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

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

PANELISTS

Jason Ebbelling, JDVP of Student Affairs

Mitchell College

Brian Van Brunt, Ed.D.Director of Counseling and Testing Services

Western Kentucky University

The Association for University and College Counseling Center Directors Annual Survey (2009)3

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

Understanding the Data

National Survey of Counseling Center Directors (2009)4

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


www.campushealthandsafety.org The Jed Foundation (2008) 5

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


http://www.campushealthandsafety.org/

Association of University College Counseling Center Directors (2009)6

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.


7

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)


American College Health Association- National College Health Assessment Findings

Within the past school year 2000 2002 2004 2006 2008 2009

Felt very sad 80% 82% 81% 78% 79% 62%

Felt depressed 44% 45% 45% 42% 43% 30%

Diagnosed with depression 10% 12% 15% 15% -- 10%

Considered suicide attempt 9% 10% 10% 9% 9% 6%

Attempted suicide 1% 1% 1% 1% 1% 1%

Intentionally self-injured -- -- -- -- -- 5%

8


mtvU & The Associated Press (2009) 9

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

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.


Let’s look at ways to identify and refer at-risk students while

improving the management of these students on campus.

Identify Refer Manage

Connecting All the

“Dots”IDENTIFICATION


Identification

• Who are the students we are concerned about?

• What categories do they fall under?


Identification

On January 22, 2009, 25-year-old male doctoral student, Halyang Zhu, murdered a female graduate

student in a campus caféat Virginia Tech.

He had not come to the attention of the campus police or Risk Management Team

prior to this incident.


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 betweenJudicial Affairs and Counseling Services

is essential.


IdentificationWe 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).

16


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


Identification

• Classroom management problems:Disruptive behavior in classroomThreat to professorAggressive to other students or unexplained

aggressionProjects or papers that contain violent or

threatening content which is not part of a class assignment


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


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


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.


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.


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.


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



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.





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


http://www.hipaacomply.com/

http://www.ed.gov/policy/gen/reg/ferpa/index.html


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.


HIPAA and FERPA

28


Connecting All the

“Dots”REFERRAL


Referral

• What are the best practices in referring at-risk students for a counseling assessment or psycho-educational sessions?


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.


• 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.

32

Referral


• Who do you refer to for your assessments?A) On campus counselor or psychologistB) Off campus psychologist or counselorC) Off campus psychiatristD) Off campus emergency room doctorE) Leave it up to the student

33

Question


• 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.

34

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.

35

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.

36

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.

37

Referral


• Gallagher (2006) surveyed college counseling centers (367) in the American College Counseling Association (ACCA).

38

12%

40%48%

None

Assessment Only

Assessment and Counseling

Referral

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 AssessmentWhat it is What it’s not

Clinical Interview Predicting future violence

Psychological Testing Done in isolation, without information gathering from referral sources

Information Gathering Something only off-campus forensic psychologists can perform

Looks at situations and behaviors Requires extensive test purchases

Gives sense of level of concern

Assess general attitude


• 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.

40

Risk Assessment


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)


42

• 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)

Informed Consent


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.


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


45


• 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.


46


• 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.”


47

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

Connecting All the

“Dots”MANAGEMENT


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.


• 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.

50

Management(Counseling Services)


• A connection is the start. It is the first step towards motivation, persuasion and compliance.

• The actual work will take some time.

• Consider the subtle move of “No, I’m not going to do that.” to “I’ll think about it”.

• Help an aggressive student understand why their current behavior isn’t in their best interest.

51

Management(Counseling Services)


• Courts view conduct codes and honor codes as “essential functions” of the university and are not subject to accommodation.

• Be sensitive to what led to the conduct (possibly a mental health issue), but be firm with the expectations related to appropriate conduct.

• Never discipline a student for a mental health issue – always focus on the behavior or conduct.

52

Management(Judicial Affairs)


• Specific expectations for the student may need to be clearly defined in writing if disciplinary action has not yet been necessary:

May not enter and leave class multiple times. May not arrive late. May not “self-cut” in the residence hall. May not hug female students you don’t know.

53



• Failure to comply with conduct expectations may result in disciplinary action.

• Keep your Counseling Director informed of any behavior or conduct situations you believe may be related to a mental health issue even if the Counseling Director can’t share information with you.

54



Connecting All the

“Dots”SUMMARY


Take Away, Case Study, & Resources

• Importance of all three stages:

• Importance of communication between Judicial Affairs and Counseling Services.

• Importance of having a clearly stated policy for your campus regarding mandated assessments and psycho-education sessions.

