CABRILLO COLLEGE
Program Review 2012
Student Health Services
Marion Brodkey, MA, RN, Director; and Katie Dowling, MSN, FNP, Incoming Faculty Director
Spring 2012
PART I: PROGRAM MISSION
1. Department name
2. Mission statement
Student Health Services (SHS)
It is the mission of Cabrillo College Student Health Services to
support educational success by
• Facilitating access to affordable health care
• Promoting optimal wellness
• Advocating for a healthy environment
• Educating informed health care consumers
• Promoting personal responsibility and healthy decision
making
3. Student Learning Outcome measured
Students will locate and access the medical and psychological
counseling services provided by Student Health Services
• Communication: SHS encourages student empowerment
through the use of verbal and written communication in all
clinician-patient interactions. Health and well-being
information is exchanged in meaningful encounters that
promote healthful living.
• Critical thinking and information competency: SHS models
analytical and problem-solving processes in the clinicianpatient relationship, especially in the processes of diagnosis
and treatment decision-making, in which the student is seen as
an equal partner in the exchange.
• Global awareness: SHS provides some programs to inform
students about current health trends and issues.
• Personal responsibility and professional development: Taking
responsibility for one’s own wellness is one of the core values
of SHS. We promote professionalization in each encounter
with Allied Health program students.
4. SHS’s mission is aligned with the college’s 4 core competencies
as follows:
1
PART II: DESRIPTION OF PROGRAM AND STAFFING
1. Service locations and hours
•
•
Aptos campus: Room 912 (open ~43 hours/week)
Watsonville campus: SRC (open 4 hours/week for nurse care
plus 6-8 hours for personal counseling appointments)
2. Program description: SHS provides direct medical and mental health care services, individual and population-based health education and
outreach for the students of Cabrillo College. SHS also provides supportive services for the campus at large.
•
Direct medical services provided by SHS include the care of acute illnesses/injuries, and wellness care including physical exams,
health screenings, routine vaccinations and lifestyle counseling. Health status verifications required for athletics, school transfer,
academic programs, and employment are performed regularly. Low cost comprehensive laboratory and prescription drugs are
available in the SHS clinic, as well as free over the counter medications, condoms, and first aid supplies. Students with complex
medical needs or chronic disease requiring long-term follow up are referred to providers in the community. These services are
provided by licensed registered nurses (RNs) and nurse practitioners (NPs), with medical consultation available through an off-site
supervising physician with whom SHS contracts.
•
SHS was recently awarded FamPact provider status. Starting Fall 2012, students will have access to expanded reproductive health
services and state funding for these services any day that SHS is open. In the past we offered pregnancy testing, emergency
contraception, and sexually transmitted infection testing and treatment for nominal fees, and referred students unable to pay or in
need of cervical cancer screening or birth control to an on-campus reproductive health clinic offered only on Friday afternoons
through a community partner. This expanded service will increase access to care for students, and serve as a source of income for
SHS.
•
Direct mental health services offered to students include crisis intervention and short-term psychotherapy with personal counselors
(PCs). Issues frequently addressed by SHS PCs include stress management, substance abuse, eating disorders, relationship problems,
domestic violence, sexual assault, anxiety, depression, and suicide prevention. While most direct mental health service is provided
by appointment, PCs are also available for urgent visits for students in crisis.
•
Since the last program review, our staff PC launched a successful intern program. Personal counseling interns at SHS are Master’s
degree prepared marriage and family therapist interns registered with the California Board of Behavioral Science and are supervised
by our staff PC, who holds a license as a marriage and family therapist (MFT). The intern program has grown from two to four 10
hour/week positions and has greatly increased SHS’s ability to respond to increasing student demand for personal counseling and
mental health services.
2
•
All direct services are available throughout the weeks when Cabrillo is in session, including 4 mornings/week during a 6-week session
in the summer. Frequent collaboration and cross referral between physical and mental health providers and enhances the quality of
care available to students in both disciplines.
•
Health education and outreach is a major focus of SHS. Patient teaching regarding self-care, healthy behaviors, and coping skills is
included in every student interaction. These efforts support student success through promoting optimal wellness and removing
health related barriers to academic success. Health education is offered to individuals and groups of students seeking direct care.
Educational outreach efforts include classroom presentations, curriculum infusion, social norming campaigns and tabling events. Our
reach into the campus community is extended via health information brochures available in various campus locations, the
SHS website, partnerships with other on-campus departments and community organizations. Data identifying the most prevalent
health problems effecting academic performance is gleaned from the annual Nation College Health Assessment survey and used to
steer our health educational outreach efforts. Breakout data from other participating California Community College Health Services
Agencies, as well as data from Cabrillo’s 2007 participation in this large national survey are given particular credence. SHS strives to
address the 10 most prevalent health problems indicated by these sources in at least one health outreach campaign or event each
year, and all of them at our annual Wellness Fair.
