Apr 25, 2017Stretching Resources
Despite a lack of funds and initial support, sports medicine professionals in Milwaukee figured out how to bring athletic training services to inner-city schools.
This article first appeared in the April 2017 issue of Training & Conditioning.
In the late 1980s, several health care organizations began providing athletic training services to a limited number of high schools throughout rural and suburban Wisconsin. At the time, athletic trainers were a novelty at the high school level, and providing broad coverage was no easy undertaking. However, it was a challenge many athletic trainers relished, and the schools’ administrators, coaches, parents, and athletes were thrilled to be blazing a new trail.
As athletic trainers became more common across the state over the next 30 years, one population stood out as still lacking the benefit of their services: athletes in Milwaukee Public Schools (MPS), the largest school district in Wisconsin. At Milwaukee’s Midwest Orthopedic Sports Medicine (MOSM)-a joint program between Ascension Healthcare-Wisconsin, now a part of Ascension, and Midwest Orthopedic Specialty Hospital-we wanted to change this. We formed a partnership with MPS in 2014 and started brainstorming ways to bring athletic training care to the district.
Yet, we had to keep in mind the different needs for delivering sports medicine coverage at an urban school district. Differences included educational obstacles and limited resources for an athletic training program.
These challenges threatened to delay and derail our collaboration at times, but we always found solutions. Ultimately, with planned funding, a pooled staffing structure, and effective community outreach, MOSM was able to achieve a shared goal of bringing together, for the first time, athletic training coverage for the 2015-16 school year to 19 MPS high schools.
PLANTING THE SEED
MOSM’s relationship with MPS began with the dedicated efforts of Al Holmes, a longtime basketball and track coach at MPS’ Morse Marshall High School. For years, Coach Holmes had advocated to get athletic trainers for the district’s athletes. He had attempted to gain support from nearby health care systems and college athletic training programs but had no success. That changed when Coach Holmes met Eric Ford, MPA, MHA, then the Vice President of Medical Group Operations for what was formerly known as Wheaton Franciscan Healthcare (now Ascension Healthcare-Wisconsin). Eric put Coach Holmes in touch with Mark Alberg, LAT, Manager of the Athletic Training Program at MOSM.
Discussions with Coach Holmes introduced Mark to the needs of MPS athletics and the potential for a great opportunity for MOSM. Coach Holmes outlined how the coaches in the district were ill-equipped to deal with injuries. He saw that injuries were keeping student-athletes from reaching their potential, causing them to lose direction in school, or impeding their team’s success. Coach Holmes challenged Mark to consider why suburban athletes had the benefit of athletic training services but their urban counterparts did not. As a result, Coach Holmes and Mark agreed they had an idea worth pursuing.
In the fall of 2014, they met with Bill Molbeck, MPS Athletics Commissioner; Russell Thomas, MEd, Supervisor for MPS Sports and Athletics; and Ryan Wilkinson, EdD, ATC, CSCS, then the Athletic Training Curriculum Director at the University of Wisconsin-Milwaukee, to discuss the scope of MPS sports programs and the opportunities for athletic trainers. Bill and Russell expressed support for athletic trainers becoming involved with MPS athletics but noted the district’s resources and other obstacles could stand in the way of the partnership. Ryan was supportive and suggested possible ways to offset costs and work through the obstacles.
After this meeting, the partnership between MPS and MOSM was official. However, it was still a diamond in the rough. Like the other attendees, Mark left the meeting with thoughts racing through his mind about how to polish the idea into a gem.
SET THE GROUNDWORK
For the plan to succeed, the obstacles facing MPS and MOSM had to be identified. A framework had to be developed, one comprehensive enough that Bill and Russell could present to the MPS administration with confidence, ensuring its prudent feasibility and affordability. It also needed to offer minimal financial risk to the MOSM Athletic Training Program.
