Assisting Students in Distress Raquel Contreras, Ph.D. Lisa Sims, Ph.D., May 15, 2018 Presentation for Library Staff

MISSION STATEMENT VISION STATEMENT To strengthen Clemson University by providing quality medical and mental health care, public health leadership and initiatives that enhance the academic success of our students and promote the health, safety and well-being of the campus community. As an introduction, reference the Mission and Vision statements. Confidentiality is the cornerstone of RHC services. This presentation will provide a virtual tour of our services and introduce you to some of the people who provide them. VISION STATEMENT To be an innovative health care system providing integrated quality services that are responsive to the needs of the University community. 2

THREE DIVISIONS www.clemson.edu/studenthealth Student Health Services, housed in Redfern Health Center and Fike Recreation Center, is defined as an integrated outpatient organization comprised of three divisions and more than 80 health professionals. The three divisions are Medical Services, Counseling and Psychological Services, located in Redfern Health Center and Healthy Campus, located on the third floor of Fike Recreation Center. RHC is accredited by The Joint Commission, which demonstrates our commitment to quality healthcare and patient safety. The Joint Commission is the highest level of healthcare accreditation and RHC is the only student health center accredited by The Joint Commission in South Carolina, as well as one of only 17 in the country. 3

Learning Objectives Learn to identify students in distress and crisis. Distinguish between a student in distress and a student in crisis. Distinguish between levels of mental health risk. Learn strategies to intervene with a student in distress or in crisis. Learn about Clemson University resources for students in distress. Identify CAPS’ resources. 4

Stress-Performance Curve Source: haleo.co.uk Clemson University’s As stress increases beyond “Peak Performance” then it shifts to distress. Performance then decreases with escalating distress. DISCLAIMER: I didn’t create this graph—thus, don’t claim the word “Lame.” Although, I can certainly follow… 5

Signs of Distress—Academic Performance Poor preparation for class Drop in performance Excessive absences or tardiness Excessive anxiety about classwork Exaggerated emotional responses Exaggerated need to oppose teaching Inability to communicate clearly 3 major signs that we look for considering distress (leaning towards the dysfunctional level of stress): 1. Marked changes in academic performance, or attitude towards academic performance: 2. Behavior (next slide) 3. Appearance (2 slides down) 6

Signs of Distress--Behavior Depressed or lethargic mood, apathy Avoiding participation in class activities Unusual or changing pattern of interaction with others Consistently avoiding activities with others Marked increase or decrease in energy level Increase in irritability, emotional reactivity Low tolerance for frustration Disruptive behavior Look for changes in behavior. 7

Signs of Distress—Appearance* Marked changes in personal hygiene Marked differences in dress/attire, or attire that consistently does not fit the context* Dramatic weight loss or gain Swollen or red eyes * Take cultural and individual differences into account Unusual appearance*, or changes in appearance: 8

Beyond Distress…to Crisis? Distressed students may become students in crisis, with or without appropriate intervention. Determining the difference between distress and crisis is a matter of degree. Multiple factors cause a person to move from distress to crisis; there is rarely one cause. Level of intervention varies and depends on several factors as well. Explain the slide. NOT everyone goes from distress into crisis. It’s unique to each individual. Has much to do with a person’s resilience and capacity to regain balance. 9

Defining a Mental Health Crisis Crisis: a mental health-related situation that has escalated to an urgent or emergent level. A student becomes unable to utilize his or her typical healthy coping style. A student’s physiological and emotional responses escalate to unmanageable levels. Without immediate outside intervention, this situation can escalate to disturbance of conduct, harm to self or others, or high levels of campus disturbance. 10

Identifying a person in crisis Watch for: Atypical or disruptive behavior (physical or verbal aggression, public disturbance) Overt suicidal threats (written or verbal) Homicidal threats in any form Inability to communicate clearly (incoherent, garbled, slurred speech) Loss of contact with reality (seeing or hearing things that are not there, paranoia) 11

Risk of Harm to Health and Safety Five Classifications: Mild Moderate Elevated Severe Extreme As risk moves from mild to extreme, dangerous or threatening behavior becomes more likely. This behavior can be directed inward, towards the student, or outward towards others. The next 5 slides describe the various levels of risk and what you can do for each. One can see the escalation of distress to crisis. 12

Classifying Risk: Mild Disruptive or concerning behavior No threat of harm made or present Action: This is a student of concern that may be monitored informally. Consultation is a good option if there are questions on how to proceed. Approaching the student is a good option to prevent further deterioration. File CARE Network report. File a CARE report. 13

Classifying Risk: Moderate More involved or repeated disruption. Threatening behavior-- vague and indirect. Threat lacks realism, detail. Content of threat suggests that it’s unlikely to be carried out. Action: This could become an urgent mental health situation. When student is approached, behavior may stop. If not, seek consultation about how to intervene. File CARE Network report. File a CARE report. 14

Classifying Risk: Elevated Seriously disruptive incident(s) Clear distress or disturbance Threating behavior (or student is perceived as threating by others) Threat may be vague, but repeated to several observers Action: This is an urgent mental health situation. When/if approaching student, offer to walk student to CAPS as soon as possible. Seek consultation. If student refuses, file CARE Network report. With increasing risk, the potential threat to the student increases (possible risk to others, as well.) 15

