Away from school, mental well-being of students a cause for concern

Whole-child approach of education-based athletics looks for ways to respond

July 20, 2020

Russ Plummer checks the calendar, selects the letter for the day – he’s back around to ‘A’ – and starts thumbing out text messages.

“Everybody in my phone, whose name starts with an ‘A,’ past players, friends, coaches, colleagues, I just send them a text,” says Plummer, a 33-year high school soccer coaching veteran now serving the Tennessee Athletic Coaches Association as assistant executive director. “Nothing major. Just to find out if they’re doing OK. In these times, I think communication is huge.

“There may be some guys or girls out there struggling, and all it takes is a simple, ‘You doing OK?’ for them to open up. We may not have all the answers, but we may be able to direct them to someone who can help them. It’s a culture of looking out for each other.”

The virus, in current context, hardly needs a specific label; it is COVID-19, the global pandemic still tossing normalcy on its side and sweeping through states with numerous infections and perhaps just as many unanswered questions.

Models attempting to forecast and predict the COVID-19 path and its impacts are as ubiquitous as opinions on how best to combat the disease. Face-masks. Social distancing. Hand sanitizer as a de facto currency.

Doctor Tim McGuine, a distinguished scientist in the sports medicine program at the University of Wisconsin School of Medicine and Public Health, is working with a team to explore another model: the impact of these school closures – some now more than four months – on the quality of life for young people.

Using a baseline of information from a similar question set from athletes dealing with recovering from injuries between 2016-18, McGuine and his team of physicians, child health experts and researchers developed a less-than-seven-minute online survey for high school athletes gauging Mental Health (MH), Physical Activity (PH) and Health Related Quality of Life (HRQoL).

Only recently decoding the information from the nationwide-survey featuring more than 13,000 high school athletics respondents, McGuine believes the national responses show a clear need – if not mandate – for young people to return to their in-person school settings and athletic competitions.

“It was incredibly, incredibly striking,” says McGuine, who also serves on the advisory board of the National Federation of State High School Association (NFHS). “We know that depression scores in athletes are usually pretty low. So from our initial data set, 70% of healthy kids had no symptoms of depression at all. That drops to 32% in this new sample. Sixty-eight percent scored high enough on depression screenings that, in a normal clinical situation, it would trigger a referral to get the kid extra help. A person would look at these numbers and say, ‘Let’s have your son or daughter talk to someone.’

“Physical activity decreased by 50% overall and quality of life went down 15 to 20% depending on the group. These numbers are so low, and actually lower than kids who had sustained a concussion and couldn’t go to school for two weeks. The only scores higher than these were kids with chronic conditions such as cancer, cerebral palsy, diabetes, things like that.”

The look of the average classroom is still evolving after the nearly nationwide-halt to in-person classes in most states by late-March and Gov. Lee’s extension of Tennessee’s Emergency Order through August 29.

Tennessee is responsible for nearly 1.5 million of the more than 47 million COVID-19 tests administered nationwide, according to the Centers for Disease Control, and is among the top 10 states nationally for testing; it has a positive rate between 6-10%. Among 12,107 positive test reports in-state for ages 0 through 20, Tennessee has three total deaths. The state does not disclose how many people aged 20 and under are among its total test subjects.

Here, in mid-July, rest two of the biggest queries: How and when to resume public education, specifically as it pertains to in-person schooling? How to navigate the unprecedented complexities of high school athletics?

Nashville Metro Schools announced it would resume classes in a virtual setting, rather than in-person, earlier this month. Shelby County Schools in Memphis is pushing its start date from August 10 to August 31 and surveying parents on whether to return to in-person teaching environments or go with an online approach. Alcoa City Schools, like several other systems in Tennessee, is setting up a rotation to bringing back students, with children only attending in-person classes on certain days of the week, based on the first letter of their last name. Many districts are planning to re-evaluate the success of their approaches by the Labor Day holiday in September.

“I’ll be starting my 13th year with the association and there has never been a more pressing issue in terms of the membership wanting help in trying to get information,” said Mark Reeves, TSSAA assistant executive director. “I think it would be fair to say that we have received hundreds of requests for help. We as a staff have all just been inundated with requests from our schools to just give us something.

“The difficult thing is that you can give something right now but your something may not be applicable in their situation because of where they live, what local regulations may be in place and what their (COVID-19) case count may be. What we’ve tried to do is just get what we can out there, simplify as best we can, and try to align ourselves as best we can with guidance issued by Gov. (Bill) Lee. The governor seems to be the guiding light for the majority of our schools around the state, and since we are education-based athletics it makes sense to walk in line with the governor.”

The scenario leaves high school coaches, the majority of whom also have classrooms, with plenty of questions, but few answers, for their hallways and fields of competition.

Hope for a return to athletics, they say, is the key.

