Programming for Building Collegiate Resilience and Readiness for Young Adults with Mental Health Challenges

Paul Cherchia, MA & Dori Hutchinson, Sc.D, CPRP, CFRP Boston University

The Critical Intersection of Mental Health, Educational Attainment and Employment in Young Adults

• Recent prevalence rates of mental health conditions in higher education is 37% and higher in community colleges (Eisenberg & Lipson, 2014

• Strong Association between mental health and academic success (Eisenberg, et. al, 2009)

• Lack of emotional resilience is an impediment to learning and pronounced in students with MH conditions (ACHA, 2014).

• Consequences of inattention to these students include low GPA’s, lack of retention & dropout, and lower graduation rates->less career opportunities.

• Capacity to be successful in higher education has lifelong consequences for employment, income and health (Douce & Keeling, 2014).

• Most colleges provide limited access to treatment and reasonable accommodations-it is not sufficient.

What we have learned about students with mental health conditions and their struggles• Difficulty building and benefiting from social

relationships: Loneliness

• Disrupted cognitive tasks such as memory, attention, and problem solving which impact academic capacity.

• Increased physical health conditions related to stress that disrupt and negatively academic success and wellness (sleep, IBS, Crohns).

• Lack of ability to manage, productively struggle with the multiple demands of academics, mental health condition, social life.

• Lack of ability to regulate emotions and anxiety which often leads to isolating behaviors.

• Non-suicidal self injury such as cutting.

• Suicide is now the second leading cause of death in college aged students and the presence of a mental health condition increases this risk.

• Abuse of substances (including food) as students age

• Expressed powerlessness through questioning of authority and disruptive behaviors in classrooms.

• Cyber-bullying, cyber stalking, harassment, and lack of empathy for self and others. Title 9 violations.

• Experience struggle as a weakness and shameful; reluctant to ask for help-67% turn to peers when in distress and do not seek help. Cultural influences play a large role.

TRANSFORMATIVERESILIENCE • Resilience: Adapting well and improving

because of the challenges, adversity, trauma, tragedy, threats or whatever one experiences as significant sources of stress.

• It is a person’s capacity to not only bounce back from adverse events, but use them as life’s learnings and change.

• If we help students with MH conditions to be resilient, Will they succeed academically, grow, flourish and thrive as healthy adults who work, live, and learn with life satisfaction?

• (Maddi & Khoshabe, 2005; Reivich & Shatte, 2002)

Principles of Resilience• Everyone has the capacity for

resilience. It is not just for students from high risk populations.

• It is a process, not a trait.• Resilience is ordinary-not

extraordinary.• Resilience isn’t a program or a

curriculum. It requires that we shift from a “problem based deficit model to a strengths-based model". It is part of our mission. It is a culture. It is an outcome.

• Challenges of all kinds are opportunities for growth and change. (Truebridge & Benard, 2013)

7 Factors of Resiliency (Reivich & Shatte, 2002)

• Emotional Regulation

• Impulse control

• Causal Analysis

• Self-Efficacy

• Realistic optimism

• Empathy

• Social Connectedness

• I AM (strengths)

• I CAN (skills)

• I HAVE (supports)

Skills for Transformative Resilience• Responding to self with empathy and to

others.

• Defining personal values and goals.

• Mindfulness: using apps and in person tools.

• Problem-solving, attention, memory and Planning skills.

• Tolerating and respecting differences.

• Merging Perspectives.

• Resolving interpersonal conflicts.

• Identifying Personal daily rhythms & wellness tools.

• Connecting Skills.

• Resisting Shame.

• Distress tolerance skills.

• Refusal Skills.

The Hub: Innovative Programming for Collegiate Mental Health, Academic Success &

Resiliency

• NITEO

• NITEO Activities

• Peer Mentoring

• LEAD BU

• College Coaching

• Training & Consulting

• Advocacy

• Community Building

With Gratitude for Funding from: NIDRR, the Sidney Baer Foundation and The Ronder Family

NITEO: “thrive, bloom” 15 hr week/1 semester program for ANY college student with serious mental health condition

Simulated higher education academic and resiliency environment: classroom and coaching.

