Questions for Dr. Jennifer Howes (12/2 at 5pm)
- Is there any possibility to remove the requirement of same-day initial appointment? That can still be an option, but perhaps it could be extended to within 48 hours or 72 hours? This would make the counseling services a lot more reachable to students.
Framed to work around schedule, same day or next-day. Calling as a barrier, but in January a new portal where health and counseling can communicate with students. Online scheduling for initial appointments will be fully operational by fall of next year.
- Would it be possible to hold student training sessions during intersession in crisis intervention/suicide intervention?
Big picture yes there is a capacity to do that in the future. There is a mindfulness based program that used to run during intersession.
- The Counseling Center is proposed as a “first line of defense.” But the issue is that student insurance doesn’t cover 100% of outside psychiatry services, and the costs pile up over multiple provider sessions – it is 90% for in-network which is around $25 on average according to the Internet, and 70% coverage for out-of-network which amounts to $75/session according to the internet). Johns Hopkins Medicine counts as an out-of-network psychiatry service for student insurance! Is there a way to reduce the costs of community mental health?
Chrissy St. Clair manages student benefits. Might not be true ALL Hopkins psychiatry members are out-of-network. Case staff works with you to make sure it is in-network. Chrissy St. Clair is the best contact for that. For capacity, the counseling center used to have contract psychiatrists, but they are working hard to hire full time staff for that. 2 nurses joining us and a director of psychiatry, and a part-time psychiatrists. Hopefully will be moving towards making less referrals to community. Have timely-care psychiatry which is available but they cannot prescribe. No specific limit on the number of sessions. Interim solutions before building up staffing.
- Idea: putting standing desks, with treadmills under the desks in a designated section of the renovated MSE library.
- Would it be possible to have pre-recorded videos for mindfulness and stress relief that are available on the website and promoted during finals season
New website (https://wellbeing.jhu.edu/MentalHealthServices/) and those resources can be put on the website. Have other resources for mindfulness. Want to provide things for on-demand on the website. Partnership with health promotion and well-being is really important because they do a lot of the programing already.
- What kind of initiatives are being done to diversify the mental health professionals offered so students see more representation in their counselors?
Think a lot about making sure different identities are supported through the counseling services. They focus on hiring people who are diverse and component clinicians. Can’t come up with a staff member for every single identity because they are so many. Don’t want to create an environment where one clinicians is the sole landing place for students from an identity. Don’t want to set it up so a single counselor feels responsible for the entire community needs. Want to see it as a skill-set builder so all of the staff is competent on various different aspects of identity as it relates to a particular position. In terms of hiring, they post on general boards but also connect with groups with identity-focus to push jobs and make sure there is a diverse staff.
- Does CC do gues-speaker series workshops on issues related to procrastination (which was a top complain in 2022 survey) or productivity?
Reason for occupational therapy positions. Not necessarily a mental health problem. If we are thinking about traditional therapy, outside of that. So the occupational therapy positions are to reach a larger number of students. Will be able to deliver interventions such as workshops. SDS and well-being and health promotion can also take on a roll. Interested in collaborating with others for that.
- What capacity does the counseling center have in terms of assessments? Have issues with outsourcing a lot of assessments?
The first position of two are submitted to focus on testing and assessment. Trying to start a testing and assessment program. The earliest they will be able to offer testing and assessments are next fall. They are trying to renovate another space where they can do testing. Part of a larger initiative on helping students, also hiring two occupational therapists. Help people with things like procrastination, working with a disability, balancing clubs and classes. Will be more targeted work for students who have executive functioning challenges. Other position is a clinician for neurodiversity students, and another clinician for FLI students.
Counseling Center:
Statistics & surveying Rationale:
We are interested in knowing if, since the publication of the final report of the Task Force on Student
Mental Health and Well-Being in February 2018 (which was initiated by the presentation of concerns by SGA in 2016 to President Daniels and the Provost) there has been any major efforts to collect data post-COVID on the following topics.
• We encourage you to also refer to our 2021 update report on the Task Force recommendations - https://provost.jhu.edu/wp-content/uploads/2022/02/TFSMH-Implementation-Report-2021.pdf
JM: Was not aware of this update beforehand. I uploaded a copy of this document into the SGA teams
under General -> Files -> University reports. Worth HSS looking into at a future meeting.
1. Does SHWB have the number of professional counselors employed at the Counseling Center?
In the Homewood Counseling Center, we currently have 16 clinical staff positions and 4 doctoral interns. Three of these positions are vacant and we are currently searching.
JM: Assuming that the vacant positions are amongst the clinical staff, there are 13 clinical staff and 4 doctoral interns currently employed at the Counseling Center (CC). I am curious why there are there so few doctoral interns, especially since the Johns Hopkins School of Education is within 500 ft of the CC. Is this usual among universities with schools of education that have mental health counseling programs?
