Distressed &
Distressing
Students
Creating a Safety Net
For High Risk Students
Elizabeth Downing, M.D.
UCSB Medical Director
Burt Romotsky, L.C.S.W.
Student Health Social Worker
UCSB & Community
Mental Health Resources
Health Ed
Counselors
Eating Disorders
Nutrition
Sexual Health
Stress Management
Alcohol &
Drug Program
Alcohol &
Drug
Counseling
Student Health
Services/
Clinicians
CASE*
SAM*
Tobacco
Marijuana
REST*
SBIR*
CASE – College Alcohol & Substance Education
SAM – Skills, Awareness & Motivation
REST – Recovery Enhancement Success Training
SBIR – Screening, Brief Intervention & Referral
Distressed Student Protocol – SW point of contact
Coaching Program – support for ADHD/LD students
Hosford Clinic – campus sliding scale counseling
PAC – Psychological Assessment Clinic
CLAS – Campus Learning Assistance Services
Urgent Care
General Medicine
Doctors
Nurse Practitioners
Mental Health NP
Student Health
Social Worker
Social
Work
Intern
Triage & Refer
ADHD Triage
Crisis Intervention
Case Management
Distressed Student Protocol*
Campus/Community Referrals
Campus
Academic/
Support Services
DSP
Coaching Program*
CLAS*
EOP
Academic Services
Career Services
students
Student Health
Psychiatry
Campus
Mental Health
Assessment/
Treatment/
Counseling Services
Hosford Clinic*
PAC*
Women’s Center
Community Mental Health
Assessment/ Treatment
Therapy Referrals
Psychological Assessment
Sliding Scale Counseling
Psychiatry Referrals
Crisis/Psychiatric Hospitals
distressed
Pilot Project
• Social Worker hired 11/2002 with ADA
Advisory group and Student Health funds
• Campus Social Work role developed
• Brochures developed
• Education/Outreach to campus community
• Distressed Student Protocol committee
students
distressed
Why a Social Worker?
• Complicated and time-consuming student
situations
• Multiple department contacts
• Single point of contact
• High risk students
• Early intervention
• Crisis intervention
students
distressed
Student Health –
Next Exit?
Increasing number of
UC students are
taking psychotropic
medication
(UC student Mental Health
Committee, 2006)
students
distressed
National Trends of
Distressed Students
students
distressed
National Trends of
Distressed Students
• 85% of college counseling
centers reported an increase
in the number of students
they treat for psychological
problems
UC Davis, Counseling & Psychological Services, “Responding to Distressed or Distressing Students”.
students
distressed
National Trends of
Distressed Students
• 62% of college students reported feeling
hopeless, 44% said they felt so depressed they
could barely function, 79% were very sad and
9% felt suicidal
2005-2006
62
79
9
American College Health Association-National College Health
Assessment (ACHA-NCHA) Web Summary. Available at
http://www.acha-ncha.org/data_highlights.html
students
hopeless
depressed
suicidal
very sad
44
distressed
National Trends of
Distressed Students
• Top 10 physical and mental problems
2005-2006
9
8 12
11
8
47
13
46
18
American College Health Association-National College
Health Assessment (ACHA-NCHA) Web Summary.
Available at
http://www.acha-ncha.org/data_highlights.html.2006.
students
29
Back Pain
Allergy
Sinus Infection
Depression
Strep Throat
Ear Infection
Asthma
Bronchitis
Anxiety
SAD
distressed
National Trends of
Distressed Students
• Suicide is the 3rd leading cause of death among
15-24 year olds and the 2nd leading cause of
death among college students
• 44% of college students describe themselves
as binge drinkers
• 13.3% of college women say they have been
forced to have sex in a dating situation
UC Davis, Counseling & Psychological Services, “Responding to Distressed or Distressing Students”.
students
distressed
Why are College
Students Distressed?
• Normal developmental issues
• Pressure and competition: academic,
extracurricular,
parental, racial &
cultural
• Financial worries
• Social fears
• Feeling hopeless and helpless: depression,
sleep disorders, substance abuse, anxiety
disorders, eating disorders, self-harm
students
distressed
Kadison, R. & DiGeronimo, T. (2004) “College of the Overwhelmed”.
The Millennials
•
•
•
•
•
students
Highly structured academic life
High parental involvement
High levels of individual attention
Emphasis on performance
Little experience with failure
distressed
The Millennials
•
•
•
•
•
Increasing competition
High admissions standards
Limited coping resources
Difficulty being average
Helicopter parents
students
distressed
Hovering Parents/
Needy Students?
