TOWARD A MORE DATA-DRIVEN SUPERVISION OF COUNSELING CENTERS

Transcription

1 TOWARD A MORE DATA-DRIVEN SUPERVISION OF COUNSELING CENTERS APLU s CSA Summer Meeting June 2011 Jackson Hole, WY Lori Varlotta, VP for Student Affairs California State University, Sacramento Debra Robinson, VC for Student Affairs Missouri University for Science and Technology

2 Introduction Who we are What we bring to this conversation

3 Presentation Overview Summary of CSU Mental Health Project Discussion: Seven Questions Supplemental Information Additional Survey Data (CSU) Key Findings/Conclusions and Recommendations of CSU Study Overview of Missouri University S&T s Counseling Center Review of Key S&T Data and Assessment

4 Background of CSU Mental Health Project Created in 2009 by Chancellor s Office to: Collect and analyze campus data on mental health services Assess national and CSU mental health Identify the appropriate level of CSU mental health services and the resources necessary to provide them Provide counsel for a Student Mental Health Services Implementation Oversight Committee

5 Background of CSU Project (cont.) Fueled in part by local tragedy Researched national trends in college counseling Surveyed CSU Directors of Counseling Services, Health Services, Disability Services, and Housing Perhaps the largest and most comprehensive data set of its type in the country

6 Seven Questions Several issues emerged as the research project unfolded These issues prompted me to begin asking a series of questions, many of which were quite unpopular

7 Seven Questions 1. Is there a broad agreement in collegiate mental health and counseling on the definition of direct clinical services? 2. Does the IACS recommendation that counselors spend no more than 65% of their time providing direct clinical services mean that full-time counselors see ~24 clients per week?

8 Seven Questions 3. For the purposes of budgeting, are counseling centers being held to some of the (emerging) data-driven standards that are starting to inform budgets in other areas? 4. Does empirical evidence support the common notion that severity of college students mental health disorders, illnesses, and symptoms is on the rise? To what extent does existing or absent data inform budget decisions?

9 Seven Questions 5. What is the relationship between the number of clients scheduled and the number of clients seen? 6. Does the existence of a waitlist mean that counselors cannot increase the number of students they see? What might be creative and effective ways to manage a waitlist?

10 Seven Questions 7. How restrictive are laws like HIPAA and FERPA regarding the sharing of pertinent risk information? How do these laws, combined with profession standards, and campus policy/procedure affect your ability to get timely and relevant information?

11 Survey Data Of the CSU Clients Seen in Counseling Centers: 50% experience anxiety 40% have depression 15% struggle with substance use 10% have suicidal thoughts (These percentages are not unique to the CSU)

12 Survey Data Over 5 students (per CSU campus counseling center) are hospitalized for psychiatric purposes each year The suicide rate on CSU campuses is.92 students a year (compared the national average of.44) This number does not take campus size into account; ~14 CSU campuses have 10,000+ students

13 Survey Data Personnel Ratios Mean CSU counselor-to-student ratio: 1:2933 Tremendous variability in ratios among CSU campuses range: 1:425-1:10,500 National Mean Ratios by size < 2,500 students (n=91): 1:876 2,500 7,500 students (n=102): 1:1,500 7,500 15,000 students (n=63): 1:1,800 > 15,000 students (n=64): 1:2,500 IACS Accreditation-recommended ratio: 1:1500 Source: Gallagher, Robert P. (2010) National Survey of Counseling Center Directors. IACS.

14 Survey Data Recent CSU counseling-center trends, Utilization increased 18.7% Enrollment increased 12.5% Counselor FTE increased 8%

15 Survey Data Penetration Rate (Median % of Students Using Campus Counseling Centers) CSU: 5% Nationally: 9% Two possible reasons for CSU s lower penetration rate: Perceived or real lack of availability of appointments Commuter nature of CSU campuses

16 Survey Data Client Load Summary 2.6 clients per day during routine periods 3.4 clients per day during peak periods This means on a per week basis, counselors see an average of clients per week. Counselors other tasks: documentation, supervision, case management, other SSP-AR and center-specific tasks

