1. .
1.1. .
2. Conduct monthly consultation with student stakeholders
3. Use primary care approach at initial consultation (STEP 1)
3.1. Just as a family physician is the case manager for all patients seen, intake consultant is the go-to person for any problems with support/treatment plan
3.1.1. Combined with ongoing walk-in intake responsibility, this motivates efficient case-management
3.1.2. Responsibility for student access to supports is distributed among all staff
3.1.3. Draw inspiration from primary care experts - family physicians
3.2. Identify one key goal and co-prescribe a plan
3.3. Use solution-focused / single session language and philosophy
3.4. Be transparent about the model, the empowerment, trial and error philosophy and develop a tentative support/treatment plan immediately
3.4.1. Provide overview of model in initial consultation session as part of informed consent
3.4.1.1. Show a graphic if you have one
3.4.1.2. Obtain signed consent
3.4.2. Admit that assessment is limited and explain rationale for this
3.4.2.1. RATIONALE:
3.4.2.2. We are going to assume that you are more healthy than you are ill until you state otherwise
3.4.2.3. Focusing only on deficits risks reifying and reinforcing a negative outlook and outcome
3.4.2.4. We want to encourage you to self-monitor and take responsibility for asserting your needs
3.4.2.5. We believe you are an expert on you and want to be clear that we depend on you to say what is wrong and what you need at any given time
3.4.2.6. We want to increase our accessibility to you and others in need, when you need it but not before
3.4.2.7. We want to focus on developing solutions right away
3.4.2.8. We believe that the best solutions come from trial and error
3.4.2.9. We believe there is more risk in delaying supports and solutions than in missing uncovering some less obvious underlying problem
3.4.2.10. In respect of privacy, we will engage in deeper assessment only if simple solutions are not available. Deeper assessment is justified if the solution to your distress remains a mystery
3.4.3. Allow for rapid re-assessment and access if client wishes to adjust plan
3.4.3.1. Write out the treatment plan, give a copy to client and keep one for the records
3.4.3.1.1. .
3.4.3.2. Provide instructions and contact details for rapid follow-up should the client wish to adjust the plan
3.5. Distinguish between distressed students and students in crisis. Refer students in distress to peer helpers or mentors on standby (Step 4) and those in crisis to case management or community crisis services (Mobile Crisis, Hospital, 911) - STEP 9.
3.6. Obtain buy-in for feedback-informed-treatment/programming by integrating a balance of strengths and deficits outcome monitoring into every therapeutic encounter
3.6.1. Pathology/Risk
3.6.1.1. CCAPS?
3.6.1.2. BHM20?
3.6.1.3. OQ45?
3.6.1.4. C-SSRS?
3.6.2. Strengths/Coping
3.6.2.1. Warwick-Edinburgh Mental Well-Being Scale?
3.6.2.2. ORS?
3.6.2.3. Thrive Quotient?
3.6.2.4. Flourishing Inventory?
3.6.2.5. BHM-43 Well-Being and Personal Effectiveness scales?
3.6.3. Readiness for change
3.6.3.1. Psychotherapy Readiness Scale - BHM?
3.6.3.2. University of Rhode Island Change Assessment?
3.6.4. Therapeutic alliance
3.6.4.1. SRS?
3.6.4.2. Therapeutic Bond Scale (BHM)?
4. Provide support, training and incentives to staff and stakeholders fostering innovation, curiosity and experimentation especially pertaining to STEPS 1-5
4.1. Involve students in the design of a "made at [your university] model"
4.1.1. Invite clients to help with model design adjustments
4.1.2. Ask stakeholders if peer mentors, puppies and /or study spaces in the waiting area are good ideas
4.2. Reward effectiveness and efficiency not number of clinical hours worked
4.2.1. All counsellors share directly in the responsibility for avoiding waiting lists through a single session model of open access to services
4.2.2. Counsellors only need to see whoever comes in on their walk-in period
4.2.3. No set number of clinical hours/week
4.2.4. Flexible use of time is encouraged - 5, 10, 15, 25, 50 minute sessions with shorter sessions (i.e., 20-25 minutes) as default
4.2.5. Research shows that it is better to have more frequent but shorter sessions than full length sessions less often
4.3. Automate outcome monitoring and provide training in feedback-informed treatment"
4.3.1. Develop solid SC assessment protocol that monitors both strengths and deficits
4.3.2. Designate a staff lead for SC model monitoring
4.4. Integrate SC programming with healthy campus work
4.4.1. Designate a staff lead for online program engagement
4.4.1.1. Free up clinical time to allow this staff member to evaluate low intensity resources and train internal and external staff
4.4.1.2. The lead is also part of campus mental health strategy
4.4.2. Partner with campus experts on marketing and public engagement
4.5. Reduce administrative load including unnecessary documentation
4.5.1. Training on efficient record keeping
4.5.2. Development of templates
4.6. Provide opportunities for staff, students and other stakeholders to contribute to ongoing evolution of the innovation
4.6.1. Create staff room wall of innovation for staff to share discovery of new ways to empower students
4.6.1.1. Graphic format option
4.6.1.1.1. Can use a large poster presentation printout to depict your campus stepped care graphic as "scaffolding" on which post-it note solutions are arranged
