Unit 1 Regulatory control and governmental affairs in Athletic Training

Virginia's practice act

"Practice of athletic training" means the prevention, recognition, evaluation, and treatment of injuries or conditions related to athletic or recreational activity that requires physical skill and utilizes strength, power, endurance, speed, flexibility, range of motion or agility or a substantially similar injury or condition resulting from occupational activity immediately upon the onset of such injury or condition; and subsequent treatment and rehabilitation of such injuries or conditions under the direction of the patient's physician or under the direction of any doctor of medicine, osteopathy, chiropractic, podiatry, or dentistry, while using heat, light, sound, cold, electricity, exercise or mechanical or other devices.

NATA Definition of Athletic Training

(approved by NATA Board of Directors in October, 2007) Athletic training is practiced by athletic trainers, health care professionals who collaborate with physicians to optimize activity and participation of patients and clients. Athletic training encompasses the prevention, diagnosis, and intervention of emergency, acute, and chronic medical conditions involving impairment, functional limitations, and disabilities.

The Role Delineation Survey rating system continued

0= Minimal harm (not knowing this skill would lead to error with minimal consequence) 1= Moderate harm (not knowing this skill would lead to error with moderate adverse consequence) 2= Substantial Harm (not knowing this skill would lead to error causing substantial adverse consequences) 3= Extreme Harm- need I say more

NATA was founded when?

1950

Code 3: Professional Responsibility continued

3.7 Complies with all BOC exam eligibility requirements and ensures that any information provided to the BOC in connection with any certification application is accurate and truthful 3.8 Does not, without proper authority, possess, use, copy, access, distribute or discuss certification exams, score reports, answer sheets, certificates, certificant or applicant files,documents or other materials 3.9 Is candid, responsible and truthful in making any statement to the BOC, and in making any statement in connection with athletic training to the public 3.10 Complies with all confidentiality and disclosure requirements of the BOC 3.11 Does not take any action that leads, or may lead, to the conviction, plea of guilty or plea of nolo contendere (no contest) to any felony or to a misdemeanor related to public health, patient care, athletics or education;, this includes, but is not limited to: rape; sexual abuse of a child or patient; actual or threatened use of a weapon of violence; the prohibited sale or distribution of controlled substance, or its possession with the intent to distribute; or the use of the position of an Athletic Trainer to improperly influence the outcome or score of an athletic contest or event or in connection with any gambling activity 3.12 Cooperates with BOC investigations into alleged illegal or unethical activities; this includes but is not limited to, providing factual and non-misleading information and responding to requests for information in a timely fashion 3.13 Does not endorse or advertise products or services with the use of, or by reference to, the BOC name without proper authorization

How many members make up the NATA?

35,000 members

What is a mission statement?

A mission statement explains the organization's reason for existence. It defines what your organization does and its intention.

what is a vision statement?

A vision statement describes the organization as it would appear in a future successful state. When developing a vision statement, try to answer this question: If the organization were to achieve all of its strategic goals, what would it look like 10 years from now?

The unique knowledge and skill that ATs possess

ATs are first responders with specific sports med skills ATs are part of the sports medicine team ATs are qualified to make return to play or in the military return to service decisions ATs make the final call on how and if to participate in extreme weather conditions . . . Heat, humidity Surveys show significantly high satisfaction from those who receive our service ATs have specific orthopedic skills coupled with first responding ability Our prevention skills should reduce corporate liability AMA recognizes us as an allied health care provider AT must have the BOC credential ATC acts as the voice of reason in injury prevention dealing with coaches . . . .

Values of the CAATE

Accountability Transparency Integrity Excellence Leadership Partnership

Forming the Role Delineation of ATs

After setting our domains, the expert panel decided the essential tasks that an AT performs in each of the domains. The panel came up with a list of knowledge and skills required to perform each task in a competent and safe manner.

BOC Definition of Athletic Training

Athletic Trainers (ATs) are health care professionals who collaborate with physicians. The services provided by ATs comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.

What is an athletic trainer?

BOC Certified ATs are healthcare professionals who collaborate with physicians to optimize activity and participation of patients and clients. Athletic training encompasses the prevention, diagnosis and intervention of emergency, acute and chronic medical conditions involving impairment, functional limitations and disabilities

Code 6

Business Practices The Athletic Trainer or applicant: 6.1 Refrains from deceptive or fraudulent business practices 6.2 Maintains adequate and customary professional liability insurance

Standard 4

Clinical Evaluation and Diagnosis Prior to treatment, the Athletic Trainer assesses the patient's level of function. The patient's input is considered an integral part of the initial assessment. The Athletic Trainer follows standardized clinical practice in the area of diagnostic reasoning and medical decision making.

