Changing Concussion Culture


It could be because a player doesn’t want to let the team down by stepping off the field.

It could be the fear of getting pulled out of a big game.

Or it could be the pervasive misunderstanding about the severity of an injury to the head.

Whatever the reason, concussion reporting rates across the nation have hardly budged, despite a surge in policy changes, educational efforts and intensive research on the topic, a group of Northern Arizona University researchers said on Wednesday. The four professors, who come from NAU’s psychology department and its athletic training education program, are trying to tackle the issue from another angle.

Thanks to a $400,000 grant from the NCAA and the U.S. Department of Defense, the four women will examine how organizational culture influences concussion reporting and then test different strategies to boost reporting rates.

“It’s a national epidemic with the concussion issue and it’s not being solved with education,” said Debbie Craig, an athletic training education professor. “The NCAA and the Department of Defense had the foresight to say, ‘If these aren’t working then it’s most likely due to culture, so how do we change that culture?’”

NAU is one of eight universities that received grant money to research “How to spur changes in the culture surrounding concussion,” according the grant description.

The Flagstaff group’s study involves visiting four NCAA Division I football programs five times each over the span of two and a half years. They aren’t releasing the names of the schools because the anonymity allowed them to gain access to the universities and helps preserve the accuracy of their results, the researchers said.

The first visit to each university will be spent conducting player surveys, interviewing coaches and observing practices, games and places where the athletes spend time like locker rooms and meeting rooms. The women also will run association tests to gain insight into players’ subconscious beliefs about things like big hits on the field or head injuries, said Ann Huffman, an associate professor in the College of Social and Behavioral Sciences and the W. A. Franke College of Business and chair of the university’s intercollegiate athletics committee.

Pilot research the researchers already did in Arizona found that there are multiple reasons for low concussion reporting rates. Those include misconceptions among athletes about how hurt they are, a sense of brotherhood that discourages reporting on a teammate who looks concussed, and a misunderstanding that a person has to lose consciousness to experience a concussion.

In fact, only 10 percent of concussed cases lose consciousness, said Monica Lininger, an assistant professor in the athletic training education program.

After gathering that baseline data on concussion culture within each program, the NAU research team will develop specialized intervention strategies for each school, then sit down with representatives from each program to see which suggestions they like and what other ideas they may have to address the problem. Research has shown that allowing participant input, instead of imposing the ideas brainstormed by researchers, facilitates creative ideas and buy-in, said Heidi Wayment, a professor of social psychology who has years of athletic experience as a college and professional basketball player.

A possible intervention might be identifying one or two influential people within the team and working with each individual to lead by example in terms of taking concussions seriously and reporting them, Craig said. Another idea might be removing photos or posters that appear to celebrate violent play on the field, Lininger said.

Suggestions for changes may also involve piggybacking on the positive values, like hard work, camaraderie and sacrifice, that athletes and teams already carry, Wayment said.

“It will be helpful for us to understand what motivates them to do this very very exhilarating and difficult work,” she said. “Maybe some of those same values can help nudge behavior in a way that might help them with their own safety and health and their teammates.”

The final three visits to each university, which will kick off in the fall of 2017, will be a pre-intervention assessment, a post-intervention assessment to look for changes in behavior or in the players’ environment, and then a visit to present the study’s results and ask for feedback.

The women’s hope is that their research will provide useful insights for not only college football players but other athletes and age groups as well. Ideally, their recommendations will inspire athletic policy changes among institutions, conferences and even the NCAA, they said.

“We can do research that makes a difference,” Huffman said.



NAU researchers receive grant to study concussion reporting


The long-term impact of concussions is widely known but many athletes still fear opening up about head injuries.

NAU interdisciplinary researchers have been awarded a $400,000 grant to study how organizational culture relates to concussion reporting among athletes, coaches and staff.

