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REGIONAL RULES:SPORT SCIENCE INSTITUTE OVERVIEW

Brian Hainline, MDNCAA Chief Medical OfficerClinical Professor of NeurologyIndiana University School of MedicineNew York University School of Medicine

MISSIONTo promote and develop safety, excellence, and wellness in college student-athletes, and to foster life-long physical and mental development.

VISIONTo be the pre-eminent sport science voice for all student-athletes and NCAA member institutions, and to be the steward of best practices for youth and intercollegiate sports.

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

STRATEGIC PRIORITIES

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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

CONCUSSION

>80% of military TBIs are concussions.

85% of military concussions are biomechanically similar to sport-related 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.

NCAA AND DoD JOINT ENDEAVOR

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CSC & ARC ASSESSMENT PROTOCOL

Pre-Season

Acute Concussion Sub-Acute ConcussionPost-

Concussion

Baseline<6hrs

Post-Injury24-48hrs

Post-Injury

Asymptomatic / Cleared for

Return to Play Progression

Unrestricted Return to Play 7 days

following Return to

Play

6 Months Post-Injury

Neurocognitive and Behavioral Testing (CSC)

X X X X X X X

Blood Biomarker & DNA Collection X X X X X X

Multi-modal MRI Studies O X X X X

Head Impact Measurement: HITS (FB) and non-helmeted sensors (FB, SCR, LAX, IH)

• 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

DATA SUMMARY

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NCAA-DoD MIND MATTERS GRAND CHALLENGE

Executive CommitteeRauch (DoD), Hack & Hainline (NCAA), Koroshetz (NIH)

Education and Research Challenge

Consortium(Operating Committee)

NCAA: Dawn Buth, Amy Dunham, Dana ThomasDoD: Tara Cozzarelli, Stephanie Maxfield-Panker, Kathleen Quinkert

CDC: Kelly Sarmiento

Education Challenge Research Challenge

Administrative Coordinating Center:Indiana U School of Public HealthNir Menachemi, Ross Silverman

MomsTEAMInstitute(de Lench)

University of Arizona(Valerdi)

U. of South Alabama(Marass)

Creative Street Media (Katzenberger)

Johnson C. Smith U.(Williams)

UNC Greensboro

(Wyrick)

U. Wis-Madison(Warmath)

UNC Chapel Hill

(Mihalik)

Colorado State U.

(Coatsworth)

U. of Georgia(Schmidt)

Northern Arizona U.

(Craig)

U.S. Air Force

(D’Lauro)

Arizona State U.(Corman)

Chestnut Hill College(Ernst)

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.

MIND MATTERS CHALLENGE

www.ncaa.org/concussionsafety

Independent medical care

Year-round practice contact

Concussion diagnosis & management

INTER-ASSOCIATION GUIDELINES

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ENDORSEMENTS

American Academy of Neurology

American College of Sports Medicine

American Association of Neurological Surgeons

American Medical Society for Sports Medicine

American Orthopaedic Society for Sports Medicine

American Osteopathic Academy for Sports Medicine

College Athletic Trainers’ Society

Congress of Neurological Surgeons

National Athletic Trainers’ Association

NCAA Concussion Task Force

Sports Neuropsychological Society

American Football Coaches Association

Football Championship Subdivision Executive Committee

National Association of Collegiate Directors of Athletics

National Football Foundation

Year-round football practice contact.

Concussion diagnosis and management.

Independent medical care.

Primary athletics health care providers.

Director of medical services.

Catastrophic injury.

Second Safety in College Football Summit(February 2016)

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

Year-Round Football Practice Contact: Draft Recommendations

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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 student-athletes.

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.

Independent Medical Care

MENTAL HEALTH

MENTAL HEALTH OCCURS ON A CONTINUUM

Mental HealthResilience and thriving

Mental health disorders

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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.

THE NCAA BELIEVES THAT…

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 . .

ATHLETE-SPECIFIC CONCERNS

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.

NCAA MENTAL HEALTH TASK FORCE NOVEMBER 2013

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Coach

Athlete Development

Sports Medicine

Sports Nutrition

Strength & Conditioning

Counseling & Sport Psychology

Athlete

SUMMARY OF FINDINGS

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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 SUMMARY

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.

GUIDELINE #1

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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

Athlete Development

Sports Medicine

Sports Nutrition

Strength & Conditioning

Counseling & Sport Psychology

Athlete

Licensed Clinical Psychology

Performance Enhancement Consulting

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 #1

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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 #2

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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 #3

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.

GUIDELINE #4

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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 student‐athletes 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.

ADDITIONAL CONSIDERATIONS

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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.

IN SUMMARY

www.ncaa.org/violenceprevention

ADDRESSING CAMPUS SEXUAL ASSAULT AND INTERPERSONAL VIOLENCE

CARDIAC HEALTH

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CARDIAC TASK FORCE

PEER-REVIEWED PUBLICATION

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.

CONSENSUS OUTLINE

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OVERUSE & EARLY SPECIALIZATION

SOCCER SUMMIT

www.ncaa.org/soccerhealth

WRESTLING SUMMIT

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USOC, NGBs, NCAA and invited scientists.

Early Specialization.

Overuse Injuries.

Illnesses.

Periodization.

Concussion Risk.

Rules Implications.

Wellness for Life.

SPORT-SPECIFIC SUMMITS

DOPING & RECREATIONAL DRUG USE

Doping is cheating.

Recreational drug use is different.

Inconsistency is problematic.

Need: Effective deterrence model.

Need: Conference consistency.

Need: Effective intervention.

DOPING AND RECREATIONAL DRUG USE

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DATA ANALYTICS & INFORMATICS

Evidence-based decisions.

No centralized data collection or analysis.

Solution: Datalys.

Solution: Trust.

Target: PPE.

DATA ANALYTICS

THANK YOU

Contact info: Brian Hainline

ssi@ncaa.org

@ncaa_ssi

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