The program model consists of three key components, which are displayed in Figure 1.
First, it is interdisciplinary. Attempting to change the culture of concussion is a complex and challenging endeavor. Consequently, expertise from multiple professionals and resources from different departments is likely to bring about the broadest and most significant change.
Next, a peer mediated model is employed to engage the primary constituents– student-athletes, in the change process. In order to increase the likelihood that true and lasting change will occur, the student-athletes themselves need to take ownership of the change process as individuals and as a team.
Third, a cognitive-behavioral model of behavior change is utilized to identify cognitions that inhibit reporting concussions and to replace them with cognitions that facilitate reporting.
More information on the program model and rationale is provided below:
Left – Figure 1: Key components of the CHC Peer Concussion Education Program Model
Most approaches to concussion education consist of educational videos (e.g. Concussion: Don’t Hide It. Report It. Take Time to Recover) and fact sheets (e.g. Concussion: A Fact Sheet for Student Athletes) developed by organizations such as the NCAA and the Centers for Disease Control and Prevention (CDC). Online educational programs are also available (e.g. ConcussionWise SPORT for Athletes). All of these programs employ a “top down” model of education where information is disseminated from an expert authority (e.g. healthcare professionals; organizations) to participants including student-athletes. These approaches have several advantages including portability as well as evidence supporting the effectiveness of using health care professionals to improve knowledge of the signs and symptoms of concussion as well as appropriate post-concussion responses (Bagley et al., 2012).
That said, the effectiveness of concussion education is likely to be enhanced when “top-down” approaches are combined with “bottom-up” approaches such as peer education. Review studies have pointed to the effectiveness of peer-assisted learning and behavioral management in a range of populations including school-aged students (Dart, Collins, Kingbeil, & McKinley, 2014), college students (Dawson, van der Meer, Skalicky, & Cowley, 2014), and adult veterans (Beattie, Battersby, & Pols, 2013).
In addition to research supporting their effectiveness with a wide range of populations, peer oriented programs are likely have the following advantages with respect to concussion education: 1) peer educators are likely to be aware of individual differences in their fellow teammates as well as team dynamics that may enhance or impede concussion reporting and management, 2) peer educators are in a position to act as a liaison with coaches and health care professionals to enhance pro-safety cognitions and behaviors as well as mitigate counterproductive cognitions and behaviors, 3) peer educators can serve as role models with respect to concussion safety, and 4) peer educators are likely to have interactions with fellow teammates outside of practice and games that may reinforce cognitive and behavioral changes with respect to concussion safety.
Cognitive behavior therapy (CBT) is a broad family of psychotherapy models that includes both theoretical principles as well as assessment and intervention techniques. Although there are many specific models of CBT, they share certain features in common. They are grounded in learning theory, tend to focus more on the present than the past, de-emphasize insight in favor of building skills, view behavior — and to varying degrees cognitions and emotions — as appropriate targets for change rather than as mere signs of underlying pathology, and emphasize scientific research to evaluate treatment effectiveness.
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