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REGIONAL RULES: SPORT SCIENCE INSTITUTE OVERVIEW Brian Hainline, MD NCAA Chief Medical Officer Clinical Professor of Neurology Indiana University School of Medicine New York University School of Medicine MISSION To promote and develop safety, excellence, and wellness in college student-athletes, and to foster life-long physical and mental development. VISION To be the pre-eminent sport science voice for all studentathletes and NCAA member institutions, and to be the steward of best practices for youth and intercollegiate sports. STRATEGIC PRIORITIES Cardiac Health Concussion Doping and Substance Abuse Mental Health Nutrition, Sleep and Performance Overuse Injuries and Periodization Sexual Assault and Interpersonal Violence Athletics Healthcare Administration Data-Driven Decisions CONCUSSION CONCUSSION We do not understand the natural history of concussion. We do not understand neurobiological recovery in concussion. Solution: NCAA-DoD Grand Alliance. CARE Consortium. Mind Matters Educational Grand Challenge. Inter-Association Guidelines and Legislation NCAA AND DoD JOINT ENDEAVOR >80% of military TBIs are concussions. 85% of military concussions are biomechanically similar to sportrelated concussion. 15% are from blast injuries. College s-a and military service are similar in age, athleticism, risk taking and pushing to the edge of excellence. The military theatre is poorly controlled; college sports are a much more controlled environment. Numerous meetings, evaluations, culminating in NCAA-DoD MOU and CRADA and White House announcement. CSC & ARC ASSESSMENT PROTOCOL PreSeason PostConcussion Sub-Acute Concussion Acute Concussion Unrestricted Return to Play Baseline <6hrs Post-Injury 24-48hrs Post-Injury Asymptomatic / Cleared for Return to Play Progression Neurocognitive and Behavioral Testing (CSC) X X X X Blood Biomarker & DNA Collection X X X X X X Multi-modal MRI Studies O X X X X X 7 days following Return to Play 6 Months Post-Injury X X Head Impact Measurement: HITS (FB) and non-helmeted sensors (FB, SCR, LAX, IH) DATA SUMMARY • Data extracted in April, 2016. • N= 18,370 evaluations – 17,490 unique subjects – 2,643 in their 2nd year – 2014-2015: 3,818 baseline evaluations – 2015-2016: 13,569 baseline evaluations • N= 939 concussions – 1/3 female NCAA-DoD MIND MATTERS GRAND CHALLENGE Executive Committee Rauch (DoD), Hack & Hainline (NCAA), Koroshetz (NIH) Education and Research Challenge Consortium (Operating Committee) NCAA: Dawn Buth, Amy Dunham, Dana Thomas DoD: Tara Cozzarelli, Stephanie Maxfield-Panker, Kathleen Quinkert CDC: Kelly Sarmiento Education Challenge Chestnut Hill College Creative Street Media Johnson C. Smith U. (Ernst) (Katzenberger) (Williams) MomsTEAM Institute University of Arizona U. of South Alabama (de Lench) (Valerdi) (Marass) Research Challenge Administrative Coordinating Center: Indiana U School of Public Health Nir Menachemi, Ross Silverman Arizona State U. Colorado State U. Northern Arizona U. U.S. Air Force (Corman) (Coatsworth) (Craig) (D’Lauro) U. of Georgia UNC Chapel Hill UNC Greensboro U. WisMadison (Schmidt) (Mihalik) (Wyrick) (Warmath) MIND MATTERS CHALLENGE Goal: To change important concussion safety behaviors and the culture of concussion reporting and management by funding research to better understand behavior change strategies and by identifying novel educational approaches. Aim 1 (Immediate Impact Challenge) Develop a multi-media educational program based on the best evidence currently available about how to change culture in young and emerging adults. Aim 2 (Long-term Impact Challenge) Identify key factors and ways to affect change in the culture and behavior of young and emerging adults and their influencers around concussion. INTER-ASSOCIATION GUIDELINES www.ncaa.org/concussionsafety Independent medical care Year-round practice contact Concussion diagnosis & management ENDORSEMENTS American Academy of Neurology American College of Sports Medicine National Athletic Trainers’ Association NCAA Concussion Task Force American Association of Neurological Surgeons Sports Neuropsychological Society American Medical Society for Sports Medicine American Football Coaches Association American Orthopaedic Society for Sports Medicine Football Championship Subdivision Executive Committee American Osteopathic Academy for Sports Medicine National Association of Collegiate Directors of Athletics College Athletic Trainers’ Society National Football Foundation Congress of Neurological Surgeons Second Safety in College Football Summit (February 2016) Year-round football practice contact. Concussion diagnosis and management. Independent medical care. Primary athletics health care providers. Director of medical services. Catastrophic injury. Year-Round Football Practice Contact: Draft Recommendations Inseason and bowl: 3 days of practice are non-contact. 