Identifying & Responding to the Distressed Student A Guide for Faculty & Administrators

Identifying & Responding to the Distressed Student

A Guide for Faculty & Administrators

This Presentation Includes

• Your Role as a COE Member• Scenarios & Responses• Recognizing a Distressed Student• Addressing Distressed Behavior

– Making a Referral– Utilizing Campus Resources– Worst Case Scenario: Suicide

• Confidentiality• A Snapshot of Engle Center Clients

Your Role as a COE Member

Your Role as a COE Member

• Recognize that students may need different levels of care and assistance

• Establish and maintain appropriate learning environment

• Have knowledge of Messiah, legal guidelines and campus resources

As a COE Member

• You are more available and more knowledgeable about the college environment than a student’s previous support system of friends and family

• You may be the first to recognize something is wrong

• You are in an excellent position to identify and respond to students in distress

Scenarios & Responses

What would you do?

Scenario #1

You observe that a student in your class appears disheveled, unshaven, and has stopped participating in class. His grades and attendance have dropped. You are concerned about him and want to contact the counseling center or discuss the situation with your department head. Would you be violating FERPA?

Response:

• No. FERPA covers academic records, and observations are not “records.” Even so, FERPA allows for the release of records without student consent to employees of the college with a legitimate interest. Discussing a student of concern with those in a position to assist the student, or assist you in helping the student, is clearly allowed under FERPA

Scenario #2

A student turns in a writing assignment which contains disturbing content such as: violence, cruelty, paranoia, despair. You are unsure whether this simply an assignment to the student or insight into their psychological state of mind. What might you do?

Response:

• If the material contains any direct threat or plan of harm, contact the Department of Safety.

• If there is not a clear threat, a first step might be to ask to speak with the student privately. Be direct. “When I read these passages in your work, (give specific examples), I was wondering if you are talking about yourself. Do you feel as angry/vengeful/hopeless as this sounds?”

• You might also consult with the Director of Counseling for another professional’s opinion and for guidance about how to handle the conversation and to inquire about appropriate follow-up for the student.

Scenario #3

You receive a note from one of the counseling center staff stating that a student is having difficulties this semester, (which does not qualify as a psychiatric disability covered under ADA). To what lengths should you go to assist this student?

Response

• We send such notes only when we deem that the student’s difficulties warrant some flexibility, but your judgment as the faculty member is always of primary importance.

• We will give you as much information as the student allows, but in some cases (assaults, etc.) the student may not feel comfortable disclosing the reasons for the difficulty.

• You are not being asked to re-teach the class to the student or to unfairly disadvantage other students.

• If there are ways to assist the student without compromising the integrity of the class, we appreciate you doing so.

Scenario #4

You have developed a good relationship with a student, who has then disclosed that she is having personal difficulties. She schedules time to talk with you frequently during office hours. You are glad to listen and have suggested counseling to her to deal with the matters on her mind. She continues to request to see you often and/or stop you after class. You begin to feel burdened.

Response

It is appropriate to set professional and personal boundaries with students.

• You may not always be best suited to assist students, their concerns may be too severe.

• Their requests for your time may interfere with the ability of other students to access you.

• Their request of you may go beyond what is appropriate for the role of faculty.

Tell the student plainly how you can and cannot help. Be firm and gentle. Suggest counseling again.

In Summary…

Each student situation is unique and complex.

Whenever you feel the need, contact the Engle Center. We are glad to help.

Recognizing a Distressed Student

The Distressed Student

• Excessive absences, especially if attendance was previously consistent

• Marked changes in personal hygiene• Falling asleep in class• Poor attendance with little or no work completed• Weight gain or loss

How to recognize?

The Distressed Student

• Unusual or exaggerated emotional responses

• Markedly changed patterns of interaction

(avoiding participation or dominating discussion)

• Communicates problems in essays or emails

• Repeated requests for special consideration,

extensions, etc.

• Serious grade problems

How to recognize?

The Distressed Student

Evidence of self-injuryTalk of harm toward

self or othersLoss of contact with

realitySeeing/hearing things

that do not existStrange remarks or

disjointed thinking

How to recognize?

Indicates immediate intervention needed

Addressing Distressed Behavior

Addressing Distressed Behavior

Many of us already know this, but remind yourself of these principles:

Give your full attention. • Don’t try to have a private conversation in the

classroom while others students waiting to talk with you.

• Don’t stand with your hand on the doorknob.• Don’t multi-task, put down what

you are working on.• Sit down somewhere private.

Addressing Distressed Behavior

Look directly at the student.

Express your concerns in behavioral, specific, nonjudgmental terms.

I've been noticing …(specific things you have observed)

and I’m concerned because….”

Addressing Distressed Behavior – Helpful Conversation Starters

“You have a number of missing assignments lately. Is there something preventing you from getting them done?”

“You seem very quiet and distracted in class. That’s not like you. Is there something going on that you would like to talk about?”

“Tell me how

things are going?”