Discussions for the partnership continued during the spring of 2015, focusing on two main areas: funding and staffing. We knew from the beginning that MPS had limited financial resources to dedicate to this project. The district had set aside some money for athletic training services, but it wasn’t enough to support the whole cost of the program.
So, we looked elsewhere for additional funds. A game-changing opportunity presented itself when Ryan helped MPS get a two-year grant from the Green Bay Packers and the NFL Foundation to pay for athletic trainers for football coverage. The grant was enough to financially support sports medicine coverage for all levels of MPS football, along with school visits for injury checks-two of our biggest expenses. Once we had funding from the grant, MOSM provided a discounted rate for the remaining athletic training services required.
When it came to staffing the partnership, we knew MOSM’s suburban sports medicine outreach model of having an athletic trainer at each school for 30 plus hours per week was not feasible for MPS. This would cost close to $750,000, a figure far more than MPS had allotted and MOSM could absorb.
Instead, we determined that the staffing model would have to meet the following criteria:
• The cost to MPS (after the grant) needed to be less than $100,000 for all 19 schools combined.
• The structure would have to allow for coverage of multiple events simultaneously, with peak demand requiring 15 athletic trainers to cover basketball games at the same time.
• The structure had to provide continuity of care among the 19 schools.
• The structure had to be expandable to accommodate more services as demand increased.
One option considered was dividing MPS’ 19 high schools into regions, with each having a dedicated athletic trainer. However, that option was not going to work. Although the numbers balanced financially, there were time conflicts-one athletic trainer would not be able to cover multiple athletic events for their region occurring at the same time in different locations.
Finally, after discussing different ideas with executives at Wheaton and physicians at MOSM, Mark came up with an affordable model that fit all the predetermined criteria. It was composed of one full-time athletic trainer and 18 hourly, part-time athletic trainers-all of whom would be Wheaton employees. Additional MOSM staff athletic trainers would be used to cover MPS contests when not working a sporting event at their own assigned schools.
MOSM Athletic Trainer Lisa Strick, MSEd, LAT, CSCS, was chosen to be the lead on the project. Her previous involvement and passion for working with MPS student-athletes made her the perfect choice.
OFF AND RUNNING
The partnership between MPS and MOSM officially began in fall 2015. We offered athletic training services for all levels of football, boys’ and girls’ basketball, wrestling, boys’ and girls’ soccer, and multi-team track and field meets over the course of the entire school year.
Our coverage started with Lisa. Her first order of business was to order sports medicine supplies, track inventory, and provide the part-time athletic trainers with the tools they needed to cover events. Due to a limited supply budget, Lisa had to get creative. For example, she purchased crutches and walking boots at Goodwill, and several MOSM athletic trainers donated extra supplies from their schools.
None of the MPS schools had existing athletic training rooms or areas to store supplies, so Lisa kept many of the items at her home or at the MPS Central Office. Part-time athletic trainers were provided supplies and medical kits that they kept with them. Frequently, Lisa went to events to replenish necessary supplies.
Lisa’s other major responsibilities included scheduling athletic trainers to cover games; keeping injury reports in the MOSM electronic medical record system; following up with athletes, coaches, and parents on significant injuries; covering events when needed; and working with school nurses in caring for injuries, especially in the event of a concussion. Lisa also networked with anyone and everyone affiliated with MPS athletics and served as the primary liaison between MPS athletic directors and MOSM.
The part-time athletic trainers were primarily responsible for providing coverage at games and communicating injury information to Lisa. We tried to consistently schedule them at the same schools, but this was not always possible, since many often had other jobs or commitments that caused conflict. However, we kept the same athletic trainers assigned to the three district stadiums for football and soccer games during the fall.
FINDING OUR PLACE
As excited as we were to finally be providing coverage to MPS athletes, we spent a lot of time our first year working out kinks in the program. The biggest challenge was gaining acceptance for our athletic trainers from the MPS athletes, coaches, and parents. There was some skepticism about why MOSM was caring for MPS athletes in the first place since it had never ventured into the inner city before.
