WEST VIRGINIA LEGISLATORS’ AND SUPERINTENDENTS’ PERCEPTION
OF ATHLETIC TRAINING

A THESIS
Submitted to the Faculty of the School of Graduate Studies
and Research
of
California University of Pennsylvania
in partial fulfillment of the requirements for the degree
of
Master of Science

by
Jeremy Shepherd

Research Advisor, Dr. Linda Meyer
California, Pennsylvania
2010

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ACKNOWLEDGEMENTS

I would like to thank the following individuals for
their contributions to my thesis:
My thesis committee:

Dr. Linda Meyer for her insight

during this study through her professional experiences; Dr.
Bill Biddington for his suggestions and recommendations for
grammar and formatting; Dr. Jamie Weary for her
contributions to this study and for sharing her clinical
knowledge throughout the year while I worked with the
football team.
Dr. Tom West for setting the deadlines to keep me on
track, for calling my survey “pretty”, and for his MS Word
formatting skills.
Ms. Carolyn Robinson and her work study students for
helping get my surveys printed, and envelopes addressed and
stamped.
Sarah Seabrook and Steve Lebate for helping me stuff
envelopes.
A very special thank you to my mom, Brenda, and dad,
Jerry, for a lifetime of patience with me.
where I am today if it were not for them.

I would not be

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TABLE OF CONTENTS
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SIGNATURE PAGE

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AKNOWLEDGEMENTS .

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TABLE OF CONTENTS

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LIST OF TABLES

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LIST OF FIGURES .

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INTRODUCTION .

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METHODS

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Research Design

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Subjects

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Preliminary Research
Instruments

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Procedures .

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Hypothesis .

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Data Analysis .

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Demographic Data .

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Hypothesis Testing

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Additional Findings .

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Discussion of Results

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Conclusions

RESULTS

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DISCUSSION

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Recommendations

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REFERENCES

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APPENDICES .

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APPENDIX A: Review of Literature.

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Need for Credentialing of Athletic Training

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State Regulation

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Athletic Training Regulation in West Virginia.

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Introduction.

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Evolution of Athletic Training and NATA
Role of the Athletic Trainer

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History of West Virginia Policy 5112 .

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Licensure Efforts in West Virginia.

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Perception of the Athletic Trainer
Secondary School Administrators
and Legislators .

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Orthopedic Surgeons.

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EMT Directors.

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Coaches.

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Athletes

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General Public

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APPENDIX B: The Problem.

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Statement of the Problem.

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Definition of Terms

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Basic Assumptions .

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Limitations of the Study.

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Significance of the Study

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Summary

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APPENDIX C: Additional Methods
WV P5112 (C1)

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ATS Survey (C2).

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ATS Cover Letter (C3).

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IRB: California University of Pennsylvania (C4) .

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H.B. 3152: Athletic Training Registration Act(C5) 100
REFERENCES.

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ABSTRACT

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LIST OF TABLES

Table

Title

Page

1

Frequency of Return

10

2

Frequency for Gender

11

3

Frequency for Age

11

4

Frequency of Years at Current Position

12

5

Frequency that Participated in Sports

13

6

Sustained an Injury

13

7

Have Children High School Age or Older

14

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Children that Participated in Athletics 14

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Children Injured Part. in Athletic

15

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Utilized the Services of an AT

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Hypothesis Results

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Part. in Athletics Significance

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Domain I: Prevention

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Domain II: Clinical Eval. and Diagnosis 19

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Domain III: Immediate Care

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Domain IV: Treatment, Rehab., Recond.

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Domain V: Organization and Admin.

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Domain VI: Professional Responsibility

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State Regulatory Status

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LIST OF FIGURES

Figure

Title

Page

1

Athletic Training State
Regulatory Status Map

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1

INTRODUCTION

Certified athletic trainers (AT) are allied healthcare
professionals that work under the direction of a licensed
physician in the areas of sports injury prevention,
evaluation, diagnosis, treatment, and rehabilitation.

The

settings that ATs practice are wide ranging including high
school and collegiate athletic programs, professional
sports teams, hospitals and sports medicine clinics,
physician offices, law enforcement, the United States
military, performing arts organizations, and in the
industrial and commercial sectors.1 Despite these various
employment settings, the professional roles and
responsibilities of ATs are not easily recognizable by
those not directly involved with the athletic training
profession.
Athletic training has grown into a highly specialized
healthcare profession.

In terms of professional

development, many consider the profession to still be in
its adolescent stage.

That said, athletic training in the

United States dates back to the late 1800’s.2 Since the late
19th century, more individuals have begun to engage in
physical activity hence the incidence of injuries related

2

to the activity has also increased.

While an increase in

physical activity heightens the demand for athletic
training services, it also increases the potential for
litigation.
Most states have a documented position to help protect
the public from unqualified practitioners, protect ATs
against legal action and to serve the athletic population.
The states that have identified the need to protect both
ATs and individuals under the care of ATs have passed
credentialing legislation.

The remaining states’ athletic

training associations have acknowledged the need for
legislation and are trying to make changes to their state’s
current position.

It is the desire of the National

Athletic Trainers’ Association (NATA) to produce a
universal, nationally accepted document to regulate
athletic training in all 50 states and the District of
Columbia.1
It is the NATA’s position that all secondary schools
have a full-time, on-site, AT available to student
athletes.3 The number of students participating in athletics
at the high school level was 7,536,753 as reported by the
2008-2009 high school athletics participation survey.4
Athletic trainers employed in either the secondary school
or clinic/secondary school setting numbered approximately

3

6,803 according to the 2008 NATA membership statistics.5 The
need for employment of ATs in secondary schools is evident
by the ratio of student athletes to ATs working in this
setting.
Until February 2010, West Virginia (WV) was one of
three states with no state regulation over the practice of
athletic training; Alaska and California are the other two
states.6 Athletic trainers in states without state
regulations are more vulnerable to litigation.

Therefore,

WV is a state having difficulty providing adequate athletic
training coverage to its student athletes.

There are

numerous high schools in WV that do not employ ATs as
defined by the Board of Certification (BOC).

The West

Virginia Department of Education (WVDE) does recommend that
ATs, as defined by West Virginia Policy 5112 (WV P5112)
(Appendix C1), cover all varsity high school football
practices and games, but this mandate does not guarantee
the presence of a BOC AT.

WV P5112 is worded to allow

county school boards in WV to employ other personnel on a
permit or limited football authorization to fill the role
of an AT without violating any state laws if a BOC AT
cannot be employed.

These employees hired to fulfill WV

P5112 may be very competent individuals in their respective
fields, but they lack the concentrated training and

4

experience in the prevention, evaluation, treatment, and
rehabilitation of athletic injuries.7
The purpose of this study was to survey the WV state
legislators (WVL) and WV county school superintendents
(WVS) to collect their perceptions and knowledge of BOC
ATs’ scope of practice and professional role.

West

Virginia P5112 is governed by the WVDE and allows for
multiple types of state specific certification in the form
of professional service certificate, permit, and limited
football authorization to those hired by school boards.8
This paper will investigate WVLs’ and WVSs’ opinions of
ATs’ qualifications and abilities to professionally
practice within the six domains of athletic training as
described by the BOC Role Delineation Study (RDS) 5th ed.9

METHODS

5

The purpose of this study was to determine the
perceptions of WVLs’ and WVSs’ regarding the athletic
training profession.

The goal is to provide the West

Virginia Athletic Trainers’ Association (WVATA) and NATA
with survey results that can be used to assist them in
pursuing state regulation of athletic training in WV.

The

methods section describes how this research was carried out
and includes the following:

research design, preliminary

research, subjects, instruments, procedure, hypotheses, and
data analysis.

Research Design

A descriptive research design was used in conjunction
with the Athletic Training Survey (ATS) to conduct this
study (Appendix C2).

Subjects

The target subjects (N=189) in this study consisted of
members of the WV legislature (n=134) comprised of state
senators (n=34) and house delegates (n=100), and WV county
school superintendents (n=55).

All members of this

6

population were mailed the ATS to be completed and returned
to the researcher.

Included with the survey was a cover

letter (Appendix C3) written by the researcher introducing
himself and explaining the purpose of the study.

The

subjects then completed the ATS and returned it to the
researcher at California University of Pennsylvania via the
United States Postal Service (USPS) and informed consent by
the WVLs and WVSs was implied through the anonymous return
of the survey.

Each participant was assured that his or

her response would remain confidential.

The Institutional

Review Board (IRB) at California University of Pennsylvania
approved the study and the participants (Appendix C4).

Preliminary Research

A pilot study for this project was not required
because all questions were derived directly from the six
domains of athletic training defined in the BOC RDS 5th ed.
Validity and reliability were already tested in two phases.
First, by a panel of experts assembled by the BOC in
November 2002 to identify the domains, task, knowledge, and
skills consistent with the essential elements of athletic
training.9 The BOC RDS panel included ATs and other diverse
professionals that included: a lawyer, physician, parent,

7

and athletic administrator.9 The second phase required a
sample of 5,000 ATs to review and validate the work of the
panel, in particular, to evaluate the “importance and
criticality” for the proposed domains and tasks by way of a
survey.9 The results of the survey validated the domains and
tasks identified by the panel of experts.9

Instruments

The researcher created the entire survey with all
questions derived from the six Domains of athletic training
described in the BOC RDS 5th ed.
was collected and includes:

Demographic information

gender, age, current position,

and years of experience as a WVL or WVS.

Additional

demographic questions pertaining to participation in
athletics, injury history resulting from playing sports,
and if the services of an AT were utilized if injured was
also asked of the survey participants.

This series of

questions also consisted of questions related to the survey
contributor’s children and their participation in
athletics.

Following the demographic questions, the ATS

contained 35 Likert scale questions derived from the six
domains as defined in the BOC RDS 5th ed. with a Likert
scale ranging from:

1 – strongly disagree, 2 – somewhat

8

disagree, 3 – no opinion, 4 – somewhat agree, 5 – strongly
agree.

The answers of the surveys were analyzed using an

independent samples t-test to examine the hypothesis.
The ATS was distributed by the researcher to each WVL
and WVS using the USPS.

Distribution of the survey using

the USPS was chosen because it was more formal, hence more
likely to be seen by the targeted audience compared to
emailing the survey.

Procedures

The IRB at California University of Pennsylvania
approved the study before it was sent to any participants.
At this same time, a cover letter was developed and
included with the survey stating the purpose, directions,
risks involved, and informed consent.

The names and

mailing addresses of all 134 WVLs were obtained from the WV
legislature website available at:
http://www.legis.state.wv.us/.

The same information was

found about all 55 WVSs at the WVDE website available at:
http://wvde.state.wv.us/.

The survey was mailed by the

researcher using the USPS to each WVL and WVS with the
cover letter, and a postage paid, pre-addressed envelope to
return the completed questionnaire to the researcher at

9

California University of Pennsylvania.

Postage for the

study was allotted from the graduate athletic training
program budget.

The survey was designed to take less than

10 minutes to complete.

Hypothesis

The following was the hypothesis examined in this
research.
1.

WVSs will have a significantly greater perception

compared to WVLs regarding the scope of practice of an AT
as defined by the six Domains in the BOC RDS 5th ed.

Data Analysis

An independent samples t-test was performed to compare
the WVLs’ answers to the WVSs’ responses.

All data was

analyzed by SPSS version 17.0 for Windows with a level of
significance of 0.05.

RESULTS

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The following section will reveal demographic data and
hypothesis testing obtained through the ATS.

Demographic Information

The ATS was mailed to a total of 189 WVLs and WVSs.
The WV legislature is comprised of 34 state senators and
100 house delegates.

The WVSs represent each county in WV

and consists of 55 individuals.

A total of 79 surveys were

returned resulting in a completion rate of 41.8%.

Table 1

is a breakdown of the frequency of return by position.

Table 1. Frequency of Return
Position

Frequency (%)

Superintendents

40 (50.6)

Legislators

39 (49.4)

Table 2 represents the frequency for the gender of the
participants whom returned the survey by position.

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Table 2. Frequency for Gender
Gender

Superintendent (%)

Legislator (%)

Females

9 (22.5)

7 (17.9)

31 (77.5)

32 (80.0)

Males

Table 3 reports the frequency for participants grouped
by age class for both positions.

