Developing a Behavior Health Plan for College Athletes Marcy Buselli MS ATC R. Mark Laursen MS ATC Boston University Athletic Training Services

Overview Values Philosophy Team Making Connections across campus

Values

Philosophy

Team

Making Connections across campus

Components of the System Coach Education Sports Psychology Performance enhancement Patient education Nutrition Prevention and Screening Psychosocial Counseling Mandatory vs Voluntary Medical Management Medication and return to activity Case Management Confidentiality and Communication

Coach Education

Sports Psychology

Performance enhancement

Patient education

Nutrition

Prevention and Screening

Psychosocial Counseling

Mandatory vs Voluntary

Medical Management

Medication and return to activity

Case Management

Confidentiality and Communication

Coach Education Group Meetings Individual Basis Challenges

Group Meetings

Individual Basis

Challenges

Sports Psychology Performance Enhancement Policies and Requirements Doctoral student with exception Mandated on campus supervision weekly Review of scope of practice Referral policy and chain of command Documentation Cost

Performance Enhancement

Policies and Requirements

Doctoral student with exception

Mandated on campus supervision weekly

Review of scope of practice

Referral policy and chain of command

Documentation

Cost

Patient Education First meeting of the year Team/Group meetings Specific conditions/diseases Life skills (mandatory in athletics) Campus Policies and Procedures

First meeting of the year

Team/Group meetings

Specific conditions/diseases

Life skills (mandatory in athletics)

Campus Policies and Procedures

Nutrition Fitness Center Nutrition Fitness Center Health Service Athletics PERD Dining Services Sargent College

Nutrition Fitness Center Services Nutrition Fitness Center

Nutrition Fitness Center Services Nutrition Fitness Center Group Counseling Sargent Choice Dining services Individual Counseling PERD Classes

Group Counseling Sargent Choice Dining services PERD Classes Individual Counseling Nutrition Fitness Center Health Service Athletics Dining Services Sargent College PERD

Prevention and Screening Process “ Red Flags”

Process

“ Red Flags”

Red Flags for behavioral health Do you ask these questions? Current Medications Current Eating Practices Attitudes and Behaviors Females – Menstruation Hx Body Measurements Personal Health History Other Topics

Current Medications

Current Eating Practices

Attitudes and Behaviors

Females – Menstruation Hx

Body Measurements

Personal Health History

Other Topics

Prevention and Screening Process “ Red Flags” Future plans

Process

“ Red Flags”

Future plans

Psychosocial Counseling Campus Student Health Services- Behavioral Medicine Danielsen Institute Clinic Psychological Services Center Center for Anxiety and Related Disorders University Chaplains Center for Psychiatric Rehabilitation

Campus

Student Health Services- Behavioral Medicine

Danielsen Institute Clinic

Psychological Services Center

Center for Anxiety and Related Disorders

University Chaplains

Center for Psychiatric Rehabilitation

Campus Resources Your Concern Type of Service Whom to Call Name of Service Description/ Information Contact Information Help managing depression and school work Mental Health/ Counseling Mitzi Kane (Patient Care Coordinator) BU Student Health Services- Behavioral Medicine Individual Counseling and Psychotherapy Psychopharmacological evaluation and treatment Group Therapy Emergency support 881 Comm. Ave W. Boston, MA 02215 617-353-3569 (24 hr on call) www.bu.edu/shs/behavioral George Stavros Danielsen Institute Clinic Assessment Individual, group, and family therapy 185 Bay State Road Boston, MA 02215 617-353-3047 www.bu.edu/danielsen Life Skills Support Dori Hutchinson Andrea Bengtson (Clinical Coordinator) BU- Center for Psychiatric Rehabilitation Skill building and support services for individuals with serious psychiatric challenges Individual recovery and rehabilitation services Individual case management 940 Comm. Ave Boston, MA 02215 617-353-3549 For Information about other services: www.bu.edu/cpr/services Academic Support (see section on Academic Resources for information on Educational Resource Center) Lorraine Wolf Office of Disability Services Services/ Accommodations Provided- Note taking Accessibility Services Assistive Technology Interpretation Tutoring Study Skills Support 19 Deerfield Street (2 nd Floor) Boston, MA 02215 Ph: 617-353-3658 (V/TTY) www.bu.edu/disability

Individual Counseling and Psychotherapy

Psychopharmacological evaluation and treatment

Group Therapy

Emergency support

Assessment

Individual, group, and family therapy

Skill building and support services for individuals with serious psychiatric challenges