Addressing Distressed Behavior

Listen first. Don’t assume you know what the student is going to say. If you have been working with students long enough, you may feel you have heard it all. But this

student is unique and wants to be heard in order to trust you with their problem.

“People don’t care about what you know until they know how much you care.”

Addressing Distressed Behavior – Unhelpful Conversation Stoppers

"You had better get your act

together if you expect to pass

my class."

"Why did you wait so long to

ask for assistance?”

“It’s time to grow up and start taking

responsibility for your life. You’re not in high

school anymore."

Addressing Distressed Behavior

• Listen first,

without interrupting.• Focus on listening,

not on what you will say next.• Acknowledge the student with attending

behaviors, (nodding, “Ok”, “I see”, “uh-huh.” Even if you don’t agree, you are communicating that you are listening and understand what the student is trying to say.

Addressing Distressed Behavior

Communicate understanding by summarizing what the student has said.

Avoid judging, evaluating, or criticizing. Respect the student’s point of view, even if you disagree with it.

to Make a Referral

• You feel overwhelmed or unsure of how to proceed.

• Assisting this student is compromising your time and attention to other students.

• You believe the concern is outside expectations for your position.

• You want consultation; the behavior does not need to be severe.

to Make a Referral

“Sounds like you are really struggling with________. That’s really a lot to deal with, Talking it over with a counselor might help you sort through it all.”

“Give counseling a try. You have nothing to lose.”“These are services your tuition pays for; take advantage of

them.”

Let the student know that it is not necessary to know exactly what is wrong in order to seek assistance.

Assure the student that seeking help does not necessarily mean their problems are unusual or extremely serious.

Be frank about your own limits of time, energy, training, and objectivity.

If the Student Is Reluctant

• Normalize help-seeking. – “Hundreds of students use the Counseling

Center every year.”

• Services are confidential, and will not go on a student’s academic record.

• Engle Center is for medical and psychological concerns. – “No one needs to know why you are there.”

If the Student Is Reluctant

• Counselors can teach self-help strategies. – “They can teach you ways to solve your

problems yourself.”

• No commitment, no cost: – “Give it a try, you have nothing to lose.”

• Be honest: – “What you’re doing now is not working /is

not healthy.”

I suggested counseling, but they didn’t go!

Change is a process, not a single decision.

Where is this student in this process?

How can you help move the student forward at each stage?

I suggested counseling, but they didn’t go!Stage 1- Not interested in

counseling

Student thinks: “The relationship with you is safe and familiar, why involve someone else?”

Encourage re-evaluation of current behavior and its effectiveness

I suggested counseling, but they didn’t go!Stage 2- Considering

Counseling

Student thinks: “Maybe counseling could help, I’ll think about it.”

Encourage evaluation of pros and cons of counseling

I suggested counseling, but they didn’t go!Stage 3- Getting ready for

counseling

Student thinks: “I want to sign up for counseling, but what will I say when I walk in the door?”

Encourage small steps and assist in problem solving.

I suggested counseling, but they didn’t go!

If you choose to continue your discussions with the student ask yourself the following questions:

• Do you and the student believe the talks are helpful? Is the situation getting better?

• Do you believe the situation and problems mentioned are within your ability and background to appropriately assist the student?

• Are you able to commit to the student in this way? Consider the time commitment, your availability, emotional investment and the potential impact on your other students.

• Are you in danger of developing a “dual relationship” with the student that could lead to future complications?

I suggested counseling, but they didn’t go!

It is appropriate to establish firm boundaries with students and let them know that you are no longer able to best help them. Let them know that referring them does not mean that you will have no further contact with them. You will continue to be concerned and caring in a way that is appropriate for you. No one wants to feel “dumped,” especially when most in need of support. Provide a clear statement about what you can and cannot do.

Campus Resources

• Engle Counseling and Health Center – Counseling and appropriate outside referrals. – Website resources (psycho-educational)

• Office of Community Development– ext. 5380, Doug Wood

• Office of Disability Services– ext . 5382, Keith Drahn– http://www.messiah.edu/offices/disability/

• Support from Residence Life Staff.• Formation of multi-disciplinary CARE TEAM for some

students needing support from several areas.• Generous medical leave policy.

Suicide:What we fear the most

SuicideNational Statistics• Second leading cause of death among North

Americans of college age.

• For every successful suicide, there are 40 failed

attempts. • 1 in 12 college students makes a suicide plan.• More teenagers and young adults die from

suicide than from all medical illnesses combined.

(Sources: Kadison, 2004 & Seaman, 2005)

Students in Crisis:Signs of a Student Needing Immediate Assistance

• Evidence of self injury such as cutting or burning.• Suicidal statements, gestures, or attempts.• Acts or threats of harm to other individuals or property.• Extremely disruptive behavior, such as outbursts,

aggression, or hostility.• Loss of contact with reality, disoriented thought or

hearing/seeing things that are not present.• Homicidal threats (written or verbal), or attempted

homicide or assault.