17 Survey Data Wait Times in the CSU (there is no national comparison data): Two weeks for the first intake (non-crisis*) appointment; likely to increase to three weeks during surge times, or the 2 busiest months of the year The second appointment, on average, is scheduled 1.5 weeks after intake. This is likely to double to 3 weeks during a campus 2 busiest months *Special arrangements are made for students who describe themselves in crisis

18 Key Findings/Conclusions CSU students have significant mental health needs and referral options are slim. Overall CSU counselor-to-student ratio is worse than national average, but this is not true at all CSU campuses, and does not account for campus size. At many CSUs staffing has not kept pace with enrollment increases over last 10 years. There are significant wait times, especially during high-demand periods. The average number of sessions CSU students utilize is lower than the national average.

19 Key Findings/Conclusions The suicide rate on CSU campuses is more than double the national average (mean of.92 vs..44) However, an apples-to-apples comparison is difficult since campus size varies significantly 23 campuses Range from <1,000 to 30,000+ headcount Average = 17,875

20 Recommendations to the CSU CEO 1. Develop an Executive Order for counseling centers. 2. Provide adequate funding for basic services. 3. Review the Classification and Bargaining Unit Placement of CSU Mental Health Counselors. 4. Require a Campus Review of Counseling Center Structure and Work Distribution. 5. Obtain Clarification Regarding Release of Student Health Information. 6. Constitute an Implementation Committee. 7. Structure and Coordinate Data Collection. 8. Better Integrate Counseling Services with Other Campus Departments in an Effort to Promote Overall Wellness.

21 Executive Order 1053 The Select Mental Health Committee s report and recommendations led to the Chancellor signing Executive Order 1053 in December EO 1053 develops and communicates systemwide policies, procedures, and/or guidelines for mental health services to matriculated students.

22 EO 1053: Important Features Defines required basic services CSU counseling centers must provide Defines the role of counselors Should spend at least 60% - 65% of their base time providing direct clinical services Establishes uniform data collection standards for CSU counseling centers

23 Minimum Required Services Counseling/Psychotherapy Individual, couples, and/or group at campuses discretion Permits session limits Suicide and Personal Violence Services Response protocol Continuum of services for students, families, campus community Emergency/Crisis Response Services Response protocol Outreach Workshops, programs, services that address critical issues Mental Health Consultation For members of the university community who request such consultation, or are otherwise identified Referral Resources Indentify appropriate referrals within university and community

24 Counseling Center Snapshot: Missouri University of Science and Technology

25 Missouri University of Science and Technology Engineering & Technological Focus Average ACT = 28 Residential campus in rural setting 7206 students enrolled Fall semester Females (22%) and 5596 Male (78%) 6520 on campus & 686 distance learning 5504 undergraduates & 1702 graduates University of Missouri system has 4 campuses

26 Overview of S&T Counseling Services Generalist staff, no trainees Services for students, faculty, and staff Gatekeepers to access psychiatric services contracted by Student Health No charge for services Brief treatment model with 12 session limit Average sessions/client is 3.6 Office is open 8 am -4:30 pm Monday to Friday On call access to staff through Residential Life and University Police for after hour emergencies

27 Professional Staff in Counseling, Disability Support, and Student Wellness Director Licensed Clinical Psychologist Licensed Counseling Psychologist Licensed Counselor (75%) Licensed Counselor (25%) for peak times Health Educator Disability Support Services Coordinator

28 Counseling Staff to Student Ratios S & T Staff to On-Campus Student Ratio: 1:2167 (Based on 6500 on-campus students and 3 FTE counseling staff) 4 year public university ratio: 1:2607 IACS Accreditation recommended ratio: 1:1500 The department is open year round. No intern training program, tenure, or union for staff.

