University of Idaho

HS 490 Health Promotion

Interventions
Assignment 3
Directions
The following pages guide you on each step of this assignment. You
will look for intervention resources on web sites, class readings, class
notes and peer reviewed journals (Research Notes 1-3). You will pull it
all together and create an evidence based plan based on your findings
(Pulling it All Together) and include references, APA format. You may
type directly on these pages but it is not required. I put the assignment
in boxes to make it easier to follow but it may be easier for you to
create a word document with all the assignment components.
Total Point Value- 90 points- 30% of course grade
Research Notes-Website Review -15 points
Intervention Research Readings- 15 points
Research Notes- Articles-Peer Reviewed 30 points
Pulling it All Together- 30 points
Unlike the other assignments you will submit in this in hard copy
in class and also on Bblearn.

Professor Helen Brown- Spring 2016

Concussion Prevention in High School Athletes, Target (can be a primary and secondary
target) and Location (must be clearly defined):

NAME:
Shelbie Hackett
Site- 15 pts.

#1 Intervention Research- Web

Review a website with intervention strategies related to your topic.

Website and Link:
Concussiontreatment.com
http://concussiontreatment.com/blog/
APA citation of website: O'niel, A. (2015, April 28). Sports Concussion Institute Intervention Program.
Retrieved April 7, 2016, from
http://www.concussiontreatment.com/images/SCI_Prevention_Intervention_Program
General Purpose of the Website
The site has resource tabs for parents, athletes, coaches, and teachers. This site provides several
services, basic information, news & media, partners, and history.
What did you learn about effective interventions for your topic? Answer the questions
below and add additional comments.
They follow a four-component cycle process for their interventions that I outlined below. These are the
most recommended techniques to follow. One of their main partners is the National Sports Concussion
Coalition, as well as others so their backing shows that their tactics are encouraged.
Education + Awareness
->
InformationalPresentations
ConcussionResources
SupportMaterials

Baseline Testing ->

Clinical Care ->

Return to Play ->

MeasuresBrainFunction
SymptomScore
Computation
IndividualandGroup
AdministrationAvailable
MacandPCCompatible

Comprehensive
NeuropsychologicalTesting
Multidisciplinary
ApproachtoConcussion
Management
Intensive,ShortTerm
CognitiveRehabilitation
Model

Gradual,Stepwise
Procedureforreturnto:
PhysicalActivity
Academic/Cognitive
AccommodationsLifeasa
StudentAthlete

Critical thinking and relation to your health promotion topic

What did you learn from the website that you can apply to your project? Organize by answering # 1-3
below:
1) Intervention activities that are appropriate for your project- Ways to advocate for your childs
safety under the parent tab.
2) Useful tools and resources, including health education/promotion resources- Under the 4 tabs they
had (Athletes, Parents, Coaches, and Teacher) they had direct information each population would be
interested in. Underneath their Services tab they offered several types of consulting, testing, and
rehabilitation information. To give you a visual I outlined they offered tabs from their home page alone.
Hom About us
Services
News Resources
Nation Contact
e
&
al
us
Media
Summi
t
History
BaselineTesting
ConcussionFacts
Clinicians&
Staff

Cognitive
Rehabilitation

ForAthletes

Partners

Concussion

ForParents&Family

Management
Scientific
Advisory
Committee

Neuropsychological
Evaluation
Neurology

ForCoachesandAthletic
Trainers

Neurosurgical
Consultation

ForTeachers&Educators

PainManagement

ForHealthcare
Professionals

Psychiatric
Consultation
Psychotherapy
3) Other resources- give web links for at least two other helpful resources the web page directed you to
and write 1-2 sentences about what you was helpful about each site- They gave direct links that went
to the website of each partner they have in their program. This was very helpful when trying to find
information because each of the partners had more information of offer on the subject of concussions.
They also had a tab on page management; from this they had many other branches such as
management, education, and consultations. I also really liked the News & Media tab. This brought to
your attention where advancements in this area are occurring and how it is being implemented today.

#2 Intervention Research Readings- 15 pts.

