Student Wellness Team’s Daunting Charge
How to take care of 27,000+ UB students and manage all their medical and psychological needs
Story by Ann Whitcher
Photos by Doug Levere, BA ‘89
A student is injured in a car accident. Several months after his hospitalization, he arrives at UB’s Student Health Services complaining of chronic pain. While doing the standard medical workup, campus health officials notice the student is also having difficulty coping with the stress of academics and demonstrates a poor self-image. The health team immediately joins forces with psychological counselors to explore the student’s feelings of loss and confusion stemming from the injury and his subsequent disability. After taking advantage of a stress-reduction program on campus, the student begins to improve. Today, he is doing well—academically, emotionally and physically.
While students 20 years ago might have occasionally trooped over to the campus infirmary when fighting the flu or a bad cold, today’s undergraduates—and graduate students, too—have unique health challenges that demand complex systems, sophisticated know-how and a caring presence.
A phone call to Student Health Services quickly reveals the dramatic shift in campus health issues: The menu of choices points the caller not only to expected directions on immunization, insurance and how to call an ambulance, but also to information on HIV testing and seeing a psychiatrist.
At UB, it’s the job of campus health-care providers—officially known as the Student Wellness Team—to understand the unique issues facing 27,500 students in all age groups and academic disciplines. Psychological help is also part of the package. Indeed, UB students—like those on campuses across the United States—now experience far more serious mental health concerns than they did 20 years ago, with depression and anxiety disorders among the most evident concerns. All these campus health services—whether physical or mental—are funded through mandatory student fees.
The Student Wellness Team’s mission amid these challenges: to offer integrated health care for mind, body and emotional well-being, amid the rigors of academics at a large research university. “We provide the full continuum of care to all students, graduate and undergraduate, professional—full- and part-time,” says Sue Snyder, newly appointed wellness team leader and Student Health Services’ administrative director.
“We think in terms of the ‘students first,’ rather than our internal needs,” says Dennis R. Black, JD ’81, UB’s vice president for student affairs. “We thus have a greater ability to focus all of our efforts on problems or concerns by being one team, gathered around one table.”
At Michael Hall on the South Campus, the medical staff handled a whopping 25,000 patient visits during the 2004–05 academic year. Students make an appointment and then wait in a cheerful room with posters aimed at a youthful demographic. A sign advises them that student health services do not extend to writing medical excuse notes for missing a class. “We don’t want to create a climate in which we disempower the students—they are responsible for class assignments, attendance and communicating the reasons for an absence to one’s professor,” Snyder explains.
“We provide primary care on an outpatient basis for the student body—these are services found in any primary care office,” says Frank Carnevale, MD ’95, health services director who until recently served as wellness team leader.
“They include physicals and office visits and involve treating everything from abdominal pain to panic attacks to travel immunization,” Carnevale says. “We also have specialty clinics for women’s health. These entail screening for sexually transmitted disease [STD], pregnancy prevention and contraception. We also have STD clinics for male students, and we have a travel clinic for students who are going overseas for vacation or for study abroad.”
Students can have confidential testing for HIV, as well as testing for strep throat and other conditions that may crop up. For conditions needing a specialist’s care, or emergency treatment, students are referred to an appropriate setting off campus. (All full-time UB students must carry health insurance coverage for such outside intervention, but the particular type and range of coverage isn’t specified, other than for international students. Students do have the opportunity to buy health insurance if they do not have coverage.)
According to Carnevale, UB students have access to an on-call provider (physician, physician assistant or nurse practitioner) if faced with an urgent issue that cannot wait until health services reopens for regular hours, which is six days a week during the academic year. The Michael Hall staff includes physicians, nurse practitioners, physician assistants, registered nurses and other personnel.
“Decades ago, colleges simply collected health forms on students as a preventative measure,” observes Black. “Today, prevention is far more proactive. Responding to medical concerns and legislative standards, students now cannot even attend a college without an updated and documented MMR [measles, mumps and rubella vaccine] and compliance with meningitis education, or the vaccine. We also have serious obligations under the federal Drug Free Schools and Communities Act that push us to improve our prevention programs, maintain appropriate services and seriously sanction violators.”
MENTAL HEALTH A FOCUS, TOO
As for mental health services, they are voluntary and extensive, explains David Gilles-Thomas, a clinical psychologist and associate director of UB Counseling Services.
