A Grant Request for the Winningham FoundationTEAM INJURYPREVENTIONLauren Burt, Jeremy Chittavong, Liz Deutchki, JamiePetta, and Madison TreeceH10/003

Table of ContentsProgram Rationale .2Health Problems at a National, State, and Local Level . .3Our Program .4Needs Assessment .5Target Population Risk Factors .Priority Index Matrix Predisposing, Reinforcing, and Enabling Factors .Mission Statement .Program Goals and Objectives .Implementation of the Intervention .Health Belief Model Intervention Strategy Program Resources .Resources Needed to Start the Program .Gantt Chart .Intervention Design .Program Marketing Marketing and Advertising .Budget .Evaluations .References .Appendix .Concussion Prevention 1

Program RationaleThe health problem our program will address is Traumatic Brain Injuries(TBIs), specifically sports-related concussions. Concussions are a subset orsubclass of TBIs; however, they are often used interchangeably. According to theSports Concussion Institute (2012), concussions are “a complexpathophysiological process that affects the brain, typically induced by trauma tothe brain.” Since concussions are mostly the result from direct impact to the skull,symptoms typically include any of the following physical, mental, or emotionaleffects: headaches, nausea, difficulty concentrating, memory impairments,irritability, sadness, sleep disturbances, and changes in energy level.Age plays a huge role in the severity of concussions. High school studentshave proven to take longer to recover than collegiate and professional athletesbecause they have not fully developed neurologically. Once getting an initialconcussion, athletes are at a higher risk to suffer from a concussion again, andthey will take longer to recover the second time. The frontal lobes of the braindevelop mostly during youth years up until around 25 years of age. Concussionsdisturb neurological development, so the younger an athlete is when sufferingfrom a concussion, the more complex the recovery process can be. This is one ofthe key consequences of concussions and failing to manage them properly.Additional consequences include mild cognitive impairments (MCIs), chronicConcussion Prevention 2

traumatic encephalopathy (CTE) and neurological damage (SportsConcussion Institute, 2012).According to Mayo Clinic (2016), MCIs are referred to as “ an intermediatestage between the expected cognitive decline of normal aging and themore-serious decline of dementia.” Typical complications include memory issues,language, and development of thinking. CTEs are defined as “brain degenerationlikely caused by repeated head trauma.Scope of the Health ProblemAccording to the Brain Injury Research Institute (2016): National It is estimated that 1.6-3.8 million concussions related to sports andrecreation occur annually in the United States. Between the years 2001-2005, young athletes ages 5-18 accounted for2.4 million emergency department (ED) visits each year due tosports-related injuries (Brain Injury Research Institute, 2016). Of the 2.4million ED visits, roughly 6% (135,000) involved a concussion. State/Local South Carolina will serve as both state and local level data. According to the South Carolina Department of Health and EnvironmentalControl (2015) there are: 1,117 deaths per year as a result of concussions/TBIsConcussion Prevention 3

2,800 hospitalizations 11,500 ED visits The leading cause of nonfatal TBIs/concussions are falls (35%), motorvehicle traffic crashes (22%), “struck by/against” events (11%), andassaults (10%) (SCDHEC, 2015). “Struck by/against” events include sports related injuries due toimpact.Program OverviewOur program seeks to ultimately reduce sports-related concussions bygiving coaches more information about the severity of concussions on theirplayers as well as proper tackling techniques that are both effective for the sportand more safe for the players. Programs such as this one will reduce thefrequency of concussions in athletes and also reduce the negative results thatcome along with TBIs. This will reduce the long term effects faced by theindividuals who suffer from concussions and reduce family stress or worry fortheir loved ones.This program would be a great investment and opportunity for participants,potential funders, and stakeholders: Participants: Reduced rate for Gamecock Youth coaches for in-kindfacilityConcussion Prevention 4

