REALIZING OUR COMMITMENT TO DIVERSITY THROUGH OUTREACH AND RESEARCH

Counseling and Psychological Services

Indiana University Bloomington

OUTLINE The history of the diversity outreach

program What we have developed and learned Practice and research synthesis:

Diversity research project

THE INDIANA UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICES (CAPS) DIVERSITY OUTREACH PROGRAM

In August 2008 CAPS launched the Diversity Outreach Team, with the goal of assessing and addressing the needs of under-represented students.

Relies on a multidimensional approach to address barriers to minority student service utilization, including: Proactive outreach and service in collaboration with the

campus community Practice-oriented research, including needs assessment Systemic interventions

WHY THE DIVERSITY OUTREACH PROGRAM WAS INITIATED CaPS staff noticed underrepresentation of minority

students amongst clientele What statistics showed:

2007-2008 2009-2010

CAPS % IU % CAPS% IU %African American 3.5 4.27 3.7 4.45Asian American 4.88 3.61 5.23 4.26Latino/Latina 2 2.47 2.93 2.60American Indian 0.31 0.29 0.38 0.29European American 74.42 78.04 75.08 75.38International Student 5.94 9.62 5.35 10.35

BARRIERS TO SEEKING COUNSELING HELP

Minority college students tend to avoid formal mental health treatment, such as university counseling centers.

In general, only 1 in 3 African Americans who need mental health care receive it, and furthermore are more likely to stop treatment early

Why might this be?

(American Psychiatric Association; 2010)

CULTURAL ATTITUDES Stigma or shame

Negative attitudes towards mental disorders as a sign of:

Weakness Being “crazy’ Double disempowerment

Cultural values emphasizing family and social relationships over mental health counseling• Religious and family values/beliefs

e.g. preferring to go to family or minister with problems

Resilience: as social and religious support serves as a buffer against mental disorders within communities of color(Constatine, Wilton, Caldwell, 2003)

BARRIERS TO SEEKING MENTAL HEALTH TREATMENT IN COMMUNITIES OF COLOR

Access to Care: insurance, transportation, cost, culturally competent care Cost of therapy is often seen as a barrier (For IU students,

services are available at CaPS at low cost)

Distrust of formal healthcare systems

Myths about Counseling • Fear of experiencing institutionalized racism as part of the

counseling process• Distrust towards mental health professionals who tend to be

predominantly white(Constatine, Wilton, Caldwell, 2003)

Common vs. Unique stressors for ethnic/racial minority students

COMMON COLLEGE STUDENT STRESSORS

“traditional problems” death of a parent dating violence Breaking up with boyfriend/girlfriend Academic difficulties Family issues/conflict/ responsibilities

(Fukuyama, 2001)

UNIQUE STRESSORS AND ATTITUDES• Racism and Cultural Adaptation

• Acculturative stress• racial/ethnic identity struggles, including within-group

identity struggles• Racism and microaggressions• classism isolation

• First generation ethnic minority students Pressure from family, financial stress, identity struggle

(Fukuyama, 2001)

A RESPONSE TO THESE ISSUES:

THE DEVELOPMENT OF THE CAPS DIVERSITY OUTREACH TEAM

DEVELOPMENT OF THE PROGRAM

• Year 1 (2008-2009) One practicum student, Peiwei Li One staff psychologist supervisor, Paul Toth Established foundation of the program, began

networking

• Year 2 (2009-2010) Two practicum students and one pre-doctoral

intern; Alison Schwing, Ian Arthur, & Julia Arany Predoctoral Internship Diversity Rotation

established Further expanded programming

• Year 3 (2010-2011) Two practicum students and one pre-doctoral

intern: Amanda Voils-Levenda, Whitney Stewart & Alison Schwing

Formalized relationships, focus on outreach

Alison Schwing

Dr. Paul Toth

Ian Arthur

Julia Arany

Whitney Stewart

Consultations• Collaboration with

Campus Groups• Cultural Centers• Student Groups• Administrative

Groups • The IU Diversity

Committee

Outreach Workshops

• Presentations tailored to underserved students

• Workshop Series • Collaboration with

student and campus groups

Service & Networking

• Pre-counseling hours at university culture centers

• Networking and collaboration with university multicultural communities• Articles for Diversity

