Tag: services

  • Colleges address barriers to mental health with integrated services

    Colleges address barriers to mental health with integrated services

    Mental health challenges are among the greatest threats to student persistence and retention in higher education, but providing large-scale preventative and responsive mental health care is a looming challenge for colleges and universities.

    In addition to having sufficient clinicians and trained professionals to support students in crisis, finding ways to deliver wellness support to students before they’re in crisis is critical.

    One strategy is embedding mental health counselors into student spaces or academic departments. By integrating services into a physical location, such as a student center, clinicians can connect with students in informal and intentional ways, gaining their trust and supporting specific pockets of the campus community. Around 32 percent of college counseling centers employ an embedded clinician, according to a recent survey by the Association for University and College Counseling Center Directors.

    In this episode of Voices of Student Success, host Ashley Mowreader spoke with Estevan Garcia, chief wellness officer at Dartmouth College, to learn more about public health approaches to mental health support on college campuses. Later, hear from Casey Fox, associate director of integrated services at the University of South Carolina, who leads the university’s integrated mental health program, about how efforts have scaled.

    An edited version of the podcast appears below.

    Inside Higher Ed: The focus on health and wellness is an ever-present and growing concern in higher education, as more institutions realize the potential that negative health and wellness can have on student retention and outcomes and their thriving throughout their college experience. We’ve seen more recently, mental health has grown as a concern; students are telling us that, national data is showing that.

    I wonder if you can talk a little bit about the public mental health crisis that we’re seeing among young people, especially college students, and just this ever-growing need for more support and more resources to help our young people?

    Estevan Garcia, Chief Wellness Officer at Dartmouth College

    Dartmouth College / Katie Lenhart

    Estevan Garcia: To think about where we are today, and a little bit about how we got here, as far as young adults, adolescents, teenagers as well, and the challenges around mental health, the way I look at this is probably, for the last 10-plus years, we’ve seen an increase in mental health concerns, an increase in depression, anxiety.

    I’m a clinician; I work in emergency departments. And in about 2012, 2014 in that area, I started seeing children and young adults coming in in crisis with mental health crisis. This is not something that we saw before.

    I tell folks all the time that I did not have a significant amount of training around emergent mental health crisis in children and young adults—even though my specialty is pediatric emergency medicine, which is this area where we take care of kids in the emergency department—and I say young adults, because we really do cover till about age 25.

    So this was not looked at as a need for the training back then, and I trained in the ’90s up to about 2000, but then we saw this really increased need, I think, and most researchers believe that this coincides significantly with the use of a cellphone or the use of an iPhone, and the idea that social media has become so pervasive in everything that our children do.

    That is something that we know is a contributor. There’s quite a bit of evidence that suggests that. So what we’ve understood, that we were in crisis for several years, we were starting to see these needs of our children, adolescents and young adults, and then the pandemic hit in 2020 and that really tipped us over.

    The reason that happened, and we all understand this now, at the time, I was a public health practitioner and so really was an advocate of, “Let’s make sure we’re not spreading COVID. Let’s close those schools,” and do all of the things that we thought were the way we kept our kids safe and our faculty safe.

    What happened is, any of those social connections that students had really dissipated during the pandemic. They were not allowed to be in school together. They weren’t allowed to even play outdoors. We were so worried about the pandemic. That was kind of the fraying of the social fabric that was supporting many of these kids.

    So that’s when this really did peak, and what we’ve noticed since then—it wasn’t as if those students in college in 2020 to 2024, it’s over once they graduate. That’s not it at all. Because there were children in middle school who weren’t able to go to school. They were children in elementary school, those kids in high school that clearly impacted their ability to have social cohesion and support from peers.

    And what we’ve seen in colleges now is there is a leveling off of the anxiety and depression numbers we were seeing—and that’s good news—since about 2021, 2022. And we’re hopeful that what that means is that we’re starting to see some correction here, but it’s still significant. There’s still a significant need. We’ve kind of returned to that pre-pandemic level of anxiety, depression and need, and that is ongoing. It’s across college campuses, whether you’re an Ivy League or you’re a community college. It’s across high schools, junior highs, and there’s real need for us to pay attention, to support students through this process and happy to talk about that some more, but that need is there. It’s real, and we need to really focus on how we address those needs.

    Inside Higher Ed: We know from research also that sometimes college students who have the most need are not the ones accessing resources, as well. We see students from historically marginalized backgrounds, who may come from less resourced communities, feel more independent where like they can solve problems on their own.

    I’m thinking of our first-gen students who are historically rewarded for being independent and solving their own problems, and then get to college and might not access those same resources. Providing access to support for these students with greater mental health concerns is a growing issue.

    I wonder if you can talk about the clinician role in helping students break down those barriers to accessing mental health resources and understanding the role that they can have in their recovery and their support throughout college.

    Garcia: I think it’s important to divide our efforts into two camps, or two ways of really approaching this.

    You have individuals who have clinical needs, and at Dartmouth, that’s about 20, 25 percent, and those clinical needs are clinical diagnoses of anxiety or depression … and that is what we provide on campus and a bunch of different ways. I’m happy to address those.

    In addition to that, I think we need to work with the rest of the student body from a preventative wellness approach, to make sure that they understand that they have access to wellness activities, to things that build resilience. It’s a toolbox or a tool kit of ways to manage daily stressors in life, failing a test, breaking up with a significant other, potentially loss of a family member—all of the things that they’re going to encounter, in addition to being in academics and being in college.

    We need to build their portfolio of resources. That’s also, I think, very important in the way we approach this kind of mental health crisis, is to really look at it from a preventative lens.

    So to your point about making sure that we are addressing the individual needs of communities, especially marginalized communities, potentially first-generation communities, I think it’s important to not paint this with a broad brush. We need to be individual, and we need to work with the individuals. We need to look at our individual groups and really understand what they need.

    This is when we partner with our students: Our students are telling us what they need, and we can’t assume that they’re going to come to us; we need to come to them. We need to make sure that we’re embedding mental health resources where the students would access them and not [saying], “Come to the counseling center, and that’s when we’ll meet with you.”