Individual recovery and rehabilitation services

Individual case management

Services/ Accommodations Provided-

Note taking

Accessibility Services

Assistive Technology

Interpretation

Tutoring

Study Skills Support

Campus Resources Your Concern Type of Service Whom to Call Name of Service Description/ Information Contact Information How to talk to a friend who might be cutting himself/ herself. Where can they get help. Mental Health/ Counseling Mitzi Kane (Patient Care Coordinator) BU Student Health Service- Behavioral Medicine Individual Counseling and Psychotherapy Psychopharmacological evaluation and treatment Group Therapy Emergency support 881 Comm. Ave Boston, MA 02215 617-353-3569 (24 hr on call) www.bu.edu/shs/behavioral George Stavros Danielsen Institute Clinic Assessment Individual, group, and family therapy 185 Bay State Road Boston, MA 02215 617-353-3047 www.bu.edu/danielsen Valerie Wilson/ Lisa Smith BU Psychological Services Center Assessment Individual Psychotherapeutic treatment 648 Beacon St, 5 th Floor Boston, MA 02215 617-358-4290 www.bu.edu/psc Information How to help someone in distress- www.bu.edu/helpinfo

Individual Counseling and Psychotherapy

Psychopharmacological evaluation and treatment

Group Therapy

Emergency support

Assessment

Individual, group, and family therapy

Assessment

Individual Psychotherapeutic treatment

Psychological Referral Mandatory vs Voluntary Voluntary Department ID Mandatory Self referral Voluntary Voluntary Crisis Mandatory Mandatory

Medical Management Team Physician Athletic Trainer Behavioral Health Provider Contracts Team Physician Athletic Trainer Student-athlete Coaches Nutrition Behavioral health

Team Physician

Athletic Trainer

Behavioral Health Provider

Contracts

Team Physician

Athletic Trainer

Student-athlete

Coaches

Nutrition

Behavioral health

Eating Disorders Evaluation And Treatment Athletic Trainer Other Nutritionist Behavioral Health Team Physician Student Athlete

Behavioral Contract for the 2009-2010 Academic Year I, ___________________, agree that my dietary habits and exercising may be detrimental to my health. My goal over the upcoming academic year is to compete to the best of my ability in a manner that will not compromise my health and safety. To this end, I am entering into this agreement with Boston University Athletic Training Services . I agree to meet weekly with Health Care Provider (HCP) for weight checks and to monitor my progress. Meetings may be more frequent if the HCP feels that is warranted. I may also opt to meet more frequently if I feel it is needed. These visits may be spaced out later in the year as my goals are achieved and maintained as determined by HCP . I agree to meet at least twice per month with a sports nutritionist to review dietary goals. I agree to meet with a psychologist once per week . Meetings may be more frequent based on recommendations by the mental health care provider and/or HCP . We have determined that my health may become compromised if my weight drops below X pounds. If at anytime over the next year my weight drops below X pounds, I will be held from participation in any team events, including practice and competition for at least 2 weeks as determined by HCP . I will attend practices and competitions but will not be allowed to practice or compete. If my weight drops below X pounds, I agree to blood tests to assess several aspects of my health as determined by HCP . At the end of this 2 week period, HCP will decide on my return to participation based on my weight and any tests results if available. I will not be allowed to participate fully with the Boston University athletic team until my weight is above X pounds . I will adhere to workouts set forth by the coaching staff and agree not to work out on my own without their consultation. I may be allowed partial participation including limited workouts if my weight is above X pounds, but not participate fully until my weight reached X pounds. If I miss any of these mandatory appointments, I will be subject to temporary disqualification from team activities as determined by HCP , and my eating disorder team (nutritionists, mental health provider, and athletic training staff). Frequent breach of this contract will result in permanent disqualification. _________________________ _______ ______________________ _______ Student-athlete Date Team Physician Date _________________________ _______ Athletic Trainer Date

Behavioral Contract for the 2009-2010 Academic Year

I, ___________________, agree that my dietary habits and exercising may be detrimental to my health. My goal over the upcoming academic year is to compete to the best of my ability in a manner that will not compromise my health and safety.

To this end, I am entering into this agreement with Boston University Athletic Training Services .

