Exploring The Integration of
Health and Counseling Centers
Mental Health Section
“Best Practices” Task Force
ACHA Annual Meeting
Philadelphia, June 2010
Program Goals
Objective 1: Overview of task force
 History of the task force
 Current charge of the task force
 Membership of the task force
Program Goals
Objective 2: Discuss issues relevant to merger
of centers



Issues related to mergers
Staff concerns of mergers
Rationale for and against merger
Program Goals
Objective 3: Review of the survey and data
collection results
Objective 4: Discuss implications of collected
quantitative and qualitative data
Task Force Members
Keith Anderson, PhD (Rensselaer Polytechnic Institute)
Sylvia Balderrama, EdD (Vassar College)
James Davidson, PhD (University of Nevada, Las Vegas)
Peter De Maria, MD (Temple University)
Gregory Eells, PhD (Cornell University)
Caroline Greenleaf, JD (The Julliard School)
Joy Himmel, PsyD, RN-CS, LPC (Penn State University-Altoona)
Heidi Levine, PhD (State University of New York-Geneseo)
Kevin Readdean, MSEd (Rensselaer Polytechnic Institute)
Drayton Vincent, MSW, LCSW (Louisiana State University)
Joy Wyatt, PhD (Case Western Reserve University)
History of the Task Force
• Initially suggested by Joetta Carr, Mental Health Section
chair (2004)
• Focused on exploring practice guidelines
• Gradually began to focus on more specific issues
• Based on the geographic constraints of the Task Force,
early meetings were held in Philadelphia
Task Force Charge
 Primary charge is the development of a white paper that
discusses the issues that are relevant to the integration of
counseling centers and health centers on campuses.
 Current trends suggest integration of counseling and health
centers continues to be a salient issue among campus
administrators. A variety of concerns and issues are present
during these mergers.
 Where relevant, offer suggestions for resolving these
concerns.
Secondary Charge
• Provide guidance to the Board of Directors regarding
strategies to increase dialogue within ACHA and with
others about college mental health issues.
 Task Force sponsored a summit of the leadership of
allied professional associations and groups whose
memberships are concerned with college mental health.
Through its partner organizations, HEMHA represents over 217,000
individual members.







American College Counseling Association (ACCA)
American College Health Association (ACHA)
American College Personnel Association (ACPA)
American Psychiatric Association (APA)
American Psychological Association (APA)
American Psychiatric Nurses Association (APNA)
Association for University and College Counseling Center Directors
(AUCCCD)
 The Jed Foundation
 National Association of Student Personnel Administrators (NASPA)
Integration as a Hot Topic
 Recent ACHA Annual Meeting Topics
 A Primer for the Integration of Health and Counseling in a University
Health Service
 Initial Lessons Learned on Integration of Primary Care Services and
Counseling Services
 Integration of Primary Care and Counseling Services: The New York
University Experience
 Blending Mental Health and Student Health: One Experience in
Integration
 Leadership Issues Among Primary Care, Psychiatry, and Counseling:
Coordination, Case Management, and Medications
Literature Review
 An Outcome Survey of Mergers Between University Student
Counseling Centers and Student Health Mental Health Services
(Federman, Russ, & Emmerling, D: 1997, JCSP)
 Merger 1980: The organizational integration of college mental health
services (Foster, T: 1982, JACHA)
 Integration of behavioral health and primary care services: The Group
health cooperative model. (Strosahl, K, et. al: 1997, in Cummings,
Cummings and Johnson, Behavioral Health in Primary care)
Literature Review cont
 Developing an Integrated Primary Care Practice: Strategies, Techniques,
and a Case Illustration. (Walker, B., & Collins, C.: March, 2009, JCP)
 Integrated Care in College Health: A Case Study. (Tucker, C., Sloan, S.
K., Vance, M. & Brownson, C., 2008, JCC)
 The need for integrating behavioral care in a college health center.
(Alschuler, K., Hoodin, F., & Byrd, M., 2008, Health Psychology)
Survey Construction
 Development
 Content
 Implementation
 Analysis of data
 Qualitative data
Development













Communication issues
Confidentiality
Record keeping
Physical facilities
Multi-disciplinary issues
Cultural differences
Reporting structure
Ethics
Accessibility for students
Equitability/staff issues
Strategic planning
Treatment approaches
Staff and credentials












Student impact/reactions
Staff reactions
Internal referrals
External referrals
Peer review
Quality assurance
Benchmarking
Reporting, annual
Staff supervision
Philosophical approaches
Budgeting/fees
Components
Content
 Clinical supervision
 Scheduling
 Case conference
 Use of IT
 Administrative meetings
 Website
 Productivity
 Marketing
 Trainees
 Support staff
 Professional development
 Hours of operation
 Research
 Ancillary services – dietitian,
 Outreach/programming
 Other resources/interaction
with campus
 Sexual assault
 Substance abuse
 Accreditation