There were nine

individuals whom did not provide their age on the returned
survey.
Table 3. Frequency for Age
Age

Superintendent (%)

Legislator (%)

< 39

0 (0.0)

3 (7.7)

40 - 49

6 (15.0)

2 (5.1)

50 - 59

21 (52.5)

11 (28.2)

60 - 69

11 (27.5)

13 (33.3)

> 70

0 (0.0)

3 (7.7)

Not Given

2 (5.0)

7 (18.0)

Table 4 reports the frequency for individuals grouped
by classes for the total number of years at their current

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position.

All participants whom returned the survey had

been at their current position for greater than one year.

Table 4. Frequency of Years at Current Position
Years

Superintendent (%)

Legislator (%)

1 - 5

29 (72.5)

11 (28.3)

6 – 10

6 (15.0)

15 (38.4)

11 - 15

2 (5.0)

5 (12.8)

16 - 20

0 (0.0)

8 (20.5)

> 21

3 (7.5)

0 (0.0)

Table 5 represents responses given to the survey
question that asked if the individual participated in
school sponsored athletics in high or college.

Table 5. Frequency that Participated in Sports
Participation

Superintendent (%)

Legislator (%)

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Yes

29 (72.5)

30 (77.0)

No

11 (27.5)

9

(23.0)

Table 6 shows those individuals whom sustained an
injury while participating in athletics in high school or
college.

Table 6. Sustained an Injury
Injured

Superintendent (%)

Legislator (%)

Yes

21 (52.5)

18 (46.2)

No

19 (47.5)

21 (53.8)

Table 7 examines those survey participants whom have
children that are high school age or older.

Table 7. Have Children High School Age or Older

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Children

Superintendent (%)

Legislator (%)

Yes

32 (80.0)

27 (69.2)

No

8 (20.0)

12 (30.8)

Table 8 illustrates those survey participants whom
have children that did or currently are participating in
sports in high school or college.

Table 8. Children that Participate(d) in Athletics
Participation

Superintendent (%)

Legislator (%)

Yes

31 (77.5)

24 (61.5)

No

9 (22.5)

15 (38.5)

Table 9 shows those with children whom participate(d)
in athletics in high school or college and sustained an
injury while playing sports.

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Table 9. Children Injured Participating in Athletics
Injured

Superintendent (%)

Legislator (%)

Yes

24 (60.0)

16 (41.0)

No

16 (40.0)

23 (59.0)

Table 10 illustrates those participants and their
children that were injured participating in athletics whom
utilized the services of an AT.
Table 10. Utilized the Services of an AT
AT Services

Superintendent (%)

Legislator (%)

Yes

22 (55.0)

13 (33.3)

No

18 (45.0)

26 (66.7)

Hypothesis Testing

The hypothesis was tested using an alpha level of .05.
Hypothesis: WVSs will have a significantly greater
perception compared to WVLs regarding the scope of practice
of an AT as defined by the six Domains in the BOC RDS 5th
ed.

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To test the acceptability of this hypothesis an
independent samples t-test was utilized.

No significant

difference was found t77 = .589,P > .05.

The mean of the

WVSs 146.9 ± 14.9 was not significantly different from the
mean of the WVLs 143.9 ± 16.1.

Table 11 illustrates the

independent samples t-test used to test for significance.

Table 11. Hypothesis Results
Position

n

M

SD

Superintendents

40

146.9

14.88

Legislators

Conclusion:

39

143.9

P

t

.589

.853

16.10

The hypothesis was not supported.

There

was no significance between WVSs’ and WVLs’ perceptions of
athletic training.

Additional Findings

Further analysis of the data was conducted.

Each WVS

and WVL was asked to indicate on the ATS if he/she
participated in athletics while in high school and/or

17

college.

An independent samples t-test comparing the mean

scores of the WVSs and WVLs that did or did not participate
in athletics in high school and/or college found a
significant difference between the means of the two groups
t77 = .024, P < .05.

The mean of the WVSs and WVLs that

answered “yes” was significantly higher 146.1 ± 18.4 than
the mean of the “no” group 146.0 ± 10.2.

This indicates

that WVSs and WVLs whom participated in high school and/or
collegiate athletics are more likely to understand the
duties and skills of an AT than those who have no
competitive athletic history.

Table 12 illustrates the

independent samples t-test used to test for significance.

Table 12. Participation in Athletics Significance
Participation

n

M

SD

Yes

59

146.1

18.4

No

20

146.0

P

t

.024

.035

10.2

Tables 13 - 18 show the means of each of the 35 Likert
questions. Each table includes questions from the ATS for
which of the six Domains it represents.

The six Domains

18

include:

prevention; clinical evaluation and diagnosis;

immediate care; treatment, rehabilitation, and
reconditioning; organization and administration; and
professional responsibility.

Table 13. Domain I: Prevention
ATS
Question

Superintendents
Mean (SD)

Legislators
Mean (SD)

11

4.4 (0.70)

4.3 (0.76)

12

4.2 (0.75)

4.1 (0.85)

13

4.4 (0.75)

4.3 (0.80)

14

4.2 (0.84)

4.1 (0.77)

15

4.5 (0.60)

4.3 (0.73)

16

4.8 (0.42)

4.6 (0.49)

17

4.3 (0.79)

4.2 (0.80)

18

3.8 (0.89)

3.8 (0.94)

19

4.9 (0.30)

4.8 (0.54)

19

Table 14. Domain II: Clinical Evaluation and Diagnosis
ATS
Question

Superintendents
Mean (SD)

Legislators
Mean (SD)

20

4.2 (0.80)

4.1 (0.80)

21

4.4 (0.78)

4.3 (0.89)

22

4.3 (0.80)

4.3 (0.82)

23

3.8 (1.16)

3.7 (0.93)

24

4.2 (0.77)

4.1 (0.68)

Table 15. Domain III: Immediate Care
ATS
Question

Superintendents
Mean (SD)

Legislators
Mean (SD)

25

4.9 (0.36)

4.5 (1.00)

26

4.8 (0.49)

4.4 (0.94)

27

4.6 (0.74)

4.4 (0.96)

28

4.3 (0.94)

4.7 (1.33)

20

Table 16. Domain IV: Treatment, Rehab., Reconditioning
ATS
Question

Superintendents
Mean (SD)

Legislators
Mean (SD)

29

4.8 (0.38)

4.6 (0.63)

30

4.8 (0.42)

4.6 (0.72)

31

3.7 (1.08)

3.9 (0.91)

32

3.7 (1.03)

3.7 (0.94)

33

3.9 (0.88)

4.3 (0.64)

34

4.2 (0.76)

4.4 (0.64)

35

4.4 (0.93)

4.4 (0.77)

36

3.9 (1.03)

3.8 (1.01)

37

4.1 (0.85)

4.1 (0.87)

38

4.4 (0.90)

4.1 (0.85)

21

Table 17. Domain V: Organization and Administration
ATS
Question

Superintendents
Mean (SD)

Legislators
Mean (SD)

39

3.7 (1.11)

3.5 (0.88)

40

2.9 (1.10)

2.8 (1.20)

41

4.1 (0.67)

4.0 (1.04)

Table 18. Domain VI: Professional Responsibility
ATS
Question

Superintendents
Mean (SD)

Legislators
Mean (SD)

42

4.8 (0.50)

4.4 (0.99)

43

4.8 (0.63)

4.7 (0.57)

44

3.0 (1.05)

3.5 (1.19)

45

3.2 (1.07)

3.3 (1.22)

22

DISCUSSION

The discussion section is divided into three
subsections:

discussion of the results, conclusions, and

recommendations for future research.

Discussion of the Results

The purpose of this study was to determine the WVSs’
and the WVLs’ perceptions of the athletic training
profession.

Specifically, this study evaluated their

perceptions of the scope of practice of ATs as defined by
the RDS Domains.

This was accomplished by evaluating

responses given on the ATS.
The ATS was created by the researcher from the RDS 5th
ed. and included 35 Likert style questions with a scale of
1, 2, 3, 4, 5 where 1 = strongly disagree, 2 = somewhat
disagree, 3 = no opinion, 4 = somewhat agree, and 5 =
strongly agree.
questions.

The ATS also contained ten demographic

Since the questions were derived directly from

the six Domains of athletic training contained in the RDS,
all 35 Likert questions theoretically should have been

23

answered “strongly agree”.

There were no questions in the

ATS that were included to determine if the participant
could recognize what is out of an AT’s scope of practice.
The goal of the survey was to examine the perception of the
participants’ knowledge of what duties they perceive an AT
is qualified and has the ability to perform.
The findings of this research did not support the
hypothesis that WVSs’ have a significantly greater
perception of the athletic training profession compared to
WVLs’.

It was the opinion of the researcher that WVSs

would have a greater understanding of the skills and
professional role of an AT due to being involved in the
hiring process of ATs at high schools and having more
personal contact with ATs in the employment setting.

A

possible reason for survey results not supporting the
hypothesis is that while the ATS was in the hands of
participants, the WVLs were in session voting on House Bill
3152 (H.B. 3152) to establish the Athletic Training
Registration Act (Appendix C5).

Therefore, it is the

belief of the researcher that WVLs were up-to-date on the
qualifications and abilities of ATs due to the WVATA
lobbying and educating them about athletic training to pass
H.B. 3152.

24

The passing of H.B. 3152 is a huge triumph for the
WVATA, NATA, and ATs in WV.

This helps ensure title

protection for BOC ATs practicing in WV and gives those
under the care of ATs in WV confidence that the care they
receive is given from a qualified healthcare professional.
While registration in WV is a step in the right direction,
the WVATA and NATA must continue to pursue licensure to be
included as equals with healthcare professionals such as
PTs and occupational therapists (OT).

As H.B 3152 is

currently written, ATs register through the WV Physical
Therapy board. Physical therapy associations regularly
opposed any legislation athletic training associations
proposed to advance the profession and were a major
opponent of WV passing the Athletic Training Registration
Act.
To date there is not any published research that has
evaluated the perception of WVLs or any other state’s
legislators regarding their perception of the athletic
training profession.

The results of this study show that

WVLs have a realistic and favorable perception of athletic
training and have practical knowledge of the scope of
practice of ATs.
Richard Ray is credited for conducting the first
study of secondary school administrators by surveying

25

Michigan superintendents in 1987.10 Ray concluded that
superintendents in Michigan have a relatively realistic
view of the job functions of an AT, but have an extremely
inaccurate perception of the importance of certification
for ATs.10 Gould and Deivert conducted a similar study in
2003.11 The authors surveyed secondary school administrators
(SSA) which included superintendents in NATA District four.
It was concluded by the researchers that superintendents
have accurate knowledge of the athletic training
profession, but have an inaccurate perception of the
worthiness ATs can provide.11 The results from the ATS
regarding WVSs were very similar to the survey findings by
Ray, Gould and Deivert pertaining to the perceptions of
superintendents.

The results of the ATS for this study

show that WVSs have an overall accurate and realistic
knowledge base of the skills and abilities of an AT.
Upon further examination of the ATS, it was discovered
that question five was significant.

This question asked if

the survey contributor if he/she participated in athletics
while in high school and/or college.

A significant

difference was found between the means of WVSs and WVLs
that did or did not play sports in high school or college.
This is logical because individuals that were involved in
athletics were more likely to have personal interaction

26

with an AT, therefore, are more familiar with the scope of
practice of an AT.
Additional examination was done using the ATS by
dividing the 35 Likert questions into each of the six RDS
Domains from which the question was developed.

The means

and standard deviations are located in tables 13 – 17.
The nine questions contained within Domain one asked
the WVSs and WVLs their perception of an AT’s ability to
“discern, evaluate, and communicate risk associated with
participation in athletic and physical activities.”9 The
means were above 4.0 for both WVSs and WVLs for questions
in Domain one except question 18.

Question 18 asked about

an AT’s ability to recognize the signs/symptoms of eating
disorders and did return a lower mean response of 3.8 ±
0.89 for WVSs and 3.8 ± 0.94 for WVLs.

Overall, both

groups’ ATS answers support that ATs are competent in the
skills pertaining to prevention of injuries and conditions.
There were five questions contained on the ATS from
Domain two pertaining to clinical evaluation and diagnosis
and an AT’s abilities to “practice in the area of
diagnostic reasoning and medical decision making.”9 Again
the means were above 4.0 for WVSs and WVLs for Domain two
except for question 23.

Question 23 asked about an AT’s

ability to make return to play decisions.

