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Time out for mental health: barriers and strategies for high school coaches

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Time out for mental health: barriers and strategies for high school coaches

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Time Out for Mental Health: Barriers and Strategies for High School Coaches
by
Edwin Yau

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

May 2021

© Copyright by Edwin Yau 2021
All Rights Reserved

The Committee for Edwin Yau certifies the approval of this Dissertation

David Cash
Briana Hinga
Rudy Castruita, Committee Chair

Rossier School of Education
University of Southern California
2021

iv

Abstract
Although almost half of all athletes experience a high prevalence of mental health disorders,
many do not seek help due to many barriers. Sports coaches play a significant role in addressing
and supporting mental health in their actions, but there is a paucity of literature on how coaches
promote mental health and implement strategies for their student athletes at the non-elite level.
This mixed-methods study had four overarching purposes based on the gaps in knowledge: how
high school varsity head coaches promote mental health, how they perceived barriers to mental
health for student athletes, how they are evaluated in their role of supporting mental health, and
how they implement positive mental health strategies following self-determination theory
strategies. A concurrent triangulation mixed-methods design was implemented utilizing a 17-
question close-ended survey and 11-question open-ended, semi-structured qualitative interview.
A total of 32 surveys and seven interviews were conducted with high school varsity head
coaches in Los Angeles from the CIF-LA Section. Findings included the following: (a) coaches
promote mental health for their players mainly by creating a safe environment and by talking to
their players; (b) coaches need to provide more mental health referrals; (c) barriers to mental
health for student athletes include stigma, lack of mental health literacy training for coaches, and
young people not going to professionals; and (d) high school varsity head coaches are not
currently evaluated to support mental health. This study also provides examples of how some
coaches are utilizing the self-determination theories of autonomy, relatedness, and competence to
support positive mental health for their players.

v

Dedication
To my wife, Richelle, I thank God for such a strong and loving partner. You’re the best for our
family, and I keep falling in love with you every day.

To my dear Nia pie, Baba loves watching you grow into your vocal and curious personality. I
pray you will take care of and advocate for those around you.

To my Mom and Dad, thank you for always giving your best to Joyce and me. You always told
me you were proud of me, and that has made the difference.

vi

Acknowledgements
I would like to thank my dissertation committee members, Dr. Cash, Dr. Castruita, and
Dr. Hinga. I truly appreciate your mentorship and am humbled by your support throughout my
journey as an educational leader.
I would like to acknowledge all the coaches who participated in this study. Your tireless
work with young people is truly remarkable.
In addition, I would like to thank my players who have put up with me as coach. Thank
you for being patient with me as I learned on the job.
Lastly, I would like to thank my fellow USC cohort classmates. Thank you for being my
friends and dragging me along. Let’s empower the future.

vii

Table of Contents
Abstract .......................................................................................................................................... iv
Dedication ....................................................................................................................................... v
Acknowledgements ........................................................................................................................ vi
List of Tables .................................................................................................................................. x
List of Figures ............................................................................................................................... xii
Chapter One: Overview of the Study .............................................................................................. 1
Prevalence of Mental Health Disorders Among Athletes ................................................... 1
Barriers to Mental Health for Young People ...................................................................... 2
Mental Health as an Equity Issue........................................................................................ 3
The Coach as an Advocate for Mental Health .................................................................... 3
Statement of the Problem .................................................................................................... 4
Purpose of the Study ........................................................................................................... 5
Research Questions ............................................................................................................. 5
Procedures ........................................................................................................................... 5
Significance of the Study .................................................................................................... 6
Definitions of Terms ........................................................................................................... 6
Organization of the Study ................................................................................................... 8
Chapter Two: Review of the Literature .......................................................................................... 9
History of Mental Health .................................................................................................... 9
Gender Considerations ...................................................................................................... 11
Barriers to and Facilitators of Mental Health ................................................................... 12
Role of Mental Health Providers in Schools..................................................................... 13

viii

The Coach and Mental Health .......................................................................................... 14
Coaches’ Perceptions of Mental Health ............................................................................ 14
Best Practices for Mental Health Training........................................................................ 15
Self-Determination Theory ............................................................................................... 17
Conclusion ........................................................................................................................ 22
Chapter Three: Methodology ........................................................................................................ 23
Research Questions ........................................................................................................... 24
Research Methodology ..................................................................................................... 24
Population and Sample Selection...................................................................................... 27
Instrumentation and Sources of Data ................................................................................ 28
Data Collection ................................................................................................................. 30
Data Analysis .................................................................................................................... 31
Validity and Reliability ..................................................................................................... 32
Summary ........................................................................................................................... 32
Chapter Four: Findings ................................................................................................................. 33
Participants ........................................................................................................................ 33
Results for Research Question 1 ....................................................................................... 37
Results for Research Question 2 ....................................................................................... 47
Results for Research Question 3 ....................................................................................... 57
Results for Research Question 4 ....................................................................................... 59
Summary ........................................................................................................................... 75
Chapter Five: Discussion .............................................................................................................. 78
Purpose of the Study ......................................................................................................... 78

ix

Research Questions ........................................................................................................... 79
Methodology ..................................................................................................................... 79
Findings............................................................................................................................. 80
Implications for Practice ................................................................................................... 85
Limitations ........................................................................................................................ 87
Recommendations for Future Research ............................................................................ 88
Conclusions ....................................................................................................................... 89
References ..................................................................................................................................... 90
Appendix A: Research Participant Introduction Email .............................................................. 107
Appendix B: Participant Informed Consent Form ...................................................................... 108
Appendix C: Survey Questionnaire ............................................................................................ 110
Appendix D: Interview Protocol ................................................................................................. 116
Appendix E: Question Alignment Matrix ................................................................................... 118
Appendix F: Coaches’ Survey Responses to Perceived Barriers Question ................................ 119
Appendix G: Coaches’ Survey Responses to SDT Strategies Question ..................................... 121

x

List of Tables
Table 1: Survey and Interview Inclusion Criteria of High School Varsity Head Coaches .................. 27
Table 2: Survey and Interview Participant Demographics of High School Varsity Head Coaches..... 34
Table 3: Gender of Survey Participants ............................................................................................... 34
Table 4: Ethnicity of Survey Participants ............................................................................................ 36
Table 5: Participants’ Gender, Age, Sport Coached, and Years of Experience ................................... 37
Table 6: Survey Responses to How Often Coaches Have Conversations About Mental Health
Wellness ........................................................................................................................................ 38
Table 7: Survey Responses to How Often Coaches Make Mental Health Referrals ........................... 43
Table 8: Survey Responses to the Coaches’ Perceptions of How Important Their Role Is in
Supporting Players’ Mental Health ............................................................................................... 45
Table 9: Survey Responses Regarding Coaches’ Perceptions of Barriers of Stigma for Athletes and
Coaches ......................................................................................................................................... 48
Table 10: Survey Responses to Coach Receiving Adequate Mental Health Literacy Training .......... 50
Table 11: Survey Responses to Perceived Barriers of Coaches Not Being Able to Identify Signs of
Mental Health Concerns ............................................................................................................... 51
Table 12: Survey Responses to Coaches’ Training in Mental Health Topics ..................................... 52
Table 13: Survey Responses to Coaches Being Evaluated for Mental Health Support ....................... 58
Table 14: Survey Responses to Autonomy Strategies Part 1 ............................................................... 60
Table 15: Survey Responses to Autonomy Strategies Part 2 ............................................................... 61
Table 16: Survey Responses to Relatedness Strategies Part 1 ............................................................. 66
Table 17: Survey Responses to Relatedness Strategies Part 2 ............................................................. 66
Table 18: Survey Responses to Competence Strategies Part 1 ............................................................ 70

xi

Table 19: Survey Responses to Competence Strategies Part 2 ............................................................ 71
Table 20: Self-Determination Theory Strategies Implemented by Coaches Interviewed.................... 76

xii

List of Figures
Figure 1: Self-Determination Theory Adapted to a High School Varsity Sports Team ............... 18
Figure 2: Concurrent Triangulation Mixed Methods .................................................................... 26
Figure 3: Age of Survey Participants ............................................................................................ 36
Figure 4: Survey Responses to Coaches Receiving Mental Health Training ............................... 52

1

Chapter One: Overview of the Study
Although adolescent participation in sports has been positively linked with lowering
mental health symptoms, there is a dire need to address the mental health needs of adolescent
athletes (Donohue et al., 2015). Many young people experience mental health issues but do not
seek help on their own (Mazzer et al., 2012). As figures whom the players trust, sports coaches
play a pivotal role in supporting mental health in their actions (Castaldelli-Maia et al., 2019;
Goldberg, 1991; Mazzer et al., 2012).
Prevalence of Mental Health Disorders Among Athletes
Almost half (46.4%) of all athletes experience a high prevalence of mental health
disorders (Gulliver, Griffiths, & Christensen, 2012; Rice et al., 2016). Disorders described by
Gulliver, Griffiths, and Christensen (2012) include depression, eating disorders, general
psychological distress, social anxiety, and panic disorder. Researchers have connected these
mental health disorders to causes such as injury, overtraining and burnout, intense public and
media scrutiny, and managing ongoing competitive pressure (Rice et al., 2016). The athlete
population is especially vulnerable to mental illnesses that may be related to both sports and
other factors. Athletes who are facing injury or performance difficulties or approaching
retirement experience a greater risk of mental health disorders.
Furthermore, if an athlete improperly responds to the psychological stress, more serious
mental health issues, including depression, anxiety, eating disorders, and substance abuse, may
occur (Putukian, 2016). Among elite athletes, there is a prevalence of higher levels of hazardous
drinking as a way to cope with stress (O’Brien et al., 2007). Athletes also report patterns of
bingeing during noncompetitive periods or during vacation times (Rice et al., 2016). The
literature further alludes to the importance of preventing mental health disorders among athletes
2

through coping strategies and coach support (Goldberg, 1991; Mazzer et al., 2012; McGorry et
al., 2011). Among injured players, somatic anxiety and coping with adversity were the best
predictors of injury severity (Devantier, 2011). Outside of professional and collegiate sports,
there is a lack of mental health studies (Swann et al., 2018).
Barriers to Mental Health for Young People
The prevalence of mental health disorders is greater among young people than any other
stage of life (Sawyer et al., 2000). In fact, a recent study in the United States reported that half of
all diagnosed lifetime mental disorders start in adolescence (Kessler et al., 2005). Adolescents
experience a high level of mental disorders, but they do not seek help due to many barriers;
recent studies in Germany, Norway, and Australia indicated that 18%–34% of young people with
high levels of depression or anxiety seek help (Gulliver et al., 2015). Barriers to mental health
for young athletes include stigma, lack of mental health literacy, negative experiences while
seeking help in the past, and structural systems, such as schools and community supports, that
contribute to their view of mental health (Gulliver, Griffiths, & Christensen, 2012; Mazzer et al.,
2012; Rickwood et al., 2007).
For young athletes, the development of the individual is a prevalent factor, as athletes are
prone to chronic feelings of poor self-esteem. This often stems from formulating feelings based
on worrying about what people think of them (Goldberg, 1991). Additionally, young people
prefer friends and family over professionals for help (Gulliver et al., 2015). Although adolescents
have a great need for mental health intervention, they rarely seek mental health help on their own
(Gulliver, Griffiths, & Christensen, 2012; Moreland et al., 2018).
3

Mental Health as an Equity Issue
Literature often documents disparities in access to mental health support among
marginalized communities (Alves-Bradford et al., 2020). Ethnic minorities and communities in
lower socioeconomic circles face multiple barriers to accessing mental health and are less likely
to receive mental health services (Alegría et al., 2015; Alves-Bradford et al., 2020). Other social
determinants of health include economic stability, neighborhood environment, education, and
social contexts that may increase the risk of the onset of mental disorders in children (Alegría et
al., 2015). Covid-19 has further widened the mental health gap; affluent families with access to
resources are able to limit their exposure to disaster due to their improved ability to cope with
stressors (Purtle, 2012).
The Coach as an Advocate for Mental Health
The coach is perceived to be a chief advocate of mental health who partners with the
school counselor in addressing and preventing mental health disorders (Goldberg, 1991).
Moreover, Pierce et al.’s (2010) study of football clubs emphasizes the importance of
recognizing and including the coach as a promoter to increase mental health efforts. According
to Mazzer et al. (2012), young people usually seek help from only those they trust. Often, young
people seek out help from informal sources before going to professional help (Boldero & Fallon,
1995; Rickwood, 1995). In Mazzer et al.’s (2012) study in Australia, coaches and teachers
reported high levels of mental health concerns, including depression, suicidal ideation, and body
image, for the young people they worked with. The coaches recognized the impact of mental
health issues on participation and performance in sports and had a strong perception of the
importance of and need for supporting mental health.
4

In Pensgaard and Roberts’s (2002) study of elite Norwegian athletes, the seven
respondents emphasized the importance of the coach as the creator of the climate, as well as their
preference for a supportive and caring atmosphere. A coach’s ability to establish strong
relationships is perceived to be a major factor for opportunities to positively influence a young
person’s mental health by developing trust and support (Mazzer et al., 2012). A coach can
facilitate mental health referrals and play an overall important role in the wellness of the athletes,
but coaches can also be a block to athletes receiving treatment (Brown & Blanton, 2002).
Rickwood et al. (2005) emphasized the need for coaches and other adults who influence young
people to receive targeted interventions to support mental health.
Statement of the Problem
The coach plays a significant role in influencing high school athletes and promoting
mental health support, but there is a paucity of literature on how the coach supports mental
health referrals and factors that promote positive mental health (Bissett et al., 2020). Coaches
may not address mental health or make referrals to mental health services even when they know
the student athlete may need it. There is a need for mental health support for the adolescent-
athlete population and a need for the athletic coach to play a supporting role in the mental health
of athletes (Castaldelli-Maia et al., 2019). Coaches’ perceptions of how they could address and
support mental health in their language and practice have also been neglected. Gaps in the
knowledge and research include the need to (a) explore the occurrence of high school coaches
promoting mental health through making referrals, (b) examine the coaches’ perceptions of how
their actions support mental health, (c) survey coaches’ perceptions of barriers to mental health
access for young athletes, and (d) explore the strategies coaches implement to promote a positive
mental health environment.
5

Purpose of the Study
This study had four purposes, based on the gaps in knowledge of high school varsity head
coaches in Los Angeles, California. The first purpose surveyed how varsity head coaches in Los
Angeles promote mental health. The second explored the varsity head coaches’ perceived
barriers to mental health for their athletes. The third purpose examined how varsity head coaches
are evaluated in their role of supporting mental health. The fourth purpose surveyed the
implementation of positive mental health strategies using self-determination theory by high
school varsity head coaches.
Research Questions
The following research questions guided this study:
1. How are high school varsity head coaches in Los Angeles promoting mental health, if
at all, for their student athletes?
2. What barriers, if any, prevent high school varsity head coaches in Los Angeles from
making mental health referrals?
3. How are high school varsity head coaches in Los Angeles evaluated, if at all, in their
role of supporting mental health?
4. How do high school varsity head coaches in Los Angeles implement self-
determination theory motivational strategies on their sports teams?
Procedures
For this study, a concurrent triangulation mixed-methods design was implemented with
quantitative surveys and qualitative interviews. The inquiry took place among the CIF-Los
Angeles City Section coaches. Surveys were collected for the quantitative portion, and
interviews were conducted for the qualitative portion. I identified coaches who met the criteria to
6

participate in the study based on experiences and demographics. Further details are described in
Chapter Three.
Significance of the Study
The significance of this study was to enhance the body of knowledge on the varsity head
coach’s role in supporting the mental health needs of high school athletes. Addressing the
research questions may benefit coaches, administrators, and mental health professionals by
helping them identify the barriers to mental health for their own students. High school
administrators can benefit from this study by learning of barriers to mental health for their
students and, in response, can address gaps in professional development to reduce stigma and
increase mental health literacy among the coaches. Mental health professionals may benefit by
gaining more knowledge of this specific population. In addition, training and curriculum can be
developed to enhance high school varsity head coaches’ ability to take steps to support the
mental health of their players.
Definitions of Terms
For the purposes of this dissertation study, the following terms are defined here:
1. Adolescent is defined by the World Health Organization as an individual between the
ages of 10 and 19 years who transitions from the stage of childhood to adulthood
(World Health Organization, 2004).
2. Athlete or student athlete is defined as a student who also participates in athletic
contests (Goldberg & Chandler, 1995). The term is commonly used to refer to
individuals who compete in college or high school sports (Sack, 2005).
3. CIF-LA is the California Interscholastic Federation Los Angeles City Section. It
“constitutes a Section of the CIF, and as such, conducts its athletic programs in
7

conformance with the general policies of the State” (CIF Los Angeles City Section,
n.d., para. 2).
4. Coach is defined as the adult leader of the sports team who teaches, directs, mentors,
motivates, and oversees the sports team (Ferguson et al., 2019; Mazzer & Rickwood,
2015).
5. Mental health is described as the state of well-being where individuals realize their
abilities, can cope with the normal stresses of life, and can work productively and
make contributions to their community (World Health Organization, 2004).
6. Mental health referral refers to communicating with a mental health service provider
in regard to seeking help for an individual in need of mental health support (Moreland
et al., 2018).
7. Mental health disorders is defined in the Diagnostic and Statistical Manual of Mental
Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) handbook,
which is used by health care professionals as the authoritative guide to the diagnosis
of mental disorders. According to the DSM–5, a mental or psychiatric disorder is
defined as
a syndrome characterized by clinically significant disturbance in an
individual’s cognition, emotion regulation, or behavior that reflects a
dysfunction in the psychological, biological, or developmental processes
underlying mental functioning. Mental disorders are usually associated with
significant distress or disability in social, occupational, or other important
activities. An expectable or culturally approved response to a common stressor
or loss, such as the death of a loved one, is not a mental disorder. Socially
8

deviant behavior (e.g., political, religious, or sexual) and conflicts that are
primarily between the individual and society are not mental disorders unless
the deviance or conflict results from a dysfunction in the individual. (p. 20)
For the purposes of this study, the terms mental health, mental health disorders, and
mental health diagnosis are used interchangeably.
8. Self-determination theory (SDT) is defined by Deci and Ryan (1985) as a
macrotheory of human motivation that differentiates between two types of
motivation: autonomous motivation and controlled motivation. Autonomous
motivation includes intrinsic motivation and self-enforcement of actions; individuals
who are intrinsically motivated engage in activities without external rewards or
prompts. Controlled motivation includes regulation of behavior from an external
source to attain a consequence. According to Deci and Ryan (2012), the three basic
and universal needs for autonomous motivation are competence, autonomy, and
relatedness.
Organization of the Study
This study is organized into five chapters. Chapter One provides an overview of the
study, iterates the importance of this research topic, describes the context of the problem, and
outlines the purpose of the study. Chapter Two provides a literature review pertaining to the
research questions, shares current research, and provides support as to the need for further study
of this topic. Chapter Three fully explains the methodology of the study and the rationalization
for the mixed-methods approach. Chapter Four analyzes the data collected from the surveys and
interviews. Lastly, Chapter Five provides a discussion of the findings, the implications of the
study, and recommendations for further study.
9

