Stayin ’ Alive:

1. Stayin’ Alive: Campus Health’s Take on Student Retention and Beyond

2. Why stayin’ alive? • Students come here to earn a degree, learn skills and grow for the future • Many variables must align to make that possible: • Need to understand various sides of the retention issue in order to understand retention • Focus and concentrate • Attend classes regularly • Think critically • Complete work on time • Organize and process information

3. Overview of Presentation • Overview of Campus Health - services offered • Student health and wellness needs • CHS’ contribution to student retention • Challenges to measuring retention • Data overview and what we see on the ground • A deeper look at retention, health and mental health issues

4. What do we offer our students at CHS ?

5. Campus Health Service is… • Medical Services, Counseling and Psych Services, Oasis Program Against Sexual Assault and Relationship Violence and Health Promotion and Preventive Services • Integration of services on several fronts

6. Health Services • Full service outpatient medical clinic • See a range of patients, from very mild to more severe (case example) • Staffed by licensed medical practitioners • Students seen by appointment and walk-in • On site X-ray, laboratory • Full service pharmacy • After hours phone line

7. General Medicine (cont’d) • Urgent Care • Women’s Health • Sports Medicine • Physical Therapy • Acupuncture • Massage Therapy • Immunization & Travel Clinic

8. Counseling and Psych Services (CAPS) • Treatment of depression, anxiety, eating & body image issues, substance abuse, sleep issues, grief, trauma, family & other relationship issues, ADHD management, etc.) • Staffed by licensed mental health practitioners • Same-day walk-in Triage • Solution focused counseling for individuals and couples • Psychiatric services • Support groups and other psychoeducational groups

9. Counseling and Psych Services (CAPS) cont’d • Consultation with faculty, staff, families and friends about students of concern • Education and training around college mental health issues • Suicide prevention • Risk assessment, mental health screenings • Assistance with developing coping skills and strategies (case example)

10. Oasis Program Against Sexual Assault & Relationship Violence • Team staffed by licensed Psychologist and violence prevention specialist • Counseling for individuals impacted by: • Sexual Assault • Relationship Violence • Stalking • Consultation • Education and Outreach • Community advocacy and decision making

11. Health Promotion and Preventive Services • Alcohol & other drug awareness and counseling (case example) • Sexual health • Nutrition and fitness • Stress management • Violence prevention and bystander intervention • Body issues • Suicide prevention

12. Some HPPS programs • Brief Alcohol Screening and Intervention for College Students (BASICS) • The Buzz • Student Health Alcohol and Drug Education (SHADE) • Step Up! Bystander intervention program • Question, Persuade, Refer suicide prevention training • Individual consultation and referral for alcohol and other drug issues and nutrition

13. How do the services at CHS relate to retention? Family concerns Attention/ concentration Substance use Identity Issues Physical Illness Students’ ability to succeed in college Sleep Depression Anxiety Grief Chronic pain Relationship conflict Eating disorders Intrusive thoughts

14. It’s hard to succeed academically if… • Too impacted by personal issues to complete coursework • Mental or physical illness interferes with cognitive skills or energy levels

15. retention and the role of campus health service

16. What do we know about student retention? • Reasons for leaving are varied – from finding another school to dealing with personal issues (Rummel, 1999) • The needs of students and our ability to meet them is related to retention • “Institutional efforts to ensure a healthy campus environment can have an impact on student success and potentially affect retention.” (NASPA, 2004)

17. ACHA top impediments to academic performance

18. Mental health of UA students* • 27% said depression or anxiety made it difficult to work, study, or go to class • 51% experience more than average stress • 6.6%have seriously considered suicide in the last year • 19% had experienced violence in last 3 months • 10% have been diagnosed with depression, and 11% have been diagnosed with anxiety *2012 Health and Wellness Survey, n=2,406

19. Concerns presented at CAPS Triage Top 10 concerns presented (n=1,974) 31% Isolation/withdrawal 30% Impaired concentration 30% Mood swings 28%Low self-esteem 24% Romantic relationship issues 70%Anxiety/Panic 63% Depression/sadness 44% Sleep problems 40% Low energy 36% Academic concerns

20. Intuitively, we know that wellness has an effect on retention. But what are some challenges to measuring student retention?

