Battling concussions: Solving a funding puzzle
SECOND OF TWO PARTS
When many people think of Hawaii's charms, they envision idyllic beaches and fresh tropical fruit. Mic Koester thinks about high school football — particularly the presence of medical care on the sidelines.
That's because Hawaii is the only state to provide funding for athletic trainers at all public high schools, something that Koester and other sports health advocates would like to see in Oregon.
Koester, an orthopedic doctor and member of the Sports Medicine Advisory Committee for the Oregon Student Activities Association says evidence clearly shows that athletic trainers help prevent injury and aid treatment, particularly of concussions.
He and others, say the ideal policy is to have athletic trainers working in every public high school in Oregon, regardless of size, as in Hawaii. Koester also thinks that the state should mandate that, in order to offer interscholastic sports, schools must have a certified athletic trainer as part of its sports staff.
A challenging proposal
Funding for the positions would be included in the state's school budget. The trainers would work full-time, attend all practices and games, as well as provide treatment and rehabilitation from injuries. Koester also thinks that the state should mandate that, in order to offer interscholastic sports, schools must have a certified athletic trainer as part of its sports staff.
In Hawaii, there are only 43 high schools, overseen by one school district. In Oregon, there are 235 high schools under 198 school districts. And those schools range in size from large schools with more than 1,000 students to very small rural schools with fewer than 100 students.
In Hawaii, lawmakers earmark about $4.3 million annually to fund two trainers in each school. Koester estimates that it would cost up to three times that figure to employ a single trainer in every Oregon high school. The exact dollar figure depends on a variety of factors, including the pay scale, whether trainers would be employed for 10 months or a full year, and whether the funding would cover all schools in Oregon.
Oregon also is a large state, with metropolitan population centers to rural, unincorporated communities. It's easy to justify adding a full-time athletic trainer to the staff of a large school. But "from a funding standpoint, it is difficult to justify having an athletic trainer in a school with 50 kids," Koester says.
So the main challenge would be to fund athletic training positions in a way that suits the largest to the smallest schools. "We would not leave those kids out" of any funding proposal, Koester says,
Wayne Miller, a retired teacher and the athletic director of Griswold High School, in Helix, a tiny farming community in rural Umatilla County, says there is no way that his 1A school of less than 50 students, would ever hire an athletic trainer without outside funding, or unless a member of the school's existing staff seeks training.
"Would I like to have one? How could I say no?" he asks.
Darren Shryock, athletic director and assistant principal at Stayton High School, said his rural Marion County school contracts with a health care facility, PT Northwest for athletic training services, at a deeply discounted rate of $10,500 a year. That enables the school's trainer to work on a part-time basis. He arrives about 3 p.m. and stays through the day's games, but has little desk time to document the work he does.
"Our trainer here is almost at triage mode because it's three o'clock and everyone that needs help is lining up," said Shryock. He praised PT Northwest for offering its discounted rate, and was grateful to school boosters who paid half that cost, but conceded that "it would be nice to have more time."
'Co-op' model shows promise
Koester and others, including Johnson, think it's feasible to pursue what Koester calls a "co-op" model, where multiple, small schools would contract with an athletic trainer, who would split their time between schools. It's similar to the work Dr. Derek Earl does in the Hermiston area, and how small private schools in Hawaii provide athletic training services (see sidebar).
"Dr. Earl's model is an excellent example of the type of system that we hope to replicate throughout that portion of eastern and frontier Oregon," says David Kracke, a personal injury lawyer and Oregon's brain injury advocate coordinator.
Kracke also thinks there is potential in finding medical doctors willing to work as volunteer athletic trainers who, at the very least, would attend games.
Miller thinks sharing an athletic trainer among a few smaller schools would work. "Some days," at Griswold High, he says, "there would be nothing to do and other days there would be."
Ross Oshiro, coordinator of the sports medicine program at the Queen's Medical Center in Honolulu, and a former athletic trainer, thinks the issue essentially comes down to whether the money is spent in the school budget or in the courtroom. "Am I going to appropriate x number of millions of dollars for this program like Hawaii did? Or am I going to wait till I get sued for a million more dollars?"
Recruiting trainers is tough
Yet funding, were it to come, might not be enough. Many rural communities struggle to recruit and hire teachers, doctors and other professionals — including athletic trainers.
Newport High School won a $35,000 grant last year from the National Football League Foundation to help hire an athletic trainer and promote better health care for the school's athletes in general. The local hospital also agreed to pay half the trainer's salary in exchange for the trainer working at the hospital part-time.
A year later, they haven't found anyone willing to move to the rural coastal area. "It seems like most of the trainers want to live in the valley, more an urban atmosphere," says Joe Zagel, the high school's recently retired principal.
"We have money sitting in our accounts ready to hire a trainer," Zagel continues. "And we're going to have to explain to the NFL … we're struggling finding the trainer."
On the other end of the size spectrum, many of Oregon's largest high schools already have an athletic trainer. They could easily use a second position, and Koester hopes any funding proposals would take that into consideration. "If (the district) is already funding the position and the state provides funding … ideally they would fund two," he says.
