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Psychological Services - Vol 14, Iss 4

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Psychological Services Psychological Services is an American Psychological Association Division publication. The official publication of the Division of Psychologists in Public Service (Division 18), Psychological Services publishes high-quality data-based articles on the broad range of psychological services. While the Division’s focus is on psychologists in "public service," usually defined as being employed by a governmental agency, Psychological Services covers the full range of psychological services provided in any service delivery setting.
Copyright 2017 American Psychological Association
  • College counseling services: Meeting today’s demands.
    This article is an introduction to the special issue of Psychological Services highlighting college counseling services as integral agents in public service delivery. The editors hope that readers across varied environments will enjoy learning of samples of the creative work being implemented across counseling centers to the benefit of all those who are served in public service settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Are we in crisis? National mental health and treatment trends in college counseling centers.
    The current state of college student mental health is frequently labeled a “crisis,” as the demand for services and severity of symptomatology have appeared to increase in recent decades. Nationally representative findings are presented from the Center for Collegiate Mental Health, a practice research network based in the United States, composed of more than 340 university and college counseling centers, in an effort to illuminate trends in symptom severity and patterns in treatment utilization for the campus treatment seeking population. Clinical data collected over 5 academic years (2010–2015) showed small but significantly increasing trends for self-reported distress in generalized anxiety, depression, social anxiety, family distress, and academic distress, with the largest effect sizes observed for generalized anxiety, depression, and social anxiety. On the other hand, a significantly decreasing trend was observed for substance use. No significant changes were observed for eating concerns and hostility. Utilization data over 6 years indicated a gradual yet steady increase in the number of students seeking services (beyond the rate expected with increasing institutional enrollment), as well as increases in the number of appointments scheduled and attended, with great variation between centers. Within the context of changing national trends, we conclude that it is advisable to consider the specific needs of local centers to best accommodate distinct student bodies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Presenting concerns in counseling centers: The view from clinicians on the ground.
    Despite growing evidence that a greater number of students are seeking counseling in college and university counseling centers throughout the United States, there is a dearth of empirical information about (a) the presenting concerns for which students seek treatment and (b) how these concerns differ according to client demographic factors. The purpose of this descriptive and exploratory study was to explore how counseling center clinicians categorize client presenting concerns, and how these concerns vary according to client demographics. Given the importance of client suicide within the field of college counseling, the frequency of suicidality as an identified presenting concern was also explored. A sample of 1,308 clinicians from 84 counseling centers rated the presenting concerns of 53,194 clients using the Clinician Index of Client Concerns (CLICC) after an initial consultation. Results of descriptive and nonparametric analyses indicated that the most prevalent concerns were anxiety, depression, stress, family, and academic performance, and that clients who belong to different demographic groups frequently present to counseling with broadly similar types of concerns. Furthermore, suicidality represented an area of concern for 8.4% of all clients, and it ranked 20 of 44 as a clinician-rated concern. Comparable rates emerged across the range of client demographic groups examined, although rates were notably higher for a handful of groups. The findings offer one of the largest and most generalizable descriptions of why college students seek counseling services, as determined by clinicians’ evaluations of presenting concerns. Implications for research and clinical applications of the findings are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Meeting the mental health needs of today’s college student: Reinventing services through Stepped Care 2.0.
    A new stepped care model developed in North America reimagines the original United Kingdom model for the modern university campus environment. It integrates a range of established and emerging online mental health programs systematically along dimensions of treatment intensity and associated student autonomy. Program intensity can be either stepped up or down depending on level of client need. Because monitoring is configured to give both provider and client feedback on progress, the model empowers clients to participate actively in care options, decisions, and delivery. Not only is stepped care designed to be more efficient than traditional counseling services, early observations suggest it improves outcomes and access, including the elimination of service waitlists. This paper describes the new model in detail and outlines implementation experiences at 3 North American universities. While the experiences implementing the model have been positive, there is a need for development of technology that would facilitate more thorough evaluation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Collaboration, confidentiality, and care.
