A Circle of Referrals

Sooner or later, your athletes will need more help than you can give them. Are you ready to make those referrals?

By Guillermo Metz

Guillermo Metz is an Associate Editor at Training & Conditioning.

Training & Conditioning, 12.6, September 2002, http://www.momentummedia.com/articles/tc/tc1206/referrals.htm

Athletic injuries come in so many types and levels of severity that there is no way to have ready answers for every question or concern that arises. Even if you reach a point where you’ve seen every possible injury, each athlete is unique, and what worked for one athlete may not work as well for another.

Sometimes athletes need things you simply can’t provide. That’s why it’s important to regularly review and update your referral pool and the resources you make available for your athletes. In this article, athletic trainers discuss how to tap into resources you may not have thought of, make the most of available resources, and ensure that those resources are the best they can be.

There are standard referrals that most athletic trainers already have close at hand—professionals who can provide expert advice or treatment above and beyond what most athletic trainers are able to give. These include the obvious, such as nutritionists and physical therapists. But you’re not providing the full spectrum of referrals if you don’t also have contacts among the following specialists: gynecologist and urologist; dentist, oral surgeon, and otolaryngologist; optometrist and ophthalmologist; gastroenterologist; emergency medicine doctor, general surgeon, and orthopedist; neurologist; cardiologist; pulmonologist; rheumatologist; podiatrist; plastic surgeon; and infectious disease specialist.

And that list covers only an athlete’s physical needs. You also have to consider an athlete’s emotional needs. A serious injury can turn an athlete’s world upside down. He or she may need someone to talk with on a level beyond your comfort zone. So add a psychiatrist or a clinical psychologist to your list, preferably one who has worked with injured athletes. And it may be a good idea to foster contacts among the various religious communities on campus or in your area.

“When trauma hits, or even when the strains and stresses of life simply become too much, people seek out all sorts of avenues for help,” says George Salvaterra, ATC, PhD, Head Athletic Trainer at Penn State University. “These problems have to be worked through with counselors, psychologists, and maybe even psychiatric help. Some kids are more able to talk to peer counselors. Some seek out religious counselors. Others find that they can be counseled by coaches, athletic trainers, sports psychologists, or our team physician.”

That means you should have referrals in each of those areas. To get a sense of some of the non-medical referrals that you should have available, let’s look at a common example in-depth: an injured athlete making the transition from being a competitive student-athlete to just being a student.

“After a serious injury, a lot of kids realize that they won’t triple-jump 45 feet any more, but they still want to play pick-up softball or pick-up volleyball or pick up their kids someday,” says Scott Doberstein, MS, ATC, Head Athletic Trainer at the University of Wisconsin-LaCrosse. “My main concern is that they are functional and that the long-term complications are minimized.

“It’s a tough situation, because these student-athletes have been competing since they were little,” he continues. “They’re coming to a realization that their competitive athletic days, for the most part, are over. So, it’s a pretty traumatic time for them.

“It becomes our job to make sure they get the help they need. A lot of that help is facilitated through the coach. But we make sure to look at it from the medical side and get them to the right doctors at the right time so that they have a functional body the rest of their lives.”

Beyond getting those former athletes the physical and emotional services they need, you may also find yourself helping them take those first steps toward the next phase of their lives. “Most student-athletes are not going to be professional athletes,” says Ohio State University’s Director of Athletic Training, Bill Davis, MS, ATC. “They’re here for an education. So you try to make sure they have a happy competitive athletic career, but if something happens, you want to make sure you’re giving them the support they need to concentrate on academics.

“We have excellent student-athlete support services,” he continues. “There is multiple programming that addresses the transitional period after their athletic career ends. There’s a course here that our student-athletes are able to take called ‘Positive Transition,’ which is also available for the student-athlete who has a medical waiver or is unable to participate for a variety of reasons. It can help them make the transition from competitive athletics into finishing school, getting their resume together, and going out to interview for their first job.”

As the head athletic trainer, you may not be intimately involved in setting up such programs, but being aware of what they offer and who administers them will greatly help you counsel your student-athletes. And you can also play an important, direct role in counseling a former athlete looking to make some career decisions. You are, after all, a sports-medicine expert. Think about how many of your peers got into athletic training as injured athletes and became fascinated by the medical process.

It also helps to know what other sport-career options are out there. “We had a kid on the football team who got hurt and couldn’t play any more,” recalls Doberstein. “I happened to be talking to him about how much he loved football and how he could still be active with the team. I mentioned that the team needed a manager and that he should talk with the coach. He had never thought of that, but the next thing you know he’s the team’s equipment manager.

“Now, he’s engaged in football and he’s interested in pursuing a certification process for equipment managers. I think this kid’s going to be one heck of an equipment manager because he’s found his niche. He’s good at it, he likes the athletes, he likes to be involved, and he understands the sport.”

Doberstein didn’t have to do any more than be in tune with the needs of his athletes and athletic department, and then match the two. In one simple conversation, he changed that former athlete’s life.

“We’re always getting calls from the community as well,” he says. “The YMCA will call and say, ‘We need a swim teacher,’ or ‘We need someone to supervise the playground.’ We’re finding students jobs, both volunteer and paid, and these become feathers in students’ caps.”

At first glance, you may think that the resources an athletic trainer can provide at institutions such as the University of Pennsylvania, the University of Washington, or Ohio State University are vastly different from those available at a smaller school. But while the sheer number and depth of those resources will vary greatly, in both cases, you can bet student-athletes will have the same needs. Which simply means that the challenges of providing those resources for them are different for athletic trainers working at these two types of schools.

At a large university, developing an effective referral network may be a matter of acquainting yourself with the full breadth of what’s already available. At a smaller campus, it may mean spending more time and energy making connections in the larger community. But in all cases, the bottom line is the more resources you acquaint yourself with, the better prepared you’ll be to steer your athletes to them when they are needed.

