By Amy Benson
Alumna and former Griffins soccer player, Beth McCormick’s concussion happened in the fall of 2016, during an away game at Shippensburg University, where she had a collision with an opposing team member and hit her head—hard—on the turf.
“The day after, when all the adrenaline is gone, that’s when you really start to feel it,” says Beth.
But what about when the adrenaline is still surging?
According to Beth, had it been up to her, with just two minutes left in the game, she would have stayed in and played through the injury. She was a freshman, a walk- on, a starter—and by no means did she want to come of the feld at such a critical moment.
Beth isn’t alone. Most students—in fact most professional athletes and military personnel, two groups at particularly high risk for traumatic brain injuries—want to stay in the game (or in the combat zone) when they take a blow to the head, even, sometimes, when they understand the grave consequences of concussion.
In Beth’s case, she was lucky; the College had on hand a peer concussion educator, specifcally trained and placed to help student-athletes to come forward with concussion symptoms. She was lucky to have a peer mentor who had previous concussions herself and knew just how to handle the disappointment and to drive home the importance that Beth report her concussion to the team’s athletic trainer.
For decades, many players, from middle school on to college, haven’t been so lucky.
Jesse Balcer ’11 SGS, CHC’s Director of Athletics and Recreation, can remember a time, as a student-athlete himself, when he and his peers would never have said anything about a blow to the head. “The stigma of having a concussion was, for a long time, a sign of weakness because it’s not visible; teammates would question your toughness, whether or not you really got hit that hard. For a kid, that’s a hard thing to shake.”
"I’ve had numerous of our peer educators come up to me to tell me they think something is of with one of their teammates, but that they’re probably not going to say anything about it themselves,” says Denise Wisniewski, Assistant Director of Athletics, Senior Woman Administrator and Compliance Coordinator at the College. “This probably wouldn’t have happened before we implemented the program. We’re changing perceptions around concussion and seeing students really step up to help their peers.”
Yet, shaking things up with regard to concussion is precisely what the College’s own William Ernst, Psy.D., Associate Professor of Psychology, set out to do five years ago when he, together with colleagues Lynn Ortale, Ph.D. (Vice President of Student Life), Meredith Kneavel, Ph.D. (whose focus is biopsychology), and Lynn Tubman (then CHC Director of Athletics), founded CHC’s Center for Concussion Education and Research, with Dr. Ernst as founding Executive Director of the Center.
A LUCKY CONVERGENCE
Dr. Ernst is a man of many interests. As a neuropsychologist, Dr. Ernst’s clinical training led him down many neurological pathways (pun intended), concussion a priority among them. As a result, he understood the danger and physicality of it, true, but, due to his training in cognitive-behavioral therapy, he also had an interest in the kind of behavioral interventions aimed at those of high risk for concussion and how one might go about changing the culture surrounding it from one of secrecy and uncertainty to one of understanding, frankness and camaraderie. He is also a former high school athlete and was a youth sports coach to his own children’s teams.
So, when the NCAA and the U.S. Department of Defense (DoD) came together (a seemingly unexpected alliance that makes perfect sense once you understand the behavioral and cultural similarities between athletes and soldiers) to put out the call for the development of educational programs designed to change the culture surrounding concussion, Dr. Ernst was poised for action. And act he did.
CHOSEN AS ONE OF SIX WINNERS FROM AROUND THE NATION
This was 2015 and the NCAA-DoD alliance called it the Mind Matters Challenge, a quest, backed by $7 million in grant opportunities, to fundamentally change behavior around concussion. Ultimately, the aim was to ensure that all concussions are reported instead of being hidden from peers, coaches, and commanders. Mind Matters included an Educational Programs Challenge, which was open to anyone—from the nonproft, business or higher education worlds—to participate and focused on two critical areas: 1) changing attitudes about concussions in young adults and 2) developing educational programs targeting young adults that could be deployed immediately.
The latter is where Dr. Ernst and his team focused their energies. They submitted their idea to build a peer-to- peer behavior change platform—alongside a large number of applicants—which is now called the Peer Concussion Education Program (PCEP). Their plan was chosen as one of only six winners to receive funding. Dr. Ernst and Dr. Meredith Kneavel, the Founding Director of Research and Assessment at the Center, led the development of the PCEP with considerable support from Brendan Connell, ATC a former Athletic Trainer at the College, and the Departments of Athletics and Student Life.
"Changing culture is hard and marrying theory to practice was the only way we thought it could work to actually make a diference in the lives of student-athletes,” says Dr. Lynn Ortale, a founding director of the Center. “You cannot do that without heavily involving the students and coaches.”
This is exactly what the program was designed—and continues—to do. The PCEP elevates the student-athletes themselves to positions of trusted, informed confdantes and stakeholders in getting concussion reporting among their peers right every time. This approach is a departure from the traditional, which emphasizes increasing knowledge about concussions (of which there is no shortage today). It moves instead toward the idea that a more promising way to actually get athletes consistently reporting is to embed trained peers within the team itself, making them the primary messengers of how bad things can get when a concussion goes unrecognized.
This is how it works: two peer concussion educators from any given team are chosen, trained and put in a room with their teammates to take them through two modules, including one based on the principles of cognitive behavioral therapy. (The program was piloted and is on- going at CHC, but was designed for broad dissemination and was implemented at 10 colleges and universities as part of the Center’s national randomized controlled trial of the program.)
