Conduct and Counseling: Working
Together to Address At-Risk Students
PANELISTS
Jason Ebbelling, JD
VP of Student Affairs
Mitchell College
Brian Van Brunt, Ed.D.
Director of Counseling and Testing Services
Western Kentucky University
Understanding the Data
 96% of Directors reported the number of students
with significant psychological problems is a
growing concern
 80% reported the number of students with severe
psychological problems has increased in the past
year
The Association for University and College Counseling Center Directors Annual Survey (2009)
3
Understanding the Data
 48.4% of clients have severe psychological problems;
7.4% of these have impairment so serious that they
cannot remain in school
 260 college counseling centers hospitalized an
average of 8.5 students per school for psychological
reasons during the past year
 Directors reported 103 suicides in the past year
National Survey of Counseling Center Directors (2009)
4
Understanding the Data
 Campuses also feel the burden when students with mental
health difficulties do poorly on coursework and drop out of
school.
 Poor student retention means losses in tuition, fees, and
alumni donations.
 Colleges and universities may face legal issues and negative
publicity as a result of student crises and tragic events
www.campushealthandsafety.org
The Jed Foundation (2008)
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Understanding the Data
 Across all respondents, 10.2 percent of
students sought counseling during the
2008-9 academic year, about the same
as in the directors group’s two previous
surveys.
 At institutions with fewer than 1,500
students, an average of 18.3 percent of
students sought counseling. At
institutions with enrollments of more
than 35,000, it was 7.2 percent.
Association of University College Counseling Center Directors (2009)
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Understanding the Data
 Colleges and Universities are
experiencing an increase in
students struggling with
depression
 17% have a friend who has
talked about suicide in the
past year & 7% have
contemplated suicide
themselves
mtvU & The Associated Press (2009)
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Understanding the Data
Within the past school year 2000 2002 2004
2006 2008 2009
Felt very sad
80% 82% 81%
78% 79% 62%
Felt depressed
44% 45% 45%
42% 43% 30%
Diagnosed with depression 10% 12% 15%
15% --
10%
Considered suicide attempt 9%
10% 10%
9%
9%
6%
Attempted suicide
1%
1%
1%
1%
1%
1%
Intentionally self-injured
--
--
--
--
--
5%
American College Health AssociationNational College Health Assessment Findings
8
Understanding the Data
 85% of students report stress
and worry on a daily basis
 52% of students report the
economy as a source of stress
 6 in 10 students report being
unable to complete work
 53% of students report not
wanting to be with friends on
one or more occasions
mtvU & The Associated Press (2009)
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Understanding the Data
 The most common conditions seen in students were
depression (seen in 37.5 percent of students visiting
a counseling center), anxiety (36.8 percent) and
relationship issues (35.9 percent).
 Nearly a quarter of patients seen in counseling
centers were taking psychotropic medications.
mtvU & The Associated Press (2009)
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Let’s look at ways to identify and
refer at-risk students while
improving the management of
these students on campus.
Identify  Refer  Manage
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Identification
• Who are the students we are concerned
about?
• What categories do they fall under?
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Identification
On January 22, 2009, 25-year-old male doctoral
student, Halyang Zhu, murdered a female graduate
student in a campus café
at Virginia Tech.
He had not come to the attention of the campus police
or Risk Management Team
prior to this incident.
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Identification
Even with Risk Management Teams in place, some
violent students may go unidentified – but we must
continue to identify those students who are high-risk
when warning signs come to
our attention.
Communication between
Judicial Affairs and Counseling Services
is essential.
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Identification
We are concerned with addressing behavior,
not targeting those with mental illness.
We are concerned with aggression, threats,
intimidation, hoarding of weapons and isolation that
leads to an act of violence.
Those with mental illness are more likely to be the
victims of violence, not perpetrators.
(Choe, Tepin, Abrams; 2008).
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Identification
 Students who may attempt suicide
 Students who threaten to harm other students
 Domestic violence situations
 Students with weapons on campus
 Students who concern faculty
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Identification
• Classroom management problems:
 Disruptive behavior in classroom
 Threat to professor
 Aggressive to other students or unexplained
aggression
 Projects or papers that contain violent or
threatening content which is not part of a class
assignment
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Identification
• Deisinger’s (2008) handbook on threat assessment
and management suggests the threat
assessment/management goal should be:
“Identify a student, faculty member, or staff member who has
engaged in threatening behaviors or done something that
raised serious concern about their well-being, stability, or
potential for violence or suicide.” p. 47
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Identification
• Deisinger (2008) suggests the follow groups should
be “touch points” for identifying campus threats:
 Student judicial process
 Faculty and Staff grievance/conduct board
 Equal opportunity & diversity office
 University legal counsel
 Campus police/security; local law enforcement
 Residential life conduct boards
 Greek counsel
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Identification
• Remember to send information to your Counseling
Center – they need to be aware of a student who has
appeared on the “radar” of those identifying
threatening students.
