THE CALIFORNIA COMMUNITY COLLEGE STUDENT MENTAL HEALTH PROGRAM:
ITS IMPACT ON THE CAPACITY OF GRANT-AWARDED COMMUNITY COLLEGES’
ABILITY TO RESPOND TO STUDENT MENTAL HEALTH
A Thesis
Presented to the faculty of Graduate and Professional Studies in Education
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
Education
(Higher Education Leadership)
by
Isabel Reyna
SUMMER
2014
THE CALIFORNIA COMMUNITY COLLEGE STUDENT MENTAL HEALTH PROGRAM:
ITS IMPACT ON THE CAPACITY OF GRANT-AWARDED COMMUNITY COLLEGES’
ABILITY TO RESPOND TO STUDENT MENTAL HEALTH
A Thesis
by
Isabel Reyna
Approved by:
, Committee Chair
Francisco Reveles, Ed.D.
, Second Reader
Betina Hsieh, Ed. D.
Date
ii
Student: Isabel Reyna
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library and credit is to
be awarded for the thesis.
, Chair
Susan Heredia, Ph.D.
Date
Graduate and Professional Studies in Education
iii
Abstract
of
THE CALIFORNIA COMMUNITY COLLEGE STUDENT MENTAL HEALTH PROGRAM:
ITS IMPACT ON THE CAPACITY OF GRANT-AWARDED COMMUNITY COLLEGES’
ABILITY TO RESPOND TO STUDENT MENTAL HEALTH
by
Isabel Reyna
Brief Literature Review
Students experiencing mental illnesses find their campus experience challenging for a
number of reasons, including the enduring and detrimental stigma so strongly associated with
mental illnesses. With one in three undergraduate students reported feeling so depressed it was
difficult to function, and with 86% of students with mental illnesses are expected to withdraw
from college before obtaining their degree, the importance of propagating mental health
awareness and encouraging help-seeking behavior is vital (Salzer, 2012). Students at higher risk
for mental health issues, particularly student veterans, foster students, and LGBT students, are
matriculating in higher education at higher rates. This beckons the conversation that a larger,
more visible and comprehensive dialogue around mental health and the reality of its presence on
college campuses needs to be instituted.
Statement of the Problem
California Community Colleges constitute 25% of the nation’s college student
population, and as more and more students enroll into higher education, more students with a
mental illness are in college classrooms. The education of student mental health at institutions of
higher education is critical if campuses are to address the prevention and early intervention needs
iv
of their students, faculty, and staff.
Methodology
The methodology used for this research was both qualitative and quantitative.
Qualitative methods were utilized to assess how the grant enhanced campus responded to student
mental health needs.
Conclusions and Recommendations
Based on the data collected and analyzed between June 1, 2012 and March 31, 2013, the
Campus Based Grant (CBG) resourced the delivery and education of prevention and intervention
(PEI) strategies and best practices to over 21,000 persons. Additionally, the CCC SMHP
enhanced the capacity of 23 campuses’ to respond to the mental health needs of students by as
much as 76%. Overall, the CCC SMHP had a significant impact on the existing mental health
services on campuses and was awarded a CBG. Furthermore, based on the findings of this
research, college leaders and policymakers should consider the struggles with which students
with mental illnesses contend, and the difference mental health education can have on all
stakeholders of institutions of higher education.
, Committee Chair
Francisco Reveles, Ed.D.
Date
v
DEDICATION
This work is dedicated to all students who have experienced difficulty with his or her
mental health. To all students who have been referred to as crazy, have been feared, felt
alienated, and have struggled in college because of it.
This work would not have been possible without the hard work and dedication
demonstrated by the primary contacts at the community colleges awarded the Campus-Based
Grant. Thank you for your commitment to making every student count and for putting in the 11th
hour to seeing that students with mental illness enjoy resources they either never knew existed or
were never offered.
vi
TABLE OF CONTENTS
Page
Dedication ................................................................................................................... vi
List of Tables ................................................................................................................ x
List of Figures ............................................................................................................. xi
Chapter
1. INTRODUCTION .................................................................................................. 1
Overview ........................................................................................................... 1
Statement of the Problem .................................................................................. 3
Significance of the Study .................................................................................. 3
Definition of Terms........................................................................................... 4
Organization of the Thesis ................................................................................ 6
2. REVIEW OF RELATED LITERATURE .............................................................. 7
Introduction ....................................................................................................... 7
Current State of Mental Illness in California .................................................... 7
Disparities in Mental Health Need .............................................................. 8
Unmet Mental Health Needs and Treatment ............................................ 11
Current State of Mental Health among College Students in California.......... 16
Veteran Populations .................................................................................. 18
Lesbian, Gay & Transgender Populations ................................................ 19
Theoretical Frameworks ................................................................................. 21
Kohlberg’s Theory of Moral Development .............................................. 21
vii
Chickering’s Theory of Identity Development ......................................... 24
California Responds to Student Mental Health Challenges ............................ 28
The Department of Mental Health and CalMHSA ................................... 29
California Community College Student Mental Health Program
(CCC SMHP) ............................................................................................ 30
Rationale for the Study ................................................................................... 33
Summary ......................................................................................................... 34
3. METHODOLOGY ............................................................................................... 36
Introduction ..................................................................................................... 36
Research Design.............................................................................................. 37
Setting of the Study................................................................................... 37
Population and Sample ............................................................................. 39
Design of the Study......................................................................................... 40
Data Collection Procedures............................................................................. 41
Instrumentation ......................................................................................... 43
Data Analysis Procedures ............................................................................... 44
Limitations of the Study.................................................................................. 44
4. FINDINGS AND INTERPRETATION ............................................................... 46
Introduction ..................................................................................................... 46
Presentation of Data .................................................................................. 47
Students, Faculty and Staff Reached ........................................................ 47
viii
Impact of Training and Services on Campus Mental Health Support
and Infrastructure ................................................................................ 57
Analysis........................................................................................................... 62
CCC SMHP Delivery of Mental Health Services ..................................... 62
Increase in Student Mental Health Infrastructure ..................................... 64
Summary ......................................................................................................... 65
5. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS........................ 66
Summary ......................................................................................................... 66
Conclusions ..................................................................................................... 68
Recommendations ........................................................................................... 69
Recommendations for Future Research ...........................................................70
Appendix A. CCC At-Risk Faculty/Veterans/At Risk Student Leader .................... 73
Appendix B. Student Mental Health Programs ........................................................ 79
References ................................................................................................................... 82
ix
LIST OF TABLES
Table
Page
1. Suicide Prevention Training (SPT) and Post-Survey Participants .........................47
2. CBG Completed Suicide Prevention Trainings (SPT).......................................... 48
3. Campus Roles of “At-Risk for Faculty & Staff” and “Veterans on Campus”
Participants ...................................................................................................... 50
4. SPT Reach to Priority Student Populations .......................................................... 51
5. Allocation of TTA Service Delivery to CCCs from April 2012 to February
2013................................................................................................................. 51
6. Type of TTA Delivery to CCC Campuses from April 2012 to February 2013
(N=121) ........................................................................................................... 52
7. Reach through Training of Trainees (TOT) .......................................................... 54
8. Reach by Presentations and Trainings .................................................................. 55
9. Reach though Regional Strategizing Forums (RSFs) ........................................... 56
x
LIST OF FIGURES
Figure
Page
1. Different Mental Health Services ......................................................................... 58
2. Mental Health Service Expansion ......................................................................... 60
3. The capacity of existing resources ........................................................................ 61
xi
1
Chapter 1
INTRODUCTION
Overview
Eighty-six percent (86%) of students with mental illnesses are expected to
withdraw from college before obtaining their degrees, compared to the 45% withdrawal
rate of the general student population (Salzer, 2012). Unfortunately, many students
experiencing mental health problems will not seek help because of the powerful and
detrimental stigma that accompanies mental illness. The fact that mental health is
gaining national attention due to traumatic events, such as the Virginia Tech and Sandy
Hook Elementary tragedies, largely continues to propagate the malignant image that
many people may have toward individuals with a mental illness. This negative outlook
on mental illness keeps many students from seeking help, and can result in many
withdrawing from college, remaining in states of depression, and even committing
suicide. Fortunately, California has taken action (California Department of Mental
Health, 2010) to raise awareness around the realities of mental health, and educate
students, faculty and staff to combat the adverse effects mental illness has on student
performance.
The California Community College (CCC) system represents the nation’s largest
system of higher education, enrolling over 2 million students and constituting 25% of the
nation’s community college population (Baca et al., 2011). The CCC system also
provides a gateway to four-year universities that have very diverse student populations,
which vary in background and academic preparation. Among the minority student
2
populations that the CCC system takes pride in educating are student veterans, LGBT
students, and foster students. These populations happen to be at higher risk for a mental
illness (Baca et al., 2011). In July 2012, the California Community Colleges Student
Mental Health Program (CCCSMHP) granted 23 CCCs Campus-Based Grants (CBG) to
support Student Mental Health Programs on their campuses to reduce the gaps in mental
health services and to enhance campus capacity to address the mental health prevention
and early intervention needs of their students, faculty, and staff.
This thesis focused specifically on the outreach made to students, faculty and staff
through these grants and how they impacted the capacity of campus grantees to respond
to the mental health needs of their students. In addition, the following questions were
used to guide this research (Beca et al., 2011; Children’s Advocacy Institute University
of San Diego School of Law, 2010; Student Mental Health Program, 2013):
1. What are California Community Colleges (CCCs) doing to address the
challenges of students with mental health issues?
2. How is the CCC SMHP expanding services to students struggling with mental
health?
3. How many students, faculty and staff are participating in mental health
training in prevention and early intervention, services and strategies?
4. How are campuses planning to determine the effectiveness of their services
for students with mental health issues? (p. 18, 14; p. 4)
Data for this research was gathered primarily from contacts on campuses awarded
a CBG, as well as from contractors appointed as resources to campuses by the CCC
3
SMHP. Through this methodology, it was demonstrated how effective funding to support
the development of mental health resources impacts the capacity of campuses to respond
to the mental health needs of students.
Statement of the Problem
Institutions of higher education offer students many resources to support their
academic performance in college. However, the campus experience for students with
mental illnesses remain difficult as far too many campuses fall short of supporting, or
simply acknowledging students experiencing problems with their mental health. This
research explores mental health resources delivered by CBG campuses and the impact it
has on the campus’ capacity to respond and support students with a mental illness. What
mental health trainings and activities were offered as a result of this grant? Are campus
stakeholders participating in these activities? How has these mental health resources
affected the existing services on campuses? As the number of students enrolling in
higher education continues to grow, the conversation of how many students may be
suffering from mental health problems must be not only acknowledged, but addressed.
Significance of the Study
According to the American College Health Association (2012), nearly 30% of
students reported “feeling so depressed it was difficult to function” within the given year,
6.9% seriously considered suicide, and 1.2% attempted suicide. Mental illness is not
exclusive to students, for one in four Americans will experience symptoms associated
4
with a diagnosable mental condition in a given year (Salzer, 2012). These figures not
only have implications on student academic performance and retention, but in the overall
livelihood of individuals and ultimately the economic stability of the nation. As the
National Alliance on Mental Health (NAMI) (Gruttadaro, D., & Crudo, D., 2012) argued
higher education is the foundation for securing stable employment and achieving
financial independence. At the same time, it places pressure on schools to
provide the services and supports that are necessary for these students to stay in
school and to achieve academic success. (p. 4)
Success of students in higher education plays a role in the nation’s prosperity, and
students with mental illnesses should not be considered any less of valuable agents. This
study provides greater insight on how mental health services on CBG campuses
experience growth since the advent of Campus Based Grants, as well as the alarming
number of Americans affected with mental illnesses.
