Health Services Advisory Committee May 7, 2015 Bert Epstein

Health Services Advisory Committee May 7, 2015 Bert Epstein

But, first a therapy cartoon

Student Psychological Services--- Outline Diagnostic Profile Utilization Specialized Services (Spanish-Language Therapy/Psychiatry) Students Served; Sessions/Student Wait List Referrals Outcome: CCAPS Client Satisfaction Client Feedback in Narrative

Diagnostic Profile Compressed List, Primary Issue: 1. Anxiety 189 students 2. Depression 115 students 3. Bereavement 41 students 4. Substance Abuse 33 students Compressed List, Environmental Issue: 1. Relational/Primary Support Group 291 2. Academic Problem 135 3. Social Environment/Economic - 90

Diagnostic Profile - Expanded Anxiety, Other 96 Major Depressive Disorder 64 ADHD 49 PTSD 42 Dysthymia (long-term depression) 31 Bipolar (Manic-Depressive) 20 Panic Disorder 19 Generalized Anxiety 18 Social Phobia 14 Substance Abuse - 13

Utilization: Specialized Services Spanish-Speaking Therapy (10 hrs/wk) & Psychiatric Service (4 hrs/wk) 250 200 150 100 2011-12 2012-13 2013-14 2014-15 50 0 SPA Cs SPA Sess PSY Cs PSY Sess 5

Utilization: Sessions per Student (including drop-in session) Consistent Reduction = More students served 8 7 6 5 4 3 2 1 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15EST 1

Utilization: Unduplicated Headcount Steady increase in students served 600 500 400 300 200 100 0 2010-11 2011-12 2012-13 2013-14 2014-15EST

Utilization: SR & Pet 8/20-4/29 450 400 350 300 250 200 150 100 50 0 SR Pet SR Pet SR Pet 2012-13 2013-14 2014-15

Wait List About the Same as Last Year: Maximum number students on Wait List: 11-12: 50 12-13: 25 13-14: 19 14-15: 23* * one particular week, second most: 18 Average number students on Wait List: 11-12: n/a 12-13: 22 13-14: 8 14-15: 7 Average number days from first contact to first ongoing therapy appointment (for students put on wait list): 11-12: 62 12-13: 29 13-14: 18 14-15: 18.6

Wait List More Number of students placed on wait list in 2014-2015 compared to previous year: 18% reduction Much greater access for students! Number of students on wait list who were then either seen, did not respond, or declined services remained constant.

Reasons for Reduction in Number of Students Placed on Wait List: Focus on referrals Wait list viewed with interns weekly so they can see the need. Several years ago there was a 10- session limit. By this year all interns present were not here then and focus more on very brief therapy (and referral).

External Referrals 2012-2013: 75 2013-2014: 85 2014-2015: 140 (as of 4/24/15) Increase this year due to increased emphasis on referrals and on documenting via data entry

External Referrals MH PCP Substance Abuse Tx PCP Support Group Other Community Resource MH Community Clinic 0 10 20 30 40 50 60 70 80 90 100

Training Provide one week orientation Provide weekly didactic training Focused more this year on practical issues Evaluation: On Likert scale of 1-5, with 5 being best, interns rankers trainers: 4.03 av.

Supervision: Evaluation of Trainees Likert Scale Competency 3- Meets 4- Above 5 Significantly Above Clinical Assessment and Training Professional Roles and Skills Supervision Overall Evaluation Fall Spring Fall Spring Fall Spring Fall Spring 3.42 4.42 3.42 4.42 3.58 4.5 3.58 4.5

Outcome: CCAPS (Counseling Center Assessment of Psychological Symptoms) This is second year of use at SPS 62 symptom questionnaire completed by student at intake, followed by similar 34 question version at 3 rd and final session 60 students (of 300) measured, as they received multiple CCAPS Asks students to rate each symptom statement on a 0-4 scale, with 0 meaning it was not at all like me and 4 meaning it was extremely like me

Outcome: CCAPS (Counseling Center Assessment of Psychological Symptoms) Second year of integration with Medicat (Electronic Health Records) The Good: Seamless and confidential records storage + easy for therapists to access client scores The Bad (for now): Lack of ability to compute entire agency benchmarks and amount of clinical change. Working on it Two years ago - it looked like this:

Outcome: CCAPS (Counseling Center Assessment of Psychological Symptoms)

Outcome: CCAPS Change Score first to last administration - % improvement of reliable change NOTE: Subscale scores deflated due to beta version 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 Depression Anxiety Social Anx. Academic Eating Hostility Alcohol Distress

Client Satisfaction

Client Satisfaction Q5: Since receiving counseling, have you noticed any improvements in:

Outcome: Client Evaluations The therapy kept me focused and helped reinforce my drive to succeed. I am now more confident that my faults don t have to hold me back from academic success. Now I feel more motivated, my goals and plans looks more clear, and I have plans to continue with my education and have a better life.

Outcome: Client Evaluations My academic performance was very close to imploding prior to therapy. Now it is strongly concrete. I am surprised by how I have really improved. I see myself as much more capable than ever before. It was so good that the experience pushed me to find a permanent therapist. Dayne helped me to get over the stigma of utilizing Disability Services.

Outcome: Client Evaluations It helps to not go to class in a neurotic and paranoid state of mind. Therapy has been a sort of verbal yoga for me, which gets the thoughts out of my mind. I would have dropped a class without counseling. My academic performance improved. I didn t expect to encounter such a superb level of counseling.

SPS Areas of Strength Client satisfaction Diversity of services (individual, Spanishspeaking, psychiatry, outreach) Access very good capability to assess students immediately + small wait lists Provision of ADHD Assessments for DRD Positive outcomes for therapy Crisis response and management/coordination with CAPE, CIRT Robust training program, very satisfied trainees

Areas of improvement this year Referrals: making referrals, mechanisms for recalling, and tracking those made [across all SHS] Successful recruitment of 8 trainees for next year increase of 1 Refined/improved didactic trainings Refined/improved group supervision More integration with nurse practitioners, athletic department Bilingual front desk reception

Areas for focus next year Further focus on Referrals introduction at beginning of year; also supervisor tracking Further integration with other SHS groups Technology Expand website / on-line presence Full year of using new computerized recall (reminder) system Ability to obtain agency-wide CCAPS results

Increase outreach opportunities for trainees at beginning of semester Make lobby even more inviting for diverse set of students Evaluate # hours in Petaluma Increase trainee/psychiatrist collaboration Improve group attendance (explore academic credit, synch with class schedules) Increase collaboration with DRD, Counseling

. Final Thoughts: Caterpillar Therapy

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