Clinical Case Management:
A New Service Offering in College Health
Cara Ludlow, LMSW, CAADC
Michigan State University
Jamie Pyo, MS, LPC
Penn State Altoona
Learning Objectives
O Define three roles of Case Management
in college health
O Define three benefits of Case
Management to college students
O Identify three improvements in service
delivery that have resulted from the
implementation of Case Management
services within student health care
settings
The Complexities
of Today’s College Students
2012 NCHA Survey Results
Percent of Students for Whom Various Issues
Were Traumatic/ Very Difficult in the Past Year
2012 NCHA survey results prepared by Larry Hembroff, Ph.D., Director of IPPSR's Office for Survey Research
Percent of Students Feeling
Emotionally Challenged
2012 NCHA survey results prepared by Larry Hembroff, Ph.D., Director of IPPSR's Office for Survey Research
Factors Impacting Academic
Performance
2012 NCHA survey results prepared by Larry Hembroff, Ph.D., Director of IPPSR's Office for Survey Research
Two Models of Case
Management
Michigan State
University
Penn State Altoona
Michigan State University
O
Big Ten University outside state capital
O
49,343 students from all 83 counties in
Michigan, all 50 states in the United States
and 130 other countries worldwide
O
37,988 undergraduate
O
11,355 graduate and professional school
O
50% women and 50% men
O
16.6 % students of color; 14.5 %
international
O
Third largest single-campus residential
system in the nation
Fall 2013 statistics: http://www.msu.edu/about/thisismsu/facts.html
MSU Student Health Services
Olin Student Health Center
Primary Care
O
O
O
O
O
O
O
50,000 visits per year
40% of students visit annually
6.2 CFTE Physicians
2.3 CFTE Physician Assistants
1.1 CFTE Nurse Practitioner
9.0 FTE Nursing
6.0 FTE Medical Assistants
Psychiatry
O
O
O
O
O
5000 visits per year
2.5% of students visit annually
4.0 CFTE Psychiatrists
1.0 FTE Psychiatric Nurse
2.5 FTE Clinical Social Worker, Care
Manager and Social Work Fellow
MSU Counseling Services
O 10,000 individual visits a year
O 3,000 unique students
O 14 FTE Counselors;
Psychologists, Masters of
Social Work and Licensed
Professional Counselors
O .83 FTE Case Manager
O 4 FTE Pre-Doctoral and
Post-Doctoral Students
August 31, 2013 - May 12, 2014
History of Case Management within
Student Health Services and
Counseling Center
O
In 2008 Michigan State University joined the National College
Depression Project
O
Added Part Time Case Manager position to follow NCDP
participants
O
In 2011 grant was completed
O 2012 added full-time Case Manager position
O 2013 added Post-Master of Social Work Fellow
O 2013 MSU Counseling Center added full-time Case Manager
Penn State Altoona
O 4,000 undergraduates
O Rural area
O Commuter campus
O 900 residence hall spaces
O 22% minority students
Penn State Altoona
Sheetz Family Health & Wellness
Center
Health and Wellness Center
Services
O
O
O
O
O
O
O
Primary Care
3100 visits per year
2 FTE NP
1 PT Physician
Counseling & Psychological Services (CAPS)
1650 visits per year
80 case management visits per year
4 FTE LPCs
4 hours per month consulting Psychiatrist
Health & Wellness Center (HWC)
O Integrated Health and Counseling services
O Shared EMR
O Weekly Multidisciplinary Team Meetings
O Seamless in-house referrals
History of Case Management at
PSU Altoona
O 2008 Penn State Altoona received the GLS
Suicide Prevention Grant, allowed for new
position (Mental Health Outreach Coordinator)
O MH outreach coordinator assumed case
management responsibilities to follow National
College Depression Partnership students
O 2009 MH outreach coordinator began meeting
with students to provide supportive counseling
through case management as a new service
The Role of Case Managers
in Student Health
Case Management at
Penn State Altoona
O Meet with students individually who are
in need of additional educational and/or
community mental health resources
O Meet individually with students who don’t
meet the criteria for individual counseling,
but need support
O Meet with students who are in individual
counseling and need additional support
Case Management at
Penn State Altoona
O Early Alert Program Coordinator
O First option for students presenting in crisis
O Instruct students in the use of the biofeedback
EASE program
Case Manager Role in Student Health
Services at Michigan State University
O
Provide direct and indirect services to students as part of integrated treatment team
O
Monitor high-risk students as part of an interdisciplinary team providing ongoing risk
assessment, crisis intervention, safety planning and follow-up with high acuity students
O
O
Part of Clinical Review Team in Partnership with MSU Counseling Center
O