Definition of Terms
Throughout this work, there are key terms and language used that are specifically
related to this research. To understand the language and phrases referenced throughout,
the following terms are defined:
Mental Illness
Mental illnesses are medical conditions causing a variety of symptoms that can
affect one’s daily life. Mental illness can disrupt a person’s feeling, mood,
thinking, ability to relate to others, and daily functioning, with diagnoses
5
including depression, schizophrenia, bipolar disorder, obsessive-compulsive
disorder (OCD), and posttraumatic stress disorder. (National Alliance on Mental
Illness, 2013, p. 1)
California Mental Health Services Authority (CalMHSA)
The California Mental Health Services Authority oversees the implementation of
three statewide prevention and early intervention (PEI) statewide initiatives, and is the
founder of the California Community College Student Mental Health Program.
California Community College Student Mental Health Program (CCC SMHP)
A program focused on addressing the mental health needs of students through
prevention and intervention strategies. The CCC SMHP is a partnership between
the California Community Colleges Chancellor’s Office (CCCCO) and the Foundation
for Community Colleges (FCCC).
Campus-Based Grant (CBG)
A Campus-Based Grant is a grant awarded to 23 California community colleges
by the CCC SMHP based on their Request for Application and Technical Proposal
submitted to the Foundation for California Community Colleges and California
Community College’s Chancellor’s Office. The grant is intended to expand and enhance
the capacity of the awarded campuses to address mental health preventions and early
intervention needs of their students, faculty, and staff.
6
Prevention and Early Intervention (PEI)
Includes education, services, strategies and best practices informing individuals
on how to identify persons who may be affected by a mental health issue, as well as how
to appropriately intervene.
Organization of the Thesis
The organization of this work is introduced in Chapter One, providing an
overview and background of the subject and study, populations of concern, statement of
purpose, and explains the significance and implications of the study. Chapter Two
provides a comprehensive review of the literature as it pertains to student mental health,
including the current state of mental health in California and group populations at higher
risks. Theoretical frameworks of Arthur Chickering and Lawrence Kohlberg in Student
Development in College: Theory, Research, and Practice by J. Evans, et al. (2010), are
reviewed to further ground and justify the study, followed by an overview of the action
taken by California to combat the alarming figures of mental illnesses among students.
The methodology used in this study is introduced and discussed in Chapter Three.
Insight to the setting of this study is provided, as well as the research design to explain
the population and sample, and data collection procedures. The trajectory of the results,
interpretation and analysis of the data are then presented in Chapter Four. Chapter Five
concludes this thesis with a summary, conclusions, and recommendations for
future research.
7
Chapter 2
REVIEW OF RELATED LITERATURE
Introduction
This chapter provides a review of the literature that addresses the role of mental
health and mental health services have on students attending higher education in
California. In particular, the following four areas will be discussed in this chapter: the
current state of affairs of mental illness statewide in California, the adverse effects mental
illnesses has on college students, how institutions of higher education are responding to
students with mental illnesses, and how California legislation is supporting efforts led by
institutions of higher education. The review of the literature on these matters allows for a
better understanding of the scope of mental health on California Community College
Campuses.
Current State of Mental Illness in California
Approximately one in four adults, or 26% of Americans, will experience
symptoms associated with a diagnosable mental condition in a given year (Salzer, 2012).
In California, results from the 2007 California Health Interview Survey showed 2.2
million of the 26.8 million adults (8.3% of California’s adult population) were identified
as having mental health needs (Grant et al., 2011). Data also indicated an alarming
50.4% of those individuals did not receive treatment, and 26.2% reported having received
some, but not minimally adequate, treatment (Grant et al., 2011). Findings show distinct
8
disparities among particular population groups that constitute the 76.6% reported adults
in California with unmet mental health needs.
UCLA’s Center for Health Policy Research defines disparities in mental health
needs as “differences in the prevalence of mental health needs among specific
populations within California” (Grant et al., 2011, p. 8). Additionally, those with reported
“mental health needs” are adults with both “serious psychological distress and at least a
moderate level of impairment in one or more life domains” (Grant et al., 2011, p. 9).
Socio-demographic indicators of mental health needs include health insurance status, race
and ethnicity, age, sexual orientation, nativity status and English proficiency.
Disparities in Mental Health Need
Health insurance coverage status. Findings from the CHIS 2005 suggest having
any type of health insurance coverage made visits to and utilization of mental health
services more likely. At a rate of 9%, adults with health insurance were nearly twice as
more likely to seek services within the given year than the 5% without health insurance
(Grant et al., 2010). Similarly, insured adults with perceived needs reported seeking
mental health services at a much higher rate (37%) than uninsured adults at (19%) (Grant
et al., 2010). Among adults experiencing serious psychological distress, based on the
number and frequency of symptoms, visits to a mental health professional were more
likely for those insured at (37%) than the uninsured at (24%) (Grant et al., 2010). The
prevalence of visits to mental health professionals were not only affected by health
insurance coverage, but use of services also varied by the type of coverage, there seems
to be a correlation between whether one has private or public healthcare. Among the 23
9
million adults in the 18-64 age group, 18.5% of those with public health insurance had
mental health needs, approximately doubling the statewide average of 9.2% for this
population group (Grant et al., 2011). Those with private coverage had significantly
lower rates of need at 7%, while those with inconsistent health coverage, such as being
uninsured for part of a year, had higher rates of mental health needs at 14.4% (Grant et
al., 2011). Furthermore, findings from the CHIS 2007 suggested that having inconsistent
health care coverage or public health insurance put California adults ages 18-64 more
likely to have mental health needs, even when adjusted for age, gender, income and
education. What these figures indicate is that not only does health insurance coverage
play a role in the mental health needs of California adults, but it may also serve as a
barrier to seeking treatment.
Race and ethnicity. In addition to mental health needs varying by status of health
insurance coverage, race and ethnicity also plays a role in the rate of mental health needs
among California adults. Before adjusting to age, gender, income and education, the
CHIS 2007 found that American Indians and Alaska Natives had 16.7% of mental health
needs among California’s racial and ethnic population, twice the statewide rate of 8.3%
(Grant et al., 2011). Native Hawaiians, Pacific Islanders and multiracial groups had the
next highest rates of mental health needs at 13%, and it remains higher than the statewide
average after adjustments to age, gender, income and education (Grant et al., 2011).
African Americans, Latinos and non-Latino Whites have rates statistically comparable to
the statewide average, while Asians showed the lowest rate at 6% (Grant et al., 2011).
After the same adjustments, the proportion of mental health needs for Latinos decrease by
10
statistically significant amounts, indicating the higher unadjusted rates of mental health
needs for this population may be attributed to other demographic factors such as age,
gender, income and education (Grant et al., 2011).
English Proficiency. California is home to large populations of individuals who
speak a language other than English. To understand how this plays a role in the rate of
mental health needs among California adults, English proficiency was analyzed from
CHIS 2007 by comparing data among three groups: those who speak English only, those
who speak another language in addition to speaking English well or very well, and those
who do not speak English very well if at all. Results show among those who spoke
another language and did not speak English well if at all, had mental health needs at a
rate of 6.4%, significantly lower than the state average of 8.3% (Grant et al., 2011).
Whereas those who speak English only and those who speak English well or very well,
the rate of mental health needs was 8.9% and 8%, respectively, statistically similar to the
statewide rate (Grant et al., 2011).
Sexual orientation. Findings from the CHIS 2007 show mental health needs also
vary by sexual orientation. Among the 20.3 million adults who were asked about their
sexual orientation, 1.7 million, or 8.5%, reported having mental health needs (Grant et al.,
2011). Sexual minorities, those who are 18 to 70 years old who self-identified as gay,
lesbian or bisexual or who have reported having sex with someone of the same sex within
the past 12 months, reported mental health needs at more than double this statewide rate
(8.5%) at 19.7% (Grant et al., 2011). As opposed to the mental health needs among
heterosexuals was 7.9%, which remained consistent after adjustment (Grant et al., 2011).
11
California regions. The CHIS 2007 also surveyed adults’ mental health needs by
regions in California and were analyzed according to the following areas: the Northern
and Sierra area, Greater Bay Area, Sacramento Area, San Joaquin Valley, Central Coast,
Los Angeles, and Other Southern California regions. Results showed most regions had
rates statistically similar to the statewide rates, even when adjusted for income, age,
gender and education (Grant et al., 2011). The only areas that had statistically higher
rates of mental health needs were counties within the Northern and Sierra regions that
yielded a need of 10.7%. After adjusting for demographic factors, the Northern and
Sierra regions showed rates no longer statistically similar to the state rate of 8.3%,
indicating that the higher levels of mental health needs in this area would be attributed to
demographic differences associated with mental health needs (Grant et al., 2011).
Unmet Mental Health Needs and Treatment
While mental health needs in California adults varied by socio-demographic
indicators such as race and ethnicity and sexual orientation, they also showed alarming
rates of disparities in unmet mental health needs. Among the 2.2 million adults in
California, 76.6%, had unmet mental health needs with a rate of including those who had
not received minimally adequate treatment (Grant et al., 2011). CHIS uses the measure
of minimally adequate treatment to capture whether or not adults with mental health
needs visit health professionals, their number of visits, and whether or not they had taken
prescription medications for their mental health (Grant et al., 2011). Thus, those adults
with unmet needs include adults who did not receive any treatments as well as those
adults who received some treatments but did not satisfy the minimally adequate treatment
12
criteria. Only 23.4% of adults had received what the CHIS defined as minimally
adequate treatment (Grant et al., 2011). Various indicators, including age, gender,
education, insurance status and race and ethnicity plays a role in the utilization of mental
health services among adults in California with mental health needs.
Age. Adults ages 18-24 and 65 and older were among the population groups most
likely to have unmet mental health needs (Grant et al., 2011). Ninety-one point eight
percent (91.8%) of adults 65 years and older yields a rate of 85.3% of unmet needs, with
young adults 18-24 at a rate of 91.8% (Grant et al., 2011). These age groups utilized
services that were not minimally adequate at rates of 25% - 27.5%, with those not
receiving treatment in this age group showing rates of 40.5 – 65.7% (Grant et al., 2011).
Furthermore, adults within the 40-64 years age range were found to have reported the
highest rates of having mental health needs met (Grant et al., 2011).
Gender. Data from CHIS in 2005 showed women in California were nearly 1.5
times more likely to report serious psychological distress at rates of 4.5%, compared to
males at 3.1% (Grant et al., 2010). Similarly, women were also 1.5 times more likely to
report the needs for services for mental health problems at 22.7%, versus the 14.3% for
males (Grant et al., 2010). Although men yielded lower rates of reporting mental health
issues, men were also less likely to report utilization of mental health services than
women, at rates of 6.5% and 10.1% respectively (Grant et al., 2010). Men, when
compared to the statewide rate of 50.4% of adults not receiving treatment in the past 12
months, only 18.5% of California adult males had their mental health needs met (Grant et
al., 2011). This left 82% of males with unmet needs, representing 56.5% of males
13
receiving no treatment and 25.1% of males failed to receive minimally adequate
treatment (Grant et al., 2011). For adult women in California, 46.7% did not utilize
mental health services, representing 26.9% of women who did not receive minimally
adequate treatment, compared to 26.5% of women who had their mental health needs met
(Grant et al., 2011).
Education. An individual’s position of educational achievement in California
also plays a role in the use of adequate mental health services. Those with the lowest
level of educational achievement, constituting anything before the 9th grade, reports the
greatest number of unmet mental health needs at 87%, with 63.1% of individuals failing
to receive any treatment, and 24.1% receiving some treatment but not minimally adequate
treatment (Grant et al., 2011). All levels of educational achievement varied in terms of
not receiving any treatment when comparing to statewide rates of 50.4%, with rates
ranging from 37.2% to 63.1%, but yields similar patterns in the utilization of services that
did not satisfy minimum adequate treatment, falling between 23.3% and 28.3% (Grant et
al., 2011). In particular, 42.8% of adults with some college education did not seek
treatment for their mental health needs, while 29.1% report needs being unmet after
treatment, similarly, 28.1% reported receiving minimally adequate treatment (Grant et al.,
2011). Adults with a postgraduate education reports the highest percentage of mental
health needs of 34.6%, while 37.2% receive no mental health treatment, and 28.3%
receive some treatment, but not minimally adequate treatment (Grant et al., 2011).