Receive participation certificate for knowing propertechniques to reduce concussions Good resume booster Opportunity to win Carolina Panthers football tickets Potential funders: Help reduce growing health problem Serious issue that needs to be addressed Children are the future Stakeholders: Serious health problem More studies are coming out about the future neurologicalimpacts for the injured players Set a precedent early that concussions should not be takenlightlyNeeds AssessmentOverview of Health ProblemConcussions affect almost 4 million people each year in the United States (BrainInjury Research Institute,2016). Various problems can arise from suffering aconcussion, including neurological disturbances and mild cognitive impairments (SportsConcussion Institute, 2012). Once suffering a concussion, the chances of sufferinganother increase, and the recovery time also increases. Since concussions mostlyConcussion Prevention 5

result from direct impact to the skull, it is important to focus on correct tacklingtechniques to combat the persistence of concussions.Who Is Affected By Concussions? All athletes involved in contact sports An athlete who has suffered a concussion can experience brain traumaand short term and/or long term mental difficulties. Parents and loved ones of athletes Parents of athletes with concussions will have to pay for potential medicalcosts and help care for their child after any mental injury. Coaches Coaches are supposed to teach players proper technique to avoidconcussions so they may feel morally responsible for their players injuries.They may also lose that player from their team for an extended amount oftime while they recover.Target PopulationThe target population is the coaches of the Gamecock Youth FootballAssociation male football players in the Jr. Pee Wee division. This group of coaches willserve as our pilot test group. The coaches of this program coach a team of maleplayers ages 8-10. The players are a secondary population because the knowledgeConcussion Prevention 6

gained from this program is intended to filter down to the players. The coaches for thePee Wee division were chosen because of the age group they coach. According toCantu (2015) young children are more prone to brain injuries than adults because theirbrains have not matured to that of an adult. Stephenson found that between 2001-2009“approximately 2.7 million children under the age of 19” were treated each year forsports-related injuries, and of those incidents 6.5% were from traumatic brain injuries.Risk FactorsAccording to Levy, Ozgur, Berry, Aryan, & Apuzzo (2004) some risk factorsrelated to behaviors include player position, game speed, helmet and protectiveequipment, the skills/knowledge about how to take hits and give hits with less damage,and the weight of the player*. There are also environmental risk factors to take intoaccount, including the surface on which the athletes play on. This can influence the rateof concussions (Daneshvar, Baugh, Nowinski, McKee, Stern, & Cantu, 2011). Norton,Schwerdt, & Lange (2001) have shown that synthetic fields are harder and allows forathletes to reach faster speeds, therefore increasing the risk of concussions.*indicates risk factors suggested by the planning committeeFactor TypeFactorThere may be a lack ofknowledge.PredisposingExplanationIf the coaches do not teachthe athletes propertechnique, they may go inhead first for the tacklewhich could lead to aConcussion Prevention 7

concussion.Coaches are not teachingplayers about concussionsand the issues that comealong with it.EnablingGiving the players theknowledge of theoutcomes of concussionswill allow them to be morecareful.Coaches do not correct the If the coach does not try toplayers when they tacklecorrect it at practice thenwrong at practice.the players will continuetackling the incorrect way.Internal reward: Thecoaches are glad that theydo not have players sittingout from practice orgames.ReinforcingWith proper tacklingtechniques, it is less likelythat the athletes will getinjured and as a result lessplayers will have to sit out.Priority Index MatrixBelow is a Prioritization Index Matrix which places different risk factors based onimportance and changeability.More ImportantMoreChangeable Individual style of play(targeted by theintervention to teachplayers how to playcorrectly, avoidingconcussions) Coaching correct tacklingtechniquesLess Important Surface athlete plays onPlayer positionGame speedHelmet and protectiveequipmentConcussion Prevention 8

LessChangeable History of concussions Weather Younger age/slowerrecovery Height of the player Weight of the player (forthe purpose of theintervention, too slow tochange in this case)As you can see above, the most changeable and most important risk factors forour cause is the individual style of play and the coaches’ tackling technique.Target Population InputWe plan to obtain target population input with a post program survey seeing thesatisfaction of the coaches as well as suggestions for change in the future. In addition,we have a pre-assessment and post-assessment survey to see change in knowledge ofthe coaches. We will also have continuous monitoring of the techniques used by thecoaches during the football season to see if they reflect the information taught by theintervention.Planning committee members Head director of Intervention and accountant Our head director of the intervention is Stacy Greene who has amajor in Public Health and got her MBA from University of Chicago.She has worked with other companies in the past for concussionprevention.Concussion Prevention 9

