jon brunner, ph.d. director, counseling and health services
TRANSCRIPT
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Jon Brunner, Ph.D.Director, Counseling and Health Services
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FGCU Health and Wellness Services
Student Health ClinicCounseling Center (CAPS)Adaptive Services for Students with DisabilitiesPrevention & Wellness Services (health
education)Testing Center
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Millennial Students: The Good, the Bad, and the Ugly(Born between 1982 through to today)
They tend to: not to learn from failure.
idealistic—hopeful of the future have increasing levels of stress and anxiety be more nurtured than previous generations.
parents tend to be overprotective and highly involved exposed to more structured upbringing Greater expectation for personal and immediate resolutions
have been raised by parents believing in the importance of self-esteem
have been pushed to study hard and succeed to choose careers that “pay off” nicely
multi-task well having juggled sports, school, and social interests as children
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Millennials contd. be quite interdependent (i.e. on friends, family, teachers/role-
models) be more inclusive and tolerant of religions, ethnicity and sexual
orientations have exposure to vast information but go less in-depth acknowledge and respect positions, titles, and rules
however, see it as a challenge to find a way around the rules. value peer bonding (e.g. organized team sports, church groups,
clubs) banding together to date and socialize rather than pairing off work well in groups, preferring this to individual endeavors
be quite technologically savvy (self-taught from experimenting and exploring)
computers, internet, smart phones, pocket pc
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American College Health Association (ACHA)National College Health Assessment (NCHA)
The largest known and most comprehensive data set on the health of college students
Initiated in 2000Revised in 2008 (NCHA II)Last given at FGCU, Fall 2009
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The Top 10 Impediments to Academic Performance According to Students 2000-2007Stress- 32% (32.4%)Cold/Sore Throat- 26% (20.7%)Sleep Difficulties- 24% (27%)Concern for Family or Friend- 18% (21.2%)Depression/Anxiety- 16% (14.3%)Relationship Difficulty- 15.5% (17.6%) Internet/ Games- 15% ** (12%)Sinus Infection- 8.5% (8.5%)Death of Friend/Family- 8.5% (11%)Alcohol Use- 7% (4.5%)
ADHD 6%
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The NCHA II Top 10 Impediments to Academic Performance According to Students 2008-Present
Stress- 27.3% (19.5%)Sleep Difficulties-
19.6% (19.5%)Anxiety- 18.4%
(19.9% #1) Cold/Sore Throat-
17.3% (16.4%)Work- 13.3% (16.4%)
Depression- 11.3% (13.9%)Internet/ Games- 11.1%
(10.3%)Concern for Family or
Friend- 11.0% (8.2%)Extracurricular Activities-
10.6% (6.5%)Relationship Difficulty-
10.5% (8%)ADHD- 6.7% #9
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NCHA II Survey - Mental Health2008-Present, Incidence in Last 12 Months
46.3% felt hopeless once during the year (50.2%)
48.4% felt overwhelming anxiety (49.8%)
38.1% felt overwhelming anger (44.1%)
30.3% reported being “so depressed that it was difficult to function” (31.0%)
6.2% seriously considered suicide (6.0%)
81% felt exhausted (not from physical activity) (84.5%)
5.3% intentionally injured themselves (3.5%)
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NCHA II Survey - Mental Health continued75.1% of students found some aspect of their life
being traumatic or very difficult to handle in the last 12 months (77.3%)44.9% reported Academics (47.5%)27.3% reported Family problems (30.7%)32.3% reported Intimate relationships (36.5%)35.4% reported Finances (43.6%)24.4% reported Sleep difficulties (31.6%)
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NCHA II Survey - SleepOnly 58.6% of students reported getting enough
sleep to feel rested in 3 or more mornings of the past 7 days (56.8%)
60.5% of students reported feeling tired, dragged out or sleepy during the day for 3 or more days of the past 7 days (63.5%)
NCHA II Survey - Stress
50.7% of students rated their level of stress as above average or tremendous within the last 12 months (51.2%)
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NCHA II Survey – Violence & Abusive Relationships2008-Present, Incidence in Last 12 Months
21.7% reported receiving a verbal threat (25.6%)10.6% reported unwanted sexual activity (8.4%)10.0% reported an emotionally abusive intimate
relationship (15.1%)
NCHA II Survey – Sexual Behavior68.0% had a sexual partner in the last 12
months (72.3%)
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NCHA II Survey – Alcohol & Other Drug Use2008-Present
Number of drinks consumed that last time students “partied” or socialized – Median of 4 (4)
33.1% of student reported binge drinking (five or more drinks per sitting) within the past 2 weeks (27.9%)
Substance Used (within last 30
days)
Actual Use Perceived Use
Alcohol 63.7% (62.9%) 94.3% (97.1%)
Marijuana 14.0% (9.8%) 78.2% (88.9%)
All Other Drugs 13.6% (12.9%) 76.6% (87.9%)
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CORE SurveyDeveloped by the Department of EducationPublished by the CORE Institute University Southern IllinoisMeasures alcohol and drug usage attitudes,
related events and perceptions of studentsCompleted online
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CORE Survey Forms
CORE Alcohol and Drug Survey-Long Form (Core Survey)
Survey of Students’ Perceptions of Campus Alcohol and other Drug Norms (Norms Survey)
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2004 Both Surveys Special Question n=640
“ I feel comfortable in situations where alcohol is consumed.”
