Webinar Follow Up
Thank you for attending the April 26 webinar with Dr. Peter Cornish for a discussion on How to Improve Mental Health on Campus. If you weren't able to join not to worry - everything is included here! Feel free to download the webinar and presentation and share with your colleagues. Please also take a few moments to see Dr. Cornish's responses to the questions he didn't have time to answer during the webinar. Lastly, also available is a recent presentation I gave on the relationship between mindfulness and mental health in case that's of interest.
We hope you take us up on our offer to trial the 30 Day Mindfulness Challenge for five days starting on Monday, May 8. As you heard from Dr. Cornish, this evidence-based mental health tool has been deployed at numerous colleges and universities across North America including Memorial University, Harvard Law School, The University of British Columbia, Brown University, and more, helping faculty, staff, students and the campus community become more resilient, engaged and connected.
Geoff Soloway, PhD
Dr. Cornish Answers Your Questions
Thanks to Dr. Cornish for taking the time to provide responses to the questions we didn't get to on the webinar. More from Dr. Cornish on Stepped Care can be found on his blog.
What do you recommend faculty do/teach to help decrease stress and increase resilience in students?
- Within the context of stepped care and a mental health strategy that provides support to faculty and staff to integrate wellness as part of student engagement and good teaching practices, there is a lot we can do to support faculty.
- A simple thing is not to be afraid to listen, offer common sense advice – the kind of thing that was done before we medicalized problems in living. Many staff and faculty think they are doing the right thing by sending all students with “problems” to specialists. We encourage faculty to try being supportive, ask the student to come back next week, before defaulting to specialists. So a mental health literacy program would teach faculty that most problems simply require an ear and common sense support. It would encourage people to assume students are resilient and capable until proven otherwise. It would encourage trial and error with stepping up only upon failure. If a faculty member has doubts, they would be encouraged to consult rather than immediately “passing the hot potato.” A partnership with teaching and learning specialists is crucial for identifying potential faculty champions who would be willing to integrate something like MindWell or the Wellness Inventory into required courses (e.g., on professionalism, ethics, leadership; alternatively in cornerstone and capstone courses). These programs could be configured as required reading like a text book that students would have to purchase. Connecting with Associate Deans to identify courses would be helpful.
- Finally, working with HR when they offer new faculty orientations would be useful especially if the wellness program is aimed at a faculty member’s major pain point – obtaining tenure. This gets them on board with the idea that wellness is crucial for academic success and preps them to be the healthy campus champions of the future.
Tell us more about peer-based support models and successes.
- At Memorial, all peer helpers receive two days of mental health first aid training plus ongoing supervisory and peer-to-peer support as needed.
- There are two levels of peers:
- Step 4 independent peer helping.
- Step 9 closely supervised peer helping.
- Step 4 peer helping: Students are recruited through a variety of means – social media, posters, advocacy groups student clubs and societies, and honours classes. There are two types of peers at this level – (a) the 7 Cups online program is administered and overseen by our Wellness staff; (b) a face-to-face peer program is administered and overseen by a student advocacy group called “MUNMinds”; we supply training when asked. Within the context of stepped care clinical services we sometimes refer people to make use of the groups as users, and at other times we refer clients to make use of the programs as peer helpers. We find the latter works especially well for our otherwise “dependent” clients, including some with emotional dysregulation as it gives them a purpose and focus outside of their own “drama.”
- Step 9 peer helping: This is administered as part of our “students of concern case management team.” We have three case management leads (a nurse who is also our wellness lead and system navigator, another nurse who works in primary care, and a third case manager who works with the conduct office in the department of student life). When some ongoing support is needed for students who are sometimes disruptive but not dangerous, one of the case manager leads will guide a trained peer helper (usually a student hired for the purpose) to be available when the students (often high functioning on the spectrum) as a support going to classes or studying on campus.
During the daily schedule, what proportion of clinician time is spent in the "first step" consultation appointment”?
- Memorial University and George Washington Universities have a similar system.
- At Memorial (student population around 17,000 on the St. John’s campus), we have nine primary care providers (experienced counsellors and residents) who each provide one half-day (three hours of counsellor time) of walk-in coverage per week. All new clients enter through this walk-in service. Clients who do not wish to use the walk-in, can book in advance the first 30-minute block of any walk-in session. Usually this will result in a 2-3 week wait. Incidentally, there is a 50 % no-show rate for these “booked” walk-ins. This is not an issue, since the next person can be seen. In any walk-in session, up to six clients will be seen.
- At GW, they have three times as many staff and slightly more than double the student population. At any one time, three staff are covering walk-ins.
Are there any professional development opportunities to participate in a CoP?
- We are developing communities of practice. So far, we have had the most interest for a “small schools CoP.” Any counsellor or director can join and we operate as a roundtable discussing successes and challenges with implementation.
- We will be launching a med/large school CoP sometime in the fall.
- Canada is emerging as the leader in single session therapy (Hoyt and Talmon is a good reference). For single-session therapy training, Karen Young – Ontario-based, provides good one or two day workshops. We have local experts here in St. John’s. There are experts in Alberta as well.
- Please, if anyone in attendance is interested in participating in a CoP, contact me at: email@example.com
- Training videos on our model will soon be available in the public domain. This will be announced on my blog: http://steppedcaretwopoint0.ca/
How do you help students presenting predominantly with emotional dysregulation in this system?
