Reaching The Ones That Reaching The Ones That Won’t Walk-in: A Community Won’t Walk-in: A Community Based Service Approach to Based Service Approach to

Students in NeedStudents in Need

Gregory T. Eells, Ph.D. Cornell University

Mahnaz Mousavi, Ph.D.Georgetown University School of

Foreign ServiceDoha, Qatar

OutlineI. IntroductionII. Relevant DataII. Philosophical FrameworkIII. Description of Community Based Services at Cornell

IV. Application in QatarV. CasesVI. Conclusion

IntroductionThe Virginia Tech tragedy has brought considerable attention to college counseling services.Questions have been raised about mental health care and college students who might “fall through the cracks.”Raising questions of how we continue to extend The Colorado Cube of Morrill, Hurst, and Oetting into today’s counseling center

IntroductionWe are all more challenged by the need for consultation and support among the network of faculty and staff on our campuses.There are a significant proportion of students in distress who are not receiving services.The majority of students who kill themselves never receive counseling services Gallagher (2005)

Relevant Data In past year:

“so depressed it was difficult to function”

Cornell: 44% seriously contemplated suicide

Cornell: 11%attempted suicide

Cornell: 1.3% (~175 undergraduates)

2006 National College Health Assessment (NCHA) 1902 Cornell undergraduates responding

In last 12 months, was unable to function academically for at least a week due to depression, stress, or anxiety:

White: 37%Asian-American: 50%URM*: 54%International: 51%

*URM = underrepresented minority2005 Enrolled Students Survey

4790 undergraduates; 37% response rate

In last 12 months, seriously considered attempting suicide:

White: 6%URM*: 8%Asian-American: 10%International: 10%

In last 12 months, attempted suicide:White: .04%URM*: 1.9%Asian-American: 2.5%International: 2.9%

*URM= underrepresented minority2005 Enrolled Students Survey

4790 undergraduates; 37% response rate

CAPS Utilization Rates

0

5

10

15

20

25

30

2000 2001 2002 2003 2004 2005 2006

% u

tili

zin

g C

AP

S

African-American Hispanic

American Indian Student Body

CAPS Utilization Rates

0

2

4

6

8

10

12

14

2000 2001 2002 2003 2004 2005 2006

% u

tiliz

ing

CA

PS

Asian-American International Student Body

Asian and Asian-American students: >50% of completed suicides

Philosophical Framework engagementbuild relationships before counselingreach students in alternative waysnot bound by the traditional counselor role and setting don't wait for students to come to us

Philosophical FrameworkAddress problems where they occurMental health concerns do not just originate “in the students’ heads,” but also in the systems and communities in which they live.Therefore, environmental interventions are essential

Philosophical FrameworkOperate from a social justice multicultural frameworkThe narrative around mental health is increasingly told by the pharmaceutical industry that says all mental illness is brain disease-defective.In reality this narrative is a small part of the story

Philosophical FrameworkThese organic explanations of every form of

mental problem-including crime and delinquency, alcohol and drug addiction, and all forms of child and adult distress-make social change unnecessary. If underpaid workers, exploited and undervalued women, uneducated minorities, the unemployed, the aged, all have high rates of mental disorders, alcoholism, drug addiction, and crime these pathologies are due to defective biology/chemistry. They are not the fault of the system say the ruling elite.

George W. AlbeePast President, APA

Philosophical FrameworkRealize that traditional mental health services are outside of the “Meaning making sentence” of many groups.Culture involves both an internal and external experience and is the space that cross cuts all of our work. Our goal is to open up these spaces:Through asking difficult questionsThrough assessing the impact of crossing bordersThrough approaching justice by understanding that human life is more malleable than we understand

Community-Based Services

Clinic-Based Services

Counseling and Psychological Services (CAPS)

What is Community-Based Services (CBS)?

The outreach arm of Counseling and Psychological Services (CAPS) at GannettAn effort to support students who don't usually come to counselingAn attempt to overcome stigma, cultural barriers & institutional barriers

THE CBS Program at Cornell

Presentations, trainings & orientations"Let's Talk" offsite walk-in hoursInformal discussion groupsCommunity Consultation and Intervention (CCI)

Presentations, Trainings and Orientations

Presentations, Trainings and Orientations

opportunity to meet students outside of counseling contextreduce barriers to seeking helpinform students about mental health issues and resources

Pre-Freshman Summer Program

all seven colleges90 minute interactive presentation on survival skills for Cornellintroduction to CAPS and related resources

Let’s Talk

Let's Talk daily walk-in availability nine sitesfreedirect referrals from trusted members of the student's communitymeeting outside of the health center, often within the student's community

Let’s Talk

“consultation and support”informal, friendly formatfocus on immediate problem solving, resources, and advocacyoption for anonymous visitreferral to CAPS if necessary

Let’s Talk Utilization55% are students of color or international students Vs. 32% of CAPS clients

Informal Discussion Groups

Community Consultation and Intervention

(CCI)

CCI Components• Student-centered consultation• Direct intervention• Program-centered consultation

Student-Centered Consultation

Consultation with faculty and staff regarding students in distress

Student has already been unsuccessfully referred to counseling, or the issue is predominantly environmental (e.g., financial problems), not intrapsychic

Advise staff on providing informal counseling when necessary

Behind the scenes case management and advocacy

Periodic follow-up to monitor student’s situation

Direct Intervention Relationship with staff member

sometimes helps facilitate referral Service defined as “student support” Focus is on immediate problem-solving,

support, advocacy, and case management First contact often outside of counselor’s

office Sometimes evolves into counseling

relationship, sometimes not

Program-Centered Consultation

Specific cases highlight systemic problems creating student distress

Program centered consultation evolves from cases

Consultations often lead to training Issues surfaced by multiple cases lead

to policy changes Program-centered consultation and

training leads to more student-centered consultation and direct intervention

Application in Qatar

Cases

DirectionsCollecting data and quantifying the rich qualitative data that already existsChallenges of systematizing and institutionalizing the workMore general clinicians doing CBS workTelling the story about the work

Conclusion