Download Document

Reaching The Ones That Won’t
Walk-in: A Community Based
Service Approach to Students in
Need
Gregory T. Eells, Ph.D.
Cornell University
Mahnaz Mousavi, Ph.D.
Georgetown University School of
Foreign Service
Doha, Qatar
Outline
I. Introduction
II. Relevant Data
II. Philosophical Framework
III. Description of Community Based Services
at Cornell
IV. Application in Qatar
V. Cases
VI. Conclusion
Introduction
The Virginia Tech tragedy has brought
considerable attention to college counseling
services.
Questions have been raised about mental
health care and college students who might
“fall through the cracks.”
Raising questions of how we continue to
extend The Colorado Cube of Morrill, Hurst,
and Oetting into today’s counseling center
Introduction
We are all more challenged by the need for
consultation and support among the network
of faculty and staff on our campuses.
There are a significant proportion of students
in distress who are not receiving services.
The majority of students who kill themselves
never receive counseling services Gallagher
(2005)
Relevant Data
In past year:
“so depressed it was difficult to function”
Cornell: 44%
seriously contemplated suicide
Cornell: 11%
attempted suicide
Cornell: 1.3% (~175 undergraduates)
2006 National College Health Assessment (NCHA)
1902 Cornell undergraduates responding
In last 12 months, was unable to function
academically for at least a week due to
depression, stress, or anxiety:
White:
Asian-American:
URM*:
International:
37%
50%
54%
51%
*URM = underrepresented minority
2005 Enrolled Students Survey
4790 undergraduates; 37% response rate
In last 12 months, seriously considered
attempting suicide:
White:
URM*:
Asian-American:
International:
6%
8%
10%
10%
In last 12 months, attempted suicide:
White:
URM*:
Asian-American:
International:
.04%
1.9%
2.5%
2.9%
*URM= underrepresented minority
2005 Enrolled Students Survey
4790 undergraduates; 37% response rate
CAPS Utilization Rates
30
% utilizing CAPS
25
20
15
10
5
0
2000
2001
2002
2003
African-American
American Indian
2004
2005
Hispanic
Student Body
2006
CAPS Utilization Rates
% utilizing CAPS
14
12
10
8
6
4
2
0
2000
2001
2002
Asian-American
2003
2004
International
2005
2006
Student Body
Asian and Asian-American students:
 >50% of completed suicides
Philosophical Framework
engagement
build relationships before counseling
reach students in alternative ways
not bound by the traditional counselor
role and setting
don't wait for students to come to us
Philosophical Framework
Address problems where they occur
Mental health concerns do not just
originate “in the students’ heads,” but
also in the systems and communities in
which they live.
Therefore, environmental interventions
are essential
Philosophical Framework
Operate from a social justice
multicultural framework
The narrative around mental health is
increasingly told by the pharmaceutical
industry that says all mental illness is
brain disease-defective.
In reality this narrative is a small part of
the story
Philosophical Framework
These organic explanations of every form of mental
problem-including crime and delinquency, alcohol
and drug addiction, and all forms of child and
adult distress-make social change unnecessary. If
underpaid workers, exploited and undervalued
women, uneducated minorities, the unemployed,
the aged, all have high rates of mental disorders,
alcoholism, drug addiction, and crime these
pathologies are due to defective
biology/chemistry. They are not the fault of the
system say the ruling elite.
George W. Albee
Past President, APA
Philosophical Framework
Realize that traditional mental health services are
outside of the “Meaning making sentence” of many
groups.
Culture involves both an internal and external
experience and is the space that cross cuts all of our
work. Our goal is to open up these spaces:
Through asking difficult questions
Through assessing the impact of crossing borders
Through approaching justice by understanding that
human life is more malleable than we understand
Counseling and Psychological
Services (CAPS)
Clinic-Based Services
Community-Based Services
What is Community-Based
Services (CBS)?
The outreach arm of Counseling and
Psychological Services (CAPS) at
Gannett
An effort to support students who don't
usually come to counseling
An attempt to overcome stigma,
cultural barriers & institutional barriers
THE CBS Program at Cornell
Presentations, trainings & orientations
"Let's Talk" offsite walk-in hours
Informal discussion groups
Community Consultation and
Intervention (CCI)
Presentations, Trainings
and Orientations
Presentations, Trainings and
Orientations
opportunity to meet students outside of
counseling context
reduce barriers to seeking help
inform students about mental health
issues and resources
Pre-Freshman Summer
Program
all seven colleges
90 minute interactive presentation on
survival skills for Cornell
introduction to CAPS and related
resources
Let’s Talk
Let's Talk
daily walk-in availability
nine sites
free
direct referrals from trusted members of
the student's community
meeting outside of the health center,
often within the student's community
Let’s Talk
“consultation and support”
informal, friendly format
focus on immediate problem solving, resources,
and advocacy
option for anonymous visit
referral to CAPS if necessary
Let’s Talk Utilization
55% are students of color or
international students
Vs. 32% of CAPS clients
Informal Discussion Groups
Community Consultation
and Intervention
(CCI)
CCI Components
• Student-centered consultation
• Direct intervention
• Program-centered consultation
Student-Centered Consultation
 Consultation with faculty and staff regarding students




in distress
Student has already been unsuccessfully referred to
counseling, or the issue is predominantly
environmental (e.g., financial problems), not
intrapsychic
Advise staff on providing informal counseling when
necessary
Behind the scenes case management and advocacy
Periodic follow-up to monitor student’s situation
Direct Intervention
 Relationship with staff member sometimes
helps facilitate referral
 Service defined as “student support”
 Focus is on immediate problem-solving,
support, advocacy, and case management
 First contact often outside of counselor’s
office
 Sometimes evolves into counseling
relationship, sometimes not
Program-Centered
Consultation
 Specific cases highlight systemic problems
creating student distress
 Program centered consultation evolves from
cases
 Consultations often lead to training
 Issues surfaced by multiple cases lead to
policy changes
 Program-centered consultation and training
leads to more student-centered consultation
and direct intervention
Application in Qatar
Cases
Directions
Collecting data and quantifying the rich
qualitative data that already exists
Challenges of systematizing and
institutionalizing the work
More general clinicians doing CBS work
Telling the story about the work
Conclusion