4.6.1.1.2. Staff can share using post-it notes the new, more effective and efficient ways of practicing
4.6.1.2. SWOT format option
4.6.1.2.1. Challenges on left
4.6.1.2.2. Solutions on right
4.6.2. Include SC suggestion box
4.6.2.1. For staff?
4.6.2.2. For clients?
4.6.3. Encourage staff to participate in CoP
4.6.3.1. Small schools
4.6.3.2. Medium and large schools
4.7. Train peer helpers and support staff to assist with wellness programming referrals, as well as supportive listening in quiet room for students in distress
4.7.1. Distinguish between emergency which requires 911 call and distress which requires sympathetic ear not a specialist
4.8. Ensure that any training reinforces the SC model and/or includes SC related content
4.8.1. SC relevant topics
4.8.1.1. Single session theory
4.8.1.2. Solution-focused interviewing
4.8.1.3. Low intensity interventions
4.8.1.3.1. Strengths & Resilience based
4.8.1.3.2. iCBT
4.8.1.3.3. Therapist-assisted
4.8.1.4. Walk-in service models
4.8.1.5. Using time creatively
4.8.1.6. Primary care psychology
4.8.2. Format:
4.8.2.1. Pre-consultation with trainers should include introduction of your campus model with negotiation on how this will be integrated into the training
4.8.2.2. Two day workshops are optimal with second day focused on adaptations of learning to the your site's characteristics
4.8.2.3. Follow-up consultation with trainers by video can be helpful
5. Rule out lower steps as "best options" before considering STEPS 6 or 7
5.1. Develop low-intensity resource bank to assist counsellors in managing caseload and students not ready for intensive therapy
5.1.1. Ensure that lowest-intensity self-help resources either promote mental health literacy (STEP 2) or build resilience using only positive psychology skill development (STEP 3)
5.1.1.1. Market these resources to entire campus population just as you would a fitness centre
5.1.1.1.1. Encourage staff and faculty to use the resources
5.1.1.1.2. Adjust resources to meet the priorities or address the pain points of the various constituents
5.1.1.2. Content that reflects deficit or pathology is not appropriate at this autonomous self-help level. Do not use terms such as:
5.1.1.2.1. Depression
5.1.1.2.2. Anxiety
5.1.1.2.3. Other DSM terms
5.1.1.2.4. Treatment (use supports or programs instead)
5.1.1.3. Mobilize non-student affairs champions for these resources
5.1.1.3.1. HR
5.1.1.3.2. Athletics
5.1.1.3.3. Faculty association
5.1.1.3.4. Student advocacy groups
5.1.1.3.5. President
5.1.1.4. When possible, embed into the curriculum low intensity mental health programing in the form of resilience and emotional intelligence skill learning outcomes
5.1.1.4.1. Leadership skills for capstone courses in arts and social science
5.1.1.4.2. Public engagement in capstone courses for arts and science faculties
5.1.1.4.3. Self-care, ethics and professionalism courses in professional schools
5.1.2. Start with collating counsellors' and students' favorite resources
5.1.3. Resource links online organized according to your model?
5.1.4. Be creative
5.1.4.1. Resources can be developed on low budget
5.1.4.1.1. e.g., GWU
5.1.4.2. Develop handouts for series of youtube videos on selected topics
5.1.4.3. Invite clients to contribute to your resource bank by engaging in online research on programs that might address their particular issues
5.1.5. Develop counsellor toolkits using storage clipboards?
5.1.5.1. .
5.1.5.2. .
5.1.6. Allocate time for one staff member to conduct periodic environmental scans to identify and update collection of low cost resources
5.1.7. Ensure that STEP 4 campus peer programs and workshops are well-integrated into your service model
5.1.7.1. If possible ensure that all workshops are led or co-led by students or student staff with input or co-facilitation by professional staff
5.1.7.2. Peer mentors can be stationed in waiting room to:
5.1.7.2.1. escort students in distress to quite room where they can provide support
5.1.7.2.2. direct students to online resources while they are waiting
5.1.7.2.3. provide academic support to students who are studying while they wait
5.1.7.2.4. Other?
5.1.7.3. Train peer mentors to be online chat listeners
5.1.7.3.1. .
