Supported Higher education: Research Translation & Innovations

1. Supported Higher education:Research Translation & Innovations Rhode Island Governors Commission on Disabilities, Providence, R.I. --- October 19, 2011 Funded by the National Institute on Disability and Rehabilitation Research, Grant # (H133A050006). Innovative Knowledge Dissemination & Utilization Project for Disability & Stakeholder Organizations

2. Pat Deegan on Recovery • Recovery is a way of life, an attitude, a way of approaching life’s challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup, start again…The need is to meet the challenge of the disability to reestablish a new and valued sense of integrity and purpose within and beyond the limits of the disability.(Deegan, 1988, p. 15). • http://www.youtube.com/watch?v=DVlhfuKDjYE

3. Presenters…From Boston University, Center for Psychiatric Rehabilitation Joan Rapp, Rehabilitation Training Specialist Rob Denney, Job Development Specialist

4. OUTLINE • Who are the Students? • Key Elements & Services • Challenges for Students in Higher Education • Systematic Review of the Research • BU Innovation Example • Higher Education Toolkit • Q. & A.

5. Who are the Students? Those with major psychiatric illnesses such as psychotic disorders (schizophrenia, psychotic depression, bipolar disorder) Those with significant mood disorders (depression, anxiety) And other psychiatric disorders that interfere with one’s ability to perform valued roles.

6. Who are the Students? • -They may come to college/university with a psychiatric illness (known or unknown) • -They may develop a psychiatric illness after being in school for a while • -Early intervention makes a huge difference in the outcomes

7. Definition “Supported Education … provides supports & other assistance for persons with psychiatric disabilities for access, enrollment, retention and success in postsecondary education.” (Collins & Mowbray, 2005)

8. Models & Services: The Flowers • Classroom Model students attend closed classes on campus designed for the purpose of providing supported ed. • On Campus (On Site) Model sponsored by a college and provides support for an individual rather than group • Mobile Support Model provides services through a mental health agency helping students to attend the school of their choice • Free Standing Model located at the sponsoring agency such as a rehabilitation agency, a university or other entity. (Collins & Mowbray, 2005)

9. An Array of Services • Use staff with specialized training • Include career & vocational direction • Help with financial aid; • Help with coping skills for academic environment • On campus info re: rights and resources; • Mentor with authentic relationship & personal support • Help with course access and completion • Access to tutoring & other academic support; • Access to good (current) general support & referrals. • Be available when it is not convenient.

10. CHALLENGES FOR STUDENTS • Low self esteem • Social skills problems • Personal & family issues • Memory and concentration • Conflicts with faculty (Collins & Mowbray, 2005) • Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.  Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

11. CHALLENGES FOR STUDENTS • Getting accommodations and supports • Coping with school • Attendance & participation • Specific disability issues including medication • General anxiety & test anxiety • Expectations & pressure: internal & external • Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.  Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

12. So What Works? • We have lots of clinical and anecdotal “evidence”… • We have counted the programs… • We have described the models and methods in a book and journal articles…. • We have adapted and innovated and won some awards… • We have developed manuals and tool kits… But how well have we actually measured it so we know what works? What is essential? What do we replicate? What to avoid? Let’s discuss the research…..

13. RESULTS OF RESEARCH ANALYZED “Suggestive of Change” • In uncontrolled evaluations participants improved in their level of employment and educational status as a result of participation in a supported education intervention (Unger et al., 1991; Hoffman & Mastrianni, 1993; Unger et al., 2000; Unger & Pardee, 2002; Best et al., 2008; Cook & Solomon, 1993). • Individuals who remain engaged in supported education are able to complete courses and achieve a satisfactory grade point average (Unger et al., 2000; Unger & Pardee, 2002; Cook & Solomon, 1993; Best et al., 2008); the strength of this evidence is weak due to the poor research designs used. • A supported education intervention (classroom model) was more effective than a control group in improving empowerment and school efficacy (Collins et al., 1998). Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.   Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

14. RESULTS OF RESEARCH ANALYZED • Satisfaction with supported education was significantly higher among those in a group supported education intervention when compared to a control group (Collins et al., 1998). • In terms of goal specificity, being in a supported education intervention lead to setting more specific and optimal goals (Collins et al., 1998) • Supported education is a viable intervention for many to meet their goals for educational advancement, personal development, and better jobs (Mowbray et al., 1996) • But strong research support regarding hard outcomes e.g. employment…was not there Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.   Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

