The integration of physical health and behavioral health services: three university case examples

To improve the quality of care, the Institute of Medicine has called for the integration of mental health and substance use care with primary care services. This article reports three case studies of service integration efforts in universities. The results provide support for the feasibility of such initiatives. In the three case studies, service integration proved to be both clinically and financially feasible.

The development of an evidence-based toolkit to prevent meningococcal disease in college students

This article describes an innovative, evidence-based approach to community healthcare: the creation of toolkits to address health problems. The exemplar used is the development of an evidence-based meningococcal disease prevention toolkit, with action plans for dissemination, implementation, and evaluation, to be used by healthcare providers in developing comprehensive programs on college campuses. Qualitative research methods were used to develop the content. Formative and summative evaluations were conducted. Anticipated outcomes of such toolkits when implemented as designed are provision of evidence-based healthcare, improved health status of individuals, populations, and communities, fewer hospitalizations, and reduction of healthcare costs.

Striving to Help College Students with Mental Health Issues

Mental health problems in the college population appear to be increasing in number and severity. University counseling services are limited in the number of counselors they can hire to meet the increasing demands. In addition, it is believed that many students do not actually seek much-needed counseling services due to lack of knowledge about mental health problems or services, stigma, or denial of the severity of the problem. Left unrecognized and untreated, mental health problems may lead to students dropping out or failing out of college, attempting or committing suicide, or engaging in other risky, dangerous behaviors that may result in serious injury, disability, or death. Mental health nursing faculty can help address this problem on college campuses by offering courses on mental health issues and skills, becoming involved with NAMI-on-Campus groups, and seeking grant opportunities that can be used to help develop and enhance services for the college community. Information about how to establish a NAMI-on-Campus group can be obtained by accessing http://www.namioncampus.org or http://www.nami.org.

A campus wellness program: accepting the challenge

The federal government challenges universities to promote health and prevent illness by creating awareness of health issues and encouraging healthy practices. Establishing a wellness program on campus is a means to provide excellence in health care for students and a way to reach out to faculty and the community at large. In this paper, the authors explicate the process of a multidisciplinary, collaborative effort in a university to develop a wellness program. Various data supported the need for the program. Using a model center, the design and implementation of the program are addressed, as well as the benefits of the wellness program.

Unwanted sexual contact on campus: a comparison of women's and men's experiences

While sexual victimization continues to be a problem on college campuses, recent attention has been drawn to understanding gender differences in victimization rates and consequences. To date, these studies remain relatively few in number. The current study surveyed 651 male and female undergraduate students about unwanted sexual experiences during 1 academic year. Comparison of men and women revealed expected differences in incidence rates, with women reporting higher rates of unwanted contact. Within the subsample of reported victims, however, there was gender similarity in terms of the context of unwanted sexual experiences. Analyses also revealed the negative consequences of these experiences for both men and women and low rates of disclosure regardless of gender. Across the full sample of students surveyed, there were interesting gender differences in knowledge of campus support services, with women more likely to have attended a prevention program and to have indicated greater knowledge of rape crisis services.

The provision of mental health services on Long Island college campuses: a pilot study

College students, often away from home for the first time, are at risk for mental health disorders that can affect academic performance and quality of life. The purpose of this pilot study was to describe the provision of mental health services to students attending colleges on Long Island, NY and to explore information about the policies developed in regards to disclosing mental health information to a student's family in the event of crisis. A descriptive questionnaire was developed for the purpose of this study. Qualified professionals are providing mental health services to students on Long Island college campuses but few policies exist to enhance communication in the event of crisis. Nurses employed in college health centers can work with students and families towards health-promoting behaviors and to proactively plan for the management of health information in the event of a mental health crisis.

Learning disabilities in the community college and the role of disability services departments

The community college offers educational opportunities to a diverse population of students. Many of the students attending the community college are considered non-traditional, and have numerous factors not faced by traditional-age students that can affect retention in this population. Learning disabled (LD) students attend the community college at a higher rate than other higher education institutions (Barnett, 1996; Bigaj, 1995; & Henderson, 1992). The American Association of Community Colleges (AACC) reported that LDs now constitute the largest single category of disability served by disability service offices in the community colleges (Barnett, 1992). Accommodations are set up by the Disability Support Services Departments, and it is the Disability Services offered by the college that can be the deciding factor for the student regarding the choice of institution (Cocchi, 1997). A trend for the future involves many students who attend the community college self-identifying as being learning disabled and requesting accommodation. Faculty, staff, and administrators in the community college will need to be very familiar with legislation that impacts the rights and availability of services for LD students.

University and college of pharmacy collaboration to control health plan prescription drug costs

OBJECTIVE

To describe the Raising Energy and Awareness in Campus Health (REACH) program, an innovative pharmacy practice model implemented within a self-insured employer.

