1. Collaboration with a Community Provider to Offer an On-campus Intensive Outpatient Program at a University Counseling Center May 29, 2014

2. Presenters Melissa Eshelman, MD Associate Director for Psychiatric Services University of Texas at Austin Julie Osofsky, LPC UT Epoch Intensive Outpatient Program Leader Seton Mind Institute Behavioral Health Services Austin, TX

3. Learning Objectives Identify which students would benefit from mental health IOP treatment. Describe the function, components and advantages of an on-campus mental health intensive outpatient program (IOP) List factors leading to a successful collaboration between counseling center and a community provider in offering an IOP on campus.

4. Overview Information about UT Austin and CMHC Clinical services Identify acute MH issues that may require a higher level of treatment than offered at a counseling center Intensive Outpatient Program at UT Austin Factors leading to a successful community provider-counseling center collaboration Time for Q&A

6. The University of Texas at Austin 350-acre main campus 18 colleges and schools, About 24,000 faculty and staff More than 51,000 students Students are not required to have health insurance

8. Student Services Building Counseling and Mental Health Center University Health Services Services for Students with Disabilities Office of the Dean of Students Student Financial Services Pharmacy

10. CMHC 2012-2013 CMHC served 5,178 students in 23,967 clinical appointments Individual Counseling 4,663 students attended 18,721 appointments Psychiatric Services 681students attended 2,416 appointments Crisis Teams 580 students requested Same Day Appointments 469 interventions by Crisis team/18 hospitalizations

11. Issues Students at CMHC Report 2012-2013 Data

12. ACHA-NCHA-II Fall 2013 Executive Summary ACHA-National College Health Assessment II National research survey organized by ACHA Student self-report data on health topics Web-based National reference data available since April 2012 UT Austin 934 student respondents, 11.8 response rate

13. ACHA-NCHA-II Fall 2013 Mental Health Issues Within the last 12 months: 19.8% felt overwhelming anxiety 17% felt so depressed it was difficult to functn 5.4% seriously considered suicide 0.7% attempted suicide Diagnosed with or treated for: Anxiety 12% Depression 10.5% Bipolar 1.2%

14. ACHA NCHA-II Fall 2013 Impact of MH on Academics Within the past year: 53.2 % found academics traumatic or difficult to handle Impacted academic performance: 35.4% stress (#1 reported barrier to academic success) 24.7% anxiety 13.7% depression

15. Students who would Benefit from MH IOP Students with Anxiety, Depression, Bipolar disorder, suicidal ideation when symptoms are severe when symptoms are negatively impacting academic and overall functioning when college counseling services are not enough to adequately treat

16. Treatment Options before On-Campus IOP Outpatient biweekly university counseling services (+/- on-campus psychiatric services) Individual therapy off-campus 1-2 times a week (+/- on-campus psychiatric services) Off-campus Outpatient Programs: Partial Hospital Program (PHP) or Intensive Outpatient Program (IOP) Inpatient Psychiatric Hospitalization

17. Off-campus Programs PHP: group therapy 6 hrs per day/5 days a wk plus psychiatric services. Limitations: Can’t attend classes, transportation, cost, little in common with other adult group members (lower functioning, chronic mtl illness) IOP: group therapy 3 hours per day/4 days a wk Limitations: Transportation, cost, time commitment, less in common with other adult group members, no easy access to psychiatrist

18. What Students Need Location accessible, with little to no transportation time Treatment that addresses their concerns as college students Group is inclusive and welcoming of similarities/differences among students Treatment is affordable and available Timely access to psychiatric services, if needed

19. Seton Healthcare Network Seton Healthcare Network is a not for profit organization made up of 11 hospitals (including one psychiatric hospital) and three medical outpatient community care clinics serving almost two million people in 2013 Seton also has a psychiatric outpatient clinic, behavioral health clinics, and a psychiatric emergency room which opened on 4/29/14 Seton Healthcare Family Mission Message: “Our mission inspires us to care for and improve the health of those we serve with a special concern for the poor and the vulnerable”

21. Seton Mind Institute Behavioral Health Services Travis county facility offers five intensive outpatient programs Generations Program for the geriatric population Two programs for adolescent population SMIBHS satellite locations in Williamson County, Hays County, and the University of Texas at Austin Morning, afternoon, and evening programming is available and over 21 groups are held daily Monday through Thursday

