Khalila Fordham PsyD Raquel Contreras PhD Counseling and Psychological Services CAPS September 10 2015 Presentation for Library Supervisors Learning Objectives This presentation is intended to help attendees ID: 463498
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Slide1
Assisting Students in Distress
Khalila Fordham, Psy.D.
Raquel Contreras,
Ph.D.
Counseling and Psychological Services (CAPS)
September 10, 2015
Presentation for Library SupervisorsSlide2
Learning Objectives
This presentation is intended to help attendees:
Learn to identify students in distress
and crisis.
Distinguish between a student in distress and a student in crisis.
Distinguish between levels of mental health risk.
Learn strategies to intervene with a student in distress or in crisis.
Learn about Clemson University resources for students in distress.
Identify how CAPS can assist all university personnel
in
responding to students in distress and crisis.Slide3
Students in Distress
Everyone experiences distress!
Many times, the student may not approach you, may not want you to be involved, or may not need staff involvement.
It is important to give students space to resolve their own problems, to a degree.
If the student’s distress shows no signs of going away, or is increasing in severity over time, this may show a need for assistance or intervention.
If you are concerned, it is best to consult with a colleague and/or approach the student.Slide4
Specific Signs of Distress
Marked
changes
in academic performance, or attitude towards academic performance:
Poor preparation for class
Drop in grades
Excessive absences or tardiness
Excessive anxiety about classwork, perfectionism
Exaggerated emotional responses that are obviously inappropriate to the situation
Inability to communicate clearlySlide5
Specific Signs of Distress (continued)
Changes
in
b
ehavior:
Depressed or lethargic mood, apathy
Avoiding participation in class activities
Unusual or changing pattern of interaction with others
Consistently avoiding activities with others
Marked increase or decrease in energy level
Increase in irritability, emotional reactivity
Low tolerance for frustrationSlide6
Specific Signs of Distress (Continued)
Unusual appearance*, or
changes
in appearance:
Marked changes in personal hygiene
Marked differences in dress/attire, or attire that consistently does not fit the context*
Dramatic weight loss or gain
Swollen or red eyes
*
Take cultural and individual differences into accountSlide7
Distress or Crisis?
Both require our attention!
Distressed students can become students in crisis, with or without appropriate intervention.
Determining the difference between distress and crisis is a matter of
degree.
Multiple factors cause a person to move from distress to crisis; there is rarely one cause.
Level of intervention varies and depends on several factors as well.Slide8
Defining a Mental Health Crisis
Crisis:
a mental health-related situation that has escalated to an urgent or emergent level.
A student becomes unable to utilize his or her typical healthy coping style.
A student’s physiological and emotional responses escalate to personally uncontrollable levels.
W
ithout immediate outside intervention, this situation can result in displayed disturbance of conduct, harm to self or others, or high levels of campus disturbance. Slide9
Identifying a Person in Crisis
Watch for:
Highly bizarre or disruptive behavior (
physical or verbal aggression, public disturbance
)
Overt suicidal threats (
written or verbal
)
Homicidal threats in any form
Inability to communicate clearly (
incoherent, garbled, slurred speech
)
Loss of contact with reality (
seeing or hearing things that are not there, paranoia
)Slide10
Distress, Crisis, and RiskSlide11
Risk
Risk can be categorized into 5 classifications: mild, moderate, elevated, severe, or extreme.
As risk moves from mild to extreme, dangerous or threatening behavior becomes more likely. This behavior can be direct inwards towards the student, or outward towards others. Slide12
Classifying Risk: Mild
Disruptive or concerning behavior
No threat of harm made or present
Action:
This is a student of concern who should be monitored informally.
C
onsultation is a good option if there are questions on how to proceed. Approaching the student is a good option to prevent further deterioration.Slide13
Classifying Risk: Moderate
More involved or repeated disruption
Possible made or perceived threat, vague and indirect
Threat lacks realism, detail
Content of threat suggests unlikely to be carried out
Action:
This is could become an urgent mental health situation. The student should be approached. Seek consultation as soon as possible about how to intervene.Slide14
Classifying Risk: Elevated
Seriously disruptive incident(s)
Clear distress or disturbance
Threat made or present
Threat may be vague, but repeated to several observers
Action:
This is an urgent mental health situation. Seek consultation immediately. The student must be approached. Call CAPS or offer to walk student to CAPS as soon
as possible.Slide15
Classifying Risk: Severe
Dysregulation
Threat made or present
Threat is vague but direct, or specific but indirect
Threat is consistent, plausible, or with increasing levels of detail of a plan
Content of threat suggests it may be carried out
Action:
This is an urgent mental health crisis. Consult CAPS immediately about how intervention should proceed. Call and/or offer to walk the student to CAPS immediately.Slide16
Classifying Risk: Extreme
Dysregulated
or medically disabled
Threat made or present
Threat is specific, direct
Threat includes details of plan, often with steps already taken
Threat repeated with consistency
Content of threat suggests that the person will carry it out
Action:
This is an emergent mental health crisis. Call 911 immediately. Notify CAPS.Slide17
Interventions for
Students in Distress and CrisisSlide18
Preparing to Intervene
If there is any question about whether or not a student should be approached or assessed, please contact CAPS at 656-2451 between 8am and 5pm. Our staff can provide guidance.
Be ready and willing to walk the student of concern over to CAPS, with student consent. Students in crisis are served immediately for stabilization purposes.
If after hours, contact the CAPS On-Call counselor through CUPD at 656-2222.
