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SUPPORTED HIGHER EDUCATION:RESEARCH TRANSLATION & INNOVATIONS

Rhode Island Governors Commission on Disabilities,

Providence, R.I. --- October 19, 2011

Funded by the National Institute on Disability and Rehabilitation Research, Grant # (H133A050006). Innovative Knowledge Dissemination & Utilization Project for Disability & Stakeholder Organizations

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Pat Deegan on Recovery Recovery is a way of life, an attitude, a

way of approaching life’s challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup, start again…The need is to meet the challenge of the disability to reestablish a new and valued sense of integrity and purpose within and beyond the limits of the disability.(Deegan, 1988, p. 15).

http://www.youtube.com/watch?v=DVlhfuKDjYE

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Presenters…From Boston University, Center for Psychiatric

Rehabilitation

Joan Rapp, Rehabilitation Training Specialist

Rob Denney, Job Development Specialist

OUTLINEWho are the Students?

Key Elements & Services

Challenges for Students in Higher Education

Systematic Review of the Research

BU Innovation Example

Higher Education Toolkit

Q. & A.

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WHO ARE THE STUDENTS?

Those with major psychiatric illnesses such as psychotic disorders (schizophrenia, psychotic depression, bipolar disorder)

Those with significant mood disorders (depression, anxiety)

And other psychiatric disorders that interfere with one’s ability to perform valued roles.

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Who are the Students?

-They may come to college/university with a psychiatric illness (known or unknown)

-They may develop a psychiatric illness after being in school for a while

-Early intervention makes a huge difference in the outcomes

Definition

“Supported Education … provides supports & other assistance for persons with psychiatric disabilities for access, enrollment, retention and success in postsecondary education.”

(Collins & Mowbray, 2005)

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Models & Services: The FlowersClassroom Modelstudents attend closed classes on campus designed for the purpose of providing supported ed.

On Campus (On Site) Modelsponsored by a college and provides support for an individual rather than group

Mobile Support Modelprovides services through a mental health agency helping students to attend the school of their choice

Free Standing Modellocated at the sponsoring agency such as a rehabilitation agency, a university or other entity. (Collins & Mowbray, 2005) 8

An Array of Services

Use staff with specialized training Include career & vocational directionHelp with financial aid;Help with coping skills for academic environmentOn campus info re: rights and resources;Mentor with authentic relationship & personal support Help with course access and completionAccess to tutoring & other academic support;Access to good (current) general support & referrals.Be available when it is not convenient.

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CHALLENGES FOR STUDENTS

Low self esteem Social skills problemsPersonal & family issuesMemory and concentrationConflicts with faculty

(Collins & Mowbray, 2005)

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Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.  Innovative Knowledge Dissemination & Utilization Project for

Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

CHALLENGES FOR STUDENTS

Getting accommodations and supportsCoping with schoolAttendance & participationSpecific disability issues including medicationGeneral anxiety & test anxietyExpectations & pressure: internal & external

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Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.  Innovative Knowledge Dissemination & Utilization Project

for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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So What Works?

We have lots of clinical and anecdotal “evidence”… We have counted the programs… We have described the models and methods in a book and journal articles…. We have adapted and innovated and won some

awards… We have developed manuals and tool kits…

But how well have we actually measured it so we know what works? What is essential? What do we replicate? What to avoid? Let’s discuss the research…..

RESULTS OF RESEARCH ANALYZED

“Suggestive of Change”

In uncontrolled evaluations participants improved in their level of employment and educational status as a result of participation in a supported education intervention (Unger et al., 1991; Hoffman & Mastrianni, 1993; Unger et al., 2000; Unger & Pardee, 2002; Best et al., 2008; Cook & Solomon, 1993).

Individuals who remain engaged in supported education are able to complete courses and achieve a satisfactory grade point average (Unger et al., 2000; Unger & Pardee, 2002; Cook & Solomon, 1993; Best et al., 2008); the strength of this evidence is weak due to the poor research designs used.

A supported education intervention (classroom model) was more effective than a control group in improving empowerment and school efficacy (Collins et al., 1998).

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Compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation.   Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder

Organizations/ NIDRR Grant # (H133A050006)

RESULTS OF RESEARCH ANALYZED

Satisfaction with supported education was significantly higher among those in a group supported education intervention when compared to a control group (Collins et al., 1998).