Chapter Two: Review of the Literature
This chapter examines relevant literature relating to the coach’s role pertaining to mental
health for athletes. The first section explores the history of mental health in youth. The second
section covers the barriers to and facilitators of mental health. The third explores how mental
health is being addressed in the high school setting by school-based mental health professionals
as well as coaches. The fourth section highlights the best practice interventions for increasing
mental health awareness among coaches and athletes. The fifth and last section explains relevant
motivational concepts coaches engage in through the framework of self-determination theory.
History of Mental Health
There is a history of mental health issues in student athletes. The term student athlete
is commonly used to describe high school and collegiate athletes (Sack, 2005). Student athletes
have a different experience compared with their non-athlete peers; they have to balance the time
demands of completing rigorous coursework and practice in addition to maintaining their
relationships (Moreland et al., 2018; Watt & Moore, 2001). Among school-aged children, 18% to
22% experience mental health problems (Maag & Katsiyannis, 2010). Merikangas et al. (2010)
surveyed 10,123 adolescents in the United States and concluded that approximately 40% of
youth between 13 and 18 years met the criteria for a lifetime disorder; 31.9% had anxiety
disorders, 19.1% had behavior disorders, and 14.3% had mood disorders. Among athletes, the
risk for mental health may be higher, as student athletes have additional stressors and engage in
more problematic behaviors such as drinking and dieting during high school (Andes et al., 2012;
Cranford et al., 2009; Geisner et al., 2012; Rice et al., 2016). Elite athletes are at an even higher
risk of anxiety and depression compared with the general public (Rice et al., 2016). Athletic
culture often promotes high-risk alcohol consumption (Andes, 2012), and dieting and eating
10

disorders are also higher among athletes (Giel et al., 2016). Athletes often experience stress
when thinking about their sports performance or when they are injured (Gulliver, Griffiths, &
Christensen, 2012). Furthermore, there is limited research for non-elite athletes and sports
programs, including recreational and high school student athletes (Swann et al., 2018).
Nevertheless, some studies have found athletes have higher levels of positive self-efficacy, self-
esteem, and resilience and are psychologically healthier at a young age compared with non-
athletes (Findlay & Bowker, 2009; Laborde et al., 2016).
The onset of mental health disorders typically occurs within the early part of an
individual’s life; half of all mental health disorders have their onset before age 14 (Kessler et al.,
2005), and most appear before the individual is 30 years old (McGorry et al., 2011). Early
treatment alleviates the severity of impact of the disorder (McGorry et al., 2011). Mental health
disorders have a negative impact on individuals related to negative life outcomes (Fergusson &
Woodward, 2002; McLeod & Kaiser, 2004). Young students with mental health issues displayed
symptoms of poor school attendance and lower academic achievement (DeSocio & Hootman,
2004). The 14- to 16-year-old students who were diagnosed with depression had an increased
risk of major depression as adults, anxiety disorders, nicotine dependence, alcohol abuse, suicide
attempts, unemployment, educational underachievement, and early parenthood (Fergusson &
Woodward, 2002). Students with mental health disorders are also more likely to drop out of
school and less likely to enroll in post–high school education (Fergusson & Woodward, 2002;
McLeod & Kaiser, 2004).
Many young people will experience mental health issues, but only a small percentage of
students will receive mental health services. Studies have shown 38% to as low as 7% of youth
receive treatment for their mental health disorder (Maag & Katsiyannis, 2010; Suldo et al.,
11

2014). At a large university in the Midwest, Cranford et al. (2009) found college students who
had substance abuse and mental health issues were not seeking services. Athletes are also not
receiving the help they need (Bauman, 2016). In fact, athletes seek help less often than their non-
athlete counterparts (Klenck, 2014; Watson, 2005).
Gender Considerations
While there are numerous studies specific to gender, there is scarce literature with mixed
results examining the different experiences of mental health in males and females. Hyde (2005)
indicated that there are mostly similar psychological variables between male and female.
However, a French study of elite athletes found women had a higher rate (20.2%) of
psychopathology over men (15.1%) and almost twice the diagnosis of anxiety or depression.
Burleson and Hanasono (2010) explained sexual differences in the way males and females
process supportive messages, which could directly affect how male and female athletes perceive
the coach-athlete relationship. Female athletes may be more likely than males to perceive
problems in the coach-athlete relationship if they sense a lack of support from their coach. Eating
disorders were also far more common in women, especially among women in racing sports
(Schaal et al., 2011). A Slovenian study compared Olympian athletes’ mental health measures
based on gender and found females to have a higher rate of eating disorders and higher reported
anxiety (Kotnik et al., 2012).
On the other hand, males are less likely to seek out help than females (Boldero & Fallon,
1995; Rickwood & Braithwaite, 1994). Barker et al. (2005) noted perceived gender norms as
factors in determining whether the individual seeks help. Males are more likely to deny that there
is a problem (Offer et al., 1991) and reported higher self-confidence scores (Kotnik et al., 2012).
In addition, males ranked higher in impulsivity and experience high-risk behaviors more often
12

(Miller, 2009). Adams et al. (2010) highlighted the toxic language among male athletes in the
history of sports and explained how sports have generationally served as a transmission of
misogynistic, homophobic, and femphobic attitudes; through sports, males were socialized to
exhibit toughness, violence, and aggression in order to highlight social dominance and
superiority. According to surveys in a Midwest college, more college males struggled with
substance abuse and revealed a stronger link between binge drinking and having general anxiety
disorder (Cranford et al., 2009).
Barriers to and Facilitators of Mental Health
There are numerous barriers to mental health, including stigma and lack of access
(Bauman, 2016; Bird et al., 2018; Gulliver, Griffiths, & Christensen, 2012; Maag & Katsiyannis,
2010; Moreland et al., 2018). Students often lack the access to the help they need (Maag &
Katsiyannis, 2010; Moreland et al., 2018). Also, teachers and coaches lack the knowledge of
how to get their students help (DeSocio & Hootman, 2004). Mental health programs in schools
are often underfunded (Maag & Katsiyannis, 2010). Athletes utilize mental health services much
less than their counterparts because they have less favorable views and lower expectations of
counseling services (Watson, 2005). Furthermore, one study of college students revealed another
barrier to mental health for student athletes was not having enough time (Bird et al., 2018). For
many athletes, mental health issues are often seen as a weakness and a direct contradiction to the
sports culture of minimizing weaknesses and praising strength and mental toughness (Bauman,
2016). However, Gucciardi et al. (2017) proposed that mental health is dependent on numerous
contexts and mental toughness may actually represent a positive indicator of mental health.
Coaches can also inhibit a player’s access to mental health services (Choi et al., 2013;
Jones et al., 2005). Athletes who perceived their coach to have a mental health stigma would not
13

get help if they felt it would affect their roles on the team (Kroshus, 2017). Other notable barriers
include the athlete’s lack of mental health literacy, negative past experiences of seeking help
(Gulliver, Griffiths, & Christensen, 2012) and peer norms for athletes and coaches (Moreland et
al., 2018).
There are, however, some facilitators for athletes utilizing mental health services
(Gulliver, Griffiths, & Christensen, 2012; Moreland et al., 2018; Suldo et al., 2014). Those who
sought help were often encouraged by others, had a previous relationship with the provider, or
had positive attitudes of mental health from their coaches and other adults (Gulliver, Griffiths,
Christensen, Mackinnon, et al., 2012). One study of 55 adolescent males aged 12–17 found
coaches and family to be key players for supporting mental health (Swann et al., 2018).
Moreland et al. (2018) and Suldo et al. (2014) encourage including more partnerships between
key stakeholders and administrators to improve mental health barriers in schools.
Role of Mental Health Providers in Schools
Mental health professionals in the school setting include counselors, social workers, and
nurses (DeSocio & Hootman, 2004; Suldo et al., 2014). The mental health school employees are
responsible for the entire school population and are trained to address the socioemotional and
academic needs of students including athletes (Suldo et al., 2014). The best practice of the
mental health professional in the schools is to be the specialist who coordinates preventive
programs and educates coaches and teachers (Goldberg, 1991; Watson & Kissinger, 2007).
Goldberg (1991) explained that counselors should be the coordinators and consultants of
mental health to the “athletic triangle” of the coach, athlete, and parent. Counselors should
increase parent and coach awareness of mental health, value the partnership between the adults,
and draw focus away from performance of the sports. When working with middle school
14

athletes, counselors should focus on teaching developmental skills such as stress management,
coping skills, decision making, asking for help, and relationship-building skills (Goldberg &
Chandler, 1992). Although the mental health expert in the school setting is responsible for
addressing the students’ socioemotional needs, it is important for counselors to recognize the
significant influence coaches have on students’ mental health (Goldberg, 1991).
The Coach and Mental Health
The coach is often viewed as a mentor, educator, confidant, and motivator (Ferguson et
al., 2019; Mazzer & Rickwood, 2015) but can at times prevent a player from attaining services
(Choi et al., 2013; Jones et al., 2005). In an interview, a female swimmer who had an eating
disorder said her coaches had created a culture that promoted her mental illness by what they
were saying about her body (Jones et al., 2005). Coaches play an important role in creating a safe
environment and teaching coping skills for their players (Kroshus, 2017). However, there have
been limitations to the study of how coaches contribute to supporting mental health (Bissett et
al., 2020). Furthermore, there are currently no policies or standards of evaluation to support
mental health in place for non-elite athletes including high school student athletes (Vella &
Swann, 2021).
Coaches’ Perceptions of Mental Health
All coaches of athletes between the ages of 12 and 18 in an Australian study recognized
they could be a support system and responsible for their players in getting mental health support
(Mazzer & Rickwood, 2015). Both teachers and counselors perceived promoting mental health to
be a part of their roles, but they acknowledged how their roles were different from those of
mental health experts (Mazzer et al., 2012). In Ferguson et al.’s (2019) focus group study of 20
coaches’ perceptions of mental health, only some coaches felt they could facilitate the linkage to
15

professional mental health services, but many more felt the parents played a larger role in
addressing mental health and teaching life skills. However, in a United Kingdom study that
compared coaches’ and elite athletes’ perceptions of the athletes’ need for mental health services,
the responses were incongruent; the athletes agreed that they had a higher prevalence of mental
health concerns, but some coaches minimized the need for or were unaware of such mental
health concerns (Biggin et al., 2017). When asked about barriers, many coaches felt they were
undertrained in identifying mental health signs and complained of not having the time to attend
workshops on mental health (Ferguson et al., 2019).
Best Practices for Mental Health Training
There are few mental health studies of athletes and coaches (Rice et al., 2016) and even
fewer intervention studies targeted for coaches and athletes to address mental health (Breslin,
Haughey, et al., 2017). The inquiry suggests mental health topics should already be included in
current training for coaches (Breslin, Shannon, et al., 2017; Ferguson et al., 2019) despite results
varying as far as how training should be conducted and for whom (Breslin, Haughey, et al.,
2017). Kokko (2014) proposed recreational sports clubs to be a setting for health promotion. Gill
(2008) recommended social workers be involved at the collegiate level. Training is
recommended for all levels of support, including providers, patients, and communities, to
address stigma (Alves-Bradford et al., 2020). Mental health literacy training and resources
should be provided for youth sport coaches, and at the bare minimum, parents should be notified
of adolescent mental health concerns (Ferguson et al., 2019; Swann et al., 2018). Coaches would
benefit from mental health literacy training (Bapat et al., 2009; Breslin, Shannon, et al., 2017;
Ferguson et al., 2019; Pierce et al., 2010). In previous studies, which ranged from a 3-hour
session in the UK for sports coaches (Breslin, Haughey, et al., 2017) to a 12-hour
16

psychoeducational group for Australian football club leaders (Pierce et al., 2010), all
interventions increased mental health knowledge and gave coaches and leaders confidence to
help someone who has a mental health disorder. Furthermore, sports club leaders also reported
reduced levels of stigma toward mental health (Bapat et al., 2009). All three studies, however,
had a small sample size and may not be generalizable. Another study found coaches were
knowledgeable of depression but lacked the education to be aware of when players needed help;
however, 77% of coaches surveyed had strong interest in receiving additional education (Hegarty
et al., 2018). Although some interventions exist, quality of methodology may be lacking and
there was a high risk of bias in studies (Bissett et al., 2020; Breslin, Shannon, et al., 2017).
Interventions for athletes and officials could also help address mental health (Breslin,
Shannon, et al., 2017). Some studies utilized the internet to administer mental health training
(Gulliver, Griffiths, Christensen, Mackinnon, et al., 2012; Van Raalte et al., 2015). In Van Raalte
et al.’s (2015) evaluation of a web-based mental health program, the 10 college students reported
better mental health knowledge. In another education-based intervention program for college
student athletes, the brief videos and presentations were found to reduce stigma and promote
help-seeking behavior (Kern et al., 2017). In contrast, there was no effect on help-seeking
attitudes after mental health awareness training for elite athletes in another study (Gulliver,
Griffiths, Christensen, Mackinnon, et al., 2012). One study utilized sport mentors to provide life
skills training for at-risk students between the ages of 12 and 16 and concluded the students
improved in self-esteem (Tester et al., 1999). The research, albeit limited, indicates athletes may
benefit from some type of mental health intervention.
17

Self-Determination Theory
The conceptual framework utilized to guide this research study is self-determination
theory (SDT). Self-determination theory, developed by Deci and Ryan (1985), is a macrotheory
of human motivation that differentiates types of motivation as opposed to focusing only on
whether individuals have motivation. The two forms of motivation are autonomous motivation
and controlled motivation. Autonomous motivation includes intrinsic motivation and self-
enforcement of actions; individuals who are intrinsically motivated engage in activities without
external rewards or prompts. Controlled motivation, on the other hand, includes regulation of
behavior from an external source to attain a consequence. Autonomous motivation produces
healthy behaviors, positive mental health, and effective long-term performance. Deci and Ryan
(2008b) explained the three basic and universal needs for autonomous motivation are
competence, autonomy, and relatedness. Self-determination theory presents concepts that have
been applied in the contexts of health care, education, and sports (Deci et al., 2017; Hagger &
Chatzisarantis, 2007). The self-determination theory adapted to high school varsity sports teams
is presented in Figure 1.
For the purpose of this research, the psychological needs of competence, autonomy, and
relatedness were applied to explain the pro–mental health behaviors a coach can utilize. I
theorized that coaches who regularly apply autonomous motivators by addressing the
psychological needs outlined in SDT would have a positive relationship with making mental
health referrals when needed and a positive relationship with their perceptions of mental health.
Because of the lack of specific literature on mental health and self-determination theory training
for coaches, the following sections highlight literature containing concepts of autonomy,
relatedness, and competence.
18

Figure 1
Self-Determination Theory Adapted to a High School Varsity Sports Team

Note. Adapted from Deci et al. (2017).