The means for

27

WVSs was 3.8 ± 1.16 and for WVLs was 3.7 ± 0.93.

It is

usually within an AT’s scope of practice to make return to
play decisions regarding injuries an athlete may sustain
during a game or practice.

Domain two overall also

revealed a positive perception of an AT’s ability to
evaluate and diagnosis musculoskeletal injuries.
The four questions from the ATS derived from Domain
three yielded the most favorable perception from both WVSs
and WVLs.

Domain three addresses immediate care and an

AT’s ability to provide “direct services rendered by
members of health professions for the benefit of a
patient.”9 All means were 4.3 and above.

The skills

contained in Domain III that deal with the immediate care
of athletes on the field are the most recognizable by
people not directly involved with an AT and probably a
reason for the high positive return.
Domain four contained ten questions pertaining to an
AT’s ability and qualifications to treat, rehabilitate, and
recondition injuries.

This set of questions included six

questions that show means of 4.1 for both WVSs and WVLs.
Question 33 pertained to performing therapeutic massage
which revealed a difference in means between WVSs of 3.7 ±
1.08 and WVLs of 4.3 ± 0.64.

There were three questions

that resulted in means ranging from 3.9 – 3.7 for both WVSs

28

and WVLs.

Questions 31, 32, and 36 asked about an AT’s

ability to use electrical stimulation to reduce pain, use
ultrasound for sore muscles, and create a treatment plan.
Surprisingly to the researcher, question 37 which asked
about an AT’s ability to rehabilitate injuries yielded
favorable results from WVSs and WVLs.

ATs’ rehabilitation

knowledge is an area that has been challenged by groups
such as the American Physical Therapy Association (APTA)
and these responses on the ATS by WVSs and WVLs are
encouraging.
Domain five discusses organization and administration
which is a “series of plans, policies, and procedures by
which ATs organize the athletic training program to ensure
responsive and efficient operations in accordance with the
BOC Standards of Practice and NATA Code of Ethics.”9 There
were three questions pertaining to this domain on the ATS.
Questions 39 and 40 showed means less than 3.9 for both
WVSs and WVLs.

The result for question 40 about an AT’s

ability to manage a health care facility yielded the lowest
mean for any question on the ATS for both WVSs 2.9 ± 1.10
and WVLs 2.8 ± 1.20.

Question 39 resulted in a mean of 3.7

± 1.11 for WVSs and 3.5 ± 0.88 for WVLs which asked about
an AT’s ability to establish policies and procedures for
the delivery of healthcare.

Perhaps the reason for the low

29

result for questions pertaining to healthcare
administration is that the wording of the questions made
the WVSs and WVLs in vision an AT doing the job of a
healthcare administrator such as an individual that would
manage a hospital.
Lastly, Domain six entails professional responsibility
and “acknowledges that competent practice involves
compliance with ethical, legal, and other professional
standards whose purpose is to protect the public.”9 The ATS
contained four questions pertaining to Domain six.

The

means for questions 44 and 45 were 3.5 or below for both
WVSs and WVLs.

Question 44 asked about an AT’s ability to

receive third party reimbursement from insurance companies
for services.

WVSs had a mean of 3.0 ± 1.05 and WVLs had a

mean of 3.5 ± 1.19.

Question 45 asked if ATs can reduce

workers compensation claims in the industry setting and
resulted in WVSs with a mean of 3.2 ± 1.07 and WVLs with a
mean of 3.3 ± 1.22.
The findings of this study were limited to only WVSs’
and WVLs’ perceptions of athletic training.

In addition,

the WVSs and WVLs were given the option to allow an
assistant or staffer complete the ATS if time did not allow
them to personally complete the survey.

There were seven

surveys returned by individuals that did indicate

30

themselves as staffers and the results were included with
WVLs.

The ATS included questions from all six Domains

contained in the RDS, but the researcher did not choose the
same number of questions for each domain.

In addition, the

Likert scale for the ATS included a choice of “no opinion”
that allowed the participant to possibly not give their
true perception if perhaps he/she believed a defense of
their answer would be needed in the future.

As one WVL

stated in a note attached to a blank returned survey,
“…politicians do not take tests because it can come back to
hurt them in the future.”

Conclusions

The inability to pass athletic training legislation in
favor of ATs in WV is not due to the lack of understanding
or knowledge by WVLs or WVSs.

The results from the ATS

overwhelmingly show that WVLs and WVSs have accurate
knowledge of the abilities and qualifications of ATs in
Domains one through four and have average knowledge of
Domains five and six.

Therefore, the researcher believes

that financial concerns are the main issue most WVSs and
WVLs have in supporting or passing legislation that would
advance the athletic training profession in WV.

31

West Virginia is a poor state compared to most of the
other 49 states and has the lowest paid teachers in its
schools.

It is the impression of the researcher that WV

would have an extremely difficult time financially creating
and supporting ATs in public schools in WV at any level.
While WVSs and WVLs possess accurate knowledge of the
athletic training profession for Domains one through four
that entail directly caring for patients, they have an
inaccurate perception of an AT’s ability to establish
healthcare policies and procedures as described in Domain
five and imprecise knowledge of an AT’s professional
responsibility to comply with ethical, legal, and other
professional standards in place to protect the public as
defined in Domain six.

Hopefully with the passing of the

Athletic Training Registration Act, the worth and
significance of ATs will be fully recognized by WVS and
WVL.

Recommendations

It is the hope of the researcher that the results from
this study will be utilized by the WVATA and NATA to
continue to advance the athletic training profession in WV.
This study is the first to formally survey WVLs and WVSs

32

about their perceptions of an AT to work within the Domains
in the RDS.

The passing of the WV Athletic Training

Registration Act has put ATs in WV in a better position,
but further progress is still needed.

Currently, ATs in WV

will register through the WVPT board and historically this
has not worked in the ATs favor for ATs in states working
under their PT board.

The results of the ATS can be used

by the WVATA to focus its efforts to educate WVLs and WVSs
in the Domains that collectively yielded lower mean scores
on the ATS to achieve licensure.
The researcher suggests the following modifications to
this study in the future.

First, the ATS contained a

Likert scale of 1, 2, 3, 4, 5.

Elimination of the 5 point

Likert scale and using a 4 point scale so participants
cannot select “no opinion” may yield more accurate results.
Another change to the ATS could be to do away with the
Likert number scale and just ask the participant “yes” or
“no” if an AT is qualified and has the ability to perform
what the question asks.

The researcher does believe that

using the USPS to deliver the survey is the best choice as
the response was adequate from both WVSs and WVLs because
emailed surveys most likely will not reach the intended
recipient especially when surveying WVLs.

33

Second, there is a need to compare the answers from
WVLs and WVSs to the legislators and superintendents of
other states so survey results can be compared and
analyzed.

In particular, surveys could be sent to WVLs and

WVSs, and then compared with legislators and
superintendents from a state(s) that has licensure.
Third, the individual positions of superintendent,
senator, delegate, and staffer could be analyzed using an
ANOVA to test for significance.

34

REFERENCES
1. National Athletic Trainers’ Association. Athletic
Training Terminology. Available at:
http://www.nata.org/about_AT/terminology.htm. Accessed
November 12, 2006.
2. O’Shea ME. A History of the National Athletic
Trainers’ Association. Greenville, NC: National
Athletic Trainers’ Association; 1980.
3. National Athletic Trainers' Association. Secondary
School Official Statement. Available at:
http://www.nata.org/statements/official/highschools.pd
f. Accessed September 22, 2009.
4. National Federation of State High School Associations.
2008 - 2009 athletics participation totals. Available
at:
http://www.nfhs.org/content.aspx?id=3282&terms=partici
pation+survey. Accessed September 22, 2009.
5. National Athletic Trainers' Association. NATA total
membership by job setting for January 2002. Available
at:
http://www.nata.org/membership/MembStats/2002Januaryht
m. Accessed June 30, 2009.
6. Board of Certification. State Regulatory News.
Available at:
http://www.bocatc.org/index.php?option=com_content&tas
k=view&id=96&Itemid=102. Accessed October 6, 2009.
7. Potter BW. A Historical Review of Secondary School
Athletic Training Coverage in West Virginia [thesis].
Huntington, WV: The Graduate College of Marshall
University, Marshall University; 2005.
8. Morin GE. An Overview of Selected State Licensure
Athletic Training Laws. J ATHL TRAINING. 1992;27:162169.
9. Board of Certification: Role Delineation Study. 5th ed.
Omaha, NE;2004:3-32.

35

10. Ray R. A Survey of Michigan School Superintendents’
Knowledge and Attitudes toward Athletic Injuries,
Athletic Trainers, and Legal Liability. J ATHL
TRAINING. 1987;22(4):311-315.
11. Gould TE and Deivert RG. Secondary-School
Administrators’ Knowledge and Perceptions of Athletic
Training. ATHLET THER TODAY. 2003;8(1):57-62.

36

APPENDICIES

37

APPENDIX A
Review of Literature

38

REVIEW OF LITERATURE

The historical evolution of the athletic training
profession compared to other healthcare professions is very
different.

Athletic training originated outside of the

clinical medical system when educational and sports
organizations were developed in the late 1800s and early
1900s.

Establishment of the NATA in 1950 led to the

creation of standards for professionalism and education of
athletic training.

However, the extent to which the

profession was viewed as a legitimate member of the medical
community was dramatically increased by the American
Medical Association (AMA) recognizing athletic training as
an allied health profession in 1990.

Even though national

board certification, state regulation and educational
program accreditation standards have established a very
high degree of professional competence to deliver health
related services to the physically active population, the
identity of the athletic training profession remains
strongly linked to the image of a minimally qualified
technician that tapes ankles and supplies water for a
sports team.1

39

Evolution of Athletic Training and NATA

The roots of athletic training date back to the
beginning of competitive sports.

The first competitive

sports organized with rules were started by the ancient
Greeks.2 However, it was not until centuries later that
athletic training began to take shape as the profession is
today.

In 1881, Harvard University hired the first ATs

followed soon after by the University of Oklahoma in
1887.2,3 In 1898, the first textbook describing procedures
of how to treat athletic injuries was published in England.3
The Trainers Bible and articles related to the
treatment and management of football injuries were
published in the early 1900’s.4 In 1916, the Trainers Bible
was written by Dr. Samuel Bilik, an AT at the University of
Illinois.

He is considered by many to be the “The Father

of Athletic Training.”4 This book was the first devoted
entirely to the discipline of athletic training.

Dr. Bilik

also worked with the football team and taught courses
exclusively planned for ATs at this same time.2-4
Chuck Cramer of Cramer Chemical Company located in
Kansas, and Bill Frey from the University of Iowa are
recognized as starting the NATA in 1938.3,5 The purpose of
the NATA was to provide networking opportunities for ATs

40

and those interested in the profession to share ideas.

The

Trainers Journal was started in 1941 as a result of their
interest to advance research and continuing education of
ATs.

Cramer also published a periodical called the First

Aider during this same time period.3,5 The NATA halted
operations, and the Trainers Journal stopped being
circulated due to World War II in 1944.2,3
After a brief period of inactivity, five regional
associations that formed during the idle period during
World War II consolidated in 1950 to create the current
NATA.

Upon re-organization of the NATA, professional

growth began.

Moving to educate the group of

professionals, The Journal of the National Athletic
Trainers’ Association was initially published in 1950.
Today, the Journal of the National Athletic Trainers’
Association is known as the Journal of Athletic Training.
Additionally in 1950, the NATA wrote its first code of
ethics.3,4
The next substantial development of the NATA was
setting educational standards for potential ATs.

These

standards were the responsibility of the Committee on
Professional Advancement with the goal of elevating the
standard of athletic training in 1959.

By rule of this

committee, candidates satisfying the minimum requirements

41

earned a certificate of completion.

In 1968, two sub-

committees were appointed by the Committee on Professional
Advancement.

The task of one committee was to govern which

institutions of higher education could offer an athletic
training curriculum.3 The responsibility of the other subcommittee was to create certification standards and in 1970
the first examination was administered by the NATA.3,4
Today, the Commission on Accreditation of Athletic
Training Education (CAATE) administers athletic training
education curriculums in colleges and universities.
Initially, the Joint Review Committee on Educational
programs in Athletic Training (JRC-AT) was incorporated in
1991 to oversee curriculums in athletic training.

The JRC-

AT was a committee on Accreditation under the Commission on
Accreditation of Allied Health Educational Programs
(CAAHEP).

