Amnesty for Help Seeking Behaviors: A Preliminary Review of Implementation History and Administrative Burden

A Thesis Submitted in Partial Fulfillment of theRequirements of the Renée Crown University Honors Program at

Syracuse University

Kyle Rosenblum

Candidate for Bachelor of Artsand Renée Crown University Honors

Spring 2020

Honors Thesis in Policy Studies

Thesis Advisor: _______________________ Dr. Zach Huitink, Assistant Teaching Professor, Public Administration and International Affairs

Thesis Reader: _______________________ Dr. Austin Zwick, Assistant Teaching Professor, Policy Studies

Honors Director: _______________________ Dr. Danielle Smith, Director

Abstract

This paper explores Syracuse University’s Amnesty for Help Seeking Behaviors policy implemented in Fall 2019 to encourage help-seeking behaviors among students in alcohol or drug-related emergencies. Responding to increasing risk of alcohol-related mortality on college campuses, many colleges and universities across the United States began implementing policies designed to reduce barriers to seeking help during alcohol or drug-related incidents; however, there is limited literature examining the success and empirical foundations of these policies. Using stratified purposive sampling, administrators of Syracuse University’s policy were interviewed and qualitative data were analyzed to examine perceived goals and measures of success for the policy, sources of administrative burden, and perceptions of the policy. Findings suggest that there are no severe sources of administrative burden and that administrator perceptions of the policy are generally positive. Further, qualitative analyses suggest the policy may have ameliorated previously existing sources of burdens and could have positive implications in student perceptions of administrators. Based on these findings and the existing literature, I offer two recommendations: to conduct and publish an empirical evaluation of the policy and to increase marketing and promotion of the policy.

Executive Summary

Between 1998 and 2014, alcohol-related poisoning deaths among 18- to 24- year-olds

increased 254% per 100,000, from 207 to 891 (Hingson, Wenxing, & Smyth, 2017). There are a

number of health risks presented by the prevalence of binge drinking on college campuses

(National Institute on Alcohol Abuse and Alcoholism, 2020; Wechsler et al., 1995; Wechsler et

al., 1994), but alcohol-related mortality presents the most severe risk of binge drinking and has

resulted in a series of high-profile news stories about campus deaths due to alcohol (Larimer,

2017; New, 2014; Sink, 2004; Udell, 2019). Thus, the risk of alcohol-related mortality should be

of particular concern to universities working to address alcohol and drug-related issues.

In a root-cause analysis, a multitude of potential causes of alcohol-related mortality were

identified. Good Samaritan policies and medical amnesty policies, referred to in this paper

broadly as Help-Seeking Amnesty Policies (HSAPs), are emerging harm-reduction practices

being employed by colleges and universities across the United States that attempt to address one

specific root cause of alcohol-related mortality—the possibility that students fail to call for

emergency services in an alcohol or drug-related medical emergency out of fear of getting in

trouble. HSAPs are policies promoted by an institution of higher education which absolve

students of any university-based conduct charges or judicial consequences if they seek help for

themselves or a peer in an alcohol or drug-related emergency (Oster-Aaland and Eighmy, 2007).

These policies attempt to remove student fears of disciplinary consequences in order to increase

the likelihood that they seek help, thus reducing the risk of alcohol-related mortality. Educational

interventions are typically still required to address individual students’ needs and continue to

work to decrease binge drinking overall on college campuses.

The first reference to a campus HSAP in the literature was in Meilman (1992), in which

the author discusses Dartmouth College adopting a Good Samaritan clause in 1987 and the

College of William and Mary following suit in 1990. Literature focusing on these policies began

increasing in the early 2000’s, with Lewis and Marchell (2006) publishing an analysis of Cornell

University’s newly adopted Medical Amnesty Protocol. In 2007, The Chronicle of Higher

Education noted that dozens of colleges had implemented HSAPs (Hoover, 2007), and by 2019,

an article in Inside Higher Ed suggested that most colleges have these policies in place

(Anderson, 2019). This paper focuses specifically on Syracuse University’s HSAP, called

Amnesty for Help Seeking Behaviors, which was implemented in the Fall of 2019. The policy is

written as follows:

Syracuse University encourages all community members to care for themselves

and others. Therefore, when a student or student organization initiates help from

a campus or community resource, involved students or organizations will

generally not be subject to the University’s Code of Student Conduct. Students

may be required to complete educational interventions designed to assist them in

their decision-making process and/or the outcomes of their decisions and the

University will generally alert emergency contacts. The University retains the

right to hold individuals and organizations accountable when the health and

safety of community members is at risk. (Syracuse University, Amnesty for help

seeking behaviors).

This policy was examined in terms of associated administrative burdens, which refers to

sources of frustration in either implementing the policy (as administrators) or utilizing the

policy’s intended services (as clients—i.e., students) (Burden et al., 2012). Administrative

burden results from three potential areas of cost: learning costs: barriers based on the necessity to

know about and understand eligibility for a policy; compliance costs: barriers caused by

administrative requirements such as filling out documentation or following specific procedures;

and psychological costs: barriers that exist due to stigmas about participating in a program or

general stress produced by the nature of the process (Moynihan, Herd, & Harvey, 2015). Much

of the literature on administrative burden examines burdens imposed on clients by government

agencies. The analysis presented in this thesis extends literature on burden for administrators in a

context not examined in the literature: an educational setting.

Stakeholder interviews were conducted with administrators at Syracuse University

through purposive stratified sampling, specifically choosing individuals to interview based on

their proximity to administering aspects of the Amnesty for Help Seeking Behaviors policy. Five

individuals were interviewed: one from the Department of Public Safety (DPS), which is in

charge of responding to alcohol-related emergencies; two from the Dean of Students Office,

which communicates with students about their conduct charges and supports them through

conduct processes; and two from the Office of Student Rights and Responsibilities (OSRR),

which meets with students who have conduct charges regarding alcohol or drug-related

incidents, determines if amnesty applies, and assigns educational outcomes.

