Distressed & Distressing Students Creating a Safety Net For High Risk Students Elizabeth Downing, M.D. UCSB Medical Director Burt Romotsky, L.C.S.W. Student Health Social Worker

distressed UCSB & Community Mental Health Resources students Health Ed Counselors Alcohol & Drug Program Student Health Services/ Clinicians Psychiatry Social Worker Eating Disorders Nutrition Sexual Health Stress Management Alcohol & Drug Counseling SBIR* CASE* SAM* Tobacco Marijuana REST* Urgent Care General Medicine Doctors Nurse Practitioners Mental Health NP Social Work Intern Triage & Refer ADHD Triage Crisis Intervention Case Management Distressed Student Protocol* Campus/Community Referrals Campus Academic/ Support Services Mental Health Assessment/ Treatment/ Community Mental Health Assessment/ Treatment DSP Coaching Program* CLAS* EOP Academic Services Career Services Counseling Services Hosford Clinic* PAC* Women’s Center Therapy Referrals Psychological Assessment Sliding Scale Counseling Psychiatry Referrals Crisis/Psychiatric Hospitals CASE – College Alcohol & Substance Education SAM – Skills, Awareness & Motivation REST – Recovery Enhancement Success Training SBIR – Screening, Brief Intervention & Referral Distressed Student Protocol – SW point of contact Coaching Program – support for ADHD/LD students Hosford Clinic – campus sliding scale counseling PAC – Psychological Assessment Clinic CLAS – Campus Learning Assistance Services distressed students

distressed Pilot Project students Social Worker hired 11/2002 with ADA Advisory group and Student Health funds Campus Social Work role developed Brochures developed Education/Outreach to campus community Distressed Student Protocol committee distressed students

distressed Why a Social Worker? students Complicated and time-consuming student situations Multiple department contacts Single point of contact High risk students Early intervention Crisis intervention distressed students

distressed Student Health – Next Exit? students Increasing number of UC students are taking psychotropic medication (UC student Mental Health Committee, 2006) distressed students

National Trends of Distressed Students distressed students

distressed National Trends of Distressed Students students 85% of college counseling centers reported an increase in the number of students they treat for psychological problems UC Davis, Counseling & Psychological Services, “Responding to Distressed or Distressing Students”. distressed students

distressed National Trends of Distressed Students students 62% of college students reported feeling hopeless, 44% said they felt so depressed they could barely function, 79% were very sad and 9% felt suicidal 2005-2006 62 79 44 9 distressed American College Health Association-National College Health Assessment (ACHA-NCHA) Web Summary. Available at http://www.acha-ncha.org/data_highlights.html students

distressed National Trends of Distressed Students students Top 10 physical and mental problems 2005-2006 American College Health Association-National College Health Assessment (ACHA-NCHA) Web Summary. Available at http://www.acha-ncha.org/data_highlights.html.2006. distressed students

distressed National Trends of Distressed Students students Suicide is the 3rd leading cause of death among 15-24 year olds and the 2nd leading cause of death among college students 44% of college students describe themselves as binge drinkers 13.3% of college women say they have been forced to have sex in a dating situation UC Davis, Counseling & Psychological Services, “Responding to Distressed or Distressing Students”. distressed students

distressed Why are College Students Distressed? students Normal developmental issues Pressure and competition: academic, extracurricular, parental, racial & cultural Financial worries Social fears Feeling hopeless and helpless: depression, sleep disorders, substance abuse, anxiety disorders, eating disorders, self-harm distressed students Kadison, R. & DiGeronimo, T. (2004) “College of the Overwhelmed”.

distressed The Millennials students Highly structured academic life High parental involvement High levels of individual attention Emphasis on performance Little experience with failure distressed students

distressed The Millennials students Increasing competition High admissions standards Limited coping resources Difficulty being average Helicopter parents distressed students

Hovering Parents/ Needy Students? distressed students

distressed Distressed Student Trends at UCSB students Crisis cases have increased each year since 1991 Severity of cases have increased Counseling Services provides assistance to approximately 10% of the UCSB student population More students are referred to Student Health psychiatrists each year Concerns of distressed student affect academic performance to a significant degree distressed students

SOCIAL WORK SERVICES ARE AVAILABLE TO STUDENTS AT NO COST Social Worker Role Single point of contact Psychosocial assessment Case management of “at risk students” Crisis services Safety net: collaboration with clinicians, faculty, staff, hospitals Closure SOCIAL WORK SERVICES ARE AVAILABLE TO STUDENTS AT NO COST distressed students

distressed Social Work Student Referral Issues students Parental Concerns Mental Health Concerns Triage Financial Issues Crisis Intervention distressed students

distressed Social Work Student Referral Issues students Academic Concerns Health Insurance ER & Psychiatric Hospitals Withdrawal & Re-entry distressed students

