ORGANX project

Student Name

HSCI 430

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Organ-X Project

Organization Description

The organization that I have chosen to evaluate for the project is the Northern Illinois

University (NIU) athletic training and sports medicine department. This is the department of

people who treat the injuries and everyday aches and pains of athletes. People who are highly

athletic are prone to getting certain injuries that other people would not get normally, and also

have to keep being highly active while injured sometimes. These circumstances mean that

athletes often need a specialized type of care that only specially trained sports medicine

specialists are qualified to give. I am only slightly familiar with the NIU athletic training

department because I am part of a group of people that they refuse to help. I, and several other

dancers, have been turned away from this department because we are not “athletes”, even though

what we do is highly athletic in nature.

In terms of demographics that the NIU athletic training department serves, they don’t

offer very much information on racial demographics, but I was able to find some basic racial

demographics, and information on the proportion of men’s and women’s sports teams that they

serve. The overall population of NIU is 50.8% male and 49.2% female, and 55% White, 15.8%

Black, 17.9% Hispanic, and 5.4% Asian. According to the NIU athletic training website the

department serves seven men’s and nine women’s teams, not including dancers or cheerleaders,

however, they serve a total of 230 men and 160 women. To find racial demographics on the

sports teams I had to personally do some calculations based off of the provided sports team

rosters and pictures. I found that NIU athletes are about 65.9% White, 26.7% Black, 6.9%

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Hispanic, and .5% Asian. I also found that many NIU athletes came from foreign countries, such

as Romania, Slovenia, Germany, Taiwan, Russia, Bosnia, Greece, and many more.

Informal Assessment

Based on my personal experiences with the NIU athletic training and sports medicine

department I would have to say that they are not very culturally inclusive. I cannot personally

speak to cultural inclusion on an ethnic level, but I can speak to it in a different way. I believe

that being a part of a sports team is, in a way, a type of culture since teams almost operate as a

small family with their own traditions and values. Being a part of a dance company or

cheerleading team is much the same. Dancers and cheerleaders also have their own personal

traditions and values, but are similar in sports teams to the athleticism involved in what they do. I

have to say that the athletic training department at NIU is not at all culturally competent in this

regard because the flat out do not serve dancers or cheerleaders. This is a huge problem because

dancers and cheerleaders get the same kinds of injuries as other athletes, and need to receive the

same kind of care for those injuries.

When an athlete gets injured during, for example, a football game at NIU there are plenty

of on hand trainers and possibly even doctors ready to assess and treat that injured person.

During a dance performance at NIU there is no one there waiting to help in the event of an

injury. Dancers have just as great a chance, if not more, of getting injured during a performance

as any other type of athlete but we are still refused care from the athletic trainers. While football

players are crashing into each other on the field we are standing on our toes and being lifted high

into the air, hoping that we don’t fall or get dropped. I believe that the athletic training

department at this school is discriminating against dancers and cheerleaders simply because we

engage in a different type of athletic culture than most athletes. Usual sports have a very

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competitive culture that goes along with their athleticism. Dance and cheerleading can be

considered art forms, as they are beautiful and amazing to look at, but are also highly athletic in

nature. It is a huge problem that the athletic training department at NIU discriminates between

athletes, simply because they engage in a different type of athletic culture.

Assessment Strategy

In order to more officially assess the NIU athletic training department for cultural

competence I will take a closer look at three specific areas. The first area will be the

organizational values, or how committed the athletic training department is to providing

culturally competent care to all of its patients. To do this I will analyze data on the gender and

ethnicity of the athletes they serve, and also the different types and cultures of the athletes they

serve. The next area I will assess is the planning and monitoring that the training department has

in places to collect and use information on the cultural needs of the student athletes it will be

serving. I will assess this by examining the documents that every incoming athlete must fill out,

which includes previous medical history and other important to know information. Finally, I will

look at the communication skills of the training department, as they must be able to communicate

with many different kinds of athletes, and also be prepared to help athletes from visiting teams. I

will assess this by examining the qualifications of current training staff members and also the

information and help provided to visiting athletic teams.