Code 2

Competency The Athletic Trainer or applicant: 2.1 Engages in lifelong, professional and continuing educational activities 2.2 Participates in continuous quality improvement activities 2.3 Complies with the most current BOC recertification policies and requirements

Regulation of Athletic Training

Currently, 49 of the 50 United States require athletic trainers to be licensed, registered or state certified (state certification is not the same as A.T. C.). Each state government manages licensure for athletic trainers. The one state not regulated is: sunny California

State Regulation in Athletic Training

Currently, 49 states and the District of Columbia regulate the practice of athletic training. Individuals must be legally recognized by the appropriate state regulatory agency prior to practicing athletic training. The BOC exam is recognized by all Athletic Trainer state regulatory agencies to meet their exam requirement. Compliance with state regulatory requirements is mandatory and the only avenue to legal athletic training practice.. Alaska As of June 18, 2014, Alaska is the 49th state to regulate Athletic Trainers! Governor Sean Parnell notified the Alaska ATA of a bill signing ceremony for their licensure bill. California California's Athletic Trainer title protection legislation, passed by the Assembly and Senate, was vetoed by the governor July 18, 2014. AB 1890 had broad support from both legislators and the public.

The CAATE mission

Defining, measuring, and continually improving AT Education.

Standard 1

Direction The Athletic Trainer renders service or treatment under the direction of a physician.

An athletic trainer's legal duties

Duty to properly assess the athlete's condition Duty to provide or obtain proper medical treatment The treatment you give The referral that you make *Duty to report abuse (child abuse/domestic abuse) Duty to provide clearance to participate Duty to inform the athlete of the risks of athlete participation due to specific medical condition. Duty to have followed standard of care

Four elements of negligence

Duty, Breach of the duty, Causation, Injury/harm

Standard 3

Immediate Care The Athletic Trainer provides standard immediate care procedures used in emergency situations, independent of setting.

The CAATE Vision

Improving Health by assuring and recognizing excellence in AT education.

As stated earlier, our current domains are

Injury/Illness Prevention and Wellness Protection Clinical Evaluation and Diagnosis Immediate and Emergency Care Treatment and Rehabilitation Organizational and Professional Health and Well-being

BOC Practice Domains in Athletic Training

Injury/Illness Prevention and Wellness Protection Clinical Evaluation and Diagnosis Immediate and Emergency Care Treatment and Rehabilitation Organizational and Professional Health and Well-being

NATA code of ethics Principle 2

Members shall comply with the laws and regulations governing the practice of athletic training. 2.1 Members shall comply with applicable local, state, and federal laws and institutional guidelines. 2.2 Members shall be familiar with and abide by all National Athletic Trainers' Association standards, rules and regulations. 2.3 Members shall report illegal or unethical practices related to athletic training to the appropriate person or authority. 2.4 Members shall avoid substance abuse and, when necessary, seek rehabilitation for chemical dependency.

NATA code of ethics Principle 3

Members shall maintain and promote high standards in their provision of services. 3.1 Members shall not misrepresent, either directly or indirectly, their skills ,training, professional credentials, identity or services. 3.2 Members shall provide only those services for which they are qualified through education or experience and which are allowed by their practice acts and other pertinent regulation. 3.3 Members shall provide services, make referrals, and seek compensation only for those services that are necessary. 3.4 Members shall recognize the need for continuing education and participate in educational activities that enhance their skills and knowledge. 3.5 Members shall educate those whom they supervise in the practice of athletic training about the Code of Ethics and stress the importance of adherence. 3.6 Members who are researchers or educators should maintain and promote ethical conduct in research and educational activities.

NATA code of ethics principle 4

Members shall not engage in conduct that could be construed as a conflict of interest or that reflects negatively on the profession. 4.1 Members should conduct themselves personally and professionally in a manner that does not compromise their professional responsibilities or the practice of athletic training. 4.2 National Athletic Trainers' Association current or past volunteer leaders shall not use the NATA logo in the endorsement of products or services or exploit their affiliation with the NATA in a manner that reflects badly upon the profession. 4.3 Members shall not place financial gain above the patient's welfare and shall not participate in any arrangement that exploits the patient. 4.4 Members shall not, through direct or indirect means, use information obtained in the course of the practice of athletic training to try to influence the score or outcome of an athletic event, or attempt to induce financial gain through gambling.