56

Take Away


• Don’t become overly focused on one piece of the argument that ends up being 2% of the issue. Keep the big picture in mind.

• For counselors, learn more about motivational interviewing and change theory.

• Counselors; don’t confuse “something you don’t do” with something that is “unethical.”

57

Take Away


• U.S. Dept. of Health and Human Services and U.S. Dept. of Education (November 2008) 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

• FERPA Regulations: www.ed.gov/policy/gen/reg/ferpa/index.html

• HIPAA Regulations: http://aspe.hhs.gov/admnsimp/pl104191.htm

• Campus Safety and Security Survey. Released 8/2009. Retrieved on 9/12/09 from www.nacubo.org/Documents/Initiatives/CSSPSurveyResults.pdf

• naBITA BIT tool. Retrieved fromwww.nabita.org/docs/2009NABITAwhitepaper.pdf

Online Resources



http://www.ed.gov/policy/gen/reg/ferpa/index.html

http://aspe.hhs.gov/admnsimp/pl104191.htm

http://www.nacubo.org/Documents/Initiatives/CSSPSurveyResults.pdf

http://www.nabita.org/docs/2009NABITAwhitepaper.pdf

Amada, G. (1999). Coping with Misconduct in the College Classroom: A Practical Model.

Amada, G. (2001). Mental Health and Student Conduct Issues on the College Campus: A Reading.

American Association of Suicidology, Suicide Prevention Resource Center, Educational Development Center. (2006). Assessing & managing suicide risk: Core competencies for university and mental health professionals.

American College Counseling Association (2009). Top ten issues in college student mental health. Unpublished.

American College Health Association (2009). American College Health Association – National College Health Assessment Spring 2008 Reference Group Data Report (Abridged). Journal of American College Health, 57(5), p. 477-488.

Archer, J., & Cooper, S. (1998). Counseling and mental health services on campus. San Fransisco, CA: Jossey-Bass, Inc.

Benton, S. A. & Benton, S.L. (2006). College Student Mental Health. Effective Services and Strategies Across Campus.

59

References/Resources

Byrnes, J. (2002). Before Conflict: Preventing aggressive behavior. ScarecrowEducation.

Center for the Study of Collegiate Mental Health (2009). Center for the Study of Collegiate Mental Health Pilot Study 2009, Executive Summary. Penn State University.

Choe, JY., Teplin, LA & Abram, KM. (2008). Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatric Services, 59(2), 153-164.

De Becker, G., Taylor, T. & Marquart, J. (2008). Just 2 Seconds: Using time and space to defeat assassins. Gavin De Becker and Associates.

Deisinger, G., Randazzo, M., O’Neil, D., Savage, J. (2008). The handbook for campus threat assessment & management teams. Boston, MA: Applied Risk Management.

Drum DJ, Brownson C, Denmark AB, Smith SE. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology, 40(3): 213-222.

60


Gallagher, R. (2006, 2007). National Survey of counseling Center Directors. International Association Counseling Services.

The Jed Foundation (2008). Student Mental Health and the Law: A Resource for Institutions of Higher Education.

Kadison, R. & Digeronimo, T. F. (2004). College of the Overwhelmed. The Campus Mental Health Crisis and What To Do About It.

Miller, W.R. & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Publications.

MtvU & The Associated Press (2009). Economy, College Stress, and Mental Health Poll. Retrieved from: www.halfofus.com/press.aspx

Pavela, G. (1985). The Dismissal of Students with Mental Disorders: Legal Issues, Policy Considerations, and Alternative Responses.

Pavela, G. (2006). Questions and Answers on College Student Suicide: A Law and Policy Perspective.

61


http://www.halfofus.com/press.aspx

Rando, R. & Barr, V. (2009). The Association for University and College Counseling Center Directors Annual Survey. Reporting period: September 1, 2007-August 31, 2008.

Silverman MM, Meyer PM, Sloane F, et al. (1997). The Big Ten Student Suicide Study: a 10-year study of suicides on midwestern university campuses. Suicide Life Threat Behav. 27:285–303.

Suicide Prevention Resource Center (2003). www2.sprc.org/collegesanduniversities/campus-data-risk-and-protective-factors

Substance Abuse and Suicide Prevention: Evidence and Implications—A White Paper.. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2008. www.sprc.org

Waehler, C. A., Hardin, S. I., & Rogers, J. R. (1994). College students’ perceptions of the relationship between fee and counseling. Journal of Counseling & Development, 73, p. 88-93.

62


http://www.sprc.org/

Date post:	12-Jan-2016
Category:	Documents
Upload:	shanna-henderson
View:	216 times
Download:	0 times