Interviews were conducted to examine perceived goals and indicators of success as

identified by the participants, assess administrative burden related to the policy, and evaluate

participants’ perceptions of the policy, its strengths, and its weaknesses. Key sources of

administrative burden for administrators included adapting to new policies and procedures

(learning cost) (n=4), creating the new policies and procedures (compliance cost) (n=4), and

discovering that students perceived the administrators as not caring about their health and well-

being (psychological cost) (n=2). Key sources of perceived administrative burden for students as

identified by the participants included understanding what amnesty is and when it applies

(learning cost) (n=4), following through with educational sanctions (compliance cost) (n=2), and

experiencing stress from the alcohol or drug-related incident itself (psychological cost) (n=2).

Identified goals included encouraging help-seeking behaviors and keeping students safe (n=4),

having students engage with educational interventions (n=3), and improving students’

perceptions of the administrators and their offices (n=2), while indicators to measure the policy’s

success were identified as an increase in utilization of the policy by students (n=2), an increase in

the number of calls for emergency services for alcohol or drug-related incidents (n=1), students’

perception of their treatment as fair (n=1), and the number of students successfully completing

educational interventions (n=1). Perceptions of the policy were generally positive (n=3).

Identified strengths included that the policy is more in line with the philosophy of the

administrators (n=2) and that it can provide second chances to first-time offenders (n=1).

Identified weaknesses included a lack of student awareness about eligibility (n=2), the belief that

the policy need not exist (n=1), and the fear that students may abuse the policy (n=1).

I offer two recommendations to Syracuse University based on these findings and the

existing literature. First, it is important to engage in and publish research evaluating the impact

of this policy to contribute to the limited existing literature and to ensure the policy is successful.

Second, in order to reduce learning costs for students and increase the likelihood that the policy

be used, it is necessary to improve marketing and promotion of the policy.

Table of Contents

I. Introduction..................................................................................................................................8

History of Implementation.........................................................................................................11

II. Background & Context.............................................................................................................13

III. Outline of Policy......................................................................................................................16

Policy Process............................................................................................................................17

IV. Administrative Burden............................................................................................................20

V. Data and Methods.....................................................................................................................23

Limitations.................................................................................................................................24

VI. Findings...................................................................................................................................24

Goals and Measures of Success.................................................................................................25

Administrative Burden...............................................................................................................26

Perceptions, Strengths, and Weaknesses....................................................................................29

VII. Conclusion..............................................................................................................................30

Recommendations......................................................................................................................32

References......................................................................................................................................34

Appendix I.....................................................................................................................................37

Peer Institutions..........................................................................................................................37

ACC Institutions........................................................................................................................38

Other Institutions........................................................................................................................39

I. Introduction

The prevalence of binge drinking on college campuses is well-documented by a substantial

body of literature (Hingson, 2010; Keeling, 2002; Quigley and Marlatt, 1996), as are the health

risks of binge drinking in college (National Institute on Alcohol Abuse and Alcoholism, 2020;

Wechsler et al., 1995; Wechsler et al., 1994). These health risks can range from minor effects on

daily life to more severe, potentially fatal incidents. A study by Wechsler et al. (2000) projected

that over 30,000 students likely need treatment for alcohol overdose annually in the United

States, based on a self-reporting survey. The rates of hospitalizations and mortality due to

alcohol-related incidents have been rising as well. Alcohol-related poisoning deaths among 18-

to 24-year-olds increased 254% per 100,000 between 1998 and 2014. Hospitalizations for

overdoses involving alcohol among that same group increased 26% per 100,000 over the same

period and alcohol-related non-traffic deaths increased 21% per 100,000 (Hingson et al., 2017).

A number of high-profile campus deaths involving alcohol (Larimer, 2017; New, 2014; Sink,

2004; Udell, 2019) have forced institutions of higher education throughout the country to grapple

with how to prevent deaths, injuries, and community harm related to alcohol.

The problem examined in this paper is defined as follows: college students in the United

States are at risk of alcohol-related mortality. As can be observed by the root cause analysis

presented in Figure 1, alcohol-related mortality among college students in the United States is a

complex and multi-faceted issue with many potential causes. In fact, it is extremely likely that

the interplay of a variety of identified causes contribute differently to each individual instance of

alcohol-related mortality. For the purposes of this paper, the policy being analyzed attempts to

address the specific root cause demonstrated in Figure 2. This specific root cause analysis

suggests that one of the contributing factors to alcohol-related mortality among college students

Figure 1

in the US is a reluctancy to seek help during incidents involving severe intoxication out of fear of

possible disciplinary sanctions. In an article about states adopting medical amnesty policies, USA

Today highlights one example wherein an individual with severe alcohol poisoning refused to let

anyone seek help for them because they feared that a citation for underage drinking would hurt

their chances of enlisting in the army (Daves, 2015). This thinking could translate easily to

college students, who may fear any damage to their ability to become employed, attend graduate

school, or even successfully complete their undergraduate degree.

Figure 2

History of Implementation

One such way that colleges and universities in the United States have addressed the risk

of alcohol-related mortality among their student bodies is amnesty policies. Though amnesty

policies refer to several things, in this paper, I focus generally on Good Samaritan policies and

medical amnesty policies, as well as Syracuse University’s Amnesty for Help Seeking Behaviors

policy. These nomenclatures define slightly different categories of policies and there is variation

among institutional policies of the same category. However, the goal of each policy is the same:

to increase help-seeking behaviors in order to ensure students receive medical care in the event

of alcohol- or drug-related incidents. For this reason, I will refer generally to these policies as

examples of a Help-Seeking Amnesty Policy (HSAP).