Race and ethnicity. The use of mental health services also vary among racial and
ethnic groups. Unmet mental health needs were highest among Asians and African-
14
Americans compared to Latinos, Whites, American India/Alaska Natives, and Native
Hawaiian/Pacific Islander & multiracial groups. For Asians with mental health needs,
only 13.4% received minimally adequate treatment, leaving 86.6% of Asians with unmet
mental health needs – including 62.7% of those who did not seek any treatment and the
23.9% that received some treatment, but not minimally adequate treatment (Grant et al.,
2011). Similarly, 83.5% of African Americans report having unmet mental health needs,
with 22.6% utilizing services that did not meet the minimally adequate threshold, and
only 17.6% of African Americans reported having received adequate treatment (Grant et
al., 2011). Of the racial and ethnic groups surveyed, white adults reported the highest
number of seeking treatment and having their mental health needs met at a rate of 30.5%
(Grant et al., 2011).
Region. The CHIS 2007 showed limited variations in mental health treatment by
California region. The Northern and Sierra regions show the highest number of adults
having their mental health needs met, whereas all other regions, including the Los
Angeles, Sacramento, Greater Bay Area, and San Joaquin Valley region, show
approximately 75% of adults in these areas did not have their needs met (Grant et al.,
2011). In particular, over half of adults in the Los Angeles, Sacramento and San Joaquin
Valley did utilize any mental health services relative to the statewide rate of 50.4% (Grant
et al., 2011). The Los Angeles region had 21.6% of adults receive minimally adequate
treatment, with 56.2% not receiving any treatment at all and 22.2% of adults receiving
inadequate treatment, for a total of 78.4% of adults in Los Angeles failing to have their
needs met (Grant et al., 2011). Similarly, the Sacramento and San Joaquin Valley area
15
shows that 74.9% and 77.3% of adults reporting their mental health needs unmet,
respectively (Grant et al., 2011).
The Northern and Sierra regions had about one-third, or 33.8%, of adults
receiving minimally adequate treatment, compared to the Great Bay Area, which shows
the lowest fraction of adults receiving minimally adequate treatment at 19.7% (Grant et
al., 2011). The CHIS 2007 data investigated the variation in mental health needs by
assessing indicators that may play a role in the receipt of minimally adequate treatment.
Using the statewide rates as a benchmark, data shows adults in California were less likely
to receive minimally adequate treatment that would satisfy their mental health needs
depending on variables including age, gender, educational attainment, race and ethnicity,
and region (Grant et al., 2011).
Furthermore, more exhaustive analyses shows that falling under the younger age
groups, being male, having lower educational achievement, having poor English
proficiency and being uninsured were risk factors associated with having one’s mental
health needs unmet (Grant et al., 2011). All of this data sheds light on the
disproportionately higher level of mental health needs among particular subgroups within
California. An insight is provided on the landscape of mental health needs and where the
most vulnerable populations to the worsening or development of mental health issues
may be. There is alarming disparities of both mental health needs and adequate treatment
among adult subgroups in California.
Suicide. As the tenth leading cause of death in California, approximately 3,300
Californians lose their lives to suicide every year, averaging to nine Californians dying by
16
suicide everyday (California Department of Mental Health, 2010). Suicide rates among
adults 65 and older increases significantly, with adults 85 years and older having the
highest suicide rates in the state (California Department of Mental Health, 2010).
Although suicide rates is high among adults over 65, it does not fall under the top ten
leading causes of death for this population. However, for young adults between the ages
of 16 and 25, suicide is the third leading cause of death (California Department of Mental
Health, 2010). Ninety percent (90%) of those who have died by suicide had a
diagnosable mental condition, and male Veterans are two times more likely to die by
suicide than their fellow American peers (NAMI, 2013).
Current State of Mental Health among College Students in California
California offers the largest system of higher education in the nation, educating
over two million students and constituting 25% of the nation’s community college
population (Baca et al., 2011). Across the state, the 112 community colleges enroll
students of all ages, backgrounds and academic preparation. This includes working
adults over the age of 25 that comprise half of the community college population, as well
as a large population of California veterans receiving GI educational benefits (Baca et al.,
2011; About the Colleges, n.d.). Each year, the community college system provides a
gateway to four-year universities for its diverse student body. The 55% of graduates from
California State Universities and 28% of graduates from University of California schools
are transfers from California community colleges (Baca et al., 2011). Although
community college systems takes pride in these numbers, the campuses have been struck
17
with a potent reality that adversely impacts the academic performance of its students:
mental health.
According to NAMI (2013), nationwide, one in four adults, ages 18 and older, or
approximately 61.5 million Americans, experience mental illness within a given year.
Six point seven percent (6.7%) of American adults cope with major depression, and
18.1% live with anxiety disorders, including panic disorders, obsessive-compulsive
disorders (OCD), posttraumatic stress disorders (PTSD), and generalize disorders and
phobias. Additionally, according to the National Institute of Mental health (2013),
approximately 20% of youth within the ages of 13 to 18 experience mental illnesses
within a given year. Recent mental health findings from the National College Health
Assessment, sponsored by the American College Health Association (ACHA-NCHA,
2012), provide insight to the state of mental health among the general college and
university student populations. Results from the 2012 ACHA-NCHA II found that 29.5%
of students report “feeling so depressed it was difficult to function” (American College
Health Association, 2012). Moreover, 6.9% of students report having seriously
considering suicide within the past 12 months, and 1.2% attempt suicide (American
College Health Association, 2012). A disconcerting 86% of students with mental
illnesses are expected to withdraw from their institution of higher education before
completing their degree, compared to the 45% withdrawal rate of the general student
population (Salzer, 2012). While data on the number of Americans affected by mental
illnesses exists, understanding the role mental health plays in the campus experience for
students is still undergoing comprehensive understanding but continues to evolve through
18
collaborative data collection efforts. Fortunately, other studies have shown prevention
and early intervention strategies and services can help curtail these alarming figures.
Although there is help-seeking behavior among community college students, there are
particular student population groups that, in addition to the subgroups listed above, are atrisk students and vulnerable to mental health issues, including student veterans and
LGBT students.
Veteran Populations
Over two million veterans have returned from active duty from Operation
Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq – a
decade of combat operations that results in escalating rates of mental health problems
among veterans of OEF and OIF, including post-traumatic stress disorder (PTSD),
substance abuse, depression, anxiety and suicide (Bryan, Goulding & Rudd, 2011). With
suicide as the second leading cause of death among military service members, veterans
with combat exposure face much greater risks of suicide than their civilian counterparts
(Bryan, Goulding & Rudd, 2011). According to the National Comorbidity Survey, PTSD
often coexists with another mental condition, with 80% of those with PTSD meeting
criteria for at least one other mental disorder (Braquehais, Casas & Sher, 2012).
Similarly, rates of PTSD, major depression, and substance abuse are significantly higher
among veterans with combat experience, variables that strongly associates with suicidal
thoughts (Hoge et al. 2004). The risk of suicidal ideation is nearly six times higher in
veterans with PTSD experiencing comorbid mental health disorders, than in veterans that
have PTSD alone (Braquehais, Casas & Sher, 2012). Since OEF and OIF, US military
19
members’ suicide rates have increased from 12.4 per 100,000 in 2003, to 18.1 per
100,000 in 2008 (Braquehais, Casas & Sher, 2012). In 2009, an estimated 460,000
veterans were expected to enroll in an institution of higher education, begetting the
conversation as to whether campuses are equipped to face the unique needs of this
student population (Widome et al., 2009). With the number of matriculating veterans
growing in numbers nationwide, a 2011 study assessed the national risk of suicide risk
among student veterans separating from military service from OEF and OIF. The
national study shows that 34.6% of the sample report severe anxiety, 23.7% experience
severe depression, and 45.6% exhibit severe symptoms of PTSD (Bryan, Goulding &
Rudd, 2011). Furthermore, 20% of the sample reports having had suicidal ideation with a
plan, with 7.7% reported having made a suicide attempt (Bryan, Goulding & Rudd,
2011). These numbers are alarming, especially when the 7.7% of suicide attempt rates
are compared to the 1.2% attempts of suicide among college students nationwide.
Lesbian, Gay & Transgender Populations
Another population group vulnerable to mental health problems are LGBT
students, which have a history of reporting higher rates of depression, hopelessness, and
suicidal behavior than their heterosexual counterparts (Heimberg & Safren, 1999). A
meta-analyses of cross-sectional studies in 2008 found that the risk for depression is at
least twice as high among lesbian, gay and transgender (LGBT) individuals,
disconcerting results when compared to the national rate of mental health conditions of
26% (Killaspy et al., 2010; Salzer, 2012). Moreover, anxiety, alcohol and substance
abuse is approximately 1.5 times more common among LGBT populations, and are 2.5
20
times more likely to attempt suicide than their heterosexual counterparts (Killaspy et al.,
2010). Another study conducted on LGBT youth aged between 16-20 years old yielded
alarming findings in mental health rates and suicidal behavior. The 20% of the
participants who identified as transgender met criteria for major depression, while 17.9%
of lesbian and gay participants and 7.1% of bisexual participants met criteria for major
depression (Emerson, Garofolo & Mustanski, 2010). Similarly, 10%, 11.3% and 7.1% of
transgender, lesbian and gay, and bisexual individuals report evidence of PTSD,
respectfully (Emerson, Garofolo & Mustanski, 2010). Data also shows 10%, 7.3% and
4.3% of transgender, lesbian and gay, and bisexual individuals have attempted suicide
within the last 12 months, respectfully, with other studies estimating that 26-43% of
transgender individuals have attempted suicide at least once in their life (Emerson,
Garofolo & Mustanski, 2010; Daley, McIntyre, Ross & Rutherford, 2012). Another study
conducted by Westefeld, Maples, Buford and Taylor (2001) attempts to measure suicidal
risk among LGBT student populations comparing to a sample of their heterosexual peers.
The study found that LGBT students were at a higher risk for feeling depressed and
lonely, with evidence of a positive correlation to suicidal tendencies (Suicide Prevention
Resource Center, 2004). These figures are representative of college-going youth and
beget the conversation around whether or not college campuses are prepared to provide
adequate support to assist this student population in their path to academic success.
Several theoretical frameworks may serve to inform how institutions of higher education
can respond to the prevalence of mental health problems among college students.
21
Theoretical Frameworks
These numbers above indicate that a more urgent conversation on addressing the
mental health needs of students is needed. This conversation should also include how to
understand the role it plays in their academic performance and campus experiences.
Lawrence Kohlberg, Arthur Chickering, and William G. Perry Jr. (as cited in Evans et al.,
2010) offer theoretical frameworks that validates the needs to develop a strong
infrastructure for mental health on college campuses. Kohlberg’s theory of moral
development and “just communities” were largely directed for the development of moral
education programs and can serve to guide student affairs educators on how they can play
an instrumental role in students’ moral development and ultimately their mental health (as
cited in Evans et al., 2010).
Kohlberg’s Theory of Moral Development
Kohlberg defined moral development as “the transformation that occur in a
person’s form or structure of thought,” in regards to what is perceived as right or
necessary (as cited in Evans et al., 2010). Kohlberg also argued one condition that can
foster moral development is when an individual is faced with disequilibrium, or cognitive
conflict (as cited in Evans et al., 2010). Disequilibrium occurs when an individual is
encountered with situations that “[arouse] internal contradictions in their moral reasoning
structures” or when one recognizes that their reasoning is different from their significant
others (as cited in Evans et al., 2010). This conflict in reasoning, outlooks and opinions
can serve to facilitate moral development, and as Norma Haan argued, has been effective
in nurturing moral development among students living in residence halls exposed to a
22
variety of moral structures and perspectives (as cited in Evans et al., 2010).
