Counseling and Psychological Services Executive Summary A Report to the Student Incidental Fee Committee October 2013

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1 Counseling and Psychological Services Executive Summary A Report to the Student Incidental Fee Committee October 2013 Counseling and Psychological Services (CAPS) provides mental health counseling to students, and consultation, outreach and education to OSU students, faculty and staff. We do this in order to (1) facilitate student s academic success, mental health, and personal development and (2) promote a culture of positive mental health at OSU. SUMMARY OF SERVICES PROVIDED Clinical Service Over several years, CAPS experienced a significant increase in both number of client appointments and number of clients seen, and we were granted by SIFC and ASOSU additional positions, which have allowed us to better serve (1) students clinical needs and (2) the campus s needs for the prevention of mental illness and suicide, and the need for the promotion of factors that help people thrive. In response to students and clinicians concerns that they weren t able to work together in therapy as regularly as needed, CAPS has adjusted its system to allow most students to be seen in individual therapy at least on an every-other week basis, and those in crisis to be seen more frequently until they were stabilized. Group therapy occurs weekly, so those students seen in this mode of treatment receive more frequent treatment. This adjustment was made for two primary reasons including: (1) many students concerns have become more severe and need more intervention/treatment to remit, and (2) even those students with mild to moderate concerns could not make adequate progress unless they were receiving treatment regularly. One will see from our data below that for the past couple of years we have increased the average number of sessions by 23.4%. The average number of individual counseling sessions per students is now 4.48, and the most common distribution of those appointments is over a period of 10 weeks, though many students have different patterns of use. We are still working out of a brief-therapy model, as evidenced by almost 75% of students being seen 5 times or fewer and 90% of students being seen 10 times or fewer, and our service to students has improved, and satisfaction has increased, both on the part of students and clinicians Individual and Group Counseling Data Total Number of Clients Number appts attended 7371 (79%) 5869 (76%) 5968 (75%) Number of groups Number of group sessions On Call 1.1% 2% 7% Same Day 17.2% 20.3% 18% No-Show/Cancel all appts 7.2% 9.5% 9.5% Triage 1.7% na na Average Individual sessions to 5 74% 77.70% 81.7% 6 to 10 16% 15.70% 11.4% % 4.4% 4.6% % 1.4% 1.5% % 0.8% 0.8%

2 Mental Health Promotion and Prevention A core function of CAPS is to provide educational presentations promoting healthy life skills and good mental health. This year, we served 16,051 students, faculty and staff through presentations to classes and various student groups. This number represents a 33% increase compared to FY We have worked to become more strategic in how we do this work, so as not to replicate services provided by other units, and we attempt to reach larger audiences in fewer hours. This is an area of increasing emphasis for CAPS, as we believe that the prevention of mental illness and the promotion of factors that help students thrive are critical to addressing the overall mental health needs of OSU students. Outreach Services Provided To: Presentations Total CAPS* Appts Hours People Appts Hours People Alcohol and other Drugs Anorexia Anxiety Body Image CAPS Services Communication Culture Shock Debriefing about X event Depression Depression-Suicide Diversity-related Eating Disorder Educational/Clinical Event Attendance General Mental Health- Related Grief Helping Students in Distress Liaison Marketing MBTI Mind Spa Mindfulness Other Policy Positive Psychology Relationships SASS Self-Esteem START Stress Management- SUCCEED Student Groups Suicide Prevention Tabling Events Test Anxiety Transitions Wellness-related Totals