The history of HSAPs can be traced back to the introduction of the harm-reduction

framework, on which HSAPs are based (Oster-Aaland and Eighmy, 2008), into public health

discourse. Harm-reduction as an alternative public health strategy to prohibitive or punitive

policies was initially aimed at addressing HIV/AIDS contraction rates amongst people who

injected drugs (Roe, 2005). Literature and government-funded reports examining harm-reduction

approaches to alcohol and drug use in a college setting increased throughout the 1990’s (Dejong

et al., 1998; Kivlahan et al., 1990; Onken, Blaine, & Boren, 1993; Paglia and Room, 1999). Until

the 2000’s, literature on HSAPs was scarce, though Meilman (1992) describes Dartmouth

College adopting a Good Samaritan clause in 1987 and the College of William and Mary

following suit with a similar policy in 1990, indicating these institutions as some of the earliest,

if not the first, adopters of HSAPs. Literature specifically focusing on campus HSAPs increased

in the 2000’s (Lewis and Marchell, 2006; O’Malley, 2002; Oster-Asland and Eighmy, 2008).

Lewis and Marchell (2006), analyzing Cornell University’s Medical Amnesty Protocol,

published one of the only comprehensive analyses of a campus HSAP that exists. The authors

broadly define the purpose of this policy as aiming to “eliminate or reduce judicial consequences

for students involved in alcohol-related medical emergencies” (Lewis and Marchell, 2006, p.

330), a definition consistent with existing literature. These policies may apply to individuals

requiring medical attention, peers seeking medical services on behalf of another individual, and

organizations involved in the incident. Oster-Asland and Eighmy (2008) further identify five key

assumptions that these policies operate under, listed as follows:

1. Students can identify the symptoms of alcohol poisoning2. Students understand the risk associated with the symptoms of alcohol

poisoning3. Students responsible for help-seeking are sober enough to adequately judge

the level of risk involved4. Students are currently not calling for help due to fear of getting in trouble

with the university5. Students will be more likely to call for help if they are assured that they

will not get in trouble

These assumptions present a particular challenge to the success of HSAPs—not only must

barriers to calling for help be removed, but universities must also ensure students are equipped

with the knowledge, resources, and ability to assess and respond to emergency situations.

Though the definition and assumptions are restricted to alcohol-related medical emergencies,

many colleges and universities have extended their policies to include drug-related medical

emergencies as well (Appendix I).

There has not been a comprehensive review of the history of HSAPs on college campuses

to date; however, the literature suggests these policies began increasing in popularity at colleges

and universities throughout the United States during the 2000’s. One potential reason for this

timing may be that in 1998, the United States Congress amended the Higher Education Act of

1965 to encourage institutions of higher education to develop new strategies for addressing

alcohol and drug abuse (Bergen-Cico, Urtz, & Barreto, 2004). In a 2007 article from The

Chronicle of Higher Education, the author estimates that “…dozens of colleges have adopted

medical-amnesty exemptions…”, referring to these policies (Hoover, 2007). By 2019, Inside

Higher Ed notes that “most colleges have medical amnesty policies in place to protect students

from university discipline when they call emergency services…”, citing Students for Sensible

Drug Policy, an international non-profit that advocates for drug policy reform (Anderson, 2019).

This thesis describes the history of implementation of an HSAP at Syracuse University,

outlines the policy as written, discusses the relevance of administrative burden to policy

implementation, and analyzes qualitative findings from stakeholder interviews with key

university administrators using a purposive stratified sampling method. The findings include

identification of goals and measures of success for the policy, a breakdown of perceived

administrative burdens on behalf of both administrators and students, and perceptions of the

policy, its strengths, and its weaknesses. Implications of these findings are discussed along with

recommendations for the future.

II. Background & Context

Syracuse University is a private, four-year university situated in central New York with

an enrollment of about 22,000 students, including 15,000 undergraduates. In the Fall of 1999,

following an increasing prevalence and severity of alcohol- and drug-related conduct issues,

Syracuse University implemented a 12-Point Plan for Substance Abuse Prevention and Health

Enhancement (SAPHE). This plan was in accordance with the then emerging public health

literature focused on harm-reduction strategies and comprehensive environmental approaches to

addressing alcohol and other drug (AOD) misuse on college campuses. Coupled with this plan

was a three-year longitudinal study by Bergen-Cico, Urtz, & Barreto (2004) assessing the

effectiveness of the plan in relation to correlating changes in AOD incidents and campus

perceptions. The study found that the environmental approach to reducing AOD issues on

campus was correlated with largely positive outcomes, both in the frequency of AOD incidents

and the campus perceptions toward the new policies. More importantly, the plan itself

demonstrated an institutional commitment to harm-reduction strategies in addressing AOD and

led to the creation or pre-cursor of several important campus institutions that exist today,

including the Options program, which provides educational interventions, and a peer educator

group focusing on preventative health education.

Twenty years after the implementation of the SAPHE plan, Syracuse University formally

implemented a Help Seeking Amnesty Policy. The history of the development of this policy is

examined through news stories archived by Syracuse University’s student newspaper, The Daily

Orange, and internal documents of Syracuse University’s Student Association.

A 2015 article in USA Today notes that a rise in student advocacy had begun to influence

the adoption of state and college policies promoting HSAPs (Daves, 2015). Syracuse

University’s own history of student advocacy on this issue can be traced back to the Fall of 2009,

when a Junior in the College of Visual and Performing Arts started a chapter of Students for

Sensible Drug Policy (SSDP) (Janis, 2009). The SSDP chapter, aided by the national parent

organization, began to advocate for an HSAP modeled from that presented in Lewis and

Marchell (2006) (Montalvo, 2010). The issue quickly gained prominence on campus, garnering

the attention of the undergraduate Student Association (SA) (Leveille, 2010), The Daily Orange

Editorial Board (The Daily Orange Editorial Board, 2011), and even an SU alum who worked

with addiction in a medical setting (Letter to the Editor, 2011). The university formed a campus

task force in 2011 dedicated to examining the policy and providing recommendations for future

steps (Leveille, 2011). The task force ultimately rejected the SSDP chapter’s proposal for a new

policy, citing a lack of empirical backing for medical amnesty policies and potentially conflicting

university messaging, but committed to updating the policy to encourage help-seeking behaviors

and reducing some of the more severe punishments outlined under the previous AOD policy

(Barillari, 2012).