In 2006, the JRC-AT became independent from

CAAHEP and changed its name to the CAATE.

CAATE is the

agency responsible for the accreditation of 350+ entrylevel athletic training education programs at colleges and
universities.

The American Academy of Family Physicians

(AAFP), the American Academy of Pediatrics (AAP), the
American Orthopedic Society for Sports Medicine (AOSSM) and
the NATA cooperate to sponsor CAATE and collaborate to

42

develop the “Standards for Entry-Level Athletic Training
Educational Programs.”6
Support from the AMA has been vital to the growth and
advancement of the athletic training profession.

In 1967,

the AMA recognized ATs as a part of athletic health care.5
Athletic trainers were officially accepted in 1990 by the
AMA as a legitimate member of the allied health profession.3
Unanimously in 1998, AMA leaders announced that it was
their recommendation that ATs be available at every high
school for student athletes.5
Today, the NATA, BOC, and CAATE are all independent
agencies that work together to oversee the athletic
training profession.

The NATA is headquartered in Dallas,

Texas with global membership totaling more than 30,000 and
includes a full-time staff.

It is the mission of the NATA

to “enhance the quality of health care provided by
certified athletic trainers and to advance the athletic
training profession.”7 The BOC also has full-time employees
and is located in Omaha, Nebraska.

It sets the standards

for the practice of athletic training.

The BOC is the sole

accreditation certifying agency for ATs in the United
States.

CAATE is located in Round Rock, Texas and employs

two full-time administrative personnel.

Leadership

consists of BOC AT representatives from institutions

43

offering athletic training educational programs, an NATA
representative, physicians from the sponsoring
organizations, and one public member.8 The ATs are appointed
by the NATA and the physicians are appointed by their
respective professional association.8

Role of the Athletic Trainer

Until 1989, the BOC was operated as a committee within
the NATA (NATABOC).

NATA leaders realized that an

independent entity was needed to set the standards for
practice of athletic training.

Every five years the BOC

publishes the RDS to identify essential knowledge and
skills for the athletic training profession.

This

publication also serves as the blueprint for development of
the certification exam.

The current RDS is the fifth

edition and is valid from 2006 to 2011.

There are six

Domains defined by the RDS that detail the professional
role and scope of practice of ATs.

The Domains include:

prevention, clinical evaluation and diagnosis, immediate
care, treatment, rehabilitation and reconditioning,
organization and administration, and professional
responsibility.9 Each Domain is its own entity and builds on

44

one another to make certain individuals receive proper
care.9

Need for Credentialing of Athletic Training

The NATA, BOC, and CAATE are constantly elevating the
standards of the profession of athletic training.

The most

recent change pertains to how an individual attains the
right to sit for the BOC examination to earn the certified
athletic trainer (ATC) trademark credential.
Historically, the two most popular routes a
prospective AT could take to be eligible for the
certification examination was candidates could have
attended a college or university offering an undergraduate
NATA or CAAHEP (now CAATE) approved curriculum for athletic
training, or a second way was the candidate could complete
an internship.

In January of 2004, the BOC eliminated the

internship route to certification.10 Elimination of the
internship option means that all athletic trainers
certified since 2004 have met the same educational
standards.
Every candidate that qualifies to take the BOC
examination has earned a bachelor’s degree in athletic
training or completed a similar bachelor’s program with a

45

concentration in athletic training from a CAATE accredited
institution.

Today, 20 institutions have implemented an

entry level master’s route for individuals that already
hold a bachelor’s degree and have met prerequisite course
work.11 Additionally, there are also 14 universities that
offer NATA accredited master’s of athletic training
programs for individuals that already have a bachelor’s
degree in athletic training looking to further their
education.12

State Regulation

While the athletic training associations have made
great strides to advance the profession, credentialing
regulation of athletic training at the state legislative
level is still a concern in some states.

Most state

licensing boards in the United States have restricted the
scope of practice by establishing rules and regulation
creating the potential for practice violations.13 Athletic
training regulation in these states is governed by the same
state practice acts that apply to other health professions
like: medicine, physical therapy, and dentistry.14
All but three states have passed legislation to
regulate athletic training.

The other 47 states have some

46

form of athletic training regulation in the form of
licensure, certification, registration, or exemption.
The table below represents the classifications of each
state’s athletic training regulatory status according to
the BOC.15
Table 19: Athletic Training State Regulatory Status
Credential

State

Licensure (38)

Alabama, Arizona, Arkansas,
Connecticut, Delaware, Georgia,
Florida, Idaho, Illinois, Indiana,
Iowa, Kansas, Maine, Maryland,
Massachusetts, Michigan, Mississippi,
Missouri, Montana, Nebraska, Nevada,
New Hampshire, New Jersey, New Mexico,
North Carolina, North Dakota, Ohio,
Oklahoma, Rhode Island, South Dakota,
Tennessee, Texas, Utah, Vermont,
Virginia, Washington, Wisconsin,
Wyoming

___________________________________________________________
Certification (5)

Kentucky, Louisiana, New York,
Pennsylvania, South Carolina

___________________________________________________________
Registration (4)

Colorado, Oregon, Minnesota

___________________________________________________________
Exemption (1)
Hawaii
___________________________________________________________
No Regulation (2)

Alaska, California, West Virginia*

* WV passed registration in February 2010

47

Figure 1: Athletic Training State Regulatory Status Map15

Athletic Training Regulation in West Virginia

The regulation of athletic training in WV is a unique
state of affairs.

Only those employed by the WV public

school system are included in the state practice act, WV
P5112.

This means that ATs working in WV in any other

setting other than the WV public school system are not
covered by WV P5112.

The WVDE governs WV P5112 which

48

outlines the minimum requirements of public school
employees and defines the regulations for employees serving
as ATs.

The WV P5112 definition of those that may serve as

an AT and the BOC definition are very different.

WV P5112

was last updated and became effective in 2004.17

History of West Virginia Policy 5112
West Virginia drafted and approved a formal policy in
1980 regarding ATs in its high schools.

The legislation

was known as the Policy of the West Virginia Board of
Education on Athletic Trainers in Public Schools of West
Virginia, Policy 2422-13, and was allocated in 1981.
Policy 2422-13 was approved to provide for the professional
development of an individual to function as a state
certified athletic trainer to improve the health care of
student athletes in the public schools of WV.

In the

short-term, this policy required one person from every
school sponsoring football to complete an athletic training
workshop by the 1980 - 1981 academic year.

In the long-

term, each county board of education was required to hire a
state certified athletic trainer in middle, junior and
senior schools that offer football by the 1985-1986
academic year.18

49

The WVDE amended Policy 2422-13 replacing it in 1983
with Policies 5013 and 5112.

The roles and functions of

ATs in state public schools were defined by Policy 5013 and
Policy 5112 explained the certification requirements and
program details to achieve a state of WV AT certificate.
Defined by Policy 5112, the professional role of the AT in
WV was to instruct/advise, evaluate, provide emergency care
and rehabilitate student athletes, and perform
administrative duties relative to athletic training.18
Although Policy 2422-13 had excellent intentions, it
became obvious the expectation of all county school boards
to be complaint by the 1985 - 1986 academic year was an
unrealistic goal.

Therefore, in 1984, WV P5112 was amended

to grant more time for required compliance until the 1987 1988 school year.

School boards that were noncompliant

were required to submit a report that efforts were
exhausted to become complaint and had to submit an outline
of their plan to fill this vacancy by the deadline.18
Revisions extending compliance with WV P5112 were
amended in 1985 for the 1986-1987 academic year and again
in 1988 for compliance for the 1990-1991 school year.

This

revision changed the wording of WV P5112 for high schools
to explain that each county’s Board of Education must hire
a WV state certified athletic trainer for all high school

50

football activities including practices and games.
However, a waiver could be granted from the county Board of
Education if an AT was not employed.

Also at this time,

Policy 5013 which is the governing principles for
employment and assignment of state certified athletic
trainers in public schools of WV, was merged to WV P5112.18
Statistics were reviewed in 1990 of the results of WV
P5112 during the 1989-1990 school year.

Of the 140 WV high

schools sponsoring football teams, only 35% had state
certified athletic trainers. Of this 35% of schools, 15%
had state certified athletic trainers working on an expired
certificate.

It was reported by 26% of schools that there

was no state certified athletic trainer employed at all.
The remainder of the schools met the WV P5112 AT
requirement by hiring a school employee on a waiver basis.18
It was five years later before WV P5112 would be
amended again.

In 1995, changes were made to allow NATABOC

certified ATs to obtain WVDE authorization to work as ATs
within its schools.

The goal of this change was to

increase the number of ATs working in WV’s public schools.18
Several years passed by from the last change to WV
P5112.

Then in 2004, WV P5112 was amended to state that if

the county Board of Education is unable to employ a BOC
certified AT or a state certified AT, then a relevant

51

healthcare worker like a physician, nurse, chiropractor,
paramedic, emergency medical technician, or physician
assistant may be hired under a limited AT authorization.18
The lack of qualified state certified ATs in WV could
be due to the amount of course work needed to achieve state
certification and the time requirement to complete the
coursework.

BOC certified ATs are deterred by the low pay.

Athletic trainers in WV high schools earn a salary ranging
from $500 to $8,000 a year.19 Often times the previously
mentioned healthcare workers or school employees that
fulfilled the requirements to be state certified ATs under
WV P5112, fill these jobs and this salary is secondary to
their full-time employment income.

Licensure Efforts in West Virginia
Hiring qualified ATs for WV’s high schools has proven
to be a daunting task.

Absence of state regulation in WV

over the practice of athletic training may be a
contributing factor.

As previously mentioned, WV is one of

three states that does not have any regulation of athletic
training.16,17
Conversation pertaining to licensure for ATs in WV
began in the mid-1980s.

In the mid-1990s, the first

attempt to introduce licensure to govern the practice of

52

athletic training in WV was unsuccessful.

In 2000, the

members of the WVATA agreed the time had come to consult a
lobbyist to aggressively pursue licensure.

Through the

years 2001 -2008, WVLs were lobbied to gain support and
bills for licensure were drafted and submitted.

Each year

bills were introduced, but died in the WV House or Senate.18
In 2009, Senate Bill 551: Athletic Trainers Registration
Act was introduced to state legislators to establish a
registration process for ATs in WV, but this bill also
died.20
According to email correspondence from Daniel Martin,
EdD, ATC, (November, 2009) at WV Wesleyan College in
Buckhannon, WV, the reasons that the bills repeatedly fail
are many.

WV is a poor state compared to most other states

in the nation.

The teachers employed by the WVDE and teach

in public schools in WV are among the lowest paid in the
country.

If WV adopted regulation of athletic training,

then a new state practice act would have to be developed
and WV P5112 would be obsolete.

State regulation in WV

would require the WVDE to re-write a state practice act
that would require BOC certified ATs to be hired and county
school boards would not have the option to employ state
certified ATs under WV P5112.

Most counties in WV would

53

have a difficult time financially creating a position for a
full-time BOC certified AT.21
Dr. Martin also stated that since the WVATA started
introducing bills for regulation of athletic training it
has always been met with opposition from a variety of other
professional associations, organizations, and groups.

The

APTA has shown the strongest opposition to athletic
training regulation in WV and has fought it each year.

The

American Chiropractic Association has also contested
athletic training regulation in WV on a regular basis.
Other groups that have at least once opposed legislation to
pass regulation of athletic training in WV are: WVDE,
Parent Teachers Association (PTA), WV Association of School
Administrators, Association of Principals and Association
of Athletic Directors.21
Other reasons cited by Dr. Martin that WV has not been
able to achieve regulation is that the WVATA membership and
funding is lacking; parent groups, principals and athletic
directors are not on board; the lack of appropriate public
education about the benefits of ATs; coaches that do not
see the purpose; WVLs that played sports, but do not see
the cost benefits.21
Most of these groups cite financial reasons for not
supporting regulation of athletic training.

However,

54

groups are also trying to protect professional territory.
Dr. Martin surprisingly reveals that one PT school in WV
includes several class sessions where the PT students are
taught that ATs, chiropractors and OTs are poorly educated
and PTs are better.

The PT students in this class are then

required to complete a research assignment to justify that
PTs are better.21
At the national level, 2009 brought the NATA and APTA
settling a fair practice lawsuit filed by the NATA in 2008.
The NATA argued the APTA frequently and inaccurately used
terms such as “non-qualified,” “unqualified,” “not
qualified,” describing ATs in letters advocating against
federal and state legislative and regulatory efforts
introduced by the NATA.