NATA code of ethics Principle I

Members shall respect the rights, welfare and dignity of all. 1.1 Members shall not discriminate against any legally protected class. 1.2 Members shall be committed to providing competent care. 1.3 Members shall preserve the confidentiality of privileged information and shall not release such information to a third party not involved in the patient's care without a release unless required by law.

In all settings, the service of athletic training is managed

Must be a referring physician in place Setting specific practice guidelines Athletic trainer practices only those skills in BOC standards of practice and legally permitted by state AT documents care given AT is properly credentialled

Standard 7

Organization and Administration All services are documented in writing by the Athletic Trainer and are part of the patient's permanent records. The Athletic Trainer accepts responsibility for recording details of the patient's health status.

Code 1

Patient Responsibility The Athletic Trainer or applicant: 1.1 Renders quality patient care regardless of the patient's race, religion, age, sex, nationality, disability, social/economic status or any other characteristic protected by law 1.2 Protects the patient from harm, acts always in the patient's best interests and is an advocate for the patient's welfare 1.3 Takes appropriate action to protect patients from Athletic Trainers, other healthcare providers or athletic training students who are incompetent, impaired or engaged in illegal or unethical practice 1.4 Maintains the confidentiality of patient information in accordance with applicable law 1.5 Communicates clearly and truthfully with patients and other persons involved in the patient's program, including, but not limited to, appropriate discussion of assessment results, program plans and progress 1.6 Respects and safeguards his or her relationship of trust and confidence with the patient and does not exploit his or her relationship with the patient for personal or financial gain 1.7 Exercises reasonable care, skill and judgment in all professional work

The Role Delineation Survey career rating

Point in Career where one is totally competent in each domain: 0= entry level 1= after one year 2= after three years 3= after 10 years (yikes!)

Standard 2

Prevention The Athletic Trainer understands and uses preventive measures to ensure the highest quality of care for every patient.

Code 3

Professional Responsibility The Athletic Trainer or applicant: 3.1 Practices in accordance with the most current BOC Practice Standards 3.2 Knows and complies with applicable local, state and/or federal rules, requirements, regulations and/or laws related to the practice of athletic training 3.3 Collaborates and cooperates with other healthcare providers involved in a patient's care 3.4 Respects the expertise and responsibility of all healthcare providers involved in a patient's care 3.5 Reports any suspected or known violation of a rule, requirement, regulation or law by him/herself and/or by another Athletic Trainer that is related to the practice of athletic training, public health, patient care or education 3.6 Reports any criminal convictions (with the exception of misdemeanor traffic offenses or traffic ordinance violations that do not involve the use of alcohol or drugs) and/or professional suspension, discipline or sanction received by him/herself or by another Athletic Trainer that is related to athletic training, public health, patient care or education

Unique Knowledge and Skills Base

Professions distinguish themselves from one another by their distinct skills base. In athletic training, The Board of Certifications does this every five years by surveying members of the profession and analyzing this data. This data is published in the Role Delineation Study which is now in its 6th addition.

Standard 6

Program Discontinuation The Athletic Trainer, with collaboration of the physician, recommends discontinuation of the athletic training service when the patient has received optimal benefit of the program. The Athletic Trainer, at the time of discontinuation, notes the final assessment of the patient's status.

The BOC sets our requirements for certification maintenance

Publish Standard of Practice for us to follow You must pay your renewal fee You must demonstrate appropriate level of emergency cardiac care You must meet BOC CEU requirements in stated timeframe

The Role Delineation Survey rating system

Rate the knowledge that an AT should have in the ________domain: 0= of little importance 1= Moderately important 2= Very Important 3= Extremely important

Typical patients and clients served by athletic trainers include

Recreational, amateur, and professional athletes Individuals who have suffered musculoskeletal injuries Those seeking strength, conditioning, fitness, and performance enhancement Others delegated by the physician

Typical patients and clients served by athletic trainers include:

Recreational, amateur, and professional athletes Individuals who have suffered musculoskeletal injuries Those seeking strength, conditioning, fitness, and performance enhancement Others delegated by the physician