Classifying Risk: Severe Dysregulation. Threat made or present. Threat is vague but direct, or specific but indirect. Threat is consistent, plausible, or with increasing levels of detail of a plan. Content of threat suggests it may be carried out. Action: This is an urgent mental health crisis. Consult CAPS immediately about how intervention should proceed. Call and/or offer to walk the student to CAPS immediately. If the student refuses CAPS walkover, file an incident report, if during business hours. If outside of business hours, call CAPS on-call for consult or CUPD for welfare check. 16

Classifying Risk: Extreme Dysregulated or medically disabled Threat made or present Threat is specific, direct Threat includes details of plan, often with steps already taken Threat repeated with consistency Content of threat suggests that the person will carry it out Action: This is an emergent mental health crisis. Call 911 immediately and/or call CAPS. This is a crisis. Seek emergency assistance. 17

Preparing to Intervene If there is any question about whether or not a student should be approached or assessed, please contact CAPS at 656-2451 between 8am and 5pm. Our staff can provide guidance. Be ready and willing to walk the student of concern over to CAPS, with student’s consent. Students in crisis are served immediately for stabilization purposes. If after hours, contact the CAPS On-Call counselor through CUPD at 656-2222. If there is any question about safety, or risk of harm to self or others, contact 656-2222 or 911. 18

General Advice for Any Situation Whether the student is in mild distress or intense crisis, Ensure that the student understands you will attempt to help them find assistance, or you will obtain assistance if need be. Update the student on the status of this assistance to help reassure the student and maintain control of the situation. Minimize the involvement of others; only essential individuals should be aware of, and be directly involved with the situation. 19

General Advice for Any Situation (Continued) Use clear, concise language with the student. Be as transparent as possible. Communicate as much as you can about the process of helping the student, even if you must share information that could cause discomfort. Do not ever promise confidentiality to a student, parent, or anyone else involved, unless, you are in a position to keep it. Offer to keep information private, but clarify that if the student’s safety is at issue, you will refer to proper office. Note your own responses and ensure you have a space to debrief or otherwise engage in self-care. 20

Helping a Student in Distress DO Consider: Talking: Find a time that you can meet with the student to discuss the issues and your concerns. Listening: Listen actively with an ear to understanding before giving any advice. Instilling Hope: Help the student to determine appropriate solutions with the resources available to them on campus, changing the focus on conversation solely on the problem. Avoiding Evaluation: Respect the student’s value system, decisions, and choices even if you do not agree with them. 21

Helping a Student in Distress (Cont.) DO Consider: Maintaining Boundaries: Focus on the student and avoid unnecessary self-disclosures. Clarifying Rules: Identify rules/requirements and enforce them as you would for any other student. Referring: Encourage use of resources as a sign of strength and self-care; assist as needed. Following-up: Continue to maintain contact with the student to see if they accessed resources, and encourage student feedback on the process. Consulting: CONSULT when in doubt. You never have to decide or intervene alone. 22

Helping a Student in Crisis Do’s and Don’ts Provide a safe, secure, quiet place Respect the student’s privacy Invite the student to stay with you until help arrives Listen actively and show empathy Maintain a straightforward, supportive attitude Keep a phone with you 23

Use Caution During a Crisis Do’s and Don’ts Leave the student alone Try to restrain the student if he or she wishes to leave the immediate area Take the student anywhere without her or his consent Challenge or shock the student Minimize the student’s distress Promise confidentiality 24

Resources Office of Advocacy and Success—CARE Network http://www.clemson.edu/studentaffairs/advocacy-success/ Redfern Health Center https://www.clemson.edu/campus-life/student-health/ Counseling and Psychological Services Medical Services Healthy Campus Office of Community and Ethical Standards http://www.clemson.edu/campus-life/student-conduct/ Clemson University Police Department https://www.clemson.edu/cusafety/cupd/ Title IX--http://www.clemson.edu/campus-life/campus-services/access/title-ix/ Emphasize that Medical Services now screens for depression and suicidal ideation at every medical appointment. Healthy Campus conducts TigersTogether, suicide prevention trainings. 25

Access to CAPS Services Walk-in clinic, 10 a.m. to 2:30 p.m., M-F First-come, first-served Students complete intake information on iPad and are seen by a counselor. Individual Assessment allows for understanding of the student’s presenting need, arrive at diagnosis and development of treatment recommendations All students are assessed for safety and level of risk at this initial contact. Students can access CAPS care through the Walk-in Clinic that operates M-F, from 10-3. The last appointment of the day is taken at 2:30. CAPS has 3-layer deep of dedicated counselors ready to see the walk-in students. We see students on first come, first-served basis After completing the intake information on the iPad, the students are routed to a counselor for Individual Assessment (IA)—this is a full diagnostic interview that allows the counselor to explore the presenting problem, diagnose, draft a preliminary treatment plan and assign to a treatment modality. The student walks out with copy of 1)CAPS Terms of Service and 2)Treatment recommendations. 26

THANK YOU CAPS supports you in your role in maintaining the health and safety of the Clemson University communty. Severity of Presenting Concern to Service type. Although the scale is the same as we use for risk of harm, the scale here reflects the severity of the presenting concern. This is determined at the Individual Assessment (initial visit) 27

THANK YOU! CAPS supports you as you continue to maintain the health and safety of the Clemson University community. 28