Gilles-Thomas reports a “significant” change in campus mental health treatment needs, citing a 77 percent increase over the past three years in students seeking mental health services of one form or another. He offers several trends responsible for this phenomenon, including an increase in students who arrive on campus with diagnosed mental health conditions and who need to continue in some form of treatment once they arrive. “We are seeing a range of conditions from basic adjustment disorders common at university and college counseling centers, to issues of suicide, eating disorders and substance abuse.”
The model here is a community-based mental health facility. “We provide the full range of counseling services—individual, group, couples, as well as psychiatric care—and we have a psychiatrist on staff,” says Gilles-Thomas. “Our prime focus is to provide these services to any registered student, whether full- or part-time. In addition to providing counseling to individuals, groups and couples, we also provide crisis response services for the campus community.”
Of course, UB is not alone in needing to confront changing mental health issues for its students. When Richard D. Kadison, chief of mental health services at Harvard University Health Services, surveyed his counterparts around the country in 2004, they responded that more students now face “more environmental stresses and have more pressing psychological problems.”
Gilles-Thomas agrees with this assessment and offers his own explanation: “The world is a smaller place now; the pressures of a global community, the uncertainty of the future, and the closer-to-home uncertainty about one’s own career and life choices, all contribute to the stress and pressure our students experience today.”
HELP IN A CRISIS
Many on campus recall how what is now the wellness team intervened following 9/11, helping a campus cope not only with a national tragedy, but also with the loss of family members, friends and alumni. That outreach extended a full year after the tragedy, helping, for example, the UB student who lost a parent in the Twin Towers and another student whose parent was badly injured at the Pentagon. Today, the wellness team stands ready to help with any crisis that should arise and to anticipate how its services might be shaped to meet a pressing need.
They also never forget the individual student who may be overwhelmed by academic pressures, romantic disappointment or ill health. “In addition to our after-hours on-call counselor,” says Gilles-Thomas, “we have counselors available for same-day crises should a student need to speak to a counselor without waiting for a scheduled appointment.”
As an example of this continuous outreach, Black recalls how the wellness team helped a student who had lost two friends during his first year at UB, one to suicide, the other in an accident. Then, he was diagnosed with a serious illness. “With support, he faced the challenges and succeeded,” says Black. “He graduated and now is winning the battle for good health.”
Like universities across the country, UB must face the issue of student suicide. “In any community of size and scope, concern about self-harm is real and steps are needed to educate the population, identify those in need and respond to incidents and attempts,” says Black. “Our suicide prevention efforts are multifaceted and include counseling, outreach/prevention, consultation services for faculty and staff, after-hours crisis response, and on-call service and referral,” adds Gilles-Thomas. “We work closely with key offices, such as university police and the residence halls and apartments, to identify students who might be at risk and to develop appropriate responses.”
A BROAD VIEW OF HEALTH AND WELLNESS
A group interview with UB’s Student Wellness Team leaders quickly reveals their dedication to a higher ideal—one not exclusively concerned with treating physical illness or helping students achieve and maintain mental health. Wellness education is also their common aim, as it is the daily goal of Sherri Darrow, PhD ’90 & MS ’83, UB Wellness Education Services director.
An epidemiologist by training, Darrow asks students to complete the statement, “When I am healthy, I am C9.” The question reveals her belief that “health is a process—that is, it is more than a lack of illness. It is a sociocultural phenomenon, as is education. We know that academic success and health are dynamically interrelated.”
Darrow explains that wellness education—in effect, the health promotional division for the UB health team—helps students grapple with issues connected with alcohol awareness, drugs, sexual health, mental health, nutrition, physical activity and exercise. Also figuring in health promotion efforts is the need to address students from different cultural backgrounds, as well as students with disabilities, she says. “We are also working with the residence halls and with the apartments to reach out to students there,” Darrow comments.
A recent study by researchers at the University of Missouri at Columbia found that 18 percent of U.S. college students had problems related to alcohol. Meanwhile, the U.S. Surgeon General has identified binge drinking among college students as a major public health issue. Not surprisingly, a number of UB programs exist to address this chronic problem, including content in the UB 101 course, which gives new students information and techniques for adjusting to life on campus.
