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Distressed & Distressing Students

Distressed & Distressing Students. Creating a Safety Net For High Risk Students. Elizabeth Downing, M.D. UCSB Medical Director Burt Romotsky, L.C.S.W. Student Health Social Worker. Alcohol & Drug Program. Student Health Services/ Clinicians. Student Health Psychiatry.

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Distressed & Distressing Students

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  1. Distressed & Distressing Students Creating a Safety Net For High Risk Students Elizabeth Downing, M.D. UCSB Medical Director Burt Romotsky, L.C.S.W. Student Health Social Worker

  2. Alcohol & Drug Program Student Health Services/ Clinicians Student Health Psychiatry Student Health Social Worker Health Ed Counselors Eating Disorders Nutrition Sexual Health Stress Management Urgent Care General Medicine Doctors Nurse Practitioners Mental Health NP Triage & Refer ADHD Triage Crisis Intervention Case Management Distressed Student Protocol* CASE* SAM* Tobacco Marijuana REST* SBIR* Campus Academic/ Support Services Social Work Intern Campus Mental Health Assessment/ Treatment/ Alcohol & Drug Counseling Community Mental Health Assessment/ Treatment Campus/Community Referrals DSP Coaching Program* CLAS* EOP Academic Services Career Services Therapy Referrals Psychological Assessment Sliding Scale Counseling Psychiatry Referrals Crisis/Psychiatric Hospitals Counseling Services Hosford Clinic* PAC* Women’s Center UCSB & Community Mental Health Resources CASE – College Alcohol & Substance Education SAM – Skills, Awareness & Motivation REST – Recovery Enhancement Success Training SBIR – Screening, Brief Intervention & Referral Distressed Student Protocol – SW point of contact Coaching Program – support for ADHD/LD students Hosford Clinic – campus sliding scale counseling PAC – Psychological Assessment Clinic CLAS – Campus Learning Assistance Services distressed students

  3. Pilot Project • Social Worker hired 11/2002 with ADA Advisory group and Student Health funds • Campus Social Work role developed • Brochures developed • Education/Outreach to campus community • Distressed Student Protocol committee distressed students

  4. Why a Social Worker? • Complicated and time-consuming student situations • Multiple department contacts • Single point of contact • High risk students • Early intervention • Crisis intervention distressed students

  5. Student Health – Next Exit? Increasing number of UC students are taking psychotropic medication (UC student Mental Health Committee, 2006) distressed students

  6. National Trends of Distressed Students distressed students

  7. National Trends of Distressed Students • 85% of college counseling centers reported an increase in the number of students they treat for psychological problems distressed UC Davis, Counseling & Psychological Services, “Responding to Distressed or Distressing Students”. students

  8. National Trends of Distressed Students • 62% of college students reported feeling hopeless, 44% said they felt so depressed they could barely function, 79% were very sad and 9% felt suicidal 2005-2006 62 79 44 9 distressed American College Health Association-National College Health Assessment (ACHA-NCHA) Web Summary. Available at http://www.acha-ncha.org/data_highlights.html students

  9. National Trends of Distressed Students • Top 10 physical and mental problems 2005-2006 American College Health Association-National College Health Assessment (ACHA-NCHA) Web Summary. Available at http://www.acha-ncha.org/data_highlights.html.2006. distressed students

  10. National Trends of Distressed Students • Suicide is the 3rd leading cause of death among 15-24 year olds and the 2nd leading cause of death among college students • 44% of college students describe themselves as binge drinkers • 13.3% of college women say they have been forced to have sex in a dating situation distressed UC Davis, Counseling & Psychological Services, “Responding to Distressed or Distressing Students”. students

  11. Why are College Students Distressed? • Normal developmental issues • Pressure and competition: academic, extracurricular, parental, racial & cultural • Financial worries • Social fears • Feeling hopeless and helpless: depression, sleep disorders, substance abuse, anxiety disorders, eating disorders, self-harm distressed students Kadison, R. & DiGeronimo, T. (2004) “College of the Overwhelmed”.

  12. The Millennials • Highly structured academic life • High parental involvement • High levels of individual attention • Emphasis on performance • Little experience with failure distressed students

  13. The Millennials • Increasing competition • High admissions standards • Limited coping resources • Difficulty being average • Helicopter parents distressed students

  14. Hovering Parents/ Needy Students? distressed students

  15. Distressed Student Trends at UCSB • Crisis cases have increased each year since 1991 • Severity of cases have increased • Counseling Services provides assistance to approximately 10% of the UCSB student population • More students are referred to Student Health psychiatrists each year • Concerns of distressed student affect academic performance to a significant degree distressed students

  16. Social Worker Role • Single point of contact • Psychosocial assessment • Case management of “at risk students” • Crisis services • Safety net: collaboration with clinicians, faculty, staff, hospitals • Closure SOCIAL WORK SERVICES ARE AVAILABLE TO STUDENTS AT NO COST distressed students