We are slated to hire 7 new positions with the goal of hiring within the next 6 months
JM: I interpret this to mean that there will then be 23 clinical staff positions and 4 doctoral interns after this hiring concludes. Please ask Dr. Howes where JHU is in the hiring process — have the job descriptions been released yet? I searched jobs.jhu.edu for “counselor” and “therapist” and here is what I found:
Mental Health Services Clinician/Coordinator of Services for LGBTQ+ Students (111807)
Unsure where the other 2 open old positions are or the 7 new positions.
2. Does SHWB know the approximate number of students-to-counselor (i.e., the average number of unique students each counselor sees in a year)?
• This varies depending on the other responsibilities (outreach, leadership, etc.) Typically, a full-time clinician has clinical contact with 80-120 students per year.
JM: Not sure what the average figure is at other schools. Would be interested in knowing if JHU knows this figure.
3. Does SHWB have a plan to hire more counselors to provide care for students at all 9 divisions? Specifically, is there a plan to hire more counselors at the Counseling Center in the immediate future?
• We are hiring for seven new positions across Student Mental Health. As we expanded our services to other schools at the university over the last two year, we have also increased staff to account for the additional students eligible for services. In addition, the university added nine crisis counselors as part of the BHCST that serve Homewood, E. Baltimore, and Mt. Vernon areas. BHCST counselors provide crisis response and follow-up but do not carry a regular patient load.
4. Has the Counseling Center done any surveying post-COVID to understand for what primary reasons students are seeking counseling resources at JHU?
• The top presenting concerns for those seeking care at the CC are anxiety, depression, and stress
JM: Sources for this bullet? How does SHWB measure the degree of “top presenting concerns”? Are these concerns communicated before the first appointment or are they the opinion of the professional counselor after the first appointment?
5. Has SHWB done any surveying post-COVID to understand reported causes of stress amongst the entire student body?
In the fall 2022, Student Health and Well-Being distributed the National College Health
Assessment (NCHA) survey to all students university wide that looks at population mental health and other dimension of wellness. Previously, the survey had been administered on the Homewood campus to a random sample of Homewood undergraduates only. The previous survey years were 2016 and 2018. Due to Student Health and Well-Being transitions and COVID, the survey was not done in 2020. The instruments from 2016 &18 compared to what was used in 2022 did have several changes to the questions.
The 2022 survey had 966 respondents. The 2018 had 560 respondents and 2016 had 516.
Undergraduate students report that their top stressors are:
Academics o Career
Procrastination
JM: What were the other options for students to select? Helps with figuring out what these top stressors are relative to in the rest of the student’s life.
Respondents are asked in numerous places throughout the survey about issues that might have negatively impacted their academic performance within the last 12 months. This is defined as negatively impacting their performance in a class or delaying progress towards their degree.
Students identified the following impediments to academic performance o Procrastination (40.2%) o Stress (36%) o Anxiety (26.2%)
Depression (19.3%)
These data have not changed since the onset of COVID and are consistent across other US colleges and universities.
JM: Very curious about how high procrastination is on this list, and if it speaks to larger academic culture issue at Hopkins. Procrastination is higher than stress, anxiety, and depression. Would be interested to know if Dr. Howes has any insight on this.
The survey covers a wide range of health topics that includes use of campus resources, health status, health attitudes, and a number of validated measures selected by the American College Health Association. Jacki Stone would be glad to come back to another meeting and talk about these in greater detail.
JM: Missed this! Would be a good idea to follow up with SHWB about this, either through HSS or Exec. Lets talk about this at some point.
6. What is the average number of counseling sessions per student who uses Counseling Center services?
In 2022-23, average was 7.22 appts
35% of students are seen for 7+ appointments
JM: See my longer comment below but we need to know more about the process behind at what point a student no longer seeks counselling services, especially since many mental health conditions are long-term or chronic.
7. Does the University collect follow-up data after students stop using counseling center services? If not, does the University follow up with students at all after they stop using counseling center services or miss an appointment?
Patient satisfaction questionnaires have been given in the past, although frequency has been variable
The new electronic health record system will include features to gather satisfaction data more easily and on a more consistent basis
If a patient misses an appointment, their clinician reaches out to follow up and reschedule or learn whether student is discontinuing services
We also use the CCAPS (Counseling Center Assessment of Psychological Symptoms), which is a nationally benchmarked treatment survey to help identify treatment progress and track presenting concerns
JM: From personal experience, I did not receive communications from the CC after I discontinued services. Students stop using services for all kinds of reasons (do not like their current counselor, heavy courseload, worse depressive state) and may not disclose them upfront unless they have an anonymous way of doing so that is offered to them directly. Even if a student discontinues their services in what appears to be a good state of mental health there needs to be some sort of follow up 2 months after, etc.
