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Exploring The Integration of Health and Counseling Centers Mental Health Section “Best Practices” Task Force ACHA Annual Meeting Philadelphia, June 2010. Program Goals. Objective 1: Overview of task force History of the task force Current charge of the task force

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Exploring The Integration of Health and Counseling CentersMental Health Section “Best Practices” Task ForceACHA Annual MeetingPhiladelphia, June 2010

program goals
Program Goals

Objective 1: Overview of task force

  • History of the task force
  • Current charge of the task force
  • Membership of the task force
program goals1
Program Goals

Objective 2: Discuss issues relevant to merger of centers

  • Issues related to mergers
  • Staff concerns of mergers
  • Rationale for and against merger
program goals2
Program Goals

Objective 3: Review of the survey and data collection results

Objective 4: Discuss implications of collected quantitative and qualitative data

task force members
Task Force Members

Keith Anderson, PhD (Rensselaer Polytechnic Institute)

Sylvia Balderrama, EdD (Vassar College)

James Davidson, PhD (University of Nevada, Las Vegas)

Peter De Maria, MD (Temple University)

Gregory Eells, PhD (Cornell University)

Caroline Greenleaf, JD (The Julliard School)

Joy Himmel, PsyD, RN-CS, LPC (Penn State University-Altoona)

Heidi Levine, PhD (State University of New York-Geneseo)

Kevin Readdean, MSEd (Rensselaer Polytechnic Institute)

Drayton Vincent, MSW, LCSW (Louisiana State University)

Joy Wyatt, PhD (Case Western Reserve University)

history of the task force
History of the Task Force
  • Initially suggested by Joetta Carr, Mental Health Section chair (2004)
  • Focused on exploring practice guidelines
  • Gradually began to focus on more specific issues
  • Based on the geographic constraints of the Task Force, early meetings were held in Philadelphia
task force charge
Task Force Charge
  • Primary charge is the development of a white paper that discusses the issues that are relevant to the integration of counseling centers and health centers on campuses.
  • Current trends suggest integration of counseling and health centers continues to be a salient issue among campus administrators. A variety of concerns and issues are present during these mergers.
    • Where relevant, offer suggestions for resolving these concerns.
secondary charge
Secondary Charge
  • Provide guidance to the Board of Directors regarding strategies to increase dialogue within ACHA and with others about college mental health issues.
    • Task Force sponsored a summit of the leadership of allied professional associations and groups whose memberships are concerned with college mental health.

Through its partner organizations, HEMHA represents over 217,000 individual members.

  • American College Counseling Association (ACCA)
  • American College Health Association (ACHA)
  • American College Personnel Association (ACPA)
  • American Psychiatric Association (APA)
  • American Psychological Association (APA)
  • American Psychiatric Nurses Association (APNA)
  • Association for University and College Counseling Center Directors (AUCCCD)
  • The Jed Foundation
  • National Association of Student Personnel Administrators (NASPA)
integration as a hot topic
Integration as a Hot Topic
  • Recent ACHA Annual Meeting Topics
    • A Primer for the Integration of Health and Counseling in a University Health Service
    • Initial Lessons Learned on Integration of Primary Care Services and Counseling Services
    • Integration of Primary Care and Counseling Services: The New York University Experience
    • Blending Mental Health and Student Health: One Experience in Integration
    • Leadership Issues Among Primary Care, Psychiatry, and Counseling: Coordination, Case Management, and Medications
literature review
Literature Review
  • An Outcome Survey of Mergers Between University Student Counseling Centers and Student Health Mental Health Services (Federman, Russ, & Emmerling, D: 1997, JCSP)
  • Merger 1980: The organizational integration of college mental health services (Foster, T: 1982, JACHA)
  • Integration of behavioral health and primary care services: The Group health cooperative model. (Strosahl, K, et. al: 1997, in Cummings, Cummings and Johnson, Behavioral Health in Primary care)
literature review cont
Literature Review cont
  • Developing an Integrated Primary Care Practice: Strategies, Techniques, and a Case Illustration. (Walker, B., & Collins, C.: March, 2009, JCP)
  • Integrated Care in College Health: A Case Study. (Tucker, C., Sloan, S. K., Vance, M. & Brownson, C., 2008, JCC)
  • The need for integrating behavioral care in a college health center. (Alschuler, K., Hoodin, F., & Byrd, M., 2008, Health Psychology)
survey construction
Survey Construction
  • Development
  • Content
  • Implementation
  • Analysis of data
  • Qualitative data
  • Communication issues
  • Confidentiality
  • Record keeping
  • Physical facilities
  • Multi-disciplinary issues
  • Cultural differences
  • Reporting structure
  • Ethics
  • Accessibility for students
  • Equitability/staff issues
  • Strategic planning
  • Treatment approaches
  • Staff and credentials
  • Student impact/reactions
  • Staff reactions
  • Internal referrals
  • External referrals
  • Peer review
  • Quality assurance
  • Benchmarking
  • Reporting, annual
  • Staff supervision
  • Philosophical approaches
  • Budgeting/fees
  • Components
  • Clinical supervision
  • Case conference
  • Administrative meetings
  • Productivity
  • Trainees
  • Professional development
  • Research
  • Outreach/programming
  • Other resources/interaction with campus
  • Sexual assault
  • Substance abuse
  • Accreditation
  • Scheduling
  • Use of IT
  • Website
  • Marketing
  • Support staff
  • Hours of operation
  • Ancillary services – dietitian, SA, LD, sports med, athletic trainer
  • Emergency coverage
  • Testing
  • Dismissal of case
  • Fee for service issues
questions of interest
Questions of Interest
  • How many centers are merged
  • Different models of integration
  • Rationale for merger
  • Problems resulting from merger
    • Strategies used for dealing with these issues
  • Effectiveness of the current model
  • Who is pleased with the merger, who is not
  • Surveys were sent in the fall of 2007 to
    • ACHA members
    • SHS listserve
    • NASPA members
    • AUCCCD
  • Surveys were completed by staff working at counseling and health centers at schools across the country
    • When multiple responses occurred, mental health responses were used for the institutional response
    • 359 useable surveys were returned
    • Of 359 responses, 92 (25.6%) were from Integrated Centers
defining an integrated center
Defining an Integrated Center
  • Health services director and counseling services director report to a single center director, the center director reports to a senior administrator (n=29)
  • Single chief health and counseling director reports to a senior administrator (n=20)
  • Health services director reports to the counseling services director who reports to a senior administrator (n=16)
  • Counseling services director reports to the health services director, the health services director reports to a senior administrator (n=27)
integration outcomes
Integration Outcomes
  • Staff communication
  • Staff morale
  • Efficiency of administrative processes
  • Funding/budget
  • Ability to meet the needs of clients
integration outcomes cont
Integration Outcomes cont
  • Quality of Clinical Services
  • Quality of Programs
  • Comprehensiveness of Services
  • Comprehensiveness of Programs
  • Utilization of Services
  • Client Satisfaction
qualitative interviews
Qualitative Interviews
  • Rationale to conduct qualitative interviews
  • How schools to be interviewed were selected
  • Telephone interview process
interview questions
Interview Questions
  • What factors drove the integration of services?
  • What issues supported or hindered the integration?
  • How were decisions made regarding the sharing of patient/client information?
  • What aspects of the services were improved or diminished?
  • What were the reactions of students, staff and campus?
interview responses
Interview Responses

