Responding & Working With Students Who Are Disruptive And In Distress

1. Responding & Working With Students Who Are Disruptive And In Distress Tow Yee Yau, Ph.D. Director of Health & Wellness Counseling & Psychological Services (CAPS) And Student Wellness Center Division of Student Affairs, University of Cincinnati October 16, 2014

2. Objectives • Understand roles as faculty & staff in managing students who are disruptive and in distress • Describe different types of concerning student behaviors • Learn skills to use when talking with students in distress • Learn how and when to refer students for psychological assistance and learn about CAPS Services

3. Faculty/Staff Role Important Role

4. Faculty/Staff Role • Not mental health professionals • Limited but important responsibility • Eyes and Ears • Today: (a) Increase understanding of problems (b) Learn options for engaging students (c) Learn to refer (d) Review CAPS services

5. Know Your Role • If feeling overwhelmed by student’s needs you might be outside of your professional role • Support • Containment • Helping within limits • Safety first • Discretion ≠ confidentiality • Balancing limit setting and disciplinary actions with support and caring

6. Helping Within Limits • Set boundaries • You’re not expected to resolve distress or solve crises • Consult and refer • Self care

7. How Do I Know When a Student Needs Help? General Signs of Distress

8. Common signs of distress These are non-specific; they do not necessarily signify a disorder • Appearance • Behavior Skipping class, odd behavior, crying spells, withdrawal • Mood changes Argumentative, irritable aggressive/violent, depressed, anxious

9. More signs of distress • Eating habits Increase/decrease, rapid weight changes • Sleep habits Increase/decrease, disruption, tiredness • Substance use/abuse Frequent use/need, intoxication, hangovers • Disorderly behavior, disciplinary action • Other students’ having concerns

10. Academic Indicators • Deterioration in quality/quantity of work • Missed assignments or exams • Repeated absences from class or lab • Continual seeking of special consideration

12. Some Difficult Situations Identifying and Handling High Risk Behaviors

13. Thought Disorders • Irrational, talking “crazy” • Hard to follow, disorganized speech • Rapid speech • Suspicious attitude • Fixed false beliefs (delusions) • Visual or auditory hallucinations • Deterioration of personal care

14. Example of Thought Disorder

15. Eating Disorders • Significant weight loss, extreme thinness • Vomiting • Binging • Excessive concern with food or dieting • Excessive need to be thin • Excessive exercise • Food restriction • Other students’ concerns

16. Manic Behavior • Loud, rapid speech • Flight of ideas, pressured speech • Argumentative, irritable • Rapid mood swings, intense moods • Excessive energy; can‘t stay still • Little sleep • Excessive spending or other risky or indulgent behaviors (including sex) • Extreme over-confidence

17. Example of Manic Episode

18. Substance Abuse • Signs of intoxication/ repeated intoxication • Change in sleeping and/or eating • Missing classes • Hung over • Dilated pupils, blood shot eyes • Pressuring peers to use • Money problems • Not fulfilling role/responsibilities • Denial of the problem

19. Suicidality

20. Recognizing Possible Signs of Suicide • Verbal threats or talk about killing oneself • Talk about or looking for ways to procure weapons or other means of suicide; Collecting Pills • Writing about death, dying, or suicide when this is out of the ordinary • Giving things away • Self-cutting/Self-harm • If in doubt, consult! Follow your chain of command

21. General Ways To Help with Extreme Behavior • Respond Immediately -Tell the person you’re there to help • Ask the student if there is someone you may call to provide help or support • Escort them to UC CAPS or call us for a consultation • If UC CAPS is closed, or if the risk is imminent, talk to the student about going to the hospital • Call UC Public Safety (513-556-1111) if you are concerned about immediate safety or for transport to the hospital • If in doubt, consult! Follow your chain of command

22. Making Effective Referrals How to make referrals and talk with students about referrals

23. Helping Skills Before you initiate contact • Plan for your conversation with student in person • Think about open-ended questions • Have referral sources in mind • Remember to stay calm

24. Core Helping Skills • As you engage the student: • Undivided attention • Put phones on silent • Consider physical communication • Good eye contact, open body language, respect personal space, friendly face • Show empathy and care • Tone and rate of speech • Label emotions observed • Non-judgmental stance → normalize student experience

25. Core Helping Skills • Use “listening skills” • Active listening • Paraphrasing and reflecting • Use the words/labels the student uses • Most Important! • Understand your scope of practice and limitations • Recognize/set limits and refer