Both NATA and APTA agreed it is a

priority to protect the public from harm and to compete
ethically and honestly in the health care marketplace.21
Despite the opposition, licensure for ATs in WV is the
ultimate goal of the WVATA and NATA.

However, registration

is a realistic first step as proposed in 2009 and
reintroduced in 2010.

By NATA standards, registration is

less desirable than licensure, but would be a great
improvement in ensuring quality healthcare for student
athletes in WV public schools and open new opportunities

55

for athletic training to expand into other settings within
the state.

Perception of the BOC Certified Athletic Trainer

Athletic trainers have gone to great lengths to
improve their professional image as reputable allied health
care providers for athletes and the physically active.
Despite the public relations efforts by the NATA, it is
still a mystery to a majority of the public what exactly it
is that an AT does professionally.

The certified athletic

training credential (ATC) is not recognized like other
closely related allied health professions that indicate
title, license and/or certification.

Athletic trainers are

often left to answer the question, “What is it you do?”
There exists an obvious lack of understanding by the public
about an AT’s scope of practice despite the benefits of a
rigorous academic curriculum, national board certification,
in most states licensure, and stringent continuing
education requirements.

Secondary School Administrators and Legislators
Superintendents, principals, and athletic directors
make up the secondary school administrators (SSA) and these

56

individuals are responsible for the hiring of ATs within
secondary schools.

Therefore, it is vital that SSA’s have

accurate knowledge and positive perceptions because of
their potential to impact the growth of athletic training
in the secondary school setting.

Similarly, poor

perceptions combined with a lack of understanding of the
athletic training profession could lead to a lack of
professional development in the secondary school setting.
In 1987, Ray surveyed the superintendents in Michigan
about athletic injuries, ATs, and legal liability.

This is

believed to be the first research conducted investigating
any SSA’s knowledge or perception of the athletic training
profession.

The author found that 76% of superintendents

acknowledged ATs to be the people most qualified to prevent
and treat athletic injuries.22

The survey revealed that 65%

of superintendents are very concerned about legal liability
in their schools.22 However, when asked if a certified AT
was currently employed, 85% of the superintendents
answered, “no”.22 Ray concluded that superintendents have a
relatively realistic view of the job functions of a
certified AT, show concern for legal liability at schools,
but have an extremely inaccurate perception of the
importance of certification for ATs.22

57

A year later building from Ray’s previous work,
Pinciaro investigated Pennsylvania (PA) secondary school
athletic directors (AD) for their knowledge and attitudes
of the athletic training profession.

Pinciaro discovered

ADs in PA high schools had a practical perception of the
job functions of ATs and were very concerned about legal
liability issues.23 The researcher’s survey disclosed that
19.5% of PA school districts employ an AT.23 The research
completed by Pinciaro shows PA secondary school ADs have
similar knowledge and attitudes to those of Michigan school
superintendents.

Both professions are aware of the

benefits and skills that an AT provides, but overwhelmingly
the majority of schools do not employ one.23
In 2003, Gould and Deivert studied SSA’s that
included: superintendents, principals, and ADs in NATA
District Four (Indiana, Illinois, Michigan, Minnesota,
Ohio, and Wisconsin) regarding their knowledge and
perceptions of the athletic training profession.24 The
questionnaire answers for superintendents, principals, and
ADs combined show that 63% believe a “bachelor’s degree” is
the required education level to practice as a certified AT
and 59% feel a salary range of $25,000 - $34,999 is
required to employ a certified AT.24 Overwhelmingly, 93% of
SSA’s within District Four view an “athletic trainer” as

58

the most qualified person compared to a coach, physical
education teacher, school nurse, or other professional with
75% stating “athletic trainer” is the best title describing
the profession.24 In terms of legal liability, 72% responded
they are “very concerned” regarding the potential for
litigation at their school, but 48% predict that hiring a
certified AT would only “moderately reduce” liability.24
When asked if their school should hire a certified AT to
reduce legal liability, 45% answered “no”.24 55% reported
employing a certified AT either full or part-time.24
Individually in this study, ADs were the most familiar with
the functions of an AT.
The authors concluded that the salary offered by SSA’s
in District Four is too low and is a factor in the low
employment rate of certified ATs at these schools within
the district.24 It is also the opinions of the researchers
that SSA’s have accurate knowledge of the athletic training
profession, but have an inaccurate perception of the
worthiness certified ATs can provide.24
Felling, Kahanov, Lilienthal, and Schlicher examined
the knowledge possessed by California high school
principals and ADs regarding the professional role and
duties of the AT.

Over half (57%) employed an AT and a

majority of the respondents were familiar with the athletic

59

training profession.

However, more ADs “strongly” agreed

with statements explaining ATs’ capabilities and education
while principals tended to “moderately” agree or feel
neutral about the same statements.25 The authors found that
72% of ADs and 54% of principals from high schools that
employ an AT strongly agreed with statements describing
injury rehabilitation, while 54% of ADs and 37% of
principals agreed with statements concerning organization
and administration of athletic care.25 A majority of
individuals in these two SSA groups strongly agree that
athletic training is a misunderstood profession.25
These authors agree with previous research that
implies that even though California’s SSA’s have a
favorable opinion of ATs’ professional roles and
responsibilities, the profession is still misunderstood by
those in positions to hire certified athletic trainers.25
Due to the findings of this study, the authors suggest
including the AD in the hiring process because principals’
perceptions of the athletic training profession are not
accurate.25
The perception of Utah SSA regarding the need for, and
the willingness to hire ATs was studied by Knerr, Kaiser,
Myrer, and Fellingham.

This research included all

superintendents, principals, and ADs in the state.

The

60

majority of ADs, 90%, see the most need for ATs in schools
while superintendents, 37%, see the least need.26 Budget
limitations were listed as the single most important factor
for not hiring an AT.26 The administrators stated that
possessing a secondary or vocational teaching certificate
would most enhance the employment potential for an AT.26 The
authors suggest educating superintendents about athletic
training since they do the hiring and due to their
inaccurate knowledge of the professional role of ATs.26
The researcher was unable to find any previous studies
that researched or surveyed WVLs or legislators in any
state about their perception of athletic training.

Orthopedic Surgeons
Athletic trainers collaborate with and work under the
direction of physicians to optimize activity and
participation of patients.

Storch, Stevens, and Allen

completed a study to investigate the perceptions of
orthopedic surgeons in the Mid-Atlantic United States
regarding different health care providers and their
qualifications as physician extenders.

The study also

examined the factors that may affect orthopedic surgeons’
perceptions of ATs as physician extenders.

The authors

evaluated answers to 101 returned surveys that included

61

three different professions: nurse practitioners (NP-C),
physician assistants (PA-C), and ATs. The orthopedic
surgeons surveyed had the least accurate perception of NP-C
with a score of 72.0, a more accurate perception of ATs
that scored 78.6, and the most accurate perception of PA-C
with a score of 87.5.27 Orthopedic surgeons that served as a
team physician had a more accurate perception of ATs with a
mean score of 80.9 compared to those who have not been a
team physician had a mean score of 65.8.27 Given the
opportunity, the researchers found that 44% of the
orthopedic surgeons surveyed would hire an AT as a
physician extender.27 PA-Cs were ranked by 82% of the
surgeons as the most qualified physician extenders.28
A factor that affects an orthopedic surgeon’s decision
to hire an AT is reimbursement for the services.27 Many
physicians are still under the impression that services
performed by ATs could not be reimbursed.

Some major

insurance companies are now reimbursing ATs with the
establishment of regulatory codes for athletic training.27
The researchers concluded that as more physicians are
educated about AT reimbursement options, it is possible
that they may be more willing to hire ATs as physician
extenders.27

62

In a similar study, Bumgardner, Smith-Goodwin, and
Walker investigated 16 southwestern Ohio orthopedic
surgeons’ attitudes of rehabilitation skills of ATs.
Fourteen of the orthopedic surgeons had experience working
with ATs and the other two did not. The descriptive survey
was formatted from Domain four of the 2003 RDS that
includes: treatment, rehabilitation, and reconditioning.
The survey data revealed that orthopedic surgeons that had
prior experience with an AT had a more positive attitude of
their rehabilitative skills. Fourteen (88%) of the
orthopedic surgeons had very favorable attitudes toward
ATs, strongly agreeing that ATs are skilled in the
following areas:

therapeutic modalities, educating

athletes about treatment, and providing guidance or
counseling for athletes about treatment, rehab, and
reconditioning.28 Two (14%) orthopedic surgeons disagreed
that ATs were capable of reassessing injuries, could
formulate a rehabilitation protocol or effectively educate
athletes about rehabilitation.28 Similarly to Storch,
Stevens, and Allen’s findings, the authors concluded that
the more experience orthopedic surgeons had with an AT the
more positive attitude toward their rehabilitation skills.28

63

Emergency Medical Service (EMT) Directors
ATs must be confident in their ability to manage
sport-related emergencies.

Biddington, Popovich, Kupczyk,

and Roh surveyed 64 emergency medical services (EMS)
directors to find out their perception of how ATs manage
emergencies.

Sixty percent of EMS directors who had

preseason meetings with the AT had a significantly better
perception of the ATs ability to handle emergencies than
did the 40% of EMS directors who did not.29 The EMS
directors scored 4.0 or higher on 13 of 15 items on a 5
point Likert scale.29 The researchers concluded that EMS
directors believe ATs can manage most emergencies that can
arise during sporting activities, but a pre-season meeting
significantly improves the perceptions EMS directors have
toward ATs.29

Coaches
Mensch, Crews, and Mitchell explored the perspectives
of coaches toward the AT’s role in the high school setting.
The authors conducted a 12 question interview with 20
Indiana and Alabama high school basketball coaches. The
questions uncovered the following 3 things:

the coaches’

limited knowledge of the ATs background and qualifications;
the coaches’ expectations regarding ATs availability and

64

accessibility; and identifies communication as a
significant aspect of the coach-AT relationship.30
Half the coaches’ perceptions of his or her ATs
background and direct supervisor were inconsistent with the
factual information collected from the ATs.

Ten of the 20

coaches were not able to correctly identify the ATs direct
supervisor.30 Eight of these ten coaches stated they had “no
idea” who their AT’s direct supervisor is and two coaches
reported that they were the ATs direct supervisor.30 The
other ten coaches correctly identified their ATs direct
supervisor.30 Eleven of the 20 coaches did not know the ATC
credential or if their AT was BOC certified.30 Seventeen of
the 20 coaches were unaware of their ATs athletic training
professional experience or background.30
During the off-season, coaches’ expectations almost
unanimously were that the AT should simply be available to
give advice and to “compliment” what the coaches do.30
Most coaches’ expectations for the pre-season were
similar to those during the off-season.

The coaches

indicated a general sense of wanting availability of the
AT.31 The basketball coaches understood that many ATs still
may be working with fall sports and understood that the AT
cannot be in two places at once.30

65

Coaches were better able to communicate specific
duties for their AT during the season.

Specific pre-game

duties that were identified by coaches were centered on
three areas:

being available to tape, stretch, and take

care of any injuries prior to games.30 During games, coaches
wanted their ATs to sit on the bench and take care of
anything that might happen during the game.

However, the

authors feel after reviewing the interview data that
overwhelmingly the coaches only need their AT to be
“available.”30
Eleven coaches mentioned specific duties they wished
their AT would perform and the other nine coaches stated
there were no other duties they wished their AT would
perform beyond the services already provided.30 Examples of
duties some coaches would like from their AT are
implementing a weight-room conditioning program, nutrition
program, and consistent stretching routine; establishing a
coach’s clinic; and traveling to away games.30 Only one
coach out of the 11 coaches that wished for more from their
AT mentioned doing anything about getting it.30 One coach
responded he believed his AT was too “conservative and this
was bothersome”, but mentioned the AT had not been told
these feelings.30

66

All coaches interviewed were more than “satisfied”
with their AT with respect to their basketball programs and
13 coaches stated they were “very satisfied.”30 All 20
coaches said it was important to have a good professional
relationship with their AT.30
The researchers concluded that although all
participants valued good communication and that poor
communication appeared to limit ATs contributions to player
performance beyond simple availability.31 The authors added
that coaches must be educated by ATs to ensure they are
receiving qualified athletic training support.31

Athletes
The AT is often the first member of the health care
team with whom the athlete interacts.