Always – 20.9%
Often- 37.4%
Sometimes- 24.8%
Rarely- 11.3%
Never- 5.8 %
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Norm Survey: Alcohol Use
General Student
Perceived Norm
Binge Drinking 54%
Average Drinks 5.8
Consumed
Abstinence from 17.8%alcohol
Actual Norm
38%
3.2
17.3%
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Norm Survey:Attitude Toward Alcohol
Response Options:a. Drinking is never a good thing to do b. Drinking is all right but a person should not get
drunkc. Occasionally getting drunk is OK as long as it does
not interfere with academics or other responsibilities
d. Occasionally getting drunk is OK even if it does interfere with academics or responsibilities
e. Frequently getting drunk is OK if that’s what the individual wants to do.
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Norm Survey:Attitude Toward Alcohol
Response Options:a. Drinking is never a good thing to do (.3%)b. Drinking is all right but a person should not get
drunk (5.0%)c. Occasionally getting drunk is OK as long as it
does not interfere with academics or other responsibilities (52.1% - median)
d. Occasionally getting drunk is OK even if it does interfere with academics or responsibilities (20.5%)
e. Frequently getting drunk is OK if that’s what the individual wants to do (22.1%)
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Student Perceptions of Alcohol Use
77.2% breaks the Ice75.6 % enhances social
activity74.4% gives people
something to do68.7% gives people
something to talk about62.3% allows people to
have more fun61.8% facilitates a
connection with peers59.1% facilitates male
bonding
53.9% facilitates sexual opportunities
48.4 % facilitates female bonding
27.7% makes women sexier
17.8% makes men sexier17.5% makes me sexier
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2001 2004 2008 Reference Group
Consumed alcohol in past year
85% 81% 83% 84%
Consumed alcohol in past 30 days
72% 69% 64% 72%
Under age consumed in past 30 days
68% 65% 54% 68%
Binge drinking in previous 2 weeks
36% 38% 37% 47%
Average # drinks a week
3.6 3.2 4 5.8
Driven Under the influence
31% 18% 27% 26%
FGCU CORE Survey Comparison
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2008 CORE SurveyIllegal Drug Use (2004 Comparisons)
Marijuana 28.7 % used in past year (30.6%) 14.8% used this past 30 days (17.5 %) 11.4% used illegal drug other than marijuana
in past year (16.0%) 4.2% used illegal drug other than marijuana
in past 30 days (5.3%)
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Student Health Services (SHS)Location: Wellness Center
Hours: **8:30am – 5:30pm Mon.-Thurs**9:00am-4:30pm Fri
**Hours subject to change per semester
Phone: 590-7966
Appointments are strongly recommendedwalk-ins accepted
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Health Center Services All Services are Free and ConfidentialSHS uses EMRProvide Routine Medical CareGeneral PhysicalsHealth EducationWomen’s HealthVaccinationsBirth Control/MedicationsHIV Orasure TestingAfter Hours Service through NURSE RESPONSESupplies e.g. band-aids, crutches, condoms)
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Student Health Services Rendered (last year/outside of routine care)
Nearly 50% of FGCU students use SHSFlu Shots-2602Women’s Exams- 214STD Tests-529
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TOP Five Diagnostic Reasons Students Seek Health Services
Upper Respiratory InfectionContraceptive ManagementReproductive Health IssuesDermatological IssuesGenital/Urinary Issues12,449 student visits in 2009
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Student Health Services Staff and InsuranceStaffed by:
Medical Doctors Nurse Practitioners Registered Nurses
Voluntary Student Health Insurance through Academic Health Plans (not needed to receive health center services and available for year or semester)
Under age students need parent approval (forms available)
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Parent TipsIf your student is sick, tell them to go to the health center
first (its free, accessible and good first response)If they are told to take pain relievers, drink fluids, and get
plenty of rest, tell them that is a good thingRemind them about Nurse Response for non-service
hoursRemind them there are cost recovery charges for tests
and medicationsRemind daughters to keep up with female health examsAsk them if they are keeping up with sleep and dietary
needs (remind them there are free nutritionist services)
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2009-10 Student Survey of Health Services