•
In addition, the SHS Website is a venue for communicating SHS hours and staffing, as well as sharing links to community agencies.
The Website is also the forum in which SHS announces the services that are provided to the larger campus, such as flu vaccine clinics
and the blood drives provided by the local Red Cross. Furthermore, brochures written in easy-to-read formats, supplied through
display racks around campus, provide easy access to a wide array of health information. Outreach tables staffed by trained
volunteers have been another means of informing students about the existence of and access to SHS.
•
Services to the campus at large include infection control measures, such as TB surveillance, and hepatitis B and influenza
vaccinations; and courtesy emergency visits for staff. Additionally, PCs provide individual and small-group counseling to staff
members who have recently been through a traumatic experience on campus, such as a student threatening violence or a campuswide lockdown. Special services are provided to Allied Health program students related to health screening compliance activities.
An RN compliance coordinator is hired, supervised, and paid through the collection of a compliance fee by SHS. DMV and other onor off-campus job-related physical health screening exams are provided as a fee-for-service courtesy to students and staff. Bloodborne pathogen occupational exposure trainings and consultations are provided to various college departments on an as-needed
basis. All SHS nurses are certified in CPR/BLS and will respond to campus medical emergencies, but it is always best to call 911 first.
Cabrillo is blessed by a rapid EMS response time that is generally faster than a nurse walking to the scene.
3
3. Current staffing and descriptions of duties
Position title
FTE
1.0
Director
(0)
* Management position eliminated for 20122013. Faculty Director appointed from existing
faculty position. Many duties shifted to
Faculty Director, some to VP of Student
services, and some shared by SHS staff.
Brief description of duties
• Clinical care: Provide clinical services
and care within the scope of practice
of the CA licensed RN and SHS RN
standardized procedures during
regularly scheduled hours as well as
filling in on a regular basis for
overflow patients. With the financial
and training support of Health
Improvement Partnership of Santa
Cruz County, encourage development
and implementation of screening and
triage protocol for depression in all
students seen at SHS.
• SHS management: Supervise
managerial functions of SHS and
participate in district and community
committees concerning health issues
and campus safety. Build bridges
between departments on campus to
improve student success and
professionalization. Maintain links to
county health and social service
agencies, the American College Health
Association, and the Health Services
Association of CA Community
Colleges. Update and disseminate as
needed the campus blood-borne
pathogen occupational exposure
protocol and procedure.
• Health information dissemination:
Implement already existent health
education programs. Conduct
4
•
Physician supervisor
4 hours/month
Administrative assistant
0.80
Nurse practitioner (faculty)
*Appointed Faculty Director for 2012-2013.
See Director position for additional duties.
0.75
(1.0)
classroom presentations on healthy
lifestyles and wellness. Work with
marketing department to optimize
outreach efforts through print, Web,
and other media. Provide health
promotion information during
encounters with students in the SHS
front office and exam room.
Health counseling: Provide personal
health counseling and
recommendations in both physical
and psychological realms through
measurement tools such as the
cardio-vascular risk assessment and
the PHQ-9/ AUDIT/DAST health
questionnaires.
Provides off-site consultation and on-site
chart review and co-signature for prescription
medications. In-servicing provided on
request.
Perform reception duties, such as answering
phones, scheduling patients, and checking
patients in/out of SHS. Collect fee-for-service
monies from patients. Order office supplies.
Monitor mail and bank deposits. Supervise
and train front office student assistants. Assist
with use of electronic patient management
system. Pay invoices.
Perform physical exams and clinical
assessments, and provide treatments.
Perform TB testing and provide
immunizations. Order and interpret labs.
Order prescription and over-the-counter
5
Nurse practitioner (contractor)
12-16 hours/week
(24 hour/week for 2012-2013 to backfill
faculty NP hours)
Registered nurse (faculty)
0.75
Personal counselor (faculty)
0.75
Personal counselor (contractor)
Personal counseling intern
12 hours/week
(16 h/w funded by Director salary savings)
4 @ 10 hours/week
Student assistant
Various
6
medications for dispensary. Implement clinical
quality assurance program.
Perform physical exams and clinical
assessments, and provide treatments.
Perform TB testing and provide
immunizations. Order and interpret labs.
Participate in classroom presentations on
various health topics.
Provide clinical services and care within the
scope of practice of the CA licensed RN and
SHS RN standardized procedures. Perform TB
testing and provide immunizations.