Code 4

Research The Athletic Trainer or applicant who engages in research: 4.1 Conducts research according to accepted ethical research and reporting standards established by public law, institutional procedures and/or the health professions 4.2 Protects the rights and well being of research subjects 4.3 Conducts research activities with the goal of improving practice, education and public policy relative to the health needs of diverse populations, the health workforce, the organization and administration of health systems and healthcare delivery

Code 5

Social Responsibility The Athletic Trainer or applicant: 5.1 Uses professional skills and knowledge to positively impact the community

How do states regulate athletic training

Some professions have their own regulating boards: Board of Medicine-always regulates its state's physicians and may regulate a host of other professions. Physical Therapy for example, in some states has its own state regulating board. Maryland is one such state I have not seen many athletic having independent boards. Iowa does have one however, where each health professions has its own board under the Department of Public Health. When athletic trainers don't have their own board they most commonly are regulated under the state's Board of Medicine, or, Board of Physical Therapy. Maryland is an example of a state where athletic trainers fall under the PT Board.

What is the difference between state license and BOC certification?

State law defines the scope of practice and requirements for the legal practice of athletic training. Scope of practice can vary from state to state. State regulation always takes precedence over certification standards.

BOC Standards of Practice

The BOC Standards of Professional Practice consists of two sections: I. Practice Standards II. Code of Professional Responsibility

Regulatory Control in Athletic Training

The BOC regulates us as the body that publishes the Role Delineation Study (which determines how the board exam is composed), they give the board exam that gives us the ATC credential, and they monitor our CEUs to keep our credential current The NATA's executive education committee (formerly known as the Educational Council) determines what the competencies are both cognitive and psychomotor that we must instruct in athletic training education programs. Please refer to the NATA competency 5th edition in the unit 1 folder.

BOC Vision & Mission

The Board of Certification, Inc. (BOC) has been responsible for the certification of Athletic Trainers (ATs) since 1969. The BOC was the certification arm of the professional membership organization the NATA until 1989 when the BOC became an independent non-profit organization.

What is the BOC?

The Board of Certification, Inc. (BOC) was incorporated in 1989 to provide a certification program for entry-level Athletic Trainers (ATs). The BOC establishes and regularly reviews both the standards for the practice of athletic training and the continuing education requirements for BOC Certified ATs. The BOC has the only accredited certification program for ATs in the US.

Code of Professional Responsibility Preamble

The Code of Professional Responsibility (Code) mandates that BOC credential holders and applicants act in a professionally responsible manner in all athletic training services and activities. The BOC requires all Athletic Trainers and applicants to comply with the Code. The BOC may discipline, revoke or take other action with regard to the application or certification of an individual that does not adhere to the Code.

The CAATE

The Commission on Accreditation of Athletic Training Education (CAATE) is a 501(c)(3) non-profit organization currently incorporated in the State of Texas. Filings of incorporation are available through the Texas Secretary of State. The CAATE is recognized as an accrediting agency by the Council of Higher Education (CHEA)

NATA Code of ethics preamble

The National Athletic Trainers' Association Code of Ethics states the principles of ethical behavior that should be followed in the practice of athletic training. It is intended to establish and maintain high standards and professionalism for the athletic training profession. The principles do not cover every situation encountered by the practicing athletic trainer, but are representative of the spirit with which athletic trainers should make decisions. The principles are written generally; the circumstances of a situation will determine the interpretation and application of a given principle and of the Code as a whole. When a conflict exists between the Code and the law, the law prevails

Practice Standards Preamble continue

The Standards are NOT intended to: prescribe services provide step-by-step procedures ensure specific patient outcomes

Practice Standards Preamble

The Standards are intended to: assist the public in understanding what to expect from an Athletic Trainer assist the Athletic Trainer in evaluating the quality of patient care assist the Athletic Trainer in understanding the duties and obligations imposed by virtue of holding the ATC® credential

Management of Athletic Training Service

The board of Certification (BOC) provides certification of entry-level practitioners. Certification is a means of determining minimal professional competency in the profession to protect the public. The BOC mandates that the ATC keep up to date with skills by having to take continuing education courses. One must submit the evidence of these courses to keep their credential.

Causation

The breach was the cause of an injury to the victim. The causation does not need to be direct: defendant's act (or failure to act) could begin a continuous sequence of events that ended in plaintiff's injury, a so-called "proximate cause".

Breach of the duty

The defendant breached that duty.

