Strategies for Effective Psychiatric Hospitalization of College and University Students

ABSTRACT

University and college counseling services face growing demands for services and self-reported increases in the level of presenting psychopathology, including need for psychiatric hospitalization. However, challenges in communication often occur between the systems of an inpatient psychiatric unit and an outpatient college and/or university counseling service. Concerns include students being sent back to the college or university with no communication, premature discharge, and lack of understanding by hospital staff of the college environment. The present article discusses critical components of developing effective collaborative relationships, protocols for assessing and transporting students, and ways to facilitate good aftercare.     

An Analysis of Reported Counseling Services in Selected Public Community Colleges in the Southeastern United States

Abstract

87% of the small, public coeducational community/junior colleges in the United States, having total student enrollments of 5,000 or fewer students, reported that they provided student counseling services. The median ratio was 1 counselor per 338 students; education counseling was reported to be the primary service rendered, while job-placement counseling was seen as the least important function of the counseling center. Of the institutions responding, 77% provide counseling services to nonstudents, and 37% indicated that vocational counseling was the area in which they most needed to improve services for students.     

Student Counseling Needs

Abstract

Three hundred forty-three students at a small urban northeastern college rated their needs for counseling assistance on fifty-three personal, learning and career issues. Strongest areas of concern included financial stresses, academic perfonriance, career development, relationship skills, bereavement and the fear of getting AIDS. Gender and racial groups are compared and implications for counseling center service delivery are discussed.     

Expanding Counseling Services Through a Collaborative Practicum-Based Resource

Abstract

This article notes the growing challenges for college counseling centers. One solution to these challenges is described as a collaborative initiative designed to actively help university students presenting a range of personal problems with a practicum-based service.     

Psychotherapy Services Provided by a College Counseling Center

Abstract

This study compared the delivery of psychological services at a university counseling center after an interval of almost 40 years in a partial replication of an earlier study at the same center. The results indicate that the changes that have occurred in service delivery reflect more the transitions in the culture of the university than trends in mental health treatment.     

Chapter 2.

Abstract

In 2002, the first in a series of working conferences was held as a collaboration between the counseling service of Bennington College and the Austen Riggs Center's Erikson Institute. The title of the first conference was The Escalating Use of Medications by College Students: What Are They Telling Us, What Are We Telling Them?. It was meant to provide a space to explore the meaning and context of this phenomenon. The primary contexts examined were the student's familial/ cultural context and then the institutional context from which the counseling staff was attempting to respond to the student. This paper describes that initial conference and the emergent themes over the next few years.     

Parent–youth discordance about youth-witnessed violence: Associations with trauma symptoms and service use in an at-risk sample

ObjectiveStudies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence. However, little is known about whether disagreement is associated with poorer outcomes and less utilization of mental health services. The purpose of the current study was to examine disagreement among youth and parents about youth witnessed violence, and determine whether concordance predicted trauma symptoms and recognition of need and receipt of counseling services.MethodsConcordance about youth-witnessed violence was examined in 766 dyads from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Youth participants self-reported trauma symptoms, caregivers indicated youth need for and receipt of services. Both youth and parents provided information about youth-witnessed violence exposure in the last year.ResultsResults showed youth and caregivers differed significantly about youth-witnessed violence. Specifically, 42% of youth reported youth-witnessed violence, compared to only 15% of parents. For those parents who reported youth-witnessed violence, only 29% reported an identified need for services and only 17% reported the youth had received any mental health services. Concordance between parent–youth dyads was associated with greater identified need for services but was not associated with the use of counseling services or trauma symptoms.ConclusionsYouth who reported witnessing violence reported more frequent trauma symptoms regardless of concordance. Parents from dyads in which both informants reported youth-witnessed violence were more likely to endorse need for, but not receipt of counseling services. Given this association between youth-witnessed violence and mental health problems, more work is needed to identify barriers to concordance as well as service utilization.     

Sociocultural Factors and Referral Outcome: An Exploratory Investigation

ABSTRACT

One response to increased service needs at university counseling centers has been community provider referrals. However, certain demographic groups may be more successful in these referrals than others. We hypothesized that students who identify as White, female, sexual minority, and older, would be more likely to be successfully referred. Self-reported demographic information was collected from clients at a Mid-Atlantic counseling center. A logistic regression analysis was conducted to test differences in referral status. Age alone emerged as significant, with older students being more likely than younger students to have a successful referral outcome. Implications of these findings are discussed.     

Psychiatry Resident Rotations in University and College Counseling Centers: A Pilot Study of Rotation Types and Challenges

With an increased demand for mental health services, perceived increased severity of students presenting for services, and increased number of students prescribed psychotropic medications, university and college counseling center directors have had to increasingly identify psychiatric service options. Psychiatry residents can potentially help fill these needs. To better understand the role of psychiatry residents in university and college counseling programs, we conducted a web-based survey of United States psychiatry residency program directors. This study describes clinical activities and rotation characteristics of psychiatric residents working in counseling centers. Of the 48 residency programs that responded, 27 provide rotations at university or college counseling centers, and of those with rotations, 100% report that the residents rate these as very good or excellent. Expanding psychiatry residency rotations at college counseling centers may be mutually beneficial both to the centers and to psychiatric residents.     