Research conducted by James Rest shows individuals attending college yields an
increase in “principled reasoning”, supporting the argument that collegial environment
can play an active role in fostering moral development by exposing students to a variety
of (conflicting) social, intellectual, and cultural experiences (as cited in Evans et al.,
2010). John M. Whiteley further argued that students are in environments where they
interface with conflicting perspectives and diverging ideas on various issues through
collegial conditions which guide moral development, including living away from home,
residence halls, and coursework (as cited in Evans et al., 2010).
Student Affairs educators can leverage Kohlberg’s theory of moral development
(as cited in Evans et al., 2010) and particularly his disequilibrium theory, to present
students with the opportunity to become more educated around the reality of mental
health illnesses that may exist among their peers. Although mental health is garnering
more national attention, several studies have shown that media coverage delivers a
negative and stigmatized portrayal of individuals living with mental health conditions
(Bednarova, 2011). For example, as Otto Wahl argued, when mass media covers a tragic
incident committed by someone with a mental condition, who is very commonly cast as
dangerous and unpredictable, it may amplify fear (as cited in Chapman, DiIorio &
Kobau, 2010). Not only does this coverage amplify the fear of suicide, the negativity
portrays and promotes hesitation to seek help. Additionally, media coverage of suicide
cited on the American Foundation for Suicide Prevention (AFSP) indicates significant
potential for irresponsible reporting (as cited in Suicide Prevention Resource Center,
23
2004). Such coverage may deliver negative outlooks on individuals living with a mental
condition, exacerbating existing stigmatization and may have detrimental effects on those
living with a mental health issue (Bednarova et al., 2011). While these individuals fight
stigma every day, they are likely deterred from recovery or from seeking treatment at all
(Bednarova et al., 2011).
On the same note, public stigma may facilitate the paradox of self-stigma,
whereby one internalizes the stigma and discrimination, consequently eroding selfefficacy, self-esteem and mood (Corrigan & Rao, 2012). With an estimated 1,100
students that die by suicide annually – an average of three per day – as reported by the
Jed Foundation (2006) and the Mental Health America formerly known as National
Mental Health Association (n.d), leaders on college campuses are urged to educate the
campus community and promote a positive dialogue around the realities of mental health
through in-class discussions, advocacy programs and/or awareness campaigns (Jed
Foundation, 2006). The Suicide Prevention Center suggested that mental health mass
education and awareness campaigns can “stimulate cultural changes that de-stigmatize
mental health problems,” and encourage help-seeking behavior (Suicide Prevention
Resource Center, 2004, p. 23). College educators can play a role in a students’ moral
development by applying Kohlberg’s theory of moral development through the
encouragement of student participation in an active dialogue around mental health (as
cited in Evans et al., 2010). By offering students the opportunity to face their potential
stigmatized perceptions of mental health, advocacy programs and awareness campaigns
may arouse “internal conflict” on one’s perception of mental health (Crisis of Identity?
24
Veteran, Civilian, Student, 2011).
Consequently, this may guide students to achieve a paradigm shift about those
living with mental conditions, and ultimately abandon any existing stigma associated one
may have harbored toward mental health. When disequilibrium and cognitive dissonance
expose students to conflicting social, intellectual, and cultural outlooks on reasoning,
such as mental health, college leaders can transform the perception of mental health on
college campuses and ultimately promote help-seeking behavior.
Chickering’s Theory of Identity Development
College leaders can also apply Chickering’s theory of identity development (as
cited in Evans et al., 2010) to achieve similar outcomes through student communities and
student development programs. Chickering proposed there are seven vectors to
development that facilitate the formation of an identity, providing a “comprehensive
picture of psychosocial development during the college years,” (as quoted in Evans et al.,
2010, p. 67). The seven vectors are what Chickering argued as the “major highways for
journeying toward individuation”, a journey that can allow for effectively addressing
issues that may arise later in one’s development process and enhance student growth (as
quoted in Evans et al., 2010, p. 65). While Chickering considered identity development
as a critical development issue that many students grapple with during their college years,
the experience of realizing identity can vary according to a student’s social identity and
pre-entry variables such as ethnicity, gender, race, sexual orientation, and/or one’s
transition experience to higher education (as cited in Evans et al., 2010). Additionally,
while Chickering’s theory of identity development expands on the issues of development
25
that students contend with, those student populations at higher risk for mental health
issues may experience extra difficulty in progressing through the seven vectors of identity
development.
Students’ progress through the seven vectors of development, which are not
rigidly sequential or linear and build on each other through developing competence,
managing emotion moving through autonomy toward interdependence, developing
mature interpersonal relationships, establishing identity, developing purpose, and
developing integrity (Evans et al., 2010). Through the resolution of each of the seven
vectors, a student will develop intercultural and interpersonal tolerance and appreciation
of differences, comfort with one’s sexual orientation, commit to interpersonal decisions
even in the face of opposition, and finally, establish a personal value system while
acknowledging the interests and beliefs of others (Evans et al., 2010).
Studies found that in resolving each component to identity development, students
showed growth, particularly, in areas of purpose, mature interpersonal
relationships, academic autonomy, and tolerance, which is healthy for success in
college. Navigating through the vectors to identity development not only
accomplishes sense of purpose, integrity and identity, but can also promote
humanitarian concern, which can play a strong role in students’ understanding of
mental health among their peers and to not be threatened by differences. (as
quoted in Evans et al., 2010 p. 73)
This theoretical framework of development emerges from Erik Erikson’s theory
of identity development as “an evolving sense of self that changes, adapts, [or
26
maladapts], when one encounters challenges in the environment;” this is notably salient
among student vulnerable to mental health, including LGBT students and student
veterans (Crisis of Identity? Veteran, Civilian, Student, 2011, p. 54). If institutions of
higher education are to support students’ establishment of identity and ascertainment of a
sense of purpose, then college leaders need to recognize the supplementary trouble
particular student populations may have with realizing these feats. According to the
Association for the Study of Higher Education, identity development for student veterans
may be stalled by their struggles with the transition from active duty to student (Crisis of
Identity? Veteran, Civilian, Student, 2011). For student veterans coming from a military
environment where daily routines are strongly defined and decision-making is based on
external authority, traversing college grounds with a “less programmed civilian world”
can be challenging (Crisis of Identity? Veteran, Civilian, Student, 2011, p. 56).
The college environment, where self-regulation is pivotal to a successful
transition, presents a stark contrast to the structure conditions that were exerted by
outside forces and where relationships were predetermined for veterans (Crisis of
Identity? Veteran, Civilian, Student, 2011). As one student who spent thirty-four months
in Iraq and Kuwait shared, “I was more scared of college than I was of the Marine Corps,
and that’s the truth” (Crisis of Identity? Veteran, Civilian, Student, 2011, p. 56).
Chickering and Reisser argued that veterans returning from combat will realize a sense of
identity once “they have questioned authority, explored identity options, grappled with
the idea of change, and become comfortable with the need for interdependency” (as
quoted in Crisis of Identity? Veteran, Civilian, Student, 2011, p. 64). By providing
27
support in student veterans’ renegotiation of identity after separating from active duty,
college leaders can assist student veterans in their transition to college life. This can be
accomplished by understanding their needs for specific support.
Similarly, Heidi Levine and J. Bahr founded that the development of sexual
identity may retard psychosocial development among LGBT students (as cited in Evans
et al., 2010). In addition to maneuvering through campus culture and the seven vectors
identified by Chickering (as cited in Evans et al., 2010), LGBT students face additional
trials of sexual identity developments, a developmental task heterosexual students do not
experience (Evans et al., 2010). During the establishment of a new minority identity,
LGBT students may face stigmatization, prejudice, and consequently experience
hesitation in disclosing their sexual orientation to friends, family, and the campus
community at large; this may unfortunately lead to a roadblock in development that may
present difficulties in resolving through more advanced tasks of the seven vectors (Ivory,
2005; Evans et al., 2010).
Furthermore, Chickering (Evans et al., 2010) argued that a student’s development
is strongly influenced by the institutional environment, and identified “key influencers”
that exert a powerful influence on a student’s path to development, including student
communities and student development programs and services (Evans et al., 2010, p. 69).
It is noted in Evans et al., 2010 by Chickering and Linda Reisser, “a student’s most
important teacher is often another student” - a key influencer that can occur through the
development of friendships and student communities (p. 71). By supporting the
development of diverse student communities, college campuses can facilitate significant
28
interactions between students of not only diverse backgrounds, but can also expose
students to disequilibrium and cognitive dissonance (as cited in Evan et al., 2010).
These findings warrant more attention to supporting campuses to enhance their
capacity to respond to these student needs. The unique challenges veteran and LGBT
students face on campus grounds during identity development may play an influential
role in the mental health challenges they are vulnerable to encountering. Thus, it is
critical that college leaders make efforts to not only implement educational campaigns
that raise awareness on student mental health, but also build student communities that
will support identity development for students, particularly those of high-risk for mental
health challenges. Furthermore, with nearly one in five adults in California reporting a
need for mental health services, these numbers are likely to grow with the evolving
economic crises in the state (Grant et al., 2011).
California Responds to Student Mental Health Challenges
As California Community College Chancellor Jack Scott said in a press release to
the California Community Colleges Chancellor’s Office (2011), while community college
students experience significant budget cuts and become more laden with economic
plights, recent data shows that stress, anxiety and depression are among the top factors
that affect student performance. In response to the one in three undergraduates reporting
feeling so depressed it was difficult to function, the California Mental Health Services
Authority (CalMHSA) awarded a $6.9 million grant to twenty-three California
Community Colleges to fund a California Community College Student Mental Health
29
Program (CCC SMHP) on its campuses (American College Health Association, 2012).
With the l Proposition 63 legislation in 2011, the CCC SMHP will provide faculty and
staff training on student mental health issues, suicide prevention and peer-to-peer
services.
The Department of Mental Health and CalMHSA
Recognizing the adverse effects of mental health issues among undergraduate
students and suicide as the tenth leading cause of death in California, Governor
Schwarzenegger charged the Department of Mental Health (DMH) with the development
of a strategic plan for suicide prevention in 2006 (California Department of Mental
Health, 2010). The California Strategic Plan on Suicide Prevention was approved by the
Governor’s Office on June 30, 2008, and by 2011 became a component of Proposition 63
(California Department of Mental Health, 2010).). Proposition 63, also known as the
Mental Health Services Authority (MHSA) Act, was approved by voters in 2004 and
operates through five components: community services and support, capita facilities and
technological needs, prevention and early intervention, and innovation (Mental Health
Oversight and Accountability Commission, 2009).
The Mental Health Oversight and Accountability Commission (MHOAC)
explains that 20% of the MHSA funds are allocated toward Prevention and Early
Intervention (PEI) Statewide Projects as a “key strategy to prevent mental illness from
becoming severe and disabling and improve timely access for underserved populations”
(2011, para. 1). The MHPAC approved for three of the five PEI Statewide Projects to be
implemented by a single administrative entity with a combined funding level of $40
30
million per year (California Mental Health Services Authority, 2010). The California
Mental Health Services Authority (CalMHSA) was then created in 2009 to oversee the
implementation of three PEI statewide initiatives with a total budget of $160 million,
including Suicide Prevention, Stigma and Discrimination Reduction (SDR), and the
Student Mental Health Initiative (SMHI) (California Mental Health Services Authority
Board and Staff, 2010; California Mental Health Services Authority, 2013).
After the Work Plan was approved by the MHSAC, requests for proposals (RFP)
and requests for applications (RFA) were released with detailed scopes of work for
twenty-four separate programs, including the Statewide Student Mental Health California
Community Colleges Student Mental Health Program RFA released in February of 2011
(2013). As CalMHSA stated, the SMHI “promotes and applies strategies to strengthen
student mental health statewide across K-12 educational systems and through institutions
of higher education” (2013, para. 1). As part of this initiative, CalMHSA awarded the
California Community Colleges Chancellor’s Office (CCCCO) $6.9 million to be utilized
through the California Community College Student Mental Health Program (CCC
SMHP) on preventive and early intervention (PEI) strategies (Center for Applied
Research Solutions, 2012).