• While that office may not be able to share
information with you about the student before
completing an assessment, it helps their staff to be
informed should the student appear on their
doorstep.
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Identification
• The level of risk or threat will determine whether
immediate police or disciplinary action is taken first
or if the student can be referred for an assessment.
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Referral
• Before moving onto the topic of referral, we want to
briefly mention HIPAA and FERPA since these Federal
Regulations can affect the information we may be
able to share in a referral.
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Referral
• HIPAA – Health Insurance Portability and
Accountability Act of 1994.
– Enacted to establish national standards and requirements for
electronic health care transactions and to protect the privacy
and security of individually identifiable health information.
Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA)
And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student
Health Records.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf
Identify  Refer  Manage
Referral
• FERPA – Family Educational Rights and Privacy Act of
1974.
– Enacted to protect the privacy of students’ “education records.”
Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA)
And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student
Health Records.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf
Identify  Refer  Manage
Referral
• HIPAA – Health Insurance Portability and
Accountability Act of 1994.
HIPAA website:
http://www.hipaacomply.com
• FERPA – Family Educational Rights and Privacy Act of
1974.
FERPA website: www.ed.gov/policy/gen/reg/ferpa/index.html
Identify  Refer  Manage
Referral
• HIPAA – Health Insurance Portability and
Accountability Act of 1994.
• FERPA – Family Educational Rights and Privacy Act of
1974.
Be familiar with these Federal Regulations yourself and know how
they apply to your particular institution.
Also be aware of any applicable state regulations or guidelines.
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HIPAA and FERPA
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Referral
• What are the best practices in referring at-risk
students for a counseling assessment or psychoeducational sessions?
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Referral
• Many campus groups “refer” students to counseling
because of various concerns. For the purposes of this
presentation, we are talking about mandated
referrals or assessments, not voluntary suggestions
that the student go to counseling.
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Referral
• Be thoughtful and clear about when your campus
requires mandated assessments or psychoeducational sessions.
• Consult with your legal department as you review
which students your require to be assessed or
attend psycho-educational sessions.
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Question
• Who do you refer to for your assessments?
A) On campus counselor or psychologist
B) Off campus psychologist or counselor
C) Off campus psychiatrist
D) Off campus emergency room doctor
E) Leave it up to the student
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Referral
• Be clear about what you are looking for as a result
of a mandated assessment. Who will receive and
act on the mandated referral?
• When the referral is done, is a letter needed?
• Does that letter need to include specific statements
or come from a particular provider?
– Ask for these things prior to the mandated referral.
– Be clear at the start what you need.
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Referral
• Referrals work better when there is an on-going
positive relationship with the referral source.
Everyone is stressed with the heightened “hot
potato” issues raised with threat teams and judicial
referrals.
• Take the time to form relationships during the down
times of the year so that the relationship is solid
when the difficult situations arise. A crisis is not a
fruitful moment for creating a positive relationship.
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Referral
• There are some counselors and psychologists who
aren’t comfortable with “mandated” anything when
it comes to their clients.
• They make arguments against this based on the
idea of autonomy---that all clients must choose to
enter treatment or assessment willingly.
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Referral
• Mental Health professionals on a college campus
are not like private practitioners; the greater good
of the community needs to be taken into account.
• Nearly every community utilizes court mandated
involuntary assessment.
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Referral
• Gallagher (2006) surveyed college counseling centers (367)
in the American College Counseling Association (ACCA).
12%
None
Assessment Only
48%
40%
Assessment and
Counseling
AUCCCD (2010, 424) showed Twenty-six percent (26%) of directors reported that
they provide mandatory treatment at their center with 53% reporting that they only
provided mandatory assessment (no counseling) at their center.
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Risk Assessment
What it is
What it’s not
Clinical Interview
Predicting future violence
Psychological Testing
Done in isolation, without information
gathering from referral sources
Information Gathering
Something only off-campus forensic
psychologists can perform
Looks at situations and behaviors
Requires extensive test purchases
Gives sense of level of concern
Assess general attitude
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Risk Assessment
• There is no set qualification for those who perform
threat assessment on a college campus.
• Psychologists and counselors must work within their
personally defined scope of practice.
