College Counseling in the United States Brian Van Brunt, Ed.D Senior Executive Vice President of Professional Program Development The NCHERM Group, LLC American College Counseling Association

2 What do you call someone who speaks three languages? Trilingual. What do you call someone who speaks two languages? Bilingual. What do you call someone who speaks one language? American.

3 Center for Collegiate Mental Health. (2014, January) Annual Report. Gallagher, R. (2014). National Survey of Counseling Center Directors. Alexandria, VA: American College Counseling Association, and the International Association of Counseling Services. Available at Association of University and College Counseling Center Directors (2013). Survey of counseling center directors. Available at Resources

4 Organizations for College Counseling

5 Psychologists: assessment and supervision, prestige of American Psychology Association (APA) doctoral programs Master level counselors (LPC): more generalist clinicians, cost less to employee, larger job pool Social workers (MSW, LICSW): more systems orientated, working with other departments Marriage and Family Therapists (MFT): couples counseling and background Substance Abuse (LADC): working with addictions Masters of Divinity (MDIV): grief, loss, existential counseling Clinical Diversity

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7 Student to Staff Ratio

8 Community Colleges Growing area in United States Community and technical colleges typically have open enrollment. Students attend two years to prepare for work or transition to four year More students coming back to school to retool in other careers Counseling staff often para-professional. If licensed, not hired to provide mental health treatment Life coaching, academic support, career support, or general adjustment to life, family and work stress

9 Successful counseling centers split their time between individual care and outreach to the community Pairing with other departments such as police, residential life, student activities, academics, orientation and clubs and organizations Centers offer mental health awareness programs, screening events for depression, anxiety, substance abuse and eating disorders The Importance of Outreach

10 Suicide gatekeeper programs train staff, faculty and students to identify the signs of suicide, teach skills needed to ask follow up questions and how to refer the at-risk individual to care Suicide Prevention

11 Suicide gatekeeper programs train staff, faculty and students to identify the signs of suicide, teach skills needed to ask follow up questions and how to refer the at-risk individual to care. 86% of students who commit suicide never are treated in the counseling office Suicide Prevention

QPR is one approach to educating staff, faculty and students in order to prevent suicides on campus This approach is similar to CPR in its focus on training those in a short, 90 minute session to provided to non-clinical staff – Question signs/symptoms of suicidal behavior – Persuade people to get help – Refer them directly to that help QPR training is $495 for 1 day training that allows the trainer to offer it on campus Question, Persuade, Refer (QPR)

safeTALK: is suicide alertness for everyone and teaches participants how to recognize when thoughts of suicide are present & initiate alert steps to get some assistance The TALK steps are Tell, Ask, Listen, and Keep Safe. The training includes discussion of why persons might miss, dismiss, or avoid the idea of suicide and offers participants the opportunity to practice TALK steps safeTALK participant cost $6 resource book, pocket card, sticker, and certificate. safeTALK training for trainers cost $ (cost is lower if you have 10 trainer candidates). Trainer prerequisite is ASIST training 13 safeTALK

ASIST stands for Applied Suicide Intervention Skills Training and is a 2 day workshop for professionals and non-professionals ASIST complements safeTALK because persons who are identified by suicide alert helpers receive the first aid intervention they need. Beginning with a full exploration of caregiver attitudes, ASIST is highly interactive and participatory. Over ½ of the workshop involves working with suicide intervention simulations ASIST participants receive workbook, prompter card, sticker, suicide intervention handbook, National Suicide Lifeline card. Workshop participant costs vary by location ($50-300). They often offer 15 CEUs. 5 day Training for Trainers around $ ASIST

15 Anxiety continues to be the most predominant presenting concern among college students (46.2%; up from 41.6% in 2012), followed by depression (39.3%, up from 36.4% in 2012), and relationship problems (35.8%, unchanged from 2012). Other common concerns are suicidal ideation (17.9%, up from 16.1% in 2012), alcohol abuse (9.9%, down from 11% in 2012), and sexual assault (7.4%, down from 9.2% in 2012). Usage Data for Counseling Centers

16 Usage Data for Counseling Centers

17 Some centers limit care based on certain diagnosis or clinical acuity Students with bi-polar, schizophrenia, eating or personality disorders may be triaged out to community providers There is a current debate in the field around this practice. Some argue centers should provide general care to all. Others suggest this type of care is time and staff intensive and takes clinical hours away from other students Scope of Practice

18 30% of centers report that (with some exceptions) they limit the number of counseling sessions students are allowed. 43% do not have a specified limit on sessions but promote their center as a short-term counseling service, 28% tend to see students as long as it takes to resolve the student’s presenting issues but will make external referrals when deemed clinically advisable The Question of Session Limits

19 There has been a trend to combine counseling services with health services in order to create a cost- saving model Counseling staff have a concern on having care decisions taken over by medical providers Most centers work collaboratively with health providers on campus Combined Health and Counseling

20 Combined Health and Counseling

21 Combined Health and Counseling

22 Some centers provide psychological testing for their students This can be to identify and accommodate learning difficulties in the classroom or living accommodations in the residence hall This testing can also include personality and diagnostic testing to aid in clinical care Psychological Testing

23 Group counseling is often a desired service to be offered by counseling centers Many centers struggle with offering groups consistently to students in need Mandated groups to address sexual harassment, anger management or substance abuse have better success in attendance Successful wellness groups are offered for women’s empowerment, developing better study skills or adjusting to college tend to have higher attendance Group Counseling

24 Sexual assault cases are on the rise in the United States There is pressure for counselors to share information about the assault to administrators, causing some ethical problems for clinicians The government now requires colleges and universities to teach sexual assault education and prevention training to address stalking and Intimate Partner Violence (IPV). Sexual Assault Cases

25 Mandated assessment is the process where a third- party requires a student to meet with a counselor. The counselor assesses the risk of violence to self, to someone else, substance abuse or addiction, or the stability of their behavior or mental health condition Most centers offer some form of mandated assessment as a service to the students and then administration Mandated Assessment

26 Mandated treatment is less common on college campuses and when it is required it involves the student seeking mental health care for substance abuse, dangerousness to self or others or in order to better control behavioral symptoms (e.g. responding to hallucinations in the classroom) This care is an area of debate among clinical staff. Some argue any care that a student seeks must be voluntary in nature to comply with ethics standards Others argue that those who most need to be in care are often reluctant to see a therapist by their own choice Mandated Treatment

Meloy, J., Hoffmann, J., Guldimann, A. and James, D. (2011). The Role of Warning Behaviors in Threat Assessment: An Exploration and Suggested Typology. Behavioral Sciences and the Law. “Threat assessment involves the assessment of levels of concern on a subject who has been flagged by some aspect of their behavior, and is based upon what (often limited) evidence is available at the time” (p. 18) “Threat assessment seeks to make an informed judgment on two questions: how credible and serious is the threat itself? And to what extent does the threatener appear to have the resources, intent, and motivation to carry out the threat?” (p.5) O’Toole, M. (2002). The school shooter: A threat assessment perspective. FBI. 27 Threat Assessment

College Counseling in the United States Brian Van Brunt, Ed.D Senior Executive Vice President of Professional Program Development The NCHERM Group, LLC American College Counseling Association