California Community College Student Mental Health Program (CCC SMHP)
The CalMHSA funds awarded to the CCC SMHP are for the development and
implementation of PEI strategies that will “address the mental health needs of students
and advance the collaboration between educational settings, county services, and the
community at large” (2012, para. 2). Through its four main components, the CCC SMHP
31
seeks to achieve this by increasing the capacity of the CCC system to meet the mental
health needs of its students through: Training and Technical Assistance (TTA), Suicide
Prevention Training for Faculty and Staff (SPT), Campus Based Grants (CBG), and
Program Evaluation. These components will operate to educate students, faculty and
staff on student mental health and how to identify individuals at risk or showing early
signs of mental illness to connect them with treatment and other resources through
sustainable PEI strategies.
The Campus Based Grants (CBG) represents the 21 campuses and 3 consortium
campuses, representing a total of 30 campuses, selected by the CCC SMHP to enhance
their campus capacity to respond to student mental health needs (Center for Applied
Research Solutions, 2013). Selection were based on a campus’ existing viable
infrastructures, such as mental health services or other supportive student services,
demonstrated through each applicant’s Request for Application (RFA) (2013). As part of
their program design, each CBG is mandated to address at least one of the three PEI
strategic approaches of the Student Mental Health Strategic Plan as part of their grant
implementation efforts, including staff and faculty training, the development of peer-topeer networks, or SPT. In addition to addressing at least one of the strategic directions,
CBGs are required to host a Regional Strategizing Forum (RSF) to increase dialogue and
foster relationships between mental health partners and to share best practices, models
and strategies with stakeholders and neighboring campuses, including California State
Universities and University of California campuses.
CBGs are also required to participate in statewide evaluation efforts to measure
32
the CCC SMHP’s effectiveness in meeting student mental health needs. SPT, TTA and
the CCC SMHP are available to each CBG free of cost to support each campus in the
delivery of their mental health objectives. Among some deliverables CBGs have
identified as the means to accomplish one of the strategic plan’s approaches, campuses
have implemented Crisis or Behavioral Intervention Teams to address faculty and staff
training, an Active Minds chapter, a student support network to promote positive dialogue
around mental health, and/or Applied Suicide Intervention Skills Training (ASIST).
The TTA component delivers statewide mental health training and technical
assistance services to support the operation of the CCC SMHP grant on awarded
campuses through a contract between the CCCCO and the Center for Applied Research
Solutions (CARS) (2012). Additionally, the TTA services are available at no cost to all
California Community Colleges (CCC) and CCC mental health partners, including
county mental health, campus health services and mental health professionals (2012,
para. 6). Services can range from webinars, to customized training and technical
assistance to regional trainings such as Trauma Informed Care, Gay Alliance Safezone
Training and Welcome Home: Veterans on Campus Training (2012).
Suicide Prevention Training (SPT), provided by Kognito Interactive, offers
gatekeeper training designed to enhance the skills, knowledge, and abilities around
student mental health for CCC faculty, staff and key student populations (2012). This
avatar-based online training trains faculty, staff and student leaders through role-playing
simulations on how to identify signs of psychological distress, and how to approach and
talk with an at-risk student, including student veterans and LGBT students, to make a
33
successful referral (Kognito, 2013). The trainings are offered at no cost to all CCCs,
include At Risk for Faculty and Staff, Veterans on Campus, LGBTW on Campus for
Faculty and Staff, At Risk for Students, Veterans on Campus Peer to Peer, and LGBT on
Campus for Students (Kognito, 2013). The trainings are designed to prepare faculty, staff
and student leaders to not only identify students in distress, but also on how to manage a
conversation with the student (Kognito, 2013). The veteran and LGBT tailored trainings
offer a more tailored course to understand the challenges unique to this at-risk population
and on how to conduct supportive conversations with these particular student
populations.
Rationale for the Study
The current state of mental health among students in California is alarming and a
cause for concern. One in four adults will experience signs of a mental health condition
within a given year, and with CCCs constituting 25% of the nation’s college student
population, the possibility of these students having a mental illness should not be
overlooked. The review of the literature reflects on the implications of mental health
conditions going unmet, the unrelenting stigma associated with mental illness, and the
theoretical frameworks of Chickering and Kohlberg (Evans et al., 2010) that can be
leveraged to educate campus constituents and tackle the lack of self-seeking behavior
among college students. While there are new tools currently in place to measure the
impact of mental health on a student’s campus experience, such as through the ACHA
NCHA, there is little literature on how much the delivery of mental health resources and
34
services can enhance a campus’ capacity to respond to the mental health needs of
its students.
The purpose of this study is to determine how many stakeholders were reached
through the delivery of mental health education and services made possible by the CCC
SMHP, and how much these resources impacted the capacity of a campus to respond to
student mental health. The mental health problem exists, and has been acknowledged;
now administrators must consider the best course of action in response to the problem if
they are to ensure the success of its students and of the institution.
Summary
Research in The Mental Health Needs of Today’s College Students: Challenges
and Recommendations and Posttraumatic Stress Disorder, Depression and Suicide in
Veterans (Gallagher, R., Sysko, H., & Zhang, B., 2001; Casas, M., Braquehais, M.D.,
Sher, L., 2012) shows students are matriculating into higher education at higher rates and
experience greater difficulty in college when living with a mental illness. It is imperative
to not only recognize and understand the struggles that accompany students with mental
illnesses, but vital for campuses to play a role in supporting these students through degree
completion. The review of literature and theories discussed can guide students and
administrators with strategies and best practices for how to best be a change agent in
curbing the student mental health challenge.
This research will provide an understanding of how the implementation of student
mental health programs can educate students, faculty and staff on the reality of student
35
mental health to inform appropriate instructor-to-student and peer-to-peer interactions, as
well as on how to successfully refer a student of concern to a professional. This research
can serve as the impetus for more research and study on best practices in the delivery of
education on student mental health and in prevention and early intervention strategies.
36
Chapter 3
METHODOLOGY
Introduction
The purpose of this qualitative and quantitative study was to determine the effects
of the implementation of mental health prevention and intervention (PEI) programs,
services and strategies on 23 California Community Colleges (henceforth refer to as
CCCs) with existing mental health support and infrastructure. Shaped by the California
Community Colleges Chancellor’s Office (CCCCO), the Chancellor’s Office Advisory
Group on Student Mental Health (COAGSMH), and additional input from professionals
within the CCC system, evaluation efforts for this study focused on the training received
by students, faculty and staff within the 23 CCCs participating in the California
Community Colleges Student Mental Health Program (henceforth referred to as CCC
SMHP), and the impact it also made on the campus’ ability to identify students in need of
infrastructure of mental health services (Pacific Institute for Research and Evaluation
[PIRE], 2013). To determine this, a CCC SMHP Evaluation Midyear Report from July 2,
2012 to March 31, 2013 was administered and examined with additional data collected
between February 27 and April 10, 2013 for a CCC SMHP Capacity Survey of Mental
Health Services Baseline Report to illustrate changes administered by the program and to
measure the impact of SMHP activities and trainings on participants.
Data is comprised of analyses from the three components of the CCC SMHP:
Suicide Prevention Training (SPT), training and technical assistance (TTA), and at least
37
one PEI strategic direction of faculty and staff training, peer-to-peer support and/or
suicide prevention. Evaluation efforts continue throughout the duration of the two-year
grant. This chapter will provide information regarding the setting of the study, the design
of the study, the population and sample size, as well as all data collection procedures and
data analysis procedures conducted for the implementation of the CCC SMHP during its
first year and the changes in infrastructure of CCC student mental health services.
Research Design
Setting of the Study
The Request for Applications (RFA) for Campus Based Grants (CBGs) was
released and made open to all 112 CCCs on March 30, 2012 by the FCCC and the
California Community College Chancellor’s Office (CCCCO) for mental health
prevention and early intervention programs, services and strategies. Of the 34 campuses
that applied by May 18, 2012, 23 grants, representing a total of 30 campuses, were
selected to receive the grant. Data was collected from those campuses awarded the CBG
on a monthly and quarterly basis for analysis and evaluation, as well as from other
participating colleges within the system. It should be noted, however, that special
attention has been paid to those colleges awarded the CBG. Research and evaluation
efforts were conducted on the following CBG recipients within the reporting period of
July 1, 2012 – March 31, 2013:
Butte College
Reedley College
Fresno City College
College of the Canyons
38
Los Angeles Harbor College
Sierra College
Los Angeles City College
College of the Desert
Los Angeles Mission College
Riverside City College
Los Angeles Pierce College
Gavilan College
Los Angeles Southwest College
San Bernardino Valley College
Los Angeles Trade Tech College
Mira Costa
Pasadena City College
San Diego City College
Rio Hondo College
Cuesta College
Santa Monica College
College of San Mateo
West Los Angeles College
West Valley College
Orange Coast College
Santa Rosa Junior College
Golden West College
Modesto Junior College
Santiago Canyon College
Columbia College
The CCC SMHP footprint represents geographic equity, with grant
implementation efforts taking place on these campuses in the northern, central and
southern California regions. Similarly, population equity was achieved, with CCC
SMHP activity reaching students in the greater Los Angeles area, the San Francisco bay
area, the greater Sacramento area, and the San Diego metropolitan area. Evaluation was
primarily conducted by the Pacific Institute for Research and Evaluation (PIRE), under
various collaborative evaluation efforts with CalMHSA’s evaluators, Research and
Development (RAND), to reduce competing demands for data (PIRE, 2013).
39
Population and Sample
The population for the CCC SMHP Midyear Evaluation Report sample represents
faculty, staff and students that participates in trainings and activities resources by the
grants intended to enhance the skills, knowledge and abilities in regards to students in
need of mental health support. As stated above, CCCs not granted the student mental
health grant participated in CCC SMHP efforts, but special attention was given to those
30 CCCs resourced by the grant. The sample for this research consists of faculty, staff
and students who participated in Kognito Suicide Prevention Training (SPT), training and
technical assistance (TTA) provided by the Center for Research and Applied Solutions
(CARS), and CBG quarterly report data (PIRE, 2013).
Data for SPT was collected through an interactive online training using “Avatar”
programming for three products currently in place during the reporting period: At-Risk
for Faculty & Staff, At-Risk for Student Leaders, and Veterans on Campus (PIRE, 2013,
p. 4). At-Risk for Faculty & Staff and the Veterans on Campus trainings are made
available strictly to faculty, staff and administration, with At-Risk for Student Leaders
available to students, all three at no cost to participants. The SPT data is a self-selected
sample of a total of 3,384 completed trainings by faculty, staff and/or students,
representing an average of 30 trainings per CCC campus (PIRE, 2013). Between April
2012 and February 2013, a total of 121 TTA services were delivered to CCC campuses.
The nature of the delivered services included TTA initial readiness calls, webinar
trainings, onsite trainings or presentations, other phone consultations, product
development, and facilitations – a majority of which were provided to faculty, staff
40
and/or administration (PIRE, 2013). Project progress for the CBG component of the
grant was obtained through quarterly reports submitted every quarter by the 27 CBG
grantees, with data representative of students, faculty and/or staff that participated in
trainings and presentations, training of trainers (TOT), and Regional Strategizing Forums
(RSFs).
The sample population for the CCC SMHP Capacity Survey of Mental Health
Services Baseline Report represents 77 staff, faculty and/or campus administration
respondents. The Capacity Survey was sent to identified contacts for 107 CCCs, both
CBG and non-CBG campuses. Of the 107 faculty, staff and/or campus administration
contacted, 77 campus contacts completed the online survey with a completion rate of
70%. As stated above, this report provides a summary of what services newly developed
or enhanced since the advent of the grant, and is analyzed alongside PIRE’s the CCC
SMHP Midyear Evaluation Report.
Design of the Study
The design of this study used both quantitative methods to capture how the CCC
SMHP expanded the capacity of support services for students in need of mental health
resources since the advent of the grant. Both the CCC SMHP Midyear Evaluation Report
and CCC SMHP Capacity Survey of Mental Health Services were designed with
quantitative methodology through online surveys, with the exception of the TTA data
collected for the Midyear Evaluation Report, which was pulled from the CARS database.