Autonomy
Deci et al. (2017) explained the motivating variable of autonomy as the inherent need for
individuals to have independence, personal agency, responsibility, and control over their own
actions. Self-determination theory states individuals need to decide, accept, and regulate their
own goals and actions. Cross-culturally, the universal need of autonomy supports motivation and
psychological well-being (Chirkov & Ryan, 2001; Lekes et al., 2010). Among high school
students in China and North America, Lekes et al. (2010) recommended parents prioritize
encouraging intrinsic life goals by being supportive of their children’s autonomy. Russian high
school students who perceived autonomous support from their parents and teachers performed
better in academics and felt more self-motivated. Autonomy-supportive behaviors also have a
clear beneficial impact on athletes’ intrinsic and self-determined extrinsic motivation, which are
Independent
Variables
• Context of a
high school
varsity
sports team
Mediators
• Basic
psychological
needs
(autonomy,
competence,
relatedness)
Dependent
Variables
• Health and
wellness
• Performance
19

important determinants of performance and persistence (Fortier & Gaumond, 2007, as cited in
Deci & Ryan, 2008a; Hagger & Chatzisarantis, 2007; Mageau & Vallerand, 2003).
When coaches exercise autonomy-supportive behaviors, players are more engaged and
perform better (Mageau & Vallerand, 2003). Keegan et al.’s (2009) qualitative investigation
suggested that coaches and parents support autonomy by having a collaborative leadership style
as opposed to an autocratic leadership style, meaning coaches and parents should allow students
to discuss decisions. Wallace and Sung (2017) explained that students in classrooms were
attuned to how their teachers supported their shared academic goals of success. In the same way,
autonomy-supportive behaviors can be transferred into the team environment by the coach,
particularly through process-focused praise, increased youth competence, and relatedness in the
coaching relationship (Coatsworth & Conroy, 2009). Mageau and Vallerand (2003) encouraged
coaches to adapt their practices to the athlete for greater motivation by offering choices,
providing a rationale for decisions, acknowledging the athlete’s feelings, giving noncontrolling
feedback, and avoiding tangible rewards. Finally, teachers and coaches also need their own sense
of autonomy to flourish. Teachers will lose energy if they are given too many restrictions (Ryan
& Deci, 2002). The coach’s psychological health was associated with autonomy-supportive
behaviors (Stebbings et al., 2015).
Relatedness
Relatedness explains a person’s need, regardless of culture, to feel a sense of belonging
(Jowett et al., 2017). Lack of a sense of belonging could have adverse effects, such as
depression, poor psychological adjustment, a lowered ability to self-regulate, and compromised
physical health (Leary & Cox, 2008). Through healthy relationships, athletes’ psychological
needs are met, and they can then reach their potential (Jowett et al., 2017). One study showed
20

elite athletes in individual sports had higher levels of depressive symptoms than those in team
sports (Nixdorf et al., 2016). An inquiry including focus groups found a link between the quality
of friendship and peer acceptance with the overall happiness and competence of the individual
(Keegan et al., 2009).
The relationship between a coach and an athlete affects the athlete’s well-being. Teacher-
student relationships have been positively associated with happiness and the satisfaction of
psychological needs for autonomy, relatedness, and competence (Froiland et al., 2019). When
students feel emotionally supported by their teacher, their sense of safety and positive motivation
are likely to increase (Wentzel et al., 2010). Conversely, teachers relating with students also
leads to higher levels of engagement. (Klassen et al., 2012). The research can be transferred from
the teacher-student relationship to the coach-athlete relationship due to the nature of the
mentorship relationship. A supportive coach and feeling connected with the team are the most
profound protective factors against mental health symptoms in college athletes (Armstrong &
Oomen-Early, 2009). Coaches make a positive contribution to mental health because they are
one of the trusting adults in the student’s life (Mazzer et al., 2012). However, conflicts between a
coach and players or negative support from a coach can also trigger psychopathology
(Shanmugam et al., 2014). To form supportive relationships with athletes, coaches should
convey care and respect to their players (Niemiec & Ryan, 2009) and encourage friendships
within the team to increase motivation (Keegan et al., 2009; Mageau & Vallerand, 2003).
Increasing team culture allows the players to conform to team rules and social norms because
they long to be accepted (Bissett et al., 2020; Leary & Cox, 2008). For coaches of young girls
who have experienced trauma, one of the targeted behaviors that was emphasized and recorded
was to use “circle ups” to emphasize team culture (Andrea et al., 2013). In addition, adolescents
21

may perceive pressure from peers, and individual attitudes and behaviors are reinforced by peer
group values (Ryan, 2000). In Bergholz et al.’s (2016) guide of 10 trauma-sensitive skills for
youth sports workers, two of the strategies highlight group cohesion. Coaches were asked to
provide opportunities for youth to make friends with each other and contribute to the group
community. Coaches were given the task to teach how players’ actions better the team rather
than the individual.
Competence
Competence is the third basic need of autonomous motivation in self-determination
theory. It refers to the individual’s experience mastering a behavior (Niemiec & Ryan, 2009;
Ryan & Deci, 2002). Athletes’ competence needs are met when they can meet the requirements
and excel at the sport they are playing. Self-concept and self-esteem are directly linked to mental
health outcomes (Ryan et al., 1995; Suldo & Shaffer, 2008). Self-esteem can lead to better health
and social behavior, and poor self-esteem is associated with a broad range of mental disorders,
social problems, and physical health issues (Mann et al., 2004; Suldo & Shaffer, 2008). In one
study, one of the strongest predictors of depression in collegiate athletes was self-esteem
(Armstrong & Oomen-Early, 2009). In addition, the perception of their own confidence can
affect how the players perceive their coach’s behaviors. If players have low self-esteem, they are
more likely to negatively perceive their coach (Baird, 2018). On the other hand, if individuals are
committed and close with the team, they are more likely to have their competence need met
(Choi et al., 2013).
For a coach to develop competence in his or her players, it takes many steps, including
feedback and ongoing reinforcement of desired behaviors. While training young female athletes
who have experienced trauma, coaches were asked to focus on specific praise and one-on-one
22

feedback to each of the players (Andrea et al., 2013). Keegan et al. (2009) recommended that
coaches allow independent training and give noncontrolling competence feedback to the players.
According to Bergholz et al. (2016), one strategy is to allow the player to complete a self-
regulation strategy called “checking yourself,” where the child identifies, modulates, and
expresses his or her internal emotions. Patall et al. (2019) explained motivation and engagement
is a daily and long-term process involving both the teacher and the student in a motivationally
supportive environment.
Conclusion
The literature demonstrates the need for mental health support for the adolescent-athlete
population and the need for the sports coach to play a pivotal role in supporting the mental health
of athletes. However, there is scant research on the prevalence of mental health referrals, the role
of the coach in promoting mental health, and best practices for creating a motivational
environment between the player and the coach. Furthermore, there is research that has examined
the need for interventions targeting NCAA athletes, but some studies have indicated that it may
be just as important to target adolescent club and intramural athletes (Donohue et al., 2016).
Based on Ferguson et al.’s (2019) research on the perception of coaches, many coaches express
that they do not have the time to attend an additional training to address mental health. In
response, my research design incorporated mental health–supportive motivational practices. I
hypothesized that if a coach is made aware of and implements the self-determination theory
strategies that address the student’s universal needs of autonomy, relatedness, and competence,
then relationships between the coach and the players will be stronger, thus improving the
psychological health of the student athletes.

23

Chapter Three: Methodology
The intent of this concurrent mixed-methods study was to examine how high school
varsity head coaches in Los Angeles support mental health services for their athletes. Previous
studies indicated that almost half of all youth athletes experience a high frequency of mental
health disorders (Gulliver, Griffiths, & Christensen, 2012; Rice et al., 2016) and often lack
access to the help they need (Moreland et al., 2018). Coaches from Los Angeles public schools
were selected as the target population to explore the disparities in mental health support among
lower socioeconomic and minority communities (Alegría et al., 2015; Alves-Bradford et al.,
2020; Purtle, 2012). Further, the varsity head coach plays a substantial role in promoting mental
health support (Castaldelli-Maia et al., 2019; Goldberg, 1991; Mazzer et al., 2012), but there is
limited literature on how the coach supports mental health referrals and factors that promote or
inhibit mental health (Bissett et al., 2020).
This mixed-methods study had four overarching purposes, based on the gaps in
knowledge. The first was to explore how varsity head coaches in Los Angeles promote mental
health. The second was to explore the varsity head coaches’ perceived barriers to mental health
for their athletes. Third was to explore how varsity head coaches are evaluated in their role of
supporting mental health. The fourth was to examine the ways varsity head coaches implement
positive mental health strategies using self-determination theory as a reference. For this
concurrent triangulation mixed-methods study, quantitative and qualitative methods were
implemented in the form of surveys and interviews to analyze the resulting data. This chapter
includes the research questions, research design and methodology, population and sample
selection, instrumentation, data collection, data analysis, validity and reliability, and a summary.
24

Research Questions
The following research questions guided this study:
1. How are high school varsity head coaches in Los Angeles promoting mental health, if
at all, for their student athletes?
2. What barriers, if any, prevent high school varsity head coaches in Los Angeles from
making mental health referrals?
3. How are high school varsity head coaches in Los Angeles evaluated, if at all, in their
role of supporting mental health?
4. How do high school varsity head coaches in Los Angeles implement self-
determination theory motivational strategies on their sports teams?
Research Methodology
A concurrent triangulation mixed-methods strategic design was implemented with both
quantitative and qualitative components in addition to the literature for this study. A diagram of
the concurrent triangulation mixed methods is presented in Figure 2. Utilizing a mixed-methods
design allows the researcher to use both quantitative and qualitative data to form a better
understanding of the subject matter under examination (Merriam & Tisdell, 2016) and integrate
various sources of evidence to fully analyze the research questions (Maxwell, 2013). It helps the
researcher understand contradictions in findings and allows participants to share their
perspectives. The researcher can combine, or triangulate, numeric trends from the quantitative
section and the specific details from the qualitative research (Maxwell, 2013). I chose the
concurrent triangulation mixed-methods strategy for multiple reasons:
1. It allows for the data to be collected during the same phase and in a shorter time
period.
25

2. It allows for quantitative and qualitative data to be interpreted together with the
documents during the analysis phase.
3. It allows for both the quantitative and the qualitative data to be interpreted with equal
weight, with the goal to confirm emerging findings.
4. It balances the weaknesses of having only a quantitative or a qualitative design.
5. The findings from the survey can be checked against the interview and literature
review (Creswell, 2009; Merriam & Tisdell, 2016).
The quantitative portion of this research consisted of a 17-question close-ended survey
addressing the research questions. The survey questions were strategically curated based on the
literature review to address how high school varsity head coaches in Los Angeles promote
mental health, what coaches perceive to be barriers to mental health, how the coaches are
evaluated in their role of supporting mental health, and whether and how often positive mental
health strategies are implemented based on the three mental health–promoting components from
self-determination theory (Deci & Ryan, 2012). The quantitative design allowed for analysis of
trends based on the coach’s demographics, the specific sport coached, and the mental health
components included in the survey.
The qualitative portion of this research consisted of 11 open-ended, semi-structured
interviews of high school varsity head coaches in Los Angeles high schools. The coaches were
asked in detail how they supported mental health for their players, what their perceptions of
barriers to mental health were, what they thought were the accountability measures for
supporting mental health, and how they implemented or would ideally implement self-
determination theory strategies for their team. Qualitative inquiry allowed the study to focus on
understanding the processes, meanings, and specific examples for the specific group of people in
26

a specific setting (Maxwell, 2013) while allowing me to enter into the participants’ perspective
and understand the construction of their experiences (Merriam & Tisdell, 2016; Patton, 2002).
This interview study included purposeful conversations to gather more in-depth and purposeful
information, full of descriptive words that help paint a picture for the reader (Bogdan & Biklen,
2007; Merriam & Tisdell, 2016). The semi-structured open-ended interviews included a set of
predetermined questions including follow-up questions with the flexibility to change wording
and order to adapt to emerging themes. I chose to use the semi-structured format with the intent
to respond to the emerging worldview of the participants and be open to ideas (Merriam &
Tisdell, 2016).

Figure 2
Concurrent Triangulation Mixed Methods

Quantitative survey
data collection
Quantitative data
analysis
Results compared and
integrated
Qualitative interview
data collection
Qualitative data
analysis
27

Population and Sample Selection
The sample of the study was drawn from men and women who are currently varsity head
coaches at high schools located in Los Angeles. In total, 32 coaches completed the survey and
seven coaches were interviewed. The inclusion criteria were that the coaches had to have at least
1 year of experience as a high school varsity head coach, be the coach for a team with 10 or more
players on the roster, be coaching for a team in the Los Angeles City Section and be coaching at
a public school. Of the 32 coaches who participated, 22 were male and 10 were female. The
coaching experience ranged from 1 to 15 years of experience with the average of 5.5 years. The
team sports participants coached included basketball, volleyball, baseball, softball, soccer,
wrestling, football, cross country, and track and field. An in-depth description of demographics
is provided in Chapter Four.

Table 1
Survey and Interview Inclusion Criteria of High School Varsity Head Coaches
Survey Interview
1. Must have 1 or more years of experience
as a high school varsity head coach.
2. Must coach a team sport with 10 or more
players on their roster.
3. Must be coaching in Los Angeles,
California.
4. Must be coaching for a high school in the
CIF Los Angeles City Section.
5. Must be coaching at a public school.
1. Must have 1 or more years of experience
as a high school varsity head coach.
2. Must coach a team sport with 10 or more
players on their roster.
3. Must be coaching in Los Angeles,
California.
4. Must be coaching for a high school in the
CIF Los Angeles City Section.
5. Must be coaching at a public school.

For this study, purposeful convenience sampling was implemented to select the coaches
with the objective to develop a comprehensive understanding of how coaches promote mental
28

health for their athletes. Purposeful samples were selected to gain in-depth understanding and
insights from the perspectives of the coaches (Patton, 2002). Purposeful sampling was
implemented to focus on selecting unique, knowledgeable participants with specific
characteristics who could speak extensively about their experiences (Johnson & Christensen,
2014; Maxwell, 2013; Merriam & Tisdell, 2016). Convenience sampling was utilized due to
participants’ location and availability coupled with the requirements of school districts’
guidelines (Maxwell, 2013; Merriam & Tisdell, 2016). Snowball sampling was also utilized;
some participants identified potential participants who may fit the target population. The
participants of the mixed-methods study were selected based on the specific inclusion criteria, as
shown in Table 1.
Participants were recruited from the California Interscholastic Federation (CIF) Los
Angeles City Section. I did not collect data from coaches employed by the Los Angeles Unified
School District due to my affiliation with the school district. I emailed points of contact in my
professional network including section commissioners, administrators, and athletic directors (see
Appendix A) and asked for the contact information of high school varsity head coaches who fit
the criteria. I also contacted high school varsity head coaches directly through various high
school directories. I asked the coaches to respond to a brief demographic questionnaire and sign
an informed consent form (see Appendix B prior to participating.)
Instrumentation and Sources of Data
A mixed-methods study using both quantitative and qualitative instruments was
implemented during the data collection phase in the form of surveys and interviews.
29

Quantitative Instrument
The quantitative component of the study consisted of a self-reported question survey. The
survey had a total of 17 close-ended questions and was deployed online using Qualtrics. The 17-
question survey contained close-ended responses that addressed the four research questions. In
addition to collecting the varsity head coaches’ demographics, a 5-point Likert scale was
implemented. For the Likert scale, participants were able to choose frequency from “always” to
“never” and agreement from “strongly agree” to “strongly disagree.” The 5-point Likert scale
was chosen for its user-friendly nature and to meet adequate reliability standards (Dillman et al.,
2014).
The barriers analyzed included stigma of players, stigma of varsity head coaches, not
knowing mental health disorder signs for coaches, and not knowing whom to talk to. Questions
also addressed how often the coaches implemented the specific self-determination theory
strategies to promote positive mental health. For example, one item on the survey was “My
school administrator evaluates how I support mental health for my players.” The full text of the
survey is available in Appendix C.
Qualitative Instrument
The qualitative component of the study consisted of one-on-one interviews. The
interview had a total of 11 open-ended questions and was implemented in a semi-structured
manner. The semi-structured open-ended interview approach allowed me to write down the
interview questions in advance to address each of the research questions (Patton, 2002), yet
granted flexibility in the order questions were asked as patterns emerged (Merriam & Tisdell,
2016).
30

Each interview question addressed a specific research question and explored the
participant’s experience, knowledge, interpretation, opinions, positions, feelings, and ideal
position in their own narrative (Merriam & Tisdell, 2016). The interviews were conducted online
via Zoom; I took annotated notes during the interview (Creswell, 2009). After I received consent
from the participant, I recorded the interviews to allow for transcription and analysis. The full
text of the qualitative interview protocol is available in Appendix D.
Data Collection
Following approval by the Institutional Review Board at the University of Southern
California, I began the data collection process. Considering the gatekeepers (Bogdan & Biklen,
2007), I emailed the school district administrators an introductory cover letter (see Appendix A
requesting participants who met the high school varsity head coach criteria. The outreach email
contained a link to the Qualtrics online survey for quantitative data as well as the request for an
interview to satisfy the qualitative portion of the study. Participants were informed that their
participation was completely voluntary, and they could discontinue at any time during the study.
In addition, confidentiality was emphasized to ensure the participants were not harmed in any
way during the study (Rubin & Rubin, 2012).
Applying the concurrent triangulation mixed-methods approach, both the quantitative
surveys and qualitative interviews were conducted during the data collection phase prior to
analysis (Merriam & Tisdell, 2016). All survey and interview responses were saved on a
password-protected computer to protect the participants’ confidentiality (Bogdan & Biklen,
2007). The quantitative survey data were collected via Qualtrics. The online survey included
additional consent language, and all participants provided consent prior to participation. The
survey included limited demographic information, questions about how the varsity head coach
31

promotes mental health, questions about the perceived barriers of mental health, questions about
the coach’s accountability for supporting mental health, and questions about implementing self-
determination theory strategies. The survey responses were immediately tabulated on the online
program and saved for analysis after the data collection phase.
I conducted all seven video conferencing interviews through Zoom. Each interview lasted
approximately 45 minutes and was recorded with the participant’s consent. After each interview,
the questions and answers were transcribed and coded. Follow-up phone calls were made as
needed to clarify responses and to perform member checking practices.
Data Analysis
Following the concurrent mixed-methods approach, I analyzed both the quantitative and
the qualitative data following the data collection phase. The quantitative surveys and qualitative
interviews were combined for analysis. The quantitative data were analyzed via Qualtrics Stats
IQ. Descriptive statistics including mean, range, and standard deviation were completed to
explore trends. In addition, the statistical program Stats IQ created tables and visual aids for each
question.
The qualitative data were analyzed and coded following transcription. Each question was
coded for recurring themes. I took annotated notes throughout the interviews (Merriam &
Tisdell, 2016) using two levels of categories and themes. I then developed findings based on the
codes.
The concurrent triangulation strategy combines the findings from both the quantitative
and the qualitative data with the literature to determine convergence or divergence conclusions
(Creswell, 2009; see Figure 1). Through the use of multiple methods of data collection, the
findings from each method can be compared against the other (Merriam & Tisdell, 2016), thus
32

balancing the limitations of both quantitative and qualitative designs. This strategy not only
increases credibility of the findings, but also increases the internal validity of the study.
Validity and Reliability
Throughout this study, I was attentive to strategies implemented to address validity and
reliability concerns (Bogdan & Biklen, 2007; Creswell & Creswell, 2018; Maxwell, 2013;
Merriam & Tisdell, 2016; Patton, 2002; Willits et al., 2016). I followed Merriam and Tisdell’s
(2016) description of ensuring validity through the use of triangulation, a method of checking
results from more than one source to ensure credibility. Through the use of triangulation, the
study ensured validity by combining multiple sources of evidence and varying methods of data
collection, reducing the risk of bias (Merriam & Tisdell, 2016). I also implemented the strategies
of reflexivity, critically self-reflecting and bracketing biases and being transparent about personal
values that could affect the analysis (Merriam & Tisdell, 2016). Furthermore, I incorporated the
strategy of member checking by asking for clarification (Merriam & Tisdell, 2016).
Summary
Chapter Three explained the adoption of the concurrent triangulation mixed-methods
strategy to address the study. Both quantitative data from surveys and qualitative data from
interviews were collected from high school varsity head coaches in Los Angeles from the CIF
Los Angeles City Section. The data were analyzed to answer the four research questions, and the
analysis and findings are discussed in Chapter Four.