3 MAJOR ACCOMPLISHMENTS Administration Additional Staffing and Restructuring. CAPS was granted an additional OS2 position, and restructured our Office Manager position into a Executive Assistant. The additional administrative support has allowed counselors to focus more exclusively on their clinical work with students, and has increased the functionality of our support staff services, including reception. Clinical Service After-hours Emergency Mental Health Care. CAPS began providing mental health services after regular business hours through a telephone service and, on average, about 30 calls were made to the service monthly. We are highly satisfied with the service and plan to continue it indefinitely. To access a counselor anytime, all students need to do is call our main number, When students access our after hours service, they speak to licensed, mental health counselors who assess the students level of concern, identify appropriate interventions to de-escalate the crisis, plan for safety, and help the students get connected to resources that will help them long-term. In addition, the mental health professionals are able to work with our campus personnel to assure that students in who are at great risk of harming themselves or others receive immediate assistance. After they finish working with the students, they send a report to CAPS so that we can follow up with the student the next business day. Mental Health Promotion OSU s Mental Health Initiative. CAPS created an OSU Mental Health Initiative, involving a campus-wide coalition of people who are invested in mental health issues, and whose departments have an important role to play in changing OSU s mental health culture. The goal for this group was to identify one or two core mental health goals for OSU that will focus on public health models for population level interventions, rather than individual-level interventions. 1. We conducted a thorough review of national and local data and scholarly literature about students mental health, and will move on to conduct other needs assessments of the local community. 2. We conducted focus group to hear students perspectives about what are their most pressing mental health concerns. 3. We conducted the national Healthy Minds Study survey on campus for the first time at OSU last spring, and analyzed the data to determine at-risk populations, and areas for needed focus. 4. The OSU Mental Health Initiative, using the above data to help determine our direction, chose flourishing as its area of focus for the coming years. 5. We are applying for a grant from Bring Theory to Practice (BTtoP), an arm of the Association of American Colleges and Universities, to develop initiatives related to flourishing. 6. We are working with the First Year Experience programs to infuse them with flourishing models 7. We will identify other initiatives and target areas across campus as we continue our work this year. Healthy Minds Study. CAPS participated in the national Health Mind Study for the first time in spring This allowed us to gather data about our own community s levels of mental illness, levels of flourishing, and helped us better understand who uses our services and who doesn't. We gained information about barriers to accessing our service, and about populations that are at highest risk for developing major depression, anxiety and other mental illnesses. We partnered with many office across campus who were

4 interested in learning more about the mental health of the students they serve and oversampled several populations including veterans, international students, domestic communities of color, and graduate students with hopes of getting large enough samples to generalize our findings. We hired a doctoral student in public health to mine the data, and the results have been very helpful in setting some clear directions for our outreach efforts. CAPS would be happy to provide you with the report should you like to learn more. Training Additional Trainees. CAPS added a fourth Doctoral Intern position in , which in turn allowed us to add a fourth Practicum Student. Each Intern provides about 500 hours of clinical service annually, and Practicum students provide another 200. The cost of hiring an intern is low, and practicum students donate their time to us (but do receive academic credit at their home institutions). The additional trainees allow us to serve more students in a cost-effective way, and enrich our program by bringing a cutting edge perspective and knowledge base. CHALLENGES Demand For Clinical Service While we are pleased about our ability to serve student s on-going counseling needs better with more follow up appointments provided in timely ways (see Summary of Clinical Services above), it has highlighted our greatest challenge: we continue to have greater demand for first-time appointments than we can meet. The problem is that counselors can only do so much clinical work a day/week/term. At CAPS, we aim for each clinician providing clinical service 55% of their time, since they also engage in training interns and practicum students, provide outreach and education services, engage in community service, and must document the service they provide. We have to decide how many of the 22 hours a week will go to new patients, and how many will go to follow up appointments, groups, and emergency on-call services. Given the concerns that were expressed about the inability to see counselors more regularly, we capped the new patient load at 3 per week to allow for more follow up and treatment. But this means that there are firm limits to the number of new patients we take in, excluding emergencies, and we find that we simply don't have enough first-time appointments for new patients to keep up with demand. Possible solutions. One or a combination of the options below might help solve this challenge. Offer more first-time appointments. One option is to change the distribution of our clinical services to allow more students to be seen for initial appointments, and fewer for follow up. This option would require us to refer more students off-campus for continuing service, Pros: all students would be able to be seen for an initial screening, and likely one more appointment. Cons: Many students do not have insurance and/or the cost of co-pays/deductibles makes accessing services prohibitive for student without monetary resources. Often it takes a few weeks to get an appointment off-campus, and given we re on a quarter system, students can lose a whole term if they are struggling with a significant mental health problems. Finally, clinicians would find the work less satisfying if they did not conduct on-going counseling work, and were primarily providing only triage, assessments and referrals. Allocate more resources for clinical services. Another option is to decrease the time we spend in mental health promotion or training, and reallocate that to clinical service. Currently clinicians have a total of 8 hours a week to put towards mental health promotion or training activities. IACS, our accrediting body stipulates that clinicians may not spend more than 65% of their time in direct face-to-face service, so we could increase the clinical hours by 4 per week, dropping the time for mental health promotion and training to 4 hours per week. Pros: We would be able to provide some additional service to students. Cons: We would still not meet clinical demands, nor would we meet the community s need for prevention and health promotion. Additionally we might not be able to maintain our internship s APA accreditation.