Unruh, Unruh,

Moorman, and Seshadri randomly selected 20 Division I and
II athletic training programs in four time zone regions
across the United States.

The number of athletes that

agreed to participate was 325.

A 50 question survey was

used with a purpose of evaluating athletes’ satisfaction
with their ATs and athletic training services at their
institutions.31 The researchers found significant
differences in satisfaction scores between athletes in high
and low profile sports and between male and female

67

athletes.31 The authors concluded that female athletes and
athletes in high profile sports demonstrated greater
satisfaction with their ATs, but competition level did not
significantly influence satisfaction.31
In another study, Robbins and Rosenfeld assessed
athletes’ perceptions of social support provided by their
head coaches, assistant coaches, and ATs during
rehabilitation.

There were 35 male and female Division I

collegiate athletes from various sports that completed a
Social Support Survey (SSS).

The results indicated a

significant difference between the athletes’ satisfaction
and the impact on the athletes’ overall well being during
rehabilitation from the head coach, assistant coach, and
AT.32 The survey implied that ATs were perceived by these
athletes to provide more support than either the head
coaches or assistant coaches.32 Injured athletes perceived
their ATs’ “listening, task appreciation, task challenge,
and emotional challenge” support as more influential to
their well-being than support from their head or assistant
coaches.32 The authors concluded that results of this survey
confirm the positive effects of ATs’ social support on
injured athletes’ recovery efforts.32
A similar study by Bricker-Bone and Fry built on the
findings of Robbins and Rosenfeld that investigated whether

68

athletes’ perceptions of social support from their ATs were
related to their beliefs about the rehabilitation process.
Fifty-seven male and female athletes from a single Division
I institution participated in a SSS and Sports Injury
Rehabilitation Survey (SIRBS).

The survey results revealed

significant correlations between the SSS and the SIRBS
scales only for athletes who had sustained severe
injuries.33 The researchers concluded that when athletes
with severe injuries perceive that their ATs provide strong
social support, the athletes are more likely to believe in
their rehabilitation programs.33

General Public
Botto, Fuller, Hurlbert, and Botto examined the public
perception regarding roles and responsibilities of an
athletic healthcare professional.

Data was collected using

a 30 question descriptive survey based on the BOC RDS from
608 individuals at state parks located in the northeast
United States.
options:

Each survey question had the following

1 - AT, 2 - athletic therapist, 3 - both AT and

athletic therapist, 4 - neither AT or athletic therapist.
Data that supported ATs were:

develops strength, power and

endurance programs, provides emergency care, and develops
cardiovascular programs.34 Data that supported athletic

69

therapists were: evaluates orthopedic injuries, counsels
individuals through injury and refers, applies therapeutic
modalities, works under the direction of physician, applies
joint mobilizations, is recognized as a healthcare
professional by AMA, applies therapeutic massage, and fits
assisted devices.35 Data supporting both AT and athletic
therapist were:

applies bracing, taping, strapping, and

splinting, obtained a 4-year college degree, flexibility
training, teaches ergonomics and sport specific mechanics,
and public safety.34 Data supporting neither AT nor athletic
therapist were:

evaluating dermatological conditions and

education about medication.34 The authors concluded that the
data demonstrates the public’s misperception of the role
and responsibilities of an AT among athletic healthcare
professionals.34

Summary

Athletic trainers are health care professionals that
practice under the direction of a physician to optimize
activity and participation of the physically active in the
domains of:

prevention; clinical evaluation and diagnosis;

immediate care; treatment, rehabilitation, and
reconditioning; organization and administration; and

70

professional responsibility.9 Over the past century the
athletic training profession has evolved into a
sophisticated health care profession that is recognized by
the AMA.

The NATA, BOC, and CAATE have developed into

well-organized agencies that manage and advance the
profession.
Despite the efforts of the national, regional, and
state associations, state regulation of the practice is
still a concern in some states.

There are three states

that do not regulate athletic training with a purpose of
protecting both practitioner and patient.

West Virginia

has attempted to regulate athletic training with its own
state policy, but due to lack of funding and support has
failed to pass legislation to license ATs as it does other
closely related health care professionals.
The research on the perception of the athletic
training profession is revealing that a majority of the
population does not have an accurate view of what an AT’s
scope of practice entails.

Only those professionals that

work or have worked directly with an AT such as physicians
or AD’s seem to understand an AT’s education, professional
role, and capabilities.

The views of the general public

and other health care professionals have a direct impact on

71

continued growth and expansion beyond the traditional
setting for athletic trainers.
There are suggestions to try and improve the
perception of the profession.

One idea is changing the

nomenclature from AT to athletic therapist as the Canadians
refer to it.

The goal is to clarify the public’s

understanding that athletic training is a health care
profession and distance it from occupations with similar
names, but not recognized as health care professionals.

72

APPENDIX B
The Problem

73

Statement of the Problem
West Virginia is one of three states that do not have
any form of regulation over the practice of athletic
training.

The WVLs and WVSs seem to not fully understand

the professional role of BOC ATs due to lack of awareness
of an ATs professional role, scope of practice, and
educational background as defined by the BOC RDS.

WVLs and

WVSs are cutting financial corners at the potential safety
of student athletes by hiring state employees under WV
P5112 that are not trained to handle emergency situations
that can arise during the course of a sporting event.
Recently, the mismanagement of concussions or spinal cord
injuries that are unrecognized by individuals filling the
absence of an AT among high school students is of great
concern.

Many high schools in WV do not even have a WV

P5112 state certified AT.
The purpose of this study was to investigate the
perception that WVLs’ and WVSs’ have pertaining to the
athletic training profession.

Specifically, this paper

attempted to determine if WVLs and WVSs are aware of the
differences between a BOC certified AT and a WV state
certified AT hired under WV P5112 to fulfill the state
mandate that recommends that each high school sponsoring
football have a state certified AT.

Additionally, this

74

study will examine WVLs’ and WVSs’ knowledge of ATs’ scope
of practice, professional role, and employment settings.

Definition of Terms
The following terms have been defined to increase
overall understanding of the study:
1. Athletic training - Athletic training is practiced by
athletic trainers and collaboration 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.
2. Certified athletic trainer (AT) – are health care
professionals that practice athletic training and have
national certification through the Board of
Certification (BOC).
3. State certified athletic trainer – a person is not
certified by the Board of Certification (BOC) to
practice athletic training and who has registered his
or her certification with the office of the Secretary
of State in West Virginia in accordance with WV P5112.
4. National Athletic Trainers’ Association (NATA) - is
the professional membership association for certified

75

athletic trainers and others who support the athletic
training profession.
5. Board of Certification (BOC) - sets the standards for
the practice of athletic training. The BOC is the only
accredited certifying body for Athletic Trainers in
the US.
6. WV Policy 5112 (WV P5112) – the West Virginia state
practice act for athletic training.
7. Commission on Accreditation of Athletic Training
Education (CAATE) - is the agency responsible for the
accreditation of 350+ professional (entry-level)
athletic training educational programs.
8. Licensure – a form of state credentialing, established
by statute and intended to protect the public, that
regulates the practice of a trade or profession by
specifying who may practice and what duties they may
perform.35
9. Certification – a form of title protection,
established by state law or sponsored by professional
associations, designed to ensure that practitioners
have essential knowledge and skills sufficient to
protect the public.35

76

10. Registration – a type of state credentialing that
requires qualified members of a profession to register
with the state in order to practice.35
11. Exemption – a legislative mechanism used to release
members of one profession from the liability of
violating another profession’s practice act.35
12. No regulation – no credentialing by the state.35

Basic Assumptions
The following are basic assumptions associated with
this study:
1. All respondents answered the survey honestly on their
knowledge and perception of the athletic training
profession.
2. The survey questionnaire designed by the researcher
was a valid and reliable measure of the factors being
assessed.
3. All respondents have unequal knowledge of the athletic
training profession.
4. All respondents were given adequate time to complete
the questionnaire.
5. All respondents are elected legislators of the West
Virginia house/senate or superintendents overseeing
the secondary schools in their county.

77

Limitations of the Study
The study was limited by the following factors:
1. Data was limited to those WVLs and WVSs that chose to
respond.
2. Only questioning legislators and superintendents from
West Virginia and not other states.
3. The survey may have been completed by a staffer or
assistant to the WVLs and WVSs.
4. The respondents may have researched answers.
5. WVATA was educating WVLs to pass the Athletic Training
Registration Act.

Significance of the Study
This study attempted to reveal WVLs’ and WVSs’
knowledge of BOC ATs and state certified ATs hired under WV
P5112.

Very little research has been done disclosing the

knowledge and perceptions of WVLs and WVSs regarding the
athletic training profession.

The significance of the

study for ATs in WV was to improve the present position of
credentialing in WV and to make it known what those
individuals writing laws and hiring ATs in WV actually know
about AT’s educational requirements, scope of practice,
professional role, and employment settings.

78

In addition, the study attempted to build a foundation
for further investigation of lawmakers’ and SSAs’ opinions
of the profession.

It is important that these individuals

base their decisions on current facts and realize the
potential ATs possess as health care professionals for WV
student athletes.

79

APPENDIX C
Additional Methods

80

APPENDIX C1
WVDE Policy 5112

81

TITLE 126
PROCEDURAL RULE
BOARD OF EDUCATION

SERIES 118
Athletic Trainers in the Public Schools of West Virginia
(5112)

126-118-1.

General.

1.1. Scope. - The purpose of this athletic trainer policy
is to improve the health care of student athletes in the
public schools of West Virginia. This legislative rule
describes the role of athletic trainers and individuals
with limited football trainer authorization in the public
schools of West Virginia and provides for their licensure
and professional development.
1.2. Authority. - W.Va. Constitution, Article XII, §2; and
W.Va. Code §18-2-5.
1.3.

Filing Date. -

April 19, 2004.

1.4.

Effective Date. -

May 20, 2004.

1.5. Repeal of Former Rule. - This procedural rule amends
W.Va. 126CSR118, Athletic Trainers in the Public Schools of
West Virginia,” filed February 24, 1995 and effective March
27, 1995.
126-118-2.

General Rules.

2.1. Each county board of education shall employ an
athletic trainer(s) or an individual(s) with limited
football trainer authorization defined under section 3.4.
to serve during senior high school football practices and
games . High schools that do not have an athletic trainer
or an individual with limited athletic trainer
authorization may not participate in football practices and
games.
2.2. Each county board of education is encouraged to
employ an athletic trainer for middle and junior high
school football practices and games.

82

2.3. County superintendents are encouraged to assign an
athletic trainer to work with other school athletic
programs.
2.4. Athletic Trainers employed to serve in any public
school capacity must adhere to the certification
requirements set forth in this policy and Policy 5202,
Minimum Requirements for the Licensure of
Professional/Paraprofessional Personnel and Advanced Salary
Classifications (126CSR136).
126-118-3.
5202).

Licensure Governing Athletic Trainers (Policy

3.1. Athletic Trainer. The Professional Service
Certificate endorsed for athletic trainer stands alone,
shall not require other certificates as a prerequisite, and
must be renewed in accordance with renewal requirements for
professional certificates approved by the West Virginia
Department of Education (WVDE). Only an individual who
holds a bachelor's degree from an accredited institution of
higher education and has completed a state approved
athletic trainer program, (including the content test)
through an accredited institution of higher education shall
be eligible for the Professional Service Certificate
endorsed for athletic trainer.
3.2. Authorized Athletic Trainer. An Authorization
endorsed for athletic trainer may be issued to an
individual who holds certification through the National
Athletic Trainers Association Board of Certification
(NATABOC). The Authorization may be reissued annually upon
application to the WVDE Office of Professional Preparation
with documentation of valid NATABOC certification and the
recommendation of the superintendent of the employing
county.
3.3. Permit Athletic Trainer. A Permit for Full-Time
Employment endorsed for athletic trainer may be granted by
the WVDE to an individual who holds a minimum of a
bachelor's degree and has completed six (6) semester hours
of credit applicable to an approved athletic trainer
program. (See Policy 5202, Minimum Requirements for the
Licensure of Professional/Paraprofessional Personnel and
Advanced Salary Classifications (126CSR136) for information
regarding issuance and renewal of permits.) Individuals
with an Athletic Trainer permit must attend an athletic
trainer workshop/clinic sanctioned by the West Virginia

83

Secondary Schools Activities Commission (WVSSAC) on an
annual basis.
3.4. Limited Football Trainer Authorization. If an
athletic trainer can not be obtained, county boards of
education shall employ a licensed health care provider
which may include one of the following: physician,
registered nurse, licensed practical nurse, chiropractor,
physical therapist, occupational therapist, physicians
assistant, paramedic, emergency medical technician. To
qualify for limited football trainer authorization, county
boards of education must:
3.4.1. post the position of athletic trainer or individual
to receive limited football trainer authorization with a
closing date on or before May 1.
3.4.2. employ an athletic trainer. If an athletic trainer
cannot be employed, county boards of education shall select
a licensed health care provider to apply for limited
football trainer authorization.
3.4.3. require the individual(s) seeking limited football
trainer authorization to attend an athletic trainer
workshop/clinic sanctioned by the WVSSAC.
3.4.4. require the individual(s) seeking limited football
trainer authorization to complete and submit the
Application for Limited Football Trainer Authorization to
the WVDE Office of Professional Preparation by July 1.
§126-118- 4. Continuing Education Requirements.
4.1. The renewal, conversion, and permanent status of the
Professional Service Certificate will be in keeping with
continuing education guidelines approved by the West
Virginia Board of Education in conformity with the School
Laws of West Virginia related to the Professional
Certificate.
§126-118- 5.