  17. Social Work Student Referral Issues • Parental Concerns • Mental Health Concerns • Triage • Financial Issues • Crisis Intervention distressed students

  18. Social Work Student Referral Issues • Academic Concerns • Health Insurance • ER & Psychiatric Hospitals • Withdrawal & Re-entry distressed students

  19. Coordinating Resources & Treatment Social Worker Distressed Student Community Parents Peers/roommates Therapists – private insurance Home community mental health treatment Medical & psychiatric hospitals Country Mental Health Treatment Government Assistance Child Care Rehabilitation Services Health Insurance Pharmacy Waiver Programs Paramedics Police/Sheriff Emergency Food & Shelter Religious Organizations Campus Student Health Counseling Services Alcohol & Drug Program OSL Resource Center for Sexual & Gender Diversity EOP Women’s Center Office of International Students & Scholars DSP Judicial Affairs Residence Halls Campus Police & Paramedics Financial Assistance Academic Advisors Faculty & Staff CLAS

  20. ADHD Treatment at Student Health Counseling Services Student Self Referral Disabled Students Program Hosford Clinic & Psychological Assessment Center • Free ADHD / LD Screening • Psychological Assessments Consult / Refer to SW Triages Service Needs Established Diagnosis And no Suspected Psychiatric Co-Morbid Conditions No Established Diagnosis and Suspected Psychiatric Co-Morbid Conditions Established Diagnosis and Suspected Psychiatric Co-Morbid Conditions Campus / Community Assessment & Treatment Services SHS Primary Care MD SHS Psychiatry • Hosford & PAC (see above) • Coaching Services • Counseling Services • Disabled Student Program • Campus Learning Assistance Services • Community Assessment /Treatment

  21. Community Collaboration • Psychiatric Emergency/Hospital • County Mental Health • County Public Health • County Social Services • Social Security/State Disability • State Department of Rehabilitation • Therapists/Counseling Clinics distressed students

  22. Distressed Student Response Protocol • Intervention guide • Referral identifiers: student behaviors and/or reactions to these behaviors • Early intervention • Coordination of care • Campus resources • Referral procedures www.sa.ucsb.edu/distressedstudentsguide distressed students

  23. Distressed Student Response System Faculty/Staff Roommates/Peers Family Judicial Affairs Student Affairs Housing Police Hospitals Counseling Services Student Health Urgent Care Psychiatry Social Worker SW Notified of Continued At Risk Behaviors Intervention Plan Parental Notification Housing Issues Treatment Issues Distressed Student Meeting Scheduled ASAP Core Student Affairs Team Members and impacted departments.

  24. Campus Outreach • Provide “Referring Distressed Student” protocol training with representation from Student Affairs core team members • Encourage early intervention • Involve departmental representatives/liaisons regarding distressed student concerns distressed students

  25. Campus Outreach • Student brochure • Web listings • Parent newsletters • Media coverage distressed students

  26. Confidentiality • HIPAA: Health Insurance Portability and Accountability Act • FERPA: Family Educational Rights and Privacy Act • Confidentiality exceptions: medical providers vs. staff/faculty • Releases of information distressed students

  27. Challenges • Parental Notification • Outreach to Students • Treatment Compliance • Eviction from Housing • Health Insurance/Pharmacy Coverage/ Medi-Cal distressed students

  28. Challenges • Intensive Treatment Options • Impact on campus community • After-hours issues • Data collection distressed students

  29. Resources • The Jed Foundation. (2006). Framework for developing institutional protocols for the acutely distressed or suicidal college student. New York, The Jed Foundation. • The Jed Foundation. (2002) Safeguarding Your Students Against Suicide. New York, The Jed Foundation. www.jedfoundation.org • Benton, S.A. and Benton S.L. (Eds.). (2006). College Student Mental Health: Effective Services and Strategies Across Campus. National Association of Student Personnel Administrators (NASPA), Inc. • Kadison, R. and T. DiGeronomo (2004) College of the Overwhelmed, The Campus Mental Health Crisis and What to Do About It. San Francisco: Jossey-Bass. • Martha Anne Kitzrow. (2003). The Mental Health Needs of Today’s College Students: Challenges and Recommendations, Vol. 41: No. 1, Article 9. • Suicide Prevention Resource Center. (2004). Promoting Mental Health and Preventing Suicide in College and University Settings. Newton, MA: Education Development Center, Inc. • University of California, Office of the President. (2006). Report of the University of California Student Mental Health Committee. University of California. www.ucop.edu/sas/studentaffairsandservices/SMHCommittee2006.pdf • www.jedfoundation.org/framework.php distressed students

  30. More Information Elizabeth Downing, M.D. downing-e@sa.ucsb.edu 805-893-2251 Burt Romotsky, L.C.S.W. romotsky-b@sa.ucsb.edu 805-893-3380 distressed students

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