5.2. For students who are not ready for change or who are not actively seeking intensive therapy, provide low-intensity programming as means for developing mental health literacy and "dipping their toes" into the change process
5.3. If it appears that a) the student is not ready for therapy or b) the prospect of a good therapist-student match is uncertain: be transparent about testing the waters using a brief single-session check-in follow-up which can be renewed if uncertainty persists
5.4. For students who may be ready to work, but have never had therapy before or had traditional therapy that was not successful, share results of therapist-assisted online research and recommend this as best-practice first-line approach
5.4.1. iCBT, Positive Psychology programming, TAO show results that are as good as or better than STEP-7 50-minute hour
5.4.2. When students have no prior expectations of what "counselling" or "therapy" is, use this as an opportunity to begin with low-intensity, strengths based approach either:
5.4.2.1. autonomously - 100% self-help
5.4.2.2. counsellor-assisted self-help with 15-minute coaching sessions
5.4.2.3. blended counsellor assistance with 30-minute support sessions
5.4.3. For students who have had previous unsuccessful therapy, suggest trying something different:
5.4.3.1. Previous therapy may have kept them stable, but perhaps a new approach could do much more than stabilizing
5.4.3.1.1. Say something like "I wish more for you than just surviving"
5.4.3.1.2. Use this as an opportunity to explain stages of readiness and how STEP-7 is designed to be powerful and used only when ready
5.4.3.1.3. Consider practicum level trainee counselling as on par with STEP-4 supports
5.4.3.2. Allow students with previous less than adequate experience browse the lower step options
5.5. Provide traditional intensive STEP-6 or 7 therapy only for those who are ready to be challenged by experienced therapists with powerful therapeutic skills
5.5.1. STEP 6 - Traditional group psychotherapy is high intensity and this is why many people are reluctant to go at first
5.5.1.1. Be transparent that a group is a powerful intervention and it may not make sense to start a person with such a high dossage
5.5.1.1.1. e.g. While an anxiety group is a perfect intervention for someone with social anxiety, this might not be the best first level of exposure for the client
5.5.1.1.2. Sometimes being transparent can have the paradoxical effect of motivating clients to take on the challenge
5.5.1.2. Don't confuse group psychotherapy with lower intensity group work such as workshops, classes and support groups (STEP 4)
5.5.2. STEP 7: Refer to this as powerful, intensive psychotherapy much like a high dosage medication
5.5.2.1. If student wants gentle weekly traditional individual psychotherapy support, consider referring to trainee
5.5.2.2. Be transparent about the rationale:
5.5.2.2.1. If a student is ready for "a challenging course" of treatment (like a challenging academic course)
5.5.2.2.2. If a student who is not ready for the challenge, they might prefer a more supportive experience and trainees are more apt to provide this
5.6. Specialist care (STEP-8) and involvement of stakeholders with influence (STEP-9) are valuable dimensions of care: Use these sparingly and thoughtfully within the context of healthy cities/campus population health theory
5.6.1. Ensure that your healthy campus strategy is integrated into the core academic mission and all university policies
5.6.1.1. Ensure that your campus mental health strategy is part of a broader general healthy community strategy focusing on the multiple determinants of health
5.6.1.1.1. Consider signing onto the Okanagan International Charter for Health Promoting Universities (Click on arrow for link to pdf)
5.6.1.1.2. Report to your campus using an annual healthy campus scorecard
5.6.1.2. Deans as well as upper level administrators should be considered key partners in your healthy campus strategy
5.6.1.2.1. Associate Deans are crucial partners who should be familiar with your campus model of care
5.6.1.2.2. Can you establish a high level administrator, or an award winning faculty member as a mental health or healthy campus champion?
5.6.1.2.3. .
5.6.2. Offer psychiatric consultation-only as the default level of care at Step 8. Consider referral to case management (Step 9) if either acute or long-term-oupatient community-based psychiatric care is required
5.6.2.1. STEP 8: In order to focus on strengths and minimize stigmatizing, over-pathologizing, or over-medicating, initial psychiatric consultation should focus on assessment and recommendations that physicians or counsellors may wish to implement
5.6.2.1.1. Consulting psychiatrist does not prescribe. This is left to the primary care physician or psychiatric nurse practitioner
5.6.2.1.2. Ongoing psychiatric care would require a second specialist referral by physician usually only when consultation is ruled out as inadequate
5.6.2.2. System Navigation (Case Management) at Step 9 brings together high-level stakeholders with both the campus and surrounding community to support an integrated healthy-campus, healthy community approach
5.6.2.2.1. Students of Concern Committee
5.6.2.2.2. Paid student peer mentors and support
5.6.2.2.3. Set up a community liaison committee with key members of hospital and community outpatient services