July/August 2014 Issue

Youth Athletes Off the Field — School Social Workers Offer Support
By Liza Greville, MA, LCSW
Social Work Today
Vol. 14 No. 4 P. 22

Sports can be great learning experiences, but student athletes with behavioral health issues may be overlooked in the quest to win.

Will Heininger grew up on the playing field, a fiery, energetic kid who competed in several sports until he settled on football and earned a spot on the roster at the University of Michigan. A standout student with supportive friends and family, he still found himself at a loss after his freshmen year in college when debilitating depression became his toughest opponent. While overcoming this depression, he developed a commitment to education and the hope that others will not suffer in silence.

Today, Heininger works with athletes at the University of Michigan and is a nationally recognized speaker who shares his story of illness and wellness in the hopes of breaking down stigma about mental health issues. In sports cultures where being intense, tough, and stoic often are overvalued, he believes social workers play a valuable role by reaching out to student athletes.

His experience brings to light the struggles that student athletes may hide in order to appear like high-performing adolescents. Given the high rates at which American youths participate in sports, social workers should be aware of the influences, opportunities, and vulnerabilities that such participation may present.

Playing Field
Before exploring ways in which social workers may intervene with student athletes, it is important to emphasize that youth participation in organized sports generally is associated with overall positive outcomes. Gathering data on sports participation is an imperfect science because no central organization regulates all youth sports. However, the Aspen Institute’s Project Play cites a 2012 household survey conducted by Sports Marketing Surveys, which found that of the estimated 51 million U.S. children aged 6 to 17, about 27.4 million play sports in some form or another, casual or organized. This represents more than one-half of American kids.

The Women’s Sport Foundation’s research report Go Out and Play: Youth Sports in America, which is based on two large-scale nationwide surveys, draws the following associations about sports participation: “Sports help create healthy, well-adjusted children. Sports are a health and educational asset for US girls and boys. Organized sports are associated with children’s general health and body esteem, healthy weight, popularity, quality of life and educational achievement” (Sabo & Veliz, 2008, p. 4-5).

“As children participate in sports, they are pulled into networks of peers, coaches, parents, other families, and communities, which increases social capital and reinforces and changes kids’ behavior in positive ways,” explains Don Sabo, PhD, a longtime youth sports researcher; a professor at D’Youville College in Buffalo, NY; and the senior public health advisor for the Women’s Sports Foundation who coauthored this report, about why sports are beneficial from a social capital perspective.

“Some anthropologists who study economically marginalized girls and girls of color have been developing a multiple worlds theory,” he continues. “The gist is that when girls’ involvements criss-cross several different social worlds, they do better developmentally than girls who mainly stay home or are more socially isolated.”

While this theory has not been tested in relation to sports participation, Sabo sees a natural dovetail with social capital theory:

As kids get involved with activity in multiple contexts, their social capital likely will go up, magnifying the positive effects.

Within that positive context, youth athletes nonetheless are vulnerable to a variety of influences unique to competitive environments. Mental health and coping skills, perception of risky and high-risk behaviors, and healthy coaching environments are three areas where social workers can offer intervention.

Talking About Mental Health
Attitudes about relying on personal strength and intrinsic drive are ingrained in athletes from an early age, thus contributing to a stigma about emotional vulnerability and help-seeking. When someone observes almost any youth sports practice field, he or she likely will see shirts emblazoned with slogans such as “Win some, lose none”; “I bust mine to kick yours”; and “Dominate everything.” Also from an early age, youths often are told to toughen up and play through both physical and emotional pain. “There is a tacit assumption not to talk about depression or other emotional issues,” Sabo says.

However, while student athletes may resist coming forward with emotional health issues, professionals in the athletic field do not. There is a surge of interest in student athlete mental health at the collegiate level, as the National Collegiate Athletic Association (NCAA) Mental Health Task Force is scheduled to release an updated NCAA Mental Health Handbook this year.

“One in every four to five young adults has mental health issues,” Timothy Neal, assistant athletic director for sport medicine at Syracuse University, said in a recent ESPN article, “but what is unique about the student-athlete is that they have stressors and expectations of them unlike the other students that could either trigger a psychological concern or exacerbate an existing mental health issue” (Noren, 2014).

While collegiate student athletes face daunting challenges in the transition from high school to college, such as demanding schedules, the distance from home, adjusting to a new level of academics, working with new teammates and coaches, and possibly suffering injuries, they often are underprepared to deal with these stressors because of underdeveloped coping mechanisms.