The accountant for our intervention is Matthew Norris who is aUniversity of South Carolina alumnus and got his masters fromUniversity of Berkley. Coaches for Jr. Pee Wee division of Gamecock Youth We will have coaches, Coach Jerry Smith and Coach John Bernett,from this league in our planning committee to be representatives ofpriority population since we want input from our participants. Participants from Gamecock Youth who have experiencedconcussions Jeremy Wilson has experienced a concussion during hisexperience at the Gamecock Youth Football Association. We chosehim for our planning committee since the health problem we areaddressing is directly related to concussive injuries such as his. Owner or head manager of Gamecock Youth Since we have an agreement with Gamecock Youth to use theirfacilities and resources, it is important that one of their programdirectors or owner is involved to see what their time and money isbeing used for. We are asking Shauna Golston, the AssociationPresident, to be present. University of South Carolina representativeConcussion Prevention 10

Since Gamecock Youth is affiliated with the University of SouthCarolina, Dr. Cindy Follum has agreed to be apart of our committeeto ensure proper representation of the university. Financial supporters Nike is sponsoring our program since they see the importance ofconcussion prevention and the impact it has on youth sports. Potentially, the Dr. Winningham foundation would be part of thiscommittee to supply monetary backing to assist in hiring personnel.Mission Statement, Goals, andObjectivesMissionOur program exists to raise awareness about the dangers of sports-relatedconcussions. We are committed to improving the physical health of the children enrolledin sports, to providing quality information about concussions to parents and coaches,and to improving the prevention and management of sports-related concussions.Goals Increase the knowledge of the proper techniques needed to be used in football Increase the knowledge of the damages of concussions later in life Encourage the use of correct techniquesObjectivesProcess Objective By March 1, 2017, program planners will have recruited 30 participants foreducational sessions on concussions.Concussion Prevention 11

By June 17, 2017, program planners will have hired one physician to serve asthe league’s chief medical officer.Learning Objective By the end of the program, 90% of coaches will be able to identify football hitsthat could result in a concussion for the players. Upon the end of the program, 85% of Jr. Pee Wee players of Gamecock Youthwill know correct hitting technique from the coaches in order to reduce theamount of concussions.Behavioral Objective Sixty days after the completion of the program fewer than 25% of the injuriesreported by coaches will be concussion-related injuries.Concussion Prevention 12

ImplementationOur program plans to use the Health Belief Model in the intervention we areplanning for The Gamecock Youth Association. This model will be most effectivebecause it suggests that individuals who feel they are in danger are more likely to takean action, and that the action has more positive outcomes than negative outcomes forthe individual (Glang, Koester, Beaver, Clay, & McLaughlin, 2010). Coaches arebecoming more aware of this concussion epidemic and are taking more preventativemeasures to help ensure safety in their players. For our intervention, the “action” istaking the necessary knowledge and precautions to prevent concussions. The HealthBelief Model , which describes the tendency to perform a particular act followed bycertain consequences, depends on three important factors (McKenzie, Neiger, &Thackeray, 2013). The first factor depends on whether or not one has the propermotivation to make youth football concussions relevant. We use this factor to explainwhy we are reaching out to coaches of the Gamecock Youth Association. If the coachesare motivated and able to realize the seriousness of sports-related concussions startingat such a young age, we can help take preventative action early. The second factordepends on whether or not one feels susceptible to getting a concussion. Within oursecondary population, there is sufficient evidence that young athletes make up almost2.4 million emergency room visits due to sports-related injuries. Therefore, there is ahigher need for coaches to properly teach players how to tackle correctly. The thirdfactor depends on whether or not one feels that addressing proper tackling techniqueswould reduce the likelihood of getting a concussion while playing youth football. Byproviding the coaches with proper knowledge about the severity of concussions at sucha young age, we would like to see the coaches relay this information onto theparticipants of the youth football team to help reduce the concussion rate while playing.Below we demonstrate how we plan to use the Health Belief Model.Concussion Prevention 13