Professional Development.

5.1 . Programs for the professional development of athletic
trainers shall comply with the program standards for
athletic trainers approved by the West Virginia Board of
Education. The issuance and renewal of certificates and the
review, approval, and monitoring of professional
development programs for athletic trainers shall be under
the jurisdiction of the West Virginia Board of Education
through the West Virginia Department of Education.

84

5.2. Any individual employed as an athletic trainer by a
county board of education on the basis of a professional
certificate, authorization or permit shall participate in
county and state approved continuing education programs
based on a Systematic Program of Continuing Education for
Public School Personnel in West Virginia. In the
development of county continuing education programs for
athletic trainers, consideration shall be given to
statewide needs assessment data related to the roles and
responsibilities of athletic trainers.
§126-118-6.

General Role Description.

6.1. Role of the Athletic Trainer and Authorized Athletic
Trainer. The athletic trainer possesses the essential
knowledge, skills, attitudes, and credentials necessary to
carry out the practices of prevention, evaluation, initial
care, and physical rehabilitation of injuries sustained by
students engaged in public school athletics. The athletic
trainer has responsibility for the development,
implementation, and management of the athletic training
program.
6.2.
Role of the Permit Athletic Trainer and Limited
Football Trainer Authorization. The duties of individuals
with limited football trainer authorization are limited to
evaluation, initial care, and referral of injuries
sustained by students engaged in public school athletics.
§126-118-7. Governing Principles.
7.1. An individual serving as an athletic trainer or
individuals with limited football trainer authorization may
not have simultaneous coaching responsibilities in the same
sport.
7.2. An athletic trainer or an individual with limited
football trainer authorization must be in attendance at all
senior high school football practices and games.
7.2.1. County superintendents may grant excuses from this
requirement for individual practices or games based on
illness, accident or unforeseen events.
7.2.2. When an athletic trainer or an individual with
limited football trainer authorization is not in attendance
because of an illness, accident or other unforeseen event,
the county superintendent must secure the attendance of
other persons with specialized health related training.

85

7.3. It is the responsibility of the athletic trainer or
individual with limited football trainer authorization to
determine whether or not an injured student athlete
participates in a game or practice.
§126-118-8.

Severability.

8.1. If any provision of this rule or the application
thereof to any person or circumstance is held invalid, such
invalidity shall not affect other provisions or
applications of this rule.

86

APPENDIX C2
Athletic Training Survey (ATS)

87
ATHLETIC TRAINING SURVEY
PART 1: DIRECTIONS: Please complete the demographic questions 1 through 10 by placing an (X) in the
appropriate space that best answers the question.
1.

Gender:

( ) Female

( ) Male

2.

Age: _________

3.

Which best describes your current position? (

4.

How many years have you been at your current position? ___________

5.

When in high school or college, did you participate in athletics?

(

)Yes

(

)No

6.

Did you sustain an injury while playing athletics?

(

)Yes

(

)No

7.

Do you have children of high school age or older?

(

)Yes

(

)No

8.

Do/did your children play high school athletics?

(

)Yes

(

)No

9.

Has your child sustained an injury participating in athletics?

(

)Yes

(

)No

10. Did you/your child utilize the services of an athletic trainer?

(

)Yes

(

)No

)County Superintendent (

)Senator (

)Delegate (

)Staffer

PART 2 DIRECTIONS: Please circle the number that corresponds with your perception of how strongly you disagree or agree with the
following questions regarding an athletic trainer’s scope of practice and professional role.
-------------------------------------------------------------------------------------------------------------------------------------------------------------1 – Strongly disagree 2 – Somewhat disagree 3 – No opinion
4 – Somewhat agree
5 – Strongly agree

Athletic trainers are qualified and have the ability to:
11. Educate patients about risks involved with participation in athletics

1

2

3

4

5

12. Recognize disqualifying medical conditions on a medical history form

1

2

3

4

5

13. Refer a patient to an appropriate medical specialist

1

2

3

4

5

14. Make custom protective devices like a finger splint

1

2

3

4

5

15. Identify safety hazards on a playing field like a divot or hole

1

2

3

4

5

16. Recognize the signs/symptoms of heat illness such as heat exhaustion

1

2

3

4

5

17. Instruct in the use of cardio-conditioning equipment like a treadmill

1

2

3

4

5

18. Recognize signs/symptoms of eating disorders

1

2

3

4

5

19. Tape an ankle

1

2

3

4

5

20. Take a medical history on a patient

1

2

3

4

5

Please continue to page 2

88
PART 2 Continued: DIRECTIONS: Please circle the number that corresponds with your perception of how strongly you disagree or
agree with the following questions regarding an athletic trainer’s scope of practice and professional role.
-------------------------------------------------------------------------------------------------------------------------------------------------------------1 – Strongly disagree 2 – Somewhat disagree 3 – No opinion
4 – Somewhat agree
5 – Strongly agree
Athletic trainers are qualified and have the ability to:
21. Diagnose a sprained ankle

1

2

3

4

5

22. Recognize the signs/symptoms of a concussion

1

2

3

4

5

23. Make return to play decisions

1

2

3

4

5

24. Perform joint tests to identify ligament laxity

1

2

3

4

5

25. Perform CPR

1

2

3

4

5

26. Use an automated external defibrillator (AED)

1

2

3

4

5

27. Apply a splint to a fractured limb

1

2

3

4

5

28. Immobilize suspected spinal cord injuries

1

2

3

4

5

29. Apply an ice bag to reduce swelling

1

2

3

4

5

30. Apply a heat pack to sore muscles

1

2

3

4

5

31. Use electrical stimulation to reduce pain in an ankle joint

1

2

3

4

5

32. Use thermal ultrasound on sore muscles

1

2

3

4

5

33. Perform a therapeutic massage

1

2

3

4

5

34. Administer therapeutic exercise

1

2

3

4

5

35. Apply knee braces

1

2

3

4

5

36. Develop treatment plans for an injured patient

1

2

3

4

5

37. Rehabilitate injuries

1

2

3

4

5

38. Develop an emergency action plan

1

2

3

4

5

39. Establish policies and procedures for the delivery of healthcare

1

2

3

4

5

40. Manage a healthcare facility

1

2

3

4

5

41. Be fluent in medical terminology

1

2

3

4

5

42. Adhere to medical records confidentiality standards

1

2

3

4

5

43. Demonstrate appropriate professional conduct

1

2

3

4

5

44. Get reimbursed by insurance companies for services

1

2

3

4

5

45. Reduce workers compensations claims in an industry setting

1

2

3

4

5

This concludes the survey. Please place it in the included pre-addressed, postage paid envelope and place it any United States
Postal Service mailbox or outgoing mail. Thank you for taking time to complete the survey.

89

APPENDIX C3
ATS Cover Letter

90
February 16, 2010

Dear (Senator, Delegate, or Superintendent):
My name is Jeremy Shepherd and I am currently a graduate student at
California University of Pennsylvania pursuing a master’s degree in
Athletic Training. Part of the graduate study curriculum is to fulfill
the thesis requirement through conducting research. I am conducting
survey research to collect opinions regarding the Athletic Training
profession. In particular, the survey will focus on the scope of
practice and professional role of the Athletic Trainer. It is my goal
to use this information to contribute to the continued professional
advancement of Athletic Training both nationally and in West Virginia.
As a native of West Virginia, I have chosen to poll all state senators,
delegates, and county school superintendents as my subjects because I
care about the safety and well-being of student-athletes in our state.
For this reason, you have been selected to participate in my study.
However, you do have the right to choose not to participate or
discontinue participation at any time without penalty and all data will
be discarded. The California University of Pennsylvania Institutional
Review Board has reviewed and approved my survey and is effective
02/02/2010 and expires 02/02/2011. I have included a pre-addressed,
postage paid envelope to return the survey to me at California
University of Pennsylvania by March 19th.
All surveys are anonymous and will be kept completely confidential at
all times. The survey results will be housed in my program director’s
locked filing cabinet in Hamer Hall 103 at California University of
Pennsylvania. Your informed consent will be assumed upon return of the
survey. The risk for participating in this study is minimal. I ask that
you please take the survey at your earliest convenience as it will take
approximately 15 minutes to complete.
If your schedule doesn’t allow
you time to complete the survey, please forward it to your staffer. If
you
have
any
questions,
please
feel
free
to
contact
me
at
she6039@calu.edu or 703-994-8433. My thesis advisor’s name is Dr. Linda
Meyer, EdD, ATC and she may be contacted via email at meyer@calu.edu.
Thank you in advance for taking the time to take part in my thesis
research. It is my hope that this study will add to the body of
knowledge for the profession of Athletic Training especially in our
great state of West Virginia. I greatly appreciate your time to
complete the survey.
Sincerely,

Jeremy Shepherd, ATC
Graduate Athletic Training Student

91

APPENDIX C4
Institutional Review Board

92
Proposal Number

Date Received

PROTOCOL for Research Involving
Human Subjects

Institutional Review Board (IRB) approval is required before beginning any research and/or
data collection involving human subjects

(Reference IRB Policies and Procedures for clarification)

Project Title West Virginia Legislators and Superintendents Perception of the Athletic Training Profession
Researcher/Project Director

Jeremy Shepherd

Phone # 703-994-8433

E-mail Address she6039@calu.edu

Faculty Sponsor (if required) Dr. Linda Meyer
Department Health Science
Project Dates January 2010 to December 2010
Sponsoring Agent (if applicable)
Project to be Conducted at
Project Purpose:

California University of Pennsylvania

Thesis

Research

Class Project

Keep a copy of this form for your records.

Other

93
Please attach a typed, detailed summary of your project AND complete items 2 through 6.
1.

Provide an overview of your project-proposal describing what you plan to do and how you will go
about doing it. Include any hypothesis(ses)or research questions that might be involved and explain
how the information you gather will be analyzed. For a complete list of what should be included in
your summary, please refer to Appendix B of the IRB Policies and Procedures Manual.
The purpose of this study is to examine the perceptions of West Virginia state legislators and county
school superintendents regarding the athletic training profession. The goal is to provide the West
Virginia Athletic Trainers’ Association (WVATA) and National Athletic Trainers’ Association
(NATA) with information that can be used to assist them in pursuing state regulation of athletic
training in West Virginia.
A descriptive research design will be used in conjunction with a survey to conduct this study. To
establish reliability the researcher will conduct a pilot study that will be distributed to a total of 15
Pennsylvania state legislators and 15 Pennsylvania school district superintendents. This is not a true
experimental design as no variables are being manipulated. The survey was designed by the researcher
and will be distributed to West Virginia state legislators and West Virginia county school
superintendents. The legislators and superintendents will be asked questions related to the athletic
training profession to gain insight about both groups' perception and knowledge of athletic training.
The questionaire will end by asking the legislator and superintendent demographic questions. The
researcher will mail the survey via United States Postal Service to all 134 West Virginia state
legislators and to all 55 West Virginia county school superintendents. Included with the survey will be
a cover letter that will introduce the researcher, explain the study, and discuss the significance behind
the study. Implied consent by the legislators and superintendents will be implied through their
anonymous return of the survey and this will be stated in the cover letter. The legislators and
superintendents will return the survey answer sheet in a postage paid, pre-addressed envelope via the
United States Postal Service to the researcher at California University of Pennsylvania. Survey answer
sheets that are returned will be coded using identification numbers by the researcher so confidentiality
is maintained.
A T-test will be used to compare the answers given by the legislators to those of the superintendents.
After the data is gathered the researcher will analyze it using SPSS version 17.0.
The following are the hypotheses that will be examined by this study:
1. West Virginia legislators’ perception of the athletic training profession is not accurate relative to the
certified athletic trainer’s scope of practice as defined by the six domains in the Role Delineation.
2. West Virginia county school superintendents will have a more accurate perception of the scope of
practice of a certified athletic trainer as defined by the six domains in the Role Delineation.

