june 10, 2009 cory wallack, ph.d.. today’s goals review the changing landscape of college mental...
TRANSCRIPT
Responding to the Changing Landscape of College Mental Health with Comprehensive Crisis Intervention and Health Promotion Strategies
June 10, 2009Cory Wallack, Ph.D.
Today’s GoalsReview the changing landscape of college
mental health and the impact on provision of crisis intervention services
Explore both philosophical and practical concerns as they relate to effective crisis intervention services
Discuss readiness issues and questions that should be addressed before implementing crisis intervention strategies, programs, and protocols
Present an overview of Syracuse University’s comprehensive crisis intervention and health promotion model
At intake a client reports:Frequently feeling overwhelmed because of multiple
tasks, responsibilities, and demands to balanceDifficulty prioritizing tasks, difficulty multi-tasking,
difficulty balancing various responsibilitiesBarely keeping her head above water, always on the
runHigh performance expectations
Failure is not an optionExternal and internal expectations of being able to
do it allSense that multiple others are watching and
waiting to see if she fails or succeedsAlthough feeling pressured and overwhelmed, she is
fearful and/or unable to voice concerns to others for fear of how she may be perceived or judged
Back to Our Case Discussion:Life in a Counseling Center
Fast paced, high demand, high stress workIncreasing intensity of client presenting
problems coupled with increasing numbers of students seeking our services
On-going struggle with balancing individual clients, crisis response, group clients, outreach/education, paperwork, etc.
Burnout level is high, feeling stressed and overwhelmed is common
To know where we are going, we have to know how we got here…
The Changing Landscape of College Mental Health
High profile legal and media casesMIT, Ferrum College, George Washington, NYU
Increased emphasis on studies reporting high rates of hopelessness, depression, suicidal ideation
2005 National College Health Assessment 2006 Counseling Center Consortium Data Counseling Center Directors' reports
Garrett Lee Smith Act and JED FoundationVirginia Tech and Northern Illinois
The Changing Landscape of SU’s Counseling Center Services
2007 Statistics
4546 Client Contacts1523 Students
Receiving Services304 Emergency Assessments 216 Psychiatry
Clients18.2% of clients
report suicidal thoughts
2008 Statistics
4871 Client Contacts
1579 Students Receiving Services
440 Emergency Assessments
234 Psychiatry
Clients 23.6% of clients
report suicidal thoughts
Percent Change
7%3.7%
45%
8.3%5.4%
The Changing Mental Health Picture of Our Students
Students coming to campus with more significant mental health problems
Students described as:Facing overwhelming demandLacking coping skillsLacking distress tolerance
Connected-disconnected generationImpact of global eventsSoaring tuition ratesHelicopter parents
Responding to the Changing Landscape
Counseling Centers at maximum client capacity and lacking resources to meet the demand, yet students expecting to be seen immediately – e.g., increased crisis intervention
Increased demand on colleges and universities to demonstrate comprehensive crisis intervention, risk assessment, and suicide prevention programs
Increased employment of mandated assessments, mandated counseling, and forced leave of absences
Increased employment of behavioral consultation teams and case managers
Crisis Intervention Broadly Defined
Primary Prevention and Mental Health PromotionCoping skills, stress management, distress tolerance,
relationship skills Stopping the crises before it starts
Secondary & Tertiary Intervention Identifying and intervening with distressed students
Postvention and follow-upPolicies and Procedures
Mandated assessments, leave of absence, etcIdeally, your campus should address all of the
above
Where to Begin?The Importance of Sound Data
Know the national and local data on student mental healthGenerally speaking, campuses are safe placesA caution about how we reinforce the culture
of fearWhat is the unique nature of your campus
climate regarding mental health?Consider a needs assessment
Survey students and parentsSurvey faculty and staff
Where to Begin:Assessing Your Campus CultureSome questions to consider:
To what extent does fear impact your system?To what extent does the language of liability drive
decision making?What is the system’s level of distress tolerance?Are decisions being made rationally?Does your system tend to be reactionary or proactive?Does the system have a balance of prevention and
“intervention”Does your system recognize its limits, resources, etc and
create an appropriate model for your students, or is there a parallel process at play?
To effectively move forward, we have to thoroughly understand the culture we are working in and address it first
Philosophical Thoughts on the Role of Counseling Centers
College counseling centers can and should be the leaders in developing mental health protocols, policies, procedures, programsAt times, mental health professionals appear to
have lost their voiceToo often we defer to attorneys and
administrators who may not be expert in the field of mental health
The vast majority of counseling center staff aren’t qualified to conduct threat assessment
Counseling center staff can’t do it alonePublic health model is a vital approach
Where to Begin?The Importance of Theory
What are your driving beliefs, theories, and passions about crisis response?JoinerBaumeister“Well Theory”“Dark Nights of the Soul”
Essentially a mission, vision, and values statement
Sound theory allows you to connect all crisis intervention protocols back to central driving themes and values
Readiness Issues:Preparing the system
Gaining institutional support for the trainingAre relevant parties aware of the training?Will they be trained as well?Think top-down and bottom-up
Review relevant policies/procedures/protocols for the various departments you will be working withMandated assessments
Does your campus have a plan for after hours emergenciesRemember, our students live in a different time
zone than most of us!