In terms of goal specificity, being in a supported education intervention lead to setting more specific and optimal goals (Collins et al., 1998)

Supported education is a viable intervention for many to meet their goals for educational advancement, personal development, and better jobs (Mowbray et al., 1996)

But strong research support regarding hard outcomes e.g. employment…was not there

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Compiled by the Supported Education Study Group at Boston University Center for PsychiatricRehabilitation.   Innovative Knowledge Dissemination & Utilization Project

for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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SOME BARRIERS TO GETTING SUPPORT FOR EDUCATIONAL GOALS

Fear of disclosure

Lack of knowledge of what is available

Lack of knowledge re: Disability Support Services eligibility

Fear of stigma

Lack of real supported education interventions

School policies related to outreach and services: Silos of service

Lack of an environment that is welcoming and supportive for students with psychiatric disabilities

(Collins & Mowbray, 2008)

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IMPORTANCE OF PROMOTING NEW RESEARCH IN SUPPORTED

EDUCATION

High unemployment rates among those with psychiatric disabilities:

Education = Hope

Difficulty “graduating” from benefits to full time work without training and education;

Knowledge from Supported Housing and Supported Employment shows the value of the right supports in effecting outcomes

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Compiled by the Supported Education Study Group at Boston University Center for PsychiatricRehabilitation.   Innovative Knowledge Dissemination & Utilization Project

for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

VALUE OF PROMOTING NEW RESEARCH IN SUPPORTED

EDUCATION

Limitations of the existing research in methodology;

Need to evaluate the current / common, individually based Supported Education interventions.

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Compiled by the Supported Education Study Group at Boston University Center for PsychiatricRehabilitation.   Innovative Knowledge Dissemination & Utilization Project

for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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Where We Are

Rehabilitation and Recovery?A Classroom or a Computer Screen?Suicide PreventionMeasure the Progress Track the ProcessHope & ResilienceConnections you can count onAuthentic Relationships

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Education is key factor

By far the most important factor affecting participation and level of activity [in employment] is the amount of education completed. We cannot ascertain convincingly whether and to what extent educational preparedness precedes [mental] illness and the extent to which it is confounded with the seriousness and complexity of the illness. However, to the extent that educational preparation independent of illness predicts employment success, it could usefully direct effort in early treatment and in encouraging and facilitating return to school and completion of as much schooling as is feasible (David Mechanic, 2003, p.1232).

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An Emerging Best Practice

Supported Education is an emerging best practice

Not there yet….• Sally Rogers KDU Project (NIDRR)• UMNDJ RCT in SEd with Temple University

RRTC in Community Integration (NIDRR)• Fidelity Measures: University of Kansas (Diane

McDermid)• SAMHSA Tool Kit: (Karen Unger)

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A Dynamic Duo

Recovery Orientation + Supported Higher Education can = success but only if there is a deep appreciation for the lived experience of psychiatric illness and recovery.

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Early Intervention The concept of early intervention puts the onus on primary care and other community services to make themselves accessible, non-stigmatizing and relevant to young people, whether they are dealing with a mild and self limiting depression or a major psychosis.

~David Shierer, Joint Director of the National Development

Network for Early Intervention, (NIMH for England)

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Promise of Early Intervention

Teach valuable survival skills (recognition and coping) Provide for integrated treatment and

support (medical, emotional, cognitive, academic & social)

Improve chance for success in school Increase Retention & Reduce Drop Out Preserve valued Roles and Scripts Stop “careers” as patients

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Active Minds

http://www.youtube.com/watch?v=inB91LwyXxI

Alison Malmon-Changing the conversation about mental health (Part 1)

http://www.youtube.com/watch?v=SMNswwfSdas

http://www.youtube.com/watch?v=QkdwxVvxKgY

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Is it worth the risk?

You will come to a place where the streets are not

marked.Some windows are lighted. But mostly

they’re darked.A place you could sprain both your elbow and

chin!Do you dare to stay out? Do you dare to go in?How much can you lose? How much can you win?

Dr. Suess

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Supported Education atBoston University

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Our History Est. in 1984 with the

Career Education Program that taught people from the community to choose, get and keep work in a supported educational environment.

Valued role of “Student” , emphasis on doing “what it takes” to help people function successfully

26 years of psychiatric rehabilitation services an educational environment.

Service Division serves as a pilot environment for research and training.

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Our Foundations

Non-negotiable values drive our service delivery: hope, choice, self-determination, and growth.

Theories of Change

Health promotion and prevention

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Our Educational Services focus: Resiliency and Growth Active, respectful, integrated services that

promote healing and functional health through shared decision making with students and significant others-including University personnel and parents.

Rehabilitation that promotes role success as a student.

Case Management that supports students to live well on campus.

Authentic relationships

Services We Provide:• College Mental Health Coaching Service• Campus Suicide Prevention Initiative• Clinical Internship Site

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Student Mental Health

Suicide is the second leading cause of death in college students

Nationally, approximately 45% of college students report significant mental health distress

67% turn to their peers FIRST.

Use of behavioral medicine services at BU has increased 250% in the last 5 years-more and more students coming to college with mental health diagnoses as well as those who develop mental illnesses in college.

