INNOVATION WITH FIDELITY:

Transcription

1 INNOVATION WITH FIDELITY: Integrating Mental Health Screening into BASICS Share your thoughts, ideas and questions: #NASPAStrategies18 1. Go to srs.campuslabs.com 2. Create a user name 3. Connect ID: 15197

2 LEARNING OUTCOMES Explain rationale and protocol for incorporating mental health (MH) screening into the BASICS intervention, from the perspective of two different campuses Describe the benefits and challenges of incorporating MH screening into BASICS Explore preliminary connections between PHQ-9 score, substance use, and other indicators of BASICS effectiveness

3 #AudienceParticipation Step 1: Step 2: Go to srs.campuslabs.com Create a user name Step 3: Connect ID= 15197

4 #AudienceParticipation In what functional area do you work at your institution? a) Alcohol & Drug Programs (including BASICS) b) Health / Mental Health Services c) Administration / Dean / Student Affairs d) Student Conduct / Judicial Programs e) Something else (IPV, Health Promotion, faculty ) 1. Go to srs.campuslabs.com 2. Create a user name 3. Connect ID: 15197

5 Public flagship university Located in Columbia, SC (2015 pop: 133,979) 2016 enrollment: 25,556 undergrad 8,543 graduate Southeastern Conference (SEC) Football, Fraternities, Five Points Private university Located in New York City, NY (2015 pop: 1.645m) 2016 enrollment: Ivy League Conference Resident Halls, FSL 8,712 undergrad 22,605 graduate

6 SOUTH CAROLINA Housed within Department of Student Life Assistant Director + 4 MSW graduate students Approximately 300 students per year 92% mandated referrals from Student Conduct: 42% Hospitalization 26% Marijuana 19% Alcohol 13% Dual 59% Male 90% White 42% Greek-affiliated 27% Business majors 59% First-year 25% Sophomore 14% Junior/Senior

7 COLUMBIA Housed within Alice! Health Promotion, a unit of Columbia Health Health Promotion Specialist + 1 graduate student provider Approximately 100 students per year 89% mandatory referral from Residential Life or Student Conduct and Community Standards: 84% Alcohol 11% Marijuana 4% Other (usually dual) 97% Undergraduate 3% Graduate 50% First-year Majority identify as male

8 #AudienceParticipation How does your institution s BASICS program screen for mental health concerns? a) We use a standardized screening tool (i.e. PHQ-9, GAD-7) b) We screen, but without the use of a standardized tool. c) We don t currently screen for mental health concerns. d) My institution doesn t have a BASICS program. e) I don t know. 1. Go to srs.campuslabs.com 2. Create a user name 3. Connect ID: 15197

9 RESEARCH-INFORMED RATIONALE More than 7% of young adults (18-25) report suicide ideation, the highest of any age group. Alcohol use is both a distal and proximal risk factor for suicide. Alcohol use precipitates death by suicide more often in year olds. Students with symptoms of alcohol use disorder report suicide ideation more often, especially when controlling for other symptoms of depression. Students who report poor sleep quality and coping motives for alcohol use experienced more alcohol-related consequences than students with other motives. Regular cannabis use in adolescence approximately doubles the risk of suicide attempt, with a dose-response relationship. Rossom et al., 2017 Lamis et al., 2016 Lamis et al., 2016 Kenney et al., 2014 Hall, 2015

10 PRACTICE-INFORMED RATIONALE 1. High-risk substance use MH concerns (including SI) 2. Need to identify at-risk students & connect them with services 3. Increase students ability to recognize unhealthy patterns 4. Increase staff ability to identify underlying causes of use 5. Students report poly drug use, even when original referral is for alcohol 6. Professional responsibility to the holistic needs of students

11 HOW WE BROUGHT IT HOME SOUTH CAROLINA Ongoing dialogue with AD of Mental Health Initiatives Health center began use of PHQ-9 in primary care Believed it would strengthen relationships with campus partners (with hesitation) They believed they could, so they did. COLUMBIA UNIVERSITY Research indicates a correlation between substance use and mental health concerns Developing BASICS Feedback system, chose to add in PHQ-9 Work with CPS to develop a protocol for high-risk students Created a new entry point to mental health services for high-risk students

