exploring the integration of health and counseling centers mental health section “best...
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Exploring The Integration of Health and Counseling Centers
Mental Health Section “Best Practices” Task Force
ACHA Annual MeetingPhiladelphia, June 2010
Program Goals
Objective 1: Overview of task force
History of the task forceCurrent charge of the task forceMembership of the task force
Program Goals
Objective 2: Discuss issues relevant to merger of centers
Issues related to mergersStaff concerns of mergersRationale for and against merger
Program Goals
Objective 3: Review of the survey and data collection results
Objective 4: Discuss implications of collected quantitative and qualitative data
Task Force MembersKeith 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• 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 ChargePrimary 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• 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 FoundationNational Association of Student Personnel Administrators
(NASPA)
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 ReviewAn 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
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
Development
Content
Implementation
Analysis of data
Qualitative data
Development
Content
Questions of InterestHow 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
ImplementationSurveys were sent in the fall of 2007 to
ACHA membersSHS listserveNASPA membersAUCCCD
Surveys were completed by staff working at counseling and health centers at schools across the countryWhen multiple responses occurred, mental health
responses were used for the institutional response359 useable surveys were returnedOf 359 responses, 92 (25.6%) were from Integrated
Centers
Defining an Integrated CenterHealth 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)
Size of Integrated Campuses
Discipline of Respondents
Factors Driving Change to Integration
Integration OutcomesStaff communication
Staff morale
Efficiency of administrative processes
Funding/budget
Ability to meet the needs of clients
Integration Outcomes cont
Quality of Clinical Services
Quality of Programs
Comprehensiveness of Services
Comprehensiveness of Programs
Utilization of Services
Client Satisfaction
Integration Outcomes cont
Percentage Reporting Decline After Integration
Counseling and Health Collaboration
Centers Reporting Frequent or Extensive Counseling/Health Collaboration
Discipline of the Center Director
Center Layout: Shared or Separate
Separate Charts:What is
Duplicated in Records
Access to Files:
Access to Files: cont
Access to Files: cont
Psychiatric Services
Changes in staff communication
Information Sharing
Qualitative InterviewsRationale to conduct qualitative interviews
How schools to be interviewed were selected
Telephone interview process
Interview QuestionsWhat 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 ResponsesFindings from schools with “more positive” results:
Findings from schools with “less positive” results:
Motivation for integration: Enhancing patient careProcess:Generally positiveShared philosophyOutcomes: patient care referral process student satisfaction staff development team focus quality assurance
Motivation for integration: Financial concerns or an
administrative directiveProcess:Resistance from cliniciansTurf issuesDebates over access to
recordsOutcomes:Similar to the positive
comparison schools although the magnitudes were lower
Summary“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 StudySmall 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 MergingMost sites report improvements in
CommunicationQuality of servicesClient satisfactionUtilization of services
Many sites struggle(d) with record sharing
“Merged” doesn’t necessarily mean integrated care
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 goals2. 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
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 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 approach?
H. Will advertising and outreach be integrated or separate?
I. How will finances/funding be handled?
Future DirectionsHow 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
Access to records
BenefitsPotential or perceived problemsStudent perceptionOutcomes
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 Centers
Mental Health Section “Best Practices” Task Force
ACHA Annual MeetingPhiladelphia, June 2010