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Below, we present our information in a logic model so the reader canunderstand the big picture of our planning process.For our program, we have chosen to use the health communication and thebehavior modification technique for our intervention strategies. We chose healthcommunication as a strategy because we realize the importance of spreadingawareness. As discussed in the table below, we will use brochures, social media,videos, and more to get our program’s point across. We chose to use behaviormodification techniques because one of the main focus points of our intervention is toteach proper tackling techniques to coaches.Intervention StrategiesConcussion Prevention 15

ObjectiveTypeTheory 1. LearningHBM - perceivedsusceptibilityHealthCommunication Information sessions forcoaches Media focus on issue ofconcussions for this agegroup Brochures for parents fortechnique and preventativeactions for their kids2. LearningHBM - cues toactionHealthCommunication Advice from physicians Use of videos to demonstratematerials Bring in football playerswho have experiencedconcussions Use social media3.BehavioralHBM - likelihoodof takingrecommendedpreventativehealth actionOther: BehaviorModificationTechniques Proper techniques taughtwith understanding of why Comparison videos ofchange in behavior over time(so player can see thechange) Health evaluation statusspecific to technique (howlikely their form will resultin a concussion)Concussion Prevention 16

Our program intends to kickoff August 12th, 2017 at 10:00 A.M at Killian Park inBlythewood, South Carolina. When the participants arrive, they will fill out apre-assessment survey so the program planners can acknowledge the effectiveness ofour intervention. Throughout the day, the participants will sit through multiplepresentations about our intervention. The participants will also be provided with freelunch and the chance to win two Carolina Panther tickets. The entire program will lastapproximately seven and a half hours. Snacks will also be provided throughout the dayto keep participants full and focused. The program will end with a post-assessmentsurvey which will help with our program evaluation. Both the pre and post-assessmentsurvey can be found in Appendix section . The materials needed to conduct ourprogram can be found under our program resources on page .ResourcesPrior to the start of the program, we will recruit and hire the right personnel,secure a location, acquire all the equipment needed, and promote the program towardsall coaches.PersonnelJob DescriptionAthletic TrainerAssesses injuries and assists withrehabilitationMedical ProfessionalConcussion specialistGuest SpeakerGives first-hand experience of injuryProgram Director/ContinuousMonitorManages the entire programMonitors the coaches throughoutthe season to make sure coachesare providing the players withConcussion Prevention 17

knowledge from the programProgram AccountantManages the funding and makessure that the money is allocatedaccording to the budgetGantt ChartOur program will expand over seven months to plan, recruit, organize, establish, andevaluate until completion, as seen on the chart below.May June July Aug. Sept. Oct. Nov.Convene planning committeeBring in medical professionalBring in athletic trainersRecruit football coaches foryouth programFind conference room for allpersonnelProgram preparationmeetingsRevise the program based onpreparation meetingsPromote/advertise programthrough healthcommunicationPrepare for program “kickoff”Phase in programConcussion Prevention 18

Actual implementation ofprogram techniquesWrite final report on resultsand disseminate tostakeholdersContinuous Monitoring ofresults of programProgram MarketingParticipants will include all coaches and assistant coaches of the Jr. Pee Weeteams of the Gamecock Youth Football Association. There are about 6 teams perseason, with a coach and assistant coach per team, so there will be 12 participants inthis pilot test.Marketing will include flyers and newsletters/brochures sent directly to thecoaches, as well as social media and television promotion to advertise the program.Social media will include Instagram and Twitter accounts that release information aboutthe program. There will be a reduced rate for the participating coaches as a trade forbeing able to use the facility and facility equipment for the program as well as a raffle forCarolina Panthers tickets during the lunch period.BudgetPersonnelCostAthletic Trainer 1,000.00Medical Professional 1,500.00Guest Speaker 300.00Concussion Prevention 19