The quantitative portions analyzed for this study were delivered on the Capacity Survey
41
to identified primary contacts utilizing Likert Scales (rating scale) and Yes/No questions.
Quantitative data for the Evaluation Midyear Report was obtained for SPT automatically
upon successful completion of online “Avatar” training. Quantitative data for the CBG
portion of the Midyear Evaluation Report was gathered with from the CBG Quarterly
Report submitted by CBG recipients every quarter. The Midyear Evaluation Report
contains data from the quarterly reports concerning the number of TOT, presentations
and trainings, RSFs resourced by the grant. This portion of the data was also collected
using the Likert Scale as well as Yes/No questions.
Data Collection Procedures
Approval from Sacramento State University’s Institutional Review Board, as well
as from the California Mental Health Authority, was necessary to move forward with this
research. As a Program Specialist for the Student Mental Health Program (SMHP) at the
Foundation for California Community Colleges, the researcher plays a significant role in
the collection and oversight of SMHP data from the CBGs. Upon approval, the next step
was synthesizing the data collected for the CCC SMHP Midyear Evaluation Report and
the CCC SMHP Capacity Survey of Mental Health Services. The sample selection for
the SPT portion of the Midyear Evaluation Report was collected through a survey
administered before and after the suicide prevention training. Participants are students,
faculty and/or staff, depending on the training taken. The three products currently in
place at the time of this data collection were: At-Risk for Faculty & Staff (strictly for
faculty and staff to take), At-Risk for Student Leaders (strictly for students to take), and
42
Veterans on Campus (available to faculty and staff only). Those taking the training
provide demographic upon registration during a pre-test, post-test and 3-month follow-up
(PIRE, 2013).
Quantitative data compiled for the TTA component of the Midyear Evaluation
Report is from the Center for Applied Research Solutions (CARS) TTA database (PIRE,
2013). This data includes narrative on the type of TTA services delivered to CCC
campuses, the CCC campus targeted and reached, and the date of the TTA. Quantitative
data for the CBG component of the Midyear Evaluation Report was gathered from
quarterly reports submitted to the Foundation for California Community Colleges
(FCCC) online every quarter by CBG recipients. Per the CBG contract, quarterly reports
are mandatory and encompass grant implementation progress of all 30 campuses
participating in the CCC SMHP.
The sample selection for the CCC SMHP Capacity Survey of Mental Health
Services Baseline Report was chosen through online survey participation. An
introductory letter from the California Community Colleges Chancellor’s Office
(CCCCO) was sent to identify primary contacts for 107 CCC campuses (PIRE, 2013).
The letter explained the project and purpose of the capacity survey and was accompanied
with a fact sheet describing the project’s overall evaluation efforts (PIRE, 2013). Two
days later, a follow-up email was sent to the CCC contacts with instructions on how to
complete the online survey through Survey Monkey. The email also has two
attachments: (a) a copy of the survey, a survey appropriate for CBG recipients and a
survey appropriate for non-CBG recipients, and (b) a Q&A regarding the survey.
43
Invitation links to the capacity survey on Survey Monkey was emailed to the CCC
contacts approximately 2-3 days later, with two reminders spaced about a week apart via
Survey Monkey. On March 21, a PIRE research assistant conducted follow-up calls to
non-CBG recipient contacts (PIRE, 2013). The research assistant contacted only those
contacts that had received the survey invitation and email reminders to reemphasize data
collection efforts by the end of March. Similarly, in the first week of April, the CCCCO
also reminded CBG primary contacts the importance of their participation in the capacity
survey (PIRE, 2013).
Instrumentation
All questions for the Midyear Evaluation Report were intended to measure the
following areas:
1. Number of students, faculty and administrative having received student
mental health training and/or education
2. Nature of services, trainings and/or presentation offered
All questions for the Capacity Survey were intended to capture the following with
Yes/No questions and the Likert Scale:
1. Trainings and/or services offered to enhance skills, knowledge and abilities
around mental health
2. Impact on campus capacity and existing mental health support infrastructure
/measureable impact on participants
The tool used for the capacity survey was Survey Monkey at surveymonkey.com.
Chapter four provides a synopsis and breakdown of who received relevant mental health
44
training since the advent of the grant, the types of services present on CCC campuses at
baseline, the development or expansion of mental health services on CCC campuses, and
the perceived readiness to change capacity of the mental health system on said CCC
campuses. As noted above, special attention was given to CBG recipients.
Data Analysis Procedures
The quantitative data analysis served to capture the number of students, faculty
and staff administration reached by the CCC SMHP during its first year of
implementation. The analysis will also provide an understanding of how the grant
introduced or enhanced existing mental health support services and resources to students
in need on California Community Colleges.
Limitations of the Study
The limitations of this study are as follows. In the Evaluation Midyear Report,
the Suicide Prevention Training (SPT) is a self-selected sample with data from California
Community Colleges that had pre-existing licenses with Kognito before the grant was
operational, and may thus show larger reach (PIRE, 2013). Additionally, the CARS
training and technical assistance data in the Midyear Evaluation Report has limitations in
its preliminary report. The information pulled from the TTA database represents a time
period from April 2012 to February 2013, whereas the data pulled for the webinar
trainings showed data for April 2012 to March 2013 (PIRE, 2013). At the time of the
TTA report, CARS was also unable to access detailed data from Regional Strategizing
45
Forums or on-site specific trainings that took place on California Community College
campuses. Finally, the researcher was a Student Mental Health Program Specialist for
the Foundation for California Community Colleges in partnership with the California
Community Colleges Chancellor’s Office, had close relationships with the campus grant
recipients, which may have led to biased reviews.
46
Chapter 4
FINDINGS AND INTERPRETATION
Introduction
The purpose of this study was to determine the effects of the California
Community College Student Mental health program (CCC SMHP) on expanding support
services for students struggling with mental health. The study focused on the mental
health resources and support made available to students, as well as the mental health
training opportunities made available and utilized by faculty, staff and students. The
following questions guided the research:
1. What are California Community Colleges (CCCs) doing to address the
challenges of students with mental health issues?
2. How is the CCC SMHP expanding services to students struggling with mental
health?
3. How many students, faculty and staff are participating in mental health
training in prevention and early intervention, services and strategies?
4. How are campuses planning to determine the effectiveness of their services
for students with mental health issues?
This chapter covers the results and statistics gathered from surveys completed by
students, faculty and staff during the first year of the CCC SMHP instituted on 23
California Community Colleges. The chapter begins with an analysis of the survey
47
results of students, faculty and staff, collectively, as well as independently according to
individual the community college campuses part of the CCC SMHP.
Presentation of Data
Students, Faculty and Staff Reached
Suicide prevention training (SPT). Students, faculty and staff taking the Suicide
Prevention Training through Kognito Interactive were asked to participate in a pre and
post-survey. Those taking the survey provided background information, with pre and
post-survey questions tailored for students and faculty and staff. By March 31, 2013, a
total of 1,502 students and 1,882 faculty and staff took a suicide prevention training
offered through Kognito Interactive.
Table 1 shows the number of suicide prevention trainings completed by faculty,
staff and students, as well as how many completed the post-survey following the training.
Table 1
Suicide Prevention Training (SPT) and Post-Survey Participants
Product
At-Risk for Faculty &
Staff
At-Risk for Student
Leaders
Veterans on Campus
Target Audience
Completed Training
Completed PostSurvey
Faculty & Staff
1,322
891
Students
1,502
1,001
Faculty & Staff
560
454
3,384
2346
Total:
Note. From PIRE Midyear Evaluation Report, 2013
48
According to Table 1, by March 31, 2013, 3,384 trainings were completed,
yielding an average of 30 trainings per CCC campus (PIRE, 2013). Similarly, by March
31, 2013, a total of 2,318 trainings were completed by faculty, staff and students from a
campus with a CBG (Kognito, 2013). A total of 55 CCCs had faculty, staff and/or
students complete an SPT course by March 31, 2013, with 25 of those campuses being
CBG campuses (Kognito, 2013). Table 2 shows a breakdown of completed trainings in
At-Risk for Faculty & Staff, Veterans on Campus, and At-Risk for Students at CBGs by
March 31, 2013.
Table 2
CBG Completed Suicide Prevention Trainings (SPT)
At-Risk for
Faculty & Staff
Veterans on Campus
At-Risk for Student
Leaders
Butte College
0
0
0
College of San Mateo
5
2
5
College of the Canyons
67
60
26
College of the Desert
2
1
4
Columbia College
24
6
5
Cuesta College
63
7
13
Fresno City College
4
0
0
Gavilan College
33
0
53
Golden West College
13
18
31
LA Harbor College
1
1
1
College
49
(Table 2 continued)
LA Pierce College
7
8
140
LA Trade-Technical
College
0
0
0
Mira Costa College
99
14
10
Modesto Junior College
72
58
0
Orange Coast College
40
29
116
Pasadena City College
22
67
2
Reedley College
4
0
0
Rio Hondo College
28
6
6
Riverside City College
107
0
171
San Bernardino Valley
College
6
3
100
San Diego City College
50
43
53
Santa Monica College
72
1
27
15
9
12
18
6
6
137
15
16
West LA College
0
0
0
West Valley College
60
13
226
Willow International
Community
2
0
1
951
367
1024
Santa Rosa Junior
College
Santiago Canyon
College
Sierra College
TOTAL
Note. From Kognito Training Summary (March 2012)
50
Of the 30 CCCs receiving CBG resources, only 4 CBGs had not trained any
faculty, staff or students in SPT. The campus roles of those who completed the At-Risk
for Faculty and Staff and the Veterans on Campus trainings vary, as can be seen on Table
3. Table 4 provides data on the reach to priority student populations, including lesbian,
gay, bisexual, transgender and queer (LGBT), student veteran, and foster youth
student populations.
Table 3
Campus Roles of “At-Risk for Faculty & Staff” and “Veterans on Campus” Participants
Roles
At-Risk Faculty & Staff
Veterans on Campus
Full-Time Faculty
22%
21%
Adjunct (Part-time) Faculty
25%
18%
Administrator or Staff
Member
26%
33%
Graduate Student
1%
3%
Resident Assistant or
Peer Counselor
Teaching Assista
1%
1%
Other
10%
18%
NA
14%
6%
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
51
Table 4
SPT Reach to Priority Student Populations
Student Group
N
%
LGBT
73
4.9%
Student Veterans
34
2.3%
Foster Youth
13
0.9%
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
Training and technical assistance (TTA). By February 2013, CARS completed
364 days of TTA delivery, with 192 (53%) of those days reaching colleges directly
(PIRE, 2013, p. 8). Of the 185 TTA assignments completed from April 2012 to February
2013, a total of 121 (65%) assignments were delivered to California Community College
(CCC) campuses (PIRE, 2013). Fifty of those assignments (41%) were targeted to CBG
campuses, 49 (41%) targeted to non-CBG campuses, and 22 (18%) were targeted at
multiple campuses (Table 5) (PIRE, 2013).
Table 5
Allocation of TTA Service Delivery to CCCs from April 2012 to February 2013
TTA Target Audience
TTA Assignments
N (%)
TA Days
N (%)
CBG campuses
50 (41%)
61 (32%)
Non-CBG campuses
49 (41%)
72 (37%)
Multiple campuses
22 (18%)
59 (31%)
Total
121 (100%)
192 (100%)
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
52
As can be seen on Table 6, the nature of the TTA delivery to CCCs ranged from
initial readiness calls to webinars, totaling 121 assignments. Initial readiness calls are
“in-depth needs assessment and discussion of possible training and technical assistance
needs” (CARS, 2013, p. 12).