29 MS&T Counseling Staff Clinical Duties Weekly Individual Clinical Load 8 16 fifty-minute client appointments (varies by time of semester, FTE of staff, fluctuations in demand) Additional Clinical/Direct Service Responsibilities 4 thirty-minute screenings/week 1 same day urgent slot/week Conduct therapy group(s) Consultant to campus community After hours/weekend on-call for crisis intervention and assessment of danger to self/others

30 Other Professional Responsibilities Outreach Programming Resident Advisors Training (listening, responding to crisis, & referrals) Presentations about services to new students, international students, new faculty Workshops during PRO for parents and Opening Week for students Presentations by request to student groups, classes, campus units Withdrawing Student Exit Interviews Committee Participation - Critical Incident Task Force, Campus and Community Alcohol Coalition, Assessment Team, Student Leadership Team, Missouri Partners in Prevention Prevention, Education, And Awareness Initiatives -Alcohol Screenings, Depression/Mental Health Screening Days, Bystander Intervention Training, Suicide Awareness And Prevention, Counseling Awareness Month, Sexual Assault Awareness and Prevention

31 Wait Times & Intake Procedures Screening Session Timing: same /next day (unless client prefers otherwise) Client completes web-based forms just prior to intake session Informed consent/confidentiality, assessment of risk, presenting issues, treatment goals, counseling appointment and/or referral made, screening form completed, scanned, and sent to counselor Initial Counseling Session Timing: depends on severity/urgency of issue, client schedule, client preference for staff gender -Same/next day -Within three days -Next available Rarely longer than 7 business days

32 Client Presenting Concerns Rank Feeling hopeless and/or worthless Test anxiety 2 Test anxiety Feeling hopeless and/or worthless 3 How to study How to study 4 Worrying about unimportant things Worrying about unimportant things 5 Feeling overwhelmed, can't cope Feeling overwhelmed, can't cope 6 Thinking about suicide Dealing with anxiety 7 Dealing with anxiety Thinking about suicide 8 Deciding on a major or changing a major Deciding on a major or changing a major 9 Lack of motivation to do school work Lack of motivation to do school work 10 Physical symptoms (headache, dizzy, racing heart) Physical symptoms (headache, dizzy, racing heart) 11 Low energy Low energy 12 Want to learn more about myself Can't make decisions 13 Difficulties at work Feeling depressed 14 Develop assertiveness or coping skills Develop assertiveness or coping skills 15 Can't make decisions Want to learn more about myself

33 Assessments Counseling service annual usage data Five year tracking of service use patterns Counseling load projections Staff workload projections and review Client satisfaction surveys Professional staff assessments Learning outcomes for outreach programs

34 Counseling Service Annual Usage Data Counseling Academic Sessions Crisis Year Scheduled Appointments , , , , , , * 1, *New screening process implemented and data through 5/20/11

35 Service Use Patterns Over Five Years July June regular sessions provided* 5 year mean No month listed 10 July August September October November December January February March April May June total: 1089 cancellations, and 294 Crises (2433 total)

36 Counseling Load Projections Fall 2010

37 Counseling Load Projections Spring 2011 Screenings available (minimun) Spring 2011 Client Sessions Week of Semester week predicted demand Total Appts Available predicte d month target available actual schedule 0 1/3/ /10/ /17/ /24/ /31/11 44 Jan: 20 2/7/ /14/11 44 Feb: 20 2/21/ /28/11 50 March: 20 3/7/ /14/11 50 April: 20 3/21/ /28/11 28 May: 20 4/4/ /11/11 54 Total: 20 4/18/ (does not include 64 crisis 20 4/25/11 38 appts, 234 NSs, 92 ct canc'd 20 5/2/11 36 appts, which not tracked by 8 5/9/11 30 month (1085)) Total: 330 Screenings conducted 355

38 Staff Workload Projections and Review

39 Client Satisfaction Surveys Question FS2010 % agree or strongly agree SP2011 % agree or strongly agree 1. I was scheduled for a screening appointment in a timely manner The wait time before my first session was satisfactory Available session times have been convenient to my schedule My counselor understood my concerns My counselor showed respect for me as a person I am satisfied with the help my counselor provided I am satisfied with the courtesy and professionalism of the front desk staff I would recommend S&T Counseling to a friend Survey response rate 39.3% (68/173) 35.8% (58/165)

40 Annual Professional Staff Assessments Review of Activities & Accomplishments Accomplishments during past year Contributions to mission of department, Student Affairs, and the campus Professional development activities Assessment of Strengths & Challenge Areas Communication Customer Service Cooperation & Teamwork Quality Productivity/Core Skills Job Knowledge/Technical Proficiency Professionalism Professional Growth & Development Goals for the Next Year Supervision, Training, & Support Needed Comments from Supervisor