Over the following years, HSAPs generally increased in prevalence on college campuses

throughout the country. A limited analysis of the prevalence of HSAPs at colleges relevant to

Syracuse University was conducted in 2018. Colleges were divided into three sub-groups: peer

institutions (a loosely defined group with similar attributes to Syracuse University that allow for

comparison research on key university initiatives); members of the Atlantic Coast Conference

(ACC; the athletic conference in which Syracuse University takes part); and other institutions (a

group of colleges chosen that did not fit the former categories but were included either due to a

notable policy or relevance to key stakeholders to whom the research would be presented). In

total, the AOD policies for 31 schools and Syracuse University were examined for the presence

and extent of HSAPs (n=13 peer institutions, n=14 ACC schools, n=7 ‘other’ institutions). Three

institutions were cross listed in peer institutions and ACC schools but were not duplicated in

final counts. If an institution had a HSAP, it was evaluated on five measures:

1. Does the policy cover alcohol-related incidents?2. Does the policy cover drug-related incidents?3. Does the policy apply to individuals in need of medical attention?4. Does the policy apply to individuals calling for help on behalf of a peer?5. Does the policy apply to organizations present at the incident?

Data were collected through examinations of institutions’ websites and Codes of Student

Conduct and occasionally informational interviews. The full outline of results can be found in

Appendix I. In total, not including Syracuse University, 29 of the 31 institutions had full or

limited HSAPs (93.5%)—27 institutions with full policies (87.1%) and 2 institutions with limited

policies (6.5%). In the peer institution sub-group, including cross-listed schools, all 13 sampled

institutions had HSAPs (100%). In the ACC sub-group, including cross-listed schools, 11

institutions had full policies (78.6%), 2 institutions had limited policies (14.3%), and 1 institution

did not have a policy (7.1%). In the ‘other’ institution sub-group, 6 institutions had full policies

(85.7%) and 1 institution did not have a policy (14.3%).

In 2019, this research was presented to the Syracuse University Board of Trustees,

Chancellor, and Dean of Students, prompting discussion about the possibility to implement a

HSAP (initially proposed as medical amnesty and later changed to help-seeking amnesty) at

Syracuse University. The policy was drafted over the summer of 2019 by the Dean of Students

Office in conjunction with other campus departments and was formally adopted in Fall 2019.

The following section describes the new policy and outlines the full process.

III. Outline of Policy

The Help-Seeking Amnesty Policy is broadly outlined on Syracuse University’s student

conduct website, entitled “Amnesty for Help Seeking Behaviors”. The policy, as written, is as

follows:

Syracuse University encourages all community members to care for themselves

and others. Therefore, when a student or student organization initiates help from

a campus or community resource, involved students or organizations will

generally not be subject to the University’s Code of Student Conduct. Students

may be required to complete educational interventions designed to assist them in

their decision-making process and/or the outcomes of their decisions and the

University will generally alert emergency contacts. The University retains the

right to hold individuals and organizations accountable when the health and

safety of community members is at risk. (Syracuse University, Amnesty for help

seeking behaviors).

The policy is worded with vague language like “generally” to provide flexibility in

implementation and to account for situations in which amnesty should not be applied even

though a student may be eligible, particularly when “the health and safety of community

members is at risk”.

Policy Process1

The amnesty process outlined in the Amnesty for Help Seeking Behaviors policy is

initiated from the moment a student seeks help for themselves or another student who has an

alcohol or drug-related emergency. When a student calls either the Syracuse University

Ambulance (SUA) or the Syracuse University Department of Public Safety (DPS) to seek help

for an alcohol- or drug-related emergency, they will be considered for amnesty. The DPS officer

at the scene writes a situation report describing the incident and typically noting whether or not a

student called for help (other ways DPS or SUA may be notified to an incident include finding a

1 The process for the Amnesty for Help Seeking Behaviors policy was outlined with assistance from staff members from both the Dean of Students Office and the Office of Student Rights and Responsibilities at Syracuse University.

student intoxicated or receiving calls from non-student residents of Syracuse). Once these reports

are received by the Dean of Students Office, a case manager within the Dean of Students Office

sends an email to the student cited detailing the conduct charges filed against them, outlining

next steps in the conduct process, and offering to be a source of support should the student have

any questions or just want to talk.

The situation reports are then sent to Syracuse University’s Office of Student Rights and

Responsibilities (OSRR), the primary conduct office on campus. The staff examines each case

involving alcohol or other drugs to determine whether amnesty applies—primarily based on

whether it was a student who sought help. Every student, regardless of whether amnesty applies,

receives a letter notifying them that they need to set up a meeting with a staff member from

OSRR to discuss what happened, reflect on their experience, ensure their well-being, and map

next steps. These meetings including guiding questions for the OSRR staff to direct the

conversation, one of which includes inquiring whether the student or a peer sought help resulting

in the notification of campus emergency services. This serves to both confirm amnesty for cases

already believed to be qualified or qualify new cases for amnesty where eligibility was not

apparent from the initial report. Students who qualify for amnesty do not receive any judicial

sanctions. Instead, the staff member in OSRR recommends an educational or behavioral

intervention tailored to the specific individual’s needs. There are no enforcement mechanisms to

ensure students complete their assigned educational or behavioral outcomes; however, OSRR is

notified whether a student completed any items referred out (i.e. completion of programs through

Counseling Services). A visual of this process is outlined in Figure 3, below.

Figure 3*

*Gray boxes indicate actions taken by students. Blue boxes indicate actions taken by administrators.

In total, this process is completed typically around two to three weeks after the incident in

question. Both the Dean of Students Office and OSRR stress the importance of providing support

to and assessing the well-being of students throughout the process. Additionally, students are

allowed to have another individual accompany them to their meeting with OSRR as a source of

support. Amnesty for organizations also exists under this policy, but because alcohol and drug-

related emergencies involving student organizations are more infrequent and more complex than

cases about individuals, the process is not specifically outlined. Students cited for conduct

charges related to alcohol or other drugs but who are ineligible for amnesty follow additional

mandated procedures not outlined in this paper.

