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Journal of College Student Psychotherapy

ISSN: 8756-8225 (Print) 1540-4730 (Online) Journal homepage: https://www.tandfonline.com/loi/wcsp20

Assessing Campus Counseling Needs

William R. Harrar , Eric H. Affsprung & Jeffrey C. Long

To cite this article: William R. Harrar , Eric H. Affsprung & Jeffrey C. Long (2010) Assessing Campus Counseling Needs, Journal of College Student Psychotherapy, 24:3, 233-240, DOI: 10.1080/87568225.2010.486303

To link to this article: https://doi.org/10.1080/87568225.2010.486303

Published online: 21 Jun 2010.

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Journal of College Student Psychotherapy, 24:233–240, 2010 Copyright © Taylor & Francis Group, LLC ISSN: 8756-8225 print/1540-4730 online DOI: 10.1080/87568225.2010.486303

Assessing Campus Counseling Needs

WILLIAM R. HARRAR, ERIC H. AFFSPRUNG, and JEFFREY C. LONG Bloomsburg University, Bloomsburg, Pennsylvania, USA

Campus mental health needs are in the spotlight. Whether the nature and severity of problems presenting in college counseling centers are increasing or not, it is important to provide appropri- ate services for the campus as a whole. By surveying the general campus population, a better basis for determining the needs of stu- dents can be established than by surveying self-selected students who present at counseling centers. These data can also be used to establish local norms for comparison to clinical populations.

KEYWORDS college students, counseling, needs assessments, usage rates

The mental health needs of college students have recently been receiving a good deal of public attention. With the passage of the Garrett Lee Smith Memorial Act, also known as the Campus Care and Counseling Act, Congress has highlighted the need for increased mental health services for college stu- dents. While this may be partly due to recent high profile cases and greater publicity (Kadison & DiGeronimo, 2004), counseling center personnel have held that the nature and severity of psychopathology in counseling centers has been increasing for years (Benton, Robertson, Tseng, Newton, & Benton, 2003; Cornish, Kominars, Riva, McIntosh, & Henderson, 2000; Gallagher, Gill, & Sysco, 2000; Pledge, Lapan, Heppner, Kivlighan, & Roehlke, 1998).

The cost of mental health problems in the college student population can be seen in its effect on academic performance, retention, and graduation rates (Turner & Berry, 2000; Wilson, Mason, & Ewing, 1997), problematic and disruptive behaviors (Kitzrow, 2003), and the loss of life (Furr, Westefeld,

The authors thank Elizabeth Brennan for her assistance in the preparation of this manuscript.

Address correspondence to William R. Harrar, Director, Center for Counseling and Human Development, 240 Warren Student Services Center, Bloomsburg University, Bloomsburg, PA 17815, USA. E-mail: [email protected]

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McConnell, & Jenkins, 2001). The positive impact of counseling services has likewise been well documented (Turner & Quinn, 1999).

Sharkin (1997, 2004) has argued that the perceived rise in psycholog- ical distress among college students may be illusory. He advocates using objective assessments in order to test this claim. By using standardized instru- ments, the potential problem of biased counselor ratings may be avoided. In fact, Schwartz (2006) presents empirical evidence that psychopathology among college students may not be increasing. He also notes that the picture is complicated by the recent dramatic increase in the use of psychotropic medications. Rudd (2004) suggests that the seeming increase may be due to factors such as students’ greater willingness to seek help and a greater awareness of services offered on campus rather than an increase in emo- tional distress. Any actual increase in the level of psychopathology among counseling center clients might also simply reflect an increase in overall mental health problems in the general population.

It is important to note that studies such as Benton et al. (2003) and Cornish et al. (2000) have focused on students who seek support from col- lege counseling centers. Far less attention has been paid to underserved students in the general campus population; that is, students who have mental health needs but who do not seek counseling services. Knowing the actual extent of the need for campus counseling services may allow counselors to utilize their energies more effectively. It may also allow administrators to adjust staffing patterns. The International Association of Counseling Centers Services (IACCS, n.d.) recommends a ratio of one counselor to no more than 1,500 students. However, there does not appear to be an empirical basis for this recommendation. A given campus community may need a higher or lower ratio depending on the actual mental health needs of that particular student population.

This study sought to ascertain the need for counseling services among students who were not college counseling center clients. We hypothesized that there was a significant percentage of the student population who were psychologically distressed but who were not receiving services.