33

Chapter Four: Findings
This chapter presents an analysis of the data collected for this study, which aimed to
examine barriers for Los Angeles varsity head coaches in supporting student athletes’ mental
health. The purpose of this study was to examine high school varsity head coaches’ perspectives
on potential barriers to mental health and highlight strategies that promote positive mental health
for student athletes.
The findings/results in this dissertation study were framed around the following research
questions:
1. How are high school varsity head coaches in Los Angeles promoting mental health, if
at all, for their student athletes?
2. What barriers, if any, prevent high school varsity head coaches in Los Angeles from
making mental health referrals?
3. How are high school varsity head coaches in Los Angeles evaluated, if at all, in their
role of supporting mental health?
4. How do high school varsity head coaches in Los Angeles implement self-
determination theory motivational strategies on their sports teams?
Additionally, this chapter includes participant demographics and themes that emerged from
surveys, virtual interviews, and the literature.
Participants
There were 32 total participants in this study. Of those 32 varsity head coaches who
completed the survey, seven coaches were also interviewed. All survey participants were CIF
Los Angeles City Section coaches and had at least 1 prior year of experience as varsity head
coach of a sports team with at least 10 players. The team sports participants coached included
34

basketball, volleyball, baseball, softball, soccer, wrestling, football, cross country, and track and
field. A summary of the participant demographics is provided in Table 2.
Demographics of Survey Participants
The following is a breakdown of the demographical information of the survey
participants. Between September 12, 2020, and December 11, 2020, a total of 32 participants
completed the survey. The sports coached include boys and girls basketball, boys and girls
volleyball, baseball, softball, boys and girls soccer, wrestling, football, cross country, and track
and field. Of the 32 survey participants, 22 were male (68.75%) and 10 (31.25%) were female.
The participants’ gender is represented in Table 3.

Table 2
Survey and Interview Participant Demographics of High School Varsity Head Coaches
Survey Interview
• 32 participants
• 22 male, 10 female
• Age range: 24–63
• Sports coached included basketball,
volleyball, baseball, softball, soccer,
wrestling, football, cross country,
track and field
• 7 participants
• 4 male, 3 female
• Age range: 28–57
• Sports coached included basketball,
volleyball, baseball, softball, soccer,
football

Table 3
Gender of Survey Participants
Q2: What is your gender? Count % of data
Male 22 68.8%
Female 10 31.3%

35

The ages of the participants varied. The age range of the coaches surveyed were from 24
to 63 years old. The mean age of coaches interviewed was 38.4 years old. Four (12.5%) coaches
were age 28, and three (9.38%) coaches were age 50. Two participants were 24 and younger,
making up 6.25% of participants. Eight participants were 25–30 years old, representing 25% of
the samples. The 31–35, 36–40, and 46–50 age groups all had four participants, each
representing 12.5% of the sample. Five participants, or 15.6%, were 41–45. Additionally, two
participants (6.25%) were in the 56–60 age group and one participant (3.13%) was in each of the
51–55 and 61–65 age groups. All survey participants’ ages are represented in Figure 3.
Of the 32 coaches surveyed, 14 (43.8%) identified as of Latino/a ethnicity. The second
largest ethnicity identified was Caucasian with 10 (31.3%), followed by African American with
6 (18.8%). There were also one Asian American/Pacific Islander and one Filipino coach
surveyed, accounting for 3.13%. The participants’ reported ethnicity is represented in Table 4.
The coaching years of experience for participants ranged from 1 year to 15 years of
experience with an average of 5.5 years. A total of 59.4%, or 19 participants, had 1–5 years of
experience as a varsity head coach; 21.9%, or seven participants, had 6–10 years of experience.
Five participants (15.6%) had 11–15 years of experience as a varsity head coach. Additionally,
one participant had been a coach for 16 years.
The participants included coaches who coach girls and boys volleyball, boys and girls
cross country, track and field, boys and girls basketball, softball, baseball, boys and girls soccer,
wrestling, and football. All coach participants had at least 10 players on their roster, and some
participants coached more than one sport. The most common sports coached in the sample
included girls volleyball with 10, boys volleyball with nine, and boys basketball with seven.

36

Figure 3
Age of Survey Participants

Table 4
Ethnicity of Survey Participants
Q4: What is your ethnicity? Count % of data
African American 6 18.8%
Asian American/Pacific Islander 1 3.1%
Caucasian 10 31.3%
Latino 14 43.8%
Other-Filipino 1 3.1%

Demographics of Interview Participants
The following is a breakdown of the demographical information of the seven virtual
interview participants. From October 21, 2020 to December 11, 2020, seven interview
participants were selected for the qualitative portion of the study. All interviewees were varsity
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
28 50 24 27 30 40 42 29 31 32 34 35 36 38 41 43 45 47 53 57 58 63
Age of Coaches Surveyed (N = 32)
Q3: What is your age?
37

head coaches from the CIF Los Angeles Section as described in Chapter Three. Four were male
and three were female. The age range of participants was 28 to 57. The sports coached in the
study included boys basketball, boys and girls volleyball, boys and girls soccer, baseball,
softball, and football. To maintain confidentiality for the interview participants, they are referred
to as Coach A–G. Table 5 presents the age of the interview participants, gender, and sports
coached.

Table 5
Participants’ Gender, Age, Sport Coached, and Years of Experience
Interview
participant
Gender Age Sport(s) coached
Years of coaching
experience
Coach A M 45 Baseball 12
Coach B M 57 Basketball (boys) 12
Coach C M 40 Football 1
Coach D F 29 Volleyball (boys and girls) 6
Coach E M 28 Soccer (boys and girls) 1
Coach F F 41 Softball 2
Coach G F 36 Volleyball (boys and girls) 3

Results for Research Question 1
Research Question 1 was “How are high school varsity head coaches in Los Angeles
promoting mental health, if at all, for their student athletes?”
Talking to Players
Coaches have a significant influence on mental health for their athletes through their
actions (Castaldelli-Maia et al., 2019; Goldberg, 1991). The literature recommends including
more partnerships between adult stakeholders to promote mental health support (Moreland et al.,
38

2018; Suldo et al., 2014). Of the 32 coaches surveyed, 11 (34.4%) said they have conversations
related to mental health wellness with their team on a weekly basis. A total of 28.1% said they
have conversations two to three times a month, and 21.9% said they have conversations about
once a month. Table 6 displays the results of the survey question of mental health wellness
conversations.

Table 6
Survey Responses to How Often Coaches Have Conversations About Mental Health Wellness
Response n %
Never 2 6.3%
About once a month 7 21.9%
Two to three times a month 9 28.1%
About once a week 11 34.4%
More than five times a month 3 9.4%

In addition to the quantitative survey, seven Los Angeles varsity head coaches were
interviewed virtually through Zoom and asked to share how they support their student athletes in
mental health. Many discussed supporting their students by talking to their players and spending
time in practice checking in with them. Coach B had been coaching basketball for 12 years and
shared the following:
I gotta be honest. I’m a tough coach, but at the end of the day, I tell my kids how much I
love them and appreciate them. I celebrate them. In terms of mental health, you got to
have time to have those conversations. We call those check-ins. For my team as a coach,
for my assistant coaches, they already know. We just make it a point that we have to
touch base with all of our kids during the week. For example, right now with the
39

pandemic, I worry about my kids. I’ve got five returners coming back, and I worry about
every one of them because they’re not performing at the level they did when we were in
school before.
Coach A was a 45-year-old male baseball coach, and he shared how to know when to talk to his
players. Coach A was also a physical education teacher at the school. Coach A mentioned the
importance of reading body language and also alluded to the challenges of supporting students
during the pandemic:
You got to kind of be a keen observer and know their body actions. Look, for example,
do they look down normally? Are they usually kinda perky? If I see something off, I
would just kind of pull the individual aside and see if I can get some information out of
him. And more often than not, they’re pretty good with having a conversation with me
and telling me what’s going on. And right now because of the pandemic, I don’t really
see body language unless their screens are on . . . like we don’t have the signs because
they’re not required to turn their screens on. So all I see is their little tile that says their
initials or picture of their face, you know, they see me live, but you know, it’s kind of
hard to kind of read body language when you don’t get to see them.
Coach A also mentioned talking to parents as part of his role in supporting mental health:
Also, the parents will actually reach out and say, “Hey, this just happened in our life just
to give you a heads up. If you see my son acting this way, can you please take note of that
and let me know.” So, communication amongst parents and players is super important,
even if it is just kind of watching and seeing if the player acts differently. Then, I’ll just
kind of pull them aside.
40

Creating a Safe Place
In addition to talking to players, coaches have the responsibility of creating a safe
environment for players (Kroshus, 2017). During the qualitative interviews, the theme of
creating a safe place emerged. Many coaches said this was one of the main ways they supported
mental health. Through allowing athletes to feel comfortable, coaches are often approached by
their athletes for help even before seeking professional help (Boldero & Fallon, 1995; Mazzer et
al., 2012; Rickwood, 1995). Mazzer et al. (2012) explained the importance of the coach-athlete
relationship as positively influencing the person’s mental health by developing trust and support.
All coaches interviewed in the qualitative portion of the study agreed that relationships
and creating a safe space were important in how they support mental health. Coach E was a 28-
year-old male boys and girls soccer coach as well as a math teacher and athletic director at the
school. Coach E had 1 year of varsity head coaching experience and said he strives to create a
space to promote mental health:
I think first and foremost, it is just making sure that the students are comfortable in the
space that they’re working at. I think some of the groundwork as a teacher, for me in my
classroom, would just be to be able to provide a positive environment where students are
excited to come in every day. And I think that has carried over to athletics, where if
students are comfortable where they’re at, they’re more inclined to put forth more effort.
And so as a result, I think in terms of the amount of mental health and wellness is a space
where they’re comfortable, where they feel comfortable sharing things. And for me to
kind of troubleshoot some things if they feel comfortable sharing with me. I make sure
they’re comfortable with me and comfortable with each other.
41

Coach C was a football coach with 135 students on his roster. Coach C was also a teacher
at his school and agreed that creating a space is important for promoting mental health:
Sports is a healthy mental space for them. It’s the space where you know, there’s no
danger. They usually are very open and coming to you with problems when it comes to
football. I don’t know about other sports and how building relationship with kids looks
like. I just know football has a very unique track record for building that type of
relationship and for kids to feel comfortable in coming to you with problems. Being a
coach and a mentor and somebody that works with these kids, you build those
relationships. They feel comforted in the fact that they can come to you with problems,
and I think that right there is a huge weight off their shoulders when it comes to mental
health.
Like Coach C and Coach E, Coach F also felt like the primary way she supports mental
health is by creating space in practice. Coach F was a 41-year-old female softball coach. Coach F
was also a school counselor in addition to coaching softball She gave an example of how she
creates space for her players:
I like to start off every practice with like, 5 minutes of just welcoming everyone and have
them think of one word that describes how they’re feeling for that day. And then just kind
of go over the fact that we’re a team, we’re gonna be together. Let’s focus on not just
practicing, but carefully taking care of our physical body and mental health. If they need
additional time, or they need to talk to someone, you know, we can take a break to make
sure they can share anything with me. I also like to finish off with like, a 15-minute,
yoga-like meditation, where I guide the students through it. And then there’s been times
where I’ve had conversations afterwards with the entire group about the stresses that
42

constantly happen throughout our lives and even topics like healthy relationships. And I
think the most important part is for them to be able to have a space where they can ask
questions, and don’t feel judged. They have someone that’s going to be able to guide
them to the right resources. I feel like a lot of the times students will ask their friends, but
their friends are trying to figure out their own lives as well, so they’re not able to help
them. I think they’re just there to listen, which is a good thing. But I feel like me being
part of the team and being a coach does help me guide students a little bit better when it
comes to their mental health.
Lack of Mental Health Referrals
Although mental health needs are greatest among youth (Mazzer et al., 2012), only a
small percentage of students will receive mental health services (Maag & Katsiyannis, 2010;
Suldo et al., 2014). Ideally, the coach partners with the school counselor and other adults at the
school to address mental health (Bissett et al., 2020; Goldberg, 1991). In the quantitative survey,
participants were asked how often they make mental health referrals for any of their players.
From never to more than five times a month, most responses skewed toward never. A total of 21
out of 32 (65.6%) said they never make mental health referrals. The second most common
response was about once a month, with six responses (18.8%). In addition, three participants said
they make two to three referrals a month. Lastly, one participant said they make mental health
referrals once a week and one participant said they make more than five referrals a month. The
survey responses regarding mental health referrals are depicted in Table 7.

43

Table 7
Survey Responses to How Often Coaches Make Mental Health Referrals
Response n %
Never 21 65.6%
About once a month 6 18.8%
Two to three times a month 3 9.4%
About once a week 1 3.1%
More than five times a month 1 3.1%

Of the seven coaches interviewed, three coaches spoke extensively about seeking
professional help for students who needed mental health support. Three coaches who shared
about seeking professional help worked full time at the school; two were teachers and athletic
directors and one was a full-time school counselor in addition to coaching. Coach B discussed
advocating for mental health through his 12 years of experience. He described making mental
health referrals as a physical education teacher and athletic director at the school:
As the coach, you have that relationship with those student athletes that other adults at the
school don’t have. Sometimes, you are the one that needs to immediately address the
situation. We might have a plan, but we have systems in place where if it’s something
serious like if a student is going to harm themselves or, you know, threatening suicide,
that’s an immediate action type of thing where we get to those four people immediately.
My primary go-to is our two counselors. They are phenomenal. Our other counselor is
our assistant softball coach, great human being. Both of them are Latino, both speak
fluent. It’s that great dynamic of having a male and female so that students feel
comfortable. We also have a school psychologist who is an amazing human being. He’s
awesome. And then we also have a clinical services supervisor.
44

Coach G, a female boys and girls volleyball coach with 3 years of head varsity coaching
experience, was also the athletic director and worked at the school as a teacher. She discussed the
ease of making mental health referrals for coaches who work full time at the school:
It would be extremely easy to make referrals. I know our mental health counselors and
everything. We have very ongoing conversations about our student athletes. But I think
for coaches who are probably walk-on coaches, that, I don’t know that they would be as
quick to make that referral, and also might not be able to see all of the signs as easily
because if they’re only seeing them in one scenario, which is at practice or at a game,
then they might not know. Somebody can present in a certain way when they’re with
their coach or with their team, and so walk-on coaches might not pick up on it as much as
a coach that is around that student more. We are trained. We know what we’re supposed
to do, but a walk-on coach may not have the same resources and may not be able to
recognize the signs of mental health. Also, walk-ons may not feel as confident to report
something as somebody who is a staff member.
Coaches Supportive of Mental Health
Gulliver et al. (2012a) stated students who sought mental health help were often
encouraged by others and had positive attitudes related to mental health from their coaches.
Castaldelli-Maia et al. (2019) encouraged coaches to be supportive of their athletes’ mental
health. Despite most participants not making mental health referrals for their players, there is
strong support for mental health based on the coaches’ surveyed perceptions. On a Likert scale
from 1 (strongly disagree) to 5 (strongly agree), 24, or 75% of coaches, responded they strongly
agree it is important for them as a coach to support mental health. With a mean score of M =
45

4.59, participants felt strongly in favor of supporting mental health. Table 8 shows the data for
participants’ survey perceptions of their role in supporting players’ mental health.
In addition, when the seven interview participants were asked about their response to how
some people feel coaches should not talk about mental health, all seven coaches disagreed.
Coach C shared how mental health is a pivotal part of their performance:
I mean, if there’s reasons why players don’t achieve their peak potential, one of them is
physically and the other is mentally. And really, you can have individuals that have peak
physical health and are in great shape . . . and they look the part, but they’re not mentally
strong. They’re not mentally healthy. So, they aren’t going to do the things that they need
to do to make themselves academically eligible to play sports and to put themselves in a
better place to be successful on the field.