Readiness Issues:Counseling Center Concerns
Is the counseling center staff trained and prepared to effectively respond to students in crisis?Crisis intervention is a specific skill setThreat assessment and suicide assessment
Is the counseling center staff prepared for consultation role?
Is there sufficient availability of emergency appointments and walk-in assessment?
Do you have sufficient availability of psychiatric services
If you don’t have sufficient resources to address the above, do you have referral resources in place?
Readiness Issues:Assessing Your Resources
Driving question: How can you most effectively and efficiently utilize existing resources?
TimeHow much do you have? How much do you ideally
need?People
Who are your gatekeepers?Who are your trainers?What involvement do you want faculty to have?What is the role of students?
MoneyCan you secure grants or partner with other offices to
enhance cost efficiency?
Readiness Issues:Marketing Your Efforts
How can you market the trainingPress releasesSchool newspaperMailingsSuicide prevention “Kick-off” event
Handouts to give participantsReference cardsCertificate of completion
Readiness Issues:Evaluating Your Program
What goals are you trying to achieve?Need to be realisticNeed a timelineNeed to be measurable
How to measure training “success”Increased referrals
Base-line data is ESSENTIALIncreased knowledge and skills
What tools are there available to use?
Primary PreventionStudents
Stress managementRelationship building skillsCommunication skillsConflict Resolution
ParentsTrainings frequently target identifying warning
signsWe have an opportunity to help parents better
support studentsHelicopter parents will attend workshops if
invited!
Secondary and Tertiary PreventionIndividually targeted efforts:
Behavioral consultation committeesTriage issuesCase managers
Broader targeted effortsDepression/Anxiety screening daysOn-line screeningsGatekeeper training
Postvention and Follow-upFactors to consider following student death
Do you have a formal crises response team?Do you have structured processes for
conducting debriefings?Are staff that conduct debriefings properly
trained?Do you have pre-established relationship with
appropriate media outlets?How is information communicated across
campus?What happens days, weeks, months after the
event?
Defining Our Philosophy and Strategy
Our beliefs, guiding theories, and passionImpact of loneliness, isolation, lack of coping
skillsContributions of Joiner and Baumeister
Answering these questions lead to a strategy….ConnectionDistress toleranceAcceptance
Comprehensive Crisis Intervention InitiativesMH awareness and
services utilization survey
M.H. policies/procedures which sensitively respond to high risk behaviors (e.g. MLOA, mandated evaluations)
Enhanced clinical services—increased emergency and psychiatric services; AMSR training for CC staff
Gatekeeper training for students, staff, & faculty-Campus Connect, Distressed Student Module
Life Skills Development—MBSR program
Facilitating Help-seeking behaviors--campus wide media campaign/
Sustainability Plan
Creation of Our Broad GoalsFoster a greater sense of individual and
community connection
Positively influence campus culture by creating a greater tolerance for and acceptance of emotional distress
Promote life enhancing skills
Destigmatize mental health problems and increase help-seeking behaviors
Creation of Specific and Measurable GoalsCampus Connect
Train ORL, Health Services, Academic Counselors
Measure increased knowledge, skill, efficacyMBSR
Train students life skillsMeasure perceived stress, physical symptoms,
coping skillsCounseling Center awareness and utilization
Pre and Post initiative assessments
We Had a Strategy and Goals...But, How to Resource It?
Perfect timing for securing the SAMHSA Suicide Prevention GrantStayed true to our philosophyComprehensive and preventativeAllowed for innovation and creativity
Grant allowed us to fill in the gaps and create a unique, philosophically connected program
Post-grant considered sustainability
The Program Has Been A Success…But, How Do We Sustain it?
Know, educate and involve key University playersGive them languageBring them “into” your broad visionWhat’s in it for them?
Communicate your program’s data resultsTailor your data to each different audience
Write a good “white paper”Outline the strategic plan succinctly and realistically go
for the “ask”University Institutionalization
Increased resourcesCross campus mental health task force
New Pieces To be AddedBehavioral consultation committeeParent/Family workshopsMore direct outreach and support for
students through Office of Multicultural Affairs and International Student Services
Integrated eating disorder treatment protocols
Community liaison working more directly with community agencies