I agree to meet weekly with Health Care Provider (HCP) for weight checks and to monitor my progress. Meetings may be more frequent if the HCP feels that is warranted. I may also opt to meet more frequently if I feel it is needed. These visits may be spaced out later in the year as my goals are achieved and maintained as determined by HCP .

I agree to meet at least twice per month with a sports nutritionist to review dietary goals.

I agree to meet with a psychologist once per week . Meetings may be more frequent based on recommendations by the mental health care provider and/or HCP .

We have determined that my health may become compromised if my weight drops below X pounds. If at anytime over the next year my weight drops below X pounds, I will be held from participation in any team events, including practice and competition for at least 2 weeks as determined by HCP . I will attend practices and competitions but will not be allowed to practice or compete.

If my weight drops below X pounds, I agree to blood tests to assess several aspects of my health as determined by HCP . At the end of this 2 week period, HCP will decide on my return to participation based on my weight and any tests results if available.

I will not be allowed to participate fully with the Boston University athletic team until my weight is above X pounds .

I will adhere to workouts set forth by the coaching staff and agree not to work out on my own without their consultation. I may be allowed partial participation including limited workouts if my weight is above X pounds, but not participate fully until my weight reached X pounds.

If I miss any of these mandatory appointments, I will be subject to temporary disqualification from team activities as determined by HCP , and my eating disorder team (nutritionists, mental health provider, and athletic training staff). Frequent breach of this contract will result in permanent disqualification.

_________________________ _______ ______________________ _______

Student-athlete Date Team Physician Date

_________________________ _______

Athletic Trainer Date

Case Management Case Manager Administration Team physician University Case Manager Level 3 Administration/ Team physician Case Manager Level 2 Case Manager Individual AT Level 1 Support from Managed by Classification

Confidentiality and Communication Who needs to know what?

Who needs to know what?

Who needs to be informed by Athletic Training Services Teammate Parents Coaches Athletic Administration Academic Services Other ATs Residence Life Dean of Students AT coordinating care AT admin Team physician Case coordinator Behavioral Health Nutrition Rarely Sometimes Always

Teammate

Parents

Coaches

Athletic Administration

Academic Services

Other ATs

Residence Life

Dean of Students

AT coordinating care

AT admin

Team physician

Case coordinator

Behavioral Health

Nutrition

Confidentiality and Communication Who needs to know what? How a condition can affect our practice as athletic trainers? 5 minute meetings Patient centered challenges Chain of command Documentation

Who needs to know what?

How a condition can affect our practice as athletic trainers?

5 minute meetings

Patient centered challenges

Chain of command

Documentation

Please see athletes’ General Medical file for additional diagnosis and treatment information. Note: Additional information is sensitive in nature please respect the athletes’ confidentiality.

Please see athletes’ General Medical file for additional diagnosis and treatment information.

Note: Additional information is sensitive in nature please respect the athletes’ confidentiality.

Scenario (#1) It’s the fall Semester for a junior women’s track athlete. Her coaches call the athletic trainer who coordinates the care for the team concerned with her recent weight loss.

It’s the fall Semester for a junior women’s track athlete. Her coaches call the athletic trainer who coordinates the care for the team concerned with her recent weight loss.

Scenario (#1) Coach calls concerned/recent weight loss Gather more information Specific incidents, chart information: BMI, Family hx, personal hx Initiate contact with the patient Coach asks for athletic trainer to speak with SA Screen patient Referral policy

Gather more information

Specific incidents, chart information: BMI, Family hx, personal hx

Initiate contact with the patient

Coach asks for athletic trainer to speak with SA

Screen patient

Referral policy

Nutrition Medical Management Medical Management Behavioral Health

Scenario (#1) Coach calls concerned/recent weight loss Gather more information Initiate contact with the patient Screen patient Referral policy Communication

Gather more information

Initiate contact with the patient

Screen patient

Referral policy

Communication

Scenario (#2) Pre-participation paperwork is received for a transfer wrestling student-athlete. The student shows up for physicals.

Pre-participation paperwork is received for a transfer wrestling student-athlete. The student shows up for physicals.

Scenario (#2) Pre-participation paperwork/physicals. Information Medication Screen patient Team physician, Athletic trainer, Leadership Referral and treatment plan Contract, on or off campus Communication

Information

Medication

Screen patient

Team physician, Athletic trainer, Leadership

Referral and treatment plan

Contract, on or off campus

Communication

Thank You Marcy Buselli MS ATC R. Mark Laursen MS ATC Boston University Athletic Training Services

Thank You