15. The risk

16. SOME BARRIERS TO GETTING SUPPORT FOR EDUCATIONAL GOALS • Fear of disclosure • Lack of knowledge of what is available • Lack of knowledge re: Disability Support Services eligibility • Fear of stigma • Lack of real supported education interventions • School policies related to outreach and services: Silos of service • Lack of an environment that is welcoming and supportive for students with psychiatric disabilities (Collins & Mowbray, 2008) )

17. IMPORTANCE OF PROMOTING NEW RESEARCH IN SUPPORTED EDUCATION • High unemployment rates among those with psychiatric disabilities: Education = Hope • Difficulty “graduating” from benefits to full time work without training and education; • Knowledge from Supported Housing and Supported Employment shows the value of the right supports in effecting outcomes Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.   Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

18. VALUE OF PROMOTING NEW RESEARCH IN SUPPORTED EDUCATION • Limitations of the existing research in methodology; • Need to evaluate the current / common, individually based Supported Education interventions. Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.   Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

19. Where We Are • Rehabilitation and Recovery? • A Classroom or a Computer Screen? • Suicide Prevention • Measure the Progress • Track the Process • Hope & Resilience • Connections you can count on • Authentic Relationships

20. Education is key factor By far the most important factor affecting participation and level of activity [in employment] is the amount of education completed. We cannot ascertain convincingly whether and to what extent educational preparedness precedes [mental] illness and the extent to which it is confounded with the seriousness and complexity of the illness. However, to the extent that educational preparation independent of illness predicts employment success, it could usefully direct effort in early treatment and in encouraging and facilitating return to school and completion of as much schooling as is feasible (David Mechanic, 2003, p.1232).

21. An Emerging Best Practice • Supported Education is an emerging best practice • Not there yet…. • Sally Rogers KDU Project (NIDRR) • UMNDJ RCT in SEd with Temple University RRTC in Community Integration (NIDRR) • Fidelity Measures: University of Kansas (Diane McDermid) • SAMHSA Tool Kit: (Karen Unger)

22. A Dynamic Duo Recovery Orientation + Supported Higher Education can = success but only if there is a deep appreciation for the lived experience of psychiatric illness and recovery.

23. Early Intervention The concept of early intervention puts the onus on primary care and other community services to make themselves accessible, non-stigmatizing and relevant to young people, whether they are dealing with a mild and self limiting depression or a major psychosis. ~David Shierer, Joint Director of the National Development Network for Early Intervention, (NIMH for England)

24. Promise of Early Intervention Teach valuable survival skills (recognition and coping) • Provide for integrated treatment and support (medical, emotional, cognitive, academic & social) • Improve chance for success in school • Increase Retention & Reduce Drop Out • Preserve valued Roles and Scripts • Stop “careers” as patients

25. Active Minds • http://www.youtube.com/watch?v=inB91LwyXxI • Alison Malmon-Changing the conversation about mental health (Part 1) • http://www.youtube.com/watch?v=SMNswwfSdas • http://www.youtube.com/watch?v=QkdwxVvxKgY

26. Is it worth the risk? You will come to a place where the streets are not marked. Some windows are lighted. But mostly they’re darked. A place you could sprain both your elbow and chin! Do you dare to stay out? Do you dare to go in? How much can you lose? How much can you win? Dr. Suess

27. Supported Education atBoston University

28. Our History • Est. in 1984 with the Career Education Program that taught people from the community to choose, get and keep work in a supported educational environment. • Valued role of “Student” , emphasis on doing “what it takes” to help people function successfully • 26 years of psychiatric rehabilitation services an educational environment. • Service Division serves as a pilot environment for research and training.

29. Our Foundations • Non-negotiable values drive our service delivery: hope, choice, self-determination, and growth. • Theories of Change • Health promotion and prevention

30. Our Educational Services focus: Resiliency and Growth • Active, respectful, integrated services that promote healing and functional health through shared decision making with students and significant others-including University personnel and parents. • Rehabilitation that promotes role success as a student. • Case Management that supports students to live well on campus. • Authentic relationships

31. Services We Provide: • College Mental Health Coaching Service • Campus Suicide Prevention Initiative • Clinical Internship Site

32. Student Mental Health • Suicide is the second leading cause of death in college students • Nationally, approximately 45% of college students report significant mental health distress • 67% turn to their peers FIRST. • Use of behavioral medicine services at BU has increased 250% in the last 5 years-more and more students coming to college with mental health diagnoses as well as those who develop mental illnesses in college.