Other than my personal assessment of the athletic training department’s cultural

competence, I will also assess it in a few different ways. I will first use the Cultural Competency

Checklist for Assess Service Delivery to get a general overview of how well the training

department, as a general health care provider, is performing their duty of providing the best,

culturally aware care they can to all of their patients. Then, to take a closer look at the specific

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cultural competence standards for athletic trainers, I will assess the NIU athletic training

department based on recommendations from the National Athletic Trainers’ Association

(NATA). Their assessment includes things such as having awareness of the impact that cultural

differences may have on a patients attitude towards health care, working with and in a diverse

environment, and having the cultural knowledge and skill necessary to achieve the best outcomes

possible.

Assessments/Outcomes

The first assessment that I completed for the athletic training department was the Cultural

Competency Checklist. Sadly, I had to give them ones in many categories, especially those

involving linguistic services. During my research I discovered that many of the student athletes

here at NIU are actually international students from all over the world. While they all must have

some sort of English skills to be able to come to school here, they may not have the English

knowledge necessary to understand technical medical terms they may hear while receiving care.

That is why I was so disappointed to see a lack of linguistic services available in the athletic

training department. None of the staff members listed on the athletic training website appear to

have any foreign language skills, or if they do it is not listed, and there also does not seem to be

appropriate signage in any of the pictures of the training facilities provided on the training

website. This could be a serious problem for international students that attend this school, and

especially for students from visiting athletic teams who may not speak much English. Another

category that the department received a one in was their efforts to provide information on

cultural competency standards to the public. Though the athletic training department does have a

website there is absolutely no information about cultural competence efforts to be found on that

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website. Given their seeming lack of real cultural competence efforts in other areas this did not

surprise me.

Next, I performed my own assessment of the training department based Lewin’s domains.

The first domain I assessed them for was organizational values, or how committed they are to

providing culturally competent care. As I found in my first assessment using the checklist there

is not much evidence at all of the training department even attempting to provide culturally

competent care, even though they serve many international students who may not be fully

proficient in English. In terms of the planning and monitoring/evaluation domain there was also

a lack of effort. Every incoming and returning athlete is required to fill out personal information

and medical history questionnaires, which can be found on the athletic training website, but these

documents do not ask any questions about cultural, ethnic, or linguistic backgrounds. These

forms could have easily included a couple questions about culture and ethnicity, which would

greatly improve the departments cultural competence. Finally, I looked at the training

department’s communication skills. While they did provide a fairly extensive list of resources

online for visiting athletic teams this list did not include any translation services, which is a key

factor of cultural competence. Also, they do not appear to have anyone on staff who speaks

multiple languages, which could be a problem considering that there are multiple international

student athletes at NIU.

Lastly, I assessed the athletic training department based on the NATA’s

recommendations for cultural competence. On their first standard of demonstrating awareness of

the impact that culture can have on a person’s attitude towards health care I saw no evidence. As

I pointed out previously the training department does not attempt to collect demographic

information from their patients, which could really help them to better prepare for and consider

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how different patients might reacts to certain types of care. NATA’s next standard of having the

cultural knowledge and skill to obtain optimal results for each patient I cannot completely assess

because of a lack of information on this provided on their website. Other than for the head trainer

there is not very much information given on the credentials of the other athletic trainers.

However, based on the lack of collection of cultural information from their patients I can’t

imagine that the organization has the knowledge necessary to provide the best culturally

appropriate care that they could. Finally, on the last NATA standard of working effectively with

diverse populations and in a diverse work place, I found evidence of competence in some areas

but not others. While the athletic trainers do work with a diverse patient group, including White,

Black, Hispanic, Asian, and other ethnicities, they do not work in a diverse work environment.

Based on the pictures and information on the athletic trainers provided on their website all of the

trainers are White. This does not necessarily mean that all the trainers come from the same type

of background, but it does mean that they most likely have a limited understanding of certain

cultures.