    There is an increasing call to attend to the needs of students in distress (Reynolds, 2013). Furthermore, research has begun to highlight links between distress, risky, or dangerous behaviors as well as issues in mental health in the higher education population (Deasy, Coughlan, Pironom, Jourdan, & Mannix-McNamara, 2014). The National Alliance on Mental Health and the Jed Foundation (National Alliance on Mental Illness & the Jed Foundation, 2016) estimate that about 20% of enrolled college students will face some type of mental illness. As such, the work of mental health professionals, which has been increasing with time, will continue to play a pivotal role on today’s campus (Kitzrow, 2009). Yet mental health in higher education is too pervasive and significant of a topic for counseling and psychological centers to handle by themselves (Joint Task Force in Student Learning, 1998; Mitchell et al., 2012). Therefore, a collaborative approach is warranted as higher education professionals strive to meet the increasing mental health demands of the student population. Case studies amalgamated from housing and residence life professionals are used to gain a greater understanding of how interdepartmental work is carried out without compromising or breaching ethical or legal regulations as set by the Family Educational Rights and Privacy Act, the Health Insurance Portability and Accountability Act, and/or organizational standards like that of the International Association of Counseling Services Inc. (International Association for Counseling Services Inc., 2014) Specifically, the cases demonstrate ways inter- and intradepartmental staffers can work as a team, safeguard private and confidential information, and concurrently create an environment in which care is nurtured. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Outreach as intervention: The evolution of outreach and preventive programming on college campuses.
    It is widely acknowledged that demand for clinical services at university and college counseling centers (CCs) has increased over the last several years. CCs have had to adapt service delivery methods to meet the demand for services. One of the more recent developments in CCs lies in providing primary (preventive) interventions to the campus at-large through outreach and preventive programming. These interventions are aimed toward reducing demand as opposed to promoting services and gathering potential clients. This article describes changes in outreach delivery in 3 ways. First, descriptions of some of the more prevalent and proactive outreach activities are given. Brief explanations concerning the increased emphasis on social justice, large-scale events, campus partnerships, liaison programs, satellite offices–embedded models, uses of electronic and technological advances, postvention and community response, and topic-specific programming are given. Second, the changing administrative functions of those in charge of outreach at individual CCs is described. Last, a description of the establishment and ongoing need for a national organization for outreach administrators and professionals is outlined. Recent survey data completed by outreach professionals are also discussed, as are future directions and implications for how CCs quantify training and direct service activities. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The relationship between students’ counseling center contact and long-term educational outcomes.
    Numerous studies have demonstrated that counseling centers deliver a positive impact on the emotional and social development of college students who receive services. These healthy outcomes, in turn, can lead to increased academic success, such as improved performance, retention, and persistence. While these short-term academic outcomes have been widely investigated, very few studies have explored the relationship between counseling center services and longer-term educational outcomes, such as final grade point average (GPA), time spent at the university, and degree completion. In the current study, counseling center usage, including appointments that were attended, cancelled, and no showed, as well as distal educational variables were examined within 2 cohorts of first-time full-time students over a 6-year period. Findings revealed that both users and nonusers of counseling center services spent a similar amount of time to degree completion and achieved comparable final semester GPAs as well. However, students who utilized counseling services graduated at a significantly lower rate (79.8%) than those who did not use services (86.2%) across the 6-year time span. Post hoc analyses indicated that among students who used counseling services, those who did not graduate scheduled significantly more services than those who graduated, suggesting that students who use the counseling center, and have more chronic and severe mental health problems, may be graduating at a lower rate. Implications are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • University counseling service for improving students’ mental health.
    The main aims of this study were to provide an initial sociodemographic and clinical characterization of university students’ academic and psychological functioning and to investigate and compare the feasibility and clinical utility of psychotherapies (cognitive behavior vs. psychodynamic) delivered at a large University in Northern Italy for improving university students’ mental health, using self and observer-report measures. One hundred forty-9 students (102 women; MAge = 24.55, SD = 3.35) were consecutively interviewed and extensively assessed by independent clinicians of the Service before and after the intervention, using the Clinical Outcomes in Routine Evaluation and the Global Assessment Scale. Patients were enrolled in an individual psychotherapy and allocated to cognitive behavior or psychodynamic approach according to specific criteria. Psychotherapists who were not involved in the assessment phase administered the treatment. The majority of students was female and the most severe conditions emerged among students enrolled in philosophy, arts, and communication and medical schools. At posttreatment, all students improved both in terms of well-being and distress, regardless of the type of psychotherapy received. This improvement emerged both by students’ self-report and clinicians’ evaluations. These findings point to the feasibility and clinical utility of psychotherapy in promoting well-being and reducing young adults’ distress. The importance of university counseling services for promoting students’ mental health, and a positive transition to adulthood is discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Using online interventions to deliver college student mental health resources: Evidence from randomized clinical trials.