Table 8
Survey Responses to the Coaches’ Perceptions of How Important Their Role Is in Supporting
Players’ Mental Health
Variable Count Average
It is important to me as a coach to support my players’
mental health.
32 4.59
1 (Strongly disagree) 3.1% 1
3 6.3% 2
4 15.6% 5
5 (Strongly agree) 75.0% 24

46

Coach B said that mental health affects the players in the game as well:
We really want to develop the whole person, but we really want to hone in on the mental
health side for our athletes, because it’s the least paid attention to. We talk about the
mental part of the game and the physical part of the game and many say, “Oh, you know,
sports are 90% mental.” Then why are coaches spending 90% of their time on the
physical? For coaches that think mental health isn’t a part of their job, they are 100%
wrong. I tell young coaches the most important thing about coaching, teaching, and
leading is relationships.
Coach E discussed how his perception changed throughout his career:
I think, at the beginning of my career, I would have said no, athletics has no space for
anything like mental health. My mindset as a coach was way different; when I started, I
was relatively young. But now that I’ve had some years under my belt, I realized that
there’s a lot of issues that go on that student athletes don’t share. I think sports is one of
the best spaces for things like that . . . to kind of come out to speak about things like that,
especially now more than ever. I’m definitely more mindful of mental health now, since
I’ve seen the impact technology has had on our student athletes.
Coach A agreed with the change in technology and social media:
I think mental health is huge nowadays, especially with social media. I mean back when I
was in high school, we didn’t even have like cell phones or like a pager. So now
everything’s out in the open and who knows what’s going on, you know. On our team,
we talk about thinking about what you put on social media.
The coaches interviewed all agreed it was their role to support mental health. The
findings of how coaches support mental health included talking to their players and creating a
47

safe place for athletes. Although the survey showed that most coaches seldom made mental
health referrals, most coaches felt it was their role to support mental health.
Results for Research Question 2
Research Question 2 was “What barriers, if any, prevent high school varsity head coaches
in Los Angeles from making mental health referrals?”
Stigma Toward Mental Health Support
Although mental health disorders often first occur during adolescence (Kessler et al.,
2005), many student athletes do not seek help due to various barriers (Gulliver, Griffiths, &
Christensen, 2012; Mazzer et al., 2012; Rickwood et al., 2007). Stigma is often cited as a
perceived barrier to mental health support (Bauman, 2016; Bird et al., 2018; Gulliver, Griffiths,
& Christensen, 2012; Moreland et al., 2018).
When coaches were surveyed from a scale of 1 (not a barrier) to 5 (extreme barrier) about
stigma being a barrier to student athletes seeking mental health support, responses skewed
toward stigma being a barrier. When asked about their perception of student athlete stigma
toward mental health, the most common response was a moderate 3 (37.5%), followed by 18.8%
responding 4. While 15.6% of coaches said student athlete stigma was an extreme barrier (5), the
same amount of coaches (15.6%) also shared that student athlete stigma was not a barrier (1).
However, when varsity head coaches were asked about whether the coach’s stigma toward
mental health was a barrier, the responses skewed toward not being a barrier. The most common
response was a 3 with 34.4%. The second most common response was 2 with 31.3% followed by
1 (not a barrier) with 21.9%. Lastly, both 4 and 5 (extreme barrier) had 6.3% of varsity head
coaches stating coach stigma was a barrier for their athletes. The survey responses regarding
coaches’ perceptions of stigma for athletes and coaches are depicted in Table 9.
48

Table 9
Survey Responses Regarding Coaches’ Perceptions of Barriers of Stigma for Athletes and
Coaches
Response
Stigma surrounding mental
health for athletes
Stigma surrounding mental
health for the varsity head
coaches
1 (Not a barrier) 15.6% 21.9%
2 12.5% 31.3%
3 37.5% 34.4%
4 18.8% 6.3%
5 (Extreme barrier) 15.6% 6.3%

During the interviews, three coaches discussed stigma as a barrier to their student athletes
seeking mental health support. All three coaches who brought up mental health stigma were their
school’s athletic directors and worked as full-time teachers at their schools. Coach E discussed
how the stigma has something to do with how the students feel they are being seen by others:
I think the first and foremost barrier that comes to mind is just the stigma around issues
of mental health. There’s this connotation that something going on within myself . . . that
I’m going to be seen as somebody that’s not all there mentally. So I think that’s been
around for many years. But for me, personally, I would say number one barrier is stigma
for students. I try to develop that rapport and let students know that we all feel like that
sometimes, and then we could all kind of push through those moments together.
Coach G mentioned how students do not always feel comfortable going to therapy due to stigma:
I’ve had a few athletes that have had a lot of mental health issues at the school. And even
though I know them, and they’ve been in my classes and I’ve had them for a long time, I
immediately will talk to our school counselor. But therapy is so stigmatized, and students
49

don’t always feel comfortable. They don’t want to go to therapy, but we know that
students might go to coaches to want to talk about things.
Coach B said students try to keep up a particular image among each other, and coaches can
contribute to the barriers:
You know in sports . . . in the sight of other males and females, you know that they
(student athletes) have to be studs or something. They have to be a certain way in front of
their friends. And coaches can be tough; we don’t all address mental health.
The coaches interviewed shared about how they address barriers, but also mentioned how
coaches can deter mental health support. Choi et al. (2013) and Jones et al. (2005) stated coaches
can play a role in preventing students from seeking mental health support. Research has
suggested more partnerships between stakeholders to address barriers (Moreland et al., 2018;
Suldo et al., 2014; Swann et al., 2018). Coach B shared about how he addresses mental health
stigma with his players:
Hey, you know, you’re not alone. I said, I’ve been there. I’ve struggled. I said, I’ve gone
to counseling, I said, I went to this counseling. And this really helped me, it helped me,
help me get out of depression, helped me get out of a funk and help me, you know, go
through these things. He’s a freshman, and I said, “Look, if you have to go to your
sessions with your therapist, that’s okay . . . that’s all I need to know.” I need to be
supportive of that. If I want our kids to have good mental health support, I have to
support them first and foremost, and I have to model it as a leader. And I got to be open
to it. And I can’t go back to that old school mentality because I was there.
50

Lack of Mental Health Training for Coaches
Mental health training was another barrier discussed in the literature (Ferguson et al.,
2019), as some coaches minimize or are not aware of mental health concerns (Biggin et al.,
2017). When the 32 coaches were asked if they have received adequate mental health literacy
training as a coach, many said they agreed with that statement. The most common response was
“Strongly agree” with 31.3%. The next largest groups were “Neither agree nor disagree” and
“Strongly disagree,” with 21.9% in each group. The survey responses for coaches receiving
mental health literacy training is displayed in Table 10.
When asked about their ability to identify signs of mental health concerns in their
athletes, the participant responses skewed toward that not being a barrier. The most common
response (31.3%) stated the coach’s ability to identify signs of concern was a “1,” or not a
barrier. The second most common response was a “3” with 25% followed by “2” with 21.9%.
The responses are depicted in Table 11.

Table 10
Survey Responses to Coach Receiving Adequate Mental Health Literacy Training
Response
I have received adequate mental health literacy
training as a coach.
# Count
Strongly disagree 21.9% 7
Somewhat disagree 9.4% 3
Neither agree nor disagree 21.9% 7
Somewhat agree 15.6% 5
Strongly agree 31.3% 10

51

Table 11
Survey Responses to Perceived Barriers of Coaches Not Being Able to Identify Signs of Mental
Health Concerns
Response
As the varsity head coaches, not being able to identify signs of
mental health concerns
1 (Not a barrier) 31.3%
2 21.9%
3 25.0%
4 12.5%
5 (Extreme barrier) 9.4%

Despite a large number of coaches reporting having received adequate mental health
literacy coach training and stating they were able to identify signs of mental health concerns,
many have not received mental health training. Furthermore, most coaches have a strong interest
in receiving mental health training (Hegarty et al., 2018). When surveyed about how often they
are trained in mental health topics, 43.8% reported they had never received any training. The
second most common response was about once per season with 40.6%. According to DeSocio
and Hootman (2004), many coaches lack the knowledge of how to get students help, while Maag
and Katsiyannis (2010) stated mental health is often underfunded in schools. Furthermore,
coaches should receive specifically targeted training to support mental health (Rickwood et al.,
2005). Table 12 and Figure 4 record how often coaches were trained in mental health–related
topics.

52

Table 12
Survey Responses to Coaches’ Training in Mental Health Topics
Q18: How often are you trained in mental health
related topics as a coach?
Count
% of
data
Confidence interval (%
of data)
Never 14 43.8% 28.2% to 60.7%
About once during the season 13 40.6% 25.5% to 57.7%
About two to three times during the season 3 9.4% 3.2% to 24.2%
About four to five times during the season 2 6.3% 1.7% to 20.1%

Figure 4
Survey Responses to Coaches Receiving Mental Health Training

During the qualitative interviews, all coaches mentioned one significant barrier to mental
health referrals and students receiving support is mental health literacy for the coach. Coach A,
Coach B, Coach F, and Coach G all shared they felt they knew whom to seek out for help at their
53

schools, but also mentioned how not all coaches or schools have that same knowledge or
support. Coach A said coaches do not always know whom to go to for mental health referrals:
One of the biggest barriers is knowing where to go. I mean, knowing where to go? Like,
what’s the first step? I mean, who do you reach out to? What’s accessible, what’s not
accessible? We got a really good nurse at our school. And then we got the school
psychologist, so we have a good network. I know other public schools are totally, you
know, different. Some just don’t have the same resources.
Coach A continued to explain that there are more resources at the college level: “I think at the
college level, the support is there. Depending on the school, for the athletes at the high school
level, there’s support. I mean as a community college coach, there’s more for the players.”
Coach G mentioned that, as a teacher, she feels connected and can make the referral. However,
she said a walk-on coach may not know how to identify needs and navigate where to seek help:
I think that in general, I don’t know how well coaches are connected or feel supported by
the school. And, you know, for me, I’ve worked at the school for so long and I’m very
connected. I know our mental health counselors and everything, so it would be extremely
easy. We have ongoing conversations about our student athletes. But I think for coaches
who are probably walk-on coaches, I don’t know that they would be as quick to make
that referral, and also might not be able to see all of the signs as easily. Because if they’re
only seeing them in one scenario, which is at practice, or at a game, then they might not
know, if they’re to see any contradictions or things like that. Somebody can present in a
very certain way when they’re with their coach or with their team. And so they might not
pick up on it as much as a coach that is around that student more. So I think, for one,
recognizing those signs and symptoms for mental health can be a barrier. And then those
54

resources. If they’re not a teacher, what are you supposed to do? We are trained. We
know what we’re supposed to do, but a walk-on coach does not. Outside of the CIF
mandated online trainings that we all do, I don’t know if coaches would necessarily feel
as confident to report something. Because it’s not maybe as ingrained in them as it is with
somebody who is a staff member at the school.
Coach F mentioned that mental health concerns are sometimes hard to spot for coaches
who are not counselors:
I think it’s the fact one that it’s hard to be able to spot signs. I want to say spot, because,
you know, there’s certain behaviors to look out for. As a counselor, I’m able to see that
there’s certain behaviors students project. There are certain things that they will say and
there are patterns to look out for. For example, if a student’s constantly late and it’s a
pattern, then that’s a discussion. Sometimes it could be as simple as my parents dropped
me off late and it’s not necessarily the student’s fault. Other times, there could be other
things that might be happening . . . like they’re kind of forcing themselves to go to
practice, but they really don’t want to be there. So there’s more room for exploring. I had
a student who was pitching, and she was having a really hard time. She was having a
good game, but in the middle of the game, decided to throw her glove down, walked off
the pitching mound, and then ran into the bathroom and didn’t want to come out. So
that’s a very obvious situation where I needed to step in. But if you’re not a counselor,
then you would just think they’re just being a brat or they’re not showing good
sportsmanship. There’s more to that in regard to that case. And usually there usually is.
55

The participants all shared they have not received any formal mental health literacy training but
may have received mental health training in different roles. Coach G said that his school requires
him as a teacher to take a mental health training module:
We do have to take a, I think it’s like a 20–30-minute module, every year at the
beginning of the school year where there’s certain things you should look out for in terms
of like mental suicide, depression, and things of that nature. So that’s the protocol. I
forget what it’s called. I think it’s like school trainings for teachers. So, we need a
refresher every year as well.
Coach C also described the mental health training he has received as a teacher in response to the
pandemic:
Since the pandemic, since they’ve gotten a gauge for the mental health of the teachers,
right now the stress level is above a 10 on a scale of 1 to 10. The school brought in a
social worker who is giving us mindfulness techniques, we’ve talked about mindfulness. I
guess mindfulness is a stress reduction technique. And I guess you could wrap that up in
mental health somewhat.
Coach F mentioned a need for coaches to receive further training regarding mental health to
support her players:
I definitely feel like, as coaches, there needs to be some sort of workshop, where coaches
are able to learn a little bit more about the psychology behind the sport. I know they
know everything about the sport: the rules, the drills, and everything. And they’re
probably amazing coaches, but I feel if we add that mental health piece component to it,
we will see a rise in student confidence. And I’m a big believer that sports really do help
shape our communities, our students, and provide them in a different avenue. And it
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gives them that camaraderie that team teamwork, community spirit, it also keeps them
healthy.
Young People Not Receiving Professional Help
Another major barrier to student athletes seeking professional help is that most will go to
those they are most comfortable with rather than seeking professional help (Gulliver, Griffiths, &
Christensen, 2012; Rickwood et al., 2007). The coaches interviewed all shared about how their
athletes were comfortable coming to them. However, some coaches feel they need to bring in
professional help. Coach G explained the importance of drawing boundaries and asking for help:
Coaches may or may not be equipped to have those conversations, but they might also
feel like they do. I think a difficult balance for the coach is to be a confidant for an athlete
and knowing where the line is between being a confidant and needing to take it a step
further and get professional help for that athlete. That’s kind of an important thing. But I
think that sometimes coaches might just feel like, “Oh, my athletes are confiding in me.”
And that’s great. And we’ve built this really great personal relationship. But there’s got to
be boundaries, and I think boundaries can get lost in coaching.
Coach C explained there just is not enough time as a coach to address all the mental health
concerns:
I think for them the biggest barrier is comfort and trust. So, when it comes to students,
they have to feel comfortable, and they have to trust in the fact that they’re coming to you
with some type of mental health issues. I wish there was enough time in the day to do the
things that we need to do. I wish I could sit down, have 131 conversations with each of
my students, but you can’t speak to just every single one. So, at the end of the day, all
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you are is a football coach, and you don’t have enough time to do both. I think that’s a
huge barrier: time and resources.
Coach C continued to describe the campus resources:
I’m glad to see that there’s actual intervention teams, and somebody that I can go and
walk to on campus if there’s a problem. And they can follow up and do what’s necessary
on their behalf. There are too many kids that need mental health support. . . . I don’t see
the time, or the task force to be able to keep up with the numbers, which I think now is
just out of control, especially with the pandemic.
The interviews indicated that barriers to mental health support for student athletes include
student stigma and the need for additional mental health literacy training for varsity head
coaches. Coaches need to be able to identify when to refer their players to professional support,
because young people tend to go to those they already trust.
Results for Research Question 3
Research Question 3 was “How are high school varsity head coaches in Los Angeles
evaluated, if at all, in their role of supporting mental health?” The varsity head coach plays a
pivotal role in supporting mental health (Castaldelli-Maia et al., 2019; Goldberg, 1991); Coaches
are trusted to encourage, motivate, and educate their student athletes on mental health topics
(Mazzer & Rickwood, 2015). Coaches may set standards for themselves to actively support
mental health for their athletes (Mazzer & Rickwood, 2015) but are not being evaluated in any
way by others.
When surveyed from strongly disagree to strongly agree about whether a school
administrator or athletic director evaluated how they supported mental health for the players, the
participant responses skewed toward agree. A total of 65.7% positively agreed that they were
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evaluated, with 34% strongly agreeing with the statement. A total of 12.5% neither agreed nor
disagreed, while 21.9% disagreed. Three participants (9.4%) strongly disagreed that their
administrator or athletic director evaluated how they support mental health. The participant
responses are displayed in Table 13.
However, during the interviews, all seven participants said they were not evaluated in any
way to support mental health. When asked about whether they were evaluated as a coach for
supporting mental health, Coach F and Coach G responded with a simple “no, we’re not
evaluated.” Coach C said he was unaware of any type of evaluation at his school and assumed
that to be a part of coaching:
Nothing to my knowledge. To my knowledge . . . I could be wrong. I’ve not seen
anything along the lines of evaluations for that. I mean, I guess it’s just implied that it
comes with the territory of coaching, I guess, thrown in the blanket of everything.

Table 13
Survey Responses to Coaches Being Evaluated for Mental Health Support
Response
My school administrator or athletic director evaluates how I
support mental health for my players.
Strongly disagree 9.4%
Somewhat disagree 12.5%
Neither agree nor disagree 12.5%
Somewhat agree 31.3%
Strongly agree 34.4%

Coach E shared how he is evaluated for creating the environment for his team, but he is not
evaluated for mental health:
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In terms of specifically just mental health, I would say no, but definitely just the
environment of the team, I would say would fall under that domain. Making sure the
student athletes are comfortable and that they’re taking care of business, and that they’re
comfortable with me and each other. I would say it doesn’t fall under that umbrella for
me. So, I would say if I am evaluated particularly just to mental health . . . that I would
say no.
Coach A said they have other staff who address mental health:
We’re not evaluated. I mean . . . we have school psychologists on staff for the school . . .
so if we do have an issue, we can reach out to them. But I mean, we’re not evaluated, so
to speak. At least I don’t know if we are. . . . Maybe we are.
In addition to taking on the role as basketball coach, Coach B is also a teacher and the athletic
director at the school and was able to reflect on his role in response to the question:
I’m an advocate for these kids, and these kids need a good strong athletic director. That’s
why I do it. I am evaluated as a teacher, but not so much as a coach or with mental health.
I make my players go to mandatory study hall every day. . . . The interesting part is that I
am the driver of our athletics program. So, I’m not evaluated, per se. If there was an issue
that comes up as an athletic director, my principal will sit down with me, my AP will sit
down, and we will talk through those things.
Results for Research Question 4
Research Question 4 was “How do high school varsity head coaches in Los Angeles
implement self-determination theory motivational strategies on their sports teams?”
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Autonomy
Self-determination theory states players have the need to make individualized decisions
so they can accept and regulate their own goals (Deci et al., 2017). Through sharing leadership
with student athletes, coaches support autonomy and positive mental health (Keegan et al.,
2009). During the quantitative survey, when the varsity head coaches were asked about how
often they offer choices during their practice, the most common response was “sometimes” with
34.4%. From “never” (1) to “always” (5), the mean response was 3.03 and the median response
was 3.0. When asked about how often they allow players to set their own goals during practice,
the most common response was “about half the time” at 28.1%. The second most common
response was “sometimes” at 25%. From “never” (1) to “always” (5), the mean response was
3.06, with 3.0 being the median. When asked about how often the coach provides explanations
for decisions made for their team, the majority of responses was “always” (5) with 59.4%. The
second most common response was “most of the time” at 31.3%. The mean response was 4.41.
These survey data are shown in Table 14 and Table 15.