In order for this process to operate as intended, administrators and students alike must be

able to navigate through procedures with minimal barriers that may otherwise impede or prevent

the success of the policy, a concept referred to as administrative burden.

IV. Administrative Burden

For any policy to be effective, the targeted population must be able to overcome barriers

to engaging with the policy and successfully receiving the benefits it was intended to provide.

Burden et al. (2012) describe this concept, administrative burden, as an individual’s experience

of policy implementation as onerous. The perception of burdens as onerous affects an

individual’s likelihood of accessing services, a program’s likelihood of successfully achieving

intended outcomes, and overall perception of the administrative body overseeing the policy.

Administrative burden can be experienced in three categories, as defined by Moynihan, Herd, &

Harvey (2015): learning costs, compliance costs, and psychological costs.

Learning costs are barriers to accessing services based on the necessity to be aware of

the existence of the service, eligibility requirements, and methods of access. In the case of help-

seeking amnesty policies, students must be aware that their campus has an HSAP in place and be

knowledgeable enough about the substance of the policy to understand what steps to take to

ensure they are eligible for amnesty (ex: seeking help on behalf of themselves or a peer). This

also includes knowing which services to contact, how to contact them, and perhaps most

importantly, when to contact them. The literature has shown that most college students have

taken care of a peer during an alcohol-related event, but that these students generally do not seek

outside help (Wechsler, Nelson, & Weitzman, 2000; Colby, Raymond, & Colby, 2000; Oster-

Aaland et al., 2009). This means that students taking care of their intoxicated peers must

themselves be able to determine when or if emergency medical services are needed. Lewis and

Marchell (2006) found that the top reason for not calling for help was exactly that—being unsure

as to whether help was required. This is a learning cost that students must be able to overcome in

order to successfully engage with services offered through HSAPs.

Compliance costs are barriers resulting from following administrative requirements,

including completing documentation and correctly following necessary procedures. Cornell

University’s HSAP, for example, requires students eligible for amnesty through their Medical

Amnesty Protocol to complete psycho-educational interventions (Lewis and Marchell, 2006).

Other potential sources of compliance costs for HSAPs in addition to completing educational

interventions include responding to communications from the university’s conduct office,

scheduling necessary conduct meetings, and completing any documentation about the alcohol-

related event as required by first responders or conduct offices.

Psychological costs arise from stigmas of participating in a program, a sense of a loss of

individual autonomy to an administrative body, and stresses associated from involvement in the

process itself. Because substance use is correlated to co-occurring mental health disorders and

stress (Cranford, Eisenberg, & Serras, 2009; O’Hare, 1998; O’Hara, Armeli, & Tennen, 2014) as

well as other serious health problems like injuries or risky sexual behavior (National Institute on

Alcohol Abuse and Alcoholism, 2020; Wechsler et al., 1995; Wechsler et al., 1994), discussions

with conduct offices or counseling professionals as part of HSAPs may exact a psychological

toll. Another potential source of psychological costs may stem from the fear of disciplinary

actions resulting from seeking help, a cost which HSAPs attempt to eradicate (Lewis and

Marchell, 2006; Oster-Aaland et al., 2007).

While administrative burden generally refers to the experiences of a target population in

interacting with a service or program, the concept is also applicable to the administrators of a

policy themselves. Perceived administrative burden in this case is associated with increased

opposition to a policy (Burden et al., 2012) and a decreased organizational commitment and

effort (Moynihan, Herd, & Harvey, 2015). It is also important to note that some forms of

administrative burden are necessary or even desirable (Moynihan, Herd, & Harvey, 2015). For

example, educational interventions required by HSAPs pose a compliance cost to students but

are necessary to address the student’s well-being and to ensure that the policy remains in line

with university values. In the following sections, I further analyze the implementation of

Syracuse University’s HSAP and examine perceived administrative burdens of the policy.

V. Data and Methods

Data were conducted through stakeholder interviews from a sample of administrators at

Syracuse University selected through purposive stratified sampling. Strata were chosen based on

relevance to the Amnesty for Help Seeking Behaviors policy, including: one representative from

the Department of Public Safety, responsible for responding to alcohol-related events and

submitting situation reports; two representatives from the Dean of Students Office, responsible

for communicating with and supporting students throughout the conduct process; and two

representatives from the Office of Student Rights and Responsibilities, responsible for meeting

with students, assessing eligibility for amnesty, and assigning educational outcomes. The roles of

these administrators in reference to the policy process are illustrated in Figure 3.

Due to ongoing circumstances involving COVID-19, interview designs varied. Two

interviews were conducted in-person, two were conducted via video conferencing tools, and one

was conducted via e-mail response. Interviews were semi-structured and focused generally on

administrators’ roles and their perception of the policy’s goals, measures of success, and

associated administrative burden. Written notes were used to summarize the responses of

participants during in-person and video conference interviews. These notes along with the

recorded responses from the e-mail interview were analyzed for themes relating to perceived

goals and measures of success of the policy, the three costs of administrative burden (learning,

compliance, and psychological), and general perceptions of the policy. Participants were

specifically asked about their perceptions of policy goals and measures of success as well as

administrative burden; however, general perceptions of the policy were extrapolated based on

responses provided throughout each interview. Discussions relevant to each theme were

extracted from interviews and similar responses were combined.

Limitations

There are several limitations to this study. The small number of key stakeholders

interviewed as participants reduces generalizability of and presents a larger opportunity for error

in the qualitative findings. Since quantitative data were not accessible for the purposes of this

study, it is difficult to validate the implications presented by the qualitative findings.

Furthermore, due to confidentiality issues and practical concerns surrounding COVID-19,

students involved in the amnesty process were not interviewed. All findings related to

administrative burdens for students are based on the perceptions of administrators on behalf of

students. Future studies should seek to expand the number of participants interviewed, analyze

quantitative data, and include students in qualitative data collection.