Focus on critical skills and supports for return to school or work.

SKILLS: problem-solving social skills (peer mentors) time management Wellness and resilience Mindfulness & Artistic Expression Self-Advocacy and Shame resistance Academic persistence Emotional resilience Cognitive remediation Presentation and test-taking strategies Writing skills

NITEO Program Evaluation

• Demographics N=78• 59% male, 36% female, 5% other• 25% psychotic disorder• 51% mood disorder • 12% anxiety• 7% PTSD• 5% Substance Abuse• Mean age=20.8 years • 21% were enrolled in some form of

education at intake-part-time enrollment.

• Methods:• Objective and subjective effects

• Assessed at intake and 15 weeks.

• Subjective self-report measures:• Mental Health Inventory

• Self-Efficacy for Learning Form

• Adult Hope Scale

• Domain Specific Hope Scale

• Objective self report measures:• School engagement (PT/FT)

• Work Status (PT/FT)

OUTCOMES

• School Engagement post program : 68%

• Work Engagement: 44%• A combined total of 83 % of

NITEO students were involved in either work or school at the end of 15 weeks.

• Mixed effects models:• Psychiatric DX was NOT a significant

predictor for return to school.• Positive Affect and Changes in

Emotional ties were predictive indicators of participation in Higher ed.

• Psychiatric Dx was a predictor of work participation.

• Significant Increases in:• Positive affect (P<.001)• Emotional ties (p<.005)• Life satisfaction (p<.001)• Global mental health (p<.001)• Academic Self-Efficacy (p<.002)• Overall hopefulness (p<.001)

• Significant decreases in:• anxiety (p<.001)• Depression (p<.001)• Loss of control (p<.001)• Psychological distress (p<.001)

College Aged Coaching

Empowered Goal Setting Work or School? Or both? Fulltime? Parttime? WHY? Help Students walk their why with strengths, values and interests Readiness development activities…research school/work environments

Support Coordination identify and connect with community resources & clinicians collaborate with team members/providers

Preparing for Return to school or work campus tours and application submission Applying to jobs, interview preparation, networking gather supporting documentation

Skills Practice time & coursework self management skills practice disability disclosure, advocacy, wellness management emotional skill development, self-advocacy skills,

Homework Essential element of coaching

Peer Mentoring & Coaching

• Alumni of NITEO work in paid roles as peer mentors in all classes.• Share experiences in classes and role

model resiliency skills and struggles.• Share strategies in classes• Official note takers in classes• Provide leadership for social activities

to build connections and resilience.

• Peer Coaches provide academic and wellness coaching to first year and second year students with MHC to assist them to succeed (NIDILRR research project with UMASS TACR).

Discussion

• Higher education has a mission to prepare young adults to successfully enter the workforce and succeed. Yet increasingly, Colleges and Universities are overwhelmed by students with MH condition. They lack the resources to meet their needs and often express reluctance to meet the needs of these students. Treatment and reasonable accommodations are not sufficient for many students with MH conditions.

• How can resiliency programming be integrated into existing services, curriculums, training programs in higher education?• Should it be?• Whose responsibility is it?• Who will pay for it?• Would Offices of Disability Services

benefit from Peer Coaches that promote wellness and resiliency?

• There are significant worries about risk and liability around students with mental health conditions on campus. Can a resiliency framework and programming reduce these fears?

• Might resiliency programming and services increase help-seeking and reduce prejudice? Why? Why not?

Contact Information

• Dori Hutchinson, Sc.D., CFRP, CPRP• Director of Services, Center for

Psychiatric Rehabilitation, dorih@bu.edu

• Paul Cherchia, MA• Instructor and Coach, College

Mental Health Programs at Center for Psychiatric Rehabilitation

• cherchia@bu.edu