Group Newsletters

Awareness-Raising• Presence at

Diversity Fairs• CaPS Diversity

Video• Planned Diversity

Poster Campaign in Residence halls

Research

• Attitudes and needs assessment survey

• Broaden understanding of underutilization of services

Conference Presentations

• Add to the dialogue regarding these issues

• Includes student conferences for minority student leaders

EXAMPLES OF OUTREACH PROGRAMSWorkshop and presentation at

student dorms and sorority and

fraternity meetingsDepression and African American Students for a

sorority

Suicide Prevention amongst Latino college students

Presentation at Multicultural Greek Council

Collaborations with various diversity office on campus

Latino Cultural Center Mujeres en Acción Women’s Group Series: Yoga & Stress Relief

session

Asian Cultural Center Series;--Card-making and Healthy

Relationships--Mental Health Screenings

1st Generation College Students Groups Program:

Domestic Violence workshop

MAPPING OUT DIVERSITY OUTREACH

VIDEO PROJECT Multicultural focus groups For use on IU CAPS website, multicultural

offices and various outreach settings Address:

Psychological wellness Ways counseling can be helpful Counseling and ethnic minority students Myths surrounding mental health and counseling

CaPS for Everyone VIDEO

WHAT HAVE WE LEARNED? Attitude Team approach Multi-level collaborations Maintenance and continuity of efforts;

formalization of relationships Proactive stance towards outreach Documentation, archiving Iterative process, some things work better

than others Assessment Practice-research dialectics

PRACTICE-RESEARCH

CAMPUS WIDE SURVEY Ethnic minority students’ attitudes towards mental health

counseling and their psychological needs

Exploratory and descriptive in nature

research questions: What are the attitudes among ethnic minority students at IU

towards mental health counseling? What are ethnic minority students’ perceptions of CAPS? What are the prominent stressors and psychological needs of

ethnic minority students at IU?

Research purpose: To better facilitate the development and implementation of

effective programming to bridge the gap in service delivery.

SURVEY DESIGN Sampling

Convenient sampleLimited generalizability

Online survey16 demographic Qs31 Likert or Likert-type Qs6 open-ended Qs

MEASUREMENTSAttitudes Toward Seeking Professional

Psychological Help: Short Form (ATSPPH-SF) 10 items0-4 Likert scaleModified by Fischer & Farina (1995) from Fischer and Turner’s (1970) original 29-item measure.

Reported Cronbach alpha = 0.84; Reported one month test-retest reliability = 0.80

MEASUREMENTSCollege Stress Inventory (CSI)

21 items0-4 Likert-type scaleApplied to Hispanic college students (Solberg et al., 1993)

Three factors: Academic stress, social stress, and financial stress

Reliability on internal consistency: 0.72 (academic stress subscale) 0.83 (social stress subscale)

VARIABLES Independent variables/predictors

Seeking services at CAPS Gender Race/Ethnicity Class standing International student

Dependent variables Attitude: Average score of ATSPPH-SF items College stress (academic, social and financial):

Average score of CSI items

OPEN-ENDED QUESTIONS1. What comes into your mind when you think about “counseling” or

“mental health counseling”? 2. What are some of your major resources that help you when you feel

stressed or overwhelmed? 3. Have you heard about IU CAPS? If so, what is your impression about it? If yes, provide your answer here:_________________ 4. How likely do you think you may seek services at CAPS when you

experience emotional distress? Please explain your answer. 5. If you have been to CAPS, how would you describe your experiences

there? 6. What suggestions do you have for CAPS to make their services more

available to racial/ethnic minority students like you and your friends?   

RESULTS: DESCRIPTIVES 380 surveys collected 336 fully completed

“Prefer not to answer” responses coded as system missing data

Completion rate 88.4%

Attitude measure: 362 cases

College Stress Inventory: 336 cases

PARTICIPANT DEMOGRAPHICS Age Gender International student Race and ethnicity Class standing Received services at IU CAPS

AGE Range: 17-47 years old Mean: 25.8 years old Std.Dev: 5.8 years old -1SD ~ + 1SD : 20-32 years old

GENDER

(202)

(144)

INTERNATIONAL STUDENT

(106)

(240)

RACE AND ETHNICITY

Arab American or Arab or Persian

Multiracial

African American or Black or African

European American or White or Caucasian

Latino or Latina

Asian American or Asian or Pacific Islander

0% 20% 40% 60%

4%

6%

8%

11%

21%

50%(173)

(74)

(38)

(28)

(20)

(13)

DEMOGRAPHIC COMPARISON2009-2010

Survey % CAPS % IU %

African American 8% 3.7 4.45Asian American 50% 5.23 4.26Latino/Latina 21% 2.93 2.60American Indian - 0.38 0.29European American 11% (int’) 75.08 75.38International Student 59% 5.35 10.35