21. Measurement challenges • Causal link between support services and retention is hard to quantify • Students themselves may not realize impact of a problem (or its solution) on remaining in school • Multiple, complex factors at play • Multiple and varied support services to support struggling students can be synergistic

22. Measurement challenges (cont’d) • Unique challenges for CHS: • Confidentiality and data collection • Broad reaching services may support students in subtle ways • Can’t measure how a crisis averted (prevention) affects retention • All data presented here is self report

23. Health services and retention • There is very little research about the link between physical health and retention • Aitkin (1982) found that number of sick days was significantly associated with GPA • Findings from a Rutgers disease prevention program found a correlation between use of health services and GPA, retention and classroom attendance (Conciatore, 1991) • Can hypothesize that: • Illness (including chronic and severe episodes) may have a negative impact on academic performance • Health services which assist the student with these issues may positively impact retention (Case Examples)

24. 49% of UA students indicated that using CHS helped them remain a student* - equivalent to 1,178 students in sample *2012 Health and Wellness Survey – n=2,406

26. Counseling services and retention • 63% of counseling centers nationally asked students about retention • 56% indicated that counseling helped them remain a student and 61% said it helped their academic performance (AUCCCD, 2011) • Range of severity in patients, but either end may have an impact on retention (suicidality vs. grief – case examples) • Substantial literature to support Counseling advantage: • Iowa state – 14% retention advantage against control group • University of Western Illinois – followed freshman for 2 years and found 70% retention rate in counseling group vs. 68% in general student population

27. Mental health and retention • Depression, anxiety, and eating disorders are linked with lower GPA and higher risk of dropping out (Eisenberg, Golberstein and Hunt, 2009) • In one study, 1/5 students attending counseling were considering dropping out (Turner and Berry, 2000) • Socio-emotional adjustment problems are better predictors of retention than academic difficulties (Bray, Braxton and Sullivan, 1999)

28. CAPS Triage users Students surveyed after triage appointments between Feb-March 2012 (n=71) indicated that their visit to caps:

29. CAPS patient satisfaction survey 2012 • Collected April 2-12, 2012 • Administered to students after their counseling appointment • N=246 (20 triage only and 226 returning students) • Sessions at CAPS • 29% 1-3 sessions • 13% 4-5 sessions • 51% more than 5 sessions

30. CAPS patient satisfaction survey (cont’d)

31. CAPS patient satisfaction survey (cont’d)

32. …And Beyond the data:Looking deeper at college health services and retention

33. Stayin’ alive • Retention cannot be the sole focus of the CHS mission (case example) • Sometimes, we must recognize the greater need to withdraw, for reasons of health and safety • …and some get help too late • Temporary separation does not always equal failure to complete college • Direct service to students with health and mental health issues may position others in student affairs to assist students with retention in other ways

34. Retention challenges for today’s students • Students may be more difficult to retain if they have: • Reduced tolerance for discomfort and unwanted feelings • Belief in immediacy of solutions • Delay in self-responsibility • Increase prevalence of bipolar disorder due to widespread use of ADMS in undiagnosed bipolar • Increase in severity and multiplicity of symptoms • Treatment making college a possibility for those with marginal skills and coping (greater use of medications)

35. Remaining questions • How can we better examine the causal link between CHS services and retention? (measurement difficulties) • How do different types of services impact retention differently? • What is the relationship between severity of presenting problem and retention? (Achter, 2008) • For CAPS, how is number of visits related to retention?

36. Next steps in data collection • Looking at more creative ways to collect retention data • Where can we incorporate into evaluation? Support groups, educational outreach, diversion programs, etc. • How can we work with other departments? • How can we measure actual retention among those using our services, as opposed to only self report? (many complications!)

37. Summary • Retention is a complex variable • Hard to define causal relationships definitively • Hard to get hard evidence for the specific role of any single intervention • Health and mental health issues clearly impact a student’s ability to succeed and possibly remain in college You have to be alive and functional to be retained!

38. Questions/DiscussioN?

39. Contact Information(520)Main phone number: 621-6490Appointments: 621-9202Triage nurse: 621-6493CAPS:621-3334After Hours: 570-7898Administration: 621-6489Insurance: 621-5002