Athletic Directors\u27 Barriers to Hiring Athletic Trainers in High Schools

Context: The Inter Association Task Force for Preventing Sudden Death in Secondary School Athletics: Best Practice Recommendation urges all high schools to have a certified athletic trainer (AT) on staff to take charge of emergency situations and provide care for student-athletes. Despite the recommendation many high schools do not have the medical services of an AT, however there is limited knowledge regarding barriers or reasons why not to hire an AT. Objective: Examine the barriers Athletic Directors (ADs) face to hiring ATs in public high schools in a qualitative light. Design: Basic qualitative design utilizing semi-structured phone interviews. Setting: Full-time ADs in public high schools from multiple regions of the US. Patients or Other Participants: Twenty public high school ADs (M=17, F=3) divided into geographical regions (North=6, South=4, Midwest=4, West=6). Data saturation guided the total number of participants. Data Collection and Analysis: All participants completed phone interviews guided by a semi-structured questionnaire. Interviews were recorded and transcribed verbatim. Multiple analyst triangulation and peer review were included as steps to establish data credibility. The data was analyzed using the principles of general inductive approach. Results: The emergent themes included lack of power, budget and non-budget issues. Lack of power represented the inability of an AD to hire an AT; a responsibility that was perceived to fall on the superintendent and school board. Ten out of twenty ADs reported that they had made attempts to propose the hire of an AT to their school boards. Budget issues pertained to the funding allocated to specific resources within a school, which often did not include an AT. Eighteen of our twenty participants supported this theme. Fourteen participants noted non-budget issues. These issues where summarized to incorporate rural locations without clinics or hospitals nearby, misconceptions of the roll of an AT which leads to the belief that first aid trained coaches are appropriate medical providers, and community support from local clinics, hospitals and volunteers. Conclusions: Many ADs would prefer to employ ATs within their schools. Despite budget proposals and informational presentations to show the need for ATs, ADs are bound by the hiring and budgeting decisions of superintendents and school boards. Public schools systems are suffering the consequences of national budget cuts and often to not have the freedom to hire ATs when other school staff is being laid off. With this in mind, it may be necessary to create informational programs targeted to administration and state legislators with the correct level of organizational power to initiate change. Outreach programs from clinics, hospitals and universities may also provide enough support to bring ATs into rural schools and low-income districts