“The balancing act of being a student athlete is unique,” says Natalie Graves, AM, LCSW, CADC, a private practice social worker in Chicago who specializes in working with high school student athletes. She is not surprised by the focus on mental health disorders in college athletes and sees clear precursors at the high school level. “Student athletes feel the pressure of being constantly observed by parents, teachers, coaches, teammates, and classmates and the pressure to perform at a high level both on and off the field, all while dealing with all the other pressures that come with being a teenager. Student athletes inevitably place expectations on themselves, which in turn creates stress. Often, the only way they know to deal with these pressures is to ignore them and push themselves harder. At some point, that strategy will fail them.”

“There is a sizable group of kids who get the message that they need to be strong and solve their own problems. These are the kids who earn high grades, who are going to college, who are high-performing athletes, and they are the least reporting of their distress,” says Chuck Kron, LMSW, CAS, a school social worker in upstate New York. “These are the kids you’ll see crying in the car after a game. They can be harder to engage because of stigma issues but often will receive help if the school social worker reaches out.”

The University of Michigan’s athletics department employs licensed mental health professionals to work exclusively with student athletes. From a diagnostic perspective, Barb Hansen, LMSW, an athletics counselor, most likely will see students presenting with anxiety, depression, ADHD, and adjustment issues. “Students may not have had much practice coping with frustration and disappointment, and their fear of failure creates heightened anxiety,” she explains. “Often they don’t have adequate self-care skills, and the stigma that talking about emotions is a weakness presents a very real barrier. Normalization of their distress is a key step in engagement.”

Hansen believes that school social workers at the high school level have an opportunity to significantly impact student athletes and their mental health. First, they can reach out to athletic teams and coaches to destigmatize mental health issues and demonstrate that treatment cannot be undervalued. Second, they can make brief outreach efforts to teach relaxation and breathing techniques or mindfulness practices that can greatly benefit students who may eventually confront anxiety issues.

Addressing Perceived Risk and Substance Use
According to a study in the Journal of Adolescent Health, a review of literature suggests that athletes are a high-risk population for alcohol use and sexual activity. The authors noted that while studies of younger athletes indicated that sports participation may serve as a protective factor against behavioral risks, studies of older athletes suggested that sports participation leads to greater behavioral risk (Wetherill & Fromme, 2007, p. 294).

Wetherill and Fromme studied whether perceived risk or perceived likelihood of negative consequences influenced participation in these behaviors. While they did find some gender-specific variations, the overall conclusion was that athletes do drink more frequently, consume more alcohol when they drink, engage in sex with more partners, and engage in unsafe sex more frequently than their nonathlete peers during the last three months of their senior year in high school (p. 298). They found pro-use attitudes developed most strongly in college-bound athletes sometime in high school, and that the increase in drinking begins between 16.5 to 18.4 years of age (p. 299).

While the study did not investigate why this group perceives less risk, possible preferential treatment of athletes or the normative effects of high-risk behaviors among team members may suggest areas for further study.

The findings are useful for social workers engaged in prevention and education work at the high school level. Intervention with student athletes related to violations of interscholastic substance abuse policies is a common role for school social workers and one that is especially valuable given the findings on perceived risk and alcohol use.

Terry Carr, LCSW, LSSW, is a school social worker at a suburban high school in the Milwaukee area where most students go to college, many on athletic scholarships. She cofacilitates a six-week program for students who have violated the athletic code for substance use violations, most often underage drinking. The curriculum is based on the harm reduction model and teaching better decision making skills.

“We challenge the students to reduce substance use and help them to accept the consequences of their actions for themselves and others—their team, their parents,” Carr explains. “We really end up with a lot of discussion once the kids are able to open up about the situations they confront in their social lives.”

Kron facilitates a similar program as part of his responsibilities. “Students are referred to the group for a substance use violation,” he says, “but often underlying problems with depression or anxiety or life at home rise to the surface.”

In addition to the clinical skills required for direct practice with student athletes, Graves sees outreach as a key tool in prevention efforts. “Student athletes are functioning in a closed system, influenced by coaches, trainers, and staff with an objective of accomplishing sports goals,” she says. These environments may have a norming effect on behaviors that put athletes at risk. She makes concerted efforts to develop relationships with coaches, both to facilitate in the referral of students who are struggling and to encourage positive sports environments.