Table 14
Survey Responses to Autonomy Strategies Part 1
In a typical week in practice, how often do you use the following strategies on your team?
(Autonomy)
Response Count Average Median
I offer choices during practice. 32 3.03 3.0
I allow my players to set their own goals during
practice.
32 3.06 3.0
I provide explanations for decisions I make for the
team.
32 4.41 5.0

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Table 15
Survey Responses to Autonomy Strategies Part 2
Response
I allow my players to
set their own goals
during practice.
I offer choices during
practice.
I provide explanations
for decisions I make
for the team.
Never 12.5% 9.4% 0.0%
Sometimes 25.0% 34.4% 9.4%
About half the time 28.1% 18.8% 0.0%
Most of the time 12.5% 18.8% 31.3%
Always 21.9% 18.8% 59.4%

When asked about how they incorporate choices into their practices, if they do, the seven
coaches provided numerous sport-specific examples. Coach F allows the players on her softball
team to try out for their position or a new one for that season:
Before the season starts, when we start practicing, we’re able to give students every
single year the opportunity to choose a new position. They have to work for it, and they
got to earn. We usually have one or two students that want to play shortstop or want to be
pitcher. Those are the popular ones. We give them the opportunity to try out for the
position during practice. We give them an opportunity, but we also tell them, “Look,
you’re going to be back-up for that position.” So, they still have that space in that room to
be able to play that part of that position that they want to. Yes, we have those
conversations where we tell the student, “You’re better at second base because this is
what I’ve seen,” but if they really want to try, say left field, we’ll do it. We’ll make those
changes. Now they’re not necessarily going to start, but they’ll have like an inning or two
where they’ll be able to, be able to show off their skill.
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Mageau and Vallerand (2003) discussed how autonomy-supportive behaviors allow players to be
more engaged and perform better. Coach E, the 28-year-old boys and girls soccer coach,
explained that when players have a voice, they feel more comfortable:
What kind of tactics do we play today? I like to get their voice a lot. So, what happened
during the last game? What things can we modify? What things can we and you
individually adjust? If you have a voice in the game plan, you’re going to be more
inclined to put forth more effort. So, in practice I’d explain: Today we’re going to do X
amount of conditioning drills. Do we want to do option A or do want to do option B?
How do we feel today, in terms of the team collectively? Did we have a rough day? If it’s
been a rough day, let’s take care of that conditioning work on Wednesday. I give them a
lot more choice. Just because they want to be there. They’re willing to work hard. And
it’s a space that they’re comfortable in.
In addition to conditioning choice, Coach E discussed providing choice outside of practice:
And right now, we’re designing the logo for shirts for our soccer team. Usually when I
give too much choice, it just ends up going down this rabbit hole where things don’t get
done. So I give them a choice between A, B, and C logo. I told them it’s ultimately for
you guys. You guys decide what you want. Discuss amongst yourselves. They were very
receptive to that.
Coach C also lets his football players choose their uniforms and their team captain:
I’ve let players make decisions on uniforms. I’ve also let players make decisions on who
they feel is the captain. I’ll get their input and then I’ll make my decisions. I will give
them the opportunity to choose certain activities that we do in practice, I will tell them
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that their effort and output will either get them out of conditioning or make them
condition more.
Coach F explained how she allows some of the team leaders to lead drills and stretches:
We like to target leaders within their group age. So, for example, if we have seniors and
juniors in the varsity team, then we will grab one or two leaders from the 12th grade and
one or two leaders from the 11th grade and we rotate. The leaders might lead drills and
stretches for the team. Of course, there are certain drills we have them do, because it’s
part of the requirement and we also want to make sure that they’re safe and they don’t
hurt each other. We also give them the opportunity to lead a different drill that they’re
interested in. For example, we had someone lead 10–15 minutes of yoga. Also, two
students brought up wanting to go to the batting cages to work on their batting, so they
looked up the location, called them, and we set up the date with the permission slips for
the parents.
Coach A initially responded that he does not provide choice in his practices but realized how he
does allow athletes to pick their own teams and strategies:
I do this annual thing where I pick two players and they have to pick team, their team, for
a best of three series. And they have to think about it because they’re gonna need pitching
for three games, they’re gonna need catchers, and they have to follow all the rules that I
have to follow as a coach in terms of substitution. If you come and watch those games,
they’re more excited during that environment than they are in an actual game
environment. It’s a bragging right thing and what not.
Coach D also provides choices but emphasized that she limits the choices the players get to
choose from:
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I would say that if I give choices, it’s, it’s picking between my choices. So, for example,
here’s the three drills we’re going to focus on today. Which order would you like to do
them in? Perfect. Or we’re doing conditioning and we’re doing drills. Would you like to
do conditioning first or after the drills? Okay, you guys have this many sets of lines to do
today. Would you like to break it up or do the full set now? So, I will give choices in that
regard. And mostly because I want them to, I want them to be able to be successful. But I
definitely would control the choices that they’re being given. So, I’m not going to say to
them, “Do you want to work on hitting today or passing?” I’m also not a huge fan of kids
picking their own teams. If it’s a quick get into groups of three, maybe, yes. But if it was
like six on six, pick teams, or captain’s pick teams . . . I almost will never do that.
However, when asked for volleyball-specific examples, she shared how she trusts the team to
make individualized decisions during the game:
I understood that speed was the strength for that team, so I allowed them to kind of have
that freedom and creativity to create their team based on what they understood their
individual skills and how they worked together. I definitely give playing freedom in sense
like that, like what they’re doing on the court at the end of the day is up to them. If you’re
thinking about it, and you make a decision based on what you’re thinking about, I’m fine
with that. You’re gonna make mistakes, you’re gonna be successful, but as long as you
made a decision based on something that you read on the court, I’m fine because I know
you’re thinking. I try to coach my teams to be independent on the court in games so that I
can focus on what’s happening on the other side. They can control what’s on their side,
and I’ll control what’s on the other side for them. And that has made my teams a little bit
more successful without me having to baby them and tell them exactly what to do.
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Relatedness
The positive mental health needs of student athletes are met through healthy
relationships, relatedness, and the relationship with a coach, which is a protective factor against
mental health symptoms (Armstrong & Oomen-Early, 2009). To promote positive mental health
relationships, coaches can convey care and respect to their players (Niemiec & Ryan, 2009) and
encourage friendships within the team (Keegan et al., 2009; Mageau & Vallerand, 2003).
From the quantitative survey, coach perceptions were positively skewed toward
relatedness to their players. When surveyed about how often they feel connected to individual
players from “never” (1) to “always” (5), most varsity head coaches (53.1%) responded “always”
(5). The second most common response was “most of the time” with 40.6%. The average
response was 4.44. When asked how often they convey care and respect to players, the
participants overwhelmingly responded “always” (5) with 87.5%. Furthermore, none of the 32
participants responded “never” or “sometimes.” When asked about how often the coach
emphasizes team culture and team building in a typical week of practice, 87.5% of coaches
responded “always” (5). The second and only other response was “most of the time” (4) with
12.5%. The coaches surveyed strongly perceive they provide relatedness strategies. Survey
responses to relatedness strategies are shown in Table 16 and Table 17.
During the interviews, when coaches were asked to describe how they have connected
players during practice, many shared their strategies of creating team bonding experiences.
To increase connectiveness, Coach G emphasizes team building on her teams to build trust:
Definitely pre-Covid, we did a lot of team building. I think that it’s important that the
players feel like they’re in a safe space. In sports, you are put in a situation where you are
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very vulnerable. And in order to perform well in a vulnerable situation, you need to be
with people that you trust. And so, building trust is really important amongst them.

Table 16
Survey Responses to Relatedness Strategies Part 1
In a typical week in practice, how often do you use the following strategies on your team?
(Relatedness)
Response Count Average Median
I feel connected to individual players on my team. 32 4.44 5.0
I convey care and respect to my players. 32 4.84 5.0
I emphasize team culture and team building. 32 4.88 5.0

Table 17
Survey Responses to Relatedness Strategies Part 2
Response
I feel connected to
individual players on my
team.
I convey care and
respect to my players.
I emphasize team culture
and team building.
Never 0.0% 0.0% 0.0%
Sometimes 3.1% 0.0% 0.0%
About half
the time
3.1% 3.1% 0.0%
Most of the
time
40.6% 9.4% 12.5%
Always 53.1% 87.5% 87.5%

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Coach G continued to explain the importance of her players knowing each other:
Something I learned over the years is, we as coaches are so quick jump into the X’s and
O’s and the nuts and bolts, and we miss the fact that these kids don’t know each other.
And I think even more than that, when you have a team that knows each other really well,
you’re always going to have one or two or three kids that are coming in fresh.
Sometimes, I think it’s really easy for us to skip that part of connectedness. At the
beginning of the season, we will start for at least the first couple of weeks, where in every
drill that we do, we’ll say our names. I think people like to know that people know who
they are. Also, in the beginning, you have to partner with somebody new every time we
change drills. For instance, my centers, I like them to partner together. I like them to get
their group together, but it’s an idea of I don’t want to have those cliques, and I don’t
want people to feel like they’re not connected. It’s just an easy way to make sure that,
you know, we’re not getting divided and everyone is getting to know each other.
Coach A also fosters team bonding experiences to create an atmosphere where players are
comfortable:
I think I tried to create an atmosphere where the kids can feel comfortable and come hang
out near the baseball field club houses, like all the time during lunch and nutrition. We
also do this bowling night fundraiser where the kids, the parents, and everyone comes,
and we rent out all 32 lanes. It’s just a big ol’ get to know each other type of deal. We
also take a bus to San Diego during Spring Break. We play games down there and the
parents are not allowed to stay at our hotel or take their kids anywhere. It’s just us.
Coach D also utilizes gatherings outside of practice to enhance team culture:
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One thing that I schedule for team bonding is an escape room. I’ll put them in a group
just to get the relationship a little bit better in a fun environment. Every year, I also
register them for a lot of travel tournaments, things like that. They always want to room
with their best buddies, but I always choose the room, so I make sure that I’m grouping
each of the players differently to make sure that they’re kind of expanding and working
with other people that they may not necessarily be comfortable with. On my team, there
really is no first string and second string, so there is no division in terms of I’m a starter
and you’re not kind of thing. In the sense, they’re competing against each other and
improving along the way, but it’s not this negative “I’m going to take your spot” kind of
competition.
Coach C discussed how football brings players closer together compared with other sports:
I think that more so than any other sport, football for whatever reason brings people
closer. I think when you bleed together, there’s more of a connection. You know that the
guy next to you in a foxhole . . . there’s a bond when you’re fighting for your life next to
somebody else and you’re building that type of relationship. And those relationships go
on forever. I’ve seen more people that have played football remain friends.
Coach F utilizes mentorship and pairs older players with younger ones to develop relationships
on the softball team:
We like to use mentoring on our team. We’ll take a junior and pair them with a ninth
grader or a senior with the 10th grader. We show a lot of podcasts in regard to being a
student athlete, which I think is really important for them. It’s always about relationships.
We’ve had students who have graduated and who have come back and have gone to
support us and coming back to assist and provide support.
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Coach B, a basketball coach with 12 years of varsity coaching experience, utilizes the center of
the court for daily talks:
So, we teach the kids from day one, if they’re freshmen or whatever grade that they’re
coming to our program, that the center jump circle is a sacred place and that you have to
be invited into this center court. And the only person that can invite you into the circle is
a coach. And then as our captains develop, we will give them some permission to do that,
but it’s the coach. I put them all on the baseline and make them run sprints. Every time I
tell you center court, it’s a sprint to the circle. In this circle, it’s where we have our
communication at the start of the practice about what we’re doing today and what our
objective is for the day. Okay, we’re working on offense today and we’re trying to get in
these plays. This is our focus of emphasis. I put the practice plan up where they can see it
when they walk in the gym. At the end of the practice, we wrap it up, invite the captains
in first, okay, seniors, juniors, sophomore, freshman. And then you know, we do our
cheer at the end. We start and end practice at the center court.
Coach A explained that players may be hesitant to approach him with questions:
You know, they might, they might be apprehensive and asking me a question. Because
sometimes I can be tough to read or whatnot. So, they might be hesitant, but once they
get to know who I am, and they know that they can throw anything off me, and I think
they can throw anything off their teammates as well.
To allow players to share openly, Coach E first shares about his own life with the players:
In the beginning, the players don’t tend to feel that related to me. So that’s when I kind of
share my story of how my mom was a very young mom, 16 years old, still in school, and
how difficult it was for me growing up . . . sharing some of those experiences. So that
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will connect me to them. So, they’re able to kind of share their stories with me. During
our talks, we get to talk about team cohesion, team dynamics, and just talking about their
roles and my expectations. I use examples from my own high school experience and let
each player know they can contribute to the team.
Competence
Competence refers to an individual’s experience of mastering a behavior (Niemiec &
Ryan, 2009; Ryan & Deci, 2002). Coaches develop competence in players by providing specific
feedback and noncontrolling competence feedback for reinforcement of desired behaviors
(Andrea et al., 2013; Keegan et al., 2009). When the coaches were surveyed about how often
they give one-on-one feedback to players, most (87.5%) responded with “always.” In addition,
when surveyed about how often they give specific feedback to players, 84.4% responded
“always” as well. Coaches largely responded that they provide specific feedback to support
player competence. The survey responses for competence-supported strategies are displayed in
Table 18 and Table 19.

Table 18
Survey Responses to Competence Strategies Part 1
In a typical week in practice, how often do you use the following strategies on your team?
(Competence)
Response Count Average Median
I give one-on-one feedback to my players. 32 4.84 5.0
I give specific feedback for improvement to my team. 32 4.84 5.0

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Table 19
Survey Responses to Competence Strategies Part 2
Response
I give one-on-one feedback to my
players.
I give specific feedback for
improvement to my team.
Never 0.0% 0.0%
Sometimes 0.0% 0.0%
About half
the time
3.1% 0.0%
Most of the
time
9.4% 15.6%
Always 87.5% 84.4%

The interview responses were also congruent with the survey findings, as all seven
coaches gave specific examples of how they provide competence-supportive feedback. Coach E
offered the following description:
So typically, when I give feedback to my team, I only do two or three things. You don’t
want to overload them with information. Early in my career, I realized I would give too
much info, and then everything would kind of get lost in the mix. So now, I only give
them three tangible things as a team. I’ll give a specific example for my goalie. We have
a goal kick for my goalie . . . these are your options, ABC. A, you’re gonna go base,
support your defenders here, passing the ball. If he’s not there, we’re going to skip to the
guy in the middle. If he’s not there, then option C, we’re gonna split and now we’re going
to skip over to the other guy.
Coach G also described giving specific directions to players:
Yeah, I think one thing to keep in mind is that feedback should be specific. When we say
things like, do that better, the kid has no idea what you’re talking about. So, if they’re
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making a pass, I might say something like, make sure your platform is strong. Then, they
can just focus on that, and it’s not too overwhelming. It takes away all the guessing on
what to focus on . . . like was my feet not in the right position or was I standing up or
swinging my arms. Drop your shoulder, you know, try to get it over a little bit more,
something like that. So they can just focus on what you told them.
Coach E emphasized praising individuals publicly with the team:
The big thing for me is being able to reward them when positive things happen. So yes,
maybe my striker scored a goal. He did, he had a fantastic bicycle kick. But everything
started because Phil in the back made that great pass. And everything started from there.
So, you, Phil, you had an extremely big role in the process. That one’s for my goalie.
Another example is I wanted my forward to play smarter because we either lost the ball
or B, he would just kick it away. I told him as soon as you recognize that ball rolling to
that direction, I want you to sprint as fast as possible as you can to that red line. So, every
time he would do that, I would praise him tremendously. And he would be gassed. So,
just kind of rewarding him for those small things, praising him in front of the team at the
end. But during the last team huddle, so and so did a phenomenal job defending, I saw the
way you sprinted all the way from the top of the field all the way to the back. And
nobody saw that. But I saw that. And as a result, the other team didn’t score nine . . . they
scored eight. But those little things will ultimately make the team a lot better.
Coach A explained staying positive in baseball is important because there are many
individualized failures in the sport:
For example, if we’re working on push bunting, and someone’s been struggling with that,
and they execute it in the game, then obviously, I’m pretty vocal about it during the
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game. And then I’m going to make a point, at the end of the game, in front of everybody
that this person did that. I also preach to our guys all the time about, you know, practice
being over, but you guys can still get individual work done, whether it’s in the cages,
extra ground balls, whatever the case may be. Those individuals that put in the extra work
. . . all of a sudden, you’ll see it pay off on the field. And as a coach, you got to be able to
jump on that right away and acknowledge that individual. And I’ve been on the other end
of the thing to where I might have ripped into somebody, you know, and felt bad about it.
And at the end of the game, or even a practice, or maybe the next day, I’ve apologized in
front of the team. I’m apologizing to you for saying this, or for doing that, I shouldn’t, I
should have handled that much differently. So, you kind of send a message that it’s okay
to make mistakes, talk about it, and move past it. Over the years, I’ve tried to get better at
being more positive than focusing on negative stuff because baseball is a sport of failure
. . . probably the biggest sport of individual failure that there is. As a coach, I might have
to pick up some of my players. Hey, man, you’re going to get him again, don’t worry
about it, you know, let’s move on. Just one strike out, who cares? You’re gonna have
many other at bats . . . you might strike out again, you might get a hit.
Coach D tends to give more constructive feedback and explained the reasoning:
I think for me, I’ve been told I could give more praise and I like I’ve been trying to do
that as well, make that change. I’ll always give feedback whenever I see something
wrong. I think sometimes it comes off as negative. I want to make sure that you’re aware
of it so that you make the change. It’s still my coaching theory to make sure that they’re
not doing it for me because like I’m not going to be on the court playing with them. You
know, I’m directing them. And at the end of the day, I’m just trying to make them grow
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as people to kind of be able to take charge in a situation themselves without having to
look to somebody else.
Coach G discussed the importance of providing positive reinforcement during practice:
And then I think that there’s got to be a lot of positive reinforcement. Because as coaches,
we are very critical. And we can naturally be negative. Students don’t always take that
super well. I always kind of think of that sandwich, where you have that positive, then the
critical part, and then another positive thing, because you want them to hear you. At the
end of practice, we also review three positive things that happened today. Was it
something that you did? Was it something a teammate did? Was it something that we did
as a group? As far as positivity, I’ll usually say something like, “Hey, you did a great job
of being low. Now, let’s get your platform stronger.” So obviously, for in a game, it’s
going to be more specific.
Coach G also tries to coach the players’ mindset to take on challenges:
You’ve got to change your mindset. And so, changing that mindset of, instead of saying
to yourself, I hope they don’t serve it to me again, saying to yourself, I hope they serve it
to me again, I hope I can prove to them . . . let me show you. This helps build your own
confidence. Whether it’s a set reading, getting blocked, or getting a clean set . . . you’re
like okay, set me again, set me again, challenge accepted. So, I think being able to change
your mindset on a situation is really important.
Coach E sets small wins and small goals for his struggling team:
For my soccer team, they weren’t very strong when I came into the picture; they had been
struggling for a few years. The culture around the team was just very, very negative. So,
they feel that, didn’t have that confidence piece and was kind of down. So I started by
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just giving them small wins in practice and giving them that taste of success. So
obviously, the goal shifted from winning, to let’s keep this, keep it under five goals or
let’s score a goal today. Let’s do that today. Because if I would have told that team that I
want to win every single game, that’s just not realistic. And I pride myself to be
transparent. So, giving them those small wins . . . at the end of the season, yes, we had a
very bad season in terms of stats, but they were excited to come back and be able to work
hard for this upcoming season. The reality is, we’re not going to be great in two or three
months, but we’re going to get better gradually. So that by the time you become seniors,
you guys are going to be a beast team. They were very receptive to that, they were very
excited, which was pretty cool to see.
Summary
This chapter presented the analysis of data collected through 32 survey responses, seven
interviews, and literature. The study aimed to examine potential barriers for Los Angeles varsity
head coaches in supporting student athletes’ mental health and highlight strategies that promote
positive mental health for student athletes. The findings suggest that coaches promote mental
health for their players by providing a safe environment and by talking to their players. In
addition, coaches need to provide more mental health referrals for their players. Barriers to
mental health for student athletes include stigma toward mental health, lack of mental health
literacy training for coaches, and young people not going to professionals for help. Varsity head
coaches are not evaluated to support the mental health of their players. Although coaches said
they were evaluated, the interviewees could not give details as to how they were evaluated. The
findings suggest evaluation for mental health support may be a missing topic in coach
evaluation.
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Table 20
Self-Determination Theory Strategies Implemented by Coaches Interviewed
Autonomy Relatedness Competence
Choose new positions

Tactics/strategies

Asks opinions about
modifications of strategy

Ask them what they see on the
court/what the opponent is
doing.