At the time of this study, the policy has only been implemented for less than a year. The

policy being still in an early implementation stage, findings presented in this study should be

considered as preliminary and should be supplemented by continuous assessment of the policy

over time.

VI. Findings

Relevant administrators to the Amnesty for Help Seeking Behavior policy were identified

based on their level of involvement in the policy process. Interviews were conducted to gather

anecdotal data to answer three broad questions:

(1) What are the perceived goals and indicators of success for the policy?

(2) What sources of administrative burden exist or were ameliorated as part of the

policy?

(3) What are the administrative perceptions of the policy and its strengths or

weaknesses?

Goals and Measures of Success

Participants were asked to describe what they believed the goal of the policy was and

what they would identify as being an indicator that would demonstrate the policy’s success.

Participants were largely in agreement over the goals of the policy. Three main goals were

identified. The most common goal of the policy was to encourage help-seeking behaviors on the

part of students and thus keep students safe (n=4). This identified goal is consistent with that

identified in the literature (Lewis and Marchell, 2006; Oster-Aaland et al., 2007). The other

identified goals of the policy were to encourage students to engage with educational

interventions (n=3) and to improve students’ perceptions of the administrators and their

departments as sources of support (n=2).

Participant views on what measures would indicate the success of the policy were more

mixed. The most commonly identified measure of success was identified as the frequency with

which the policy is used by students, with higher frequency indicating greater success (n=2).

Related to this measure, another participant identified increased numbers of calls for emergency

services during alcohol- or drug-related incidents as indicative of success (n=1). Other identified

metrics of success included students’ perception of their treatment through the process as fair

(n=1) and the number of students that successfully complete assigned educational interventions

(n=1). Quantitative data would be needed to assess each of these measures.

Administrative Burden

Participants were asked to identify sources of administrative burden for themselves in

implementing the policy and perceived sources of administrative burden for students in using the

policy based on provided definitions of learning costs, compliance costs, and psychological

costs. If, in the course of an interview, participants referred to a source of administrative burden

without explicitly identifying it as so, these sources were still coded and included in final

analyses.

Learning costs. The most commonly identified source of learning costs for

administrators was adapting to new roles and procedures in light of the new policy (n=4). One

participant identified the need to adapt to new notification letters, new documentation, new

structures and systems, and shifts in how inter-departmental conversations about the conduct

proceed. In addition, participants identified a learning cost associated with determining

application of amnesty in cases where eligibility is uncertain or other factors are involved which

add complexity to the conversation (n=2). The policy states that students will “generally not be

subject” to the Code of Conduct if students meet the help-seeking criteria. This specific language

provides OSRR with flexibility in ensuring that students do not abuse the policy and in

accounting for extraneous variables that may complicate a case. However, it also results in a

learning cost because, as one participant describes, it creates gray areas that must be examined to

determine eligibility. Lipsky (1980) maintains that this sort of discretion exercised by

administrators is an inherent part of the roles and responsibilities of street level bureaucrats—

those administrators that directly interact with clients (i.e. the students) in dispensing benefits or

procedures of a policy.

The most commonly perceived learning cost for students was the need to understand

what amnesty is and when it applies (n=4). This is consistent with the literature that identifies

knowledge of a policy and eligibility requirements as the primary source of learning costs

(Moynihan, Herd, & Harvey, 2015). It is also important to note that the policy’s vague language

may pose additional difficulties to students in understanding eligibility. Though being

knowledgeable about the policy was identified as an important learning cost for students, two

participants who identified this cost also noted that since the policy was implemented, students

appear to have gained a better understanding of what the policy is. Two other perceived learning

costs for students included the need for students to be able to differentiate between the various

offices involved in the process (ex: Dean of Students Office vs OSRR) (n=1) and understanding

the difference between punitive outcomes and educational outcomes (n=1).

Compliance costs. Similar to the learning cost identified by administrators of adapting to

new procedures as a result of the policy, a commonly identified compliance cost for

administrators was having to actually create those new procedures and documentation and follow

them accordingly (n=4). One specific example noted by several participants was the necessity for

DPS to alter its situation reports to specifically include information on help-seeking behaviors

employed by the students involved—information not previously recorded. Another source of

compliance costs, though not specific to just amnesty cases, was reading the situation reports for

alcohol- or drug-related incidents that are then used to determine conduct charges or amnesty

eligibility (n=4). Finally, some participants noted that a compliance cost exists in the necessity to

monitor the policy, especially while still relatively new, to determine effectiveness or areas for

improvement (n=2).

Perceived compliance costs for students were limited, the most common being following

through with assigned outcome measures (i.e. educational interventions) (n=2). Based on

participants’ description of the policy, other sources of compliance cost can be inferred to

include reading email notifications of the process and setting up and following through with a

meeting with OSRR.

Psychological costs. A notable psychological cost for administrators was identified as

students’ general perception that the administrators’ roles were exclusively to get them in

trouble, rather than caring about the students’ health and well-being (n=2). One participant

specifically recounted a time in which they expressed their genuine care and concern for a

student’s well-being but were met with skepticism as a result of the student being required to go

through the conduct process. Another psychological cost identified was just generally seeing

students struggle (n=1). Both of these identified costs are not specific to the HSAP itself, but

rather to the administrator’s roles.

Interestingly, one participant suggested that the policy actually removed a psychological

cost that previously existed. The participant explained that many administrators had a

‘philosophy’ of amnesty prior to the implementation of the HSAP, believing that certain cases

warranted amnesty considerations—but there was no formal policy permitting the application of

amnesty. The implementation of the HSAP removes discrepancies between an administrator’s

desire to apply amnesty and the lack of a policy to provide an avenue to do so formally.

