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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

  • 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)
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)
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

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
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
  • 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
  • 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)
  • 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
  • Range: 17-47 years old
  • Mean: 25.8 years old
  • Std.Dev: 5.8 years old
  • -1SD ~ + 1SD : 20-32 years old



race and ethnicity
Race and ethnicity







class standing
Class standing



  • 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 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

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.

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”

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
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”
  • 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.”

“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
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