Provide personal counseling (PC) sessions to
students. Hire and provide supervision of PC
interns. Participate in planning and
implementation of crisis intervention
processes in SHS and on wider campus.
Participate in classroom presentations
regarding wellness related to mental health.
Provide personal counseling (PC) sessions to
students.
Provide personal counseling (PC) sessions to
students.
Support administrative assistant/receptionist
with phone answering, patient scheduling,
and clerical duties.
PART III: SHS UTILIZATION: SHS interacts primarily with students one-to-one in the clinic, but additionally
in the classroom and through some annual health information events, such as the Wellness Fair. Many
students arrive in SHS seeking over-the-counter medications and condoms, most of which are dispensed at
no additional cost.
Summer/Fall 2010
Winter/Spring 2011
Summer/Fall 2011
Clinic visits:
• Medical
• Personal counseling
Subtotal:
Health information/OTC meds
encounters
TOTAL
2105
526
2631
848
1439
390
1829
685
1595
469
2064
1418
3479
2514
3482
PART IV: STUDENT LEARNING OUTCOMES
SPRING 2011 SURVEY (n = 212)
1. Student demographics
•
•
•
•
2. SLO: “Do you know where SHS is located? “
•
•
•
7
40.5% males; 59.5% females
64% aged 18-25 yrs; 29% aged 26-50 yrs; 5.5% > 50 yrs old
53.5% Caucasian; 36.5% Latino/Hispanic
62.2% have health insurance; most are between 18 and 25
years of age and are white
76.3% said “yes; 21% said “no; 5.3% said “I didn’t know that
Cabrillo had a SHS”
In answer to the question “Have you used SHS in the past 6
months,” 69.4% said “no”; reasons included students have
other health care provider or had no health needs; 36% who
said no listed the following: didn’t know it’s open to all
students, unaware of its existence; didn’t know location
Visited SHS website: 20.7%
ANNUAL WELLNESS FAIR, SEPT, 2011 (n = 81)
1. SLO: “Name 2 things you learned today.”
•
•
•
Self-care: 37.5%
Available community health services: 26.4%
Physical health information: 18.1%
•
Committee revived in Fall 2012; report to committee made,
including programs, services, and budget information
Only one student attended meeting
RE-ESTABLISH STUDENT HEALTH SERVICES ADVISORY COMMITTEE
1. Determine make-up of committee, with focus on student
involvement
•
2. Devise measurable learning outcomes (SLOs) for student
participants
To be done
PART V: PROGRAM PLANNING GOALS AND ASSESSMENT GRID FOR 2011-2016
AREA
DESCRIPTION
DATA SOURCE
Quality of care:
Policy and
Procedure
Manual review
Policies and
Procedures
manual is in
process of
being revised
to reflect
current
practice
Policy and
Procedure
Manual,
Front Office
Manual, BBP
Program
manual
Quality of care:
professional
licensing,
credentialing
and insurance
Current
active
licensure,
professional
malpractice
insurance for
all
certificated
SHS files
FREQUENCY
OF REVIEW
Every 3 years
Annually in
July
BRIEF STATEMENT
OF PROCEDURE
--All written policies
reviewed for
currency,
appropriateness, and
clarity.
--Forms updated,
procedures
reviewed.
--Front Office Manual
reviewed
Updated documents
requested as they
expire
8
PERSON
RESPONSIBLE
Director
Director
EXPECTED OUTCOME
YEARS
--P and P Manual
revised and signed off
--SHS mission/vision
statement revised to
reflect College Core
Competencies.
2011/12
2014/15
All files complete and
up to date
2011/12
2012/13
2013/14
2014/15
2015/16
Quality of care:
patient
satisfaction
survey
Quality of care:
depression/drug
and alcohol use
screening and
triage
Administration:
patient
complaints
Administration:
staff
performance
staff, CPR
certification
for all nurses
Randomized
survey
evaluating
quality of
nursing and
counseling
care
Access to
counseling
services
improved for
those with
moderate to
severe
depression
and/or
problematic
alcohol/drug
use
Patient
complaints
are
responded to
according to
the Patient
Rights and
Responsibiliti
es Policy
All staff are
reviewed in
accordance
with college
policy and
collective
Survey results
(n = ??)
