Conduct and Counseling: Working Together to Address At-Risk Students

1. Conduct and Counseling: Working Together to Address At-Risk Students

2. PANELISTS Jason Ebbelling, JD VP of Student Affairs Mitchell College Brian Van Brunt, Ed.D. Director of Counseling and Testing Services Western Kentucky University

3. Understanding the Data • 96% of Directors reported the number of students with significant psychological problems is a growing concern • 80% reported the number of students with severe psychological problems has increased in the past year The Association for University and College Counseling Center Directors Annual Survey (2009)

4. Understanding the Data • 48.4% of clients have severe psychological problems; 7.4% of these have impairment so serious that they cannot remain in school • 260 college counseling centers hospitalized an average of 8.5 students per school for psychological reasons during the past year • Directors reported 103 suicides in the past year National Survey of Counseling Center Directors (2009)

5. Understanding the Data • Campuses also feel the burden when students with mental health difficulties do poorly on coursework and drop out of school. • Poor student retention means losses in tuition, fees, and alumni donations. • Colleges and universities may face legal issues and negative publicity as a result of student crises and tragic events www.campushealthandsafety.org The Jed Foundation (2008)

6. Understanding the Data • Across all respondents, 10.2 percent of students sought counseling during the 2008-9 academic year, about the same as in the directors group’s two previous surveys. • At institutions with fewer than 1,500 students, an average of 18.3 percent of students sought counseling. At institutions with enrollments of more than 35,000, it was 7.2 percent. Association of University College Counseling Center Directors (2009)

7. Understanding the Data • Colleges and Universities are experiencing an increase in students struggling with depression • 17% have a friend who has talked about suicide in the past year & 7% have contemplated suicide themselves mtvU & The Associated Press (2009)

8. Understanding the Data American College Health Association- National College Health Assessment Findings

9. Understanding the Data • 85% of students report stress and worry on a daily basis • 52% of students report the economy as a source of stress • 6 in 10 students report being unable to complete work • 53% of students report not wanting to be with friends on one or more occasions mtvU & The Associated Press (2009)

10. Understanding the Data • The most common conditions seen in students were depression (seen in 37.5 percent of students visiting a counseling center), anxiety (36.8 percent) and relationship issues (35.9 percent). • Nearly a quarter of patients seen in counseling centers were taking psychotropic medications. mtvU & The Associated Press (2009)

11. Let’s look at ways to identify and refer at-risk students while improving the management of these students on campus. Identify  Refer  Manage

12. IDENTIFICATION Connecting All the “Dots” Identify Refer Manage

13. Identification • Who are the students we are concerned about? • What categories do they fall under? Identify Refer Manage

14. Identification On January 22, 2009, 25-year-old male doctoral student, Halyang Zhu, murdered a female graduate student in a campus café at Virginia Tech. He had not come to the attention of the campus police or Risk Management Team prior to this incident. Identify Refer Manage

15. Identification Even with Risk Management Teams in place, some violent students may go unidentified – but we must continue to identify those students who are high-risk when warning signs come to our attention. Communication between Judicial Affairs and Counseling Services is essential. Identify Refer Manage

16. Identification We are concerned with addressing behavior, not targeting those with mental illness. We are concerned with aggression, threats, intimidation, hoarding of weapons and isolation that leads to an act of violence. Those with mental illness are more likely to be the victims of violence, not perpetrators. (Choe, Tepin, Abrams; 2008). Identify Refer Manage

17. Identification • Students who may attempt suicide • Students who threaten to harm other students • Domestic violence situations • Students with weapons on campus • Students who concern faculty Identify Refer Manage

18. Identification • Classroom management problems: • Disruptive behavior in classroom • Threat to professor • Aggressive to other students or unexplained aggression • Projects or papers that contain violent or threatening content which is not part of a class assignment Identify Refer Manage

19. Identification • Deisinger’s (2008) handbook on threat assessment and management suggests the threat assessment/management goal should be: “Identify a student, faculty member, or staff member who has engaged in threatening behaviors or done something that raised serious concern about their well-being, stability, or potential for violence or suicide.” p. 47 Identify Refer Manage

20. Identification • Deisinger (2008) suggests the follow groups should be “touch points” for identifying campus threats: • Student judicial process • Faculty and Staff grievance/conduct board • Equal opportunity & diversity office • University legal counsel • Campus police/security; local law enforcement • Residential life conduct boards • Greek counsel Identify Refer Manage

21. Identification Remember to send information to your Counseling Center – they need to be aware of a student who has appeared on the “radar” of those identifying threatening students. While that office may not be able to share information with you about the student before completing an assessment, it helps their staff to be informed should the student appear on their doorstep. Identify Refer Manage

22. Identification The level of risk or threat will determine whether immediate police or disciplinary action is taken first or if the student can be referred for an assessment. Identify  Refer  Manage

23. Referral • Before moving onto the topic of referral, we want to briefly mention HIPAA and FERPA since these Federal Regulations can affect the information we may be able to share in a referral. Identify  Refer  Manage

24. Referral • HIPAA – Health Insurance Portability and Accountability Act of 1994. • Enacted to establish national standards and requirements for electronic health care transactions and to protect the privacy and security of individually identifiable health information. Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records. http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf Identify Refer Manage

25. Referral • FERPA – Family Educational Rights and Privacy Act of 1974. • Enacted to protect the privacy of students’ “education records.” Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records. http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf Identify Refer Manage