METHOD

Participants

A total of 1,963 surveys were mailed to students (811 on campus, 1,152 off campus). The surveys were distributed randomly and stratified by class. A total of 257 were returned (123 on campus, 134 off campus) for an overall return rate of 13%. The university is a moderate size, Mid-Atlantic, public liberal arts institution. The survey participants were, for the most part, traditional-age, undergraduate college students (mean = 21 years) and mostly female (76%). They were predominantly Caucasian (89%), and most

Assessing Campus Counseling Needs 235

had had no previous psychological treatment (71%). Only 7% reported that they were currently receiving counseling services.

In order to establish a clinical comparison group, data were used from the counseling center at the same university. Students who present at the counseling center are routinely given the Behavioral Health Questionnaire (BHQ) prior to their initial meeting with a counselor. The students are advised in writing that their responses to the BHQ and other data gath- ered at intake may be anonymously used for research. Table 1 summarizes the characteristics of the survey participants and compares these with those of the general student body and counseling center clients.

Measures

BEHAVIORAL HEALTH QUESTIONNAIRE–20 (BHQ)

The BHQ (Kopta & Lowry, 2002) is a 20-item self-report measure that assesses mental health. Participants rate the distress and dysfunction that

TABLE 1 Survey Respondents’ Characteristics Versus University and Clinical Demographics

Survey respondents University Clinical

Gender Male 23 42 30 Female 76 58 70

Class Freshman 30 32 43 Sophomore 19 22 18 Junior 18 20 18 Senior 26 20 15 Graduate 7 6 3 No answer 0 3

Ethnicity Native American 0 0 0 Hispanic 2 3 5 Asian 2 1 1 African American 5 6 21 Caucasian 89 81 64 Other 3 8 4 No Answer 0

Previous Treatment Yes 29 No 71 No Answer 0

Current Treatment Yes 7 No 93

Note: All values in percentages. Some categories may not sum to 100 due to rounding.

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they have experienced during the previous two weeks on a 0 to 4 Likert- type scale. Lower scores on the BHQ reflect higher rates of distress. A global mental health scale is comprised of all 20 items. Although the BHQ has sev- eral subscales, a high correlation between these subscales indicates that only one dimension is being measured. The scale’s developers provide norms for community adults, college students, college students in counseling, and adults in outpatient psychotherapy. The reliability of the BHQ using coeffi- cient alpha for the global mental health score for the norm samples ranges from .89 to .90. The test-retest reliability based on a two-week interval on the global mental health scale is .90 (p < .001) (Kopta & Lowry, 2002).

Procedure

Materials were distributed to prospective study participants by campus and U.S. mail. Students were informed that their participation was voluntary and anonymous and that by responding they were giving their informed consent. They received a packet that included a cover sheet describing the study, a demographic questionnaire, the BHQ, a pamphlet describing the services offered on campus through the counseling center, and a self-addressed stamped return envelope. The packet contents and the study were approved by the university’s institutional review board. The BHQ and demographic survey responses were returned by mail. No identifying information was placed on any of the survey forms.

Students who present at the college’s counseling center are given the BHQ as part of the intake procedure. Data included in this study were collected during the fall and spring semesters. Other materials provided at intake include an informed consent to services document, a notification of privacy rights, a problem checklist, and a demographic information sheet that is completed by the student. Information regarding the general stu- dent population for the fall semester of the year in which the survey was conducted was obtained from the university’s office of institutional research.

RESULTS

Table 2 summarizes the BHQ global mental health scale results for the col- lege student population compared with the normative sample from the norm group (Kopta & Lowery, 2002) and the differences between the two groups.

In order to accurately discriminate between clinical and nonclinical cases, a clinical significance cutoff criteria was employed using the method described by Jacobsen and Truax (1991). The cutoff criterion is the point that separates the clinical and nonclinical groups. Those who score above the criterion are more like the survey group, while those who score below the criterion are more like counseling center clients. The characteristics of

Assessing Campus Counseling Needs 237

TABLE 2 Comparison of Sample and Norm Groups with Clinical Significance Cutoff Criteria (CSCOC)

Sample Norm Difference

College Students N 257 465 Mean 3.06 3.13 −0.07 SD 0.63 0.51 0.12

Counseling Clients N 253 206 Mean 2.41 2.68 −0.27 SD 0.32 0.62 −0.3

CSCOC 2.83 2.93 −0.1

the counseling center clients, which were drawn from the same campus as the survey, were used to provide the clinical population comparison group. The use of the local clinical significance cutoff criteria indicates the cut score at 2.83, as opposed to 2.93 in the normative group sample. Using this figure, 71% of the survey group in the current study did not report significant lev- els of distress or dysfunction, while 29% fell below the clinical significance cutoff criteria, indicating significant levels of distress and dysfunction. Data from the counseling center group indicated that approximately 6% of the student body had been seen at the counseling center during the year that the study was conducted.