    One example that I give is our really integrating our ability to support students and their mental health in our athletic programs. And at Dartmouth—we call it DP2, it’s really our Dartmouth Peak Performance—and we are embedding within the varsity sports, but also our club sports intramurals. About 60, 65 percent of students participate in athletics at Dartmouth.

    We are really trying to embed within those different systems supports that make it easy for a student to reach out and to talk to the coach, we then help the coach understand how to identify a student in need, what to do if they if they have higher needs, and [if] the coach and or the athletic trainer is comfortable managing, we do training and mental health first aid.

    We also do something we call Campus Connect, that allows us to identify the resources for students, and then obviously they can engage my office if there are real concerns about students, that they’re afraid, that need immediate support, and we do that as well. So that is just one example of how we embed within the activities that students are doing every day that they may not think have a wellness component or have this potential counseling component, and they’re there.

    Inside Higher Ed: I’m so glad that you bring up this network of supports for students, because there is no silver bullet when it comes to supporting student mental health, and every student’s needs are going to look a little different. It really does take a public health approach to addressing student needs, because they’re all different.

    I want to go back to your example of athletics-embedded resources, because I think that’s a really interesting student population that we have where they’re very competitive, they’re driven, they’re engaged, they’re super involved on campus. And sometimes that can result in some of these challenges when it comes to juggling mental health and academics or their personal lives or things like that, and how those targeted resources can address those specific needs that those athletes might have compared to the general student population.

    The benefit that it brings, one, to the students, but also to the practitioners who are working with them, and that intimate relationship that they get to cultivate with those athletes. So I wonder if you can just talk about that a little bit more, the relationship between how embedded resources are targeted but also personalized and intimate.

    Garcia: For our athletes, and certainly our varsity athletes here, we do have a fairly robust set of offerings. There are two embedded psychologists that have expertise in sports psychology, embedded for the varsity teams and the varsity athletes.

    But in addition to that, there are performance coaches, which is a different level of support, but focusing on what the needs are … You would understand that some athletes maybe need nutrition and sleep coaching and support. We have embedded nutritionists; we have sleep support. We have an entire module and support around leadership. So these are all areas across the campus that we’re offering to our athletes.

    Initially, this was offered really to our varsity athletes, but as we’re growing our understanding of what our … intramural students participating in sports need, we’ve selected a couple of our really winning supports, and we’re going to be able to expand those in the future to the larger population of athletes on campus. That includes that leadership component, the sleep and nutrition and mental performance. Those are three areas that we will be then taking best practices from varsity athletes and expanding the trainings, the offerings and the supports to other athletes.

    Then our ultimate goal is to be able to share these resources with any student on campus who is interested in learning in this way.

    There is a direct link from, of course, from our sports psychologist to our overall counseling center. And if they believe someone needs more in-depth counseling, or if they’re identifying other concerns, maybe an eating disorder, we’re able to utilize our system of care here on campus to support the students that have those needs identified through the sports psychologists and performance coaches … and if they need, they’re then moved to our counseling center. We have a close relationship with Dartmouth Health, which is actually our health system here, even being in a rural location, and so we have access to experts across the field, and we’re able to engage with them as well, so that that really does tie in here.

    Inside Higher Ed: Placing access where students are is one way to remove barriers to formal mental health care. Are there other strategies or interventions that you’re all considering when it comes to helping students move past the stigma of utilizing mental health resources?

    Garcia: Interestingly enough, the stigma for college students is real. It’s still there. It’s probably more significant for male college students than female college students. But it’s clearly something that we see. We mentioned a little bit about marginalized groups and their use of mental health services. I will say one thing we’re proud of at Dartmouth is that our use of mental health services is the same for that 20, 25 percent, depending on the year, is [reflective] of all students. Our first-generation students or historically marginalized students do not utilize health services at a lower rate than anybody else here. We’re really proud about that.

    We’ve made the idea of mental health services part of who you are. We’re integrating the idea of wellness into academics. I think that’s something that we forget. Oftentimes people feel like you can move it separate: You’re a student at one point, and then when you’re depressed, you’re not a student, or you’re not somebody who’s worried about the academics. And we clearly know that the pressures of academics for college students and being successful will impact them as well.

    So certainly, I think it’s important to understand that you want to go back and you want to see where the students are and meet their needs. But one thing that I think is really important is the idea of peer support.

    We have a mental health student union here on campus, and last year, they held a town hall for students, and … four individual students who had mental health concerns and diagnoses came forward and talked about those individual concerns they had and how they were able to receive the help they needed on campus, as well as through the networks, and really bringing forward the idea that it’s OK to have these conversations. They shouldn’t be talked about only in an office. They shouldn’t be talked about in whispers; we really do need to make it clear that if you have concerns or and need support, it’s here.

    We train students to be peer advisers and peer supporters, and we do it in many different areas across campus, but that is also very important, because often students will go to a fellow classmate first before they come to us. And I think that’s really important to understand. Our peer supporters get good training. They’re not expected to be counselors. They’re expected to be a shoulder to lean on, and then they understand what the resources are and available on campus. So peer support is really important as well. And I think we need to continue to strengthen those engagements between students as well.

    Inside Higher Ed: I’m so glad that that’s something that you touched on, because I think at Ivy institutions specifically, there can be a stereotype or a misconception that students are hypercompetitive. They are obviously high-achieving students, but that they are able to perform those interpersonal relationships and be vulnerable with each other about the struggles that they’re going through as well, I think really helps break down that barrier of “Everybody else is doing just fine, but I’m not,” or “I’m the only person who’s struggling with this” and really creates a community of care where students can lean on one another, and, like you said, be referred to more resources as they need.

    The University of South Carolina is one institution that has designated embedded counseling supports as a focus for holistic student care. Casey Fox from Carolina shares more about the campus work.

    Inside Higher Ed: When we talk about the integrated services program, what does that mean on a practical and logistical level?

    Casey Fox smiles for a headshot outside in the University of South Carolina

    Casey Fox, a licensed marriage and family therapist, professional counselor and professional counselor supervisor, as well as 
    the associate director of integrated services at the University of South Carolina. 

