Dr. Stephany Coakley serves as the Sr. Associate AD for Mental Health, Wellness and Performance at Temple University. A certified mental performance consultant and licensed professional counselor with a doctorate in exercise and sport science with a concentration in sports psychology, Dr. Coakley became the first full-time mental health specialist with the Temple University Department of Athletics in 2017. She is also the author of Tye the Dreamer, a story about a daddy’s girl who has a big heart and bigger dreams.
Sr. Associate AD for Mental Health, Wellness, and Performance
As a two-time graduate from Temple University, the opportunity to serve as the Senior Associate Athletic Director for Mental Health, Wellness and Performance is an honor. Serving in that role while establishing a mental health and wellness program at Temple has given me the chance to give back to the institution that was instrumental in nurturing and developing me into the clinician and person I am today.
Years before accepting the role, I meditated on and designed a program that I would implement when given the opportunity. Creating a mental health and wellness program was not an easy feat. It was, however, the challenge I was looking for.
TUWell
After reading (more like devouring) the Mental Health Best Practices document from the NCAA, I knew I had to lay the foundation for the program by ensuring that we used the best practices at Temple.
Getting the word out and engaging with as many student-athletes and coaches was of the utmost importance. As many of you know, there is a stigma attached to seeking mental health care, especially in athletics, so reducing stigma through education and mental health literacy was essential for the program’s success.
I named the mental health, wellness, and performance department “TUWell” to emphasize a strength-based service model that emphasizes wellness. Our mission is to:
Provide confidential, prevention and wellness services across the student-athlete Continuum of Wellness. We aim to be proactive and efficient when intervention is necessary. We strive to create an environment where we prioritize psychological safety, as we provide exceptional and compassionate care, prevent and treat conditions that affect the brain, and enhance the overall well-being of Temple Athletics.
If you build it, they will come. (But how?)
Our program is a brief, solution focused service that supports student-athletes through their mental health challenges with the goal to return to a thriving and resilient student-athlete.
The foundational element for the program was a streamlined referral system. It was a priority to create a referral system that ensured accessibility, confidentiality, and accountability. We established our cornerstone referral policy, which was anyone in the department can refer anyone in the department. When a referral is submitted, the individual referred is contacted within 24 – 48 hours, and an intake and assessment is scheduled within the week. During intake and assessment, TUWell clinicians gain an understanding of the individual’s background and current factors affecting their mental health, then create a plan for ongoing services.
Engaging the Athletics Department
I was a Temple student during the days of John Chaney, Peter Liacouras, Tina Sloan Green, Dr. Nikki Franke, Mark Macon, Aaron McKie, and Eddie Jones just to name a few. While I had great institutional knowledge, when I accepted the role, I did not know any of the current staff, coaches, or student-athletes.
When I arrived, I scheduled meetings with all head coaches and key athletic department personnel to introduce myself, conduct a needs assessment by asking tons of questions, and provide them with details about the comprehensive mental health and wellness service I was creating. These conversations provided vital insight while building the infrastructure. It was necessary for coaches and administrators to feel connected and have access to me if they had questions or concerns.
A few months after meeting with everyone, we implemented Wellness in Sport and Education (WISE) sessions for coaches and administrators. The WISE sessions are opportunities for coaches and administrators to learn about a variety of mental health conditions, develop tools to effectively coach student-athletes experiencing mental health conditions, and most importantly empower coaches to intervene by referring or bringing student-athletes needing care to TUWell.
For the first three years, coaches and administrators participated in annual Question Persuade Refer (QPR) Training. This training teaches them how to effectively respond if a student-athlete is experiencing suicidal ideation or is actively suicidal. In 2022, QPR training became mandatory for all coaches and administrators.
TUWell quickly implemented Best Practice 2 from the NCAA Mental Health Best Practices document, which was to develop procedures for pre-participation mental health screening prior to participation in collegiate athletics. Pre-performance wellness screenings are conducted annually before student-athletes begin athletic related activities.
Initially, we developed a pre-participation mental health screener based on criteria from the NCAA document. We eventually updated our pre-participation wellness screener to a valid and reliable measure, the DSM-5 Level 1 Cross-Cutting Symptom Measure. This measure is a 23-item self-rated measure that assesses mental health across 13 psychiatric domains. These domains include depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning and substance abuse.
TUWell is an ever-evolving program and we always look for better ways to serve our student-athletes. We currently use the Sport Mental Health Assessment Tool (SMHAT) a sport-related measure for pre-participation mental health screening. Using these measures increases our ability to accurately identify thresholds of clinical (red), subclinical (yellow), and non-clinical (green) levels of wellness.
Student-athletes assessed in the clinical range are invited to meet with a TUWell clinician for further evaluation and treatment. Student athletes identified as subclinical are provided with additional resources to learn more about specific symptoms that increase the risk for clinical mental health concerns. All data is secured and used as a baseline if a student-athlete is referred to TUWell services at a later date.
Increased utilization, and the integrated health model that is a core component of TUWell, highlighted a need to expand. In 2018, TUWell added a second full-time clinician and a consultant sport psychiatrist to the team. The expansion not only allowed more student-athletes access to mental health services, but we also started psycho-educational groups, team mental skills training, and weekend on-call services. Monthly psychiatric clinics for student athletes who require psychiatric evaluation, and ongoing medication management rounded out our services in the early years.
Diverse Student-Athlete Population
Providing support for all student-athletes at Temple University is of the utmost importance. Our student-athlete population is very diverse, with students from 37 states and 39 countries. Diversity, equity, and inclusion are essential to the services we provide. As pointed out in the article, Addressing mental health needs of NCAA student-athletes of colour: foundational concepts from the NCAA Summit on Diverse Student-Athlete Mental Health and Well-Being, BIPOC and LGPTQIA+ student-athletes are at greater risk for poor mental-health. BIPOC student-athletes prefer a clinician of the same race or one who has experience working with diverse populations. To reduce barriers to seeking services, the TUWell referral asks if they have preferences in their clinician.