DISCUSSION

The results of this study provide support for the claim that psychological distress among college students is extensive (Benton et al, 2003; Cornish et al, 2000; Gallagher et al, 2000; Pledge et al, 1998) and suggest that college counseling centers are seeing only a small percentage of the students who might benefit from counseling services. Given the fact that 29% of the study sample responded to the BHQ in a fashion similar to counseling center clients and only 7% indicated that they were currently in treatment, it would appear that a sizable percentage of the students were significantly distressed and not receiving treatment. This figure would have been even larger if the original norm group’s clinical significance cutoff criterion of 2.93 had been used, resulting in approximately 34% of the students in this study being classified as more like distressed counseling center students than nonclinical survey students.

The results suggest that a sizable percentage of college students may be in need of counseling services but are not receiving them. Given this fact, it is imperative that the members of the campus community are able to identify signs of psychopathology among the students with whom they

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live and work. These signs may include social withdrawal, drug and alcohol abuse, loss of motivation and involvement in daily life, and hopelessness, all of which are reflected on the BHQ. Counseling center professionals should engage in psychoeducational programming designed for other student affairs professionals, faculty, staff, and students to educate them about the signs of psychological distress, opportunities for consultation with the counseling center, and making referrals.

The responses of the sample rule out the possibility that a substantial number of students are receiving services elsewhere, as only 7% reported that they were currently receiving counseling services. Interestingly, 29% did report that they had received counseling services in the past. This would seem to support the idea that the reported rise in the nature and sever- ity of presenting problems in counseling centers is due, at least in part, to an increase in the overall level of distress in the adolescent population generally.

It is noteworthy that there was a significant difference between the current sample and the norm group in their reported level of psychopathol- ogy. Colleges and universities will differ somewhat in the composition of their student populations. It is therefore reasonable to assume that different campuses will have different mental health needs. Survey research such as that described here could help other college counseling centers to better assess the needs of their own schools and adjust their activities accordingly. For example, counseling center staff might elect to increase the amount of time involved in consultation and outreach in an effort to reach more of those students who could benefit from treatment. However, given the limited staffing and already high demand for services at many schools, it is impor- tant for counseling centers to find other methods of supporting distressed students such as the use of primary, preventative programming, Web-based psychoeducational resources, and peer support programs.

The current study has a number of limitations. The survey return rate was only 13%. In addition, as a group the survey respondents were skewed rather heavily toward females and somewhat so toward freshmen and seniors. Future studies should attempt to obtain a larger sample with a distribution that more closely resembles the overall student population, even if they are comprised of students who are less like the students who enter counseling. A majority of the sample and of the counseling center clients were Caucasian. Thus, one must exercise caution in extrapolating from these results to minority students.

The BHQ does not provide a means for assessing motivational distortion and, thus, students in either or both groups may have over or underreported the degree of their distress. There is no indication of why individuals in the survey group who reported elevated levels of distress were not in treatment. Those who reported receiving prior treatment were not given the opportu- nity to provide further information about their experience in treatment, or

Assessing Campus Counseling Needs 239

how long ago or how extensive the treatment was. Such information may be useful for determining how to get distressed students back into treat- ment. Future research might explore ways to reach out to those students who could benefit from treatment but who are not receiving services. It would also be useful to determine how those students not receiving ser- vices are coping with their distress. A wider range assessment including data from others such as friends, family, clergy, etc., combined with self-report information would provide a more comprehensive picture.

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Cornish, J. A., Kominars, K. D., Riva, M. T., McIntosh, S., & Henderson, M. C. (2000). Perceived distress in university counseling center clients across a six- year period. Journal of College Student Development, 41, 104–109.

Furr, S. R., Westefeld, J. S., McConnell, G. N., & Jenkins, J. M. (2001). Suicide and depression among college students: A decade later. Professional Psychology: Research and Practice, 27 , 97–100.

Gallagher, R. P., Gill, A. M., & Sysco, H. M. (2000). National survey of counseling center directors 2000. Alexandria, VA: International Association of Counseling Services.

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Pledge, D. S., Lapan, R. T., Heppner, P. P., Kivlighan, D., & Roehlke, H. J. (1998). Stability and severity of presenting problems at a university counseling center: A 6-year analysis. Professional Psychology: Research and Practice, 29, 386–389.

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