    University of South Carolina

    Casey Fox: Right now, we have integrated clinicians in four spaces across campus. We are a large urban campus, and we have a central hub where we provide our counseling services.

    In 2022 we identified a space in the law school, so we embedded a clinician over there, and she has been there doing wonderful work since then, but we now have clinicians that are in three other spaces across campus. So we’ve got the First-Gen Center, we’ve also got Global Carolina, and then we’ve got an embedded clinician in the engineering and computing school.

    The idea of integrated services is really just looking at the barriers to access. One of the pieces with that is, when you look at the central hub for coming over for services, a lot of students, depending on positionality, are not able to get to this location. Maybe it’s the parking, maybe it’s the gaps between their classes, maybe they don’t live on campus, and just even coming to that main space is difficult based on all of their competing values.

    What we’ve looked at is ways that we can spread staff out in order to address that and remove some of those barriers, so that we’re welcoming students in some spaces that maybe they’re more likely to walk into.

    Inside Higher Ed: You mentioned that you started with the law school, and that’s a population when it comes to embedded counseling I haven’t seen quite as much. We talk a lot about athletes or underrepresented minority students. What are some of those barriers for law school students that they’re not engaging at that central facility?

    Fox: When we’re looking at the barriers for law school students, I think historically, if we look at the nature of what it is like to be in the law school and be a law student, there’s a lot of time in between courses that students are really just in that space studying.

    But the other side of that, we’ve got students who, in many ways, are not traditional students anymore. Law school is not undergraduate, and so there’s a lot of things that are competing for time. There’s some law school students that are parents, there’s some law school students that have families that they attend to, and so coming over to the other side of campus for counseling services, I think can be really difficult.

    But the other piece of that, not just time, but I think there’s some perceived stigma. I think that there’s a competitive nature to being a law school student, and with that, I maybe don’t want to say that I feel weak, or this idea that I need the support or help, because this is supposed to be stressful. Then there’s this perception, I think very often, of, like, “If I need any form of mental health resources or services, that must mean that I’m not doing well, or there’s something acutely wrong with me.”

    I think what’s really beautiful about embedding someone in that space in particular, is that we’ve been able to do some of this wraparound care and mental health literacy, to really address, right, that, like, “Hey, it’s really normative to need these services.” Our embedded clinician there has become a part of that team and unit, and it’s really normalized what it means to have a conversation with someone in the world of mental health, what it means to maybe acknowledge that mental health has multifaceted layers, and that there’s a lot of areas around prevention. Like, if I’m feeling overwhelmed, maybe I need to talk to somebody to develop some coping strategies so that I can better manage this, so that it doesn’t become something that is maybe acute or pervasive.

    Inside Higher Ed: I love the relational element of integrated counseling services, because, like you’ve mentioned, it’s not just that one-on-one time. They’re also not omnipresent, but very present in those spaces, and can build relationships. I wonder if you can talk about that element and how that also decreases barriers to access.

    Fox: The relationship part is one of my favorite parts. I am over in the First-Gen Center, and I love the relationships that I’m building, not just with the students in those spaces, but also with any faculty or staff member.

    What’s really important to acknowledge is, if we look at students, if we look at faculty and staff, I think everyone genuinely cares about the Carolina community and wants to support each other, but sometimes we don’t know how. I think with faculty staff as well, there’s a lot of things that are competing for our time and energy, and if we feel like maybe we don’t have that skill set, we might not know how to navigate a difficult conversation or sit with a student in distress.

    So the relationship building, in particular, for me feels so important, because I’m able to then become a friendly face that students are like, “OK, I chatted with her about the cookies she brought in, and so now I’m feeling a little overwhelmed, and maybe I can go and chat with her about this thing that I’ve never shared with anyone.”

    Really similarly with faculty and staff, where they want to help students, but maybe are feeling like they’re not sure how. If they know me, if they’ve met me and had a conversation with me, they are much more likely to say, “Casey, I’d like to consult with you,” which is a significant part of an embedded clinician’s role is: to offer space to consult.

    The other piece that I talk about a lot is we consult with a lot of students who actually are wanting to care for friends—sometimes family, too—but friends that are students here. I have people who come in and they’re like, “I’m really worried about my roommate, and I don’t know what to do. I don’t think I need counseling. But can I talk to you about what’s available to me or how I navigate this?” I love that preventative component of this. Not only are we building relationships with a lot of stakeholders and campus partners, but we’re actually out there with students, and I think experiencing, too, some of the emerging needs and really paying attention to some of the specific components of what it means to be a law school student or engineering student.

    Yesterday, I was at a career fair for the engineering students, and I watched people walk around, and I thought to myself, “This is really intimidating, right?” I think even being in those spaces, and getting a feel for what that might be like for students allows for me to walk into a space feeling more informed and navigating that with that student.

    Inside Higher Ed: There’s obviously benefits to the student, and like you mentioned, the faculty and staff by having you be present in these spaces, but for you as a clinician as well, it helps build your knowledge of what those student needs might be, and gives you an ear to the ground on campus. Can you talk a little bit more about that?

    Fox: I believe that is part of our role. We are looking at, what are the trends, what are the themes? Law school students in particular, something our clinician has done there, has named that like during different parts or stages of the semester, there’s things that I want to home in on because students are really focusing hard on all the things they have to do. Some of their courses are comprehensive exams that can be really stressful. There are initiatives that are put in place to provide support and care with awareness of how that structure academically maybe looks different than other structures.

    Another, I think, really important piece to acknowledge is that our embedded clinician law school is aware and privy to information on, what does the bar [association] need? Another barrier right is that sometimes people are like, “Well, if I do come in for counseling, is that going to be reported to the bar? Am I not going to be able to then sit for the bar—like, what are the implications of this?”

    Our embedded clinician knows the ins and outs of that, knows how to walk students through that and to offer care and comfort around “Hey, like, this is a normative experience, and this is how this process looks, and this is what you need from me,” so that students can get the care they need without feeling that worry on the front side that really is misinformed. Like, “Oh, I can’t do this, because if I do this, then it’s going to mean this thing,” but without that information, or somebody really speaking to that, like, on the ground, I don’t know how students would know otherwise.