Annually
Survey data analyzed
Director
Measurable outcomes
not yet identified
2012/13
2014/15
PHQ-9
(depression
screening) and
AUDIT/DAST
(drug and
alcohol use
screening)
given to all
patients seen
in SHS
(medical and
counseling)
Log of patient
complaints
Annually
Review triage
process,
interventions and
referrals, and analyze
PHQ-9 data
Director and
counseling
faculty
member
All new students will be
assessed for
depression,
drug/alcohol use and
triaged for care within
1 -2 d (mod-severe) or
1 week (mild)
2011/12
2012/13
2013/14
2014/15
2015/16
Annually in
August
Complaint log
reviewed and followup calls made re:
satisfaction
Director
--Patient Rights and
Responsibilities
posted
--All complaints
responded to
2011/12
2012/13
2013/14
2014/15
2015/16
Annually for
new
faculty/classifi
ed, every 3 yrs
for tenured
faculty/
See negotiated
agreements
Director
100% compliance
2011/12
2012/13
2013/14
2014/15
2015/16
Staff
evaluations
9
Student
Learning
Outcome (SLO):
education and
outreach events
SLO: access to
affordable
health care on
campus
SLO:
blood-borne
pathogen (BBP)
classroom
trainings
Campus safety:
AED program
bargaining
agreements
Measure if
learning
happens
through
outreach
events
Measure
awareness of
SHS’
existence,
location,
services
Knowledge
about BBP
exposure
increased
through
appropriate
trainings
Document
training of
staff working
near AEDs on
campus
Management
Wellness Fair;
Sexual Assault
Awareness
event
Within 2
months of
each outreach
event annually
Students are able to
identify what they
learned at each
event to live a
healthier life
Staff
Survey
Annually
Random survey of
students outside SHS
to measure
knowledge of SHS
and health fee paid
Director
Pre- and posttests at
trainings
Annually
Test score analysis
Director
Students improve on
post-test score by 1-3
points
2011/12
2012/13
2013/14
2014/15
2015/16
Training
completion
certificates
Ongoing
Employees are
trained via online
modules in didactic
information for
AED/CPR; skills
checked by
American- Red-Crosscertified staff person
Director in
collaboration
with Safety
Committee
All designated
employees working
near AED are trained in
AED/CPR.
2011/12
2012/13
2013/14
2014/15
2015/16
10
70% of students filling
out evaluation listed
one or more healthrelated info tables they
visited (current
practice—measurable
learning outcome
needed)
75% indicate
awareness of SHS
2011/12
2012/13
2013/14
2014/15
2015/16
2011/12
2012/13
2013/14
2014/15
2015/16
PART VI: BUDGET INFORMATION AND FUTURE PLANNING
BUDGET:
Actual 2011-2012
Salaries and Benefits:
Professional Services (Non-contract MD, NP, MFT):
Supplies:
Memberships:
Licenses and Permits:
Continuing Education and Travel:
Insurance (Student Accident & Injury Policy – 50% SHS, 50%
Athletics):
Uncollectables (shared student service burden of bad debt
owed by students):
Indirect Costs (district began charging SHS 10% indirect cost
2009-2010):
Total Budget:
Projected 2012-2013
305,338
315,603
46,808
31,000
6,424
0
760
0
5577
5500
2296
200
51,239
51,239
35,664
15,000
52,794
$506,900
46,267
$464,809
Health services for students on a college campus should consist of direct clinical care, health promotion and education, and outreach activities.
Student health services can address the “learning mission” of the institution in several ways: 1) by amplifying students’ abilities to be
consistently engaged learners; 2) by advocating for social justice through access to both affordable care and current health information; and 3)
by aiding students in integrating physical, mental, emotional, social, and spiritual aspects of health into their educational experience. 1 According
to the CAS standards, health services for students on a college campus must include much more than one-to-one medical and mental health
1
The role of health promotion services. CAS Standards Contextual Statement, pp. 246-255.
11
encounters. 2 Policies and strategies that reflect the most current understanding of the needs of the student population must be implemented,
along with programmatic elements for which learning outcomes and behavior changes can be measured.
According to M. Spear, “During the twentieth century, college health moved from a reactive approach to a proactive one.…The college health
service must manage change successfully if it is to survive and grow…Thus, it is not enough to simply see disease and illness on the campus as
the responsibility of the college health service. Rather health interventions must include modifying community norms, behaviors, and attitudes”2
(p. 341). Spear refers to student health services in all college settings, including community college and 4 year university settings. Maintaining
and improving a dynamic, proactive health services program has always been more challenging on a community college campus than it is in
other settings. Never has the disparity between community college student health services budgets and that of 4 year universities been felt so
keenly as during the current state budget crisis. Universities typically have large budgets and separate buildings for direct services, health
education, and outreach staff. Achieving the American College Health Association’s recommended standard ratio of 1 full time mental health
professional for every 1,000 students seems more laughable than ever as SHS’s budget shrinks in response to a shrinking college.