CLASS STANDING

(227)

(119)

RECEIVED SERVICES AT IU CAPS

(277)

(69)

ANALYSISQuantitative data

Descriptives Reliability of measurements Analysis of variance

Two-way ANOVA Exploratory factor analysis

Quantitative data Content analysis Coding and themes

RESULTS: MEASUREMENT RELIABILITY Attitudes measure (ATSPPH-SF)

Internal consistency: Cronbach alpha = 0.79

College stress measure (CSI)Internal consistency: Cronbach alpha = 0.92

RESULTS: ATTITUDE MEASURE ATTITUDE BY RACE/ETHNICITY

Diff not sig.

RESULTS: INTERACTIONSTwo-way ANOVA: Race/Ethnicity by Gender

Gender: P=.033Gender*Race: not sig

ATTITUDE: SERVICE BY ETHNICITY/RACE INTERACTION

CaPS service: P=.004Service*Race: not sig

ATTITUDE: CLASS STANDING BY ETHNICITY/RACE INTERACTION

Class: P=.007Class*Race: P=.053

ATTITUDE: INT’ STUDENT BY GENDER INTERACTION

* Interaction was not sig.

ATTITUDE: INT’ STUDENT BY CAPS SERVICE INTERACTION

* Interaction was not sig.

ATTITUDE: INT’ STUDENT BY CLASS STANDING INTERACTION

Int’* Class interaction: P=.039

ACADEMIC STRESS BY RACE/ETHNICITY

* Difference not sig.

SOCIAL STRESS

* Difference not sig.

FINANCIAL STRESS

* Difference sig., p< 0.001

ACADEMIC STRESS: GENDER BY CAPS SERVICE

Both gender and CaPS service sig.

ACADEMIC STRESS: GENDER BY RACE/ETHNICITY

ACADEMIC STRESS: INT’L & CLASS STANDING

Class standing: P=.038

SOCIAL STRESS: INT’ STU BY CLASS STANDING

FINANCIAL STRESS

• Difference between int’ and non-int’ significant.

• p= 0.001

• Difference between graduate and undergraduate significant.

• P=0.045

SUMMARY OF THE MAJOR FINDINGS Female participants have more positive attitude towards

mental health counseling than male participants. Participants who have received counseling services at CAPS

perceive counseling more positively than those who have not. There are no significant differences in attitude between

international and domestic participants, or between graduate and undergraduate participants.

Undergraduate students perceive more academic and financial stress than graduate students. The differences between the two groups are smaller for international students.

International undergraduate students perceive more social stress than their graduate counterparts, whereas domestic graduate and undergraduate students both perceive high level of social stress.

Interesting interaction patterns between factors are indentified although not statistically significant.

SOME IMPLICATIONS FOR PRACTICE African American male participants seem to have least

positive attitude towards mental health counseling. Even those who have received services at CaPS. They may be the most difficult student body to reach. Receiving counseling at CaPS does not make African American

participants’ attitudes toward counseling significantly more positive compared to other ethnic minority groups. It suggests we need to reflect on our practice with African American students and improve the effectiveness of service.

International student participants becomes more positive towards counseling after receiving CaPS’ services.

Fine-tune the services for graduate and undergraduate students given their differences in attitudes and perceived stress.

FINDINGS FROM OPEN-ENDED QUESTIONS Focus only on Asian international students

Perception about counseling: Neutral

“privately” “professional” “psych” “couch” “A professional’s perspective” “psychology therapy” “talking therapy” “a kind of service” “professional help” “somewhere that I can receive help” “a general term about seeking for help” “help when needed” “talking frankly” “an ongoing long-term relationship”

Perception about counseling (cont’)More negative:

“bureaucracy”“trouble”“madman”“expensive”“conflict of interest”“obscurity in diagnosis process and cure”“doubt in accountability”“strange”“psychiatry”“mental illness”

Perception of client characteristics:

“people who needed help to overcome their own obstacles”

“people need professional advice and help” “someone sitting on the chair in front of a psychologist to

talk about him or herself” “experiencing psychological difficulties” “a person is in emotional or mental trouble” “depressed or confused in current condition” “has quite a period of negative feeling” “…not for those who maybe has a slight depression on

their lives” “…for people who really do have a serious mental issue” “only extremely mentally sick person need counseling” “meant for disabled people” “a person can’t fix a problem herself” “when you cannot handle your situation” “people who do not have supporting family?”