Barriers to appointments Rationale:
Students have expressed that the requirement for their first appointment with the counseling center to take place on the day they called creates a barrier for them to receive mental health support. It takes a lot of courage for students to call the counseling center in the first place, and this requirement discourages them from calling again. In addition, students with social anxiety have expressed that making a phone call to request an appointment creates an unnecessarily load of additional stress (another barrier to students seeking help)
The 2018 report stated that long wait times to schedule an initial appointment were a source of student frustration. The difficulty of scheduling an initial counseling appointment is still a common concern among current students.
1. What steps has the University taken since 2018 to change the initial appointment process?
• The feedback about long appointment wait times from the 2018 TF report as well as feedback from the wellness committee of the SGA and the CC student advisory board led to the transition to the initial consultation model, which allows students to schedule same or next-day appointments. Systems that schedule farther in advance see a higher rate of no-shows and cancellations, which means that clinical time is not utilized effectively, and that type of system often results in students scheduling an appointment for the future even if they don’t need one at the time, in anticipation of long wait times – this also disadvantages students from populations that are historically underrepresented in counseling services (and prioritizes those who have lower stigma and/or familiarity with counseling) because those folks are less likely to make an appointment until they absolutely need it, and so rapid access/initial consultation allows appointments to be available same or next day to lower barriers to entering care.
JM: Doesn’t address concerns that this isn’t compatible with the reality of JHU student schedules. I’d argue that it further disadvantages students from populations that are historically underrepresented in counseling services because it makes it harder to schedule them day-of with a counselor that matches their identity. They also may have the stress of navigating first-ever pre-appointment forms and only a couple of hours to do it between their call and first appointment. I was not aware that it was same-day or next-day; would they be able to advertise next-day appointments more broadly?
2. Is SHWB aware of any continued complaints from students and, if so, taking steps to address these concerns?
• MHS is always open to feedback from students, and we address concerns or complaints as they arise. The most consistent feedback we receive is about wanting the capability to schedule initial appointments online.
JM: “The most consistent feedback we receive is about wanting the capability to schedule initial appointments online.” If this is the case, this really should be a priority and a temporary solution implemented by next semester ahead of the full system’s introduction in Fall 2024
3. Would it be possible to change the current model for initial appointment scheduling to be less stringent than same-day?
• See above.
4. Would it be possible to switch to an online scheduling model, as this would accommodate students for whom the current scheduling model creates an unnecessary source of anxiety?
• Online scheduling has been requested, as well as web portal access; both are features of the new EHR which will be rolled out in time for the fall 2024 semester.
JM: Very interested in learning more about this; should ask Dr. Howes to elaborate.
Long term counseling support Rationale:
The 2018 report states that ~60% of KSAS students and ~40% of WSE students desired long term counseling support. Students have stated in the past that there is/was a soft cap of ~10 counseling sessions that is not communicated in the University's policies.
1. Can SHWB state what, if any, limit exists on session— and how SHWB goes about recommending students who are seeking longer-term care "a resource in the community that better fits [their] needs"?
There are no prescribed session limits, we frame our work as goal oriented, and this is something that is discussed between client and therapist at the initial consultation and on an ongoing basis.
The goals drive the treatment plan, and we use the CCAPS to establish a baseline for mental health symptoms and distress at the start of treatment, and use ongoing assessment to help determine interventions and when to close a course of therapy
Students can return to the CC to work on a different goal or problem, and many do several courses of treatment during their time at JHU
Providing unlimited, weekly therapy to every student is not feasible, and if a student has benefitted from an open-ended relationship with a therapist and wishes to continue that, they are often referred to the community so they can continue that growth-oriented work as long as they like. Sometimes students do a goal-oriented course of therapy at the CC and then decide to continue longer term work with a community provider. Other times, a student wants a specific treatment or specialty that is outside of the CC’s scope of service, and so they are supported in connecting with a community provider.
JM: Would it be possible for Dr. Howes to elaborate on specific treatment or specialties they’ve had to refer students to community providers for? If these are repeated requests, these may be areas where the CC needs to make hires.
2. What changes would be necessary for the Counseling Center to increase its capacity to offer one-visit-a-week for all students who desire long-term counseling services?
• Weekly therapy on an indefinite basis is not clinically indicated for everyone, nor is it a sustainable model for a university mental health service. SHWB has added additional resources to complement our offerings such as TimelyCare, SilverCloud and Calm app.