The only perceived psychological cost for students was going through the process in

general (n=2). As one participant noted, students who go through the process have visible

struggles and often catastrophize their situation. Given the literature that demonstrates negative

correlates between drinking and co-occurring health risks (Cranford, Eisenberg, & Serras, 2009;

O’Hare, 1998; O’Hara, Armeli, & Tennen, 2014; National Institute on Alcohol Abuse and

Alcoholism, 2020; Wechsler et al., 1995; Wechsler et al., 1994), it is reasonable to conclude that

students who had an incident related to alcohol or other drugs will also face psychological stress,

though this is not a cost stemming from the policy itself. Rather, going through the policy

process required to receive amnesty may exacerbate this psychological cost as a result of having

to discuss the incident in depth with university administrators.

Perceptions, Strengths, and Weaknesses

The final question explored through stakeholder interviews was how administrators

perceived the policy and what they believed to be the policy’s strengths and weaknesses. Overall,

perceptions of the policy were generally positive (n=3), coded as such based on the participants’

language in talking about the policy. Of the three participants who were identified as having

positive perceptions of the policy, one referred to their desire to apply amnesty to more cases,

one described the positive impacts they believe the policy will have on students, and one

described the success of the policy so far. Of the other two participants interviewed, one

indicated a neutral perception (n=1) and one indicated a slightly negative perception (n=1). The

participant indicating a negative perception of the policy described their belief that the policy is

unnecessary, specifically asserting that “if students truly cared about their peers” they would call

for help regardless of potential consequences.

Three anecdotal strengths of the policy were identified. The most commonly identified

strength was that the policy is generally in alignment with the views and philosophy of

administrators (n=2). As discussed under psychological costs, one participant noted the desire of

administrators to have an amnesty provision even before the policy was implemented. Another

identified strength included the ability to provide a second chance to first-time offenders (n=1).

One participant also noted that despite the fact that no enforcement mechanisms are in place to

ensure students who receive amnesty complete educational interventions, students have mostly

been successful in following through with their educational outcomes. This suggests a strength in

the policy’s ability maintain an educational focus that complements the HSAP (n=1).

The primary weakness identified was that students generally aren’t aware whether

amnesty applies to their situation until their meeting with OSRR, unless they are told by DPS

(n=2). Other identified weaknesses of the policy were the belief that the policy need not exist

(n=1) and the fear that students may abuse the policy (n=1).

VII. Conclusion

As of Fall 2019, Syracuse University has joined the many colleges and universities across

the nation employing Help Seeking Amnesty Policies in a harm-reduction, environmental

approach to addressing alcohol and drug misuse on campuses. As part of the implementation of

this policy, it is important to understand the administrative burden associated both with

administering the policy as an administrator and experiencing the policy as a student. The greater

in number and in severity of burdens that exist relative to a policy, the less effective the policy

will be in achieving its intended goals. However, based on stakeholder interviews, there does not

appear to be any significant burdens that are not inherent to the policy, and in fact, some

participants identified barriers which had been removed due to the new policy.

The psychological cost identified suggesting that students misperceive offices like OSRR

as existing exclusively to discipline students (n=2) has potentially significant implications for

this policy. Colby, Raymond, & Colby (2000) evaluated a campus policy mandating temporary

suspension pending treatment for substance misuse. Despite the university implementing the

policy out of concern for its students, students in the study expressed skepticism that concern

was the motivation behind the policy and believed the policy exclusively existed to deter

drunkenness (Colby, Raymond, & Colby, 2000). In the same study, involvement with college

officials was one of the top reasons that students caring for an intoxicated peer did not seek

additional help. It is worth exploring to what extent student perceptions of a university’s

motivation behind a policy influence their perceptions of college officials as a whole and thus

their likelihood to seek help. As noted by one participant in regard to Syracuse University’s

policy, students who go through the conduct process for alcohol- or drug-related offenses have

sometimes expressed disbelief that the administrators actually cared about their health and well-

being. Two participants additionally identified improving student perceptions of their offices as a

goal of the policy. With the Amnesty for Help Seeking Behaviors policy providing an avenue

through which students can still receive educational interventions without going through the

conduct process, will it improve student perceptions of the motivations of college officials? If so,

the policy may achieve the goal of improving student perceptions of administrators.

Burden et al. (2012) found that perceived administrative burden among the administrators

of a policy has important implications, such as influencing the potential for administrators to

shift responsibilities, view policies negatively, and execute erroneous discretionary judgements.

It is important, then, to note that a perceived strength of Syracuse University’s HSAP as

identified by two participants is that the policy aligns with a philosophy some administrators

have generally held even prior to the policy’s implementation. The potential psychological cost

ameliorated by implementing a policy more in line with administrators’ philosophies may have

larger, positive effects in the role of the administrators.

This study employed a qualitative method in order to compile a baseline examination of

Syracuse University’s Amnesty for Help Seeking Behaviors policy in its first year of

implementation. Based on information gathered through this study, I have included

recommendations related to the policy.

Recommendations

1. OSRR should collaborate with faculty and staff researchers to engage in and

publish research evaluating the impact of the Amnesty for Help Seeking

Behaviors policy. Even as HSAPs have increasingly been adopted by colleges and

universities throughout the country, there remains a critical need for more literature

examining the empirical merits of such policies (Oster-Aaland and Eighmy, 2007;

Lewis and Marchell, 2006; Bergen-Cico, Urtz, & Barreto, 2004; Martinez, Johnson,

& Jones, 2018). Given the limitations of this study, there is much more room to

explore the impacts and implications of this policy with greater empirical validity and

wider generalizability. Bergen-Cico et al. (2004) provide a historical precedent for

collaboration between Syracuse University faculty and staff to collaborate in

assessing alcohol- and other drug-related policies. Furthermore, this study did not

examine student perceptions of the policy. As indicated in this study, students at

Syracuse University have misperceptions of offices involved in addressing campus

alcohol- and other drug-related issues as being exclusively disciplinary in nature and

disregarding students’ health and well-being. These misperceptions may further

impact help-seeking behavior on campus (Colby, Raymond, & Colby, 2000). It is

important to gather data on student perceptions overtime to determine how this policy

may improve perceptions. Finally, in order to address the identified weakness that

students may abuse the policy, the policy should be continuously monitored for such

behaviors.