General Intervention Considerations- Answer the following using lectures and readings. 1
paragraph for each.
1. Health Behavior Theory- Identify the theory (or theories) that is most important to
guide your intervention and discuss how that theory will guide interventions. (See
Theories at a Glance).
Perceived severity- This is the belief about the seriousness of a condition and its consequences.
Most people are unaware just how serious a concussion is and the fact that it is a traumatic
brain injury (TBI). In my intervention I will hopefully make individuals aware of how serious this
condition actually is and that it should be made aware. Education will be mostly focused around
this concept.
Self efficacy- This is the confidence in ones ability to take action. This theory mostly applies to
athletes themselves. They need the confidence to approach and adult figure with the possibility
of them having a concussion, and not be afraid of their reaction.
2. Spectrum of Prevention- Based on the reading from the Prevention Institute-what
levels of prevention are most important for your topic/target and location? The
type/level of change desired will direct you to types of interventions that will have
the most impact.
I believe that strengthening individual knowledge and skills is most important for combatting
concussions. Most of my interventions are focused around the central ideal of skills and
knowledge. These include the knowledge of what a concussion is, how to identify it, and
recovery steps. If individuals are made more aware of these I believe that concussion rates will
decline. It also takes the skill to take oneself (or others) out of practices and help them recover
properly.
The next one that I believe has a very strong impact would be influencing policy- sometimes it is
hard for students to know exactly what to do, or the steps that are needed. If a policy is made
this will then enforce that proper steps are being taken and that athletes are not being left in
the dark.
3. Discuss what you learned about the predisposing, enabling and reinforcing factors
that are most related to the health behaviors you are trying to change.

Predisposing Factors
Knowledge- This plays the
biggest factor. Most are
unaware about everything a
concussion entails.

Attitudes- This plays a part

because if one does not find a
concussion to be a big deal
then they will not be proactive
in recovery.

Enabling Factors
Programs and Services- If the
services of an athletic trainer or
health clinic are not offered it
could be difficult for some
families to properly diagnose or
care for a concussion.

Reinforcing Factors
Peers- it can be hard for some
athletes to admit to a possible
concussion with the fear of
teammates reaction. If they do
not have positive support, then
their odds of stating they have
one is decreased.
Family/Coaches- Often times
coaches and some parents will
encourage playing through pain
or injury. If that is the case
athletes will be less likely to
seek help for a concussion.

#3 RESEARCH ARTICLES PEER REVEIWED- 1 of 3

3 peer reviewed research articles needed- 1 can be a review article. You do not
need to use this box format, you can use a word doc and include the headings
below. 10 pt. each -30 pt. total
APA Citation of article
Covassin, T., Covassin, T., & E. (2010). The cognitive effects and decrements following concussion.
OAJSM Open Access Journal of Sports Medicine, 55. doi:10.2147/oajsm.s6919
Participants or population reached
Concussions in athletes at collegiate level and high school (16.11 years +/- 1.89)
Describe the intervention and its effectiveness

For this they focused on cumulative effects, age differences, and gender differences
that play a role in concussions.
For the studies they monitored various behaviors post-concussion, and tracked their
progress with battery tests after 1 to 10 days of being concussed. If needed
longer than 10 days monitoring was sustained, however, not accompanied by
battery tests. They found that most athletes returned to cognitive baseline
function 5-7 days post-injury. However, more than 10% of players were still
exhibiting cognitive dysfunction 7 days post-injury. This is then a call for a
multifaceted and multi-disciplinary approach to managing the injury. It also lead
to the finding that each athlete is different in terms of injury and recovery and
should be individualized in their recovery process.
It indicated that an athlete who sustained a previous concussion was 3 to 6 times at
greater risk for getting a second concussion. When examining high school and
college football players with previous concussions they found that they were 5.8
times more likely to sustain a concussion than the players who had no history of
a concussion. They also looked into the effects of a symptom free waiting period
and risk of repeat concussions. They found that concussed high school athletes
with a history of 3 or more concussions showed more symptoms and a
significantly lower memory performance at 2 days post-injury, compared to
concussed athletes without a history of concussion.
They showed that concussed high school athletes demonstrate longer recovery
times with respect to neurocognitive performance than concussed collegiate
athletes. Collegiate concussed players showed impaired memory up to 24
hours, while high school concussed athletes demonstrated memory

impairments up to 7 days post-injury. These studies suggest that high school

athletes demonstrate slower neurocognitive recovery after a sports related
concussion, compared to collegiate athletes.
Critical thinking and relation to your project

I learned a lot about recovery times and concussions. I know previously I talked about return to
play as being a factor, but I never really discussed duration of the concept. Let alone the
concept of recovery time and susceptibility of another concussion. I think these are good
concepts that I can try to encourage more throughout my research on this topic.
In the study they did look into high school athletes, which was perfect for my findings. However,
the research findings that were found for collegiate athletes do have the exact same effect for
high school athletes (as was mentioned earlier.) This is one aspect that would need to be altered
for my interventions.

