Julian Pessier, Ph.D. Stony Brook University CCNY Breakout Presentation

1. How On Earth Are We Getting It Done?A supportive forum to discuss the present and future of college mental health clinical service delivery Julian Pessier, Ph.D. Stony Brook University CCNY Breakout Presentation Thursday June 6, 2019 @ 3:30 pm

2. Introduction/Goals of Session Discuss the Clinical Services Delivery challenges faced at Stony Brook University’s counseling center during the 2018-19 academic year Identify what the national media coverage is missing about what counseling centers are managing Answers and ambiguity from the burgeoning college mental health literature: DaraGhetie, CCMH, Cornish Predict challenges that lie ahead for 2019-20

3. Challenges Faced at SBU in 2018/2019 Increased demand and volume: Over 2700 unique clients and 16,000 visits (Individual, group, meditation, psychiatry, rapid access visits, consultation and referral) Introduction of Stepped Care model to replace Triage and Intake approach September 2018: 2 retirements, 1 departure, maternity Student/staff/parent concerns about CAPS services

5. Concerns and questions about CAPS Can CAPS handle severe student mental health concerns? Why did you refer me off-campus and not my friend? CAPS staff is not diverse and only speaks English Why do I have to switch counselors every year? Why so many questions every time I come in? I was sent to the hospital and it made me worse.

6. A Director’s Questions and Concerns Stepped Care helped reduce the wait and counselor switching, but fears of what we sacrificed to get there Reduced stigma surrounding anxiety and depression, but are they just the more comfortable topics compared to trauma, sleep, marijuana? Will the gap further widen between what students, parents and stakeholders want and what a counseling center can realistically provide?

7. College Mental Health Literature: Answers or Just More Questions? Dara Ghetie: Looking at the meaning of and rationale for our clinical service delivery choices, e.g., session limits Medical Model: For different diagnoses/symptom presentations, what is the best evidence-supported treatment approach? Developmental Model: most of our clients are at stage of life characterized by ambivalence; they need time and space to alternate between child and adult identities until they consolidate their sense of self.

8. College Mental Health Literature: Answers or Just More Questions? DaraGhetie: Know your biases to make the best choices! Medical/Developmental models as a dialectic; I can locate almost any client or stakeholder concern to misattunementor mislocation on this continuum My bias is toward the developmental; and lends me high tolerance for ambiguity and risk. Hence, I stay alert and prepared for my staff and trainees to need more structure and support than what I typically anticipate

9. College Mental Health Literature: Answers or Just More Questions? Collegiate Center for Mental Health (CCMH): More than just data; Raising terrific questions about practice. 2015: Clinical demand is outpacing enrollment 2016: Need to provide rapid access is draining resources needed to provide routine treatment 2017: Counseling centers provide effective treatment, but rigid policies can harm/impair treatment outcomes 2018: Absorption Vs. Treatment service delivery models My own bias is toward the developmental; tolerance for ambiguity and risk is high; this awareness keeps me alert (I hope!) to what staff and trainees need from me.

10. College Mental Health Literature: Answers or Just More Questions? CCMH: Better outcomes with Treatment Model, i.e., When a counselor is allowed to say they are full! “Treatment versus Absorption” also a dialectic. My values align with the “Treatment” model, but absorption has led to many benefits and creative solutions at SBU CAPS! CCMH’s recognition of the resource cost of rapid access has been invaluable to communication with administration Critique of CCMH: Unavoidable bias toward the measurable

11. College Mental Health Literature: Answers or Just More Questions? Cornish/Stepped Care 2.0: Arranging services along dimensions of treatment intensity and student autonomy. We cannot hire ourselves out of the demand problem! Rooted in change and empowerment theory. Meet students’ needs across range of problems, preferences and acuity. Most systems assume clients are ready to change; Allow students to test the waters before committing resources

12. College Mental Health Literature: Answers or Just More Questions? Stepped Care 2.0: This director loves the model, but not sure that Stepped Care yet fully understands the student. SBU CAPS found Stepped Care efficient, respectful of student autonomy and encouraging of staff creativity Less convinced about the value of the online tools. I believe Stepped Care is undervaluing relational work Can the current climate really tolerate “shifting responsibility to the client to make contact as needed?”

14. Thoughts on What Lies Ahead Has clinical volume peaked? What does student-centered really meanin our centers? Need for new approaches to assessing student satisfaction Can multiple models of care operate simultaneously in a center, exist in constructive (dialectical) tension? Will the future be more collaborative between centers and stakeholders? Or is antagonism the new normal? Can there be more moments of mutual curiosity?