    Inside Higher Ed: We’ve talked a little bit about how having somebody in the ecosystem with relationships can benefit students and that access, but I also wonder the physical element of just being in student spaces like the first-gen center, and how that can create relationships and, again, remove that barrier to access. Can you talk about the physical environment as well?

    Fox: It’s a different environment. Our central hub is part of our health center, and so students feel sometimes, “If I walk into the health center, that means I’m going for this thing that I need.” So whether I’m not feeling well, or I’m going in for therapy, or whatever they might be coming to this space for, and I think it’s really important, when we’re in these communities with students, what we’re doing is we’re not only saying this is really normative and becoming a part of just the culture of that space, but we’re also building relationship and connection for them to feel like they can broach a conversation.

    The First-Generation Center in particular is a living-learning community, so there’s a lot of students who live in that space. So I’ll sit in the lobby sometimes with students, and they’re playing board games, or they’re just hanging out in that space eating pizza, and I’m chatting with them again, not even about anything mental health connected, but just being a face and someone that they can maybe feel connected to and feel willing to then come and talk to.

    I try to open that up all the time, of, like, if you ever need something from me, if you ever want to talk about anything you might be experiencing, if you have questions, if you’re not sure how to navigate something, let me know what I can do to support you. And again, I think the difference is that’s a really different environment. They’re really comfortable, they’re lounging, they’re eating pizza, or they’re coming to me and saying, “I don’t know if I want to talk to you, but I saw you had cookies,” and I’m like, “Take a cookie. You don’t have to talk to me. I ask nothing of you, other than for you to know that I’m here and I care.” And I think that has been really powerful in itself.

    Inside Higher Ed: I think taking those baby steps to understand what mental health services could look like or could feel like is so important for students, especially who might have never engaged with those services previously, or have a misconception of what that looks like and what that means for them. So that’s wonderful that you get to do that.

    When it comes to identifying groups that are receiving embedded counselors, how does the university go about that process? Or what are some of those priorities when it comes to identifying where to place counselors?

    Fox: We are continuing to develop that process. Moving forward, I think that the demand will continue for this resource.

    The law school identified an interest and has a significant amount of care and the mental health of the students there, so it makes a lot of sense that that was our first launching of an embedded clinician. And the other ways that we’ve identified is looking at maybe students that we want to pay a lot of attention to around retention, so wanting to be really on purpose with what we offer, wanting to have somebody who can really advocate for and speak to that.

    I think there’s a lot of assumptions we make about the time students want to be seen. If we were to look at just freshman students, there’s this idea of like, well, they want to be seen in the evenings. We often will base some of what we navigate in a counseling center on information that doesn’t maybe comprehensively link to all needs. I think identifying that there’s some unique needs, there’s some unique needs in being an engineering and computing student, and so that has been how we’ve navigated it thus far, is really looking at like, again, we want to retain these people. We want to offer support.

    Honestly, the other piece of what we’ve done has been based on this awareness from faculty and staff that have shared, like, “You know what? I think that we maybe need this.” I also want to acknowledge that a lot of these requests are coming from the departments or units themselves, which I feel is really powerful, because for me, that shows this culture of care that is within those units or schools. I really love that. I know engineering, right, like, they really want us in that space, and I can say the same for all of these locations, but we’re welcomed. There’s a lot of care around mental health and sustainable well-being for students, and that is coming from everyone that is working in those units. That feels really powerful, that ask of, like, “I really want to support these students in these spaces, and I’m aware of these unique needs.”

    It has been this concerted effort that we’ve made, not just with counseling [services], because this wasn’t necessarily coming from our end. I think that that’s really important to acknowledge these requests [that] were coming from these departments or units or colleges, and that is a really powerful piece, too, where then they’re showing their care for their students.

    I have a lot of love for that idea, or concept of, like, not only are we showing up and offering what I believe to be really good-quality care and concern for students, but for them to know that my college, or this part of my identity, cares so much about me being here, that they’re advocating and pushing for a clinician to be in this space, I feel like even just that sets a standard of just welcoming conversation around needs.

    Inside Higher Ed: It also seems like the only way to really create these successful partnerships is to be in community with the faculty and staff and really have that trust and relationship. National data has told us that faculty and staff see these issues, but being able to make that partnership and bridge that gap is so critical. So it’s wonderful that you all have that community of care that is able to do that successfully.

    If you had to give advice to a practitioner who is looking to get either into this space by finding an embedded counselor to work alongside, or a clinician who’s interested in becoming an embedded counselor, what sort of insight or advice would you give?

    Fox: I think as an embedded counselor, we are wearing many hats, and so I think that you have to enjoy wearing many hats. My role shifts so much. Of course, there’s my associate director piece of what I do. But outside of that, I am sitting in spaces where I’m doing one-on-one counseling. I am then walking into [student] tabling [events]. I am walking into maybe some strategic group spaces where we’re looking at some really targeted intentional workshops based on different needs for the population. I’m sitting in these spaces with our stakeholders where I’m, like, talking about what we’re doing and advocating for that and mingling.

    Throughout my day, I love that variety, and I think if, you know, somebody were to say, “Would this be something I would want to do?” I would ask that question of, “Do you think that you would enjoy wearing many hats and maybe being in multiple spaces throughout the day?” I boogie around campus. I’m in several places throughout a day as well.

    The other piece is this love or care for mental health literacy. I have been at this university for going on seven years, and anyone who knows me here laughs when I say mental health literacy, because it is like something I’ve said a million times since I’ve been here. I love the idea of mental health literacy, the idea that every person who is employed by the University of South Carolina is a critical piece of all students’ sustainable well-being. If I can change that for faculty and staff or a student caring for another student, or student caring for themselves, that feels so incredible to me. This awareness that I can influence not only the individual I’m sitting with, but influence a college or unit or the system in a really meaningful, sustainable way. Anyone who loves that idea of mental health literacy and informing and educating all campus partners on that, this would be a really interesting role that they would probably enjoy.

    Historically, some of the data has shown us that these positions at times have led to some feelings of maybe being siloed or separated from the main center, and there’s something really magical about our main center. I love being in that space, because I can consult with all my colleagues that I just think are wonderful and are doing such great work.