Table 6
Type of TTA Delivery to CCC Campuses from April 2012 to February 2013 (N=121)
TTA Delivery Mechanism
TTA Assignments
N (%)
Initial Readiness Call
70 (58%)
Webinar
17 (14%)
Onsite Training
12 (10%)
Other Phone Consultation
10 (8%)
Product Development
10 (8%)
Facilitation
2 (2%)
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
Of the total 17 webinars conducted from April 2012 to March 2013, 13 were
delivered by CARS and four were delivered by the CCC SMHP during the launch of the
SMHP providing an overview of the TTA services offered by CARS. Fifty campuses did
not attend any of the 13 webinars offered, but 62 campuses attended one to nine webinars
offered, reaching 251 attendees (CARS, 2013). It is also important to note that while
some campuses did not attend live webinars while scheduled, records show 35 campus
contacts viewed archived webinars on the CCC SMHP website (CARS, 2013).
53
Satisfaction surveys were asked of participants via email following the
completion of each webinar conducted by. Satisfaction with each webinar was rated
using a Likert Scale from 1 to 4 with 1 meaning “not at all satisfied”, and 4 meaning
“very satisfied.” Of the 142 satisfaction surveys submitted, results ranged from 3.2 to
4.0, with an average rating of 3.6 across all webinars within the period of this research
(CARS, 2013).
Campus based grants (CBGs). Data extracted from the CBG quarterly reports
show reach for Training of Trainers (TOT), presentations and trainings, as well as
Regional Strategizing Forums (RSFs) organized by a CBG recipient. From July 1, 2012
to March 31, 2013, a total of 28 TOT events have been offered by a CBG, reaching a
total of 1,044 participants (Table 7) (PIRE, 2013). TOT can be considered training
provided to enhance one’s capacity as a trainer as it relates to student mental health, in
this case. As Table seven indicates, each TOT offered by a CBG specializes in
enhancing a particular skill and ability as it pertains to student mental health.
54
Table 7
Reach through Training of Trainers (TOT)
Target Audience
TOT Category
Total # of
Events
Total # of
Attendees
Total # of
Hours
Early Recognition of
Students of Concern
6
5
1
57
57
Crisis or Behavioral
Intervention
3
3
0
52
21
Suicide Prevention
9
7
2
218
75
General Health
Promotion
3
1
2
572
24
Peer-to-Peer Training
7
0
7
87
26
Total
28
16
12
1,044
203
Faculty/Staff Students
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
A total of 1,044 attended at least one of the events listed on Table 7.
Unfortunately, several CBGs were unable to capture an exact number of how many
students, faculty and staff constituted those who attended TOT events due to:
participants’ failure to sign-in according to his or her role on campus, and/or a
participant’s failure to follow up through a survey. Similarly, many participants at TOT
events were community members and/or stakeholders who did not assume any particular
role at an institution of higher education, and thus are not represented in the target
audience data on Table 7.
CBGs also offered general presentations and trainings to enhance one’s skill in
the area student mental health. A total of 372 events from July 1, 2012 to March 31,
2013 were offered by a CBG with a total attendance of 16,585 (Table 8) (PIRE, 2013).
55
Table 8
Reach by Presentations and Trainings
Number of Events by
Type
Student
s
Total #
of
Attendee
s
Total
# of
Hour
s
26
17
1118
90
12
18
3
768
91
16
32
15
31
2321
86
115
78
23
31
76
8449
467
64
37
20
15
41
1664
105
Other
62
19
31
8
52
2265
196
Total
372
201
135
113
220
16,585
1,035
Event
Category
Early
Recognitio
n of
Students of
Concern
Crisis or
Behavioral
Interventio
n
Suicide
Prevention
General
Health
Promotion
Peer-toPeer
Total
# of
Event
s
Presentation
s
Training
s
Faculty/Staf
f
51
34
17
30
17
50
Target Audience
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
The event, “Other,” designates an array of topics including LGBT equality and
sensitivity, veterans’ issues, nutrition and stress, strengths-based approach to reduce risk,
peer-to-peer one-on-one conversations, safety zone training, outreach, and body-mind
and wellness seminars. (PIRE, 2013). As with Table 7, facilitators at these events did not
capture the exact number of student, faculty and staff attendees, but a total of 113 faculty
and staff and 220 students were accounted for at the 372 trainings and presentations
56
offered by CBGs. It should be noted that SPT offered by Kognito is not included in the
data in Tables 7 and 8.
As part of the CBG contract, CCC recipients of the grant are required to organize
Regional Strategizing Forums (RSF). The primary purpose of an RSF is to increase the
dialogue around student mental health and to share best practices, models and strategies
“concerning the mental health needs of the overall student population, with particular
focus on high-risk student populations, such as student veterans, minorities, LGBT, and
other underserved segments of the student population,” (Center for Applied Research
Solutions, 2014).
Table 9
Reach through Regional Strategizing Forums (RSFs)
Primary Focus
# of RSFs
Total # of Attendees
Informational
4
130
Networking
10
673
Training
0
0
Other
2
76
Total
16
879
Note. From PIRE Midyear Evaluation Report (PIRE, 2013)
Several CBGs have collaboratively organized an RSF to combine resources and
expand reach, therefore there may be less RSFs organized than actual CBGs. By March
31, 2013, 879 students, faculty, staff, stakeholders and community members attended an
RSF hosted by a CBG.
57
Impact of Training and Services on Campus Mental Health Support and
Infrastructure
CCCSMHP Capacity Survey. The impact the SMHP had on CBG campus
mental health support and infrastructure is drawn from two questions asked of primary
contacts on CCC campuses: (1) The Types of Mental Health Services at a Baseline as of
July 1, 2012, and (2) the Development or Expansion of Mental Health Services between
July 1 and December 31, 2012 (PIRE, 2013). The types of mental health resources
provided by CBG campuses prior to implementing the SMHP resourced by the grant (as
of July 1, 2012) were obtained through the Yes/No survey question, “As of July 1, 2012,
did your campus provide or support the following mental health services?” Data
compiled from this question can be seen in Figure one as representing only those
respondents that answered “yes” to best show what campuses had available at a baseline
by July 2, 2012. The results (Figure 1) from this question showed that peer-to-peer
training was a service least supported by a campus at a baseline before grant
implementation, with a system of referral in place ranking among the highest available
resource on campuses at a baseline (PIRE, 2013).
58
Figure 1
Different Mental Health Services
Types of Mental Health Services at Baseline
As of July 1, 2012, my campus provides or supports the following
mental health services
100%
90%
89%
83%
80% 76%
80%
69%
70%
60%
50%
40%
52%
43%
37%
30%
41%
32%
32%
20%
20%
10%
% Yes
0%
*MH = Mental Health
**SMH = Student Mental Health
***BIT = Behavioral Intervention Team
Note. From Capacity Report (PIRE, 2013)
It should be noted that selection priority for the grant had been given to colleges
or consortiums that “[demonstrated] through responses to the Technical Proposal that
they [had] a viable existing infrastructure (such as health, mental health, or other student
support services) on which additional activities can be expanded, enhanced, and
leveraged,” (Center for Applied Resources, 2012, p. 1). Thus, the higher percentage of
59
system of referrals and behavioral intervention response teams in place before grant
implementation.
Question 4 on the Capacity Survey subsequently asked whether those services
addressed in Figure 1 were further expanded and/or if new services were developed since
the advent of the grant (Figure 2) (between July 1, 2012 – December 2012). Results
showed that a system for referring students of concern to the appropriate mental health
services ranked the highest as a service that was further expanded or newly developed
since the advent of the grant (Figure 2) (PIRE, 2013). The degree of expanded or newly
developed services addressed in Question four of the capacity survey ranged from 28% to
as high as 76% (PIRE, 2013).
60
Figure 2
Mental Health Service Expansion
Development or Expansion of Mental Health Services
Between July 1 and December 31, 2012, my campus developed or
expanded
80% 74% 76%
60%
57%
54%
47%
50%
40%
69%
67% 65%
70%
36%
33%
30%
28%
31%
20%
10%
0%
% Yes
*MH = Mental Health
**SMH = Student Mental Health
= Mental
Health
***BIT =*MH
Behavioral
Intervention
Team
**SMH = Student Mental Health
***BIT = Behavioral Intervention Team
Note. From Capacity Report (PIRE, 2013)
61
These results show since the advent of the grant, the capacity and infrastructure of
mental health services available on CCCs at baseline (Question 3; Figure 1) were
enhanced. The relationship between the existing mental health resources at baseline
against the expansion or development of mental health resources is shown on
Figure 3
The capacity of existing resources
Resources Available at Baseline Vs. Resources
Expanded or Further Developed
100%
89%
90%
80%
83%
76%
74%
67% 69%
65%
Response % Yes
70%
60%
50%
80%
76%
69%
57%
52%
54%
47%
41%
43%
40%
30%
33%
37%
32%
28%
36%
31% 32%
20%
20%
10%
0%
Baseline
As of July 1,
2012
n= 72-75
*MH = Mental Health
**SMH = Student Mental Health
***BIT = Behavioral Intervention Team
Note. From Capacity Report (PIRE, 2013)
62
increased significantly for several services including the faculty, staff and student suicide
prevention training (54% vs. baseline 37%), peer-to-peer trainings (31% vs. baseline
20%), and a system in place for staff to conduct appropriate student assessments (74% vs.
baseline 76%).
Analysis
A primary purpose of the CCC SMHP is to resource and support prevention and
early intervention strategies that address the mental health needs of students. With nearly
30% of students reporting “feeling so depressed it was difficult to function” within the
given year, the CCC SMHP sought, through its four main components, to strike these
adverse effects of mental health on students by increasing the capacity of the CCC system
to meet the mental health needs of its students through: Training and Technical
Assistance (TTA), Suicide Prevention Training for Faculty and Staff (SPT), Campus
Based Grants (CBG), and Program Evaluation (American College Health Association,
2012). Findings show that within the first year of grant implementation, the capacity of
CCCs to meet the needs of students of concern increased by as much as 76%, showing
potential in further growth and stronger impact for any CCC delivering mental health
education, services and outreach.
CCC SMHP Delivery of Mental Health Services
A great part of the PIRE Evaluation Midyear Report was also to assess the extent
to which CCCs, CBGs in particular, availed themselves of the mental health resources
granted to them. Data reveals a theme that while more resources are limited to and
63
available to faculty and staff, the rate of faculty and staff participation is lower when
compared to the rate of participation by students, relative to the number of resources
available to each.
Student reach vs. faculty & staff reach. Based on the data from the CARS
database and CBG quarterly reports, over 21,000 students, faculty and staff were directly
impacted by the delivery of student mental health resources made possible by the grant.
When combining results for both SPT offered to faculty and staff, a total of 1,882 faculty
and staff completed at least one of the trainings offered. However, a total of 1,502
students completed the At-Risk for Student Leaders SPT, the only training available to
students at the time of this research. For presentations and trainings made available to
faculty, staff and students, students showed wider participation, with a reported 220
students attendees versus the 113 faculty and staff attendees. Generally, students utilize
the mental health services funded by the grant more than faculty and staff, especially
those peer-to-peer-specific resources. Furthermore, primary student populations at risk
higher risk for mental health issues, such as student veterans, LGBT students and foster
students, were reached through SPT – demonstrating successful outreach to priority
populations. CBG quarterly reports showed trends of CBG contacts expressing difficulty
in yielding faculty and staff participation in SPT, particularly for Veterans on Campus.
Additionally, the data shows a discrepancy in the performance among CBGs in
regards to their Kognito SPT outreach. Although a total of 1,138 faculty, staff and
students completed a Kognito SPT, there were several CBG campuses with lowperforming figures in SPT completion. Butte College and West Los Angeles College
64
both did not have any completed SPT by faculty, staff or students at the time of this
research. Similarly, College of the Desert only had seven completed SPT, and the
Fresno-Reedley Consortium, a consortium of three colleges, had a total of 11 completed
SPT. These numbers appear considerably low when compared to high-performing CBGs
like West Valley College yielding 299 participants on Kognito SPT at the time of this
research. This gap in SPT delivery among could be attributed to, not geographic location
or number of constituents on campus, but to ineffective outreach informing students,
faculty and staff of the Kognito service available.