12 PROTOCOL SOUTH CAROLINA Students complete PHQ-9 upon arrival to each of 3 appointments Coach reviews prior to starting session Discussion varies, based on responses Referral: 10-14: stress assessment, soft referral to counseling 15+: mandatory referral to counseling COLUMBIA UNIVERSITY Students complete PHQ-9 before their 2nd appointment An alert is sent to administrator & provider if score is high, so follow-up can occur immediately; Referrer may also be contacted Provider reviews responses during their second appointment Student referred to CPS if deemed appropriate

13 South Carolina: PHQ-9 Paper Form

14 Columbia: Mental Health in BASICS Feedback

15 #AudienceParticipation Do you feel comfortable responding to a high score on a mental health screening tool (like PHQ-9)? a) Yes, because of my training/education b) Yes, because we have protocol c) Eh d) No, but now I m thinking I should be. e) Nope, that s not really my job. 1. Go to srs.campuslabs.com 2. Create a user name 3. Connect ID: 15197

16 OUTCOMES 1. Builds credibility with campus partners 2. Improve staff clinical skills 3. Additional entry point to mental health services 4. Provides clear protocol for high-risk students 5. Enhances conversations with students 6. Normalize conversations about MH 7. More data!

17 #AudienceParticipation Based on what you ve heard, would you want to implement a similar process at your institution? a) Yes, and I m confident I could make it happen. b) Yes, but I don t know if I have the support/resources to make it happen. c) We have a screening process in place, but maybe we ll tweak it. d) Maybe? e) No. It doesn t fit our model, isn t worth the time 1. Go to srs.campuslabs.com 2. Create a user name 3. Connect ID: 15197

18 CHALLENGES & LIMITATIONS Self-reported data Data management Refining the process Survey fatigue All zeros responses Mandatory referrals not an option Low N makes data analysis difficult

19 DATA: SOUTH CAROLINA SESSION 1: n = 256 Average = 2.87 Range = 23 SESSION 2: n = 233 Average = 1.95 Range = 18 SESSION 3: n = 234 Average = 1.58 Range= 25 ALL ZEROs REMOVED SESSION 1: n = 211 Average = 3.48 SESSION 2: n = 188 Average = 2.41 SESSION 3: n = 191 Average = 1.94 Difference in PHQ-9 score by reported alcohol use = not statistically significant

20 DATA: SOUTH CAROLINA PHQ*AUDIT N= 94 r = 0.29 p =.0044

21 DATA: COLUMBIA Majority of students do not score high on PHQ-9, making data analysis a challenge Of those students who have required a referral to Counseling & Psychological Services, they are often consuming more alcohol or marijuana than their peers

22 QUESTIONS? Aimee Hourigan: Brooke Chehoski: Alicia Czachowski:

23 DiFulvio, G. T., Linowski, S. A., Mazziotti, J. S., & Puleo, E. (2012). Effectiveness of the Brief Alcohol and Screening Intervention for College Students (BASICS) program with a mandated population. Journal of American College Health, 60(4), doi: / Hall, W. (2015). What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? Addiction, 110(1), doi: /add Kenney, S. R., Paves, A. P., Grimaldi, E. M., & LaBrie, J. W. (2014). Sleep quality and alcohol risk in college students: Examining the moderating effects of drinking motives. Journal of American College Health, 62(5), doi: / Lamis, D. A., Ballard, E. D., May, A. M., & Dvorak, R. D. (2016). Depressive symptoms and suicidal ideation in college students: The mediating and moderating roles of hopelessness, alcohol problems, and social supports. Journal of Clinical Psychology, 72(9), doi: /jclp Larimer, M. E., & Cronce, J. M. (2007). Identification, prevention, and treatment revisited: Individual-focused college drinking prevention strategies Addictive Behaviors, 32(11), doi: /j.addbeh Larimer, M. E., & Cronce, J. M. (2011). Individual-focused approaches to the prevention of college student drinking. Alcohol Research & Health, 34(2), Rossom, R. C., Coleman, K. J., Ahmedani, B. K., Beck, A., Johnson, E., Oliver, M., & Simon, G. E. (2017). Suicidal ideation reported on the PHQ9 and risk of suicidal behavior across age groups. Journal of Affective Disorders, 215(1), doi: /j.jad Simon, G., Rutter, C., Peterson, D., Oliver, M., Whiteside, U., Operskalski, B., & Ludman, E. (2013). Does response on the PHQ-9 depression questionnaire predict subsequent suicide attempt or suicide death. Psychiatric Services, 64(12), doi: /appi.ps