Stayin’ Alive:Campus Health’s Take on Student Retention

and Beyond

Why stayin’ alive?

• Students come here to earn a degree, learn skills and grow for the future

• Many variables must align to make that possible:

• Need to understand various sides of the retention issue in order to understand retention

• Focus and concentrate• Attend classes regularly• Think critically

• Complete work on time• Organize and process

information

Overview of Presentation

• Overview of Campus Health - services offered• Student health and wellness needs • CHS’ contribution to student retention– Challenges to measuring retention– Data overview and what we see on the ground

• A deeper look at retention, health and mental health issues

WHAT DO WE OFFER OUR STUDENTS AT CHS ?

Campus Health Service is…• Medical Services, Counseling

and Psych Services, Oasis Program Against Sexual Assault and Relationship Violence and Health Promotion and Preventive Services

• Integration of services on several fronts

Health Services• Full service outpatient medical clinic – See a range of patients, from very mild to more severe (case

example)

• Staffed by licensed medical practitioners • Students seen by appointment and walk-in• On site X-ray, laboratory• Full service pharmacy• After hours phone line

General Medicine (cont’d)

• Urgent Care • Women’s Health • Sports Medicine • Physical Therapy• Acupuncture • Massage Therapy• Immunization & Travel Clinic

Counseling and Psych Services (CAPS)• Treatment of depression, anxiety, eating & body image

issues, substance abuse, sleep issues, grief, trauma, family & other relationship issues, ADHD management, etc.)

• Staffed by licensed mental health practitioners • Same-day walk-in Triage• Solution focused counseling for individuals and couples• Psychiatric services• Support groups and other psychoeducational groups

Counseling and Psych Services (CAPS) cont’d• Consultation with faculty, staff, families and

friends about students of concern • Education and training around college mental

health issues• Suicide prevention • Risk assessment, mental health screenings• Assistance with developing coping skills and

strategies (case example)

Oasis Program Against Sexual Assault & Relationship Violence

• Team staffed by licensed Psychologist and violence prevention specialist

• Counseling for individuals impacted by:– Sexual Assault– Relationship Violence– Stalking

• Consultation • Education and Outreach• Community advocacy and decision making

Health Promotion and Preventive Services

• Alcohol & other drug awareness and counseling (case example)

• Sexual health• Nutrition and fitness • Stress management• Violence prevention and bystander intervention• Body issues • Suicide prevention

Some HPPS programs• Brief Alcohol Screening and Intervention for College

Students (BASICS)• The Buzz• Student Health Alcohol and Drug Education (SHADE)• Step Up! Bystander intervention program• Question, Persuade, Refer suicide prevention training• Individual consultation and referral for alcohol and

other drug issues and nutrition

How do the services at CHS relate to retention?

Students’ ability to succeed in college

Anxiety

Sleep

Physical Illness

Chronic pain

Family concerns

Depression

Substance use

Attention/ concentration

Eating disorders

Grief

Relationship conflict

Intrusive thoughts

Identity Issues

It’s hard to succeed academically if…

• Too impacted by personal issues to complete coursework

• Mental or physical illness interferes with cognitive skills or energy levels

RETENTION AND THE ROLE OF CAMPUS HEALTH SERVICE

What do we know about student retention?• Reasons for leaving are varied – from finding

another school to dealing with personal issues (Rummel, 1999)

• The needs of students and our ability to meet them is related to retention

• “Institutional efforts to ensure a healthy campus environment can have an impact on student success and potentially affect retention.” (NASPA, 2004)

ACHA top impediments to academic performance

AI-1.1    Reduce the proportion of students who report that their academic performance was adversely affected by stress in the past

12 months.

AI-1.2    Reduce the proportion of students who report that their academic performance was adversely affected by sleep difficulties in the past

12 months.

AI-1.3    Reduce the proportion of students who report that their academic performance was adversely affected by anxiety in the past

12 months.

AI-1.4    Reduce the proportion of students who report that their academic performance was adversely affected by cold/flu/sore throat in the

past 12 months.

AI-1.5    Reduce the proportion of students who report that their academic performance was adversely affected by work in the past

12 months.

Mental health of UA students*• 27% said depression or anxiety made it difficult to

work, study, or go to class• 51% experience more than average stress• 6.6% have seriously considered suicide in the last

year• 19% had experienced violence in last 3 months• 10% have been diagnosed with depression, and

11% have been diagnosed with anxiety

*2012 Health and Wellness Survey, n=2,406

Concerns presented at CAPS Triage

Top 10 concerns presented (n=1,974)

70% Anxiety/Panic63% Depression/sadness44% Sleep problems40% Low energy36% Academic concerns

31% Isolation/withdrawal30% Impaired concentration30% Mood swings28% Low self-esteem24% Romantic relationship issues

Intuitively, we know that wellness has an effect on retention. But what are some challenges to measuring student retention?