To start, we had to inform the MPS community about athletic trainers and our ability to make athletic programs more successful and safer. We explained we could take injury-care responsibilities away from coaches, and we let parents know that their children were our main priority.
Despite these efforts, some coaches resisted our care. Many told us they knew as much as we did because they had taken a sports medicine course. Each athletic trainer handled this in their own way. Some explained sports medicine was always changing, so treatment was different from when the coaches were in school. Others found it beneficial to inform coaches about their years of schooling and experience. And yet another response was to come right out and tell coaches: “You go back to coaching, and let us take care of the injuries.”
In addition, some coaches, parents, and athletes believed we didn’t want athletes to play. As a result, athletes and the adults in their lives were reluctant to tell us when an injury occurred.
Not only did this affect our initial assessment, but it made follow-up care difficult. When an athlete was hurt, we always attempted to contact their parents/guardians to let them know what happened. Far too many times, we did not hear back with acknowledgement or updates on their child’s condition. There was even a time when a mother didn’t call Lisa back because she didn’t think Lisa knew what she was talking about. Overcoming these attitudes required patience and explaining each injury to the coaches and parents.
It was clear we needed to build trust and confidence if the program was going to make a significant difference. We had to strengthen our foundation with parents and coaches. Our next move was to arrive at events earlier. This gave us time to introduce ourselves to coaches, athletes, and spectators. People got used to seeing our faces.
Connecting with the event staffers at MPS venues also helped. These staffers, hired by MPS to provide supervision at games, were critical allies to building our program. These event staffers are school aides or school safety officers during the day, and others are retired from regular full-time careers. Most are there to make sure the student-athletes had appropriate outlets for activities after school. They know the students well, and they are able to help us in various ways.
For example, prior to MPS’ partnership with MOSM, the event staffers would allow parents to run onto the gym floor or field when their child was injured. As we got to know the staffers better, they started encouraging athletes and parents to come to us for assistance. They helped keep parents calm and away from the actual scene and endorsed confidence in the care their child was receiving from us.
Inroads with the MPS community were gradual, and we still faced obstacles. An unexpected challenge was communication issues with non-English-speaking parents. Milwaukee has a diverse population that includes a large number of immigrants, so language barriers surfaced. Most students had some level of proficiency in English, but many of their parents spoke only their native language. This made explaining injuries challenging. A few coaches spoke Spanish and English, which was a great help with our Spanish-speaking athletes and parents. We also relied on assistance from teammates when possible, especially with athletes from African and Southeast Asian countries.
A more complicated issue centered on finding the time to re-evaluate injuries. We made every attempt to go to schools before practice to check in with injured athletes. However, the school day usually ended at 3:55 p.m., with practices beginning around 4:15 to 4:30, and events starting between 4:30 and 5:00. This left very little time to stop by after school for an evaluation and then make it on time to an event at a different site. We’re still brainstorming ways to solve this challenge.
For longer-term rehab, we referred some athletes to the appropriate physicians and physical therapists. Lisa also had success giving athletes home-exercise programs and then checking up on them.
A final obstacle that we faced in year one was the logistics of scheduling coverage for so many athletic events. There were times when we didn’t have enough athletic trainers for the number of games, and we had to hire more part-time staff to fulfill our obligations.
This became more complicated when handling last-minute scheduling changes. Most of the high schools had one athletic director, who also usually had responsibilities as an assistant principal, teacher, or a combination of the two. In these instances, their athletic duties often took a backseat to pressing school matters, which made them hard to reach when a change occurred. Moving forward, we hope to avoid such issues by having athletic trainers cover the same sites as often as possible. This would allow them time to develop relationships with people at the schools they frequent, promoting continuity of care.
