1. Reaching The Ones That Won’t Walk-in: A Community Based Service Approach to Students in Need Gregory T. Eells, Ph.D. Cornell University Mahnaz Mousavi, Ph.D. Georgetown University School of Foreign Service Doha, Qatar

2. Outline I. Introduction II. Relevant Data II. Philosophical Framework III. Description of Community Based Services at Cornell IV. Application in Qatar V. Cases VI. Conclusion

3. Introduction The Virginia Tech tragedy has brought considerable attention to college counseling services. Questions have been raised about mental health care and college students who might “fall through the cracks.” Raising questions of how we continue to extend The Colorado Cube of Morrill, Hurst, and Oetting into today’s counseling center

4. Introduction We are all more challenged by the need for consultation and support among the network of faculty and staff on our campuses. There are a significant proportion of students in distress who are not receiving services. The majority of students who kill themselves never receive counseling services Gallagher (2005)

5. Relevant Data In past year: “so depressed it was difficult to function” Cornell: 44% seriously contemplated suicide Cornell: 11% attempted suicide Cornell: 1.3% (~175 undergraduates) 2006 National College Health Assessment (NCHA) 1902 Cornell undergraduates responding

6. In last 12 months, was unable to function academically for at least a week due to depression, stress, or anxiety: White: 37% Asian-American:50% URM*:54% International: 51% *URM = underrepresented minority 2005 Enrolled Students Survey 4790 undergraduates; 37% response rate

7. In last 12 months, seriously considered attempting suicide: White: 6% URM*: 8% Asian-American:10% International: 10% In last 12 months, attempted suicide: White:.04% URM*:1.9% Asian-American:2.5% International: 2.9% *URM= underrepresented minority 2005 Enrolled Students Survey 4790 undergraduates; 37% response rate

10. Asian and Asian-American students:  >50% of completed suicides

11. Philosophical Framework engagement build relationships before counseling reach students in alternative ways not bound by the traditional counselor role and setting don't wait for students to come to us

12. Philosophical Framework Address problems where they occur Mental health concerns do not just originate “in the students’ heads,” but also in the systems and communities in which they live. Therefore, environmental interventions are essential

13. Philosophical Framework Operate from a social justice multicultural framework The narrative around mental health is increasingly told by the pharmaceutical industry that says all mental illness is brain disease-defective. In reality this narrative is a small part of the story

14. Philosophical Framework These organic explanations of every form of mental problem-including crime and delinquency, alcohol and drug addiction, and all forms of child and adult distress-make social change unnecessary. If underpaid workers, exploited and undervalued women, uneducated minorities, the unemployed, the aged, all have high rates of mental disorders, alcoholism, drug addiction, and crime these pathologies are due to defective biology/chemistry. They are not the fault of the system say the ruling elite. George W. Albee Past President, APA

15. Philosophical Framework Realize that traditional mental health services are outside of the “Meaning making sentence” of many groups. Culture involves both an internal and external experience and is the space that cross cuts all of our work. Our goal is to open up these spaces: Through asking difficult questions Through assessing the impact of crossing borders Through approaching justice by understanding that human life is more malleable than we understand

16. Clinic-Based Services Community- Based Services Counseling and Psychological Services (CAPS)

17. What is Community-Based Services (CBS)? The outreach arm of Counseling and Psychological Services (CAPS) at Gannett An effort to support students who don't usually come to counseling An attempt to overcome stigma, cultural barriers & institutional barriers

18. THE CBS Program at Cornell Presentations, trainings & orientations "Let's Talk" offsite walk-in hours Informal discussion groups Community Consultation and Intervention (CCI)

19. Presentations, Trainings and Orientations

20. Presentations, Trainings and Orientations opportunity to meet students outside of counseling context reduce barriers to seeking help inform students about mental health issues and resources

22. Pre-Freshman Summer Program all seven colleges 90 minute interactive presentation on survival skills for Cornell introduction to CAPS and related resources

23. Let’s Talk

24. Let's Talk daily walk-in availability nine sites free direct referrals from trusted members of the student's community meeting outside of the health center, often within the student's community

25. Let’s Talk “consultation and support” informal, friendly format focus on immediate problem solving, resources, and advocacy option for anonymous visit referral to CAPS if necessary

29. Let’s Talk Utilization 55% are students of color or international students Vs. 32% of CAPS clients

30. Informal Discussion Groups

33. Community Consultation and Intervention (CCI)

34. CCI Components Student-centered consultation Direct intervention Program-centered consultation

35. Student-Centered Consultation  Consultation with faculty and staff regarding students in distress  Student has already been unsuccessfully referred to counseling, or the issue is predominantly environmental (e.g., financial problems), not intrapsychic  Advise staff on providing informal counseling when necessary  Behind the scenes case management and advocacy  Periodic follow-up to monitor student’s situation

36. Direct Intervention  Relationship with staff member sometimes helps facilitate referral  Service defined as “student support”  Focus is on immediate problem-solving, support, advocacy, and case management  First contact often outside of counselor’s office  Sometimes evolves into counseling relationship, sometimes not

37. Program-Centered Consultation  Specific cases highlight systemic problems creating student distress  Program centered consultation evolves from cases  Consultations often lead to training  Issues surfaced by multiple cases lead to policy changes  Program-centered consultation and training leads to more student-centered consultation and direct intervention

38. Application in Qatar

39. Cases

40. Directions Collecting data and quantifying the rich qualitative data that already exists Challenges of systematizing and institutionalizing the work More general clinicians doing CBS work Telling the story about the work

43. Conclusion