    When you’re in embedded sites, it makes so much sense, and I’ve worked really hard to do this since I’ve taken on the associate director role of checking in with my embedded staff to make sure that I’m attending to their needs. I don’t want them to feel alone. I want them to feel supported and cared for. But I think when you’re out there and you’re wearing so many hats, and you’re transitioning so much throughout the day, that can be hard to even know to ask for that or when to ask for that. Then you’re also building the relationship with the faculty and staff and the spaces you’re in. And so again, how much of my time and energy do I have to then shift gears for this other need? So I think there has to be a lot of intentionality in how we care for staff in these spaces.

    But I am really excited about our move. My position is new, and so we’ve not had anyone in this space, and so that I’m meeting with the staff in those spaces, we’re meeting collectively. We’re meeting individually, and I’m working really intentionally, to make sure that they’re feeling the support and care that you would feel if you were in this main center.

    Inside Higher Ed: We’ve talked a little bit about [how] your position is new, and there’s a lot of new things happening on campus when it comes to embedded in integrated counseling. But is there anything else new we haven’t talked on that you want to share?

    Fox: I think, over all, embedded counseling is a really important initiative, and I’m really happy that the University of South Carolina is looking at ways that we can expand this. We are looking at a variety of options. I don’t know that there’s a one-size-fits-all [approach].

    I’ve talked to so many wonderful people doing the role that I’m doing at other universities across the U.S., trying to inform myself of what some of these best practices are and what I’ve learned. I keep showing up the table saying, “I don’t know that there’s a one-size-fits-all.”

    There’s so many nuanced components to what it means to be in some of these spaces and to do this work—what we’re going to do in the School of Computing and Engineering is very different than what we’re going to do in a first-gen center. I have really appreciated getting to maybe understand the flexibility that we need to have, and how we view this.

    I think the University of South Carolina is holding a lot of care for this idea that we want to care for all of Carolina, and we want to be really strategic in how we do that. I believe as we move forward, we will continue to be able to collect some really good data that shows the benefit of this.

    I speak a lot to the piece of prevention, and I love this idea of “let me have a conversation with someone before this becomes so problematic that now I’m feeling it physically in my body, let me know that it’s really normal that during final exams, I am just really struggling and I’m feeling overwhelmed.”

    I think one of the things that embedded clinicians are really able to do in these spaces is normalize a whole lot of concerns for students, faculty and staff, and then really highlight, too, like, the mental health awareness component of when do we need to have some conversations and just care for each other, and when does somebody need therapy? I think that’s a really powerful thing that we need to address as we move forward, that I think embedded is going to be a part of, is really acknowledging that.

    The statement that’s come out a lot is we could never hire enough people to meet the need, and I think that what we’re doing is trying to acknowledge that we’re aware of the needs. How can we normalize, how can we offer skills? How can we offer all of these things on the front side, so that students can feel empowered and equipped to navigate what they need for themselves, and to trust that when they do need a higher level of response or more individualized services, or one on one, that they can trust in the care that they will receive, but also trusting in their capacity to care for self when they can, or trusting that I could also have a conversation with a faculty member or staff member? Because all of the University of South Carolina cares about the Carolina community.

    Listen to previous episodes of Voices of Student Success here.

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  • Leverage expands services to Türkiye

    Leverage expands services to Türkiye

    “The Turkish young, sitting at the centre of Europe and Asia, are true globalists. Their appetite for winning on the international stage is a delight to watch,” said Akshay Chaturvedi, CEO of Leverage Edu announcing the news that the edtech firm, which specialises in study abroad services, will be launching its services in Türkiye.

    “To fuel those dreams, we are incredibly excited to launch LeverageTürkiye — starting with our AI tools for counsellors, the Leverage Edu consumer app for students, Student-ops 360 for partners, and a line-up of special exclusive products tailored to meet that ‘education to career’ arc.”

    With over 50,000 Turkish students pursuing higher education abroad in 2024 – a number that continues to climb – the country has emerged as a critical player in the global education landscape.

    Leverage Edu CEO and founder, Akshay Chaturvedi with Ali Can Cirak, regional manager, business development.

    Factors fuelling this growth include Türkiye’s youthful population, where more than 50% of its citizens are under 30, and an increasing demand for globally recognised degrees in fields such as engineering, medicine, and business.

    The Turkish young, sitting at the centre of Europe and Asia, are true globalists
    Akshay Chaturvedi, Leverage Edu

    “Türkiye represents a very dynamic opportunity, just given where it sits on our planet,” said Chaturvedi. “As a country with a vibrant young population and increasing global mobility, it not only offers immense potential for growth but also serves as a bridge linking two of the most dynamic educational ecosystems in the world – the East and the West – hence an important first-level brick on top of which we’d like to build much more.” 

    To support its Turkish students and partners, Leverage is deploying a dedicated team on the ground in Türkiye, including a country manager to oversee operations and drive business success in the region. Additionally, several university representative desks will be dedicated to Turkish students.

    In the coming months, Leverage’s ancilllary services Fly Finance and Fly Homes will also be available in Türkiye.

    “We are committed to creating many win-wins, for students and institutions alike,” Chaturvedi added.

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  • Becoming a professional services researcher in HE – making the train tracks converge

    Becoming a professional services researcher in HE – making the train tracks converge

    by Charlotte Verney

    This blog builds on my presentation at the BERA ECR Conference 2024: at crossroads of becoming. It represents my personal reflections of working in UK higher education (HE) professional services roles and simultaneously gaining research experience through a Masters and Professional Doctorate in Education (EdD).

    Professional service roles within UK HE include recognised professionals from other industries (eg human resources, finance, IT) and HE-specific roles such as academic quality, research support and student administration. Unlike academic staff, professional services staff are not typically required, or expected, to undertake research, yet many do. My own experience spans roles within six universities over 18 years delivering administration and policy that supports learning, teaching and students.

    Traversing two tracks

    In 2016, at an SRHE Newer Researchers event, I was asked to identify a metaphor to reflect my experience as a practitioner researcher. I chose this image of two train tracks as I have often felt that I have been on two development tracks simultaneously –  one building professional experience and expertise, the other developing research skills and experience. These tracks ran in parallel, but never at the same pace, occasionally meeting on a shared project or assignment, and then continuing on their separate routes. I use this metaphor to share my experiences, and three phases, of becoming a professional services researcher.

