Context: Collegiate student-athletes (SAs) experience psychological stressors due to rigid schedules, team conflict, and injury. These factors can result in symptoms of mental health conditions, decreased daily functioning, and suicidality. Objective: To explore National Collegiate Athletic Association Division I SAs’ experiences with mental health and access to and experiences with mental health resources at their university. Design: Consensual qualitative research study. Setting: One-on-one interviews. Patients or Other Participants: Twenty-three Division I SAs (18 women, 5 men; mean age = 20 ± 2 years). Main Outcome Measure(s): Participants completed a semistructured interview that focused on their experiences with mental health. The interviews were audio recorded and transcribed verbatim via Zoom. Credibility and trustworthiness were established via member checking, triangulation, and peer discussion among a 3-person coding team. Results: Two domains, increased expectations and resources and management, were identified. The participants shared how they balanced life as a college student, academic stressors, performance expectations, and a sport-first mindset they perceived from coaches and support staff. They discussed their experience with the internal support network of coaches, the athletic department, and sport psychology. Participants remarked on their external support network, which included their family, friends, and psychological services. The resources available at their institutions and their accessibility were perceived both positively and negatively. Some collegiate SAs described resources as helpful, whereas others portrayed a lack of timeliness for appointments, lack of advertisement, incomprehension by counselors of athlete demands, and no sport-specific counseling as barriers. Conclusions: Collegiate SAs expressed mental health concerns due to stress and the demands of sport participation. Self-regulated coping strategies and support networks continue to be powerful and helpful resources for mental health, with or without a diagnosed condition. Barriers to mental health service use were a lack of sport specificity and lack of access. Institutions need to focus on creating athlete-centered mental health resources with annual advertisements to increase use.

Context: The National Collegiate Athletic Association’s 2016 and 2024 Mental Health Best Practices documents outline essential guidelines for athletic programs, including mental health recognition, referral pathways, and critical incident management. Despite these recommendations, there remains a significant gap in literature and practice regarding the response to and management of suicide bereavement among athletic trainers (ATs), highlighting the need for further exploration of their experiences and institutional responses after a student-athlete’s death by suicide. Objective: To explore the lived experiences of collegiate ATs after the death of a student-athlete by suicide. Design: Qualitative. Setting: Individual interview. Patients or Other Participants: Twelve ATs (age = 37 ± 7 years; credentialed experience = 14 ± 7 years) who were providing patient care to a student-athlete who died by suicide. Main Outcome Measure(s): Each AT completed a semistructured, audio-only interview. Interviews were audio recorded and transcribed verbatim. Analysis followed the consensual qualitative research tradition using a 3-person coding team. Credibility and trustworthiness were established through member checking, triangulation, and internal auditing. Results: Participants revealed several experiences and reactions after the death of a student-athlete by suicide that focused on their institutional reaction, their emotional reaction and coping mechanisms, and shared advice for other ATs moving forward. After the student-athlete death by suicide, ATs shared their institutional reaction, which included a collaborative approach with resources and changes to policy, procedures, and their overall system. They also shared their emotional reaction and coping mechanisms after the death, which included a grief response influenced by guilt, concern for other student-athletes, and the use, and lack of use, of support systems and formal therapy. Finally, they provided shared advice concerning death by suicide that included taking care of oneself and taking mental health seriously. Conclusions: After the death, most participants expressed grief and concern for others but often did not recognize themselves as needing help. Institutional policy and provider postvention strategies are recommended.

Purpose: Experiencing an event that involves actual or threatened death or serious injury is a critical incident and produces serious emotional responses. Athletic trainers (ATs) experience critical incidents in their day-to-day work. The purpose of this study was to explore how ATs experience a critical incident during the course of clinical practice. Methods: We used one-on-one, web-based, semi-structured interviewing with a criterion sample of ATs who experienced a critical incident and used any critical incident response resources in the last year (n=17; age=32±8; years of experience=9±7; years in current position=4±5). We used a 3-person team with a multi-phase process to identify the emerging domains and categories. Results: Two emergent domains were identified from the study. External support referenced multiple personnel resources available after a critical incident occurred, specifically, trained mental health professionals, untrained personnel, and trusted colleagues/coworkers. Coping with the emotional response included debriefing, spirituality, and complementary mental health strategies. Conclusion: In preparation for critical incidents, emergency action planning and after-action planning for healthcare delivery and the emotional response are both essential. Many ATs do not have the formal training, but continuing education courses, community-based mental health resources, and the promotion of professional organization resources can assist ATs in critical incident management.