- Depending on readiness, we find skills workshops best – there are some available in the community, but wait-times are long. So when demand at walk-ins is high for regulation, we will open our own group. We only offer groups that help with our walk-in loads.
- When readiness is not there, we prescribe the 30 Day Mindfulness Challenge or WellTrack. We try to avoid step 7 for regulation because it is not the most efficient way to teach a skill.
- As I mentioned above, we are experimenting with referring dysregulated clients to be peer helpers – an empowering strengths based approach that seems to be working.
Do you have interdisciplinary collaboration for your programs? I'm an Occupational Therapist and see the value of incorporating other perspectives and professionals into the care model.
- Absolutely, this is one of the strengths of the model. There is so much room for role clarification and differentiation at the various steps as well as “above and below the line” (clinic versus healthy community development).
- Social workers are much better at system navigation, empowering staff and faculty to take on low intensity support roles, determining whether a systems intervention would be better than a clinical intervention.
- Nurses are great at coordinating and liaising between various professions and sectors within the educational and health systems.
- Counsellors with an education background seem to be more creative with positive psychology, lower intensity interventions in embedded counsellor roles in residence, judicial affairs, faculties, satellite campuses. It is easier to move to a consultation-only psychiatry model in stepped care so that physicians do the bulk of the monitoring and with support of the psychiatrist for assessment and occasional telephone consults.
- Clinical psychologists are especially good at in depth assessment and complex psychotherapy.
- We would love to have an OT on our team to work on the “life functioning” portion of the recovery journey. I could see this as the best way to transition many clients out of the high intensity psychotherapy or psychiatric work that is often difficult to terminate due to dependency.
- Our physicians find the summer slow in terms of patients, and given they operate on a fee for service basis, they have expressed interest in picking up TAO coaching roles. There is room for lots more involvement of other disciplines! (Snipes, Maragakis and O’Donahue (2015))
Results from Webinar Polls
Several polls were conducted during the webinar and as requested, we're sharing the results with you...
MWU Presentation: Relationship Between Mindfulness & Mental Health
Dr. Cornish Sources
Antwi, M., & Mruganka, K. (2014). Change management in healthcare: Literature review. Kingston, ON: Queen’s School of Business.
Bennett-Levy, J., Richards, D. A., Farrand, P., Christensen, H., Griffiths, K. M., Kavanagh, D. J., Klein, B., Lau, M. A., Proudfoot, J., Ritterband, L., White, J., & Williams, C. (2010). Oxford Guide to Low Intensity CBT Interventions. New York: Oxford University Press.
Benton, S. A., Heesacker, M., Snowden, S. J., & Lee, G. (2016). Therapist-Assisted, Online (TAO) Intervention for Anxiety in College Students: TAO Outperformed Treatment as Usual. Professional Psychology: Research and Practice, 47(5), 363.
Bower, P., Kontepantelis, E., Sutton, A, et al (2013). Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. BMJ, 346, f540.
Bryan, C., Kopta, S. M., & Lowes, B. D. (2012). The Celest health system. Integrating Science and Practice, 2, 7–11.
Firth, N., Barkham, M., & Kellett, S. (2014). The clinical effectiveness of stepped care systems for depression in working age adults: A systematic review. Journal of Affective Disorders, 170, 119-130.
Hadjistavropoulos, H. D., Alberts, N., Nugent, M., & Marchildon, G. (2014). Improving access to psychological services through therapist-assisted Internet cognitive behaviour therapy. Canadian Psychology, 55(4), 303-311.
Hoeppner, B. B., Hoeppner, S. S., & Campbell, J. (2009). Examining trends in intake rates, client symptoms, hopelessness, and suicidality in a University Counseling Center over 12 years. Journal of College Student Development, 50(5), 539-550.
Hoyt, M. F., & Talmon, M. (2014). Capturing the moment: Single session therapy and walk-in services. Bethel CT: Crown.
O’Donohue, W. T., & Draper, C. (2011). The case for evidence-based stepped care as part of a reformed delivery system. In W. T. O’Donohue and C. Draper (Eds.), Stepped-Care and e-health. New York: Springer Science.
Owen, J.J., Adelson, J., Budge, S., Kopta, S.M., & Reese, R.J. (2014). Good-enough level and dose-effect models: Variation among outcomes and therapists. Psychotherapy Research. DOI: 10.1080/10503307.2014.966346.
Snipes, C., Maragakis, A., & O’Donohue, W. (2015). Team-based stepped care in integrated delivery settings. Family Medicine and Community Health, 3(1), 39-46.
Seekles, W., van Straten, A., Beekman, A., van Marwijk, H., & Cuijpers, P. (2011). Stepped care treatment for depression and anxiety in primary care. A randomized controlled trial. Trials, 12, 1-10.
van Straten, A., Hill, J., Richards, D. A., Cuijpers, P. (2015). Stepped care treatment delivery for depression: A systematic review and meta-analysis. Psychological Medicine, 45, 231-246.
van Straten, A., Tiemans, B., Hakkaart, L., Nolen, W. A., & Donker, M. C. H. (2006). Stepped care vs. matched care for mood and anxiety disorders: a randomized trial in routine practice. Acta Psychiatrica Scandinavica, 113, 468-476.