Research team members Debbie Craigand Monica Lininger, athletic training education professors, and Ann Huffman and Heidi Wayment, psychological science professors, have been awarded the national Mind Matters Challenge grant for their proposal, “Changing the Culture of Concussion Reporting: A Cultural Analysis and Implementation Model.”

“Concussions are unique in the field of athletic injuries because the decision whether to keep playing is less clear,” said Craig, who is director of NAU’s athletic training education program. “Everyone must believe that it is OK to report concussions. This will be a significant cultural shift from the current American football culture. Our goal is to facilitate that shift.”

Wayment said this project is a tremendous opportunity given how rapidly public awareness on head trauma and chronic traumatic encephalopathy, also known as CTE, is increasing.

“As we know from research in health psychology, just ‘knowing’ that a behavior can negatively impact one’s health is not sufficient for change,” she said. “I am especially excited about our interdisciplinary approach: we will be looking very specifically at multiple factors that impact athletes’ decision-making processes. My colleagues and I each bring a different theoretical perspective to the research, and we are excited to be working together.”

The objective of the project is to investigate the organizational, athletic, individual and interpersonal factors that affect concussion-reporting behavior and develop intervention strategies that increase student-athlete safety and well-being. The research study, funded by the NCAA and the U.S. Department of Defense, will be conducted over two and a half years and involve four different NCAA Division I football programs.


Higher Education

NAU Expands Education Program


A national shift in credentialing for athletic trainers finds Northern Arizona University well positioned for expansion at its Phoenix Biomedical Campus.

The master of athletic training program on NAU’s Flagstaff campus will graduate its first cohort in May 2016, and in July the Phoenix campus will welcome its first entering class.

“The discussion started many years ago about moving the entry level for our profession from a bachelor’s degree to a master’s,” said Debbie Craig, director of the program at NAU. “As the conversation gained more steam, we knew it would be mandated eventually. So we decided to do the legwork and get ahead of it.”

That two-year process resulted in the first master’s students entering NAU’s program in the summer of 2014. Accreditation at NAU—and the anticipated national mandate—occurred in spring 2015.

The Flagstaff campus will continue to welcome 30 new master’s students per year, while the Phoenix Biomedical Campus will begin with 15. The undergraduate program at NAU will end with May’s graduating class.

Craig expects both campuses to benefit from the credentialing change and a heightened focus on the profession.

“As most people are aware, there’s a massively increased focus on concussions at the national level,” Craig said. “Not only are we thrilled there’s more attention for that problem, but it also brings a lot of attention to our profession. It’s the athletic trainers on the sidelines who are the first line of evaluation and protection for the athletes.”

The graduate program begins during the summer with classes in ethics and basic skills. Clinical rotations begin in August. Because NAU and two Flagstaff high schools can accommodate only 10 students each, the second year is spent at clinical sites around the state, with coursework performed online. Craig said the affiliation agreements with statewide clinics are a valuable asset to the program.

“There are fantastic educators who are also athletic trainers, and that’s where we like to send our students,” Craig said. “There is typically only one student at each site, so they have the clinical preceptor’s full attention. There’s a lot of learning that happens during that second year.”

Craig said that besides on-field evaluations, athletic trainers do everything from pre-practice taping to post-practice treatments for injuries that are playable. “For athletes who have had surgical injuries, the athletic trainers will often do all of the rehabilitation to get those athletes back into playing shape,” she said.

New graduates from the program, who often work at high schools, at the intercollegiate level or in rehabilitation centers, can expect starting pay of about $50,000, Craig said.

Applicants to the graduate program generally come from a background of exercise science or kinesiology, Craig said. But any student who takes the established pre-requisite courses and participates in the required number of clinical observation hours may apply.

Craig anticipates the program’s expansion will attract plenty of attention.

“People in Phoenix who are interested but can’t move up to Flagstaff for a year will be thrilled,” she said. “And we’re certainly excited about the facility in Phoenix. It’s a beautiful campus.”