Background: Most people believe that student–athletes experience fewer difficulties related to mental health than non-sport participants. However, several studies have shown high depression levels or emotional difficulties in adolescent athletes. Most secondary school students have access to athletic trainers in their schools. Secondary school athletic trainers (SSATs) are medical professionals who can provide health care for student–athletes, and they could be appropriate supporters in providing mental health management in secondary schools. However, there are no studies that have addressed their preparedness and confidence level to manage potential risk factors and mental health disorders. This study aims to ascertain preparedness and confidence levels from SSATs’ perspectives in handling mental health disorders using a survey based on the mental health management guidelines and consensus statement. Methods: This is a cross-sectional study design. The research team created an online survey questionnaire based on the National Athletic Trainers’ Association (NATA) Mental Health Guidelines for Secondary School and Interassociation Recommendation: A Consensus Statement. Utilizing the NATA Research Survey Service, the online survey was emailed to SSATs who self-categorized as secondary school athletic trainers in the NATA membership system. (n = 171, 65% completion rate). SPSS was used to analyze the survey data. Result: This study found that 29.2% of SSATs reported they have policies or guidelines regarding mental health disorders management for minors. The most frequent policy was mandatory reporting in cases in which an individual is being abused or neglected (80.5%). The highest confidence area was aligned with the most frequent policy. The least frequent policy was considering unique stressors and triggers with student–athletes to recognize the potential mechanisms that may cause a mental illness or exacerbate an existing mental illness (58.5%). Even though the least frequent policy was not aligned with the least confidence area, it was the second lowest confidence level. This study identified significant differences between two different employment structures: school-based employment and hospital-based employment structures. Policies were more common in school-based employment than in hospital-based employment structures. Conclusion: This study demonstrated the gap between organizational and individual preparation. The majority of SSATs respondents expressed moderate to high confidence in their ability to manage mental health disorders, despite the lack of mental health policies or procedures in their secondary schools. This study recommends that SSATs create guidelines or procedures in the areas where they are least confident and prepared to offer mental health management for minor student–athletes. They can use the interassociation recommendations and the NATA guidelines for mental health care to close the gap.

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.

Context: A patient-centered care (PCC) environment allows athletic trainers (ATs) to develop trusting relationships with patients, enabling them to make the most informed care decisions. To provide PCC, the AT should assess health literacy and deliver quality patient education. Objective: To explore the lived experiences of ATs from different job settings to identify how they deliver PCC specific to health literacy and patient education. Design: Qualitative. Setting: Virtual interviews. Patients or Other Participants: Twenty-seven ATs (age = 34 ± 10 years; women = 15, men = 12) from the physician practice (n = 10), college (n = 9), and secondary school (n = 8) settings. Main Outcome Measure(s): We interviewed the participants using a semistructured interview protocol. Three researchers coded the transcripts after the consensual qualitative research process for each job setting. Trustworthiness was achieved through multianalyst triangulation, member checking, and internal auditing. Results: Four domains emerged from all interviews: (1) work environment, (2) essential traits and skills, (3) health literacy assessment strategies, and (4) patient education materials and delivery. In the work environment, ATs described the patient load, interprofessional relationships, and patient characteristics across settings. Essential traits and skills varied widely between settings, and ATs needed different strategies based on differing patient needs. For health literacy assessment strategies, ATs did not formally assess health literacy and relied on perceptions and assumptions. Effective digital information and health informatics strategies were described for patient education materials and delivery. Conclusions: ATs from physician practice, college, and secondary school settings describe using various strategies to create a patient-centered environment. Participants shared their behaviors in assessing health literacy and delivering patient education from various job settings.