• This means they are responsible for obtaining additional
training, seeking supervision and building diagnosis and
assessments based on facts and producing accurate
documents.
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Informed Consent
• Creating a detailed informed consent is key to
protecting the clinician
• Develop a clearly worded informed consent spelling
out for the student what will happen and how the
results will be shared
• This must be done prior to the assessment and
should include the following: (see sample)
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Informed Consent
• The scope of your assessment
• The tests, costs and time involved in completing
• Limit access to raw data to qualified individuals with consent
• Outline who will receive the assessment
• List kind of information that will be collected (past therapy,
past inpatient, past court involvement, arrests, felonies)
• Clearly spell out what happens if the student no-shows
appointments (who is notified)
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Off-Campus Referral
• If a clinician is working with a student and an
off-campus third-party, help advocate for the
student to ensure a smooth process.
– the specifics of what they require,
– your clinician/center has acceptable credentials
for the assessment.
– it is best to avoid completing an assessment and
then learning a probation office requires a
licensed AOD counselor to sign off.
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Counselor Assessment
• When reviewing tests and measures to better
assess symptoms and risk, remember…
– There are no measures that predicts future
violence
– There is no substitute to a solid clinical interview
– You must have the training needed to choose,
administer, score, interpret and report the results
for a given test
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Counselor Assessment
• When performing assessments, there is no
test or measure that substitutes for common
sense and clinical judgment.
• When writing reports and letters, base your
observations and conclusions on the
information at hand.
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Counselor Assessment
• Avoid “going out on a limb” and making
statements that cannot be reasonably backed
up by the facts at hand.
• As a professor of mine once said, “While it
makes for a more interesting report, be careful
when using speculation and opinion that can’t
be substantiated.”
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• When using any test, remember the Saxe
poem about the blind men and the elephant…
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Management
• Once the threat has been identified, the referral has
been made, the assessment completed….colleges are
often put in the position of managing an at-risk
student on campus.
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Management
(Counseling Services)
• When working with someone who is trying your
patience, being hostile or being unmotivated,
remember your goal:
• Your goal should be to assist the person to move
towards a higher stage of change, maintain
positive momentum or gain a better
understanding of their current situation and their
decision to make a change.
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Management
(Counseling Services)
• A connection is the start. It is the first step towards
motivation, persuasion and compliance.
• The actual work will take some time.
• Consider the subtle move of “No, I’m not going to do
that.” to “I’ll think about it”.
• Help an aggressive student understand why their
current behavior isn’t in their best interest.
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Management
(Judicial Affairs)
• Courts view conduct codes and honor codes as
“essential functions” of the university and are not
subject to accommodation.
• Be sensitive to what led to the conduct (possibly a
mental health issue), but be firm with the
expectations related to appropriate conduct.
• Never discipline a student for a mental health issue –
always focus on the behavior or conduct.
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Management
(Judicial Affairs)
• Specific expectations for the student may need to be
clearly defined in writing if disciplinary action has not
yet been necessary:




May not enter and leave class multiple times.
May not arrive late.
May not “self-cut” in the residence hall.
May not hug female students you don’t know.
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Management
(Judicial Affairs)
• Failure to comply with conduct expectations may
result in disciplinary action.
• Keep your Counseling Director informed of any
behavior or conduct situations you believe may be
related to a mental health issue even if the
Counseling Director can’t share information with
you.
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Take Away
• Importance of all three stages:
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• Importance of communication between Judicial
Affairs and Counseling Services.
• Importance of having a clearly stated policy for your
campus regarding mandated assessments and
psycho-education sessions.
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Take Away
• Don’t become overly focused on one piece of the
argument that ends up being 2% of the issue. Keep
the big picture in mind.
• For counselors, learn more about motivational
interviewing and change theory.
• Counselors; don’t confuse “something you don’t do”
with something that is “unethical.”
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Online Resources
•
U.S. Dept. of Health and Human Services and U.S. Dept. of Education (November 2008)
Joint Guidance on the Application of the Family Educational Rights and Privacy Act
(FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To
Student Health Records.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajoint
guide.pdf
•
FERPA Regulations: www.ed.gov/policy/gen/reg/ferpa/index.html
•
HIPAA Regulations: http://aspe.hhs.gov/admnsimp/pl104191.htm
•
Campus Safety and Security Survey. Released 8/2009. Retrieved on 9/12/09 from
www.nacubo.org/Documents/Initiatives/CSSPSurveyResults.pdf
•
naBITA BIT tool. Retrieved from
www.nabita.org/docs/2009NABITAwhitepaper.pdf
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