    Becoming research-informed: accelerating and expanding my professional track

    The first phase was filled with opportunities; on my professional track I gained a breadth of experience, a toolkit of management and leadership skills, a portfolio of successful projects and built a strong network through professional associations (eg AHEP). After three years, I started my research track with a masters in international higher education. Studying felt separate to my day job in academic quality and policy, but the assignments gave me opportunities to bring the tracks together, using research and theory to inform my practice – for example, exploring theoretical literature underpinning approaches to assessment whilst my institution was revising its own approach to assessing resits. I felt like a research-informed professional, and this positively impacted my professional work, accelerating and expanding my experience.

    Becoming a doctoral researcher: long distance, slow speed

    The second phase was more challenging. My doctoral journey was long, taking 9 years with two breaks. Like many part-time doctoral students, I struggled with balance and support, with unexpected personal and professional pressures, and I found it unsettling to simultaneously be an expert in my professional context yet a novice in research. I feared failure, and damaging my professional credibility as I found my voice in a research space.

    What kept me going, balancing the two tracks, was building my own research support network and my researcher identity. Some of the ways I did this was through zoom calls with EdD peers for moral support, joining the Society for Research into Higher Education to find my place in the research field, and joining the editorial team of a practitioner journal to build my confidence in academic writing.

    Becoming a professional services researcher: making the tracks converge

    Having completed my doctorate in 2022, I’m now actively trying to bring my professional and research tracks together. Without a roadmap, I’ve started in my comfort-zone, sharing my doctoral research in ‘safe’ policy and practitioner spaces, where I thought my findings could have the biggest impact. I collaborated with EdD peers to tackle the daunting task of publishing my first article. I’ve drawn on my existing professional networks (ARC, JISC, QAA) to establish new research initiatives related to my current practice in managing assessment. I’ve made connections with fellow professional services researchers along my journey, and have established an online network  to bring us together.

    Key takeaways for professional services researchers

    Bringing my professional experience and research tracks together has not been without challenges, but I am really positive about my journey so far, and for the potential impact professional services researchers could have on policy and practice in higher education. If you are on your own journey of becoming a professional services researcher, my advice is:

    • Make time for activities that build your research identity
    • Find collaborators and a community
    • Use your professional experience and networks
    • It’s challenging, but rewarding, so keep going!

    Charlotte Verney is Head of Assessment at the University of Bristol. Charlotte is an early career researcher in higher education research and a leader in within higher education professional services. Her primary research interests are in the changing nature of administrative work within universities, using research approaches to solve professional problems in higher education management, and using creative and collaborative approaches to research. Charlotte advocates for making the academic research space more inclusive for early career and professional services researchers. She is co-convenor of the SRHE Newer Researchers Network and has established an online network for higher education professional services staff engaged with research.

    Author: SRHE News Blog

    An international learned society, concerned with supporting research and researchers into Higher Education

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  • Early intervention services can help premature children thrive, but too few receive them

    Early intervention services can help premature children thrive, but too few receive them

    JOLIET, Ill. — After several challenging and stressful months in the neonatal intensive care unit, Karen Heath couldn’t wait to take her triplet sons home. The boys had been born severely premature at 25 weeks, each weighing a bit over a pound. In the early hours, doctors cautioned they would not survive long. The triplets, thankfully, proved the doctors wrong. But for about three months, Heath was not allowed to hold them, satisfying herself with photos, videos and kisses blown.

    The long-anticipated discharge in the early summer of 2019 was joyful, but also rushed and, as Heath recalls it, somewhat cavalier. An hour before release, a physical therapist showed Heath how to help the babies gain strength by gently stretching their legs out. A nurse gave her a quick tutorial on how to use the oxygen tanks they would need for the next couple of months. And Heath gathered together basic necessities and a few mementos: diapers, pacifiers, blood pressure cuffs and tiny hospital bands.

    But no one at the hospital, one of Chicago’s largest, told Heath or her husband what she felt would have been the most helpful advice in the long run: The triplets’ low birth weight alone meant they were automatically eligible for what’s known as early intervention services, which can include speech, physical, occupational and other therapies.

    “This should have been a conversation way before the boys were even released,” said Heath, who lives in Joliet, a city in the suburbs of Chicago. (She declined to identify the hospital to The Hechinger Report because her children still receive regular treatment there.) 

    Related: Our biweekly Early Childhood newsletter highlights innovative solutions to the obstacles facing the youngest students. Subscribe for free.

    Doctors, and science more broadly, have made astounding gains in their capacity to save the lives of extremely premature babies, defined as those born before 28 weeks. In the 1960s, just 5 percent of premature infants with respiratory distress survived; now it’s about 90 percent.

    Despite these encouraging gains, there’s an abysmal record across the country, exemplified by Chicago, of helping these babies after they exit the NICU, particularly with access to the therapies that most reduce their risk of needing intensive, and expensive, special education services as schoolchildren. Many children who receive early intervention do not require special education services in kindergarten, including slightly less than half of those with developmental delays, according to one 2007 study.

    “We have so much information on early brain development now,” said Alison Liddle, a physical therapist in Chicago who is part of a team that studied access to early intervention in the city. One of the findings was that the system is difficult for parents to navigate. “Support systems have to catch up. We have a critical window to help families.” 

    Three of Vasquez’ four children received early intervention services as infants and toddlers. Credit: Camilla Forte/The Hechinger Report

    Federal law says children with developmental delays, including newborns with significant likelihood of a delay, can get early intervention from birth to age 3. States design their own programs and set their own funding levels, however. They also set some of the criteria for which newborns are automatically eligible, typically relying on qualifying conditions like Down syndrome or cerebral palsy, extreme prematurity or low birthweight. Nationally, far fewer infants and toddlers receive the therapies than should. The stats are particularly bleak for babies under the age of 1: Just 1 percent of these infants get help. Yet an estimated 13 percent of infants and toddlers likely qualify.

