Realizing our commitment to diversity through outreach and research
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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.

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Realizing our commitment to diversity through outreach and research

Realizing our commitment to diversity through outreach and research

Counseling and Psychological Services

Indiana University Bloomington


Outline

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

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

Why the diversity outreach program was initiated

  • CaPS staff noticed underrepresentation of minority students amongst clientele

  • What statistics showed:


Barriers to seeking counseling help

Barriers to Seeking Counseling Help

  • Minoritycollege 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

    Why might this be?

(American Psychiatric Association; 2010)


Cultural attitudes

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

    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)


    Realizing our commitment to diversity through outreach and research

    Common vs. Unique stressors for ethnic/racial minority students


    Common college student stressors

    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

    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

    A Response to these Issues:The Development of The CaPS Diversity Outreach Team


    Development of the program

    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

    • 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

    • Year 3 (2010-2011)

      • Two practicum students and one pre-doctoral intern: Amanda Voils-Levenda, Whitney Stewart & Alison Schwing

      • Formalized relationships, focus on outreach

    Dr. Paul Toth

    Julia Arany

    Alison Schwing

    Ian Arthur

    Whitney Stewart


    Examples of outreach programs

    Examples of Outreach Programs


    Mapping out diversity outreach

    Mapping out diversity outreach


    Video project

    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

    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

    Practice-Research


    Campus wide survey

    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

    Survey design

    • Sampling

      • Convenient sample

        • Limited generalizability

      • Online survey

        • 16 demographic Qs

        • 31 Likert or Likert-type Qs

        • 6 open-ended Qs


    Measurements

    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


    Measurements1

    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

    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

    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

    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

    Participant demographics

    • Age

    • Gender

    • International student

    • Race and ethnicity

    • Class standing

    • Received services at IU CAPS


    Realizing our commitment to diversity through outreach and research

    Age

    • Range: 17-47 years old

    • Mean: 25.8 years old

    • Std.Dev: 5.8 years old

    • -1SD ~ + 1SD : 20-32 years old


    Gender

    Gender

    (202)

    (144)


    International student

    International student

    (106)

    (240)


    Race and ethnicity

    Race and ethnicity

    (173)

    (74)

    (38)

    (28)

    (20)

    (13)


    Demographic comparison

    Demographic comparison


    Class standing

    Class standing

    (227)

    (119)


    Received services at iu caps

    Received services at IU CaPS

    (277)

    (69)


    Analysis

    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

    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

    Results: Attitude measureAttitude by Race/Ethnicity

    Diff not sig.


    Results interactions

    Results: interactions

    Two-way ANOVA: Race/Ethnicity by Gender

    Gender: P=.033

    Gender*Race: not sig


    Attitude service by ethnicity race interaction

    Attitude: Service by Ethnicity/Race Interaction

    CaPS service: P=.004

    Service*Race: not sig


    Attitude class standing by ethnicity race interaction

    Attitude: Class standing by Ethnicity/Race Interaction

    Class: P=.007

    Class*Race: P=.053


    Attitude int student by gender interaction

    Attitude: Int’ student by gender interaction

    * Interaction was not sig.


    Attitude int student by caps service interaction

    Attitude: Int’ student by CaPS service interaction

    * Interaction was not sig.


    Attitude int student by class standing interaction

    Attitude: Int’ student by Class standing interaction

    Int’* Class interaction:

    P=.039


    Academic stress by race ethnicity

    Academic stress by Race/Ethnicity

    * Difference not sig.


    Social stress

    Social stress

    * Difference not sig.


    Financial stress

    Financial stress

    * Difference sig., p< 0.001


    Academic stress gender by caps service

    Academic stress: Gender by CaPS service

    Both gender and CaPS service sig.


    Academic stress gender by race ethnicity

    Academic stress: Gender by Race/Ethnicity


    Academic stress int l class standing

    Academic stress: Int’l & class standing

    Class standing:

    P=.038


    Social stress int stu by class standing

    Social stress: Int’ stu by class standing


    Financial stress1

    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

    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

    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

    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”


    Realizing our commitment to diversity through outreach and research

    • 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”


    Realizing our commitment to diversity through outreach and research

    • 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

    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

    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

    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

    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 service1

    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

    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

    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 therapists1

    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

    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.”


    Realizing our commitment to diversity through outreach and research

    • “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.”


    Realizing our commitment to diversity through outreach and research

    • “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

    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


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