1 day of live contact/tackling. 1 day of live contact/thud. Preseason: 3 days of practice are non-contact. 3 days of live contact. Non-contact follows scrimmage. One day of no football practice. 2/day not allowed. 2nd session can include walk-throughs. Spring: day following live scrimmage is non-contact. CARA: 2 hours can include coaches and football skills without equipment Independent Medical Care An active member institution shall establish an administrative structure that provides independent medical care and affirms the unchallengeable autonomous authority of primary athletics health care providers (team physicians and athletic trainers) to determine medical management and return to play decisions related to studentathletes. An active institution shall designate a director of medical services to oversee the institution’s athletic health care administration and delivery. This position may become a key for addressing the administration and medical care delivery gaps at member institutions. Point person for evolving inter-association documents, checklists and health & safety legislation. MENTAL HEALTH MENTAL HEALTH OCCURS ON A CONTINUUM Resilience and thriving Mental Health Mental health disorders THE NCAA BELIEVES THAT… Mental Health is not apart from, but rather a part of athlete health. To promote health is to enhance performance. It is important to understand sport specific issues related to athlete health and safety, and engage a wide range of experts. ATHLETE-SPECIFIC CONCERNS Culture of “toughness” can limit help seeking Perception that “looking fit” or performing well means that the athlete is healthy Pressure to perform High Visibility Practice/travel = missed class = academic stress Injury Time demands (and compromised sleep) Other concerns . . NCAA MENTAL HEALTH TASK FORCE NOVEMBER 2013 Clinicians, researchers, advocates, educators, athletics administrators, coaches and student-athletes. Comprehensive assessment of stressors and mental health disorders in college student-athletes. Goal: To develop best practices and to recommend research that support member institutions in meeting their membership obligations to provide a healthy and safe environment for student-athletes. Coach Strength & Conditioning Sports Medicine Athlete Sports Nutrition Counseling & Sport Psychology Athlete Development SUMMARY OF FINDINGS GUIDELINE SUMMARY Ensure that mental health care is provided by licensed practitioners qualified to provide mental health services. Clarify and disseminate referral protocol. Consider mental health screening in PPEs. Create and maintain a health-promoting environment that supports mental well-being and resilience. GUIDELINE #1 Care should be provided by*: Clinical or counseling psychologists. Psychiatrists. Licensed clinical social workers. Psychiatric mental health nurses. Licensed mental health counselors. Primary care physicians with core competencies to treat mental health disorders. *Include registered dietician in multidisciplinary team for eating disorders. Individual providing care should have cultural competency that addresses both societal diversity and the culture of sports. GUIDE #1 “It is important to note that issues that may initially and appropriately be viewed as related to performance may upon further engagement reveal underlying mental health concerns.” Coach Licensed Clinical Sports Psychology Medicine Strength & Conditioning Athlete Sports Nutrition Performance Counseling & Sport Psychology Enhancement Consulting Athlete Development GUIDELINE #1 Additional considerations: Financial support for dedicated service. Physical location. Autonomous authority, consistent with his or her professional licensure, to determine mental health management for student-athletes. Care should be subject to relevant laws governing patient confidentiality, including possible exemption from mandated reporting. GUIDELINE #2 Ensure that athletic departments have clarified their procedures for referring athletes with potential mental health concerns to appropriate personnel. GUIDELINE #2 Emergency action management plan: Should address emergency mental health-related situations including: • Managing suicidal and/or