If there is any question about safety, or risk of harm to self or others, contact 656-2222 or 911. Slide19
General Advice for Any Situation
Whether the student you are helping is in mild distress or intense crisis,
Ensure that the student understands you will attempt to help them find assistance, or you will obtain assistance if need be.
Update the student on the status of this assistance to help reassure the student and maintain control of the situation.
Minimize the involvement of others; only essential individuals should be aware of and directly involved with the situation. Slide20
General Advice for Any Situation
Use clear, concise language with the student.
Be as transparent as possible. Communicate as much as you can about the process of helping the student, even if you must share information that could cause discomfort.
Do not ever promise confidentiality to a student, parent, or anyone else involved.
Note your own responses and ensure you have a space to debrief or otherwise engage in self-care. Slide21
Helping a Student in Distress
DO Consider:
Talking
: Find a time that you can meet with the student to discuss the issues and your concerns.
Listening
: Listen actively with an ear to understanding before giving any advice.
Instilling Hope
: Help the student to determine appropriate solutions with the resources available to them on campus, changing the focus on conversation solely on the problem.
Avoiding Evaluation
: Respect the student’s value system, decisions, and choices even if you do not agree with them.Slide22
Helping a Student in Distress
DO Consider:
Maintaining Boundaries:
Focus on the student during the contact and avoid unnecessary self-disclosures.
Clarifying Rules:
Identify rules and requirements and enforce them as would occur for any other student.
Referring:
Encourage student’s use of resources as a sign of strength and self-care; assist with accessing various resources on campus if necessary.
Following-up:
Continue to maintain contact with the student to see if they accessed resources, and encourage student feedback on the process.
Consulting:
CONSULT, CONSULT, CONSULT when in doubt. You never have to decide or intervene alone.Slide23
Using Caution When Helping
AVOID:
Judging.
Help the student problem solve instead of offering immediate criticism
Negativity.
The student can use hope from an outside source to motivate him or her to search for solutions
Excessive Questioning.
Asking many “why” questions will only lead to the student spending more time questioning his or her self. Ask only for the information you need in order to help.Slide24
Using Caution When Helping
AVOID:
Publicity.
Steer the student towards a more private venue for discussion if he or she approaches you in an open office or after class
Assuming.
Reflect back feelings and statements to the student to ensure you understand the situation as he or she is presenting it
Rescuing.
Refer the student to appropriate resources instead of trying to solve the student’s problem on your ownSlide25
Helping a Student in Crisis
DO:
Provide a safe, secure, quiet place
Respect the student’s privacy
Invite the student to stay with you until help arrives
Listen actively and show empathy
Maintain a straightforward, supportive attitude
Keep a phone with youSlide26
Using Caution During a Crisis
DON’T:
Leave the student alone
Try to restrain the student if he or she wishes to leave the immediate area
Take the student anywhere without her or his consent
Challenge or shock the student
Minimize the student’s distress
Promise confidentialitySlide27
Resources for students in distress
Dean of Students office
www.clemson.edu/deanofstudents
656-0471
Office of Community and Ethical Standards
Clemson University Police Department
Redfern Health Center
Counseling and Psychological Services
Medical Services
Healthy CampusSlide28
Access to care
Walk-in Clinic:
Students are seen on a first-come, first served basis
10am – 2:30pm, Monday through Friday.
Complete electronic documentation that takes about 15-20 minutes.
Seen for an Individual Assessment (IA)
Students needs are assessed and a personalized treatment plan is generated.
Treatment recommendations are given in writing.
All students are assessed for safety and level of risk at this initial contact.Slide29
CAPS Crisis Response Services
8-5, M-F:
To immediately address a crisis, CAPS has counselors available to assess students in need. If it is safe and the student consents to it, walk the student over to ensure he or she accesses services.
CAPS On-Call:
CAPS has a counselor on-call 24 hours a day, 7 days a week through CUPD at 656-2222. Please call and request to speak to the CAPS Counselor on-call, give contact information, and you will receive a call from CAPS as soon as possible. Slide30
Treatment Services at CAPS
Individual Assessment
Single
session
Skills-building
workshops
Group therapy-specific and general
Individual counseling
Dialectical Behavior Therapy (DBTSlide31
Online services
TAO—An intelligent mental health therapy tool
7-module,
online treatment for anxiety
Weekly video conference with
counselor
Free, anonymous online screening tools for depression, bipolar disorder, anxiety, post-traumatic stress disorder, eating disorders and alcohol use issues
http://
screening.mentalhealthscreening.org/clemson
Slide32
Source: taoconnect.org
(Reproduced with permission)Slide33
Specialized Programs
ACTT: Alcohol and Drug Abuse Services
CUCARES: Relationship and Sexual Violence Services
Eating Disorders Treatment Services
Mood Disorders Services
Anxiety Disorders Services
Veteran ServicesSlide34
Confidentiality
Confidentiality is the cornerstone of CAPS services.
Students are assured of confidentiality
-- with the exceptions under the law
Imminent threat of harm to self or others
Mandated reporting for
abuse/neglect for child,
or vulnerable
adult
Court ordered to release information
Written consent given by clientSlide35
CAPS: Serving the
Campus Community, and You!
24/7 On-Call for psychological emergencies
E
mergency Response
integrated with many campus agencies
Consultation
for employees and concerned parties about mental health issues, and how to help those who are in distress/crisis
Outreach Services
to promote health, safety, prevention, and education about mental health issues
Crisis and Grief Debriefings
Referrals
to mental health resources outside the campus community