Considerations for integration of counseling and health services on college and university campuses

Health screenings in college health centers: Variations in practice

Objective: The purpose of this study was to examine the routine screening of female students in college health centers for six priority health-related behaviors and experiences (tobacco use, alcohol use, eating disorders [EDs], obesity, anxiety and depression, intimate partner violence/sexual violence [IPV/SV]), and to identify variations in practice. Participants: A nationally representative sample of 1,221 healthcare providers (HCPs), including nurse practitioners, physicians, and physician assistants, from 471 U.S. college health centers. Methods: HCPs completed surveys (on-line or paper) and reported on routine screening of female college students. Results: HCPs reported consistently high rates (75-85%) of screening for tobacco use, alcohol use, and anxiety/depression. Rates of screening for IPV/SV, obesity and EDs were much lower. Nurse practitioners reported the highest IPV/SV screening rates. Conclusions: College health centers present unique opportunities for screening, case-finding and intervening to reduce long-term sequelae. Providers are well-positioned to lead initiatives to improve screening practices.

Exploring pre-implementation perceptions of integrated care in a university setting

Objective: To examine providers' perceptions of integrated care prior to the merger of a university's student health center and counseling services. Participants: Seventeen providers across student health services (n = 9) and counseling (n = 8) agreed to participate in the qualitative study. Method: Semi-structured individual interviews that focused on the perceived benefits and challenges of the merger were conducted in December 2019. Following the interviews, a thematic analysis was completed. Results: The perceived benefits noted by providers centered on the ability of an interdisciplinary team to improve the coordination of, access to, and quality of care delivered to students. However, more anticipated challenges were reported by providers (e.g., differences in training and care protocols, losing one's autonomy as a provider). Conclusions: This qualitative study provides a more in-depth analysis of providers' perceptions of integrated care prior to implementation in a university setting and may have implications for model adoption.

Collaborative mental health care: A narrative review

The Collaborative Care model is a systematic strategy for treating behavioral health conditions in primary care through the integration of care managers and psychiatric consultants. Several randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses. Large healthcare systems and organizations have begun to adopt Collaborative Care initiatives and are seeing improved treatment outcomes and provider and patient satisfaction. This review discusses current research on the effectiveness and cost-efficiency of Collaborative Care. In addition, this paper discusses its ability to adapt to specific patient populations, such as geriatrics, students, substance use, and women with perinatal depression, as well as the significance of measurement-based care and mental health screening in achieving improved clinical outcomes. Current data suggests that Collaborative Care may significantly improve patient outcomes and time-to-treatment in all reviewed settings, and successfully adapts to special patient populations. Despite the high upfront implementation burden of launching a Collaborative Care model program, these costs are generally offset by long term healthcare savings.

Comorbid alcohol-related problems and suicidality disproportionately impact men and emerging adults among individuals with depressive symptoms

OBJECTIVE

Depressive disorders are common among adults with alcohol use disorder and with suicidality; however, demographic differences in comorbid alcohol use disorder, binge drinking, and suicidality are understudied. The objective of this study was to determine the extent to which comorbid suicidality and alcohol use disorders and comorbid suicidality and binge drinking differ by age and gender among adults with depressive symptoms.

METHOD

The sample included adults (unweighted N=29,460) in the United States who completed the 2015-2018 National Survey of Drug Use and Heath and screened positively for depression. Gender and age groups odds of alcohol use disorder only, suicidality only, and alcohol use disorder+suicidality were compared to neither problem. Similar analyses were conducted for binge drinking.

RESULTS

Men showed disproportional odds of alcohol use disorder only, all suicidality and alcohol use disorder comorbidities, and binge drinking+active suicidal ideation than women. Emerging adults showed higher odds of: passive and active suicidal ideation only and suicidality+alcohol use disorder than adults 35 and older; binge drinking only, binge drinking+passive suicidal ideation, and binge drinking+active suicidal ideation than all older adults; binge drinking+suicide planning and binge drinking+attempts than adults 50 and older.

LIMITATIONS

Because participants all reported depression symptoms either at the subclinical or clinical level, demographic differences in suicidality, alcohol use disorder, and binge drinking found in this study cannot be generalized to non-depressed samples.

CONCLUSIONS

Treatment providers should be aware of disproportionately higher odds of comorbid suicidality and alcohol use disorder, and suicidality and binge drinking among men and emerging adults.