Part of university-wide Interdisciplinary Behavioral Intervention Team [BIT] which
includes MSU Police Department, Department of Student Life [Student Conduct],
MSU Counseling Center and Residence Education and Housing services
Assist and facilitate voluntary and involuntary hospitalizations
through admission, discharge planning and follow-up
Case Manager Role in Student Health
Services at Michigan State University
O
Coordinate referrals to MSU’s Resource Center for Person’s
with Disabilities
O
Assist students in navigating MSU’s Medical Withdraw process
through the University Physician’s Office
O
Refer and facilitate services for students with community
partners and treatment providers outside of university system
O
Provide brief supportive counseling and bridging to long term
treatment providers
O
Provide follow-up with students to confirm connection and
engagement with services
Benefits of Case Management
Benefits of Case Management
O Improved collaboration and integration with students and
providers in addressing students health and mental health needs
O Increased monitoring and support of high acuity students
O Provide transitional care and coordination during changes in
student status
Benefits of Case Management
O Provide additional model of support aside from traditional
counseling
O Identify and seek to resolve barriers
O Helping new and existing students learn about and
connect to campus and community services
O Follow-up with students to ensure care was secured
O More efficient use of Psychiatry and Counselor time
O Increase academic performance and retention
Improvements in Service Delivery
Improvements in Service Delivery
O Increased monitoring of high risk
students
O Quicker response time in engaging
students
O More comprehensive continuum of care
between treatment providers
Improvements in Service Delivery
O Increased engagement in treatment
and supportive services
O Reduction in missed or no-show
appointments
O Improved communication and
support between multi-disciplinary
staff in health centers, counseling
centers and across campus
Student Response
Penn State Altoona
O 85% of students receiving case management services were satisfied with the service
O 93% of students agreed or strongly agreed that case management provided help
with improving emotional health
O 93% of students agreed or strongly agreed that case management helped them stay
in school
O 78% of students agreed or strongly agreed that case management helped them
maintain academic performance
Challenges in Case Management
Challenges in Case Management
Michigan State University
O
Service providers in two separate buildings on
campus
O
Different administrative units and separate
funding for services
O
Documentation across two electronic records
systems that do not interface
O
Duplication of services between Health Center
and MSU Counseling Center
O
Increased risk of triangulation between multiple
treatment providers
O
Historic cultural differences:“Medical Model vs.
Developmental Model”
Challenges in Case Management
Penn State Altoona
O Students and staff lack of knowledge of the
role and service, lead to hesitancy at times
O Local students are at times reluctant to try
community resources
O Insurance issues
O Lack of availability of psychiatry and at
times counseling in the community
Bridging the Gaps
Rami
Sean
Rami
O Currently 21 year old single female
O International student from Japan
O College of Social Science; Psychology major
O First contact was 2011 fall semester, freshman year
O Withdrew from first semester and returned home to
Japan
O Returned to MSU; three suicide attempts in four
weeks, involuntary suspension from school, and
ambivalent about engaging in treatment/services
Sean
O 20 year old male student
O Diagnosed with ADHD in 7th grade, prescribed Adderall
15mg twice daily since then
O First semester, fall 2012 did well
O Second semester, spring 2013 medically withdrew
O Fall 2013 stayed home and completed online coursework
O Currently attempting third semester
O Living in the residence halls
Questions?
Contact Information
O Cara Luldlow: cara.ludlow@hc.msu.edu
O Jamie Pyo: jlp42@psu.edu
References
O 2012 NCHA Full report available at:
O http://www.ippsr.msu.edu/NCHA/NCHA_2012_Report
.pdf
O Van Brunt, B., Woodley, E., Gunn, J., Raleigh, MJ, Reinach
Wolf, C. & Sokolow, B. (2012). Case Management in
Higher Education. Publication of the National Behavioral
Intervention Team Association (NaBITA) and the
American College Counseling Association (ACCA).
O Wilson, C., Powell, A., Woodley, E., Nelson-Moss, T.M.,
Blamey, A., & Thibodeau, T. The History of Case
Management in Higher Education. Publication of the
Higher Education Case Managers Association (HECMA).