* 77% agreed the Student Health Center is their usual source of care and/ or primary care provider while enrolled at FGCU
* 85% was satisfied with the ease of scheduling an appointment that meets their needs
* 89% was satisfied with the efficiency of the check-in and check-out process
* 91% was satisfied that the provider listened carefully to their concerns
* 94% was satisfied that their confidentiality and privacy were carefully protected
* 83% was satisfied with their overall visit at Student Health Services
* 84% agreed they are very likely to recommend the health service to another student
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Prevention and Wellness Services (PWS)
Health Education ProgrammingMYSTUDENTBODY (online for all students and
parents)Alcohol and Drug EducationPeers Care (Student group)Health Fair and Guest Speaker ServicesPrevention Extension (Gazebo)Graduate Student AssistantshipsNutritionist CareMassage Therapy
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Prevention and Wellness ProgramsMen’s mental health (emotional issues)Cookies, cokes and conversation series (housing 6 weeks series)Weight loss myths (healthy weight loss)Walking Wednesday (noon time walk for all)Social hosting (for Greeks)Health Fair (all campus event)3Cs of Stress (stress management)Sexual Jeopardy (sexual health) What’s in your lunch? (nutrition) McDreamy or McNightmare? (relationships) Party Smart (alcohol) Fitness-tips-to-go (physical health) Free 10 minute massages (stress relief)Total number of programs=322 Participants=6940
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Counseling and Psychological Services (CAPS)
Located: Second Floor Howard Hall
Hours 8:00 – 6:00 Mon.-Thurs.8:00 - 5:00 Friday
Phone: 590-7950
Provides 24 hour Emergency Services
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CAPS ServicesPersonal Counseling & TherapyCareer CounselingPsychiatric ServicesConsultationReferralCase ManagementEmergency On-call (24/7 availability)Outreach ProgramsAssessment Services (neuropsych testing for LD/ADHD)Website http://studentservices.fgcu.edu/Counseling/
(mental health screening and other electronic resources)
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Top 8 Reasons Students Come to CAPS (2008-2010)
1. Anxiety2. Stress3. Depression4. Self Esteem5. Relationship6. Academic7. Dating/Marriage8. Family
5,626 Sessions in 2009
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The National Survey of Counseling Center Directors (NSCCD) of 2009
Conducted since 1981Data provided by administrative heads of
college and university counseling centers in the United States & Canada
Designed to stay abreast of current trends in counseling centers
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NSCCD 2009 Survey HighlightsThe 302 centers surveyed represent 2.6 million
students who are eligible for counseling services at their institutions.
6.1% of centers charge for personal counseling, down from a peak of 17.2% in 1996. Only 1.7% of centers collect third party payments.
10.4% of enrolled students sought counseling in the past year. This represents approximately 270,000 students from the surveyed schools.
The ratio of counselors to students in 1 to 1,527.The average number of counseling sessions for all
students is 6.2 sessions per client.61% of the surveyed directors have access to on-
campus psychiatric consultation.
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2009 NSCCD Findings93.4% of directors report that the recent trend toward
greater number of students with severe psychological problems continues to be true on their campuses.
Directors report that 48.4% of their clients have severe psychological problems. 7.4% of these have impairment, so serious, that they cannot remain in school or can only do so with extensive psychological/psychiatric help
40.9% experience severe problems but can be treated successfully with available treatment modalities.
60.6% increased the amount of time training faculty and others to respond in a helpful way to students in trouble and to make appropriate referrals.
53% expanded external referral networks.
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2009 NSCCD Findings continued48.7 % provide psycho-educational assistance on
center websites.47.4% increased training for staff in working with
difficult cases.28.5% increased counseling center staff.260 centers hospitalized an average of 8.5
students per school (2,200 students in all) for psychological reasons. The average number of hospitalizations per 1,000 students was 1.5.