    This study evaluated the efficacy of Internet-based stress management programs for college students. This approach is particularly fitting for students owing to a lack of mental health resources on campus and to high levels of Internet use among students. Because a history of interpersonal trauma (IPT) is associated with more distress and poorer academic performance, IPT history was assessed as a moderator of intervention efficacy. Students (N = 365) were randomly assigned to a mindfulness plus present control intervention, a mindfulness only intervention, or a stress management information condition that served as an active comparison. Prior research has supported the efficacy of the mindfulness plus present control intervention (Nguyen-Feng et al., 2015). Outcome measures were self-report measures of stress, anxiety, depression, and perceived stress completed online at preintervention, postintervention, and 2 follow-ups (2–3 weeks and 4–5 weeks postintervention). Linear mixed modeling was used to assess change over time. Participants in all 3 groups reported significant decreases on all primary outcomes. All time-by-intervention group interaction effects were nonsignificant, suggesting that the 3 conditions were equally effective. When examining IPT history as a moderator, the mindfulness plus present control and stress management conditions were both more effective for IPT survivors than the mindfulness only intervention. Results suggested that Internet-based interventions are effective for lowering distress among college students and that specific approaches may be differentially effective for certain subgroups of students. They also suggested that providing students with stress management information without providing training in 1 specific skill may also be helpful. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Stigma, mental health, and counseling service use: A person-centered approach to mental health stigma profiles.
    The current study examined reports of stigma toward mental health services, depressive symptoms, flourishing, and mental health service use among a sample of 8,285 college students across the United States who completed the Healthy Minds Study. The study aimed to: (a) identify profiles of public and personal stigma against mental health service utilization, and (b) examine the demographic predictors of stigma group membership and mental health service utilization. Latent profile analyses revealed 3 distinct groups based on public and self-stigma (i.e., “High Self, High Public Stigma,” “Average Self, High Public Stigma,” and “Low Self, Low Public Stigma”). Subsequent analyses examined demographic characteristics and mental health across the 3 groups. Results indicated significant differences in age, gender, race/ethnicity, mental health, and mental health service use across the 3 groups. Results further showed that students with high perceived need for mental health services, identifying as male or Asian, and belonging to the “High Self, High Public Stigma” group had lower likelihood of seeking mental health services in the past year. Implications for future research and clinical practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • University students’ perceived need for mental health services: A study of variables related to not seeking help.
    This study analyzed data from the 2012 Student Experience in the Research University (SERU) survey, collected from undergraduate students at 9 universities. Researchers explored how demographic and behavioral variables related to avoidance of psychological help when needed. A total of 7,992 SERU participants responded to target items included in the present study. We examined whether student characteristics and behaviors differed between 3 self-report groups: (1) students who indicated they did not need counseling services; (2) students who reported needing counseling services, but not using them; and (3) students who reported using counseling services at least once during the 2012 academic year. Students who reported needing, but not using, counseling services were significantly different from the other 2 groups in that they were more likely to be female, Hispanic, endorse financial difficulties, and work longer hours while attending school. The 3 groups did not differ in understanding others with observable disabilities. Implications for college counselors and student affairs personnel are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The role of personality traits and barriers to mental health treatment seeking among college students.
    Many college students experience a mental health problem yet do not seek treatment from a mental health professional. In the present study, we examined how perceived barriers (stigma perceptions, negative attitudes about treatment, and perceptions of practical barriers), as well as the Big Five personality traits, relate to treatment seeking among college students reporting a current mental health problem. The sample consisted of 261 college students, 115 of which reported experiencing a current problem. Results of a series of logistic regressions revealed that perceived stigma from others (OR = .32), self-stigma (OR = .29), negative attitudes about treatment (OR = .27), and practical barriers (OR = .34) were all associated with a lower likelihood of having sought treatment among students experiencing a problem. Of the five-factor model personality traits, only Neuroticism was associated with a higher likelihood of having sought treatment when experiencing a mental health problem (OR = 2.71). When we considered all significant predictors in a final stepwise conditional model, only self-stigma, practical barriers, and Neuroticism remained significant unique predictors. Implications for addressing barriers to treatment and encouraging treatment seeking among college students are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The role of therapy fears, ethnic identity, and spirituality on access to mental health treatment among Latino college students.
