those student-athletes with suspected or formally diagnosed mental health disorders. Because “mental health disorder” is such a broad category, it helps to see a list of the most frequent impairments cited under this umbrella in the waiver process. Common disorders include:

  • Major depressive disorder
  • Generalized anxiety disorder
  • Social anxiety disorder/social phobia
  • Adjustment disorder
  • Obsessive/compulsive disorder
  • Oppositional defiant disorder
  • Addictions
  • Post-traumatic stress disorder
  • Panic disorder
  • Bipolar disorder

It is also important to note that not every individual with a diagnosed condition (including mental health disorders) is considered “disabled” under the Americans with Disabilities Act (as amended). The ADAAA is a civil rights law with the goal “to provide a clear and comprehensive national mandate for the elimination of discrimination of individuals with disabilities.”

The ADAAA provides the following definition to help identify individuals who are protected by this law:

“The term ‘disability’ means, with respect to an individual, a physical or mental impairment that substantially limits one or more major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment. Major life activities include caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working. Major life activities also include the operation of a major bodily function, including functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.”

When an NCAA member institution submits a waiver under the EID category, we review the documentation to see if the individual has self-identified as someone with an impairment under the ADAAA. This usually occurs when the student voluntarily chooses to disclose his or her documentation to the disability office on campus.

The disability office verifies the impairment and determines reasonable accommodations or academic adjustments specific to that student in order to “level the playing field and remove barriers.”

It is important to note that a diagnosis does not automatically result in certain accommodations and services. It is the role of the disability office on campus to work individually with each student to “identify the limits caused by the disability and determine … which accommodation(s) will be appropriate and reasonable.”

The EID waiver process also includes an in-depth review of the documentation to note the date of initial onset of the disorder(s), the duration and severity of the disorder(s) and the potential educational impact (including identifying the major life activities that are substantially limited). In addition, most waivers require a written statement from the student-athlete that addresses the disability(s) and the impact he or she has encountered in the academic setting.

Whether the student chooses to disclose his or her impairment is often a key component to examine in the EID waiver process. The decision and responsibility to disclose belongs to the individual with a disability. Because concern about discrimination is so prevalent, some students decide not to disclose, even though they often forfeit needed services and accommodations.  

The October 2009 GAO report makes the following comment about students and disclosure in the postsecondary environment:

“A related challenge for schools is providing services to students with disabilities who did not initially disclose their need for accommodations. Some students choose not to disclose their disability, even when they are aware of available services, according to school officials and disability experts. While a student is not obligated to inform a school that he or she has a disability, in order for the school to provide an academic adjustment or another disability-related service, the student must identify himself or herself as having a disability. Any initial nondisclosure may become problematic for schools when students disclose and request accommodations after they fall behind academically. For example, a school may find it difficult to provide timely accommodations to a student who disclosed a visual or learning disability in the middle of a semester because of the time required to convert textbooks into electronic format. School and disability group officials told us that some students choose not to register with the disability services office and request accommodations for a variety of reasons. For example, they said some students, especially those with ‘hidden’ disabilities, such as learning disabilities, are reluctant to disclose because they want a fresh start in higher education without the label of having a disability.”

Disclosure is a critical but voluntary component in the EID waiver process. Many student-athletes find themselves in need of a waiver because they haven’t accessed the services available through the disability office. This scenario can be true for many types of waivers, such as student-athlete reinstatement, progress-toward-degree, legislative relief, and 2-4 transfers.  

For students with mental health disorders, fear of disclosure can be especially inhibiting and it is often an assertion in the waiver process. There are stigmas and perceptions related to mental illness that affect both the individual with the impairment and those around that individual. This is certainly true if the student has a first-time experience with a mental health issue after enrolling in a postsecondary institution.

The combination of unsettling symptoms and transition to the collegiate environment can result in isolating behaviors and diminished participation; student-athletes pull away from people who can provide much-needed support. In these circumstances, the athletic trainers or other athletics department staff who have regular contact with the student may have firsthand knowledge with important insight into the student-athlete’s difficulties and how his or her collegiate journey has been impacted.

Looking ahead poses a unique opportunity for athletics department staff. Departments have the important responsibility of educating their staff and developing best practices to address the specific needs of student-athletes with education-impacting disabilities. This is timely and critical because the complexity and combinations of disabilities (and specifically mental health disorders) has increased over the past several years. Many EID waivers provide documentation for students with significant personal, emotional and medical issues that impact academic progress.

Athletics department personnel are in a unique position to encourage their student-athletes with disabilities to seek all of the support and services available at the institution. Self-advocacy is a crucial skill for all students but it is especially important for student-athletes with EIDs.  

Many student-athletes need assistance in developing the ability to explain their disability and its educational impact and access their approved services and accommodations to maximize academic success. Athletic trainers and department staff can play an important role in the lives of student-athletes as they learn how to navigate the intersection between their disability and the world of college and athletics.

Marcia Ridpath is the president and founder of MAR Educational Consulting. For the past 15 years, she has served as a disability consultant to the NCAA. Before starting her consulting role in 1999, she taught high school classes as a special education teacher and served as the learning specialist for Oregon State University athletics. Rid path has more than 25 years of experience in education, working as a junior/senior high school principal, academic adviser, adjunct professor and accreditation coordinator. She is a national speaker, published author and a member of the Learning Disabilities Association of America and the Association on Higher Education and Disability. She is also affiliated with the National Association of Academic Advisors for Athletics.

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