    “It’s like people being told at 65 that they are eligible for Social Security and a year later they are not on either Social Security or Medicare,” said Dr. Michael Msall, a neurodevelopmental pediatrician who has led efforts on early intervention access at the University of Chicago’s hospital system and is on the study team. “We’d have riots in the streets.”

    The stakes are high for these fragile, rapidly growing babies and their brains. Even a few months of additional therapy can reduce a child’s risk of complications and make it less likely that they will struggle with talking, moving and learning down the road. In Chicago and elsewhere, families, advocates and physicians say a lot of the failures boil down to overstretched hospital and early intervention delivery systems that are not always talking with families very effectively, or with each other hardly at all. “They really put the onus of helping your child get better outcomes on you,” said Jaclyn Vasquez, an early childhood consultant who has had three babies of her own spend time in the NICU.

    Related: Black and Latino infants and toddlers often miss out on early therapies they need

    Hospitals use different processes for educating families about early intervention, which often occurs at an overwhelming time for parents. “That initial connection with the families is tricky because the families tend to be very busy when they take the baby home,” said Dr. Raye-Ann deRegnier, the lead physician on the study and director of the Early Childhood Clinic at Lurie Children’s.

    At Lurie and Chicago’s Prentice Women’s Hospital, where deRegnier works, the physical therapists are generally responsible for informing families of early intervention. “I wouldn’t say that happens in every NICU,” she said. “Sometimes it’s discharge nurses, sometimes discharge coordinators, sometimes others.”

    Under the current landscape, it’s helpful when physical therapists have conversations with families early and often, deRegnier said. But even when that happens, miscommunications can occur. The doctor said she recently made a point to talk to a mother about early intervention, and the woman said she had never heard of it. Yet the physical therapist had previously had a lengthy conversation with the mother about the program.

    In Illinois three years ago, the state’s Legislative Black Caucus urged the creation of demonstration projects at neonatal intensive care units in hospitals, intended to model how to better connect families to services. The state’s General Assembly supported the idea, but no funding was attached to the recommendation, and it has not become a reality.

    However, a coalition of therapists and hospital physicians, including deRegnier, has been working on a pilot study that included a look at barriers that families face after they leave the NICU at several of Chicago’s largest hospitals. 

    Their findings, published in late December, show that only 13 percent of the 60 families — all of them Medicaid eligible and with infants who automatically qualified for early intervention — were receiving those therapies three to four months after discharge. In Illinois, the therapies are overseen by the state’s Department of Human Services and its Division of Early Childhood. While the specific reasons varied, most of it came down to bureaucracy and bad communication, according to the study team. 

    “When you make the system so difficult to navigate, families give up,” Liddle said. “There were many families just waiting out there for services that they really need.”

    Every weekday afternoon after play time, Karen Heath’s children, including her 5-year-old triplets, read books with their grandmother. Credit: Camilla Forte/The Hechinger Report

    By the end of June 2019, Heath’s triplets were all at home along with their 1-year-old brother. Although her husband had to return to work, Heath’s mother was around to help. The family had little idea of how best to support their growth. Doctors had warned her that the boys might never be able to sit up, walk or communicate like other children. “My main focus for so long was on coming home,” she said. “Once we got home, I’m like, ‘Now what?’”

    About two weeks after the homecoming, a nurse from the county stopped by to check in on the 6-month-olds. Heath can’t say for sure, but she believes that the woman must have made a referral to early intervention because several weeks later, in August, the family got a call saying that the triplets might be eligible for therapy. By that time, they were more than 7 months old.

    Heath leapt at the opportunity, but the process moved slowly after the initial call. In October, when the boys were 9 months, Heath got word that they had been automatically eligible all along because of low birth weight. But it wasn’t until early 2020, after the boys celebrated their first birthday, that the therapy was scheduled to start.

    Then the pandemic hit, so the initial physical and developmental therapy sessions with three near-toddlers were all attempted over Zoom. “The boys were uninterested,” their mother recalled. “Try doing therapy on an iPad with triplets and (a toddler) hanging around.” 

    It wasn’t until the summer, when the children were 18 months, that they got their first in-person therapy. “The hospital should have had something in place so these kids could have gotten the services as soon as they came home,” Heath said. “I really feel like they dropped the ball. No one can blame the pandemic because they came home way before Covid started.”

    Family photos, including from her triplets’ lengthy stays in the hospital, line the walls of Karen Heath’s living room. Credit: Camilla Forte/The Hechinger Report

    The families participating in the multihospital pilot study had a leg up on Heath: They were at least told about early intervention, with an initial referral made before leaving the NICU. But even that was not enough for most of them to connect successfully with help. A lot of the struggle came down to “logistical and technological barriers,” said Zareen Kamal, a policy specialist in Illinois for Start Early, which advocates on early childhood issues.

    The early intervention system in Illinois is decentralized, with 25 coordinating offices across the state. Caseloads are supposed to be capped at 45, but due to underfunding and short staffing, average much higher, with some reports of service coordinators juggling over 100 families. Many of the offices rely on fax for communications, with no statewide electronic system in place. Incoming phone calls to families from the coordinators often register as spam. And most of the offices don’t staff the phones in the evening or weekends, when working parents are most likely to reach out. 

    All this means that case workers sometimes remove families from their list as “uninterested” when, in fact, the parents are unaware, or unsure how to take the next step.

    Related: Six ideas to ease the early intervention staffing crisis

    The state is currently taking steps to ensure equitable access to early intervention, said a spokeswoman for the Department of Human Services in an e-mail. That includes updating the standardized referral form and exploring options for electronic referrals.

    “We realize that technology needs to be modernized,” wrote Rachel Otwell, the spokesperson.

    That said, phone and fax remain the primary means of communication due to privacy concerns, she said.

    Otwell said the agency is engaged in ongoing surveys and focus groups with thousands of early childhood community members. The state has made progress with staffing vacancies in early intervention, she added, and remains focused on “lowering caseloads to recommended levels.” 

