INTERVENTION & REFERALS

Intervention The act of deliberate intervening into a situation or dispute in order to influence events or prevent undesirable consequences Referral The act or process of referring somebody or something to somebody else, especially of sending a patient to consult a medical or psychology specialist When to make a referral: Treatment issue is beyond the area of one’s expertise Treatment issue is very serious and warrants emergent attention When it is requested An individual’s behavior is contra-related to clinician’s values & morals (i.e., illegal acts, use/abuse of controlled substances) Other reasons?

Referral Process Internal Occurs when athletic trainers have established prior contact with members of the institution in which one is involved (i.e., team physician, school psychologist, etc.). External Occurs when athletic trainers seek help outside the institution because the presenting problem is deemed inappropriate for the institution to manage because of limited resources or because the necessary treatment requires specialized skills. IN BOTH CASES, REFERRALS SHOULD ONLY BE MADE AFTER THE ATHLETE (OR PARENT/GUARDIAN) IS INFORMED OF THE PROCESS AND GIVEN THE CONSENT FOR THE REFERRAL

Most athletes (75 – 85%) possess a psychologically-stable well-being The number of individuals with a severe psychological pathology may be lower among the athletic population because they engage in regular physical activity, which is commonly used as a therapeutic treatment, including depression. (Brewer & Petrie, 2002) Over 40% of collegiate student-athletes who sought the services of sport psychology consultants needed assistance dealing with personal or mental health issues. social academic athletic FYI: Up to 25% of a university’s workforce will experience some mild-to-moderate forms of emotional distress. It has been estimated that 10-12% of students enrolled in urban universities suffer from some form of disabling mental health disorders (www.suffork.edu/offices/4446)

It is critical for athletic trainers to develop a list of willing professionals to serve as referral sources BEFORE referrals are needed. Who should these folks include?

MEDICAL DOCTORS – GENERAL & SPECIALISTS TUTORS CLINICAL SPORT PSYCHOLOGISTS EDUCATIONAL SPORT PSYCHOLGISTS FAMILY THERAPISTS CLERGY PSYCHIATRISTS SPECIALIZED SUPPORT GROUPS (gay & lesbian groups, AA, NA, GA, anger management, stress management etc.,) ALTERNATIVE PRACTIONERS (acupuncture, massage, chiropractors) Others?

Athletes may directly request help Indirect requests are more difficult to “read” because they tend to be hidden among a variety of stated concerns or problematic behaviors. Athletes may bring academic or relationship issues into the training room because they are more “acceptable” and appropriate.

Problems with concentration, memory, attentional skills THE FOLLOWING IS A LIST OF BEHAVIORS THAT MAY INDICATE THAT AN ATHLETE MAY BENEFIT FROM VISITING A PROFESSIONAL ON THE PSYCHOLOGICAL / SUPPORT REFERRAL LIST DEVELOPED BY A SPORTS MEDICINE PROFESSIONAL Problems with concentration, memory, attentional skills Loss of interest in schoolwork, social activities Excessive tardiness to class or rehabilitation appointments & treatments Acute performance anxieties Unrealistic expectations for athletic performance or rehabilitation treatment Expressed difficulties with family, friends & relationships Expressed concerns regarding death of self or others Marked withdrawal Irrational worrying Loss of appetite, sleep

Undue concern with physical health Indications of increased / excessive drinking or drug use Plagiarism, cheating, lying and other asocial behaviors Acute increased in activity levels (i.e., talking, rambling, hyperactivity Frequent irritability, suspiciousness, irrational feelings Disordered thought

A REFERRAL IS USUALLY APPROPRIATE WHEN: An athlete presents a problem or requests information which is beyond your scope of knowledge, competency or interest Personality differences exist between you and the athlete which appear unresolvable and interfere with your assistance If the problem in “personal” and your relationship with the athlete is limited to athletic/injury interactions If an athlete brings up a problem but is reluctant to discuss it with you further You feel uncomfortable dealing with the issues raised by the athlete And then of course……… there is talk about ending one’s life…THIS NEEDS IMMEDIATE ATTENTION!!!!!!

HOW TO MAKE A REFERRAL If given approval from the athlete, parent/guardian, provide as much information as you can to whomever you are making the referral. Make the referral as soon as possible Follow-up after the referral is made to demonstrate continued interest in the athlete DOCUMENT….. DOCUMENT……DOCUMENT…. DOCUMENT…… DOCUMENT……DOCUMENT…. DOCUMENT……DOCUMENT…..