26. Referral • HIPAA – Health Insurance Portability and Accountability Act of 1994. HIPAA website: http://www.hipaacomply.com • FERPA – Family Educational Rights and Privacy Act of 1974. FERPA website: www.ed.gov/policy/gen/reg/ferpa/index.html Identify Refer Manage

27. Referral • HIPAA – Health Insurance Portability and Accountability Act of 1994. • FERPA – Family Educational Rights and Privacy Act of 1974. Be familiar with these Federal Regulations yourself and know how they apply to your particular institution. Also be aware of any applicable state regulations or guidelines. Identify Refer Manage

28. HIPAA and FERPA Identify Refer Manage

29. REFERRAL Connecting All the “Dots” Identify  Refer  Manage

30. Referral • What are the best practices in referring at-risk students for a counseling assessment or psycho-educational sessions? Identify  Refer  Manage

31. Referral • Many campus groups “refer” students to counseling because of various concerns. For the purposes of this presentation, we are talking about mandated referrals or assessments, not voluntary suggestions that the student go to counseling. Identify Refer Manage

32. Referral Identify Refer Manage 32 Be thoughtful and clear about when your campus requires mandated assessments or psycho-educational sessions. Consult with your legal department as you review which students your require to be assessed or attend psycho-educational sessions.

33. Question Identify Refer Manage 33 • Who do you refer to for your assessments? A) On campus counselor or psychologist B) Off campus psychologist or counselor C) Off campus psychiatrist D) Off campus emergency room doctor E) Leave it up to the student

34. Referral • Be clear about what you are looking for as a result of a mandated assessment. Who will receive and act on the mandated referral? • When the referral is done, is a letter needed? • Does that letter need to include specific statements or come from a particular provider? • Ask for these things prior to the mandated referral. • Be clear at the start what you need. Identify Refer Manage

35. Referral • Referrals work better when there is an on-going positive relationship with the referral source. Everyone is stressed with the heightened “hot potato” issues raised with threat teams and judicial referrals. • Take the time to form relationships during the down times of the year so that the relationship is solid when the difficult situations arise. A crisis is not a fruitful moment for creating a positive relationship. Identify Refer Manage

36. Referral • There are some counselors and psychologists who aren’t comfortable with “mandated” anything when it comes to their clients. • They make arguments against this based on the idea of autonomy---that all clients must choose to enter treatment or assessment willingly. Identify Refer Manage

37. Referral • Mental Health professionals on a college campus are not like private practitioners; the greater good of the community needs to be taken into account. • Nearly every community utilizes court mandated involuntary assessment. Identify Refer Manage

38. Referral • Gallagher (2006) surveyed college counseling centers (367) in the American College Counseling Association (ACCA). AUCCCD (2010, 424) showed Twenty-six percent (26%) of directors reported that they provide mandatory treatment at their center with 53% reporting that they only provided mandatory assessment (no counseling) at their center.

39. Risk Assessment Identify Refer Manage 39

40. Risk Assessment Identify Refer Manage 40 • There is no set qualification for those who perform threat assessment on a college campus. • Psychologists and counselors must work within their personally defined scope of practice. • This means they are responsible for obtaining additional training, seeking supervision and building diagnosis and assessments based on facts and producing accurate documents.

41. Informed Consent Creating a detailed informed consent is key to protecting the clinician Develop a clearly worded informed consent spelling out for the student what will happen and how the results will be shared This must be done prior to the assessment and should include the following: (see sample) Identify Refer Manage

42. Informed Consent • The scope of your assessment • The tests, costs and time involved in completing • Limit access to raw data to qualified individuals with consent • Outline who will receive the assessment • List kind of information that will be collected (past therapy, past inpatient, past court involvement, arrests, felonies) • Clearly spell out what happens if the student no-shows appointments (who is notified) Identify Refer Manage

43. Off-Campus Referral • If a clinician is working with a student and an off-campus third-party, help advocate for the student to ensure a smooth process. • the specifics of what they require, • your clinician/center has acceptable credentials for the assessment. • it is best to avoid completing an assessment and then learning a probation office requires a licensed AOD counselor to sign off. Identify Refer Manage

44. Counselor Assessment When reviewing tests and measures to better assess symptoms and risk, remember… There are no measures that predicts future violence There is no substitute to a solid clinical interview You must have the training needed to choose, administer, score, interpret and report the results for a given test Identify Refer Manage

45. Counselor Assessment When performing assessments, there is no test or measure that substitutes for common sense and clinical judgment. When writing reports and letters, base your observations and conclusions on the information at hand. Identify Refer Manage

46. Counselor Assessment Avoid “going out on a limb” and making statements that cannot be reasonably backed up by the facts at hand. As a professor of mine once said, “While it makes for a more interesting report, be careful when using speculation and opinion that can’t be substantiated.” Identify Refer Manage

47. When using any test, remember the Saxe poem about the blind men and the elephant…

48. MANAGEMENT Connecting All the “Dots” Identify  Refer  Manage

49. Management • Once the threat has been identified, the referral has been made, the assessment completed….colleges are often put in the position of managing an at-risk student on campus. Identify  Refer  Manage

50. Management(Counseling Services) • When working with someone who is trying your patience, being hostile or being unmotivated, remember your goal: • Your goal should be to assist the person to move towards a higher stage of change, maintain positive momentum or gain a better understanding of their current situation and their decision to make a change. Identify Refer Manage