Now almost through the second year of our partnership with MPS, we’re pleased with the progress made. This year, we were able to provide coverage for 95 percent of the fall football and boys’ soccer contests, and we’ve increased the number of injury visits done outside of games.
In addition, more coaches are taking advantage of our services. For example, football coaches started asking Lisa to come check on injured athletes during practices in the fall. This activity increased during the winter as coaches and athletes became more comfortable with having athletic trainers around.
We’ve received a lot of positive feedback from others in Milwaukee, as well. The Superintendent of MPS, civic leaders, and a variety of business owners who sponsor MPS athletic events have expressed their support for our efforts. What our team recognizes is that this partnership fits with our mission, vision, and values. To top it off, MPS parents and athletes have thanked us for providing care, an endorsement that is most meaningful to the team. These wonderful comments are humbling and remind us why we’re working with MPS athletics in the first place.
Looking to the future, the goal is to gradually increase staffing so we can ultimately assign a permanent athletic trainer to each MPS high school. They would be there for daily visits and to cover all the sports offered.
We have a two-part plan to help us get there. First, we’d break the schools into four geographical districts, with each region including one to three large schools and two to three smaller schools. Each district would have one full-time athletic trainer, with event coverage support coming from part-time staff. Total personnel would require four full-time athletic trainers and approximately six to 10 part-time athletic trainers. This is a similar idea to the regional model we originally brainstormed. But with the MPS community better understanding the benefits athletic trainers offer, we hope to get more financial support to offset the cost.
Then, down the road, we’d expand further by giving the larger schools within each district a full-time athletic trainer. The smaller schools would be divided again into three groups, with a full-time athletic trainer for each group and part-time staff to help with coverage. Staffing for this model would require eight to 10 full-time athletic trainers and approximately four part-timers.
With the partnership in full swing, it’s a privilege to look at where we’ve been and where we are headed. In our numerous years of experience as athletic trainers, our work with MPS has been the most rewarding. We are reminded every day why we became athletic trainers: to help athletes. Yet, we know change takes time. The program is still young, and we’re excited to be a part of its future growth.
During the first two years of Midwest Orthopedic Sports Medicine’s (MOSM) partnership with Milwaukee Public Schools’ (MPS) athletics, there were many instances where coaches, parents, and athletes learned the hard way that listening to an athletic trainer was in their best interest. This particular example stood out to co-author Lisa Strick, MSEd, LAT, CSCS, an Athletic Trainer with MOSM and one of the collaboration’s organizers.
MPS always has a basketball showcase over Thanksgiving weekend. One year, a coach brought one of his players to me so I could look at his knee. The player had been having problems with it, and the coach wanted to know what I could do. Following an examination, I recommended the athlete seek orthopedic evaluation to rule out a meniscal tear. I provided the coach and athlete my contact information and that of one of MOSM’s physicians.
A couple of weeks later, the athlete complained of more knee pain. I talked to his parent and discovered he never scheduled an appointment to see a doctor.
I didn’t hear much more from the athlete about his knee until one of the last regular season games. At this point, he had a significant amount of swelling and an obvious limp. However, he insisted he was okay.
Following the game, the athlete was clearly in a lot of pain, so I spoke with one of his relatives to again suggest that he see a physician. Instead, the athlete decided to go to an urgent care facility, where he was told he had water on his knee but could continue to play.
During a playoff game, the athlete turned wrong and took a hit, making the knee much worse. That’s when I finally took the bull by the horns and spoke to his mother about getting him in to see a physician right away. As a result, the athlete was evaluated and had an MRI completed within 48 hours. His diagnosis was a torn meniscus, so his season was over.
Later, it was brought to my attention that the athlete didn’t originally go to the doctor because people were telling him to “tough it out.” But by toughing it out, his injury became worse.
Despite everything that happened, this story does have a happy ending. Now, the athlete is doing great, trusts me, and comes to me just to talk. This situation-though challenging-helped me win over the athlete and his family, coaches, and many others within MPS.