#3 RESEARCH ARTICLES PEER REVEIWED- 2 of 3

APA Citation
Briefing:CarlGray'sarticleonTimeManagementhttp://www.bmj.com/cgi/content/full/316/7137/S27137seemedtogo...
(1998).Bmj,316(7149).doi:10.1136/bmj.316.7149.3a
Participants or population reached
Sport concussion clinic and their parents. (5 concussed athletes, ages 10-39 years, 4 males 1 female.)
Describe the intervention and its effectiveness
Their intervention was an education presentation based on Concussion in Sport Meeting content
consisting of case studies, discussion questions and a workbook. I thought it was unique how
they included the use of a workbook during this. I feel that it engages them more and is much
more interactive.
A survey was designed to examine baseline and changes in concussion knowledge and
attitudes, and was given to them pre and post intervention. A workshop evaluation assessed
preferred learning methods and workshop satisfaction.
When looking at the test subjects showed to have an increased knowledge of return to play
protocol as well as when one should start rehabilitation. Athletes acknowledged the seriousness
of concussions and felt that they were not alone.
This form of intervention was considered a successful form of peer support for the athletes as
well as for the parents.
Some limitations of this could be the subject size population. I feel that it is hard for the results
of 5 people to apply to a much larger population. Perhaps if the population pool was larger then
responses could vary.

Critical thinking and relation to your project

The use of more hands on/ workbook style could be applied. I talked a lot about attending
presentations and seminars. However, I now would like to make these presentations more
interactive for those attending. Keeping them engaged throughout will help increase their desire
to learn.
I do like that they have it for athletes and their parents so that aspect of the population I would

like to keep the same. However, I would need to adjust the age ranges for high school athletes
so it would vary from 15-18 years of age as opposed to 10-39. I would also like to have a larger
population than just 5 subjects.

#3 RESEARCH ARTICLES PEER REVEIWED 3 of 3

APA Citation
Zemeck,R.L.(2013).PrognosticatorsofPersistentSymptomsFollowingPediatricConcussion.JAMA,167(3).
Participants or population reached
Children following concussions ages 2-18 years.
Describe the intervention and its effectiveness
This was designed to identify predictors of persistent concussion symptoms (PCS) in children
following concussion.
It was carried out through a systemic view of literature
Fifteen studies were included in descriptive analysis.
Studies concluded that the risk for PCS was increased in older children with loss of
consciousness, headache, and/or nausea/vomiting.
Smaller studies noted that initial dizziness may predict PCS. Patients with premorbid conditions
(eg, previous head injury, learning difficulties, or behavioral problems) may also have increased
risk.
By the time children reach 10 years of age, 16% will have had at least 1 head injury requiring
medical attention
The greatest reported incidence for concussion occurs in those ages 9 years to 22 years
Their findings stated that, Future trials must be adequately powered to determine which
variables best predict the time to full symptom resolution. Expert consensus should delineate
which postconcussion assessment measures are preferred to reduce heterogeneity going
forward. Research to improve care for the epidemic of pediatric concussion depends on early
identification of those most in need of intervention (Zemeck 2013).
The main objective of this review was to identify predictors of PCS in children following a
concussion. Secondary objectives included the qualitative description of predictors of safe
return to school, sports, and activities.
The limiting factor for this is there remains a lack of evidence for direct management following
concussion that may reduce the severity/duration of PCS.
They believe the lack of prognosticators to identify children at risk for PCS is preventing
concussion research from moving forward.

Critical thinking and relation to your project

This one was a little more challenging to apply to my presentation. But this is where I could

focus on how advancements can help knowledge and findings of concussions. I did really like
the statistics of concussions that they included and would like to add those points to my
webpage and presentation.
Well since these findings do start at such a low age range to apply this to my population I would
need to increase the range at which these findings apply to. The results could also possibly vary
when doing so.

Pulling it All Together- 30 pts.

1. Select a performance measure target based on the Healthy People
2020 objectives or Healthy Campus 2020 as appropriate. 1 in 5 high
school athletes experiencing a concussion will decrease to 1 in 10 by 2020.
2. Deciding on strategies for interventions (must be appropriate for target(s).
7 pt. each- 21 pts.
Based on the intervention activities discussed in class (see ppt) and the findings
of the literature, select the 3 most important types of interventions for your
project and list 4-5 strategies for each strategy. These strategies need to be
related to evidence based practices. For a stronger paper, cite the literature
and/or evidence based practice from the intervention registries provided in class
(see intervention ppt. slide). Add enough information about the intervention
strategies selected that it is clear what the intervention will accomplish.
Generally a grant would ask for a narrative of the intervention; for this
assignment, detailed bullets are sufficient.
Concussion Prevention in High School Athletes (Targeting- Group)
Coaching staff, officials, and athletic trainers
o Conduct a weekend workshop for all coaching staff, officials, and
athletic trainers prior to the start of sporting events for that season.
During this time the target audience will be educated on concussions.
They will be informed as to what it is, the dangers of a TBI, how to
prevent one specifically for their sport, signs & symptoms, as well as
what recovery is needed after.
o Coaches/ trainers will be asked to evaluate normal habits of players
during practice and games. Understanding normal habits and work
ethic during practices will help with the identification process of
concussions.

