1. Assisting Students in Distress Khalila Fordham, Psy.D. Raquel Contreras, Ph.D. Counseling and Psychological Services (CAPS) September 10, 2015 Presentation for Library Supervisors

2. Learning Objectives This presentation is intended to help attendees:  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 how CAPS can assist all university personnel in responding to students in distress and crisis.

3. Students in Distress  Everyone experiences distress!  Many times, the student may not approach you, may not want you to be involved, or may not need staff involvement.  It is important to give students space to resolve their own problems, to a degree.  If the student’s distress shows no signs of going away, or is increasing in severity over time, this may show a need for assistance or intervention.  If you are concerned, it is best to consult with a colleague and/or approach the student.

4. Specific Signs of Distress Marked changes in academic performance, or attitude towards academic performance:  Poor preparation for class  Drop in grades  Excessive absences or tardiness  Excessive anxiety about classwork, perfectionism  Exaggerated emotional responses that are obviously inappropriate to the situation  Inability to communicate clearly

5. Specific Signs of Distress (continued) Changes in 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

6. Specific Signs of Distress (Continued) Unusual appearance*, or changes in 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

7. Distress or Crisis?  Both require our attention!  Distressed students can 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.

8. 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 personally uncontrollable levels.  Without immediate outside intervention, this situation can result in displayed disturbance of conduct, harm to self or others, or high levels of campus disturbance.

9. Identifying a Person in Crisis Watch for:  Highly bizarre 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)

10. Distress, Crisis, and Risk

11. Risk Risk can be categorized into 5 classifications: mild, moderate, elevated, severe, or extreme. As risk moves from mild to extreme, dangerous or threatening behavior becomes more likely. This behavior can be direct inwards towards the student, or outward towards others.

12. Classifying Risk: Mild  Disruptive or concerning behavior  No threat of harm made or present  Action: This is a student of concern who should 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.

13. Classifying Risk: Moderate  More involved or repeated disruption  Possible made or perceived threat, vague and indirect  Threat lacks realism, detail  Content of threat suggests unlikely to be carried out  Action: This is could become an urgent mental health situation. The student should be approached. Seek consultation as soon as possible about how to intervene.

14. Classifying Risk: Elevated  Seriously disruptive incident(s)  Clear distress or disturbance  Threat made or present  Threat may be vague, but repeated to several observers  Action: This is an urgent mental health situation. Seek consultation immediately. The student must be approached. Call CAPS or offer to walk student to CAPS as soon as possible.

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.

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. Notify CAPS.

17. Interventions for Students in Distress and Crisis

18. 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 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.

19. General Advice for Any Situation Whether the student you are helping 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 directly involved with the situation.

20. General Advice for Any Situation  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.  Note your own responses and ensure you have a space to debrief or otherwise engage in self-care.

21. 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.

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

23. Using Caution When Helping AVOID:  Judging. Help the student problem solve instead of offering immediate criticism  Negativity. The student can use hope from an outside source to motivate him or her to search for solutions  Excessive Questioning. Asking many “why” questions will only lead to the student spending more time questioning his or her self. Ask only for the information you need in order to help.

24. Using Caution When Helping AVOID:  Publicity. Steer the student towards a more private venue for discussion if he or she approaches you in an open office or after class  Assuming. Reflect back feelings and statements to the student to ensure you understand the situation as he or she is presenting it  Rescuing. Refer the student to appropriate resources instead of trying to solve the student’s problem on your own

25. Helping a Student in Crisis DO:  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

26. Using Caution During a Crisis DON’T:  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

27. Resources for students in distress  Dean of Students office  www.clemson.edu/deanofstudents www.clemson.edu/deanofstudents  656-0471  Office of Community and Ethical Standards  Clemson University Police Department  Redfern Health Center  Counseling and Psychological Services  Medical Services  Healthy Campus

28. Access to care  Walk-in Clinic:  Students are seen on a first-come, first served basis  10am – 2:30pm, Monday through Friday.  Complete electronic documentation that takes about 15-20 minutes.  Seen for an Individual Assessment (IA)  Students needs are assessed and a personalized treatment plan is generated.  Treatment recommendations are given in writing.  All students are assessed for safety and level of risk at this initial contact.

29. CAPS Crisis Response Services  8-5, M-F: To immediately address a crisis, CAPS has counselors available to assess students in need. If it is safe and the student consents to it, walk the student over to ensure he or she accesses services.  CAPS On-Call: CAPS has a counselor on-call 24 hours a day, 7 days a week through CUPD at 656-2222. Please call and request to speak to the CAPS Counselor on-call, give contact information, and you will receive a call from CAPS as soon as possible.

30. Treatment Services at CAPS  Individual Assessment  Single session  Skills-building workshops  Group therapy-specific and general  Individual counseling  Dialectical Behavior Therapy (DBT

31. Online services  TAO—An intelligent mental health therapy tool  7-module, online treatment for anxiety  Weekly video conference with counselor  Free, anonymous online screening tools for depression, bipolar disorder, anxiety, post- traumatic stress disorder, eating disorders and alcohol use issues  http://screening.mentalhealthscreening.org/clems on http://screening.mentalhealthscreening.org/clems on

32. Source: taoconnect.org (Reproduced with permission)

33. Specialized Programs  ACTT: Alcohol and Drug Abuse Services  CUCARES: Relationship and Sexual Violence Services  Eating Disorders Treatment Services  Mood Disorders Services  Anxiety Disorders Services  Veteran Services

34. Confidentiality  Confidentiality is the cornerstone of CAPS services.  Students are assured of confidentiality -- with the exceptions under the law  Imminent threat of harm to self or others  Mandated reporting for abuse/neglect for child, or vulnerable adult  Court ordered to release information  Written consent given by client

35. CAPS: Serving the Campus Community, and You!  24/7 On-Call for psychological emergencies  Emergency Response integrated with many campus agencies  Consultation for employees and concerned parties about mental health issues, and how to help those who are in distress/crisis  Outreach Services to promote health, safety, prevention, and education about mental health issues  Crisis and Grief Debriefings  Referrals to mental health resources outside the campus community