students
distressed
Distressed Student
Trends at UCSB
• Crisis cases have increased each year since 1991
• Severity of cases have increased
• Counseling Services provides assistance to
approximately 10% of the UCSB student
population
• More students are referred to Student Health
psychiatrists each year
• Concerns of distressed student affect academic
performance to a significant degree
students
distressed
Social Worker Role
• Single point of contact
• Psychosocial assessment
• Case management of
“at risk students”
• Crisis services
• Safety net: collaboration
with clinicians, faculty,
staff, hospitals
SOCIAL WORK SERVICES ARE AVAILABLE
TO STUDENTS AT NO COST
• Closure
students
distressed
Social Work Student
Referral Issues
• Parental Concerns
• Mental Health
Concerns
• Triage
• Financial Issues
• Crisis Intervention
students
distressed
Social Work Student
Referral Issues
• Academic Concerns
• Health Insurance
• ER & Psychiatric
Hospitals
• Withdrawal & Re-entry
students
distressed
Coordinating Resources
& Treatment
Social Distressed
Worker Student
Campus
Community
Student Health
Counseling Services
Alcohol & Drug Program
OSL
Resource Center for Sexual & Gender Diversity
EOP
Women’s Center
Office of International Students & Scholars
DSP
Judicial Affairs
Residence Halls
Campus Police & Paramedics
Financial Assistance
Academic Advisors
Faculty & Staff
CLAS
Parents
Peers/roommates
Therapists – private insurance
Home community mental health
treatment
Medical & psychiatric hospitals
Country Mental Health Treatment
Government Assistance
Child Care
Rehabilitation Services
Health Insurance
Pharmacy Waiver Programs
Paramedics
Police/Sheriff
Emergency Food & Shelter
Religious Organizations
ADHD Treatment at
Student Health
Counseling
Services
Student
Self Referral
Disabled
Students Program
Consult / Refer to
SW Triages
Service Needs
Established Diagnosis
And no Suspected
Psychiatric Co-Morbid
Conditions
SHS Primary
Care MD
Established Diagnosis
and Suspected Psychiatric
Co-Morbid Conditions
SHS
Psychiatry
Hosford Clinic &
Psychological
Assessment
Center
•Free ADHD / LD Screening
•Psychological Assessments
No Established Diagnosis
and Suspected Psychiatric
Co-Morbid Conditions
Campus / Community
Assessment & Treatment
Services
•Hosford & PAC (see above)
•Coaching Services
•Counseling Services
•Disabled Student Program
•Campus Learning Assistance Services
•Community Assessment /Treatment
Community
Collaboration
•
•
•
•
•
•
•
Psychiatric Emergency/Hospital
County Mental Health
County Public Health
County Social Services
Social Security/State Disability
State Department of Rehabilitation
Therapists/Counseling Clinics
students
distressed
Distressed Student
Response Protocol
• Intervention guide
• Referral identifiers: student behaviors
and/or reactions to these behaviors
• Early intervention
• Coordination of care
• Campus resources
• Referral procedures
www.sa.ucsb.edu/distressedstudentsguide
students
distressed
Distressed Student
Response System
Faculty/Staff
Roommates/Peers
Family
Judicial Affairs
Student Affairs
Housing
Police
Hospitals
Student Health
Urgent Care
Psychiatry
Social Worker
Counseling
Services
SW Notified of
Continued At
Risk Behaviors
Distressed Student
Meeting
Scheduled ASAP
Core Student Affairs
Team Members and
impacted departments.
Intervention Plan
Parental Notification
Housing Issues
Treatment Issues
Campus Outreach
• Provide “Referring Distressed Student”
protocol training with representation from
Student Affairs core team members
• Encourage early intervention
• Involve departmental representatives/liaisons
regarding distressed student concerns
students
distressed
Campus Outreach
•
•
•
•
Student brochure
Web listings
Parent newsletters
Media coverage
students
distressed
Confidentiality
• HIPAA: Health Insurance Portability and
Accountability Act
• FERPA: Family Educational Rights and
Privacy Act
• Confidentiality exceptions: medical providers
vs. staff/faculty
• Releases of information
students
distressed
Challenges
• Parental
Notification
• Outreach to
Students
• Treatment
Compliance
• Eviction from Housing
• Health Insurance/Pharmacy
Coverage/ Medi-Cal
students
distressed
Challenges
• Intensive
Treatment
Options
• Impact on campus
community
• After-hours issues
• Data collection
students
distressed
Resources
•
•
•
•
•
•
•
The Jed Foundation. (2006). Framework for developing institutional protocols for the
acutely distressed or suicidal college student. New York, The Jed Foundation.
•www.jedfoundation.org/framework.php
The Jed Foundation. (2002) Safeguarding Your Students Against Suicide. New York,
The Jed Foundation. www.jedfoundation.org
Benton, S.A. and Benton S.L. (Eds.). (2006). College Student Mental Health: Effective
Services and Strategies Across Campus. National Association of Student Personnel
Administrators (NASPA), Inc.
Kadison, R. and T. DiGeronomo (2004) College of the Overwhelmed, The Campus
Mental Health Crisis and What to Do About It. San Francisco: Jossey-Bass.
Martha Anne Kitzrow. (2003). The Mental Health Needs of Today’s College Students:
Challenges and Recommendations, Vol. 41: No. 1, Article 9.
Suicide Prevention Resource Center. (2004). Promoting Mental Health and Preventing
Suicide in College and University Settings. Newton, MA: Education Development
Center, Inc.
University of California, Office of the President. (2006). Report of the University of
California Student Mental Health Committee. University of California.
www.ucop.edu/sas/studentaffairsandservices/SMHCommittee2006.pdf
students
distressed
More Information
Elizabeth Downing, M.D.
downing-e@sa.ucsb.edu
805-893-2251
students
Burt Romotsky, L.C.S.W.
romotsky-b@sa.ucsb.edu
805-893-3380
distressed