SA, LD, sports med, athletic
trainer
Emergency coverage
Testing
Dismissal of case
Fee for service issues
Questions of Interest
 How many centers are merged
 Different models of integration
 Rationale for merger
 Problems resulting from merger
 Strategies used for dealing with these issues
 Effectiveness of the current model
 Who is pleased with the merger, who is not
Implementation
 Surveys were sent in the fall of 2007 to
 ACHA members
 SHS listserve
 NASPA members
 AUCCCD
 Surveys were completed by staff working at counseling and
health centers at schools across the country
 When multiple responses occurred, mental health responses were
used for the institutional response
 359 useable surveys were returned
 Of 359 responses, 92 (25.6%) were from Integrated Centers
Defining an Integrated Center
 Health services director and counseling services director
report to a single center director, the center director reports to
a senior administrator (n=29)
 Single chief health and counseling director reports to a senior
administrator (n=20)
 Health services director reports to the counseling services
director who reports to a senior administrator (n=16)
 Counseling services director reports to the health services
director, the health services director reports to a senior
administrator (n=27)
Size of Integrated Campuses
Discipline of Respondents
Factors Driving Change to Integration
Integration Outcomes
 Staff communication
 Staff morale
 Efficiency of administrative processes
 Funding/budget
 Ability to meet the needs of clients
Integration Outcomes cont
 Quality of Clinical Services
 Quality of Programs
 Comprehensiveness of Services
 Comprehensiveness of Programs
 Utilization of Services
 Client Satisfaction
Integration Outcomes cont
Percentage Reporting Decline
After Integration
Counseling and Health Collaboration
Centers Reporting Frequent or Extensive
Counseling/Health Collaboration
Discipline of the Center Director
Center Layout:
Shared or Separate
Separate Charts:
What is
Duplicated in Records
Access to Files:
Access to Files: cont
Access to Files: cont
Psychiatric Services
Changes in staff communication
Information Sharing
Qualitative Interviews
 Rationale to conduct qualitative interviews
 How schools to be interviewed were selected
 Telephone interview process
Interview Questions
 What factors drove the integration of services?
 What issues supported or hindered the integration?
 How were decisions made regarding the sharing of
patient/client information?
 What aspects of the services were improved or
diminished?
 What were the reactions of students, staff and campus?
Interview Responses
Findings from schools with
“more positive” results:
Findings from schools with “less
positive” results:
Motivation for integration:
 Enhancing patient care
Process:
 Generally positive
 Shared philosophy
Outcomes:
  patient care
  referral process
  student satisfaction
  staff development
  team focus
  quality assurance
Motivation for integration:
 Financial concerns or an
administrative directive
Process:
 Resistance from clinicians
 Turf issues
 Debates over access to records
Outcomes:
 Similar to the positive
comparison schools although
the magnitudes were lower
Summary
 “Merged” counseling and health centers have different
meanings at different sites
 Administrative structures
 Levels of integration of records, services, etc.
 How marketed or communicated to the campus
Limitations of Study
 Small overall sample size
- 20% Response rate (359/1800 questionnaires)
 Small number of merged centers (N=92)
- Smaller schools overrepresented among merged centers
 Follow-up Interviews (N=6)
 Concerns



How representative of the U.S.
Ability to generalize results
Selection bias
Outcomes of Merging
 Most sites report improvements in
 Communication
 Quality of services
 Client satisfaction
 Utilization of services
 Many sites struggle(d) with record sharing
 “Merged” doesn’t necessarily mean integrated care
Recommendations for Sites
Considering Merging
1. A meeting of stakeholders should be convened to discuss
the implications of the merger, the logistics of the merger,
and the goals
2. Stakeholder input should be sought so that their buy-in
will allow for a smoother integration
Address the following:
A. To what extent will the services be integrated and
merged? What will the administrative and clinical care
structure look like?
Considering Merging cont
B. Will the reception areas and reception staff be shared
or separate?
C. How will consent for treatment and release of
information be handled?
D. How will clinical records be kept, and who will have
access to which parts?
Considering Merging cont
E. Will there be joint or separate staff meetings and
in-service trainings?
F. What will be the mission and goals of the new service?
G. Will the name reflect a more holistic/wellness
approach?
H. Will advertising and outreach be integrated or
separate?
I. How will finances/funding be handled?
Future Directions
 How clinical outcomes correlate with level of clinical
integration and collaboration (multidisciplinary team
meetings)
 Studies that address the benefits and restrictions of
the various models of integration
 Exploration of collaborative outreach planning
Future Directions cont
 Access to records
 Benefits
 Potential or perceived problems
 Student perception
 Outcomes
Future Directions cont
 A step by step guide to integration
 Collaborative care models within merged and non-
merged centers- how to make it work
 Administrative merger vs. clinical merger- outcome
differences
Exploring The Integration of
Health and Counseling Centers
Mental Health Section
“Best Practices” Task Force
ACHA Annual Meeting
Philadelphia, June 2010