    This study examined the impact of therapy fears, ethnicity identity, and spirituality on the use of mental health service among Latino college students. Participants were 83 Latino college students (78% female) recruited from a university in Central Texas. Analyses of the results indicated that previous mental health services use was negatively correlated with spirituality. Previous use of mental health services was positively correlated with participants’ views that their ethnic community and religious affiliation did not influence their decisions to seek services. Additionally, ethnic identity was positively correlated with spirituality. Furthermore, participants’ views that their ethnic community did not influence their decisions to seek services were correlated with religious affiliation. Therapy fears were positively correlated with participants’ views that their ethnic community and religious affiliation did not influence their decisions to seek services. MANOVA analyses indicated that only spirituality (not therapy fears or ethnic identity) significantly impacted Latino college students’ decisions to seek counseling services. Finally, regression analyses indicated that spiritual meaning and religious affiliation predicts service use. Implications for research and practice in college counseling centers are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Mental health treatment-related stigma and professional help seeking among student veterans.
    Record numbers of military veterans are enrolling at colleges/universities across the United States. Although a substantive subset might suffer from mental health problems, the majority of these students might not be amenable to utilizing services. The purpose of this study was to examine the role of treatment-related stigma in intentions to seek professional help among undergraduate student veterans at a university on the U.S. Gulf Coast. Focusing on 251 veterans and a gender-matched comparison group of 251 nonveterans, student veterans endorsed higher probabilities of seeking care from physicians (d = .77) and psychologists or other professionals (d = .67). In addition, nonveteran students had greater self-stigma about seeking help (d = −.27) but veterans had more negative beliefs about treatment efficacy (d = 1.07). When compared with veterans who did not exceed clinical thresholds, those with a probable need for treatment had more stigma (ds = .63). Multivariate analyses also revealed an inverse main effect of self-stigma on intentions to seek help from both professional categories. However, military experience differentially moderated associations between treatment-related beliefs and intentions to seek mental health services. Finally, exploratory analyses identified that student veterans were most likely to engage in therapy/counseling at a Veterans Affairs Medical Center or Clinic, Vet Center, or other noninstitutionally sponsored settings in the community (e.g., private practices, faith-based organizations). Looking ahead, these findings will inform research and the provision of services for addressing the mental health needs of this substantive subpopulation of college students in the United States. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Evidence-based practice as a potential solution to burnout in university counseling center clinicians.
    The purpose of this study was to evaluate the impact of changes in perceptions about patient volume and severity of clinical presentations in university counseling centers (UCCS) on burnout. It was hypothesized that perceptions of increased workload and severity of conditions treated would be positively correlated with burnout. It was also hypothesized that self-reported use of evidence-based practice (EBP) would be negatively correlated with burnout. Counseling center clinicians (n = 80) completed the Copenhagen Burnout Inventory (CBI), the Evidence-Based Practice Attitudes Scale (EPBAS), and reported on factors that have been shown to impact burnout. In this sample, the following percent of respondents were at or above a level indicating potential burnout on each scale: Personal 19%, Work 15.2%, and Client 2.5%. Years of work was correlated with Client Burnout (r = .25, p <.05). Perceived increases in severity were correlated with each CBI Scale: Personal (r = .33, p <.001), Work (r = .32, p <.001), and (Client r = .33, p <.001). Self-reported use of evidence-based practice was negatively correlated with Client burnout (r = −.30, p <.001). The EBPAS Divergence Scale, which measures perception that one’s usual practice is different than research based practices, was also correlated with burnout (r = .27, p <.05) and Divergence was negatively correlated with self-reported use of EBP (r = −.25, p <.05). Respondents were also asked if they treat PTSD and obsessive–compulsive disorder and which therapies they use for these diagnoses. Findings suggest that dissemination and implementation of EBPS may be beneficial for UCCS. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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