University Of California: Student Mental Health Statewide Coordination Workgroup (9/18 – 9/19) Taisha Caldwell, PhD. Mental Health Clinical Coordinator/Program Manager
Outline • College suicide and the University of California • The Interactive Screening Program (ISP) – Overview – Implementation – What does it cost • Preliminary analysis/student feedback • Risks and Benefits • First look at the data – Is it worth it? • Helpful Tips & Considerations for partners • Sustainability
College Suicide: a bigger problem than you might think – About 30 percent of college students reported feeling "so depressed that it was difficult to function" at some time in the past year (ACHA – NCHA, 2011) – More than 6 percent of college students reported seriously considering suicide (ACHA – NCHA, 2011) • Despite the availability of counseling services at most U.S. colleges and universities, an estimated 80% of students who die by suicide each year have not utilized these services (Gallagher, 2005) • Research suggests that this epidemic is not due to students’ lack of awareness of available services, but rather, something in their life experiences, ways of thinking, and fears and concerns (Downs & Eisenberg, 2012)
College Suicide: UC students are not exempt • Similar to National Trends • UC students are presenting with mental health issues with greater frequency and complexity than ever before • An increased number of UC students are entering college already on medication • In effort to meet the demand, we were forced to reduce prevention efforts
UC Student Mental Health • Sustainability Model – Tier 1 – Responding to Critical Mental Health and Crisis Critical Mental Response Services Tier 1 Health and Crisis • *2007-2008 Response Services – Tier 2 – Targeted Tier 2 Interventions for Vulnerable Targeted Interventions Groups • *2008-2009 Tier 3 – Tier 3 – Creating Healthier Creating Healthy Learning Environments: Living Environments A Comprehensive Approach to Prevention • *2011 – current CalMHSA
Interactive Screening Program (ISP) • In 2001, the American Foundation for Suicide Prevention (AFSP) began developing a web-based method of reaching out to college students with serious depression or suicide risk factors who were not receiving treatment. • The program connects troubled students to a mental health clinician, who helps them more clearly identify the problems they are experiencing and work through the barriers that are preventing them from getting treatment. • As one of several screening methods, each of our UC campuses have committed to using this online program to reach students at risk.
ISP Implementation • Overview – UC San Diego • Key Components – Targeted email invitation from department – Anonymous online screening re: stress, depression & anxiety – Tailored response from UC psychologist (24 – 48hrs) – Option to dialogue w/ UC psychologist • Student has ability to end anonymity at any time – Psychologist builds rapport and offers counseling services, refers to auxiliary services, or recommends no treatment
Sample Lead E-mail
Sample Survey UC Counseling Center Resources Informs student of the type of intervention Emergency Services
Student View of Questionnaire
Staff View of Questionnaire
Sample Questionnaire Response Custom response & offer for anonymous dialogue
Sample Dialogue
What Does It Cost? • AFSP ISP Cost – $5,000 – initial year, $2,500 for subsequent years – Includes initial website, domain and security fees, training of local program staff and technical support • AFSP recommends one mental health clinician for every 10,000- 12,000 students. – Requires daily checking and response to notifications • UC San Diego has allocated two clinicians to ISP – Clinicians switch duties each week • Clinicians dedicate 4-5 hours/week and as needed to ISP – One person designated to check ISP during times when no invitations have been sent – Requires staff time for set-up, management, responding, clinical time, consulting
Preliminary Analysis *Numbers based on UC San Diego ISP implementation since April 2012 Invited Questionnaire Respondents 3274 300 241 250 200 Responded 154 463 150 Tier 100 61 50 Dialogued 5 0 69 1A 1B 2 3 Sought • Of 463 respondents, 52 (11.2%) acknowledged currently being in treatment at the time of the survey. Treatment • 12 1A respondents acknowledged being in treatment 33* at the time of the survey.
ISP Feedback (students who responded to the survey) How did feedback affect likelihood to seek counseling services? 50 45 40 35 30 25 20 15 10 5 0 Sought Service More Likely Neutral Less Likely
ISP Feedback (all students who received the survey) Overall how did program affect likelihood to seek counseling services? 70 60 50 40 30 20 10 0 More Likely Neutral Less Likely
ISP Feedback (all students who received the survey ) Overall, how did program affect your impression of Counseling services? 60 50 40 30 20 10 0 Positively Neutrally No Change Negatively
ISP Feedback (all students who received the survey) Would you recommend this program continue? 60 50 40 30 20 10 0 Yes, definitely Yes, probably No, probably No, definitely
Benefits of Implementation • Prevent suicide • Reach underserved populations w/ targeted outreach • Allow students with misconceptions about counseling to connect with a caring clinician • Stigma reduction • Demonstrate campus willingness to align MH outreach efforts with cultural norms • Builds institutional support – Allows staff and faculty to respond to tragic events in meaningful ways (demonstrate concern for students well- being)
Risks of Implementation • Breaches of anonymity • Misperception of online therapy • Requires strong campus collaboration – Some students could be left out • Potential for demand to be greater than resources – Unpredictability for level of engagement and response rate at any given time – could confound with in-person clinical demand
Helpful Tips & Considerations for Partners • Thinking about implementing the ISP with your population? Make sure to consider the following: – Funding for program costs and clinical staff • How many years can you fund? • How many years will it take you to survey your entire population? – How will you identify target populations? – How will you obtain campus buy-in & support
Tips for Identifying Target Populations Model for Identifying Target Populations* *Ideal model. Pragmatically, chosen target population may be driven by this model & relationships with existing campus partners, and readiness to buy-in/collaborate.
Tips for Campus Buy-in and Support • Identify key, faculty, staff, administrators, & peers • Inform and educate about ISP and suicide risk – Brief presentations, attend meetings, send emails, etc. – Include literature/slides on ISP and draft of invitation email – Discuss risks and benefits • Co-Develop invitation email draft – Must include certain language about confidentiality, anonymity, and limits of the resource (i.e. not a crisis line, or online counseling) • Develop coordinated invitation schedule – Strategize: Who do students actually read emails from? • Consider lead and follow-up emails
Tips for Campus Buy- in and Support cont… Reach out to campus partners & students • Inform relevant campus partners which students are being invited to take ISP and when – their services may be impacted during this time – University Health Services, advisors, front-line staff, other relevant student services, etc. • Inform relevant student groups to get ahead of the peer influence
Sustainability • Will maintain partnership with local AFSP chapters – Currently sponsoring UC ISP implementation • Will assess data in June 2014 to decide if ISP gains are greater than risks and costs – Individual campus decision – Some campuses already committed to allocating staff resources to ISP beyond the contract • UC Office of the President will continue system level support for mental health initiatives to fulfill promise of the 3-tier model – Lead by the Student Mental Health Oversight Committee
Next Steps: Sustainability • Actualizing Tier 3 (Building a healthy foundation) Critical Mental • “The CalMHSA [award] allowed Tier 1 Health and Crisis Response Services us to increase to roughly 15% despite the fact that we had large increase in our clinical Tier 2 Targeted Interventions demand. Without the [award], we would likely have reduced the time and budget for prevention to Tier 3 below 5%” – CAPS Director Creating Healthy Learning Environments: A Comprehensive Approach to Prevention
THANK YOU! For more information contact Taisha Caldwell, PhD. Taisha.Caldwell@ucop.edu American Foundation for Suicide Prevention www.AFSP.org
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