    As the early intervention system currently exists in many cities and states, inequities are baked into every step of the process. Lower-income families are less likely to receive timely referrals, get screened and approved expeditiously, and then connect with therapists available for in-person work. Families with private insurance can often bypass the multistep bureaucratic process by having the therapies covered through those benefits. Studies have shown that Black newborns for a host of reasons, including higher poverty rates and weaker early medical care on average, are five times less likely than white ones to receive early intervention services.

    In addition to early exposure to critical therapies, Vasquez says that strong sibling relationships and support has helped her children to thrive. Credit: Camilla Forte/The Hechinger Report

    For newborns there is pervasive confusion around who is automatically eligible, even among those who work in the early intervention system, Liddle says. “Some children are turned away from receiving services despite being autoeligible, because they do not show a delay on a specific assessment tool,” she said.

    Complicating matters, states have different eligibility criteria: In some states, an infant with lead poisoning or a parent with a mental health diagnosis qualifies for the therapies, whereas in others they do not.

    There’s also a disconnect between the medical and early intervention systems, said Msall, the University of Chicago-based physician. His colleagues in NICUs routinely fax referrals over to early intervention, he said, but the information disappears into the ether, with no follow up or technology in place for the physician to know if the connection was made or what an initial evaluation found. DeRegnier agreed that the follow-up process is complicated, partly because families may need to sign a consent form for information to be shared even with physicians.

    In a nutshell, families too often have to navigate through the system entirely on their own — with only the most knowledgeable and well resourced likely to find their way to a successful outcome.

    Vasquez felt immensely grateful her background as a special education teacher made it easier to supplement the work of overstretched hospital staff when her twin daughters were born at 27 weeks four years ago. The smaller of the two spent over a year so medicated in a Chicago NICU that she was essentially in a medical coma. But as soon as possible, Vasquez and her husband stepped in to help provide some early therapies. Following the advice of hospital therapists, they helped her sit up, roll over, learn to play with toys and regularly gave her full body massages. (She didn’t want to name the hospital because she believes any shortcomings were reflective of systemic issues, not specific to that hospital.)

    Then, when the baby was finally released after 19 months in the NICU, Vasquez knew to call early intervention without delay. The family wasn’t more than five minutes into their drive home before she picked up her cellphone and rang them up from the back seat. “There was no second to lose,” said Vasquez, whose work as an early childhood consultant focuses on equity.

    Within weeks of arriving home, the baby started upward of a half dozen different therapies, including speech, nutrition and mobility. 

    Partly because of the quick introduction to therapies, formal and informal, Vasquez’s daughter is thriving today at the age of 4. The girl had to spend only a few months in a self-contained classroom for children with severe disabilities before teachers said she was ready to join the “blended” class. It’s a milestone that seemed unreachable just a couple of years ago.

    “After six months (in school), they said she is doing awesome,” Vasquez said. “I was told my child would need a wheelchair by kindergarten. She is running, dancing, chasing siblings, dancing on trampolines — all because of the amount of time we poured into therapies at a very young age.”

    Jaclyn Vasquez plays outdoors with her children on a fall weekend afternoon. She says her background in special education made it easier to help with early therapies they needed. Credit: Camilla Forte/The Hechinger Report

    Physicians, advocates and families all agree that parents shouldn’t have to wait until leaving the NICU to begin lining up services. The coalition of groups working on the study recommend staff embedded at the hospitals who can help families enroll in early intervention before discharge. Each family who is automatically eligible would also leave the hospital with a legal document entitling them to therapy. “Our ultimate dream is to have the connection between [early intervention] and families be completed before they go home, and have the therapist assigned before they leave,” said deRegnier.

    Many advocates also believe that for those babies on an extended stay in the hospital, those therapies should be available in the NICU. “Early intervention is birth to 3 — it shouldn’t matter if you are living in the hospital or at home,” Liddle said. “You are still entitled to those services.”

    Related: OPINION: Early screening and intervention can help young children get much-needed post-pandemic support

    In Illinois, advocates say they hope to get funding to pilot a program at a few NICUs that would finally create the demonstration sites the Legislative Black Caucus called for years ago. If successful, the model could be expanded statewide. “Even if we are in one or two NICUs and can see how it turns out, that would be helpful,” says Illinois state Rep. Joyce Mason, who chairs the House committee focused on early childhood education.

    In the meantime, too many families still find the crucial therapies to be elusive.

    Even when Heath’s children finally started in-person therapy, it was limited in scope. The physical therapist, who Heath describes as an “angel,” quickly recognized that they should also be receiving other help as well, including speech and occupational therapy. Yet by the time the family worked through the bureaucratic machinery to get some of those in place, the boys were nearly 3 — close to aging out of early intervention. They received a few months of speech, but never got the occupational therapy they were entitled to.

    If they had gotten the therapies earlier, “they would be in a different place at this point,” Heath says. The boys, who were diagnosed with cerebral palsy shortly before their fourth birthdays, struggle with speech and reading skills, in particular, with one of them requiring a device in order to express himself. “If you don’t know them well, it’s hard to understand what they are saying all the time,” Heath says. “If they had gotten all the services right off the bat, they wouldn’t be as far behind.” 

    Yet the triplets have long surpassed doctors’ early warnings that they might never sit up, walk or reach other developmental milestones. Newly arrived home from school on a clear fall afternoon not long before Halloween, the triplets, now in kindergarten and dressed as Spider-Man for “superhero” day, played exuberantly in a finished basement space. They cried out gleefully while zooming after each other in miniature bumper cars.

    Heath is grateful her sons are progressing with the help of school, devoted family and the committed physical therapist, who still works with the boys. But she looks back at their first nine months and laments that, so focused on how to help the babies survive, no one in a vast team of doctors, nurses and social workers thought to discuss how the family could best help them thrive. “There was no next step for my family when we left the hospital,” she said. “It was all on us.”

    Contact Sarah Carr at [email protected].

    This story about early intervention services was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Carr is a fellow at New America, focused on reporting on early childhood issues.

    The Hechinger Report provides in-depth, fact-based, unbiased reporting on education that is free to all readers. But that doesn’t mean it’s free to produce. Our work keeps educators and the public informed about pressing issues at schools and on campuses throughout the country. We tell the whole story, even when the details are inconvenient. Help us keep doing that.

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