Shelly Jones, the athletic trainer at Oregon's Aloha High School, says that, depending on the season and the teams that are playing, she cannot cover all the practices. In the spring, she often will observe the first half of a baseball practice, then move to a different field to observe the second half of a softball practice.
To say that many athletic trainers are "stretched thin is an understatement," Koester says.
The most important factor in swaying legislators, Koester and others say, is showing that there is a financial benefit to having athletic trainers work at the school.
Associate professor Sam Johnson and other researchers at OSU's School of Public Health and Human Sciences are finishing a study that will analyze the cost savings associated with having athletic trainers in Oregon schools.
Increasingly, the presence of athletic trainers in school is viewed as a public health issue that saves schools and parents money. Student athletes with access to an athletic trainer can avoid going to physical therapy, getting X-rays and other care, and reduce trips to the emergency room for treatment and care that athletic trainers provide to students without charging them.
And it keeps kids in school, instead of missing classes for medical appointments. Johnson is president of the Oregon Athletic Trainers' Society, which has worked with various school health programs that benefit the entire student population, not just athletes, on topics such as mental health, suicide prevention, anti-bullying and emergency action planning.
"You start seeing other benefits of having an athletic trainer that don't always show up on paper," Johnson says. "We need to do a better job of informing people of what we do."
Whether Hawaii's funding for athletic trainers can be replicated in Oregon ultimately comes down to a question of values.
"Oregon has been on the forefront of a lot of things on student health care," Johnson notes, including passing Max's Law and creating a sports medicine advisory group within OSAA.
Given Oregon's proposed $2 billion budget for K-12 schools, Koester says, "I think you can find some space in there for an athletic trainer in every school."
"We know enough about the benefits of athletic trainers," he says. "If we're putting money into athletic facilities, uniforms, coaches, we can find the amount of money to help establish a program to help keep kids safe."
Rattled: Oregon's Concussion Discussionis a joint project of InvestigateWest, Pamplin Media Group and the Agora Journalism Center, made possible in part by grants from Meyer Memorial Trust and the Center for Cooperative Media. Researcher Mark G. Harmon from the Portland State University Criminology & Criminal Justice Department provided statistical review and analysis. The New York-based Solutions Journalism Network provided training in solutions-based techniques and support to participating journalists. Components of this project, which will include video and audio files, charts and graphs, will be hosted online by both InvestigateWest and the Portland Tribune.
This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, solutionsjournalism.org.
RURAL ATHLETIC TRAINER WEARS MANY HATS
At Junction City High School, Tye Rauschert wears a couple different hats.
Rauschert is the Lane County school's athletic trainer. Since the position is only part-time, he also works part-time as the secretary of the athletic department.
His day starts at 6:45 a.m. Rauschert works in his secretarial duties until the end of the school day, at 3:15 p.m. Then he puts on his athletic training hat and heads to the field to observe practice.
Depending on the season and how many sports are being played at one time, Rauschert cannot attend every practice. "You're spread thin," he admits.
But all the coaches are educated in CPR and first-aid, and Rauschert always carries a cell phone and radio with him during practice, so he can respond quickly in case of injury.
The school's athletic program also has a program called "Anyone Can Save a Life," which is recommended by the Oregon School Activities Association. "We teach all our kids, in the event of an emergency, how to respond," Rauschert says. "Who grabs the athletic trainer? Do you call him? Do you radio him? Who calls 911?"
When it comes to concussions, Rauschert has helped instill the mantra "when in doubt, sit them out." In addition to attending practices and games, he helps an average of a dozen athletes at a time who are in rehab and treatment. "It's hard to balance sometimes," Rauschert says. "So you ask, who gets priority? You do a little triage."
Junction City is one of 34 Oregon high schools with a 4A classification, where most enrollments fall between 350 and 650 students. Rauschert guesses half of 4A schools have an athletic trainer.
Junction High has employed one since 1988. Craig Rothenberger, the school's athletic director, made it a priority, as did the school district's superintendent.
Junction High's training room is 342 square feet in size. There's a whirlpool, ice pool, treatment table and room for rehab. There's equipment that Rauschert would like to add — a new stationary bike, an ultrasound machine, and an electric stimulation machine, which can help control pain, help tissue heal, and help an athlete's range of motion increase during rehab.
"A lot of schools have it," Rauschert says. But a small budget is one of many challenges that exist within rural communities.
Rauschert is a graduate of Junction City High School, where he played basketball. When he graduated from Linfield College in 2005, he quickly found a job working at his high school alma mater.
He originally thought he would become a physician's assistant. But Rauschert calls being an athletic trainer "a calling."
"In a rural setting, you can wear a lot of hats and not just be influential to (athletes) in their athletics and academics, but in their life," he says.
Rauschert says he talks to his student athletes about "everything" — from injury prevention to nutrition to managing stress. "I never want somebody to come back and say, 'you never told me about that. You never educated me about that,'" he says.
The student athletes also often confide in him about their life at home, their struggles with anxiety, depression, peer pressure.
"My whole purpose here is to serve," Rauschert says. "I advocate for health and well-being. If they can stay on the field or on the court and compete at a high level, then I've done my job."