33. College Suicide Prevention at BU • Boston University Suicide Prevention Grant (SAMHSA) • *Mental Health Round Table, website development, de-siloing of campus services charged with student mental health and wellbeing • *Active Minds Chapter-Post Secret Project, Awards • *Student Support Network Training; • ★Webinars, Screenings, parent ENews

34. BU SECRET: RAISING AWARENESS http://www.youtube.com/watch?v=bbX2siSMSkA

35. Student Voices • www.bu.edu/mentalhealth

36. Student Support Network Training • Training students to be empathetic listeners, excellent referrers to resources on campus. • Marketing it as leadership training. • Targeting Athletes, LGBTQ, international students, minority students and Greek life • Specialty trainings for ROTC cadets, residential advisors, faculty and staff • Trained over 500 people to date • SSN is an evidenced based curriculum • Motto-”tell someone, BU listens”

37. NO ORDINARY DOOR This might look like an ordinary door, but it is the door to the B.U. Recovery Center. The Center helped open and maintain my road to recovery. The many skills I have learned and been coached on at the Recovery Center are computer knowledge, communication skills, nutrition, and most importantly self-respect and confidence. The center deals with the whole person not just the mental illness. The support I receive here has been a critical aspect in my recovery process. I am leading my life because I walked through this door.

38. Higher Ed Support Toolkit The Toolkit is a resource to : Identify common difficulties experienced by students Assess student difficulties in adjusting and managing classroom and campus life Consider strategies and/or accommodations to help students Identify campus resources that are available to assist students at your institution

39. Higher Ed Support Toolkit The Toolkit is organized to help students access knowledge about mental illnesses and resources on their campus. Components include: Student Self-Assessments Forms Getting Connected to Campus Resources Actions and Accommodations in the Classroom Introduction Background and Additional Resources

40. It must be borne in mind that the tragedy of life doesn’t lie in not reaching your goal. The tragedy lies in having no goal to reach. -Benjamin E. Mayes

41. References & Resources • Collins, M.E., & Mowbray, C.T. (2005). Higher education and psychiatric disabilities: National survey of campus disability services. American Journal of Orthopsychiatry, 75(2), 304-315. • Collins, M.E., & Mowbray, C.T. (2008). Students with psychiatric disabilities on campus: Examining predictors of enrollment with disability support services. Journal of Postsecondary Education and Disability, 21(2), 91-104. • Mowbray, C.T., Brown, K.S., Furlong-Norman, K., & Soydan, A.S. (Eds.). (2002). Supported education and psychiatric rehabilitation: Models and Methods. Linthicum, MD: International Association of Psychosocial Rehabilitation Services. • Unger, L.V., Anthony, W.A., Sciarappa, K., & Rogers, E.S. (1991). A supported education program for young adults with long-term mental illness. Hospital and Community Psychiatry, 42(8), 838-842. • American College Health Association (2010). National College Health Assessment. Retrieved on May 13, 2011 from http://www.achancha.org/reports_ACHA-NCHAII.html

42. Websites • Rogers, E.S., Farkas, M.D., Anthony, W.A., & Kash-MacDonald, M. (2009). Systematic Review of Supported Education Literature 1989-2009. Boston, MA: Boston University Center for Psychiatric Rehabilitation. Retrieved on May 13, 2011, from DRRK disability research website at http://drrk.bu.edu/research-syntheses/psychiatric-disabilities/supported-education • Higher Education Toolkit. Retrieved on May 13, 2011 from BU Center for Psychiatric Rehabilitation website at www.bu.edu/cpr/resources/supportstudents/index.html • Center for Psychiatric Rehabilitation Website. Reasonable Accommodations for People with Psychiatric Disabilities. Retrieved on May 13, 2011 from http://www.bu.edu/cpr/reasaccom

43. Contact Information Anne Sullivan Soydan -- Pioneer in developing supported education & Teaches at BU Sargent College of Health and Rehabilitation Sciences apsoydan@bu.edu E. Sally Rogers – Head of research team that conducted analyses & Director of Research erogers@bu.edu Dori Hutchinson –Director of Recovery Services & College Suicide Prevention Program dorih@bu.edu Kathleen Furlong-Norman –Editor of the Psych Rehab Journal and author of Toolkit on Supported Education kfurlong@bu.edu Joan Rapp – Coordinator of Training joanrapp@bu.edu Rob Denney – Job Placement Specialist denneyr@bu.edu

44. Our Sponsors • National Institute on Disability and Rehabilitation Research • Substance Abuse and Mental Health Services Administration: Center for Mental Health Services • Other private sponsors also Contribute to Recovery Services