Program Director/ContinuousMonitor 7,500Program Accountant 2,500Travel FeesCostFlight 1,050.00Hotel 450.00NecessitiesCostFacilityIn-kind (Gamecock Youth)TablesIn-kind (Gamecock Youth)ChairsIn-kind (Gamecock Youth)Projector 495.00Laptop 1,000.00Food 90.00Emergency Fund 615.00Total 16,500.00EvaluationEvaluation of the program will be done via surveys completed by the participants of theprogram and pre/post-testing given to the coaches. Process Objective: By March 1, 2017, program planners will have recruited 30participants for educational sessions on concussions.Concussion Prevention 20

Record-keeping will be done to track how many participants havecompleted the program. Records will come from payment records kept ofcoaches that paid for the program. This will serve as a quantitative evaluation of the program. Impact Objective: Upon the end of the program, 85% of Jr. Pee Wee players ofthe Gamecock Youth will know correct hitting technique in order to reduce theamount of concussions. Coaches will have to demonstrate knowledge of correct hitting techniquesand passing the information on to the players. Evaluation of this will bedone by the program director who has been continuously evaluating theprogram. This evaluation will serve as qualitative data for the evaluation.AppendixIntervention Program DesignItinerary: August 12thConcussion Prevention 21

Below is the program itinerary. Our intervention will ultimately be a day longsession of seminars and video presentations to give more information about the severityof sports-related concussions and practical tackling techniques to reduce impact.TimeActivity10:00 amDoors OpenCoaches and Assistant coaches for GamecockYouth Pee Wee league begin to arrive.10:30 amOfficial Start of Intervention ProgramBrief introduction of what is going to be addressedand who the professionals are, as well as theimportance of this information related to thecoaches. Coaches will be given a pre-assessmentsurvey of their knowledge of concussions forcomparison sake.10:45 amVideo PresentationA video presentation will show football footage ofform that causes concussions as well as correcttechnique.11:30 amAthletic Trainer Lecture/ PresentationA certified athletic trainer will give their input oneffects they have seen from concussion on playersand more of their experiences.12:30 pmLunch ProvidedRaffle will also be done to give away two freetickets to a Carolina Panthers game.1:30 pmMedical Doctor PresentationA certified medical doctor who specializes inconcussions will give a presentation on theanatomical and physiological effects ofconcussions in order to stress the long term effectsit can have on the players.3:00pmGuest Speaker PresentationConcussion Prevention 22

The guest speaker excels in kinesiology andfootball movements and will give hands on displaysof correct football techniques.4:00pmConclusion and Final NotesPost-assessment survey of coaches’ knowledgeand surveys will be administered to see reflectionsof the coaches for the informational program. Therewill be time for any remaining questions and a briefsummary of pertinent information.4:30pmEnd of EventPre and Post Assessment for Coaches1. What are the causes of a concussion?Concussion Prevention 23

2. What are symptoms of a concussion?3. What are practical hitting/ tackling techniques to reduce the likelihood of aconcussion?4. What are proper care steps if you suspect a player has a concussion?5. Describe in your own words how severe you view concussions, and why.Overall Intervention Evaluation SurveyPlease circle a number 1 through five for the following questions (1 being mostnegative and 5 being most positive).Concussion Prevention 24

1. What overall rating would you give the program?123452. How effective was the information taught by the speakers?123453. Was the information taught helpful in preventing concussions and explaining theissues related with concussions?123454. Do you feel like this program will be helpful for your coaching in the future?123455. How likely are you to recommend this program?123456. What are some suggestions you would have for this program in the future?Concussion Prevention 25

Concussion Institute, 2012). According to Mayo Clinic (2016), MCIs are referred to as “ an intermediate stage between the expected cognitive decline of normal aging and the more-serious decline of dementia.” Typical complications include memory issues, language, and develop