Coordinating Resources & Treatment Social Worker Distressed Student Campus Student Health Counseling Services Alcohol & Drug Program OSL Resource Center for Sexual & Gender Diversity EOP Women’s Center Office of International Students & Scholars DSP Judicial Affairs Residence Halls Campus Police & Paramedics Financial Assistance Academic Advisors Faculty & Staff CLAS Community Parents Peers/roommates Therapists – private insurance Home community mental health treatment Medical & psychiatric hospitals Country Mental Health Treatment Government Assistance Child Care Rehabilitation Services Health Insurance Pharmacy Waiver Programs Paramedics Police/Sheriff Emergency Food & Shelter Religious Organizations Move the Distressed Student Oval

ADHD Treatment at Student Health Counseling Services Student Self Referral Disabled Students Program Hosford Clinic & Psychological Assessment Center Free ADHD / LD Screening Psychological Assessments Consult / Refer to SW Triages Service Needs Established Diagnosis And no Suspected Psychiatric Co-Morbid Conditions No Established Diagnosis and Suspected Psychiatric Co-Morbid Conditions Established Diagnosis and Suspected Psychiatric Co-Morbid Conditions Campus / Community Assessment & Treatment Services SHS Primary Care MD SHS Psychiatry Hosford & PAC (see above) Coaching Services Counseling Services Disabled Student Program Campus Learning Assistance Services Community Assessment /Treatment

Community Collaboration Psychiatric Emergency/Hospital County Mental Health County Public Health County Social Services Social Security/State Disability State Department of Rehabilitation Therapists/Counseling Clinics distressed students

Distressed Student Response Protocol Intervention guide Referral identifiers: student behaviors and/or reactions to these behaviors Early intervention Coordination of care Campus resources Referral procedures www.sa.ucsb.edu/distressedstudentsguide distressed students

Distressed Student Response System Counseling Services Student Health Urgent Care Psychiatry Social Worker Faculty/Staff Roommates/Peers Family Judicial Affairs Student Affairs Housing Police Hospitals SW Notified of Continued At Risk Behaviors Intervention Plan Parental Notification Housing Issues Treatment Issues Distressed Student Meeting Scheduled ASAP Core Student Affairs Team Members and impacted departments.

distressed Campus Outreach students Provide “Referring Distressed Student” protocol training with representation from Student Affairs core team members Encourage early intervention Involve departmental representatives/liaisons regarding distressed student concerns distressed students

distressed Campus Outreach students Student brochure Web listings Parent newsletters Media coverage distressed students

distressed Confidentiality students HIPAA: Health Insurance Portability and Accountability Act FERPA: Family Educational Rights and Privacy Act Confidentiality exceptions: medical providers vs. staff/faculty Releases of information distressed students

distressed Challenges students Parental Notification Outreach to Students Treatment Compliance Eviction from Housing Health Insurance/Pharmacy Coverage/ Medi-Cal distressed students

distressed Challenges students Intensive Treatment Options Impact on campus community After-hours issues Data collection distressed students

distressed Resources students The Jed Foundation. (2006). Framework for developing institutional protocols for the acutely distressed or suicidal college student. New York, The Jed Foundation. The Jed Foundation. (2002) Safeguarding Your Students Against Suicide. New York, The Jed Foundation. www.jedfoundation.org Benton, S.A. and Benton S.L. (Eds.). (2006). College Student Mental Health: Effective Services and Strategies Across Campus. National Association of Student Personnel Administrators (NASPA), Inc. Kadison, R. and T. DiGeronomo (2004) College of the Overwhelmed, The Campus Mental Health Crisis and What to Do About It. San Francisco: Jossey-Bass. Martha Anne Kitzrow. (2003). The Mental Health Needs of Today’s College Students: Challenges and Recommendations, Vol. 41: No. 1, Article 9. Suicide Prevention Resource Center. (2004). Promoting Mental Health and Preventing Suicide in College and University Settings. Newton, MA: Education Development Center, Inc. University of California, Office of the President. (2006). Report of the University of California Student Mental Health Committee. University of California. www.ucop.edu/sas/studentaffairsandservices/SMHCommittee2006.pdf www.jedfoundation.org/framework.php distressed students

distressed More Information students Elizabeth Downing, M.D. downing-e@sa.ucsb.edu 805-893-2251 Burt Romotsky, L.C.S.W. romotsky-b@sa.ucsb.edu 805-893-3380 distressed students