Influencing Coaching Environments
Researchers at the University of Kansas surveyed nearly 400 youths enrolled in a National Youth Sports Program athletic camp and found that “a positive sporting environment can predict their psychological well-being and help them deal with a range of good and bad emotions in life” (KU News Service, 2012).

Mary Fry, PhD, an associate professor of health, sport, and exercise science and the study coauthor, hopes the findings will shift negative coaching behavior: “It is not unusual to see kids who leave sports programs in tears. Coaches are often taught that being hard on their athletes will bring out the best. We know from a great body of research that’s just not the case” (KU News Service 2013).

The authors of a study published online in Pediatrics noted that coaches’ behaviors occur on a continuum from positive to negative, so it can be difficult and somewhat subjective to identify when a coach has crossed the line and to distinguish between an encouraging, affirming environment and a demeaning, shaming one. However, Shields et al. found that negative environments unfortunately are common, as 45% of children in their study reported verbal misconduct by coaches, including name-calling and insulting them during play (as cited in Swigonski, Enneking, & Hendrix, 2014, p. e274).

In addition to the difficulty of differentiating instances of so-called bad behavior from pervasive bullying environments, coaches frequently employ well-honed defensive techniques. Four common defenses are as follows (Swigonski et al., p. e274):

1. Moral justification: A coach will portray the behavior as socially acceptable and time-tested. A coach may say, “This is how we’ve always done things, and we win games” in an attempt to normalize the behavior, excuse responsibility for it, and shift expectations of kids and parents.

2. Backhanded apology: A coach will justify bullying behavior as an appropriate response to inferior performance or poor play. The study authors used this example: “I’m really sorry; I got a little carried away, but we really need to work on fundamentals if we are going to win.” This technique hinges on the coach’s power and the student’s belittlement.

3. Advantageous comparisons: Bullying behavior is compared with more egregious conduct in an effort to minimize humiliation of emotional bullying—for example, “I didn’t touch them. It’s not like I push them around.”

4. Escalation: This technique aims to make a person who may have a grievance back down or give up by suggesting an athlete could quit “if you can’t take or don’t like the way I do things.” The authors clarified that this technique does not necessarily escalate the bullying behavior but instead the consequences of pushing back until the person who has the grievance gives up.

Coaches play make-or-break roles in student athletes’ experiences at any level of competition. The National Council of Youth Sports, a membership-based organization representing more than 200 organizations from Little League baseball to the US Olympic Committee, offers developmentally appropriate online coaching courses, available on the council’s website (www.ncys.org).

The Final Score
Sports are good for kids, except when they are not, and social workers are well-positioned to understand systems issues as well as individual clinical presentations. By drawing on the person-in-environment perspective and understanding common vulnerabilities at both the system and individual levels, social workers can most effectively intervene with student athletes who may or may not appear to be struggling. And educating students, parents, coaches, and communities on positive sports environments and empowering them to insist on standards for healthy environments is an appropriate role for social workers.

— Liza Greville, MA, LCSW, is a therapist in the counseling center at the University of Pittsburgh at Bradford and at Deerfield Behavioral Health, both located in northwestern Pennsylvania.

References
KU News Service. (2012, May 8). Study: Kids in positive sports climate better adjusted, show less depression. Retrieved from http://archive.news.ku.edu/2012/may/8/positive.shtml.

KU News Service. (2013, October 15). Researchers publish article illustrating benefits of sports psychology in youth programs.. Retrieved from https://news.ku.edu/2013/10/07/researchers-publish-article-illustrating-benefits-sport-psychology-youth-programs.

Noren, N. (2014, January 22). Taking notice of hidden injury. Retrieved from http://espn.go.com/espn/otl/story/_/id/10335925/awareness-better-treatment-college-athletes-mental-health-begins-take-shape.

Sabo, D., & Veliz, P. (2008). Go out and play: Youth sports in America. East Meadow, NY: Women’s Sports Foundation.

Swigonski, N. L., Enneking, B. A., & Hendrix, K. S. Bullying behavior by athletic coaches. Pediatrics, 133(2), e273-e275. doi: 10.1542/peds.2013-3146.

Wetherill, R. R., & Fromme, K. (2007). Alcohol use, sexual activity, and perceived risk in high school athletes and non-athletes. Journal of Adolescent Health, 41(3), 294-301.