“In the freshman UB 101 class, we are currently testing best methods for correcting misperceptions regarding substance use,” Darrow says. “That is, students tend to overestimate risky alcohol use and underestimate protective behaviors. By correcting this misperception, we hope to increase the number of students who abstain from alcohol, or use alcohol moderately. This approach, called the social norms approach, is a proven method of alcohol education that we hope to tailor to our UB students.”
FORTIFYING THE TEAM APPROACH
With its innovative health-care structure in place for the past two years, UB’s program is beginning to attract attention from counterparts at other schools. “We have received phone calls from peers at other institutions across the country who have been intrigued by our approach and interested to see how it could work on their particular campus,” Carnevale says. To keep their collaboration humming, team leaders meet for 90-minute meetings every other week during the academic year, and weekly during the summer.
The team concept, when first proposed two years ago, was quickly endorsed by Dennis Black and by Barbara Ricotta, dean of students. Their comprehensive team followed goal-setting to reduce duplication of services, and also to ensure that health-care providers would spend more time on care, “rather than meetings and paperwork.” Black adds: “The vision has become a reality; today we develop materials and provide programs that are comprehensive, focused on student health, not unit goals or strategies.”
ASSESSING HEALTH IN A FORMAL WAY
This spring, UB will participate in the National College Health Assessment (NCHA), an annual study conducted by the American College Health Association that provides valuable data to institutions across the country. Darrow will lead the effort in implementing the study at UB. Though logistics of the undertaking are still being worked out, it most likely will entail a random sampling of UB students who would be selected, then contacted by e-mail.
“We plan to take advantage of the fact that UB is one of the most wired campuses in the country,” Carnevale says. “The NCHA examines students’ perceptions and behaviors across a wide array of areas—physical health, mental health, substance abuse, etc. The data derived from our participation will allow us to benchmark our campus population with that of our peers at other institutions across the country. More important, it will assist us in planning and implementing outreach projects and services to target the areas of concern that are highlighted by the study.”
“Our role as a research center necessitates that we apply research methodologies to our health promotion efforts,” adds Darrow. “Implementing the NCHA will allow us to gather the data we need to back up—or refute—our assumptions about the health behaviors, attitudes and perceptions of our students. We can then use that data to direct health promotion efforts and to apply for grants in high priority areas.”
CONFIDENTIALITY, PRIVACY AND PARENTS
Of course, overseeing student health entails numerous issues of privacy and confidentiality. Student privacy is always a top priority for the wellness team at all levels. Indeed, assuring confidentiality helps students develop trusting relationships and increases the likelihood they’ll approach the wellness team in the first place. “We actively protect against disclosure of information except when required by law, or when authorized by the client/patient,” explains Snyder.
The de facto status of students as adults can come as a surprise to parents who desire more information or consultation on their child’s physical or emotional condition. For instance, Student Health Services can’t even confirm to parents that a student is being seen at Michael Hall, unless the student has signed a release. Snyder says her office tries to be “sympathetic” to parent concerns and phone calls, even as they must stress that no student health information will be conveyed without this release.
HOPE AMID CHALLENGE
How to explain the wellness team’s approach to the wary parent looking on from afar, perhaps as a beloved son or daughter leaves home for life on campus as a UB freshman?
“College students’ medical records are protected and we treat all of our college students as adults,” says Black. “But our students are members of families and we encourage the family to stay in contact, to share appropriate information, and to offer all of the advice, support and assistance needed, not just to cope in the collegiate environment, but to thrive!”
“At this summer’s orientation,” Darrow adds, “we spoke to parents about how to speak to their sons or daughters about alcohol and other drugs. The parents participated in role-plays with our students to practice skills in open communication. We got a lot of positive feedback from the parents, who really appreciated our expertise and the knowledge that we are here to help support their children to make healthy decisions.”
Parents might also be assured by how sensitively students are viewed by their health-care team, as they assist with everyday concerns of so many.
“I am continually amazed and humbled by the strength I see in individuals who are confronting some of the most personal and challenging periods in their lives,” says Gilles-Thomas. “Despite these challenges, people find an inner resolve and strength that allows them to overcome what can seem insurmountable. When reading about the events of the day in the newspaper may engender pessimism about the ways of the world, sitting with an individual or a group and being part of these astounding recoveries and successes teaches me that there is always hope.”
Ann Whitcher is editor of UB Today.