Intervening with a student in crisis

• Ensure everyone’s safety, including your own. • Talk to the student in a calm manner.• Share your concern and belief that the

student needs assistance.• Avoid touching the student if he or she is

agitated, violent, or intoxicated.• Do not threaten the student.• Avoid arguing with the student.

Intervening with a student in crisis

• Talk to the student sympathetically.• Do not promise confidentiality to a student

who may be considering suicide.• Do not avoid discussing the topic of suicide.

Asking the student about suicide won’t "put the idea into his/her head."

• Recommend that the student seek help from Counseling Services immediately.

Intervening with a student in crisis

• If the student agrees to seek help, recommend that he/she contact Counseling Services right away from your office/classroom. After regular office hours, contact the Department of Safety

• If the student is reluctant to call, offer to call and make arrangements for them, or offer to walk the student over to the Engle Center.

• If the student refuses, it is important not to let the issue "resolve itself." Let the student know that you will be contacting Counseling Services. Call us immediately so we can contact the student.

• If you are concerned that the student is at imminent risk, do not leave the student alone. Contact the Department of Safety immediately.

• Contact Us

Confidentiality

HIPAA, FERPA and Codes of Professional Ethics

Playing by the Rules

• While not technically bound by HIPPA regulations, Counseling Services does follow the APA code of ethics which informs our policy on confidentiality.

• FERPA regulations apply primarily to college faculty and administration and address, among other things, disclosure of educational records within the college.

• The APA code of ethics, which the Engle Center follows, and FERPA regulations, which faculty and administration must follow[1], have very different rules regarding the release of information.

[1] FERPA does not consider counseling records part of a student’s “educational record.”

Confidentiality Q and A

If I refer a student for counseling will I be notified when the student makes an appointment?

Confidentiality Q and A

If I refer a student for counseling will I be notified when the student makes an appointment?

It is our policy to notify you when a student you have referred makes an appointment; however we must ask the student’s permission and they can choose to refuse.

Confidentiality Q and A

Could I inquire at the counseling center about whether a student is receiving counseling?

Confidentiality Q and A

Could I inquire at the counseling center about whether a student is receiving counseling?

No. We can disclose that information to you only in those situations where you have referred the student and the student gives us permission to speak to you about the treatment.

Confidentiality Q and A

Can the counseling center give me more detailed information regarding a student’s treatment?

Confidentiality Q and ACan the counseling center give me more detailed

information regarding a student’s treatment?

Generally speaking, we can only provide that kind of information if it would be of some specific benefit to the student and then only with her or his written permission.

Ex. if a student is requesting an “I” in a course at semester’s end or leaving school for a short time for mental health reasons, it is likely that we will encourage the student to give us permission to speak with faculty.

Confidentiality Q and A

If I am concerned about a student, may I consult with a counselor about how to be helpful?

Confidentiality Q and A

If I am concerned about a student, may I consult with a counselor about how to be helpful?

Yes. We encourage you to call us anytime you would like to discuss your concerns, regardless of whether the student is a client or not.

A Snapshot of Engle Center Clients

Current Trends in the Mental Health of College Students

– Total of 365 clients last year– 40% had anxiety/stress– 21% had relationship difficulties– 19% experienced depression

*Because students may present with multiple complaints, total is greater than 100%

A Snapshot of Engle Center Clients*

• 6 were hospitalized (national average =5.6)• 2 attempted suicide (as high as 5 in past years)• 28 engaged in self-injury• 16 left school for psych reasons• 30% were taking psychotropic medication

A Snapshot of Engle Center Clients

Percentage of Engle Center Clients with Anxiety Symptoms

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Academic Period

Students in Counseling &Total Enrollment through Time

Students Enrolled

Students in Counseling

Linear (Students in Counseling )

Mental DisabilitiesRegistered With

Disabilities ServicesNumber of Students Registered with Messiah

College Disability Services

0

10

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Attention DeficitDisorder

Autism

Learning Disability

Psychological Disability

0.0%

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Growth in Use of Psychotropic Medication

Trend Among New Students Bringing Medication to

CollegePercentage of New Students Coming with

Psychiatric Drug Rx

0.0% 2.0% 4.0% 6.0% 8.0%

02/03

03/04

04/05

05/06

06/07

Nationally: 94.4 % of college centers report an increase in number of students taking meds before seeking counseling services.

Messiah NationalCollege Norms

• Felt so depressed it was hard to function 39.0% 42.3%

• Seriously consideredsuicide 7.8% 10.6%

Attempted suicide at least once 1.0% 2.0%• Had an anxiety disorder 10.9% 13.5%

Messiah Student Problems vs. National College Student Norms in the Past Year

Messiah NationalCollege Norms

Depression/Anxiety 16.2% 15.6% Sleep difficulties 26% 23.8% Stress 35.2% 30.8% Internet/Computer Game Use 16% 12%

Factors Affecting Academic Performance

• 29% of our clients were on the Dean’s List

• 5% of our clients were Residence Life Staff

The Engle Center is not just for marginal students!