Application and Analysis of Cross Model

Regarding the Cross Model of Cultural Competence, I will start at the first level which is

cultural destructiveness. For the most part I do not believe that the athletic training department is

specifically trying not to provide culturally appropriate services, but they are in the case of

dancers and cheerleaders. The training department is outright discriminating against dancers and

cheerleaders, simply because they are a different kind or culture of athlete. Dancers and

cheerleaders do things that are just as athletic as people on other sports teams, they just do it in

different ways. Refusing to provide care to these groups of people is extremely detrimental to

them since it means that they can’t receive the specialized care they need. Part of the dance

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culture actually includes continuing to dance while injured, simply because it is often required in

professional dance companies, however these companies all have professional athletic trainers

available to their dancers to ensure they are still dancing as safely as possible while injured. If

dancers at NIU are going to keep dancing while injured, as we are required to in order to

maintain our grades in our dance classes, then the NIU athletic training department needs to open

their door to dancers too.

The next level of the Cross Model in cultural incapacity, which I believe is the main

problem of the athletic training department at NIU. As I stated before, in most cases I do not

believe that they are intentionally trying to be destructive to a certain culture. I think that either

the staff doesn’t not have the training and knowledge necessary to provide culturally competent

care, or they do not receive the funding necessary to implement culturally competent care. I think

part of it could be funding, as there are only five full-time trainers on staff to serve around four

hundred student athletes. I believe hiring more staff might help solve some internal diversity

issues, and may also help break some language barriers between the staff and patients. Another

possible incapacity issue could be the location of NIU. Dekalb is a fairly rural area, and a lot of

the population is made up of students who are only here for part of the year. This could lead to a

lack of available translation and interpretation services for the athletic training department to use.

As for the rest of the Cross Model there was limited, if any, evidence of the other stages.

I suppose an argument could be made for cultural blindness in that they seem to treat all the

patients that they choose to serve in the same way. They never ask for any cultural or ethnic

information in their personal and medical history forms, which me be an indicator that they do

not deem it important or realize that cultural background can influence how someone should be

treated. In terms of cultural pre-competence, cultural competence, and cultural proficiency there

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were no indications of these that I could find. There was certainly no information on cultural

competence provided to the public through the athletic training website, which leads me to

believe that they do not see cultural competence as very important to their practice. Either that,

or possibly they just don’t know how to start implementing it.

Analysis of Strengths and Challenges

If the NIU athletic department had the same goals as the Health Resources and Services

Administration (HRSA) they would be partially succeeding at some of their goals, but not

succeeding at others. For example, they would be succeeding at the goal of building healthy

communities through the use of community partnerships. Although the athletics department as a

whole has many partnerships and sponsors they have one particularly useful one with

Northwestern Medicine. This is a great group for the athletic training department to partner with

as it provides sponsorship for athletics along with a wider range of healthcare availability for

NIU’s athletes. However, one goal that the athletic department would not be achieving is

improving health equity across different populations and communities. Since the athletic training

department will not treat certain types of athletes, simply because they are different kind or

culture of athlete, they are definitely not promoting health equity. The athletic trainers should

really serve all kinds of athletes if they want to truly promote equal health care among all

communities.

As to how well the training department recognizes and respects cultural beliefs,

traditions, languages, etc. they really do not make an effort to do this at all. There seems to be a

major case of cultural incapacity and/or cultural blindness in this organization. In some cases, I

think the athletic training department is suffering from cultural incapacity because they have a

very small staff and are in a rural area. Both of those things can lead to limited availability of

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proper linguistic support for international students and simply a lack of diverse staff. I think there

is also a bit of cultural blindness occurring because of the opportunities the training department

has to implement some culturally competent practices that they have not taken. They could easily

collect demographic data on the personal information and medical history sheets every athlete

must fill out, but they do not. This shows either a lack of caring, or blindness to the fact that

culture and ethnicity can affect how health care should be delivered or will be accepted by the

patient.