SETTING

University of Kentucky, Lexington.

PRACTICE DESCRIPTION

A self-funded university-based health plan. PRACTICE INNOVATION/INTERVENTIONS: As part of a university-wide effort to control rising health care costs for 24,000 employees and dependents, four novel pharmacist services encompassed in the REACH program were provided: Co-Pay Counseling; Good Medicines; OutREACH; and Disease Management and Health Promotion.

MAIN OUTCOME MEASURES

University health plan expenditures and health plan member out-of-pocket expenses for prescription medications.

RESULTS

The REACH services were provided by 3.5 full-time equivalent pharmacists. Pharmacists evaluated health plan members' medications and conditions in an effort to identify more cost-effective treatment regimens in the Co-Pay Counseling program; provided confidential medication regimen review in the Good Medicines effort; provided informational programs at worksites within the university in the Out-REACH service; and worked with plan members and their health providers to prevent and/or minimize the impact of diseases such as diabetes and dyslipidemias. The overall university program and medication coinsurance strategy saved an estimated 1.6 million dollars in 2003-04.

CONCLUSION

This unique package of employee benefits and services enabled the University of Kentucky to slow the growth of health care expenditures. Pharmacists were an important element in this effort.

A mixed-methods examination of sexual coercion and degradation among women in violent relationships who do and do not report forced sex

Although partner sexual abuse is clearly an important dimension of partner violence, it has received less research attention than partner physical and psychological abuse. This article contributes to the literature by examining similarities and differences in coercive and degrading sexual tactics experienced by women who do (n = 31) and women who do not (n = 31) report forced sex using quantitative and qualitative data. The women in the sample had all been recently (within the past 6 months) stalked by a violent intimate partner. Results suggest that both women who do and women who do not report forced sex experience various coercive and degrading tactics within the context of sexual activity. Results also suggest that multiple sexual abuse dimensions should be considered within the context of partner psychological abuse, physical abuse, and stalking and that more research on understanding the outcomes associated with dimensions of sexual abuse within the context of physical and psychological abuse is needed.

Meningococcal Meningitis Prevention Programs for College Students: A Review of the Literature

BACKGROUND AND PURPOSE

The incidence of meningococcal meningitis in college students is higher than in other populations. College students, especially 1st-year students living in dormitories or residence halls, are among those at highest risk of developing the disease. It is estimated that immunization can prevent up to 83% of cases among adolescents and college students. A review of the literature was undertaken to identify and critique the research-based prevention programs that are focused on college students.

METHOD

An extensive search of the Cochrane Database of systematic reviews, Medline, PubMed, and CINAHL was undertaken. The Journal of American College Health was hand searched, and bibliographies were reviewed for studies not otherwise identified. Four publications met the search criteria. These studies were reviewed and graded for level of evidence.

FINDINGS

One study could not be compared with the other three because of its lack of detail. Of the other three studies, two were descriptive and factors were identified that related to vaccination and nonvaccination in the college student population (both Evidence Grade C). Only one study was described that included an educational intervention, which resulted in increased vaccination rates in a college student population (Evidence Grade B).

CONCLUSIONS AND IMPLICATIONS

The published literature is severely limited in the area of meningococcal meningitis prevention programs in the at-risk college student population. A critical need exists for controlled studies to test the interventions that are most effective in this population as well as broader-based studies to further identify those students at increased risk for the disease as well as for nonvaccination.

Effectiveness of the Tier 1 Program of the Project P.A.T.H.S.: preliminary objective and subjective outcome evaluation findings

There are two tiers of programs in the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes). In the Tier 1 Program, teaching units based on different positive youth development constructs are covered. Pre- and post-test data utilizing the Chinese Positive Youth Development Scale (CPYDS) and post-test subjective outcome evaluation data were collected from 546 students who participated in the 20h Tier 1 Program of the P.A.T.H.S. Project. Results showed that high proportions of the respondents had positive perceptions of the program and the instructors, with 85.3% of the respondents regarding the program as helpful to them. Positive changes in the program participants in many measures of positive youth development were also observed. Although there were some increases in problem behavior in some areas, adolescent problem behavior was generally stable. The present study provides preliminary support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.

Perspectives of college students and their primary health care providers on substance abuse screening and intervention

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.

From probation to prevention: protecting college students and workers from animal hazards

OBJECTIVE

Our objective was to develop an organized system to assess individual and group exposure to animal hazards on a college campus.

MAIN POINTS

The scope and complexity of college health services continue to expand as campuses confront unforeseen exposures and disease entities. Of great concern are students and faculty who are exposed to potentially life threatening and other serious conditions during their academic work.

