Assessment in counseling centers

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Assessment in counseling centers

• Sherry A. Benton, Ph.D., ABPP

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Our Mission

• The Mission of university counseling centers is
  to assist students to define and accomplish
  personal, academic, and career goals by providing
  developmental, preventive, and remedial
  counseling.
• Counsel for the Advancement of Standards in
  Higher Education (1999).
• The counseling center serves the academic mission
  of the university.

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Traditional Counseling Center Roles

• Developmental
• Career
• Preventive
• Multicultural and Gender
• Mental health

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Changes in Student-Institution Relationship

• In Loco Parentis
• Rights and Freedom
• Contractual Relationship
• Student as Consumer

Since the mid 1990s, Greater public scrutiny of
colleges, greater public expectation that they
will regulate and manage campus problems.
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Changes in University Administrative Needs

• Tighter budgets
• University liability and lawsuits
• More demand from the public for accountability,
  outcomes
• Accountability demands from regional accrediting
  bodies
• Student/ family requests for accountability

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Changes in Families and Communications. In
1975, communication was once per week, in 2008
communication is daily.
Helicopter parents seem to view their children as
construction projects. They hover, monitoring
every aspect of their students experience.
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Changes in Counseling Center Service Demands

• More students using services
• More problem severity, higher problem prevalence
• More diverse student population

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Changes in Prevalence of Mental Health Problems
among students
Suicidal Ideation and Intent
Benton, et al. 2003
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Future Directions for Counseling Centers

• Prevention and outreach are more important than
  ever
• Increase accessibility, decrease silo effect
  through on-line resources, campus-wide education
  efforts
• Improve problem assessment and outcome assessment
  to insure that services are best meeting student
  needs
• Decrease stigma, recognize students with mental
  health needs as a critical diversity initiative
• Train faculty and staff to recognize, respond,
  and refer

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The Age of Accountability

• Medical Practice Guidelines
• QA and UR
• In industry, Lean Manufacturing
• In Education, No Child Left Behind
• Outcome assessment in higher education
• EBTs, ESTs, EVTs in mental health

Demands to demonstrate our worth are not going to
go away.
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Evaluation Apprehension and Ambivalence

• What have been your worst experiences of
  evaluation?
• How do you informally and formally evaluate your
  outcomes now? How do you know you are effective?
• What are the advantages and disadvantages of
  doing outcome assessment?
• What are the possible consequences of avoiding
  assessing outcomes?

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Two models of evaluating psychotherapy outcomes

• The Medical Model
• Adherents believe that general effects exist,
  but find these relatively unimportant the
  therapeutic effect is primarily a result of the
  specific ingredients.
• The Contextual Model
• Adherents believe that common factors across
  psychotherapy models account for most of the
  therapeutic effect and specific ingredients are
  relatively unimportant.

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The Medical Model

• Efficacy of psychotherapy varies by theory and
  technique
• Clinical trials benchmarking studies
• used to identify ESTs and practice guidelines
• Manualized treatments
• General effects lt specific effects
• Adherence is critical, allegiance is unimportant
• Treatment effects gt Therapist effects

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Proponents claim

• Effective manuals create a structure integrating
  therapeutic techniques and common factors
• Clarifies understanding between researchers,
  clinical trials and practitioners.
• Decreases liability
• May increase efficacy and therapist job
  satisfaction
• Improves client outcomes
• Increases therapist confidence regardless of
  degree of compliance

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Contextual Model

• Common factors account for most of observed
  changes in psychotherapy
• No evidence of specific effects
• General effects gt Specific Effects
• Adherence unimportant, Allegiance is critical
• Treatment effects lt therapist effects

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Wampolds meta-analysis of client change in
psychotherapy
Specific Effects 8
General Effects 70
Unexplained Variance 22
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Factors in Client Change
Readiness, reactance Environmental events Client
relationship skills Cultural factors Self-help
Empathy Warmth Genuineness Therapeutic
alliance Collaborative approach
Hope Self-efficacy
EBTs Efficacious Treatment Procedures
Lambert, 1992
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Some case illustrations

• The student who does not neatly fit in a
  diagnostic category
• The student with cultural and contextual factors
  that affect their perceptions and responses to
  treatment (wouldnt that be all of the students)
• The therapist who chooses untested idiosyncratic
  theories and treatments
• The therapist who rigidly forces all cases to fit
  within one of the EVT manualized treatments, but
  attends little to the therapeutic relationship

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The need for local assessment of problems, needs,
and outcomes

• Only local assessment of problems assures that we
  are designing our services to best meet changing
  needs
• Only local assessment allows us to create problem
  and outcome assessment most meaningful to us and
  consistent with our values
• Only local assessment ensures that our services
  are effective and efficient for our students

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Issues in assessing counseling service outcomes

• Problem identification
• Problem severity
• Contextual and cultural considerations
• Readiness
• Reactance
• Well-being, resiliency, optimism
• Multiple services outreach, group, individual

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K-PIRS
Kansas State
Client Intake Assess. Demographic 7
factors Critical factors Readiness Social,
Academic Interference Treatment modality choice
Client Follow-up 3 session intervals 7
factors Critical items Social, Academic
Interference Symptom reduction Goal
attainment Satisfaction
Therapist Intake Assess 7 factors Client
problem, severity Readiness Social, Academic
Interference GAF Treatment modalities
recommended
Therapist Follow-up Revised Case Descriptors 7
factors Social, Academic Interference GAF Symptom
reduction Goal attainment Treatment modalities
used of sessions
Problem incidence in general student population
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Instrument Development
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The kind of questions we can answer

• Characteristics of client problems
• Client- therapist congruence
• Changes and trends across time
• Impact and change during psychotherapy
• Efficacy and outcome of treatment options
• Efficacy of services across client populations
• Impact of services in terms of the academic
  mission of the university
• Client growth and development

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University of Florida

• What are the evaluation questions we, as a
  counseling center would like addressed?
• What are the important components of assessment
  for our center?
• What are the outcomes most important to the
  university administration?
• What kinds of outcomes might be useful for
  demonstrating our value to those who make funding
  decisions?
• What are some specific outcome instruments that
  you would favor exploring towards implementation
  at UFCC?