Choosing logo/design for team
uniforms

Choosing team captain

Choose certain activities to do
during practice.

Choose between drills.

Choose when to do
conditioning.

Allowing some players to lead
drills/practice

Allow players to choose their
own teams and strategies.
Team bonding (trips,
tournaments, escape rooms,
bowling fundraisers)

Having the team pick new
partners throughout drills

Creating mentorship
relationships for younger
players

Strategic grouping for
lodging and drills

Having players call each
other by name during drills

Having a place for students to
spend time in

Creating routines when the
team talks

Coaches sharing their own
stories

Coaches sharing about clear
roles and expectations
Don’t overload players with
too much information.

Feedback should be specific
and should focus on one
thing at a time.

Praising individuals publicly

Praising effort and hard
work during and outside of
practice

Coaches apologizing for
mistakes to team

Have players think for
themselves and focus on
mindset.

Focusing on the positive and
sandwiching feedback

Set small goals and small
wins.
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Coaches are utilizing the self-determination theories of autonomy, relatedness, and
competence to support positive mental health for their players. Additionally, based on coaches’
perceptions, most coaches are promoting positive relationships among the team members. Lastly,
coaches provided competence-specific feedback to players based on the survey and interviews.
Chapter Five will present a summary of the research findings, implications for practice, and
recommendations for future research.

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Chapter Five: Discussion
Although adolescent participation in sports has been positively linked with lowering
mental health symptoms, there is a dire need to address the mental health needs of adolescent
athletes (Donohue et al., 2015). Due to causes such as injury, overtraining, public scrutiny, and
managing ongoing competitive pressure, student athletes experience a high prevalence of mental
health disorders (Gulliver, Griffiths, & Christensen, 2012; Rice et al., 2016). Many young people
experience mental health issues but do not seek help on their own (Mazzer et al., 2012). Barriers
to mental health for young athletes include stigma, lack of mental health literacy, negative
experiences while seeking help in the past, and structural systems (Gulliver, Griffiths, &
Christensen, 2012; Mazzer et al., 2012; Rickwood et al., 2007). As role models whom the
players trust, sports coaches play a pivotal role in supporting mental health in their actions
(Castaldelli-Maia et al., 2019; Goldberg, 1991; Mazzer et al., 2012). The coach is perceived to be
a chief advocate of mental health who partners with the school counselor in addressing and
preventing mental health disorders (Goldberg, 1991; McGorry et al., 2011). The findings in this
study should enhance the knowledge of the coach’s role in supporting student athletes’ mental
health and implicate gaps in addressing mental health barriers.
Purpose of the Study
This study had four purposes based on the gaps in knowledge of high school varsity head
coaches in Los Angeles, California. The first purpose surveyed how varsity head coaches in Los
Angeles promote mental health. The second explored the varsity head coaches’ perceived
barriers to mental health for their athletes. The third purpose examined how varsity head coaches
are evaluated in their role of supporting mental health. The fourth purpose surveyed the
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implementation of positive mental health strategies using self-determination theory by high
school varsity head coaches.
Research Questions
The following research questions guided this study:
1. How are high school varsity head coaches in Los Angeles promoting mental health, if
at all, for their student athletes?
2. What barriers, if any, prevent high school varsity head coaches in Los Angeles from
making mental health referrals?
3. How are high school varsity head coaches in Los Angeles evaluated, if at all, in their
role of supporting mental health?
4. How do high school varsity head coaches in Los Angeles implement self-
determination theory motivational strategies on their sports teams?
Methodology
This study utilized a concurrent mixed-methods study to examine how high school
varsity head coaches in Los Angeles support mental health services for their athletes. Both
quantitative and qualitative components were utilized and triangulated with literature to draw
findings. The quantitative data were collected through a self-reported survey with 17 close-ended
questions collected from 32 varsity head coaches in the CIF Los Angeles Section. The survey
questions contained close-ended responses that addressed the four research questions. In addition
to collecting the varsity head coaches’ demographics, a 5-point Likert scale was implemented.
The qualitative data were gathered through one-to-one virtual interviews with seven
varsity head coaches in the CIF Los Angeles Section. The interview consisted of 11 open-ended
questions and was implemented in a semi-structured manner. Each interview question addressed
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a specific research question and explored the participant’s experience, knowledge, interpretation,
opinions, positions, feelings, and ideal position in their own narrative (Merriam & Tisdell, 2016).
Findings
The findings in this study are based on the quantitative and qualitative data collected
through the perspective of the varsity head coach. In relation to the current literature and the
conceptual framework, this section provides an analysis of the data according to the four
research questions.
Research Question 1
Research Question 1 was “How are high school varsity head coaches in Los Angeles
promoting mental health, if at all, for their student athletes?” The findings from the data analysis
suggest high school varsity head coaches in Los Angeles promote mental health by talking to
players and providing a safe environment for their players. Significant findings also indicated a
lack of mental health referrals from coaches despite coaches being supportive of their players’
mental health.
The first significant finding is that coaches promote mental health by talking to their
players. As coaches have a significant influence on mental health for their athletes through their
actions (Castaldelli-Maia et al., 2019; Goldberg, 1991), coaches interviewed discussed
supporting their students by talking to them and spending time checking in with them. A total of
34.4% of coaches who were surveyed shared they have weekly conversations related to mental
wellness, and 28.1% said they have conversations two to three times a month. When asked how
they support mental health, coaches also said they read the students’ body language, talked to
parents, and simply asked questions to see how their players were doing.
Coaches also promote mental health by creating a safe environment for their players.
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Kroshus (2017) explained it is the responsibility of the coaches to create a safe environment.
Three coaches shared during the interview that the primary way they support mental health was
creating a safe space for their athletes. Coaches explained they incorporated time in their
practices such as check-ins at the beginning of practice or discussions at the end of practice.
Mazzer et al. (2012) affirmed the importance of the coach-athlete relationship as positively
influencing the person’s mental health.
The third significant finding was the lack of mental health referrals made by coaches.
From the survey, when asked how often they make mental health referrals for their players, most
coaches (65.6%) responded they never make referrals. Of the seven coaches interviewed, three
coaches comprehensively shared about how they seek mental health support for their students
who needed it. The coaches who were knowledgeable were full-time staff at the school, with two
being athletic directors in addition to their roles as coach. The findings are consistent that few
students will receive mental health services despite the need (Maag & Katsiyannis, 2010; Mazzer
et al., 2012; Suldo et al., 2014). Furthermore, there are disparities in mental health services
among marginalized communities (Alves-Bradford et al., 2020). Goldberg (1991) and Brown
and Blanton (2002) have suggested that coaches partner with the school counselor and other
professionals to facilitate mental health referrals. It is also recommended that there be more
partnerships between adults and coaches to promote mental health support (Moreland et al.,
2018; Suldo et al., 2014).
The fourth significant finding is that coaches are supportive of their players’ mental
health. When asked about their roles in supporting mental health, all seven interview participants
agreed it was an important topic and part of their role as a coach. Additionally, 75% of coaches
felt strongly in favor of supporting mental health. Castaldelli-Maia et al. (2019) reaffirmed the
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importance of the coach’s support of the athlete’s mental health, and Gulliver, Griffiths, and
Christensen (2012) further confirmed that when student athletes were encouraged by coaches,
more students were likely to have help-seeking behavior.
Research Question 2
Research Question 2 was “What barriers, if any, prevent high school varsity head coaches
in Los Angeles from making mental health referrals?” The findings from the data analysis
indicated the barriers to mental health for student athletes include stigma toward mental health,
lack of mental health literacy training for coaches, and young people not receiving help from
mental health professionals. Stigma is often cited as a perceived barrier to mental health support
(Bauman, 2016; Bird et al., 2018; Gulliver, Griffiths, & Christensen, 2012; Moreland et al.,
2018). When asked about the stigma of players toward mental health, the most common response
was that stigma was a moderate barrier, with 37.5%. However, coaches surveyed did not feel that
their own stigma was a contributing barrier to mental health. Based on the interviews, three
coaches discussed stigma as a significant barrier to their student athletes seeking mental health
support and noted students do not always feel comfortable in therapy and worry about how
others are seeing them.
The second significant finding for perceived barriers is the lack of mental health literacy
training for coaches. Coaches need to be able to identify when to refer their players to
professional support. Despite the fact that a large number of coaches (31.3%) reported having
received adequate mental health literacy coach training and stated they were able to identify
signs of mental health concerns, 43.8% had never received any mental health training. On the
contrary, all seven coaches interviewed mentioned mental health literacy for coaches was a
significant barrier. Interestingly, four coaches mentioned they knew how to identify signs of
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need but said other coaches may not. One coach said that coaches who are walk-ons may not
know whom to seek out for help, and another coach said they receive mental health training from
other roles they hold at the school. Ferguson et al. (2019), Biggin et al. (2017), and DeSocio and
Hootman (2004) confirmed the finding that some coaches lack the knowledge and are unaware
of mental health concerns due to a lack of mental health training.
The third finding of barriers pointed to young people not receiving help from mental
health professionals when they need it. When interviewed, all seven coaches shared about their
athletes being comfortable approaching them. Additionally, some coaches felt comfortable
bringing in professionals to support their players. Literature confirmed most students would
rather go to those they are comfortable with over seeking professional help (Gulliver, Griffiths,
& Christensen, 2012; Rickwood et al., 2007).
Research Question 3
Research Question 3 was “How are high school varsity head coaches in Los Angeles
evaluated, if at all, in their role of supporting mental health?” The findings from the data analysis
ascertained that many varsity head coaches are not evaluated in relation to supporting the mental
health of their players. From the surveys, most coaches (65.7%) positively agreed that they were
evaluated in how they support mental health. However, during the interviews, all seven
participants said they were not evaluated in any way regarding their support of mental health.
One interviewee reflected on their role as athletic director and how there is no current evaluation
for coaches. Research recommendations include coaches setting standards to actively support
mental health for athletes (Mazzer & Rickwood, 2015).
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Research Question 4
Research Question 4 was “How do high school varsity head coaches in Los Angeles
implement self-determination theory motivational strategies on their sports teams?” The findings
from the data analysis indicated that some coaches are utilizing the self-determination theories of
autonomy, relatedness, and competence to support positive mental health for their players. Table
20 includes a list of strategies implemented by Los Angeles varsity head coaches who were
interviewed.
In regard to autonomy, during the quantitative survey, 34.4% of varsity head coaches
shared they “sometimes” provide choice in a typical week of practice. When asked about how
often they allow players to set their own goals during practice, the most common response was
“about half the time.” Furthermore, the majority (59.4%) of coaches said they always provide
explanations for decisions made for their team. During the interviews, all seven coaches gave
sport-specific examples of providing choice, from allowing players to choose their position to
how and when athletes want to complete drills. Mageau and Vallerand (2003) confirmed players
perform better and are more engaged when autonomy-supportive practices are in place.
Next, many coaches perceive themselves to be implementing strategies to promote
positive relationships on their team. Based on the quantitative survey, coach perceptions were
positive skewed toward relatedness to their players. When surveyed about how often they feel
connected to individual players, most varsity head coaches (53.1%) responded they always feel
connected. When asked how often they convey care and respect to players, the participants
overwhelmingly responded “always,” with 87.5%. Furthermore, when surveyed about how often
the coach emphasizes team culture and team building in a typical week of practice, 87.5% of
coaches responded “always.” During the qualitative interviews, coaches said team-building
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activities included taking team trips together and strategically grouping players together during
drills to help them get to know each other better. Keegan et al. (2009) and Mageau and Vallerand
(2003) confirmed the importance of encouraging team bonding and encouraging friendships on
the team. Moreover, Armstrong and Oomen-Early (2009) explained the relationship between a
coach and player is a protective factor against mental health symptoms.
Lastly, coaches provided competence-specific feedback to players based on the data
analysis. When surveyed about how often coaches give one-on-one feedback to players, most
(87.5%) responded with “always.” Likewise, when surveyed about how often they give specific
feedback to players, 84.4% of coaches responded “always.” The interview responses were also
congruent with the survey findings, as all seven coaches gave specific examples of how they
provide specific competence-supportive feedback. Andrea et al. (2013) confirmed the need to
provide specific praise.
Implications for Practice
The findings from this study revealed key strategies that address barriers to mental health
and support positive mental health for student athletes. This study may inform the practices of
coaches, administrators, athletic directors, and mental health professionals who work with this
student athlete population. As the chief supporter of mental health whom the players trust
(Castaldelli-Maia et al., 2019; Goldberg, 1991; Mazzer et al., 2012; McGorry et al., 2011),
coaches can benefit from the findings in the study to better understand their role in supporting
mental health for their student athletes. As many coaches feel it is part of their role to support
mental health, they will do so by intentionally talking to players and providing a safe space to
discuss wellness topics. In addition, the findings implore coaches to make more mental health
referrals and connect their players to mental health professionals, despite players having a
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preference to go to trusted adults. Lastly, coaches can use self-determination theory strategies
currently utilized by coaches (Table 20) to promote autonomy, relatedness, and competence.
Administrators and athletic directors can also utilize the findings of this study to make
changes in supporting student athletes. As there are currently no policies of evaluation to support
mental health for high school student athletes (Vella & Swann, 2021), school leaders should
implement a form of evaluation for their school. Administrators and athletic directors should
create standards and protocols for the school in supporting mental health. More specifically,
school leaders can develop an evaluation tool that aids them in evaluating mental health support
given by the coaching staff. Next, administrators and athletic directors can support mental health
for student athletes by providing relevant mental health literacy training and appropriate positive
mental health training such as self-determination theory strategies to coaches. Coaches who work
at the school in another role may be aware of mental health professionals and where to seek help,
but not all coaches receive the same training.
Lastly, mental health professionals may utilize the findings to add to their knowledge of
working with this specific population. Although the barriers to adolescent mental health are
lucidly documented in the literature, especially addressing stigma (Bauman, 2016; Bird et al.,
2018; Gulliver, Griffiths, & Christensen, 2012; Moreland et al., 2018), the findings confirmed
the role of mental health practitioners in supporting other adults such as coaches and
administrators. Furthermore, the findings confirmed the importance of improving partnerships
between mental health professionals and other adults the students trust, such as the coaching staff
and administrators (Goldberg, 1991; Moreland et al., 2018; Suldo et al., 2014). It is pertinent for
mental health professionals to provide mental health literacy training and teach common signs of
mental health disorders.
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Limitations
Several limitations to the study need to be considered. The paucity of literature on high
school sports coaches and mental health support limits the coverage of understanding of the
topic. First, the study was limited to representing Los Angeles coaches in the CIF-LA Section
and may not be generalizable to other settings. Because of my current affiliation, I did not collect
data from LAUSD coaches to reduce bias. Second, the study was limited to only the perspective
of athletic coaches, specifically high school varsity head coaches. It did not directly address the
occurrence of mental health support from different stakeholder perspectives, including the
administrator, the school mental health provider, the parents, or the student athlete. The survey
instruments and qualitative interviews focused solely on the perception of the coaches, and
responses varied based on the sample participants. The high school varsity head coach study
participant is also assumed to be a supportive advocate of mental health and assumed to care for
the mental health of the players. Third, the findings of the current study were limited by the
small sample size of the quantitative surveys (N = 32) as well as by the coach interview subgroup
size. For future causal studies, a larger sample of varsity head coaches would allow for
relationship discussions.
Fourth, due to the Covid-19 pandemic, high school sports practices and contests have
been drastically affected and even placed on hold. The participant responses were limited to
sharing their varied experiences supporting student athletes prior to and during the pandemic.
Fifth, learning the barriers to mental health as perceived by the varsity coaches does not directly
address the ultimate goals of increasing the likelihood of coaches addressing mental health
concerns and coaches making mental health referrals. Further study would be needed to address
the improvement of the mental health of young athletes.
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Next, the coach’s implementation of self-determination theory motivational strategies is
highlighted to support positive mental health on the team, but the presence of strategies does not
guarantee the positive mental health of individual players. The inverse statement is also true; the
lack of self-determination theory strategies implemented in practice does not necessarily
negatively affect the mental health of athletes. This study was not intended to demonstrate a
causal link between strategies and mental health outcomes. Rather, the current methodology was
used to draw emerging themes for significant findings and topics for future study.
Because qualitative research is a subjective process by nature, another limitation includes
a plethora of variables beyond the coaches’ perceptions that could contribute to or hinder high
school athletes’ mental health. For transparency, this study provides details of the coding themes
and data extracted in the qualitative analysis. Finally, the study did not take into account cultural
considerations such as race, ethnicity, education, and socioeconomic status of the coaches or
players, which are significant variables that could be explored in future studies.
Recommendations for Future Research
The following recommendations for future research are based on the findings from this
study:
1. Future study should replicate this study with a larger sample of surveys and
interviews to allow causal and correlational discussions.
2. Future study should replicate this study and explore the perspective of other
stakeholders such as parents, school professionals, referees, administrators, athletic
directors, volunteers, assistant coaches, and student athletes.
3. Future study should survey current and potential school policies and procedures that
address evaluating mental health support for student athletes.
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4. Future study should seek to identify and evaluate specific mental health literacy
programs for sports coaches.
5. Future study should examine curricula that implement self-determination strategies
with sports teams.
6. Future study should explore cultural considerations such as race, ethnicity, education,
and socioeconomic status of the coaches or players, which may be significant
variables for access to mental health.
Conclusions
This study surveyed how varsity head coaches in Los Angeles promote mental health and
their perceived barriers to mental health. The study also explored how the coaches were
evaluated in their roles in supporting mental health and collected examples of coaches’
implementation of positive mental health strategies using self-determination theory. The findings
in the study confirm that coaches promote mental health by talking to their players and providing
a safe environment for discussion. The findings also notate the lack of mental health referrals
despite the coaches’ desire to support mental health. In regard to barriers, the findings confirmed
previous research revealing stigma, lack of mental health literacy training for coaches, and
student athletes going to individuals they are comfortable with over professionals. Furthermore,
coaches are not being evaluated in how they support mental health, and findings recommended
standards to be implemented. Lastly, coaches may benefit from utilizing the sport-specific self-
determination theory strategies shared by the coaches interviewed.