CONCLUSION

A college health service developed an effective animal-hazard surveillance questionnaire that could be scanned and analyzed for individual and group exposure to hazards and the presence or absence of protective measures. The college then provided appropriate preventive services.

Establishment of primary care centre for University Malaysia Sabah

University Malaysia Sabah campus moved to its present site in Kota Kinabalu, Sabah, Malaysia in 1999. A health centre was included in the development plans and a two-storey building was constructed to provide the facility for in-patient and out-patient care. Clinical catchments include 10,000 students, 1000 academic and support staff. The medical faculty was inaugurated in 2003, and it was given the responsibility to establish and run the facility for students and staff of the University. This paper describes the development of the facility from merely a physical structure to what is now a comprehensive, functional outpatient service catering for student healthcare, screening, preventive medicine and health promotional activities. Currently, these services are provided by the faculty members of the Medical School. The incorporation of the medical student teaching and collaborative research adds intangible value to the facility. Future plans for expansion include specialist medical services.

Aftermath of tragic events: the development and use of community support meetings on a university campus

Colleges and universities need to be prepared to address the psychological impact of tragedies on their campuses. In this article, the author describes the development and successful implementation of campus postvention services in the aftermath of college student deaths by suicide as well as by natural and accidental causes. The program has been well received and has gone a long way toward helping the campus community come together and heal after these types of tragedies. College officials adapted the program to address issues related to troubling national and international events as well local incidents, such as suicide attempts and students' loss of housing through fires. The author provides specific instructions so that readers can replicate the program on their own campuses, and additional materials are available upon request.

Student assistance program: a new approach for student success in addressing behavioral health and life events

College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations.

Campus mental health services: recommendations for change

College officials indicate that the number of students with serious mental illnesses has risen significantly. Recent media attention surrounding several high profile suicides has opened discussion of mental illness on campus. The authors summarize literature on college students and mental illness, including barriers to service receipt. Recommendations to improve campus-based responses to serious mental illness are presented on the basis of well-accepted service principles.

Web-based triage in a college health setting

The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours; however, it recommended self-care management in 22.7% of encounters. Sore throat was the most frequent chief complaint (14.2%). A subset of 59 students received treatment at student health services after requesting an appointment via e-mail. The authors used kappa statistics to compare congruence between chief complaint and 24/7 WebMed classification (kappa = .94), between chief complaint and student health center diagnosis (kappa = .91), and between 24/7 WebMed classification and student health center diagnosis (kappa = .89). Initial evaluation showed high use and good accuracy of Web-based triage. This service provides education and advice to students about their health care concerns.

Emergency contraceptive pills: a 10-year follow-up survey of use and experiences at college health centers in the mid-Atlantic United States

The authors conducted a 10-year follow-up study using a telephone survey to investigate the availability of emergency contraceptive pills (ECPs) at college health centers in the mid-Atlantic region of the United States. They also examined related issues, such as distribution procedure, existence of a written protocol, personnel involved, contraindications, follow-up procedures, methods of advertising, staff attitudes, changes in distribution over the past 10 years, and availability if ECPs become over-the-counter. Of the 119 completed responses, 58 schools (49%) reported distributing ECPs. The most common reasons schools listed for not distributing ECPs (n = 61, 51%) were religious convictions, understaffing, and lack of funding. Major changes in ECP distribution over the past 10 years related primarily to the number of schools distributing ECPs, protocol in ECP distribution, and advertising for ECP services.

Screening and brief intervention for alcohol problems in a university student health clinic

The purposes of this study were (1) to determine whether a university student health center (SHC) is a feasible location to introduce a campus-based screening and brief intervention (SBI) program for alcohol and (2) to determine whether the patients seen in the SHC differ in terms of the prevalence and severity of alcohol-related problems compared with students reported by emergency department programs. The authors used motivational interview techniques to counsel subjects from a convenience sample of patients waiting for medical treatment in the SHC who had screened positive with the Alcohol Use Disorders Identification Test (AUDIT). The authors interviewed patients again after 3 months. Seventy-five percent of eligible students participated. Sixty percent screened positive and received an intervention. The authors contacted 66 students (51.2%) again after 3 months. Seventy-five percent of students interviewed again after 3 months reported that SBI was helpful, 92% found the information clear, and 90% thought that the SHC was a good place to learn this information.

School's out for bullying

Homophobic bullying of school pupils has a devastating effect on students' physical, mental and emotional health. The RCN's Out group is working with Schools Out to tackle the problem. Schools Out was founded 31 years ago as the Gay Teachers' Group. Those who are bullied are at risk of mental health problems, which can lead to self-harm. A nurse--especially the school nurse--can be the first person a bullied child turns to for help.