Duty

The defendant must owe a legal duty to the victim. A duty is a legally enforceable obligation to conform to a particular standard of conduct. Except in malpractice and strict liability cases, the duty is set by what a "reasonable man of ordinary prudence" would have done. There is a general duty to prevent foreseeable injury to a victim.

What is a practice act?

The essential documents from a profession serve as the foundation for legislation and regulatory policy-making that help assure the public's safety. Scope and Standards of Practice, scope of practice is defined by the "who," "what," "where," "when," "why," and "how" of athletic training practice.

NATA Mission

The mission of the National Athletic Trainers' Association is to enhance the quality of health care provided by certified athletic trainers and to advance the athletic training profession.

Standard of Care Legal Definition

The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers.

Injury/harm

There must be an injury. In most cases, there must be a physical or financial injury to the victim, but sometimes emotional distress, embarrassment, or dignitary harms are adequate for recovery.

What to the regulatory boards do?

They define the process for applying for and maintaining licensure. You must follow your state's requirements. For instance, if you pass the BOC and receive your ATC credential in a state that requires licensure, and you choose to practice in that state without paying for your license, you are breaking the law. When this is discovered you may then lose your ATC credential for good! They provide your state practice act= your definition of scope of practice They provide practice regulations that you must follow They have a process for filing complaints about inappropriate practice

Exemption

This identifies a professional who is exempt from licensure requirements of another profession, such as physical therapists and ATs in Hawaii. A specific scope of practice is defined in the exemption statute of the licensing requirement. Individuals do not register with the state per se, but are held to the standards of the scope of practice defined in the statutes.

Registration

This is the least restrictive form of regulation. It usually takes the form of requiring individuals to file their names, addresses and qualifications with a government agency before practicing the occupation. This may include posting a bond or filing a fee.

Licensure

This is the most restrictive form of professional and occupational regulation. Licensure is often referred to as right-to-practice. Under licensure laws, it is illegal for a person to practice a profession without first meeting state standards.

NATA bylaws 4

To advance members' levels of knowledge through the collection, interpretation, and dissemination of information on subjects appropriate to the profession.

NATA bylaws 2

To advance the athletic training profession.

BOC vision

To be a worldwide leader in credentialing

NATA bylaws 5

To engage in any lawful act or activity for which a corporation may be organized under the Texas Non-Profit Corporation Act.

NATA bylaws

To enhance the quality of health care provided by athletic trainers.

BOC Mission

To provide exceptional credentialing programs for healthcare professionals to assure protection of the public.

NATA bylaws 3

To safeguard and advance the interests of its members by presenting the profession's viewpoints, concerns, and other important information to the media and to appropriate legislative, administrative, regulatory, and private sector bodies and by developing a working relationship with appropriate governmental and private sector not-for-profit and for-profit entities.

Standard 5

Treatment, Rehabilitation and Reconditioning In development of a treatment program, the Athletic Trainer determines appropriate treatment, rehabilitation and/or reconditioning strategies. Treatment program objectives include long and short term goals and an appraisal of those which the patient can realistically be expected to achieve from the program. Assessment measures to determine effectiveness of the program are incorporated into the program.

Certification

Under certification, the state grants title protection (right-to-title) to persons meeting predetermined standards. Those without certification may perform the duties of the occupation, but may not use the title.

What's in a Profession? Modern sociological literature suggests that the characteristics of a profession include

Unique knowledge and skill base A unique service Management of that service Regulatory control

Summary Points

Whatever state you decide to work in, it is your responsibility to determine practice law. No one will feel sorry for you and give you a break if you break the law. Not every state is set up like VA-you will have to figure out on your own where the info is Often, you state athletic training association website has information for its members to point them toward finding the info Another way to find your info is to go to the BOC site on the page on state regulation. Again, I caution you this is not always current.

Is Athletic Training Regulated?

YES!!!!!!!!!!!!!! Be aware that you must abide by: BOC Standard of Practice (practice and prof conduct) NATA Educational Competencies NATA Code of Ethics You must practice under your state's practice act. Let's say you learned something in school that your practice act does not permit you to do in your state, you are obligated to follow state law. You must follow your state's regulations document You must report practitioners who violate BOC standard of practice or state practice law

what is Torts?

a large subject area in litigation, in which a victim (e.g., plaintiff) generally seeks money from some person, or some corporation, who harmed the victim

Ethical codes of conduct and practice in athletic training are regulated by

the NATA Code of Ethics and, The BOC's Standards of Practice.