Making those connections takes some time and effort, but probably not as much as you may fear. In some cases, formal arrangements may not even be necessary. Regardless of the structure, the ability to access necessary resources as needed is vital.

“We don’t have a lot of formal things set up,” says Natalie Steadman, ATC, PT, Assistant Athletic Director for Sports Health at Texas Tech University, “but if we see someone who’s in need, we go out and find the necessary resources. We talk with people at other schools and say, ‘Here’s the kind of problem I have. What types of professionals have you guys had luck with?’”

Many times, referrals may be knocking at your door without you realizing it. “People are calling the university all the time wanting to get involved in this area or that area,” says David Burton, MS, ATC, Associate Athletic Director for Student Services and Head Athletic Trainer at the University of Washington. “Usually, they’ll call someone in the administration, the athletic office, or the university hospital.” But because Burton made contacts throughout the institution, those names are regularly passed on to him.

The process from there is straightforward. “If someone is brought to our attention who has a specialty in a particular area, then we’ll talk with them,” says Burton. “And if we feel they’re able to contribute and add to what we have available for our student-athletes, we’ll add them to our cadre of referral assistants.

“We determine their level of expertise from their resumes and any recommendations we’ve received, or we talk with other organizations that have utilized their services in the past,” he says. “And we usually do a trial period where the individual will work with an athlete or group of athletes for a short period of time. Then we’ll sit down and make an evaluation of what they have been able to offer.” (For more information on evaluating referrals and other resources, see Sidebar, “Resource Review,” at the end of this article.)

That kind of openness to new allied professionals can create very rewarding arrangements. For example, Burton hired a physical therapist who specializes in gait analysis. “His expertise has helped us figure out what’s going on with some of our athletes who just weren’t getting better,” he says.

He’s also developed a mutually beneficial arrangement with a local massage therapy school. “We help their senior students get their clinical hours necessary to become licensed in the state,” he says. “And they come here to our training room and provide a valuable service to our student-athletes.”

At the University of Wisconsin’s main campus in Madison, Head Athletic Trainer Dennis Helwig, ATC/L, makes a considerable effort to ensure all of his staff members are familiar with the resources and referrals available both on and off campus. “In addition to our policies and procedures book, we have a three-ring binder with our referral bases for everything from dentists to podiatrists,” he says. “It goes through how to activate those services and who to contact. We match up all new athletic trainers with a mentor on the staff to take them through everything in the referral book and advise them for the first three to six months they’re here.”

All schools, from the smallest to the largest, share one of the most overlooked resources for helping student-athletes: their peers. Other students, especially those with common experiences, can help your injured athletes in countless ways.

For example, while you and the team physician can explain an injury and the ensuing medical procedure in exquisite detail, a fellow student who’s gone through the same thing may be able to offer more directly meaningful information. “If there’s someone undergoing shoulder surgery, we’ll say, ‘So and so had the same sort of injury. Go talk with them,”’ says Gale Newton, ATC, Head Athletic Trainer at Miami (Ohio) University. “‘They’ll tell you what you’re going to go through.’ We mainly use people on campus, but we can even hook them up with alumni, if necessary.”

“We might ask another student-athlete who’s gone down the same road to just talk with them and let them know that there’s a light at the end of the tunnel and that everything’s going to be okay,” says Steadman. “Often, they can talk about how they dealt with things that came up during their rehab.”

Sometimes, peer support can take on a more formal structure. At Ohio State, student-athletes can not only access the services of full-time, on-staff sports psychologists, but also a formal peer support group for injured athletes. “That sports psychologist has an injured athlete assistance group that meets regularly,” explains Davis. “So, there’s a vehicle for staff athletic trainers to tell some student-athletes, ‘Hey, you’re not the only person going through this. This might be a group you might want to visit with.’”

Usually, these student-athlete peer support groups meet once a week throughout the academic year. Athletes sign on whenever they feel they could use the services of the group, and they go as often and for as long as they feel they need to. All you have to do to help your rehabbing athletes is mention that such a thing is available.

And that’s how referrals work best. They are a way to provide something to a student-athlete that you can’t. And by keeping a ready, comprehensive list of specialists available, you not only help your student-athletes, you free up your time and resources for focusing on what you do best.

Sidebar: Resource Review

When there’s something you can’t help your student-athletes with, you’ll want to point them to the best person available. You may have experts on campus, or you may have to find them in your larger community. But wherever they’re located, it’s crucial that you periodically assess them to make sure they’re filling the needs of your athletes as well as possible.

“I don’t have a formal evaluation process, but we utilize people when we get positive results,” says Dennis Helwig, ATC/L, Head Athletic Trainer at the University of Wisconsin. “I have a personal discussion with each athlete afterward. The idea is to have many people to go to, because some personalities don’t match. But if we have a situation where somebody is continuously not relating to the athlete or the situation, then you tend to go elsewhere. If you look at counselors who have an athletic background, they’re generally much quicker to relate to the athlete’s circumstances.”

Helwig realized something important early on—he wasn’t the expert in all disciplines. So, when it came to evaluating prospective counselors, he asked for help. “We have a counselor on staff who does some peer screening of the counselors in the community who we then refer athletes to,” he says. “He evaluates the counselors’ backgrounds and what they specialized in.”

After sending an athlete to someone on his referral list, David Burton, MS, ATC, Associate Athletic Director for Student Services and Head Athletic Trainer at the University of Washington, talks with the athlete and coach and gets their evaluations. “We’ll also talk with the specialist and see if they feel that they had access to all the information necessary in order to benefit the athlete to the highest degree possible,” he says. “And we meet with them at the end of the year and do a formal recap and evaluation of their performance.”