Academically Successful Students with Serious Mental Health Difficulties: A Psychodynamic Developmental Perspective

Abstract

This commentary discusses Robert May's reflections on policy for student mental health services on college and university campuses. The Report of the Harvard Provost's Committee on Student Mental Health Services is the impetus for his reflections. While May suggests that the student mental health unit be taken out of the medical unit, the Committee recommends that the variety of services be maintained, but out of the grip of managed care, and that there be greater collaboration and coordination among the services. While noting the psychiatric orientation of both the Committee and its Report, this author sees that the Report emphasizes the institutional context for students' emotional problems and the neglect of that context by recent Harvard University Health Services policies. The present author urges better collaboration between the services located in counseling services and those located in medical services.     

Social Reinforcement Counseling as an Adjunct to a Course in Education

Abstract

The purpose of this study is to determine what effects social reinforcement counseling has on attitudes toward teaching and accuracy of teacher attitude self-estimation held by beginning education students. Teacher attitudes were assessed by the MTAI. Seventy-eight education students at the Ohio State University were randomly divided into three groups that received individual counseling, group counseling, and no counseling for four sessions with social reinforcement as the major technique. The results of the study lend support to conclusions which follow. First, social reinforcement counseling in individual or group setting is more effective for changing attitudes toward teaching, but not effective for increasing students' accuracy of self-estimated teacher attitudes. Second, social reinforcement counseling in groups is as effective as individual counseling for changing MTAI scores of beginning education students.     

Childhood adversity and psychosis in detained inpatients from medium to high secured units: Results from the Scottish census survey

BackgroundThere is limited data available regarding the most common forms of psychiatric illness, the occurrence of childhood adversity, and the link between childhood adversity and criminal and psychiatric outcomes amongst forensic inpatients.AimsUsing census data for all Scottish forensic inpatients, we investigated the most common primary psychiatric diagnoses in forensic settings, the occurrence of childhood adversity amongst forensic inpatients, and whether childhood adversity experiences significantly predict a range of criminal and psychiatric outcomes.MethodData for the current study were drawn from ‘The Scottish Forensic Network Inpatient Census’ (N = 422). The Responsible Medical Officers and other members of the clinical team collected all data from official patient records. All forensic inpatients across high, medium, and low security sites were surveyed.ResultsThe majority of patients had a psychotic disorder as their primary diagnosis (86.4%), with schizophrenia being the most common (70.0%). Childhood adversity was highly prevalent (79.2%), with physical abuse being the most common adverse experience (40.1%). Increased levels of childhood adversity were significantly associated with an increased risk of criminal convictions, self-reported abuse of animals, suicidal and self-injurious behaviour, and problematic use of drugs or alcohol.ConclusionsConsidering the association between adversity and psychosis, trauma informed care is essential for the mental health and forensic needs of this population.     

A Study of the Relationships in Multiple Counseling

Abstract

An Investigation was conducted of the relevance of the perceptions of the counseling relationship to the change In self-concept of secondary school students participating in multiple counseling. Fifty students, six groups, met for 12 counseling sessions held In their own schools. The results Indicate that (a) students' perception of the relationships are Important to their growth in real-ideal self-concept congruence, (b) if a negative relationship is perceived, students’ self-concept congruence will remain the same or decrease, and (c) students, expecting a positive relationship, make more gain in self-concept congruence than those expecting a negative relationship.     

Metaphors for Change

Abstract

A metaphor is the symbolic representation of an idea or a concept in communication. In the counseling context, the use of metaphors provides an alternative intervention strategy when direct communication is ineffective or undesirable. Four critical aspects of the counseling process-communicating understanding, increasing motivation, overcoming resistance, and facilitating solutions-can be enhanced through the use of metaphors. Case examples demonstrating the efficacy and integration of therapeutic metaphors in a college counseling setting are provided.     

Process Groups

ABSTRACT

This study examined the use of long-term process oriented counseling groups at 74 colleges and universities. Colleges with fewer total staff and fewer trained group counselors were less likely to offer group counseling than were institutions with large staffs and more counselors trained to do group work. Qualitative feedback from small college respondents cites resource limitations and staff attitudes as reasons for lesser frequencies of group counseling at their respective institutions. Several staff attitudes are identified and challenged.     

Training teachers

Career counseling must be provided for the student with a strong singular artistic talent as well as for the student who demonstrates a multiplicity of artistic talents.     

The Dose-Response Relationship at a College Counseling Center

Abstract

Most college counseling centers have adopted session limits for their psychotherapy clients though little evidence exists to support such cutoff points. In the past eight years, a few studies have been published using survival analysis statistics for investigating the speed of recovery in psychotherapy. The outcome of clients at a university counseling center was studied to assess change across time, on a session-by-session basis. The analysis of these data showed that 14 sessions of psychotherapy were required for 51% of clients to meet criteria for clinically significant change. Results were interpreted as suggesting that limiting psychotherapy at college counseling centers may result in improvements that are not clinically meaningful for the majority of clients receiving services.     

Clients' Expectations About Counseling and Perceptions of the Working Alliance

Abstract

We examined the relations between clients' expectations about counseling and their ratings of working alliance dimensions. Thirty-seven clients seeking individual counseling at university-based counseling facilities completed the Expectations About Counseling-Brief form (EAC-B) prior to their first counseling session and the Working Alliance Inventory (WAI) after their third session. Results of multiple regression analyses revealed that clients' expectations for personal commitment were positively related to their WAI ratings for agreement on tasks and agreement on goals. Expectations for counselor expertise were inversely related to client WAI ratings for agreement on tasks. No significant relations were found for expectations for facilitative conditions or for WAI bond ratings. Implications for counseling and recommendations for future research are discussed.