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College Suicide Prevention at BUBoston University Suicide Prevention Grant (SAMHSA)• *Mental Health Round Table, website development, de-

siloing of campus services charged with student mental health and wellbeing

• *Active Minds Chapter-Post Secret Project, Awards• *Student Support Network Training; • ★Webinars, Screenings, parent ENews

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BU SECRET: RAISING AWARENESShttp://www.youtube.com/watch?v=bbX2siSMSkA

Student Voices

• www.bu.edu/mentalhealth

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Student Support Network Training

Training students to be empathetic listeners, excellent referrers to resources on campus.

Marketing it as leadership training.

Targeting Athletes, LGBTQ, international students, minority students and Greek life

Specialty trainings for ROTC cadets, residential advisors, faculty and staff

Trained over 500 people to date

SSN is an evidenced based curriculum

Motto-”tell someone, BU listens”

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NO ORDINARY DOOR

This might look like an ordinary door, but it is the door to the B.U. Recovery Center. The Center helped open and maintain my road to recovery. The many skills I have learned and been coached on at the Recovery Center are computer knowledge, communication skills, nutrition, and most importantly self-respect and confidence. The center deals with the whole person not just the mental illness. The support I receive here has been a critical aspect in my recovery process. I am leading my life because I walked through this door.

Higher Ed Support Toolkit

The Toolkit is a resource to :Identify common difficulties experienced by studentsAssess student difficulties in adjusting and managing classroom and campus lifeConsider strategies and/or accommodations to help studentsIdentify campus resources that are available to assist students at your institution

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Higher Ed Support Toolkit

The Toolkit is organized to help students access knowledge about mental illnesses and resources on their campus. Components include:Student Self-Assessments FormsGetting Connected to Campus ResourcesActions and Accommodations in the ClassroomIntroductionBackground and Additional Resources

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It must be borne in mind that the tragedy of life

doesn’t lie in not reaching your goal. The tragedy lies in having no goal to reach.

-Benjamin E. Mayes

References & Resources

Collins, M.E., & Mowbray, C.T. (2005). Higher education and psychiatric disabilities: National survey of campus disability services. American Journal of Orthopsychiatry, 75(2), 304-315.

Collins, M.E., & Mowbray, C.T. (2008). Students with psychiatric disabilities on campus: Examining predictors of enrollment with disability support services. Journal of Postsecondary Education and Disability, 21(2), 91-104.

Mowbray, C.T., Brown, K.S., Furlong-Norman, K., & Soydan, A.S. (Eds.). (2002). Supported education and psychiatric rehabilitation: Models and Methods. Linthicum, MD: International Association of Psychosocial Rehabilitation Services.

Unger, L.V., Anthony, W.A., Sciarappa, K., & Rogers, E.S. (1991). A supported education program for young adults with long-term mental illness. Hospital and Community Psychiatry, 42(8), 838-842.

American College Health Association (2010). National College Health Assessment. Retrieved on May 13, 2011 from http://www.achancha.org/reports_ACHA-NCHAII.html

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Websites

Rogers, E.S., Farkas, M.D., Anthony, W.A., & Kash-MacDonald, M. (2009). Systematic Review of Supported Education Literature 1989-2009. Boston, MA: Boston University Center for Psychiatric Rehabilitation. Retrieved on May 13, 2011, from DRRK disability research website at http://drrk.bu.edu/research-syntheses/psychiatric-disabilities/supported-education

Higher Education Toolkit. Retrieved on May 13, 2011 from BU Center for Psychiatric Rehabilitation website at www.bu.edu/cpr/resources/supportstudents/index.html

Center for Psychiatric Rehabilitation Website. Reasonable Accommodations for People with Psychiatric Disabilities. Retrieved on May 13, 2011 from http://www.bu.edu/cpr/reasaccom

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Contact Information

Anne Sullivan Soydan -- Pioneer in developing supported education & Teaches at BU Sargent College of Health and Rehabilitation Sciencesapsoydan@bu.edu

E. Sally Rogers – Head of research team that conducted analyses & Director of Researcherogers@bu.edu

Dori Hutchinson –Director of Recovery Services & College Suicide Prevention Programdorih@bu.edu

Kathleen Furlong-Norman –Editor of the Psych Rehab Journal and author of Toolkit on Supported Educationkfurlong@bu.edu

Joan Rapp – Coordinator of Trainingjoanrapp@bu.edu

Rob Denney – Job Placement Specialistdenneyr@bu.edu

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Our Sponsors

National Institute on Disability and Rehabilitation Research

Substance Abuse and Mental Health Services Administration: Center for Mental Health Services

Other private sponsors also Contribute to Recovery Services