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Appendix A: Research Participant Introduction Email
Dear Coach/Athletic Director/ Administrator,
You are invited to participate in a graduate research study conducted by a Doctoral Candidate at
USC Rossier School of Education. This study is designed to learn about mental health barriers
and strategies implemented by Los Angeles Varsity Head Coaches. The findings will assist in
identifying the perceived barriers to mental health as well as assist in devising best practices for
coaches to promote positive mental health for student athletes. The University of Southern
California’s Institutional Review Board has approved this research study (IRB # UP-20-00516).

You are asked to participate in this study if you are a current Varsity Head Coaches in the CIF
Los Angeles Section with at least one year of head varsity coaching experience and coaching a
team sport.

If you agree to participate in this research study, you will be asked to complete a 5-minute
survey. Also, you will also be invited to participate in an optional online video interview that will
take approximately 30 minutes to complete. You do not need to complete the interview to
partake in the survey. The interview will be recorded to ensure that what you say is captured
accurately.

Your participation is voluntary, and you have the right to withdraw at any time from the survey.
All data collected will be confidential and pseudonyms will be utilized in the final report. There
are no anticipated risks to participants.

If you have any questions or concerns regarding participation in this study, please contact me.
Thank you very much for your consideration.

Survey Link Here:
QR Code Here:
Thanks so much!
USC Doctoral Candidate Researcher

108

Appendix B: Participant Informed Consent Form
You may complete this survey on either a computer or a mobile device, but the view on the
computer is more user-friendly.

STUDY TITLE: Time Out for Mental Health: Barriers and Strategies for High School Varsity
Head Coaches in Los Angeles

PRINCIPAL INVESTIGATOR: Edwin Yau, Doctoral Candidate

FACULTY ADVISOR: Rudy Castruita, EdD

You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. You should ask questions about anything that is unclear to
you.

PURPOSE
The purpose of this study is to explore how high school varsity coaches in Los Angeles promote
mental health and perceive barriers to mental health support for their players.
You are invited as a possible participant because of your experience as a varsity head coach of a
team sport (10 or more players on roster) in the CIF-Los Angeles City Section.

PARTICIPANT INVOLVEMENT
If you agree to participate in this research study, you will be asked to do a short survey that will
take approximately 5 minutes to complete. You will also be given the opportunity to participate
in an interview that will take approximately 30 minutes to complete, but this is optional after this
survey. Your participation is voluntary, and you have the right to withdraw at any time from the
survey and/or interview without penalty. There are no anticipated risks to participants associated
with this study.

PAYMENT/COMPENSATION FOR PARTICIPATION
There is no compensation for participating in the study.

CONFIDENTIALITY
The members of the research team and the University of Southern California Institutional
Review Board (IRB) will be the only people who have access the data. The IRB reviews and
monitors research studies to protect the rights and welfare of research subjects.
When the results of the research are published, no identifiable information will be used. All data
collected will be confidential and pseudonyms will be utilized in the final report. Furthermore,
all data collected will be destroyed upon completion of the study.

INVESTIGATOR CONTACT INFORMATION
If you have any questions about this study, please contact me at xxx-xxx-xxxx or the Faculty
Advisor, Dr. Rudy Castruita at the University of Southern California.

IRB CONTACT INFORMATION
109

If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board.
( ) I have read this form and consent to my participation in this study.
( ) I do not consent and do not wish to participate.

110

Appendix C: Survey Questionnaire
Q1 Are you the current Varsity Head Coach of a team sport (10+ on roster) with at least 1 year of
experience in the CIF Los Angeles City Section?
Yes
No

Q2 What is your gender?
Male
Female
Other
I prefer not to state

Q3 What is your age?
________________________________________________________________

Q4 What is your ethnicity?
African American
Asian American/ Pacific Islander
Caucasian
Latino
I prefer not to state
Other ________________________________________________

Q5 How many seasons have you served as the varsity head coach?
________________________________________________________________

Q6 I am the current varsity head coach of the following team (select all that apply).
Baseball
Basketball (Boys)
Basketball (Girls)
111

Competitive Cheer
Football
Lacrosse (Boys)
Lacrosse (Girls)
Soccer (Boys)
Soccer (Girls)
Softball
Volleyball (Boys)
Volleyball (Girls)
Water Polo (Boys)
Water Polo (Girls)
Other ________________________________________________

Q7 Please list the sport and the number of student athletes on your team roster?

Q8 Regarding Coach’s Evaluation and Training: Please mark how much you agree with each
statement.
Strongly
disagree
Somewhat
disagree
Neither agree
nor disagree
Somewhat
agree
Strongly
agree
My school
administrator
or athletic
director
evaluates how
I support
mental health
for my
players.

Q9 Regarding Coach’s Evaluation and Training: Please mark how much you agree with each
statement.
Strongly
disagree
Somewhat
disagree
Neither agree
nor disagree
Somewhat
agree
Strongly
agree
112

I have
received
adequate
mental health
literacy
training as a
coach.

Q10 How often are you trained in mental health related topics as a coach?
Never
About once during the season
About 2-3 times during the season
About 4-5 times during the season
More than 5 times during the season

Q11 How often do you do the following related to promoting mental health?
Never About once a
month
2-3 times a
month
About once a
week
More than 5
times a
month
How often do
you have
conversations
about topics
related to
mental health
wellness with
your team?

Q12 How often do you do the following related to promoting mental health?
Never About once a
month
2-3 times a
month
About once a
week
More than 5
times a
month
How often do
you make
mental health
referrals for

113

any of your
players?

Q13 Please mark how much you agree with each statement.
1 (Strongly
disagree)
2 3 4 5 (Strongly
agree)
It is important
to me as a
coach to
support my
players’
mental health.

Q14 In a typical week in practice, how often do you use the following strategies on your team?
Never Sometimes About half
the time
Most of the
time
Always
I allow my
players to set
their own
goals during
practice.

I offer
choices
during
practice.

I provide
explanations
for decisions I
make for the
team.

Q15 In a typical week in practice, how often do you use the following strategies on your team?
Never Sometimes About half
the time
Most of the
time
Always
114

I feel
connected to
individual
players on my
team.

I convey care
and respect to
my players.

I emphasize
team culture
and team
building.

Q16 In a typical week in practice, how often do you use the following strategies on your team?
Never Sometimes About half
the time
Most of the
time
Always
I give one-on-
one feedback
to my players.

I give specific
feedback for
improvement
to my team.

Q17 Which of the following do you find to be barriers to student athletes receiving mental health
support?
1 (Not a
barrier)
2 3 4 5 (Extreme
Barrier)
Stigma
surrounding
mental health
for athletes.

Stigma
surrounding
mental health

115

for the varsity
head coaches.
As the varsity
head coaches,
not being able
to identify
signs of
mental health
concerns.

As the varsity
head coach,
not knowing
who to talk to
when one of
their players
needs mental
health
support.

Players not
seeking
mental health
support.

116

Appendix D: Interview Protocol
Introduction
My name is Edwin Yau and I am a current student at the University of Southern California
conducting a research assignment for my dissertation. Thank you so much for meeting with me
and giving your time to complete this interview.

My study is designed to explore how coaches promote mental health to student athletes at their
schools. I’ve chosen you to participate because you are the Varsity Head Coach at your high
school and would be expert in understanding your team and your role as a coach.

I will simply be asking you questions to explore your expertise and evaluate your answers. I will
not be sharing this interview with anyone and will be the only one listening to the recording.
Your answers to the questions will be analyzed for my study. This interview will remain
confidential and your name will never be shared. Is it ok if I record this interview? Do you have
any questions? Let me know if you have any questions or concerns before we begin. Do I have
your permission to record this interview? Do I have your permission to begin the questions?

Questions (with transitions)

I will have a set of questions that I will ask you but will be flexible for you to answer questions
however you’d like. I will be following-up with questions after some answers and may ask you
questions without a set order.
I’ll begin by asking some information about your coaching experience working with athletes
and then go further into some things you may or may not do in practice.

1. Tell me about your coaching background.

2. What do you think your role is in supporting mental health? (RQ1)

3. Tell me about how have you supported mental health, if you have, for your players?
(RQ1)
a. Follow-up: Who you would talk to if you’ve identified that your player needs
help.
b. How did you support them Pre-pandemic

4. Some people think mental health isn’t a topic coaches should address with their
players. What do you think about this statement? (RQ1, RQ2)

5. Tell me about any mental health training you’ve received as a coach, if you have. (RQ
2, RQ3)

6. How are you as the high school varsity head coach evaluated for supporting mental
health for your players, if at all? (RQ3)

117

7. Research says there are many reasons why student athletes have a hard time accessing
mental health services. What do you think about this statement? (RQ2)

8. What barriers, if any, do you think keep high school varsity head coaches from making
mental health referrals? (RQ2)
a. Ideally, what do you think would address these barriers?

9. Research says autonomy, or providing choice, supports positive mental health. Do you
provide your players with choice during your practices? (RQ4)
a. Please describe ways, if you have, included choice in your practices?
b. In an ideal practice on your ideal team, how would you include choice on your
team?

10. Research also says relatedness, or the ability to connect, supports positive mental
health. Connection to the teams and to the coach. (RQ4)
a. Please describe ways you have, if you have, connected players in your practices?
b. In an ideal world, how would you include connectedness on your team?

11. Research also says providing specific praise and feedback supports positive mental
health. (RQ4)
a. Please describe ways you have, if you have, implemented specific praise and
feedback?
b. In an ideal world, how would you provide specific praise and feedback for your
team?

Closing:
Thank you so much for your time and sharing your expertise with me. Is there anything else
that I did not ask that you feel would be important in me learning about mental health and
coaching?

If I think of an additional question or follow-up, is it ok for me to contact you?

Thanks again for your time.

118

Appendix E: Question Alignment Matrix
Instrument RQ 1
How are high
school varsity
head coaches in
Los Angeles
promoting
mental health,
if at all, for
their student
athletes?
RQ 2
What barriers,
if any, prevent
high school
varsity head
coaches in Los
Angeles from
making mental
health
referrals?
RQ 3
How are high
school varsity
head coaches in
Los Angeles
evaluated, if at
all, in their role
of supporting
mental health?
RQ 4
How do high
school varsity
head coaches in
Los Angeles
implement self-
determination
theory
motivational
strategies on
their sports
teams?
Quantitative
Survey
Q11-Q13 Q17 Q8-Q10 Q14-Q16
Qualitative
Interview
Q2-Q4 Q4, Q7, Q8 Q5-Q6 Q9-Q11

119

Appendix F: Coaches’ Survey Responses to Perceived Barriers Question
Which of the following do you find to be barriers to student athletes receiving mental health
support?
# Field Minimum Maximum Mean
Std
Deviation
Variance Count
1
Stigma surrounding mental
health for athletes.
1.00 12.00 4.16 3.50 12.26 32
2
Stigma surrounding mental
health for the varsity head
coaches.
1.00 12.00 2.88 2.51 6.30 32
3
As the varsity head coaches, not
being able to identify signs of
mental health concerns.
1.00 12.00 3.13 3.03 9.17 32
4
As the varsity head coach, not
knowing who to talk to when one
of their players needs mental
health support.
1.00 12.00 1.94 2.03 4.12 32
5
Players not seeking mental
health support.
1.00 12.00 5.03 4.10 16.84 32

# Question
1 (Not
a
barrier)
2 3 4
5
(Extreme
Barrier)
Total
1
Stigma
surrounding
mental health
for athletes.
15.63% 5 12.50% 4 37.50% 12 18.75% 6 15.63% 5 32
2
Stigma
surrounding
mental health
for the varsity
head coaches.
21.88% 7 31.25% 10 34.38% 11 6.25% 2 6.25% 2 32
3
As the varsity
head coaches,
not being able to
identify signs of
mental health
concerns.
31.25% 10 21.88% 7 25.00% 8 12.50% 4 9.38% 3 32
4
As the varsity
head coach, not
65.63% 21 6.25% 2 21.88% 7 3.13% 1 3.13% 1 32
120

knowing who to
talk to when one
of their players
needs mental
health support.
5
Players not
seeking mental
health support.
9.38% 3 18.75% 6 31.25% 10 15.63% 5 25.00% 8 32

121

Appendix G: Coaches’ Survey Responses to SDT Strategies Question
In a typical week in practice, how often do you use the following strategies on your team?
Autonomy 1-3
Relatedness 4-6
Competence 7-8

# Field Minimum Maximum Mean
Std
Deviation
Variance Count
1
I allow my players to set their
own goals during practice.
22.00 26.00 24.06 1.32 1.75 32
2 I offer choices during practice. 22.00 26.00 24.03 1.29 1.66 32
3
I provide explanations for
decisions I make for the team.
23.00 26.00 25.41 0.90 0.80 32
4
I feel connected to individual
players on my team.
23.00 26.00 25.44 0.70 0.50 32
5
I convey care and respect to my
players.
24.00 26.00 25.84 0.44 0.19 32
6
I emphasize team culture and
team building.
25.00 26.00 25.88 0.33 0.11 32
7
I give one-on-one feedback to
my players.
24.00 26.00 25.84 0.44 0.19 32
8
I give specific feedback for
improvement to my team.
25.00 26.00 25.84 0.36 0.13 32

# Question Never Sometimes
About
half the
time

Most of
the
time
Always Total
1
I allow my
players to set
their own
goals during
practice.
12.50% 4 25.00% 8 28.13% 9 12.50% 4 21.88% 7 32
2
I offer choices
during
practice.
9.38% 3 34.38% 11 18.75% 6 18.75% 6 18.75% 6 32
3
I provide
explanations
for decisions I
make for the
team.
0.00% 0 9.38% 3 0.00% 0 31.25% 10 59.38% 19 32
122

4
I feel
connected to
individual
players on my
team.
0.00% 0 3.13% 1 3.13% 1 40.63% 13 53.13% 17 32
5
I convey care
and respect to
my players.
0.00% 0 0.00% 0 3.13% 1 9.38% 3 87.50% 28 32
6
I emphasize
team culture
and team
building.
0.00% 0 0.00% 0 0.00% 0 12.50% 4 87.50% 28 32
7
I give one-on-
one feedback
to my players.
0.00% 0 0.00% 0 3.13% 1 9.38% 3 87.50% 28 32
8
I give specific
feedback for
improvement
to my team.
0.00% 0 0.00% 0 0.00% 0 15.63% 5 84.38% 27 32

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Asset Metadata

Creator Yau, Edwin (author)

Core Title Time out for mental health: barriers and strategies for high school coaches

School Rossier School of Education

Degree Doctor of Education

Degree Program Education (Leadership)

Publication Date 04/15/2021

Defense Date 03/08/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag adolescent student-athlete support,athletic coaches,mental health support,OAI-PMH Harvest,self-determination theory

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Castruita, Rudy (committee chair), Cash, David (committee member), Hinga, Briana (committee member)

Creator Email edwinyau@ucla.edu,edwinyau@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-443733

Unique identifier UC11668615

Identifier etd-YauEdwin-9470.pdf (filename),usctheses-c89-443733 (legacy record id)

Legacy Identifier etd-YauEdwin-9470.pdf

Dmrecord 443733

Document Type Dissertation

Rights Yau, Edwin

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA