Assisting At-Risk Students: A Psychologist's Perspective

Terry Ruthrauff, Psy.D.

Director and Licensed Psychologist

Psychological Services Center (PSC)

St. George’s University

Agenda

Psychologist’s view on how to assist students who are at-risk academically or psychologically.

Summary of: PSC services. Common psychological problems. SGU’s academic accommodation procedures. Intervening with someone who is abusing substances,

suicidal, psychotic, etc.

Discussion of these and other relevant matters.

Psychological Services Center (PSC)

PSC – A Few Facts

The mental health side of University Health Services.

As mental health professionals, our primary mission is to promote student and employee development and wellness. Active with student retention.

U.S. accredited – International Association of Counseling Services since 2009.

800 clients/3,300 clinical appointments per year. No additional charges for services. Appointments available most weekdays 8a to 6p. 24-hour emergency service. 90 percent of clients are satisfied with services.

PSC - Direct Service Components

Counseling and Psychotherapy Individuals Couples and Families Groups (e.g., Anxiety Management Skills)

Support and Advocacy (e.g., victims of assault/hate)

Academic Services Disability Services and Academic Accommodations Performance Enhancement

Career Counseling and Testing

Etc.

Counseling and Psychotherapy

To a large extent – people talk, we listen.

Individuals, families and groups.

Process experiences and feelings.

Develop coping strategies.

Prevent longer-term mental health problems.

Return to normal functioning.

Find peace.

PSC Ethics

All PSC staff adhere strictly to legal and/or ethical standards of:

American Psychological Association. International Association of Counseling Services. Individual clinician licensing boards, etc.

Client’s privacy and confidentiality is rigorously maintained. Exceptions:

Client gives informed, explicit and written consent. Imminent dangerousness to self or other (e.g., suicidal or homicidal). Abuse or neglect of child or other vulnerable person. Certain court orders.

No discrimination – All are treated with dignity and respect.

Administratively neutral.

Why come to the PSC?

Vast majority are free of severe psychopathology! Interpersonal conflicts Learning difficulties Psychological disabilities Self-esteem and personal growth problems Sexuality and gender issues Alcohol and drug abuse Eating and sleep concerns Understanding cultural differences Adjusting to St. George's University and Grenada Anxiety and stress management Depression Loss and grief Career uncertainty Violence (e.g. sexual assault, maltreatment of LGBTQQ persons)

PSC - Employees

Support Staff Corie Christopher, AS Marva Gilkes

Psychiatrists Dirk Burkhardt, MD Narasimhan Prabhakar, MBBS

Psychotherapists Denise Lewis, MA Hillary Ratna, MA (UK) Lorraine Steele, MA Cecilia Rougier, PhD (Postdoctoral Resident in Psychology)

Psychologists (U.S. licensed) Kathy Dervin, PsyD Jennifer Durst, PhD John Pettus, PhD (Senior Consulting Psychologist) Terry Ruthrauff, PsyD (Director)

PSC - How to Contact

Campeche Hall, Top Floors, Adjacent Suites

473.439.2277

sgu.edu/psc

Psychological Emergencies

Psychological Disorders – Potential Medical Evacuation

Psychotic Disorder, NOS Symptoms: Hallucinations, delusions, disorganized thinking. Worry: Unable to care for self. Tortured. Onset of major mental illness.

Major Depressive Disorder Symptoms: Sadness, impaired sleep/appetite/functioning over weeks. Worry: Suicide.

Bipolar Disorder Symptoms: Cycles between mania and depression. Worry: Suicide. Psychosis.

Substance Abuse/Dependence Symptoms: Continued use/abuse of substance despite problems. Worry: Medical problems. Vulnerability. Impaired functioning.

Psychological Disorders – More Manageable

Panic Disorder Symptoms: Acute intense fear, pounding heart, hyperarousal, sweating. Worry: Badly frightened.

Obsessive-Compulsive Disorder Symptoms: Excessive, time consuming repetitive thoughts and behaviors. Worry: Tortured. Impaired functioning.

Borderline Personality Disorder Symptoms: Emotional dysregulation, interpersonal difficulty, impulsivity. Worry: Self-mutilation, suicidal gestures.

Asperger’s Disorder Symptoms: Impaired social interaction, restricted interests, preoccupation. Worry: Might seem odd.

Psychological Disorders – Why Admit to SGU?

Many other disorders represented on our campus that are quite worrisome (e.g., eating disorders 4 to 9 percent of students), but in a less acute way.

As we cast a wider admissions net, the number of students that are coming to us with major mental illnesses is increasing.

Students have the legal, moral and ethical right, regardless of diagnosis, to obtain an academic degree.

That does not mean we cannot intervene when decompensation occurs and someone becomes symptomatic in a problematic way.

Psychological Emergencies – Immediate Intervention

Suicidal or homicidal gestures, talk or plans.

Signs of psychotic disorders (e.g., hallucinations, delusions).

Experience of traumatic events such as assault or abuse.

Inappropriate and extreme anger.

Inability to care for self or exercise good judgment that leads to endangerment.

Evidence of disorientation.

Apparent need for psychiatric hospitalization.

Psychological Emergencies – Intervention Within 24 Hours

Death of a loved one.

Witnessing a traumatic event.

Stress reactions cause significant impairments in personal, social, academic or occupational functioning.

Significant and persistent signs of depression.

Evidence of significant and persistent anxiety.

Problematic use of alcohol or other drugs.

Knowledge of another person being abused or assaulted.

Accessing Emergency System

2012: 14 Emergency Evaluations, 119 Crisis Triages.

If there is some reason to suspect imminent danger to self or other, an emergency evaluation can be mandated:

Weekdays 8a – 4:30p: Phone UHS Clinic at 444.4671.

All other times: Phone UHS Clinic NOC/DOC at 407.2791.

If a true emergency, do not waste time calling the PSC.

Clear report of your observations and concerns is necessary to act. Always better to have in writing.

Could consult with the Dean of Students in some cases to mandate an emergency evaluation.

Accessing Emergency System

Careful with implementing emergency system.

Can refer to or consult with PSC directly when no imminent danger.

When in doubt – Access emergency system!

What happens after accessing system? 1. Triage. 2. Clinic physician/PSC clinician evaluation.3. Disposition.

Intervention might include: No basis for concern – No follow-up. PSC psychotherapy and ongoing assessment. Medical Leave of Absence – Voluntary. Medical Leave of Absence – Involuntary.

Helping Persons in Crisis – Non-

emergencies (Upcraft, 1982) Listen well. Try to understand what the person is thinking

and feeling. Decide whether this is a temporary, situational crisis or

something more serious. Take the person seriously. The perception that one is in

crisis feels as real as an actual life threatening crisis. Keep calm. Stick with the person. Your physical presence and

willingness to stay will have a powerful impact. Avoid interpretation. It is likely to do more harm than good

and elevate emotional states.

Helping Persons in Crisis (Upcraft, 1982) Encourage venting of feelings (e.g., crying and talking). Avoid arguing. Doing so will just arouse anger and

defensiveness. Follow up. Your continued emotional support will likely be

very important. Be alert to another crisis. Be attentive to the re-emergence

of stressors and counterproductive patterns of behavior. Ask for help when needed. Encourage professional help

when appropriate. PSC has your back! sgu.edu/psc > Emergencies.

Disabilities

Factors Impacting Learning

Test or performance anxiety. Very amenable to treatment. Cognitive Behavioral Therapy.

Sub-clinical ADHD symptoms.

English is not primary language.

Lack of sufficient academic background.

Lack of sufficient cognitive skills and abilities.

Substance abuse. 10 – 15% of SGU students are abusing alcohol at a very worrisome level. 59% report alcohol consumption increased upon enrolling at SGU.

Medical and psychological disabilities.

Medical and Psychological Disabilities (very small percentage of student body)

1. Attention-Deficit/Hyperactivity Disorder (SGU’s most common disability) Inattention - poor focus and concentration Hyperactivity Impulsivity

2. Learning Disorders – Certain skill is weaker than should be expected given age, IQ, education, etc Reading Disorder (e.g., comprehension, rate) Disorder of Written Expression Mathematics Disorder (e.g., weak math ability)

3. Emotional Disorders Anxiety continuum Mood disorders

4. Medical Problems Visual Diabetes Etc.

Services for Disabled Students

Learning strategies (DES/PSC): Passive vs. active study methodologies ADHD coaching:

Organizational skills Time management

Performance enhancement/wellness (PSC): Anxiety management Sleep hygiene Holistic health

Psychological assessment (PSC): PSC LD/ADHD clinic (limited) Community referrals

Supplemental instruction, etc: Teaching faculty DES

Academic accommodations

Academic Accommodations for Documented Disabilities

SGU must comply with Americans with Disabilities Act and other relevant laws.

Goal is to “level the playing field” for the disabled - accommodate.

Accommodations at SGU are typically limited to: Double time on examinations. Tested in a setting relatively free of distractions.