The peer educators don’t just deliver the information. Student-athletes are engaged in an exercise where they list the thoughts that keep them from reporting concussions in themselves and teammates and change them to thoughts that support reporting. The change in thinking may lead directly to subsequent changes in behavior and, ultimately, to increased reporting. The mentors/educators are then with their teammates year-round—available to provide support and empowered to break down the idea that toughness is equivalent to silence when a blow to the head is involved.
"It’s a relatively basic idea, but that’s exactly why it works,” says Dr. Ernst of the program.
In the past five years, Dr. Ernst, Denise Wisnewiski, M.Ed., ATC and CHC doctoral student Ashley DeBlasi, M.S. have trained about 30 peer educators and put hundreds of CHC student-athletes through the program. The Center is also working with the NCAA Sports Science Institute to promote the online manual for the program, which is available for free on the Center’s website: chc. edu/concussion-center/center-concussion-education- and-research-chestnut-hill-college ensuring that other institutions around the country are able to implement the peer concussion education program and learn and beneft from the innovations being realized at CHC.
THE NATIONAL RANDOMIZED CONTROLLED TRIAL
Chestnut Hill College is a small liberal arts institution— not the kind of place you might expect to see launching a national randomized controlled trial (RCT). But this is exactly what Dr. William Ernst—along with his colleagues Dr. Meredith Kneavel and Dr. Kevin McCarthy— undertook to test the efcacy of the Peer Concussion Education Program.
Six groups, including the College, were selected to receive NCAA-DoD funding to complete prototypes of their programs, yet CHC’s was the only one to receive funding for a national trial of this kind. The RCT consisted of 10 universities, from across the country and includes D-I, II, III, which implemented the program and helped to assess its efectiveness.
Five CHC doctoral students were involved in the study, which demonstrated that the program increased concussion knowledge and intent to report, as well as supported attitudes that bode well for concussion reporting. Dr. Ernst and Dr. Kneavel were the co-principal investigators on the trial, with Dr. Kevin McCarthy, Associate Professor of Psychology at the College, serving as a secondary investigator.
The results of the RCT were recently published in the Journal of Athletic Training, along with a companion article that describes the PCEP and its development.
GROUNDED IN MISSION
The peer concussion education program, the flagship component of what has become a large-scale movement within the College to advance research, education and awareness around concussion (all housed within its Center for Concussion Education and Research), was in part the product of much scientifcally and academically-minded interest and expertise. But its true roots also lie in the fundamental and founding principles of the College—those of caring for the whole person and building a truly extraordinary community that fosters growth, love, a holistic sense of safety and a deep respect for each person’s inherent dignity and ability to lead.
“When you see one of your good players take a hard fall, one of your frst thoughts is that you hope it’s not a concussion; there’s a lot of uncertainty for the team in that,” says Balcer. “But, quickly, the primary concern becomes for their well-being and for their continued ability to pursue the whole range of their college adventure. The program helps to disarm the refex to play through a concussion so that they can do that.”
The experience of serving as a peer educator also helps student-athletes to develop critically important leadership skills that they take with them into their careers and family lives.
"Whether the students’ paths lie in athletics or not, the peer mentor program is so helpful in shaping them as leaders in general; in ensuring they know that they have the capacity to be of assistance to their peers,” says Balcer. “The program has gone a long way with that for everyone.”
Often, these are students with a vested interest in the subject—science majors curious about the neuroscience behind concussion, for instance. In fact, the project’s reach extends far beyond the feld. Drs. Ernst and Kneavel have published on the program and the steps used to develop it in the Journal of Athletic Training and the American Journal of College Health. Additionally, they, along with Kevin McCarthy, Ph.D., presented their research fndings at conferences and summits nationwide (over the past two years, they have completed 10 national conference presentations and were invited to present in 2019 at the NCAA-DoD Concussion Education Research Summit alongside some of the top research institutions in the country)—and students are almost always involved.
Some of Dr. Ernst’s students are even doing their dissertations on components of the program, which hold appeal and interest in disciplines as varied as neuropsychology, public health and injury prevention. It presents an exceptional opportunity for CHC students to do cutting-edge research that they can then present nationally, according to Dr. Ernst.
The College’s Peer Concussion Education Program got its start because of the enterprising disposition that’s fostered and celebrated on campus, but the broader Center for Concussion Education and Research, which was formed shortly after the program got underway, has its roots in more altruistic circumstances.
When Dr. Ernst and his team received the frst of two grants from the NCAA and the DoD, it came with a bonus: an unrestricted $25,000 cash prize that they used as money to seed the Center, ensuring the work on concussion at the College could continue. The development of the Center illustrates precisely the kind of entrepreneurship that’s possible within the halls of CHC and that promises to keep the project pushing forward, pushing boundaries.
A potential partnership with the military to implement the versatile peer education program in military units is being explored, as well as a developmentally appropriate high school version of the program.
Ultimately, the future of the program is about impact, but not just in one direction. As Dr. Ortale puts it, “It’s a privilege any time we can have an impact on students’ growth and development, particularly because it’s a two-way street. Not only are we educating students, but they’re educating us. That’s the crucible moment, when there’s mutual, positive change to the trajectory on both sides.”
Women’s Soccer and Men’s Lacrosse were the two CHC sports teams that helped pilot the Peer Concussion Education Program. Brianna Ferrell ’19 and Andrew Hildebrand ’17 are two of the College’s pioneer peer concussion educators.