When able to connect a student-athlete with a clinician who they are comfortable with, it is a facilitator for positive mental health outcomes. We are not always able to meet this need and a referral to one of our preferred providers may be warranted.
Emergency Services
While no one wants a crisis, we understand that they will happen. An Emergency Action Plan was developed and has been refined throughout the years to respond when a student-athlete is in acute emotional distress.
At TUWell, clinicians are available to handle emergencies such as threats of suicide and suicidal ideation, physical and sexual assault, sudden loss of life, and other types of crises. A collaboration of TUWell clinicians, other athletic department staff, and university personnel ensure that the student-athlete is safe. Our clinicians assess and triage to help determine the appropriate level of care for the student-athlete.
Every weekend during the academic year, a TUWell clinician is on-call from 5:00 pm on Friday until 9:00 am on Monday. Each clinician and student intern are scheduled for weekend on-call service, on a rotating basis. When a student-athlete is involved in a crisis, regardless of the time, TUWell has an emergency action plan with protocols for care to ensure they receive the care and treatment needed.
Digital Offerings
Although our mental health services were working seamlessly, it was time to boost our wellness options for student-athletes who were not receiving mental health services but needed resources and education to prioritize their mental well-being. To scale our offerings, we began to explore the behavioral health technology space. My thinking was that digital applications could be used to help student-athletes develop internal resources such as mindfulness, self-awareness, self-regulation, and optimism.
After many promising demos with start-ups and enterprise companies, we entered into an agreement with Headspace. Headspace is a meditation app, and meditation has been credited with reducing stress levels, increasing focus and productivity, and improving sleep. In my experience working with student-athletes, these are areas that many struggle with. The app includes over 1200 hours of content and is available 24 hours a day and seven days a week. Both coaches and student-athletes have access to it.
The agreement with Headspace proved to be more valuable than I initially thought because about six months after implementing it into the program, we faced a global pandemic that amplified and exposed mental health struggles worldwide, and racial injustice and racial trauma nationally. When the pandemic occurred Temple student-athletes had a resource to help manage some of the stress, anxiety, grief, loss, isolation, and fear they faced. This coupled with immediate access to telehealth services proved to be very beneficial.
Since the Headspace implementation, we have incorporated measurement-based care, biofeedback (for performance), and a wellness platform where student-athletes can go if they have questions about mental health conditions, symptoms, treatment, wellness topics, and mental performance skills and techniques. This is all in addition to the mental health resources provided by the university.
The use of social media channels has proven to be another proactive and successful resource for student-athlete wellness. @TUOwlswellness is how we distribute mental wellness education to our followers (1,230). Each week there is a Monday motivation post, a wellness Wednesday post, a post about our monthly theme on Thursday and a Friday safety post. With the help of student interns we have produced two video series, Minds Matter Most and Mental Health Mondays. Building our wellness services was not without failure as some of our attempts to provide digital resources failed due lack of utilization. TUWell is a data-driven service, and we use data to build or pivot when appropriate.
Additional Initiatives
Since our early days TUWell we have maintained a high standard of care for Temple student-athletes while evolving and being responsive to current trends in intercollegiate athletics and on our campus. Everything we do is intentional and with the student-athlete’s well-being at the forefront. Here are several additional initiatives implemented since our inception:
Walk-In Hours: If a student-athlete needs a place to process a real-time challenge that is impacting their mental health, they can walk-in (there is a daily schedule) and speak with a clinician about it.
Wellness Days: Each semester, teams schedule a wellness day for student-athletes. This is designed to give them an opportunity to prioritize their mental health. The wellness days are scheduled in collaboration with the head coach and based on the training and competition schedule.
Student-Athlete Mental Health Advocates: For the last three years, student-athletes have been galvanizing to form a robust group of mental health advocates who serve as support to their peers in seeking help when necessary. Student-athletes meet monthly to discuss a variety of mental health topics e.g. self-care, pressure to perform, disordered eating.
Men and Mental Health: Every year, during the month of November, we celebrate “Movember.” Movember is dedicated to bringing awareness to men’s health issues. Getting male-identified athletes, coaches and staff to talk about their mental health is achieved by hosting various events throughout the month, e.g. NBA Watch Party and halftime discussion about athletic identity and athletic foreclosure.
Staff and Student-Athlete Training: For several years we implemented mental health training for various athletic department units e.g. QPR. Student-athlete advocates engage in change talk and brief motivational interviewing. In 2023, with the full support of the Debbie and Stanley Lefkowitz ’65 Director of Athletics Arthur Johnson, the first department-wide Mental Health First Aid training took place with participation from 197 staff members. The Mental Health First Aid certification is valid for three years. In addition to Mental Health First Aid, staff members were also offered Narcan training and 25 participants have been trained to administer lifesaving Narcan to an overdose victim.
…They Will Come
In the first year of the TUWell program, we had 88 referrals for mental health services. In 2022–2023, there were 310 referrals for mental health, wellness, and performance services. This is truly a testament to the dedication of the TUWell Staff, Ed Darrah (former Director of Mental Health Counseling), Melissa Graham, Alyssa DeNofa, Dr. Alex Strauss, and the graduate clinical interns. It takes all of us.
TUWell continues to build capacity in services and resources for student-athletes. My purpose is to ensure that student-athletes have total access to compassionate mental health care, comprehensive wellness resources, and coaching for mental performance. Lastly, we have been fortunate to have both top-down support and bottom-up support which enables us to be responsive, innovative, and culturally competent.