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
African American
Asian American
Latino/Latina
American Indian
European American
International Student
2009-2010
CAPS %
IU %
CAPS%
IU %
3.5
4.27
3.7
4.45
4.88
3.61
5.23
4.26
2
2.47
2.93
0.31
0.29
0.38
2.60
0.29
74.42
78.04
75.08
75.38
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
(American Psychiatric Association; 2010)
Why might this be?
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
Dr. Paul Toth
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
Alison
Schwing
Julia Arany
Ian Arthur
Whitney
Stewart
Year 3 (2010-2011)

Two practicum students and one pre-doctoral
intern: Amanda Voils-Levenda, Whitney
Stewart & Alison Schwing

Formalized relationships, focus on outreach
Consultations
• Collaboration with
Campus Groups
• Cultural Centers
• Student Groups
• Administrative
Groups
Outreach
Workshops
•Presentations tailored to
underserved students
•Workshop Series
•Collaboration with
student and campus
groups
• The IU Diversity
Committee
Awareness-Raising
• Presence at Diversity
Fairs
• CaPS Diversity Video
• Planned Diversity
Poster Campaign in
Residence halls
Research
Service &
Networking
•Pre-counseling hours at
university culture centers
•Networking and
collaboration with
university multicultural
communities
•Articles for Diversity
Group Newsletters
Conference
Presentations
• Attitudes and
needs assessment
survey
• Add to the
dialogue regarding
these issues
• Broaden
understanding of
underutilization of
services
• Includes student
conferences for
minority student
leaders
EXAMPLES OF OUTREACH PROGRAMS
Workshop and
presentation at student
dorms and sorority and
fraternity meetings
Collaborations with
various diversity office
on campus
Depression and African
American Students for a sorority
Latino Cultural Center Mujeres
en Acción Women’s Group
Series: Yoga & Stress Relief
session
Asian Cultural Center Series;
Suicide Prevention amongst
Latino college students
--Card-making and Healthy
Relationships
--Mental Health Screenings
Presentation at Multicultural
Greek Council
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 sample
Limited generalizability
 Online survey
16 demographic Qs
31 Likert or Likert-type Qs
6 open-ended Qs

MEASUREMENTS

Attitudes Toward Seeking Professional
Psychological Help: Short Form (ATSPPH-SF)
 10 items
 0-4 Likert scale
 Modified 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
MEASUREMENTS

College Stress Inventory (CSI)
21 items
 0-4 Likert-type scale
 Applied 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 QUESTIONS
1. 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
Asian American or Asian
or Pacific Islander
50% (173)
21% (74)
Latino or Latina
European American or
White or Caucasian
11% (38)
African American or Black
or African
8% (28)
Multiracial
6% (20)
Arab American or Arab or
Persian
4% (13)
0%
20%
40%
60%
DEMOGRAPHIC COMPARISON
2009-2010
Survey %
CAPS %
IU %
8%
3.7
4.45
Asian American
50%
5.23
4.26
Latino/Latina
21%
2.93
2.60
-
0.38
0.29
11% (int’)
75.08
75.38
59%
5.35
10.35
African American
American Indian
European American
International Student
CLASS STANDING
(227)
(119)
RECEIVED SERVICES
AT
IU CAPS
(277)
(69)
ANALYSIS

Quantitative 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: INTERACTIONS
Two-way ANOVA: Race/Ethnicity by Gender
Gender: P=.033
Gender*Race: not sig
ATTITUDE: SERVICE BY ETHNICITY/RACE INTERACTION
CaPS service: P=.004
Service*Race: not sig
ATTITUDE: CLASS STANDING BY ETHNICITY/RACE INTERACTION
Class: P=.007
Class*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 HELP

Typical 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 SERVICE

Specific 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”
BARRIERS

Cultural


“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 THERAPISTS

Cultural 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 THERAPISTS

Attitude
“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