o Enforce return to play policies at school grounds during sporting events

and practices. Students will meet with school leaders and the district
school board to discuss stronger enforcement of concussion rehab.
o Conduct undercover concussion scenarios. Athletes will approach a
coaching staff or athletic trainer about the possibility of a concussion. If
the athlete is not given proper care or encouraged to seek medical
care/ sit out of playing then coaching staff will receive a violation in the
form of a write up or fine.
o Coaches will be asked to reduce the amount of physical contact during
practices. If hitting is permitted then athletes will be discouraged from
hitting at full force capacity.
o At the start of practices coaches will express an open communication
policy to athletes and that if they are questioning an injury they are
expected to inform the coach, athletic trainer, or both.
o Coaches, officials, and athletic trainers will be required to complete the
Heads up concussion course and print off certification prior to the start
of the season.
o Require that if outdoor field conditions increase risk for trips or falls that
practice is held indoors, or cancelled.
Concussion Prevention in High School Athletes (Targeting- Individual)
Athletes
o Prior to start of the first practice/ try out, all potential athletes will be
educated on what a concussion is, how to identify one, and how to tell
their coaches/parents/trainers.
o Prior to start of first practice athletes are to complete a baseline
concussion evaluation. Baseline test will be completed annually for up
to date data.
o Athletes will be given a concussion history form with other medical
history forms that must be filled out and returned to the head athletic
trainer. Knowledge of previous concussions or concussion symptoms
will help identify which athletes are more susceptible.
o Athletes will be asked to meet with either a medical professional or
previous athlete and discuss their relationship with concussions. They
will need to take notes on the possible risks of one, and write a
reflection about what they learned in their time meeting with them.
This will hopefully give athletes a new perspective that has never been
given to them before.
o Conduct undercover concussion scenarios. Athletes will approach a
coaching staff or athletic trainer about the possibility of a concussion. If
the athlete is not given proper care or encouraged to seek medical
care/ sit out of playing then coaching staff will receive a violation in the
form of a write up or fine.
o Athletes will be required to complete the Heads up concussion course
and print off certification prior to the start of the season to become
familiar with them.
Concussion Prevention in High School Athletes (Targeting- Community)
Community

o During payment of entry to each sporting event fans will receive a

small print out about concussions included basics, statistics, symptoms,
and recovery process
o During half-time events/ between periods/ during time outs of sports
the announcers will inform that audience about a concussion statistic/
provide information to the audience.
o The community will be invited to attend the weekend seminar that
coaches, officials, and athletic trainers are required to attend so the
public can gain further knowledge.
o Community members that have had a personal experience with a TBI
will all gather for an informational and personal aspect on the subject
during one of the regular season practices.
o Various types of brochures will be set on the seats of gyms and fields
during sporting games for the public to take with them if desired.
o Community members and parents will be encouraged to complete the
Heads up Concussion Course to become familiar with concussions.
o Have the community form a local concussion coalition.
3. Potential for Success- 8 pts (critical thinking questions)
a.) Discuss why your intended approaches would work (e.g., how do
they impact predisposing, enabling or reinforcing factors?)
I believe that these approaches would work because they are targeting
information on the topic. I feel like most of the experiences I have seen come
from concussions stems from lack of knowledge. It could be that they did not
know anything about having one, or that they did not recognize another with
this possibility. I also think that they could work because most people are
brought aware of the fact that a concussion is something everyone is now
watching out for. There will also no longer be the excuse that a coach or
athlete was not able to identify a concussion, this can prevent them playing
through one.
b.)
Discuss sustainability of the intervention plan- what will help this
work continue?
I think that sustainability is possible and easy to continue. Most of these take
place prior to the start of the season, which is very ideal to maintain. I think
the biggest task will be the initial set up of these new processes. Once they
are put into place it will feel very normal to accomplish each year.
References:
Briefing: Carl Gray's article on Time Management
http://www.bmj.com/cgi/content/full/316/7137/S2-7137 seemed to go ... (1998). Bmj,
316(7149). doi:10.1136/bmj.316.7149.3a
Covassin, T., Covassin, T., & E. (2010). The cognitive effects and decrements following
concussion. OAJSM Open Access Journal of Sports Medicine, 55.
doi:10.2147/oajsm.s6919

Head Case - Complete Concussion Managements. (n.d.). Retrieved April 9, 2016, from
http://www.headcasecompany.com/concussion_info/stats_on_concussions_sports
O'niel, A. (2015, April 28). Sports Concussion Institute Intervention Program. Retrieved
April 7, 2016, from
http://www.concussiontreatment.com/images/SCI_Prevention_Intervention_Program
Zemeck, R. L. (2013). Prognosticators of Persistent Symptoms Following Pediatric
Concussion. JAMA, 167(3).