Counseling Services Director of Counseling Services Sue Reimondo Counseling Services Director of Counseling Services Individual Therapy Sessions

Eliminate wait list, avoid burnout while sustaining quality treatment. Mission In support of Berea College’s mission, Counseling Services promotes the psychological, interpersonal, academic, and vocational development of students while providing mental health consultation to students and the campus community. Vision Eliminate wait list, avoid burnout while sustaining quality treatment.

SIPOC Suppliers Inputs Policies Outputs Customers -Students (Self-referral) -Faculty/Staff -Previous Therapist -Parent(s) -White House Clinics -Friends -Campus Life -Public Safety -Disability Services -Campus Christian Center -Student of Concern team Clients Emails Referral or Follow-Up from Student of Concern Requests for Information Requests for Trainings Requests for presentations Info from previous therapists -HIPPA -FERPA -Professional Ethics (i.e. age of students you can see w/o consent, When you must break confidentiality, Residential Life, Labor Requirement, Full Time Student Requirement, Swim Requirement, Emotional Support Animal Policy) -Consent for Treatment -Release of Information -65 Programs(Last Year) -Individual Therapy Sessions -Couple Sessions -Group Sessions -Faculty/ Labor Consultation -Trainings -Overview of Services -Preventative Measures -Crisis Intervention -“On Call” Services -Committee Work -Grant Admin -Psychological Assessment -Medication Management -Reports -Session Documentation -Students -Faculty -Staff -CELTS -Couples -Groups -Parents/ Guardians -White House Clinics (Information) -Bridge Program -Virgil Burnside -ARCT

Hi-Level Process Map 2016-2017 academic year Volume = 428 distinct students, 2280 sessions per yr. Lead Time = Max. wait list 2016-17 102 days before scheduling. Rework = Continual cycle of expediting, rescheduling. Constraint = Under current treatment plan students may remain in therapy longer than our current model can sustain. Therapists scheduled at max capacity requiring costly rework to handle “known unknown” emergencies. Hi-Level Process Map 2016-2017 academic year Students request services Student self-assesses triage form Student waitlisted if not emergency Appointment scheduled Students fill out intake forms Therapy begins Volume: 428 Students/2280 Sessions Peak Wait Time: 102 Days Hours Available: 86 hours per week Session Time: 50-60 minutes Average # of Sessions: 5 Psychiatric Hours Available: 11 On Call: 1 week at a time

SWOT Analysis Internal External Strengths Weaknesses Threats Opportunities SWOT Analysis Internal External Fully Licensed Therapists Caring Staff Experience/Berea Experience Relationship With Campus Location and Space Creative Varied Areas of Expertise Generalists Supremacy of Academics Student Demographics Lack of Family Support Lack of Part Time Option Lack of Support from Faculty Increased Funding Create Group Culture Educating Faculty/Staff Support from Marketing & Communications Online Scheduling Assessment Center Hours Targeted Programs Termination Conversations Transition to different leadership style Technology (Reaching different outreach mediums) Reactive Lack of time for program development Misalignment of Understanding Responsibility High Demand-Low Supply (27% of campus seen) 1 administrative assistant

At current staffing levels and program offerings therapists Problem Statement At current staffing levels and program offerings therapists cannot meet demand. Students in need of non-emergency care frequently wait-listed for services (max 2016-17 wait list 102 days). Therapists scheduled to max capacity which triggers costly expediting/rescheduling when faced with “emergency” situations. Inability to meet with students early in a crisis cycle may lead to intentional or unintentional escalation of crisis.

Charter Mission – In support of Berea College’s mission, Counseling Services promotes the psychological, interpersonal, academic, and vocational development of students while providing mental health consultation to students and the campus community. Burning platform – Waitlisted students may intentionally or unintentionally escalate crisis. Therapists scheduled to max capacity required to expedite/reschedule to meet emergency situations. Process Description – From request for services to delivery of services Problem Statement – At current levels of staffing and program offering, we can’t meet demand. Sponsor – Virgil Burnside Process Owner – Sue Reimondo Team Lead – Sue Reimondo/Joshua Johnson Facilitator – Aaron Beale Team – Sue Reimondo, Tricia Isenstein, Debra Ratliff, Julie LeBrun, Joshua Johnson, Angela Taylor, Brandon Noble

Current State Value Stream Analysis

Current State Students scheduled based on limited availability Students placed on wait list once available scheduled sessions are booked. (102 day max. wait list time recorded) Therapists scheduled at max. capacity with expediting/rescheduling needed to handle emergencies or crisis. Capacity Totals: 100% variability/unpredictability in induction schedule. 214 individual students seen per term. (428 students for entire 2016-2017 fiscal calendar year) 1,140 individual sessions per term. (2,280 sessions conducted for entire 2016-2017 fiscal calendar year)

Future State Overview

Future State induction example (full-time therapist)

Future State Value Stream Analysis

Future State On Demand Induction Schedule: Therapists available to provide same day service up to induction maximum. After that level reached students seen during next days induction with max. wait of 24 hours. Monday: Debra can induct 2-3 new students weekly (30 per term) Tuesday: Sue can induct 2-3 new students weekly (30 per term) Wednesday: Julie can induct 5 new students weekly (60 per term) Thursday: Josh can induct 6 new students weekly (72 per term) Friday: Tricia can induct 6 new students weekly (72 per term) Group Therapy: Students directed to group therapy upon completion of 4 session 6 week cycle. “Skills based” groups offered daily to facilitate access and support students transition from individual care. Capacity Totals: 22 New student inductions per week 264 Individual students served per term (Up to 528 students per Fall/Spring terms) 1,564 Individual sessions available per term (Includes backfill of returning clients)

Future State Process Script (explanation to students)   “Our Counseling Services data and outside research shows that individual sessions reach their max. therapeutic value in 3-4 sessions. We believe that you can graduate to group care, or no regularly scheduled care, in this time. Our therapy sessions are specifically designed to bring needed relief in 4 sessions. We believe that most students can thrive after that with the help of ongoing group therapy if necessary. However, we will always be here for you. If, after trying our groups, you feel the need for more individual sessions, come in and see me on my new patient day and we will start another cycle.”

Future State Induction Tracking Board

Future State Color Coded Cycle Calendar

Future State Color Coded Schedule Guide

Results Sessions conducted 8/21-11/10 2017 (12 weeks) = 932 Serving 296 individual students Sessions conducted 8/22-11/10 2016 (12 weeks) = 758 Serving 252 individual students Crisis appointments 8/21-11/10 2017 (12 weeks) = 22 Crisis appointments 8/22-11/10 2016 (12 weeks) = 57 We believe our “same day” service model for 2017 has contributed significantly to the dramatic reduction in “Crisis” appointments. So far in 2017 NO WAIT LIST FOR SERVICES 2016 UP TO 102 DAY WAIT LIST TO HAVE APPOINTMENT SCHEDULED Savings calculation: If increase in sessions continues at the same rate observed in 12 week sample for 11 months (Counselors work an 11 month contract) the Counseling Center will be able to provide an additional 696 sessions. WITH NO WAIT LIST FOR SERVICES! To convert this additional capacity to a dollar figure we used the bottom of the insurance reimbursement scale ($55) and multiplied that figure by the additional capacity. (696 x $55 = $38,280 worth of increased capacity)

Future State Group Therapy Flyer

Call or email anytime, but send what you have so far Progress Check Call or email anytime, but send what you have so far