In terms of the groups I researched in my STAT-X project, some of my research does

apply in a way. For that project I looked at the rates of men from different ages and ethnicities

who chose to reach out for mental health treatment. Although the athletic training department

does not provide mental health services itself they do have contacts and resources available for

those athletes who may need help. In the medical history questionnaires that all athletes are

required to submit each year there are mental health history related questions, and even questions

asking whether the person would like to speak to someone about mental health concerns.

Although this is not a direct guarantee that people will ask for help it is a great step towards

allowing people to ask for help in more confidential ways. In my project I learned that one of the

most common reasons that men don’t ask for assistance with mental health issues is

embarrassment. Often times people will be more will to say they’d like to speak to a counselor

on a questionnaire because it is less personal, and therefore less embarrassing, than asking in

person.

Recommendations

The first recommendation that I have for the NIU athletic training department is to

establish a committee to set goals for cultural competence improvement and oversee the progress

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of those goals. Currently the department doesn’t seem to have any real goals or even much

awareness of the need to provide culturally competent care, so I believe that they first step would

be establishing a committee to set goals and make a plan to implement them. They could start by

using assessments similar to what I used for this to see where their strengths and weaknesses lie,

and then proceed on from there. The next thing I would recommend would be to open the athletic

training services to all athletic students that attend NIU. Although things like dance and

cheerleading are not official sports they are highly athletic in nature, so those athletes deserve the

same care that all other athletes at the school receive. I would argue that this is especially

important for dancers as they get a grade for dancing in class every day. If they get injured and

can’t participate their grade, and possibly degree completion, will be negatively affected, so they

really need the care of athletic trainers to be available to them.

Another, fairly easy step, that I think the athletic training department should start

implementing is the collection of demographic information. This would be a very easy step for

them to implement because they already have all athletes fill out a medical and personal history

questionnaire at the start of each school year. It would be very simple, and also very beneficial,

for the athletic trainers to add a couple cultural and ethnic background questions onto this

questionnaire. This would also help them in having the information they need to implement my

next suggestion, of hiring some multilingual staff and putting up appropriate multilingual

signage around their facilities. Since the NIU athletic teams have many athletes from foreign

countries I think it is highly important that the athletic trainers have translation and interpretation

services available to help these students understand the care they are going to receive. It would

also be useful to possibly have a skype or phone interpreter available for when there are visiting

teams at NIU. Visiting schools most likely also have foreign students who may not all speak

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English extremely well so, in the event of an injury, it would be extremely helpful to be able to at

least call an interpreter in necessary.

Resources

The first resource that I believe would be helpful for the athletic training department here

would be the NATA. Their website has a lot of great information on athletic training in general,

but also has resources that could serve as a great starting point for implementing cultural

competency programs. They have online courses, ranging from beginner to advanced, that the

athletic training staff could take to learn about why cultural competency is important for them to

implement. There are many courses like this on the internet, but I recommend the NATA ones

for them because they are tailored specifically to the needs of athletic trainers. Taking these

courses would hopefully get the athletic training department to realize what they have been doing

wrong, or not doing at all, and also to see how easy it is to fix some of their problems. There are

also some in person conventions or web conferences hosted by NATA that the athletic trainers

could sign up for to further improve their cultural competence skills.

The next resource I would recommend to the NIU athletic training department is the

Language Services Associates, or another similar organization. Organizations like these work

with health care providers to set up interpretation and translation services that will work best for

their circumstances. In the case of the athletic trainers here they could work with a service like

this to set up a person to call should they need interpretation services rather quickly. Face-to-face

interpretation would be ideal, but since this is a very rural area video and phone interpretation

would be a great thing to have on hand for both NIU student athletes and visiting student

athletes. They could also work with an organization like this to purchase appropriate multilingual

signage for their treatment facilities. This would greatly help communication between the

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trainers and their patients, as medical terminology and instructions can be extremely hard to

understand if it is not given in a person’s native language.