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