Integrated primary care behavioral health services in college health: Results from a national survey of health center administrators

The present study investigates the organization of primary care behavioral health within student health centers and assesses the relationship between organizational structure and practice integration among physical and mental health services. Methods: We collaborated with the American College Health Association to distribute a 54 item survey to representatives of each ACHA member institution. Results: A total of 189 (26.3%) surveys were obtained and included 86 (46%) integrated (health/counseling) centers and 101 (54%) nonintegrated centers. Significant differences in levels of practice integration were noted between these two groups. Significant correlations were found between levels of practice integration and the presence of behavioral health staff. Conclusions: The organization and delivery of physical and behavioral healthcare services for students is considerably integrated and collaborative. Adding behavioral health clinicians to the primary care college health setting increases integrated care practice without embarking on full administrative integration of physical and mental health services.

Be True to Our Schools-Models of Care in College Mental Health

PURPOSE OF REVIEW

To review and synthesize the previous, current, and proposed models of care in college mental health in order to identify best practices that will address the mental health needs of today's students. To highlight data that supports existing or proposed models and describe areas where more data is needed.

RECENT FINDINGS

Despite the potentially appealing attributes of integrated care, empirical evidence supporting these systems and structures in campus settings is mixed. Recent surveys show less than half of campuses have an integrated mental health care model. Overall, there is only partial consensus on optimal models of campus mental health care. Mental health needs in college student populations are greater and more complex than ever. While the resources available are vast and varied, there is limited evidence to support which models and programs can best meet students' needs.

Modeling the mental health service utilization decisions of university undergraduates: A discrete choice conjoint experiment

OBJECTIVE

We modeled design factors influencing the intent to use a university mental health service.

PARTICIPANTS

Between November 2012 and October 2014, 909 undergraduates participated.

METHOD

Using a discrete choice experiment, participants chose between hypothetical campus mental health services.

RESULTS

Latent class analysis identified three segments. A Psychological/Psychiatric Service segment (45.5%) was most likely to contact campus health services delivered by psychologists or psychiatrists. An Alternative Service segment (39.3%) preferred to talk to peer-counselors who had experienced mental health problems. A Hesitant segment (15.2%) reported greater distress but seemed less intent on seeking help. They preferred services delivered by psychologists or psychiatrists. Simulations predicted that, rather than waiting for standard counseling, the Alternative Service segment would prefer immediate access to E-Mental health. The Usual Care and Hesitant segments would wait 6 months for standard counseling.

CONCLUSIONS

E-Mental Health options could engage students who may not wait for standard services.

Implementation of universal behavioral health screening in a university health setting

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62% female) accessing a university health center. Each semester, 9-13% of students screened positive for depression, 2.5-3% for suicidal ideation, and 33-38% for alcohol misuse, while 10% wanted help with smoking cessation and 12-13% with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.

Novel Approaches to Individual Alcohol Interventions for Heavy Drinking College Students and Young Adults

Efficacious alcohol interventions for college students and young adults have been developed but produce small effects of limited duration. This paper provides a review and critique of novel (e.g., a significant deviation from a traditional, brief, and motivational intervention) interventions published between 2009 and 2014 to reduce alcohol use in this population and covers intervention format/components and efficacy on alcohol outcomes. We reviewed 12 randomized controlled trials of novel, individual-level alcohol interventions that reported alcohol outcomes. Four domains of novel interventions are discussed: content (e.g., pharmaco-therapy and automatic action tendency retraining), setting (e.g., health centers and ED), modality (e.g., mobile technology), and treatment integration. Findings were mixed for intervention efficacy to reduce amount and frequency of alcohol consumption. Few studies assessed impact on alcohol-related problems. Despite the prevalence of efficacious interventions, there is still an urgent need for novel treatment approaches and delivery mechanisms for this difficult-to-treat population.

Development and initial validation of the Symptoms and Assets Screening Scale

OBJECTIVE

To develop and test a screening measure of mental health symptoms and well-being in college students, the Symptoms and Assets Screening Scale (SASS).

PARTICIPANTS

Participants were 758 college students at 2 universities in the Northwest sampled between October 2009 and April 2011.

METHODS

Participants completed the SASS, as well as measures of depressive symptoms, anxiety symptoms, substance problems, and eating problems in 1 session. A subset of participants (n = 259) completed the SASS 1 to 2 weeks later to allow an examination of test-retest stability.

RESULTS

The SASS demonstrated good reliability and validity and appears to assess similar constructs as well-established measures in college students. Fifty-nine percent of the sample reported having problems with their thoughts, behaviors, or emotions, whereas only 9.7% reported currently receiving treatment.

CONCLUSIONS

The SASS is a brief instrument that has the potential to effectively screen for the most prevalent mental health problems in college students.