Measurement challenges

• Causal link between support services and retention is hard to quantify

• Students themselves may not realize impact of a problem (or its solution) on remaining in school

• Multiple, complex factors at play• Multiple and varied support services to support

struggling students can be synergistic

Measurement challenges (cont’d)

• Unique challenges for CHS:– Confidentiality and data collection– Broad reaching services may support students in

subtle ways – Can’t measure how a crisis averted (prevention)

affects retention

• All data presented here is self report

Health services and retention

• There is very little research about the link between physical health and retention

• Aitkin (1982) found that number of sick days was significantly associated with GPA

• Findings from a Rutgers disease prevention program found a correlation between use of health services and GPA, retention and classroom attendance (Conciatore, 1991)

• Can hypothesize that:– Illness (including chronic and severe episodes) may have a negative

impact on academic performance– Health services which assist the student with these issues may positively

impact retention (Case Examples)

49% of UA students indicated that using CHS helped them remain a student* - equivalent to 1,178 students in sample

*2012 Health and Wellness Survey – n=2,406

44% - 1,058

19% - 457

8% - 192

% students who said any of the following services helped them remain a UA student (n=2,406)

Medical Services CAPS HPPS

Counseling services and retention• 63% of counseling centers nationally asked students

about retention– 56% indicated that counseling helped them remain a student

and 61% said it helped their academic performance (AUCCCD, 2011)

• Range of severity in patients, but either end may have an impact on retention (suicidality vs. grief – case examples)

• Substantial literature to support Counseling advantage:– Iowa state – 14% retention advantage against control group– University of Western Illinois – followed freshman for 2 years

and found 70% retention rate in counseling group vs. 68% in general student population

Mental health and retention

• Depression, anxiety, and eating disorders are linked with lower GPA and higher risk of dropping out (Eisenberg, Golberstein and Hunt, 2009)

• In one study, 1/5 students attending counseling were considering dropping out (Turner and Berry, 2000)

• Socio-emotional adjustment problems are better predictors of retention than academic difficulties (Bray, Braxton and Sullivan, 1999)

CAPS Triage usersStudents surveyed after triage appointments between Feb-March 2012 (n=71) indicated that their visit to caps:

Increased sense of hope

Increased comfort in help seeking

Improved outlook on the future

Increased awareness of options

64%

82%

59%

79%

CAPS patient satisfaction survey 2012• Collected April 2-12, 2012• Administered to students after their counseling

appointment• N=246 (20 triage only and 226 returning students)• Sessions at CAPS– 29% 1-3 sessions– 13% 4-5 sessions– 51% more than 5 sessions

CAPS patient satisfaction survey (cont’d)

Anxiety/Panic Depression Family Issues Low self esteem Hopelessness

91% 93%78%

91% 85%

45%53% 53%

60%

43%

Problems treated and impact on academic success/decision to stay enrolled

Impacted academic performance Impacted decision to stay

CAPS patient satisfaction survey (cont’d)

Life decisions Relationship Suicidal thoughts AOD issues Physical health

80% 81% 83% 84% 80%

57%

34%

56% 52%44%

Problems treated and impact on academic success/decision to stay enrolled

Impacted academic performance Impacted decision to stay

…AND BEYOND THE DATA:

LOOKING DEEPER AT COLLEGE HEALTH SERVICES AND RETENTION

Stayin’ alive

• Retention cannot be the sole focus of the CHS mission (case example)

• Sometimes, we must recognize the greater need to withdraw, for reasons of health and safety – …and some get help too late– Temporary separation does not always equal failure to complete

college

• Direct service to students with health and mental health issues may position others in student affairs to assist students with retention in other ways

Retention challenges for today’s students

• Students may be more difficult to retain if they have:– Reduced tolerance for discomfort and unwanted feelings – Belief in immediacy of solutions– Delay in self-responsibility – Increase prevalence of bipolar disorder due to widespread

use of ADMS in undiagnosed bipolar– Increase in severity and multiplicity of symptoms– Treatment making college a possibility for those with

marginal skills and coping (greater use of medications)

Remaining questions

• How can we better examine the causal link between CHS services and retention? (measurement difficulties)

• How do different types of services impact retention differently?

• What is the relationship between severity of presenting problem and retention? (Achter, 2008)

• For CAPS, how is number of visits related to retention?

Next steps in data collection

• Looking at more creative ways to collect retention data– Where can we incorporate into evaluation? Support

groups, educational outreach, diversion programs, etc.

– How can we work with other departments?– How can we measure actual retention among those

using our services, as opposed to only self report? (many complications!)

Summary

• Retention is a complex variable• Hard to define causal relationships definitively• Hard to get hard evidence for the specific role of

any single intervention• Health and mental health issues clearly impact a

student’s ability to succeed and possibly remain in college

You have to be alive and functional to be retained!

QUESTIONS/DISCUSSION?

Contact Information

(520)Main phone number: 621-6490

Appointments: 621-9202Triage nurse: 621-6493

CAPS: 621-3334After Hours: 570-7898

Administration: 621-6489Insurance: 621-5002