homicidal ideation. • Managing victims of sexual assault. • Managing highly agitated or threatening behavior, acute psychosis or paranoia. • Managing acute delirium/confusional state. • Managing acute intoxication or drug overdose. GUIDELINE #2 Routine mental health referrals Provide written institutional procedures regarding appropriate referral of student-athletes to all stakeholders within the athletics department. Identify a point person responsible for facilitating such referrals (e.g., AT, team physician). GUIDELINE #3 Consider implementing mental health screening as part of annual pre-participation exams. Determine screening approach in consultation with licensed mental health professional providing mental health care to student-athletes. Establish procedure specifying when and to whom symptomatic or at-risk student-athletes identified through this screening process will be referred. Screening tools are not validated as stand-alone assessments for mental health disorders. GUIDELINE #4 Create a health promoting environment that supports mental well-being and resilience. Student-athletes, FARs and coaches should be educated about the importance of mental health, including how to manage mental health concerns. GUIDELINE #4 Coaches play a central role and should be: educated on signs and symptoms of mental health disorders; trained in empathic response; encouraged to create a positive team culture; advised of department referral protocols. ADDITIONAL CONSIDERATIONS Medication Management Plan Ensure that student-athletes with medication are being appropriately monitored. Require student-athletes to list all medications and supplements they are taking. Maintain on file documentation from personal physicians to demonstrate appropriate diagnostic evaluation and treatment protocols for medication use. ADDITIONAL CONSIDERATIONS Financial Support Clarify institutional policies related to athletic financial awards and team engagement for student-athletes who are unable to continue sport participation, either temporarily or permanently, due to mental health considerations. Clarify institutional policies for financial support of studentathletes in need of extended outpatient treatment or inpatient care. ADDITIONAL CONSIDERATIONS Transitional Care Establish a clear transition of care plan for athletes who are leaving the college sport environment. Identify • Who is responsible for initiating transition of care? • Who is responsible for providing athletes with information about community mental health resources? • Who is responsible for ensuring athletes have adequate medication, as necessary, until continuing care is established? Establish a transition plan for returning student-athletes who have been away from campus seeking care for mental health issues. IN SUMMARY Mental health is not apart from, but rather, a part of athlete health. Athletic environments can support help seeking and facilitate early identification, appropriate referral and care. Establishing protocols for care means more equitable care across sports and within institutions. Implementation of Best Practice is an important step towards ensuring a model of care for student-athlete mental health. ADDRESSING CAMPUS SEXUAL ASSAULT AND INTERPERSONAL VIOLENCE www.ncaa.org/violenceprevention CARDIAC HEALTH CARDIAC TASK FORCE PEER-REVIEWED PUBLICATION CONSENSUS OUTLINE Introduction. Cardiovascular Risk in Student-Athletes. The Pre-Participation Evaluation. Evidence Evaluating the Efficacy of Pre-Participation Screening for Detection of Cardiovascular Risk. ECG as a Screening Tool for SCD Risk Prediction. Regional Referral Centers for Evaluation of Athletes Suspected or known to have a Cardiovascular Problem. Recognition of and Response to Cardiac Arrest. Cardiac Research Initiatives. Checklist. OVERUSE & EARLY SPECIALIZATION SOCCER SUMMIT www.ncaa.org/soccerhealth WRESTLING SUMMIT SPORT-SPECIFIC SUMMITS USOC, NGBs, NCAA and invited scientists. Early Specialization. Overuse Injuries. Illnesses. Periodization. Concussion Risk. Rules Implications. Wellness for Life. DOPING & RECREATIONAL DRUG USE DOPING AND RECREATIONAL DRUG USE Doping is cheating. Recreational drug use is different. Inconsistency is problematic. Need: Effective deterrence model. Need: Conference consistency. Need: Effective intervention. DATA ANALYTICS & INFORMATICS DATA ANALYTICS Evidence-based decisions. No centralized data collection or analysis. Solution: Datalys. Solution: Trust. Target: PPE. THANK YOU Contact info: Brian Hainline [email protected] @ncaa_ssi