3. Has there ever been a serious consideration or exploration of long term and weekly therapy options at JHU? If not, why not? If there was serious consideration, why did it not succeed?
See above.
The national average in university counseling is ~6 sessions, and the mode is 1. JHU students have an average number of sessions of 7.22; 35% of students are seen for 7 or more sessions,
and 12% are seen for 16+ sessions
We don’t have specific session limits, but help students identify goals to work on in treatment, and use community provider referrals to help students get access to care if they desire weekly, open-ended counseling
TimelyCare also provides an option for students to do 12 sessions per year, which can be done weekly if the student wishes
4. How does the University accommodate students who cannot afford out of pocket costs for an external therapist once-a-week long-term?
• The JHU student health insurance plan has generous coverage for mental health treatment, and a reduced deductible waiver is available to lower the costs further to get started with therapy with a community provider. Students who waive the insurance need to show they have comparable coverage
Student training Rationale:
The 2018 report outlines crisis intervention/suicide intervention training for RAs but not for other individuals at the University even though it states that students overwhelmingly turn to friends/peers for support— which misses out on students who do not have strong relationships with their RAs and upperclassmen.
1. Has there been a university effort to train students at-large in crisis intervention/suicide intervention and educate them about other mental health resources?
All students can be trained in Question, Persuade, Refer (QPR), Mental Health First Aid or other skills-based training. In 2022 PEEPs (peer health educators) on the Homewood campus were trained in QPR, multiple student groups received training in the East Baltimore campus as well. A Place To Talk (APTT), the highly trained peer listening group advised by the counseling center is also trained in QPR. In the summer of 2023, all First Year Mentors were trained in QPR. Student Health and Well-Being invites SGA to schedule a training for all members and affiliated groups.
JM: Let’s follow up with this and get this scheduled for a GBM or other time next semester
Every year, SHWB participates in hundreds of events across the university to promote resources
Group Therapy
1. How often is group therapy used?
• The CC offers many therapy and drop-in groups each semester; we recently promoted a clinician to a leadership role to expand the group program offerings across the University.
JM: Ask more about this— very interesting
2. Has there ever been an effort to have long-term therapy groups that meet each week at a
certain time with a qualified counselor to offer a continued commitment to students as a group?
• Yes, these groups are available each semester.
3. Why can you not join short term group therapy sessions like EMDR at any time (current policy observed to be that students can only join at the beginning of the semester)? If the counseling center is supposed to help students navigate crises and short-term problems, what happens when students must wait half a semester or more to get their problems addressed?
• Therapy groups are different than drop-in groups – therapy groups have different treatment goals, group agreements and expectations for attendance to ensure that participants are able to feel safe and develop the relationships within the group or cover specific elements of treatment, so there is a defined period when folks can enter these groups, so they function effectively. • Drop-in groups typically allow students to join mid-semester
Identity-based counseling
Rationale:
A member of SGA stated that the primary counselor for LGBTQI+ Students, Devonna Jacobs, was not offered to new LGBTQI+ counseling patients who specifically requested a counselor with experience in issues of gender identity and LGBTQI+ social problems. Though the member of SGA recognized the ability of several counselors to provide a letter for gender-affirming-care procedures, they stated that there seemed to be a particular lack of expertise for all counselors pertaining to the social issues and trauma often associated with gender variance. The member of SGA stated that they repeatedly requested a female member of the LGBTQI+ community with experience in intimate-partner-violence and gender-based-trauma, yet there was none such offered to the member. In the GBM with SHWB, SHWB stated their want to “continue to build a diverse staff,” but the SGA member stated that no available counselors on staff have experience or speciality in LGBTQI+ issues or openly identify as LGBTQI+ individuals themselves.
1. How does the counseling center decide which students can or cannot see a counselor due to identity?
The Coordinator program is currently undergoing modifications to help alleviate any one clinician from being the sole recipient of clients for any particular identity group. The coordinator roles are being redesigned to serve as bridges to specific populations that are historically underserved in counseling services, to build relationships and provide opportunities to connect (this can include formal and informal programs, events, chat hours, etc.)
JM: What is the coordinator program?
Students can make requests for specific clinicians, but depending on caseloads, that clinician may not be readily available. Instead, we are focusing on ongoing training and professional development of all staff, from all identities, to ensure that all staff are positioned to provide multiculturally competent and responsive care to all students
We are committed to hiring a diverse staff. Whenever a new position is added, or a vacancy on staff occurs, we prioritize hiring clinicians who have lived and professional experience from a range of intersecting identities.
JM: If there are any noticeable absences in major identity groups that students would be interested in having a counselor from (I would push for a disabled counselor, especially in light of events surround SOE and its mental health counseling program in 2021-2022), bring them up to Dr. Howes.