Cabrillo’s Student Health Services is a fee based program. The majority of SHS funding comes from a Student Health Fee paid by all enrolled
students. The maximum allowable fee is set by the Chancellor’s Office and is currently $16 intersessions and $19 for regular semesters. Cabrillo
currently charges $15 for Summer session and $18 for Fall and Spring semesters. Language for automatic increase to the maximum allowable fee
is being explored for board consideration.
The Director of SHS position was eliminated for the 2012-2013 school year in anticipation of a significant drop in enrollment. The college has
had to make severe cuts to course offering in its effort to survive an unprecedented state budget crisis. Enrollment, total head count, and
therefore health fees collected are expected to drop significantly in the coming year. Most of the duties of the SHS director have shifted to a
newly appointed Faculty Director of SHS, who was already employed as a faculty nurse practitioner. The salary savings from the elimination of
the management position are being used to increase hours of NP and MFT contractors. SHS recommends reinstating the management director
position as soon as economically feasible. It is important that SHS have a voice and an informed advocate for health related student needs at the
decision making table. Having a management level leader also serves to increase visibility of SHS on campus.
Other recommendations for the future of SHS include addressing the space needs of SHS, participation in the California Community Colleges
Student Mental Health Programs suicide prevention initiatives, administering the NCHA survey, purchase of electronic medical records software,
and expanded efforts to reach students via social media.
2
Spear, ME. Assessing health services. Assessment Practices in Student Affairs, chapter 25, pp. 341-364.
12
SUMMARY OF RECCOMENDATIONS:
Reinstate management level director position when economically
feasible.
Address space needs.
Participate in CCC SMHP suicide prevention initiative
Administer NCHA survey to Cabrillo students
Purchase EMR software
Expand social media outreach
COMMENTS:
Voice at decision making table
Increased visibility of SHS
SHS currently has insufficient exam room and office space, some space
not appropriate for current use. Need to improve ADA compliance.
Space identified in 1000 building, funds held in reserve for renovation.
Free trainings and resources available to CCC campuses.
Access to screening tools.
Will provide vital information on prevalent health issues and academic
impact specific to Cabrillo students. Useful as needs assessment for
health education and outreach efforts.
Will be costly initially, and will be slow to start but will eventually
increase efficiency of operations and data retrieval. Will also facilitate
exchange of health information with community providers. SHS is
currently transitioning to a new practice management system that
offers a well-respected EMR component. May also support FamPact
billing.
Increase the impact of health education and outreach efforts by
reaching students where they look for information.
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Student Services Department SLO Assessment Analysis Form
Use the form below to summarize the results of the department meeting in which you discussed the results of your SLO assessment.
Department
Student Health Services
Meeting Date
6/18/2012
Number of Staff
participating
% of department
4
SLOs measured
Assessment Tool
(Briefly describe
assessment tool)
Assessment Analysis
(Summarize the
assessment results;
discuss what student
needs and issues were
100% of regular staff
1. Students will be able to identify the location of SHS.
2. Students attending the Fall Wellness Fair will demonstrate knowledge about self-care and health resources
available to them on campus and in the community. * old SLO re blood borne pathogens removed as now
done by ALH
1. Student satisfaction survey administered by SHS annually in May.
2. Wellness Fair event evaluation administered annually at the Fall Wellness Fair, usually the 3rd Thursday in
September.
SLO #1. May 2011 76% of students answering the SHS student satisfaction survey reported knowing where SHS is
located. Outreach events, curriculum infusion and regular on-campus tabling were used in an attempt to increase
student awareness of SHS services and location. In May of 2012 79% of students completing the survey reported
knowing the location of SHS. An ad hock student advisory committee was formed in September of 2012 to get
student input on program marketing, among other things.
SLO #2. 91% of students successfully demonstrated self-care and health resource knowledge after attending the Fall
2012 Wellness Fair, as measured by the event evaluation tool.
14
revealed)
Next Steps
SHS will continue to work with the ad hock student advisory committee to determine effective ways to increase
student awareness of SHS location and services, and to reach students with health information. We will also review
student comments and suggestions for improving our Wellness Fair shared via the event evaluation tool.
(How will you address
the needs and issues
revealed by the
assessment?)
Timeline for
Implementation
(Make a timeline for
how you will implement
the next steps outlined
above )
Ad hock student advisory committee meetings will be held monthly while school is in session, with suggestions
implemented and reported back to the committee on an ongoing basis. Student knowledge of the location of SHS
will be reassessed in May of 2013. Event evaluation of the Fall 2012 will be reviewed for comment and suggestions
for improvement. These comments and suggestions will be considered in the planning for the 2013 event, and
student knowledge of self care and health resources will be reassessed in October of 2013.
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