22. What is Intensive Outpatient Programming (IOP)? Sometimes traditional weekly therapy is not enough to manage symptoms of psychiatric disorders In other cases, individuals have been hospitalized and need to be placed in daily treatment before receiving therapy only one to two hours a week IOP through SMIBHS includes three hours of therapy, four days a week for four to five weeks Goal of IOP

23. History of the Epoch Program Many Intensive Outpatient Groups were offered but there was a gap in practice as there was not a group for the developmental age of 18-24 Reports from previous clients indicated that this age range had difficulty connecting with clients aged 25-55 Due to this, many clients who were 18-24 years old did not complete treatment

24. Thus Epoch was developed… Programming for those 18-24 years old was created at the main site The programming was successful but often times university students who needed this treatment would not attend due to lack of accessibility The idea of providing intensive outpatient programming on campus was introduced

25. On-Campus IOP Development Previous CMHC visit to Seton Hospital and inquire about IOP services. Seton IOP group leader presentation to CMHC staff Director for Seton Behavioral Health Services proposed the idea of moving IOP to off clinic site locations, such as CMHC Meeting between CMHC and Seton to explore proposal

26. Planning for On-Campus IOP Protocols: Seton’s responsibility, but were developed in collaboration with CMHC CMHC referral to free SMIBHS IOP intake CMHC group room designated for Seton IOP CMHC provides an office for the Seton IOP clinician to conduct an intake Seton is responsible for patient care and documentation Seton handles billing and scholarships, in addition to county funding Qualifications of Seton IOP clinician: licensed mental health professional

27. Days and Hours of IOP The UT Epoch group meets Monday through Thursday for three hour sessions Students typically attend 20 sessions or five weeks of treatment

28. Assessment and Referral Process Factors considered when determining if the student is a good fit for group Steps taken if the student is not an appropriate fit for IOP Cultural and diversity considerations

29. Functions and Components of an on campus IOP Learning Objective 1 Components of Group Sessions Daily Check In Portion Skills Building Portion

30. Check in Portion Each student engages in a daily check in Report on severity of symptoms and any maladaptive behaviors for the day Discussion of issues or concerns Feedback from other group members Insertion of coping skills and/or education throughout the check in portion

31. Skills Building Portion The entire group engages in a didactic portion of the group The “Tool Belt” concept

32. Examples of didactics: Self-compassion education - healthy versus unhealthy perfectionism (one week) Cognitive Behavioral Therapy (one week) Assertive Communication (one week) Healthy Boundary setting Distress tolerance skills Mindfulness skills Illness recognition and relapse prevention

33. Discharge from the Epoch Group Signs that a group member is ready to finish group Requirements for completion of group

34. UT-Seton Epoch IOP February 2012 - August 2013 Data 122 completed an IOP assessment 54 UT students completed IOP  38 students completed IOP at UT  11 students received scholarship  7 students received county funding  16 students completed IOP at SMIBHS (off- campus)

35. Demographics of IOP Participants

37. College/School of IOP Participants

38. MH Symptoms/Diagnoses in IOP participants Depression: 76% Suicidal ideation 61% Anxiety 58% Bipolar 27%

39. MH Symptoms/Diagnoses in IOP Participants

40. Impact on Academics for IOP Participants

41. Factors that Led to a Successful Collaboration From CMHC standpoint CMHC point person familiar with IOP CMHC point person promoting/reminding Interest in IOP availability as treatment option Director willing to explore opportunity Ongoing communication with IOP group leader Alignment of mission/values

42. Factors that Led to a Successful Collaboration From Seton standpoint Collaboration between the leader of the group with counseling center clinicians Continuity of care and allows for a treatment team approach Access to psychiatry Referrals to other UT services

43. Feedback from Former IOP Participants

44. Summary Provided information about UT Austin and CMHC Clinical services Identified acute MH issues that may require a higher level of treatment than offered at a counseling center Intensive Outpatient Program at UT Austin Listed factors that led to a successful community provider-university counseling center collaboration

45. Finishing up Question and answer Thoughts, suggestions, feedback? Melissa Eshelman, MD meshelman@austin.utexas.edu Julie Osofsky jaosofsky@seton.org

46. Thank you!