26. Distressed Student Response • “See Something” • “Say Something” • “Do Something” • Source: Adapted & Modified from the University of California, Santa Barbara, Counseling & Psychological Services (CAPS)

27. When Unsure Always Consult • What to expect: • Support, information, and guidance • Clarification of the problem • Clarification of your role • Problem-solving • Formulating a response • Possible on-going assistance • Confidentiality

28. When To Refer to UC CAPS • Developmental problems or concerns • Adjustment problems • Relationship problems • Trauma or violence • Stalking or harassment • Depression or anxiety • Mood problems • Thought problems • Substance abuse • Social service needs • Risk of harm to self or others

29. How To Discuss Referrals • “I know you’re feeling really bad and can’t see a solution right now, but help is available. You can talk to a counselor at Counseling and Psychological Services. They can help you figure out what you can do to make things better and give you support. I can give you their phone number.”

30. Other things to keep in mind • Normalize the need to get help • Call with the student while they are in your office—with permission • Offer to let the student use your phone or walk them over • Ask them to follow up with you • Think about and discuss how involved you will be in their use of services at UC CAPS

31. Responding to a Spectrum of Student Behaviors Identifying and Handling Disruptive, Threatening, & High Risk Behaviors

32. Disruptive Behaviors • Disruptive students interfere in UC’s learning environment with behavior that is: • reckless, disorderly, paranoid, aggressive, defiant, destructive, threatening, dangerous to self or dangerous to others

33. Examples of Disruptive Behavior • Refusal to comply with faulty/staff direction • Challenges to authority • Behavior that distracts the class from the subject matter or discussion • Loud, distracting or erratic behavior inappropriate to the setting • Answering cellular phones or allowing them to ring in class • Overt hostility, defiance, insults • Computer and Social Media Acknowledgement to Kyle Linnemann, Compass Counseling Center, UC Clermont

34. Examples of Disruptive Behavior (Cont.) • Verbal or physical threats to self or other • Verbal assault or abuse (cursing or foul language) • Sexually explicit language or behavior • Physical intimidation • Excessive e-mail, phone calls or demands for attention outside of class

35. Classroom Situation Consider this situation at Florida Atlantic University (FAU): http://www.youtube.com/watch?v=lxjlk6Lv4jg • What behaviors do you see? • What are some realistic options for the teacher? • How do you address the impact of this (or any similar) behavior on other class members, during & after the incident?

36. Responses To UC Students Who Are Distress or Disruptive Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 (With Effect On Aug. 25, 2014) Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 (With Effect On Aug. 25, 2014) Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 (With Effect On Aug. 25, 2014) Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 (With Effect On Aug. 25, 2014) Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 (With Effect On Aug. 25, 2014) Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 (With Effect On Aug. 25, 2014) Is there danger to self or others? YES, or student No or not sure but I No, but student is Needs immediate am concernedhaving academic or attention personal issues Call 911 Call CAPS @ (513) 556-0648 Refer student to an appropriate campus resource After speaking with police: CAPS 24/7 Helpline Call CAPS @ (513) 556-0648 @ (513) 556-0648 Source: Adapted & Modified from University of California Santa Barbara, CAPS

37. Other Campus Resources • Women’s Center • LGBTQ office • Campus Ministry • Disability Services Office • University Health Services • Student Wellness Center • International Students Services • African American Cultural and Resource Center • Academic Excellence and Support Services • Center for Exploratory Studies • Career Development Center • Veterans One Stop Center

38. Counseling & Psychological Services (CAPS) CAPS Services

39. UC CAPS Services: • Confidential counseling for UC students – individual, group, psychiatric services • Brief Screening and Consultation for UC students • Emergent Care services during business hours • 24/7 Helpline • Consultation with faculty, staff, family, and friends concerned about a student • Workshops and presentations – stress management, communication, relationships and balancing demands, mindfulness and other life-enhancing topics • On-line mental health screenings • http://www.uc.edu/counseling.html

40. Use our website to prepare www.uc.edu/counseling Faculty, staff, family, friends for more advice on how to help students

41. UC Counseling and Psychological ServicesUC CAPS 225 Calhoun Street, Ste. 200 Ph: 513-556-0648 Cincinnati, OH 45219 Go online: www.uc.edu/counseling Entrance To CAPS: Between Rue 21 & Body Central

42. Additional Questions, Comments, or Thoughts?