Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3–7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.

Purpose: Although gender disparities and workplace vitality for women has been studied in athletic training, gender discrimination has not been widely studied. The purpose of this study was to describe gender-based aggressions experienced by women athletic trainers (ATs) within their educational and workplace environments. Methods: We used a cross-sectional design, and the web-based survey was comprised of demographic questions, the Schedule of Sexism Events (SSE), and questions on incident reporting. The SSE asks participant to rank items on a Likert Scale (1 = the event never happened to 6 = the event happens almost all the time). Items within the SSE are contextualized to either events in the past year or events in their entire life. The survey was distributed to 5,667 women ATs through the National Athletic Training Association (NATA). Five hundred thirty-nine (539) participants accessed the survey (9.5%). Four hundred seventy-eight (478) participants (age=34.2±8.6y [range=23–66y], experience=11.0±8.2y [range=0-40y]) completed the entire instrument (88.6%). We used descriptive statistics to analyze demographic variables, gender-based education- and work- related items of the SSE and incident reporting. Results: When asked about unfair treatment while interacting with teachers, professors, or engaging in academics in their lifetime, 89% (n=425) of participants indicated they had experienced unfair treatment. Comparatively, 53% (n=252) of participants experienced unfair treatment from teachers, or professors, or while engaging in academics in the last year. When asked about unfair treatment by an employer, boss, or supervisor, 88% (n=421) of participants experienced unfair treatment in their lifetime, where 55% (n=267) have experienced unfair treatment in the past year. Ninety percent (90%, n=430) indicated they experienced unfair treatment by co-workers, fellow students, or colleagues, in their lifetime compared to 61% (n=292) in the past year. When asked if they had experienced gender-based macroaggressions and microaggressions in the workplace, 41% (n=198) experienced both types of aggressions; 5% (n=22) experienced macroaggressions and 29% (n=137) experienced microaggressions. Only 25% (n=119) of participants have reported aggressions in the workplace. Conclusion: Women ATs experience gender-based aggressions in the workplace but they do not typically report these aggressions. All ATs have the responsibility to work towards an inclusive, equitable, and welcoming workplace that directly addresses aggressions.

Context: Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT’s role on interprofessional behavioral health teams is limited. Objective: To explore behavioral health providers’ perceived role of ATs in collaborative behavioral health care. Design: Qualitative study. Setting: Individual interviews. Patients or Other Participants: Nine behavioral health care providers (women = 6, men = 3; age range = 30–59 years, years in clinical practice = 6–25) from National Collegiate Athletic Association Power 5 schools were interviewed. Data Collection and Analysis: Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes. Results: Three themes emerged: (1) provider experience, (2) the AT’s role in behavioral health, and (3) collaboration. Provider experience included subthemes of formal education and interaction with ATs. Subthemes of the AT’s role included care coordination, information gathering, and positive proximity. Subthemes for collaboration included structural collaboration, cultural collaboration, collaboration concerns, and suggestions for ideal collaboration. Conclusions: Collaborative care models can enhance providers’ abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.

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

Context: Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor’s role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. Objective: To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. Design: Mixed-methods study. Setting: Online surveys and follow-up interviews. Patients or Other Participants: We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. Data Collection and Analysis: We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. Results: Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. Conclusion: Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees’ abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.