5 Stop providing training altogether. If we discontinued our training program, more time would be available for counseling because professional staff would not be engaged in supervision or teaching seminars. Pros: Students would only see professional counselors. We could take the money allocated for interns salary and benefits and hire more professional staff. Cons: We would no longer be serving an important role in preparing the next generation of university counseling center clinicians. Many professional staff find training to be a highly satisfying piece of their work which they would miss if they could no longer do it. While we would gain a couple of positions, we would still not be able to meet the demand for service. Increase the training program. If we hired more interns and practicum students, we could serve more students. Pros: We could better meet demand, and most students could be seen oncampus. Cons: Clinical staff would spend more time in supervision and training, and provide less clinical service. Many OSU students would not be seen by professional counselors, but by trainees. Hire more staff. One solution is to hire more staff, but each new counselor will likely only be able to see 3 new patients per week. Pros: Every student would be seen, and they could access services in a easy way on-campus. Cons: Hiring enough new staff to meet the demand is a very costly option, as we would need to increase our clinical staff by about 50%. Balancing Clinical Services with Mental Health Promotion We continue to struggle to do as much prevention and outreach to the OSU community as would be beneficial. Because of increased enrollment we have had an increase in our demand for counseling services, and at times we have had difficulty seeing students in a timely way. As a result, even though we know that many students would benefit from mental health prevention and promotion efforts, we struggle to prioritize them because it takes time away from remedial clinical service. Possible Solutions. One or a combination of the options below might help solve this challenge. Share the responsibility for mental Health across Campus. We have implemented an OSU Mental Health Initiative, through which we have identified a primary mental health goal for the OSU community: flourishing. By having a broad-based, interdisciplinary group working on this issue, we anticipate that responsibility for mental health will be spread across the institution, rather than resting solely with CAPS. We believe if all departments/divisions that deal with mental health issues come together, the issues of prevention and promotion will be better addressed. Pros: More people would be engaged in promoting psychological well-being across campus, and thus students would be exposed to mental health promotion efforts more broadly. This may be especially important because we know that 70-75% of student who have been diagnosed with a mental illness never speak to a mental health professional, but they do talk to others in their live, including friends, family, professors, advisors and others. If these people were more able to promote psychological wellbeing, then it would benefit many more students than we currently reach through CAPS alone. Cons: People without formal mental health training may feel that promoting mental health is beyond their skill set. CAPS would have to engage in training, which would take time and resources. Increase the time spent in preventing mental illness and promoting mental health. If we spend time in preventing depression and anxiety, increasing students abilities to manage stress, and teaching healthy relationship skills, many mental illnesses would be prevented altogether. Increasingly, this is a focus for all of health care providers Pros: Often wellness efforts only focus on the big three exercise, sleep and nutrition and leave out important psychological interventions that are at the core of why people (1) develop anxiety, depression and poor coping and (2) don t engage in the big three despite knowing it would be good for them. More energy in these prevention efforts could benefit all OSU students, rather than just the 8% who use counseling. Also, if mental illness is prevented, that means fewer students will seek counseling and we would be better able to meet clinical demands. Cons: Prevention and promotion efforts take time to implement before

6 becoming effective and decreasing the occurence of mental illness. This means that there would be fewer hours for those who need clinical service immediately. Less time spent in prevention and promotion, and more spent in clinical services. Some would argue that because CAPS is the only office on campus that can provide mental health treatment that should be their primary/sole focus. Other offices could do mental health promotion and mental illness prevention. Pros: More of the clinical needs of student would get met. Cons: There would be a gap, as very little would be offered in the area of mental health prevention and promotion by others. Other offices have not seen mental health promotion and prevention efforts as part of their mission, nor do they usually hire staff with mental health expertise to lead efforts related to mental health (e.g. SHS Health Promotion department has no mental health specialists; the College of Public Health has no faculty specializing in mental health/mental illness; the Psychology department has expertise, but does not conduct mental health promotion for the campus). Physical Facilities CAPS has been able to secure additional space on the third floor of Snell Hall, as our needs have increased with additional staff and programming. However, since Snell Hall is a substandard building we are faced with finding a new home on a campus, and therefore we continue to explore housing options with University Facilities. Both DRS and SHS have indicated interest in joint housing; however, these are long-range projects. University Facilities has indicated that there is no longer a plan to raze Snell, and that CAPS will continue to be house there indefinitely. BUDGET Budget information for FY and our current year is provided in an attachment.

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