Findings from schools with “more positive” results:

Findings from schools with “less positive” results:

Motivation for integration:

  • Enhancing patient care


  • Generally positive
  • Shared philosophy


  •  patient care
  •  referral process
  •  student satisfaction
  •  staff development
  •  team focus
  •  quality assurance

Motivation for integration:

  • Financial concerns or an administrative directive


  • Resistance from clinicians
  • Turf issues
  • Debates over access to records


  • Similar to the positive comparison schools although the magnitudes were lower
  • “Merged” counseling and health centers have different meanings at different sites
    • Administrative structures
    • Levels of integration of records, services, etc.
    • How marketed or communicated to the campus
limitations of study
Limitations of Study
  • Small overall sample size
    • 20% Response rate (359/1800 questionnaires)
  • Small number of merged centers (N=92)
    • Smaller schools overrepresented among merged centers
  • Follow-up Interviews (N=6)
  • Concerns
      • How representative of the U.S.
      • Ability to generalize results
      • Selection bias
outcomes of merging
Outcomes of Merging
  • Most sites report improvements in
    • Communication
    • Quality of services
    • Client satisfaction
    • Utilization of services
  • Many sites struggle(d) with record sharing
  • “Merged” doesn’t necessarily mean integrated care
recommendations for sites considering merging
Recommendations for Sites Considering Merging

1. A meeting of stakeholders should be convened to discuss

the implications of the merger, the logistics of the merger, and the goals

2. Stakeholder input should be sought so that their buy-in will allow for a smoother integration

Address the following:

A. To what extent will the services be integrated and merged? What will the administrative and clinical care structure look like?

considering merging cont
Considering Merging cont

B. Will the reception areas and reception staff be shared or separate?

C. How will consent for treatment and release of information be handled?

D. How will clinical records be kept, and who will have access to which parts?

considering merging cont1
Considering Merging cont

E. Will there be joint or separate staff meetings and

in-service trainings?

F. What will be the mission and goals of the new service?

G. Will the name reflect a more holistic/wellness


H. Will advertising and outreach be integrated or separate?

I. How will finances/funding be handled?

future directions
Future Directions
  • How clinical outcomes correlate with level of clinical integration and collaboration (multidisciplinary team meetings)
  • Studies that address the benefits and restrictions of the various models of integration
  • Exploration of collaborative outreach planning
future directions cont
Future Directions cont
  • Access to records
    • Benefits
    • Potential or perceived problems
    • Student perception
    • Outcomes
future directions cont1
Future Directions cont
  • A step by step guide to integration
  • Collaborative care models within merged and non-merged centers- how to make it work
  • Administrative merger vs. clinical merger- outcome differences

Exploring The Integration ofHealth and Counseling CentersMental Health Section “Best Practices” Task ForceACHA Annual MeetingPhiladelphia, June 2010