“Seeing them walk in back in June when we let the kids come to the facility and pick up their cleats and things after they’d been out of the locker room for two months, you could tell they were just happy to be on campus and together,” says Thomas McDaniel, head coach at Memphis’ Christian Brothers High School.

“I’m definitely biased, but I think young men, now more than ever, need football. There are a lot of studies that show kids need to be outside, getting dirty, battling for a common goal. They need those things.

“I’ve been at three very unique places as head coach, from Moore County to Oakland and now Christian Brothers, and those three communities couldn’t be much more different than they are. Socioeconomic, diversity, public-to-private, but the one constant is the relationships and the commitment and the process and being together with a common cause above personal gratifications. They need that. Kids need that and need to see it modeled.”

Adds Cosby High School girls’ basketball coach Cody Lowe, a former three-sport standout at the small school in rural East Tennessee, “Athletics are crucial for kids at Cosby. Growing up in a rural town like Cosby, high school basketball is a staple for our community, so playing high school sports is very important to not only the children in the community but to our faithful fans who look forward to coming to the games. Hopefully, we can make it work somehow.”

Plummer notes athletics competitions are continuing across the country this summer under different umbrellas. The former girls’ and boys’ head coach sees travel baseball leagues, AAU basketball leagues and myriad other competitive endeavors – private camps and lessons – seeing some athletes having their competitive and developmental skills honed while leaving disadvantaged youths further behind.

“We’re all in this together,” Plummer says. “Everybody supports each other. You have to mentally prepare yourself for anything. The mental state is always more important than the physical state. It goes back to that support thing, that we’re there for them, encouraging them. We just can’t stop. The world just can’t stop.

“There are kids going to New Jersey or wherever to play AAU, club sports and so forth. So in some ways, restrictions are hurting high school athletics because kids are going to find something else to get into and it might not be good. High school athletics has all these health and safety regulations, and other entities don’t have these things.

“If we can go to school, why can’t we do athletics? It’s extracurricular; not required. If you can do one, you should be able to do the other.”

The TSSAA’s hope is, in working with Gov. Lee’s office, to find something that enables schools to continue with their fall sports seasons mostly as scheduled.

McDaniel’s still talking to coaches from multiple sports across Tennessee, as well as football coaches and leaders of associations from multiple states. McDaniel has roughly 115 student-athletes in his Christian Brothers varsity football program and another 50 in its freshman team.

Somewhat to his surprise, he’s tracking about “95% participation, and we’ve all made accommodations for anyone who doesn’t feel comfortable or if they’ve had a family member with the virus.”

Hope, he says, is the key.

“I think at this point, most coaches I talk to are cautiously optimistic,” McDaniel says. “I think everybody realizes the severity of the situation and everyone is under scrutiny, at the political level and scholastic side of it. Everybody’s got jobs to do and we’ve got to be smart. I think everybody is realistic in what to expect.

“But there’s a lot of frustration. People want to know if we can play-coaches, kids, parents. But, there’s an inkling of hope. Until Gov. Lee or Bernard Childress says, ‘That’s it. We’ve taken the final step, there’s no other option,’ is that a shortened season, the ‘Virginia Model,’ whatever? I believe, even though the flip-flop of seasons may look like it could be best, if the spring sports like baseball and track get cut short again, that’s not fair to them.

“It’s not all about just saving football and you’ve got to think about everybody.”

Editor’s Note: In the University of Wisconsin School of Medicine and Public Health survey, 384 high school athletes from Tennessee are among the data set. The results, coming in just last week, and the conclusion of McGuine’s team are as follows:

Results: A total of 384 (46.4% female, 53.6% male, Age = 16.4 ± 0.1 yrs., grades 9 – 12, representing 49 Tennessee counties) participated in the study. Tennessee participants in May 2020 reported higher (worse) PHQ-9 scores than the HD participants (mean: 5.9 (95%CI: 5.3, 6.5) vs 3.3 (3.1, 3.5)) as well as a higher prevalence of moderate to severe levels of depression (18.1% vs 9.7%). Tennessee participants also reported lower (worse) PFABS scores (mean:14.2 (13.5, 14.8) vs 24.7 (24.5, 24.9)) and lower (worse) PedsQL total scores compared to athletes in the HD group (77.2 (75.1, 79.3) vs. 90.9 (90.5, 91.3)). Males in Tennessee reported greater moderate and severe anxiety percentages than the females in May 2020 (21.3% vs 8.0%, p < 0.001).

Conclusions: COVID-19 related school closures and sport cancellations in Tennessee appear to be associated with increased anxiety and depression as well as decreased physical activity and quality of life in adolescent athletes. The potential negative health impacts of prolonged school closures and sport cancellations should be considered when evaluating steps to limit the spread of COVID-19.

About John Brice

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