73% of directors describe their centers as primarily a mental health/psychological services center.
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2009 NSCCD Findings continued
Directors reported 103 suicides in the past year.95.5% of centers maintain the right to refuse treatment to a student whose problems appear to be beyond the capability of the center to handle. However, 46% of responding directors report that they would not deny service in such cases if the student refused an outside referral and demands to be seen at the center.
87% contribute to freshman orientation programs
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An article written by Twenge, J. M., Gentile, B., DeWall, C. N., Ma, D., Lacefield, K., &
Schurtz, D. R.
and published in Clinical Psychology Review, 30, 145-154 (2010).
Birth Cohort Increases in Psychopathology Among Young Americans, 1938-2007:
A Cross-temporal Meta-analysis of the MMPI
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Purpose of the study:
Use quantitative research with a large sample size to explore 2 important questions:
Is mental illness on the rise in emerging adults?
What model might best explain such a rise in mental illness?
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Meta-Analysis What is a meta-analysis?
A research method that combines the results of several studies to address related research hypotheses.
This meta-analysis used mean scores that are reported as T-scores on the MMPI measures.
This meta-analysis looked at data from the MMPI, MMPI-2, and MMPI-A for the years 1938 through 2007 (1951-2002 for the MMPI-A).
In total, this study included 117 samples of 63, 706 college students and 14 samples of 13,870 high school students.
High school students were included to confirm data found in college populations and attempt to rule out population changes in college samples.
While the study may have included students who were seen at counseling centers, to be included in the meta-analysis, a study had to report means for all students, not those chosen for high/low scores, being current clients, or otherwise indicating maladjustment.
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What is the MMPI (MMPI-2, MMPI-A)?The MMPI is a widely used personality inventory that is
designed to assess individual personality structure and psychopathology.
It was first published in 1943 and was originally developed to aid psychologists and psychiatrists assign appropriate diagnostic labels.
One of the most commonly used personality tests in the United States.
Items were chosen because they differentiated “normals” from clinical groups.
The MMPI was revised and updated norms were calculated for the MMPI-2, published in 1989.
The current meta-analysis looked at data in reference to 8 clinical scales, 2 non-clinical scales, and 3 validity scales:
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Scale 1(Hs): persistent preoccupation with the body and fears of illness and disease.
Scale 2(D): poor morale, lack of hope for the future, general dissatisfaction with one’s life situation.
Scale 3(Hy): disruption in mental, or other, functionality
Scale 4(Pd): delinquent behavior, sexual promiscuity, excessive drinking, etc.
Scale 6(Pa): feeling of persecution, suspiciousness, grandiose self-concepts, etc.
Scale 7(Pt): excessive doubts, compulsions, obsessions, unreasonable fears.
Scale 8(Sc): bizarre thoughts or experiences, misinterpretations of reality.
Scale 9(Ma): overly elevated mood, accelerated speech, irritability, etc.
Scale 5(Mf): sexual identity development.
Scale 0(Si): tendency to withdraw from social contacts and responsibilities.
L Scale(Lie Scale): used to detect attempt to present oneself in unfavorable light, malingering.
F Scale(Infrequency): used to detect deviant or atypical ways of responding, such as not reading items or random responding.
K Scale(Correction Scale): measures tendency to obscure symptoms, faking good or faking bad.
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Hypotheses and ModelsThe authors believed they might find
increases in psychopathology based on findings of previous research.
If those increases were indeed found, the authors wanted to test three potential explanatory models:
The extrinsic versus intrinsic goals model The economic cycles model The response bias model (psychopathology is more
socially acceptable)
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Results *Keep in mind a mean of 50 and a SD of 10 for the MMPI; 2 or more
SD above the mean is considered clinically significant.*
MMPI clinical scale scores rose steadily between 1938 and 2007 – US college students scored more than a SD higher on the F scale, Pd, Pa, Sc, and Ma scales.
US college students score more than ¾ of a SD higher on Hy, D, and Pt scales.
US college students scores .45 of a SD higher on Hs.In 1938, 1 – 5% of students scored above a 70 on the
clinical scales (this represents a significantly elevated score, 2 SD above the mean)…by 2007, 40% scored above 70 on Ma, 33% on Sc, 28% on Pd, 19% on Pt, 19% on F, 18% on Pa, 10% on Hy, 8% on D, & 6% on Hs.