2. The Dean of Students Office should work with health and wellness offices on

campus to improve marketing and promotion of the policy. As identified by

participants in this study and supported by the literature, the most significant learning

cost for students in accessing this policy is knowing that the policy exists and what

the eligibility requirements are. Though one participant suggested that students have

been more knowledgeable of the policy, another participant suggested that one

improvement to be made was to ensure that students were aware of the policy from

day one on campus. First-year students are especially at risk for heavy drinking

behaviors (National Institute on Alcohol Abuse and Alcoholism, 2020; Bergen-Cico

et al., 2004; Martinez et al., 2018). This suggests a particular need to market this

policy in the early days of first-year students’ transition to campus to build help-

seeking behavior tendencies as soon as possible and reduce harm among an at-risk

demographic. Educational content could be delivered through orientation sessions for

new students, promotional materials distributed throughout campus, and training

sessions delivered to student groups by staff or peer educators. Improved education

about the policy would also help to ameliorate the identified weakness that confusion

among students about the policy still exists (n=2).

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Appendix I

Peer Institutions

Name of SchoolMedical Amnesty/Good

Sam Policy?Covers Alcohol? Covers Drugs?

Covers individual in need of medical attention?

Covers individual calling for help?

Covers organizations? Link:

Boston CollegeYes Yes Yes Yes Yes No

https://www.bc.edu/publications/studentguide/behavioralpolicies.html

Boston UniversityYes1 Yes Yes Yes Yes No https://www.bu.edu/dos/policies/lifebook/drugs-alcohol/

Brandeis UniversityYes Yes Yes Yes Yes No

http://www.brandeis.edu/studentlife/srcs/rightsresponsibilities/2018-2019-rr.pdf

George Washington UYes2 Yes No Yes Yes No https://studentconduct.gwu.edu/alcohol-medical-amnesty

Lehigh UniversityYes Yes Yes Yes Yes Yes

https://studentaffairs.lehigh.edu/content/lehigh-university-medical-amnesty-policy

New York UniversityYes Yes Yes Yes Yes No

https://www.nyu.edu/about/policies-guidelines-compliance/policies-and-guidelines/substance-abuse-and-

alcoholic-beverages.html

Northeastern UniversityYes Yes Yes Yes Yes Yes http://www.northeastern.edu/osccr/medical-amnesty/

Sourthern Methodist UYes Yes Yes Yes Yes No

https://www.smu.edu/-/media/Site/StudentAffairs/StudentLife/StudentHandbook/

SMU-Student-Handbook-18-19.pdf?la=en

Tufts UniversityYes Yes Yes Yes yes yes

http://students.tufts.edu/student-affairs/student-code-conduct/iv-policies-regarding-student-behavior

Tulane UniversityYes Yes Yes Yes Yes No

https://tulane.app.box.com/s/zmr23heyas4auflustjw8uw9rjts72rb

University of MiamiYes Yes Yes Yes Yes No

https://doso.studentaffairs.miami.edu/_assets/pdf/policies/student_rights_and_responsibilities_handbook.pdf

University of Notre DameYes Yes Yes Yes3 Yes Yes4 https://dulac.nd.edu/community-

standards/standards/responsibility/

Wake Forest UniversityYes Yes Yes Yes Yes Yes

https://aod.thrive.wfu.edu/resources/medical-amnesty-policy/

Syracuse UniversityNo5 No No No No No

https://policies.syr.edu/policies/university-governance-ethics-integrity-and-legal-compliance/alcohol-other-drugs-

and-tobacco-policies/1There is a good samaritan policy, but it states that students 'ordinarily will not be subject to University disciplinary sanctions' in these situations and BU is trying to do away with the term good samaritan. Spoke with an individual from BU who confirmed that the policy would still be in effect and is still a fully functioning good samaritan policy.

2Previous administrative or disciplinary history of lack of cooperation with University of responding officials, amongst other factors may limit eligibility for the program. First time only

3Exempt from the assignment of Disciplinary Status Outcomes, but not exempt from notification outcomes, which can include an on-campus housing probation.

4Organizations that take action in the event of alcohol or drug emergencies will have their judicial consequences mitigated.

5While Syracuse University does have a section under the alcohol and other drug policy in the student code of conduct about amnesty, the amnesty does not extend to emergency services which would be used in an emergency situation.

ACC Institutions

University of Virginia No

Virginia Tech University Yes8

Other Institutions

Name of SchoolMedical Amnesty/Good

Sam Policy?Covers Alcohol? Covers Drugs?

Covers individual in need of medical attention?

Covers individual calling for help?

Covers organizations? Link:

American UniversityNo No No No No No

https://www.american.edu/ocl/sccrs/upload/AU-Student-Conduct-Code.pdf

Cornell UniversityYes Yes Yes Yes Yes Yes1 https://health.cornell.edu/resources/health-topics/alcohol-

other-drugs/good-sam

Dartmouth UniversityYes Yes Yes Yes Yes Yes

https://student-affairs.dartmouth.edu/policy/good-samaritan-policy

Harvard UniversityYes Yes Yes Yes Yes Yes1 https://handbook.fas.harvard.edu/book/drugs-and-

alcohol#thirteen

University of RochesterYes Yes Yes Yes Yes Yes

http://rochester.edu/college/cscm/assets/pdf/standards_studentconduct.pdf

USCYes Yes Yes Yes Yes No https://policy.usc.edu/files/2018/07/SCampus-2018-19.pdf

Yale UniversityYes Yes Yes Yes Yes Yes

https://aod.yalecollege.yale.edu/info/medical-emergency-policy

Syracuse UniversityNo2 No No No No No

https://policies.syr.edu/policies/university-governance-ethics-integrity-and-legal-compliance/alcohol-other-drugs-

and-tobacco-policies/1Organizations that take action in the event of alcohol or drug emergencies will have their judicial consequences mitigated.

2While Syracuse University does have a section under the alcohol and other drug policy in the student code of conduct about amnesty, the amnesty does not extend to emergency services which would be used in an emergency situation.