94
2.

Section 46.11 of the Federal Regulations state that research proposals involving human subjects must
satisfy certain requirements before the IRB can grant approval. You should describe in detail how the
following requirements will be satisfied. Be sure to address each area separately.
a.

How will you insure that any risks to subjects are minimized? If there are potential risks,
describe what will be done to minimize these risks. If there are risks, describe why the risks
to participants are reasonable in relation to the anticipated benefits.
There are no risks involved to subjects participating in a survey. All subject's answers will be
kept confidential. No research is going to be carried out before the research gains approval
from the IRB.

b.

How will you insure that the selection of subjects is equitable? Take into account your
purpose(s). Be sure you address research problems involving vulnerable populations such as
children, prisoners, pregnant women, mentally disabled persons, and economically or
educationally disadvantaged persons. If this is an in-class project describe how you will
minimize the possibility that students will feel coerced.
The selection of subjects will be all 134 West Virginia legislators and all 55 county school
superintendents.

c.

How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately documented?
Be sure to attach a copy of your consent form to the project summary.
The cover letter that will be attached to the survey will state that subjects have the right to
choose not to participate in the study. Therefore, informed consent is implied upon
completing and returning the survey to the researcher.

d.

Show that the research plan makes provisions to monitor the data collected to insure the
safety of all subjects. This includes the privacy of subjects’ responses and provisions for
maintaining the security and confidentiality of the data.
The information of the participants will be kept confidential as neither their name or contact
information will be attached to their answers. The only individuals that will have access to the
data will be the researcher and the researcher's advisor.

3.

4.

Check the appropriate box(es) that describe the subjects you plan to use.

Adult volunteers

Mentally Disabled People

CAL University Students

Economically Disadvantaged People

Other Students

Educationally Disadvantaged People

Prisoners

Fetuses or fetal material

Pregnant Women

Children Under 18

Physically Handicapped People

Neonates

Is remuneration involved in your project?

Yes or

No. If yes, Explain here.

95
5.

Is this project part of a grant?

Yes or

No

If yes, provide the following information:

Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.

Does your project involve the debriefing of those who participated?

Yes or

No

If Yes, explain the debriefing process here.
7.

If your project involves a questionnaire interview, ensure that it meets the requirements of Appendix
in the Policies and Procedures Manual.

96
Project Director’s Certification
Program Involving HUMAN SUBJECTS

The proposed investigation involves the use of human subjects and I am submitting the complete
application form and project description to the Institutional Review Board for Research Involving Human
Subjects.

I understand that Institutional Review Board (IRB) approval is required before beginning any research
and/or data collection involving human subjects. If the Board grants approval of this application, I agree
to:

1.
2.
3.
4.
5.
6.

Abide by any conditions or changes in the project required by the Board.
Report to the Board any change in the research plan that affects the method of using human
subjects before such change is instituted.
Report to the Board any problems that arise in connection with the use of human subjects.
Seek advice of the Board whenever I believe such advice is necessary or would be helpful.
Secure the informed, written consent of all human subjects participating in the project.
Cooperate with the Board in its effort to provide a continuing review after investigations have
been initiated.

I have reviewed the Federal and State regulations concerning the use of human subjects in research and
training programs and the guidelines. I agree to abide by the regulations and guidelines aforementioned
and will adhere to policies and procedures described in my application. I understand that changes to the
research must be approved by the IRB before they are implemented.
Professional Research

Project Director’s Signature

Department Chairperson’s Signature

Student or Class Research

Student Researcher’s Signature

Supervising Faculty Member’s Signature if
required

Department Chairperson’s Signature

97

ACTION OF REVIEW BOARD (IRB use only)
The Institutional Review Board for Research Involving Human Subjects has reviewed this application to
ascertain whether or not the proposed project:
1.
2.
3.
4.
5.

provides adequate safeguards of the rights and welfare of human subjects involved in the
investigations;
uses appropriate methods to obtain informed, written consent;
indicates that the potential benefits of the investigation substantially outweigh the risk involved.
provides adequate debriefing of human participants.
provides adequate follow-up services to participants who may have incurred physical, mental, or
emotional harm.

Approved[_________________________________]

Disapproved

___________________________________________

_________________________

Chairperson, Institutional Review Board

Date

98
February 2, 2010
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Mr. Shepherd,
Please consider this email as official notification that your proposal titled “West Virginia Legislators’ an
Superintendents’ perception of Athletic Training” (Proposal #09-053) has been approved by the
California University of Pennsylvania Institutional Review Board with the following stipulation:
The phrase “…choose not to participate” must be followed by “ or discontinue participation at any time
without penalty and all data will be discarded.”
Once you have made this change, you may immediately begin data collection. You do not need to wait
for further IRB approval. [At your earliest convenience, you must forward a copy including your changes
for the Board’s records].
The effective date of the approval is 2-2-2010 and the expiration date is 2-2-2011. These dates must
appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly regarding any of the following:
(1) Any additions or changes in procedures you might wish for your study (additions or changes
must be approved by the IRB before they are implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated by any events
reported in (2).
(4) To continue your research beyond the approval expiration date of 2-2-11 you must file
additional information to be considered for continuing review. Please contact
instreviewboard@cup.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

99
Certificate of Completion
The National Institutes of Health (NIH) Office of Extramural Research certifies that Jeremy Shepherd
successfully completed the NIH Web-based training course “Protecting Human Research Participants”.
Date of completion: 06/15/2009
Certification Number: 245194

100

APPENDIX C5
WV H.B. 3152
Athletic Training Registration Act

101

H. B. 3152
(By Delegates Caputo, Ashley, White, Kominar and Campbell)
[Introduced January 13, 2010; referred to the Committee on Government Organization
then the Judiciary.]
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new
article, designated §5-30-1, §5-30-2, §5-30-3, §5-30-4 and §5-30-5, all relating to
establishment of the Athletic Trainers Registration Act; providing for registration of
athletic trainers with the Secretary of State; defining athletic training and athletic trainer;
establishing the Secretary of State as agent for service of process purposes; authorizing
the Secretary of State to issue subpoenas and subpoenas ducem tecum; prohibiting the
advertisement or representation as an athletic trainer unless registered; providing
registration and renewal requirements; providing for denial, revocation, suspension or
refusal to renew registration or renewal; and allowing the Secretary of State to establish
registration and renewal fees
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §5-30-1, §5-30-2, §5-30-3, §5-30-4 and §530-5, all to read as follows:
ARTICLE 30. ATHLETIC TRAINERS.
§5-30-1. Short title.
This article may be cited as the Athletic Trainers Registration Act.
§5-30-2. Definitions.
In this article:
(a) "Athletic training" means the practice of prevention, assessment, management
rehabilitation, and reconditioning of emergency, acute, and chronic medical conditions
involving impairment, functional limitations and disabilities.
(b) "Athletic trainer" means a person who is certified by the National Athletic Trainers'
Association Board of Certification to practice athletic training and who has registered his
or her certification with the office of the Secretary of State.

102

§5-30-3. Service of process; subpoenas.
(a) By acting as an athletic trainer in this state, a nonresident individual appoints the
Secretary of State as the individual's agent for service of process in any civil action in this
state related to the individual's acting as an athletic trainer in this state.
(b) The Secretary of State may issue subpoenas or subpoenas duces tecum for any
material that is relevant to the administration
of this article.
§5-30-4. Athletic trainers; registration required.
An individual may not advertise or represent himself or herself as an athletic trainer in
this state and may not use the initials "AT," or the words "registered athletic trainer,"
"athletic trainer" or any other words, abbreviations, titles or insignia which indicate,
imply or represent that the person is an athletic trainer, unless he or she is certified by the
National Athletic Trainers' Association Board of Certification to practice athletic training
and has registered his or her certification with the office of the Secretary of State.
§5-30-5. Registration and renewal requirements; denial, revocation and suspension;
fees.
(a) An applicant for registration shall submit a current certification from the National
Athletic Trainers' Association Board of Certification to practice athletic training in a form
prescribed by the Secretary of State. An application filed under this section is a public
record. The application must be in the name of an individual and signed by the applicant
and state that the applicant has not been:
(1) Guilty of fraud in practice of athletic training, or fraud or deceit in the individual's
application for registration;
(2) Engaged in practice under false or assumed name, or impersonating another
practitioner of a like or different name;
(3) Addicted to the habitual use of drugs, alcohol or stimulants to an extent as to
incapacitate that person's performance of professional duties;
(4) Guilty of fraudulent, false, misleading or deceptive advertising or for prescribing
medicines or drugs, or practicing any licensed profession without legal authority;
(5) Grossly negligent in the practice of athletic training;
(6) Practicing athletic training with a license or other authorization to practice from
another state or jurisdiction that has been canceled, revoked, suspended or otherwise
restricted;
(7) Incapacitated by a physical or mental disability which is determined by a physician to
render further practice by the applicant inconsistent with competency and ethic
requirements; or
(8) Convicted of sexual abuse or sexual misconduct.
(b) The Secretary of State may deny an application for registration if any of the
statements set forth in subdivisions (1) through (8) of subsection (a) of this section are
answered in the positive. In making the determination to deny an application for
registration, the Secretary of State may consider:
(1) How recently the conduct occurred;
(2) The nature of the conduct and the context in which it occurred; and

103

(3) Any other relevant conduct of the applicant.
(c) An athletic trainer may apply to renew a registration by submitting an application for
renewal in a form prescribed by the Secretary of State. An application for renewal filed
under this section is a public record. The application for renewal must be signed by the
applicant and must contain current information on all matters required in an original
registration.
(d) A registration or a renewal of a registration is valid for two years.
(e) The Secretary of State may suspend, revoke or refuse to renew a registration for
conduct that would have justified denial of the original registration under this section,
only after proper notice and an opportunity for a hearing in accordance with the
provisions of article five, chapter twenty-nine-a of this code.
(f) The Secretary of State may establish registration and renewal fees in an amount
sufficient to defray the administrative costs of registration.

NOTE: The purpose of this bill is to establish a registration process for certified athletic
trainers.
Strike-throughs indicate language that would be stricken from the present law, and
underscoring indicates new language that would be added.

104

REFERENCES
1. Wilkerson GB. A Vision for the Future of the Athletic
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ABSTRACT
TITLE:

West Virginia Legislators’ and
Superintendents’ Perception of Athletic
Training

RESEARCHER:

Jeremy Shepherd

ADVISOR:

Dr. Linda Meyer

DATE:

April 2010

RESEARCH
TYPE:

Masters Thesis

PURPOSE:

The purpose of this study was to survey
the West Virginia (WV) state
legislators (WVL) and WV county school
superintendents (WVS) to collect their
perceptions and knowledge of a
certified athletic trainer’s (AT) scope
of practice and professional role.

PROBLEM:

WV is one of three states that do not
have any form of regulation over the
practice of athletic training. The
WVLs and WVSs seem to not fully
understand the professional role and
value of ATs due to a lack of awareness
of an AT’s professional role and scope
of practice as defined by the six
Domains in the Board of Certification
Role Delineation Study fifth edition.

METHOD:

A descriptive type design was used for
this study. The Athletic Training
Survey was the instrument used.
Subjects were 189 WVLs and WVSs.

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FINDINGS:

No significant difference was found (t77
= .589, P > .05). The mean of the WVSs
146.9 ± 14.9 was not significantly
different from the mean of the WVLs
143.9 ± 16.1.

CONCLUSION:

WVSs and WVLs possess accurate
knowledge of the athletic training
profession for Domains I - IV, but have
an inaccurate perception for Domains V
and VI.