Process to obtain academic accommodations:1. Obtain appropriate evaluation (sgu.edu/psc > Disabilities).2. Obtain appropriate documentation (sgu.edu/psc > Disabilities).3. Apply via DOS for Student Disabilities Committee review.

Student Disabilities Committees (SDC)

Student Disabilities Committee (SDC) reviews applications each January and August with three possible outcomes: Temporary accommodations (e.g., term or two while engaged in

treatment or further assessment). Permanent accommodations for permanent conditions. Accommodations not recommended.

January, 2013 - 30 applications: 20 ADHD 5 Learning Disabilities 3 Physical Disabilities 2 Emotional Disorders

Results of review: 14 Permanent Accommodations 7 Temporary Accommodations 9 Not eligible or Temporary Accommodations not extended

Temporary Accommodations

Temporary accommodations are possible during times SDC is not available, if student meets disability documentation requirements.

Students can see following depending on nature of problem:

Psychological – Terry Ruthrauff Medical – Pat Rooney

TR/PR review documentation.

Recommendation or not for temporary accommodations.

sgu.edu/psc > Disabilities.

Academic Accommodations: A Few More Points

Temporary Accommodations 2012 – 18 approved. According to school: SOM – 15 (T2 – 7, T4 - 0), SVM – 2, SAS – 1. Diagnosis: ADHD – 12, LD – 3, Tic – 1, Depression – 1, None – 1.

Long-term best interests of student must be considered.

Licensure board requirements for accommodations are much stricter than SGU’s.

sgu.edu/psc > Disabilities.

Substance Abuse Prevention

Substance Abuse at SGU

Recent PSC (Durst, 2009) study of 297 anonymous SGU students. Vast majority of our students do not abuse substances (e.g.,

alcohol, tobacco, caffeine, illegal and legal drugs). 25% use alcohol in hazardous range as defined by World

Health Organization. 13% reported having health, social, legal, financial or academic

problems in past six months because of alcohol use. 11% indicated that they failed to do what was expected of them

because of alcohol use. 10% reported weekly binge drinking (3,700 x .10 = 370

students). 59% described alcohol use as having increased upon

coming to SGU. 30% of SGU students drink at least weekly. 40% in SOM.

Substance Abuse at SGU

Less than 10% of all students indicated they smoked tobacco daily or almost every day.

14% of the total and 17% of the SOM-only samples indicated use of cannabis in the past six months.

10% of the SOM students who reported using cannabis in the six months preceding the survey indicated weekly or greater frequency of use. Overall, only 0.7% of student body uses weekly.

Use of other illegal drugs (i.e., sedatives, amphetamines, cocaine, opioids, hallucinogens, inhalants) are at very low rates. Misuse of legal drugs (e.g., psychostimulants) is a point of contention.

Oddly, students perceive substance use and abuse at SGU as occurring at much higher rates.

Substance Abuse Prevention Recommendations

Policy and enforcement changes (e.g., strengthen policy).

Research (follow-up to Durst, 2009).

Limit abuse of psychotropics (e.g., PSC procedural changes?).

Cultural or social norm changes (e.g., end events that promote high-risk drinking).

Encourage bystander intervention.

Environmental changes (e.g., alcohol/drug free dorm space, Fri/Sat classes).

Educational changes (e.g. include SOM in SAP Workshop, academic curriculum infusion).

Involve neighborhood, parents and other stakeholders.

Responsible Use:

No use of illegal drugs.

No use of tobacco products.

No “binge” drinking. This is defined in the research literature as the consumption in one day of five or more standard alcoholic drinks (e.g., 1 ounce of 100-proof liquor, 5 ounces of 12% wine, 12 ounces of 5% beer) for men and four or more for women.

No more than 14 standard alcoholic drinks in any week for men and only 7 for women.

Use of legal medications only as prescribed.

Getting Help

Retention – SGU is committed to helping students (and you) succeed in their academic programs.

Getting help will not jeopardize career potential.

Not getting help will.

Sources of Help

Bystander intervention – If someone is abusing, let them know you are worried about their behavior in a kind and caring way.

sgu.edu/psc > Substance Abuse. Psychological Services Center (PSC). Alcoholics Anonymous, Marijuana Anonymous and Narcotics

Anonymous: Tuesdays and Thursdays, 5:30 p.m. to 6:45 p.m. Room B1C, Windward Hall, SGU's True Blue Campus.

Medical leave for treatment abroad, if needed. Faculty, peers and family.

PSC - How to Contact

Campeche Hall, Top Floors, Adjacent Suites

473.439.2277

sgu.edu/psc

Questions and Comments?

Slides have been posted at sgu.edu/psc > Reading Room.