PERCEPTION OF THERAPISTS“trained professional” “a total stranger” “a third person” “objective listener” “a person wiling to listen to your problems and help you”

“someone helps you to cope with mental difficulties”

“someone available to help me out!”“tranquilizers” “doctor”“a friend or shoulder you can rely for some advice”

“a shrink talking you out of things”

CONDITIONS FOR SEEKING HELPTypical conditions:

“experiencing psychological difficulties” “a person is in emotional or mental trouble” “depressed or confused in current condition”

When other forms of help are not available “when…other forms of support are not helping anymore” “maybe for people who do not have supporting family?” “It could be the resort after your family/friends can’t help you out” “last resort…first definitely one must try to solve ones problem by

oneself” “when is so difficult that nobody around can help anymore”

Cannot handle oneself “when emotions went out of control” “when a person can’t fix a problem herself” “cannot solve himself” “when you cannot handle your situation”

ATTITUDES TOWARDS HELP SEEKING Negative

“not confident of sharing it…no confidence if they can understand”

Don’t need “Something I don’t need but feel like some ppl around me need

it” “something very useful but may not match my case”

Not now but open to it “I don’t need right now but might need it soon” “unaccustomed to resorting to professional help to deal with

emotional problems, but open to it” Prefer not to

“Something I would like not to have to undergo, but don’t seem to have an option because of circumstance”

“Something that I would probably not go for unless I have the need for it”

Need it “I badly need to talk to people to help me with my depression” “I should ask for counseling and mental health counseling”

SUGGESTIONS FOR SERVICESpecific programs

“Expansion of therapy groups to include students with chronic illness”

“Some workshops specially for minorities” “More support groups and invite racial/ethnic minority

students to share their experiences with the majority” “a lecture series in the orientation” “Something like meeting or tea-time for same racial or ethnic

minority students to get together and have a chat” “have lighter topics to promote mental health rather than

focusing on diagnose and pathology” “see clients outside of CAPS” “perform outreach” “hold events”

SUGGESTIONS FOR SERVICE

Collaboration“Perhaps, CAPS could work with the International Center or the Office of International Programs, especially during the orientations”

“Perhaps CAPS can participates in the activities from the International Center and other international students groups.”

“work together with student organizations”

BARRIERSCultural

“I think there are something about Asian culture that Americans never understand.”

Linguistic “language can be the greatest barrier when accessing CAPS. It

is difficult to seek help when you cannot express your problem well to the counselor”

“I think the communication between the professional ppl and us is time-consuming because the language barriers”

Hesitation and delay “Many people resort to counseling help only after waiting for a

long time.. Sometimes it becomes severe by then (I believe)” “CAPS sounds like for people who have mental and

psychological problems and this might make students to hesitate to visit CAPS”

“I have seen my international friends who were experiencing emotional problems but did not know how and where to seek help.”

ADVICES FOR THERAPISTSCultural learning and understanding

“the current counselors have a lot to learn about some deeply different social situations in other countries that affect the lives of those that seek counseling here for related problems. Most of the counselors I met are white, suburban raised and educated. I could not connect with them.”

“They should learn more about the different culture so that they know what are the barriers for people from different countries.”

ADVICES FOR THERAPISTSAttitude

“respect the culture background.” “…the staff and students working at CAPS must understand that so-called racial/ethnic minority students and international students cannot be treated as one minority group”

“Understanding of cultural differences and how that reflects everyone differently”

“general awareness” “Be confident”

SOME CRITIQUES ON OUR CONCEPTUALIZATION

“I'm not sure why the focus is on racial and ethnic minority students in your study. Wouldn't that be more cultural issues? In some cultures, seeking help from a professional is considered to be a sign of failure, but I don't think it is a racial or ethnic issue. I do see that they could be co-related, but your choice of words seems to be discriminatory.”

“Just treat racial/ethnic minority people the way you treat the majority. Sometimes I feel that Americans exaggerate our differences too much. All human beings are the same.”

“I think it should not just be restricted to racial/ethnic minority students, because making such a statements itself is a discrimination. We are not different from other students and just because our ethnicity is different doesn’t mean that we need counselling. I understand you good deeds by having this survey, but I find this survey itself as a discrimination as it is just for racial/ethnic minority students. No bad feelings, this is just what I thought.”

FUTURE DIRECTIONS Regression analysis on dependent variables Increase sample size of African American and

Arabic American students Include a domestic Caucasian control group Complete the analysis on qualitative data Use the findings to inform service and

outreach practice