Increase in Student Mental Health Infrastructure
The researcher synthesized the data results of existing mental health resources on
campuses by July 1, 2012 with data results of the enhancement or development of those
same mental health resources available at baseline from July 1, 2012 to December 2012.
Regardless of the rate of participation by faculty, staff and students, overall, results
showed that all reported mental health services available on campuses at baseline
experienced growth and development since the advent of the grant. This positive impact
on the mental health services thus shows an increase in the capacity in the mental health
support and infrastructure on campuses, indicating satisfactory achievement of the
instituted CCC SMHP during its first six months (Figure 2).
65
Summary
The data extracted from PIRE’s Midyear Evaluation Report illustrated the CCC
SMHP’s reach to students, faculty and staff and was synthesized with data from the CCC
SMHP Capacity Survey of Mental Health Services Baseline Report. Data collection was
made possible through data gathered by CARS as well as by survey participation by CCC
contacts, with special attention given to those contacts from CBG campuses. This data
analysis shows significant utilization of mental health resources by students, faculty and
staff as well as an increase in campus capacity to respond to students in need of mental
health support.
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Chapter 5
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Summary
California offers the largest system of higher education in the nation, educating
over two million students and constituting 25% of the nation’s community college
population (Baca et al., 2011). Additionally, the number of matriculating students
experiencing a mental health problem, such as veterans, continues to grow nationwide,
prompting the pressing the conversation regarding student mental health. This research
focused on the action taken by the California Community College’s Chancellor’s Office
(CCCCO) and Foundation for California Community Colleges (FCCC) to respond to the
mental health needs of students. The data from this research will not only greatly inform
CBG recipients on how to best harness and deliver the resources awarded to them, but
can greatly inform researchers and administrators of all institutions of higher education
on how to implement student mental health resources effectively.
The methodology used for this research was qualitative to capture the number of
faculty, staff and students that participated in the mental health activities and/or events
resourced by the grant. The qualitative methodology approach was undertaken to
measure impact that these services had on the capacity of the existing campus grantee
infrastructure. The research addressed the following questions:
1.
What are California Community Colleges (CCCs) doing to address the
challenges of students with mental health issues?
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2. How is the CCC SMHP expanding services to students struggling with mental
health?
3. How many students, faculty and staff are participating in mental health
training in prevention and early intervention, services and strategies?
4. How are campuses planning to determine the effectiveness of their services
for students with mental health issues?
Based on the research, over 21,000 individuals availed themselves of the
resources free of charge made possible by the CBG, including, but not limited to,
consultations, presentations and trainings, general mental health promotions, and
webinars. Additionally, all available services at a baseline reported by CBGs also
experienced growth by as much as 76%. Although services underwent growth and
development, the degree of Kognito SPT participation among CBGs was inconsistent.
While a total of 1,138 faculty, staff and students participated in SPT, CBG campuses like
Butte College and West Los Angeles College did not have any SPT completed by a
participant at the time of this research, whereas campuses like West Valley and Riverside
Community College showed high performance rates in terms of successful outreach with
Kognito SPT. This discrepancy in performance could be attributed to, not geographic
location or lack of interest among constituents, but the implementation of ineffective
outreach for Kognito SPT. The FCCC and CCCCO can use this information to
brainstorm on ways to share methods of outreach for CBGs to employ on their campuses.
Overall, regardless of the low SPT turnout for some CBGs, CBGs still reached a
significant amount of faculty, staff and students in the education of student mental health.
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Conclusions
Instituting the CCC SMHP on the 23 selected community colleges showed
significant impact on the capacity of campuses to respond to the mental health needs of
the students. The CCC SMHP funded CBGs with mental health resources, enabling them
to deliver a variety of services and tools to educate faculty, staff and students on student
mental health. Over 21,000 persons participated in a student mental health training or
activity resourced by the grant. Additionally, existing mental health services were
reported to experience growth and development by as much as 76%. The scope of mental
health education delivered on campuses was diverse, paid special attention to educating
audiences on at-risk populations including foster youth, student veterans, and LGBT
students, and were also focused according to the target audiences (faculty & staff vs.
students). Data shows that the mental health education ranged from peer-to-peer training,
to crisis and behavioral intervention training, to general health promotion and mental
health awareness, to recognizing students of concern among peers or in the classroom,
and to suicide prevention training as it pertains to veterans on campus. These are among
some of the mental health resources that were delivered to individuals on CBG campuses,
and show that they were specialized and focused to educate individuals from the fact that
student mental health is a reality to how to refer a student of concern.
The reach and increase of capacity in mental health services made possible with
the grant can, in itself, be considered an awareness campaign seeking to dismantle the
stigmatized perceptions of student mental health. College educators can seam the CCC
SMHP with Kohlberg’s theory of moral development, and particularly his disequilibrium
69
theory, to encourage an active dialogue around mental health to educate students, faculty
and staff with the reality of mental health illnesses that may exist among their peers
and/or classrooms. The Center for Applied Research Solutions (CARS) services,
Kognito’s immersive and interactive Suicide Prevention Training, the regional
strategizing forums (RSFs), and training of trainers (TOT), have all served to educate
students, faculty and staff on the landscape of mental health on college campuses, while
simultaneously combating stigmatized and detrimental image that people may have
toward others with mental health problems.
Recommendations
Based on the findings from this research, educators and policymakers in higher
education should take action toward introducing and/or enhancing existing mental health
resources on California college campuses. Results showed that CARS and Kognito SPT
significantly impacted the capacity of mental health resources on Campus Based Grant
(CBG) campuses, and continue to be a significant resource available to all California
Community Colleges (CCCs), at no cost. Once the grant period concludes in June 30
2015, however, these resources will no longer be available to CCCs at no cost. It is
imperative for CCCs to take advantage of what is currently resourced by the grant to
learn best practices, trial strategies, ask questions, and enhance or introduce the mental
health conversation on their campuses. Once grant funding is no longer available, CCCs
will have to rely on their respective counties for funding, and thus initiating a dialogue
70
with counties is fundamental should campuses want mental health funding after the fiscal
year ending June 30, 2015.
Introducing a program similar to the CCC SMHP on college campuses are
expected to play a large role in dismantling the stigma associated with mental health, but
further research could be conducted to measure this as well as the impact on help-seeking
behavior. Stigma as it pertains to mental health continues to be a significant barrier to
student academic performance, but with the development of peer-to-peer programs and
mental health education, campuses can do their part as a change agent in the fight against
stigma and the adverse effects of mental health on student performance.
Recommendation for Future Research
One major recommendation for future research would be to gather qualitative and
quantitative data from CBG campuses on the challenges during grant implementation.
The collection of this data could be a component for future reports issued by PIRE to
inform CARS on how to better assist CBG campuses in meeting goals, and may also
prepare and inform college leaders how to allocate resources to optimize outreach and
education campaigns. For example, SPT delivery was challenging for Butte College and
College of the Desert, and if quantitative data were collected to reflect where the source
of the challenge was, CARS would have been able to intervene to share best practices and
effective methods to for SPT outreach.
Further research should also be done on the effects of peer-to-peer groups on
stigma and campus climate as perceived by at-risk student populations. Many campuses
71
have student groups such as Active Minds that empowers students to speak openly about
mental health as a means to fight stigma, encourage help-seeking behavior and to educate
others. Active Minds has been praised and known to make an impact on the conversation
about mental health, but if its impact could be measured, then college leaders could fight
for funding to support and leverage peer-to-peer groups like this to deliver a more
impactful student mental health program.
The opportunities for more research on how to improve the campus experience for
students with mental illness should not be neglected. The literature addressing challenges
that at-risk populations grapple with is growing, and if it could be augmented with
measureable data that shows what can improve their campus experience, then college
leaders have a strong case to support their advocacy for a student mental health program
on their campus.
72
APPENDICES
73
APPENDIX A
CCC At-Risk Faculty - Post
1. What is your employment status?
o Full-time faculty member
o Teaching assistant
o Administrator or staff member
o Adjunct faculty member
o Graduate student teacher
o Peer Counselor
o Other (please specify)
74
2. Please provide us with the following information
City/Town:
State:
Zip:
Email Address:
75
CCC- Veterans on campus Post
Dear Faculty, Administrator, or Staff Member;
This short survey has been designed to assist your institution in assessing the course
you just completed, to learn more about the needs of its community, and to further
improve this program.
Your participation in this survey is voluntary. There will be no negative consequences
to you if you decide not to participate. All of your identifying information and answers
are confidential. Your results will be combined with responses from other survey
participants and may be presented at scientific or medical meetings or published in
scientific journals. By submitting your answers to this survey, you are agreeing that
you have read and understand the nature and consequences of participation.
Thank you for your participation.
1. What is your employment status?
o Full-time faculty member
o Adjunct faculty member
o Administrator or staff member
o Peer advisor or other student leader
o Other (please specify)
76
2. Please provide us with the following information
City/Town:
State:
Zip:
Email Address:
77
CCC At-Risk Student Leaders - Post
Dear Student,
This short survey has been designed to assist your institution in assessing the course
you just completed, to learn more about the needs of its community, and to further
improve this program.
Your participation in this survey is voluntary. There will be no negative consequences
to you if you decide not to participate. All of your identifying information and answers
are confidential. Your results will be combined with responses from other survey
participants and may be presented at scientific or medical meetings or published in
scientific journals. By submitting your answers to this survey, you are agreeing that
you have read and understand the nature and consequences of participation.
Thank you for your participation.
1. Are you a Peer Counselor or Student Leader?
o Yes
o No
2. Gender
o Male
o Female
o Transgender
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2. Please provide us with the following information
City/Town:
State:
Zip:
Email Address:
79
APPENDIX B
CCC SMHP
CAPACITY SURVEY of
MENTAL HEALTH SERVICES
BASELINE REPORT
Types of mental health programming, services, or capacity present at baseline
80
Table 3. Types of Mental Health Services Present at Baseline
(Q3) As of July 1, 2012, did your campus provide or support the following mental health
services
a) System in place to refer students of concern to appropriate center or
office
b) System in place for center staff to conduct appropriate assessments
c) System in place for staff to refer students of concern to needed
mental health services
d) Screening processes at on-campus center to identify student mental
health issues
e) Depression Screening Day events
f)
Faculty / staff / student suicide prevention gatekeeper training
g) Other suicide prevention activities
h) Suicide prevention policies
i)
j)
One-on-one services with a mental health professional offered on
campus
Group services with a mental health professional offered on campus
k) Behavioral intervention teams or crisis intervention and response
teams
l) Threat assessment protocols
m) Electronic health reporting system
n) Peer to peer training
o) Other peer to peer activities
p) Campus-based mental health related clubs / chapters / support groups
q) Stigma & discrimination reduction activities related to accessing
mental health services
r) Mental health service resources available on college website
s) Mental health service resources available through other strategies
(flyers, etc.)
Development/expansion of mental health programming, services, or capacity
Table 4. Development or Expansion of Mental Health Services (July – December,
2012)
(Q4) Between July 1 and December 31, 2012, did your campus develop or expand (a) …
81
a) System to refer students of concern to appropriate center or office
b) System for center staff to conduct appropriate assessments
c) System for staff to refer students of concern to needed mental health
services
d) Screening processes at on-campus center to identify student mental health
issues
e) Depression Screening Day events
f)
Faculty / staff / student suicide prevention gatekeeper training
g) Other suicide prevention activities
h) Suicide prevention policies
i)
One-on-one services with a mental health professional offered on campus
j)
Group services with a mental health professional offered on campus
k) Behavioral intervention teams or crisis intervention and response teams
l)
Threat assessment protocols
m) Electronic health reporting system
n) Peer to peer training
o) Other peer to peer activities
p) Campus-based mental health related clubs / chapters / support groups
q) Stigma & discrimination reduction activities related to accessing mental
health services
r) Mental health service resources available on college website
s) Mental health service resources available through other strategies (flyers,
etc.)
82
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