These results were confirmed in the high school sample.
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In plain language:(Ma) – more students are characterized by
unrealistically positive self-appraisal, overactivity, and low self-control.
(Sc) – more students feel isolated and misunderstood.(Pa) – more students may be described as sensitive
and sentimental.(Pd) – more students are narcissistic, self-centered,
and antisocial or do not follow the rules and standards of society.
General symptoms of anxiety are on the rise.(D, Hs, Hy, & Pt) – more students report worry,
sadness, and dissatisfaction, and may express these through physical symptoms.
(F) – more students are predicted to experience moodiness, restlessness, dissatisfaction, and instability.
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Which model best fits the data?The extrinsic versus intrinsic model -- linear increase in
MMPI scores…each successive generation showed an increase.
This suggests that a shift in American culture toward materialism, individualism, unrealistic expectations, and unstable relationships may account for the increase in psychopathology in young people.
-Young American’s focus on extrinsic goals is increasing. -Developing a meaningful philosophy of life is less important.-Divorce is indirectly impacting our young people.
“At the very least, college campuses now have a larger percentage of students with more serious mental health problems”
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Suicide Facts in the General Population
In America 30,000 die from suicide Every day 80 Americans take their own livesEvery day 1,500 Americans attempt suicide 11th Leading cause of death3rd Leading cause of death among 15 – 24
year old group
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Center for Disease Control and Prevention (CDC)Developed National Violent Death Reporting System
(NVDRS)Over 50,000 violent deaths in the US annuallyStarted out with 7 states (up to 18 this year)First data from 2003Majority (56.6%) of deaths were suicide (latest data
from 2007 and 16 states)Followed by homicides at 28%Most frequent method was firearmsOccurred at higher rate among males, native
Americans, non-Hispanic whites and persons ages 45-54
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College Student Suicide Facts
Suicide is the 2nd Leading Cause of Death for College Students
According to JED Foundation and NMHA over 1,000 College Students Die Each Year from Suicide
Rate of Suicide is 7.5/100,000 Students
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Do’s and Don’ts
DO:Stay in touch; encourage; be realistic; allow space
DON’T:Panic; tell them what to do; take over and assume Responsibility; insist on frequent visits or phone
calls; press your child on what they will do after school
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Remember the Developmental IssuesFor Parents:1.Competence-trusting your student2.Redefining yourself-role change from caretaker to
mentor3.Separation-mange your anxiety4.Intimacy-staying close without being over involvedFor Students:1.Achieving confidence and identity2.Separation and independence3.Managing emotions and achieving intimacy
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Parent Tips (developing the supportive partnership)If your student has had psychological issues that
required counseling/therapy and/or psychiatric medication, refer them to CAPS from the start
Find out if going to college is fulfilling their goals. Are they happy?(monitor don’t over react)
Ask about what they are discovering in terms of a career (it is OK to change)
Ask about how their relationships are going.Ask them how they are eating and sleeping
(seriously!).Ask about the pressure and stress they are feeling.
Try to help them see through it and be supportive
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Parent Tips (cont’d)Suggest they go to the CAPS website and take
whatever screening they think is relevant to how they feel.
Normalize the idea of seeking help let them know it is not a sign of weakness
Suggest they go see a counselor or therapist in CAPS. They can come just once to consult with a CAPS professional to see what we think or might suggest.
Tell them you understand college students drink, but that you would hope that it does not interfere in their academic or social life or put them or their friends at risk (explain what you mean)
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When should I be concerned about my student’s mental and emotional health?Social WithdrawalMarked change in appearance, self care, hygieneExcessive self criticismTearful calls outnumber the othersTalk of hopelessness Loss of motivationExcessive fatigue or lethargic moodExtreme increases in energy, rapid speech and thoughts Inability to think and concentrate, dramatic change in
gradesReferences to self harm or suicide
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2006-10 Student Survey of CAPS Counseling Services96% agreed they were comfortable using CAPS services,
would use them again and would refer others to CAPS92% agreed that their counselor honestly cared about them86% agreed they were better able to understand
themselves88% agreed they were able to better deal with their
concerns/problems86% agreed counseling had a positive effect on their
overall campus experience **64% agreed that counseling made them better able to focus
on academic and study requirements62% agreed that counseling made it possible for them to
continue as a student at FGCU**