（英文）行業(yè)資料 rand -Supporting the Mental Health Needs of Community College Students

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ResearchReport

LISASONTAG-PADILLA,DENISEWILLIAMS,HOLLYKOSIEWICZ,LINDSAYDAUGHERTY,HEIDIKANE,SARAHGRIPSHOVER,TREYMILLER

Supportingthe

MentalHealthNeeds

ofCommunity

CollegeStudents

SupportedbytheInstituteofEducationSciencesandtheTrellisFoundation

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AboutThisReport

iii

TheUnitedStatesfacesanunprecedentedmentalhealthcrisis,withyouthandyoungadultsatthecenter(U.S.DepartmentofHealthandHumanServices,OfficeoftheU.S.Surgeon

General,2021;WhiteHouse,2022).Evenbeforethecoronavirusdisease2019(COVID-19)

pandemic,nearly50percentofcollegestudentsreportedatleastonementalhealthconcern.TheCOVID-19pandemicnotablyexacerbatedtheseissuesandunderscoredtheurgentneedto

identifyandimplementsolutionstoamelioratetheyouthmentalhealthcrisis.In2021,the

NationalAcademiesofSciences,Engineering,andMedicine(NASEM)calledonthefieldof

highereducationtoaddressgrowingconcernsaboutstudentmentalhealthbyidentifyingand

elevatingemergingandpromisingapproachesthatofferamoreholisticwaytosupportstudentmentalhealthinhighereducation(NASEM,2021).Servingasthemainentrypointformore

than40percentofstudentsseekingapostsecondaryeducationdegree,communitycolleges

representatremendousanduntappedopportunitytobetteraddressmentalhealthintheUnited

States,particularlyforstudentswhohavebeentraditionallyunderserved(e.g.,studentsofcolor,first-generationstudents,andlow-incomestudents).However,thereislimitedevidenceand

guidancethatcollegescanusetoinformtheimplementationofmultilevel,holisticapproachestosupportstudentswithvaryingmentalhealthneeds.

Toaddressthisknowledgegap,thisreportsharesadescriptivestudyofeightcommunitycollegesattheforefrontofimplementingmultilevelapproaches(i.e.,acombinationof

prevention,earlyintervention,and/ortreatmentservices)tosupportstudentmentalhealth,andkeyfacilitatorsforandbarrierstotheirsuccess.

RANDEducationandLabor

ThisstudywasundertakenbyRANDEducationandLabor,adivisionoftheRAND

Corporationthatconductsresearchonearlychildhoodthroughpostsecondaryeducation

programs,workforcedevelopment,andprogramsandpoliciesaffectingworkers,

entrepreneurship,andfinancialliteracyanddecisionmaking.Theresearchreportedherewas

supportedbytheInstituteofEducationSciences(IES)(U.S.DepartmentofEducation)throughIESsupplementalfundsprovidedthroughtheCollegeCompletionNetwork($99,988.27)underthegrantR305H170085toAIRandbytheTrellisFoundationthroughagranttotheUniversityofTexas,Dallas(subawardtoRANDof$54,543.00tosupportreportdevelopmentand

dissemination).TheresearchteamrepresentedapartnershipamongAIR,theRAND

Corporation,theUniversityofTexasatDallas,StanfordUniversity,ActiveMinds,andtheJed

iv

Foundation(JED).RANDEducationandLaborservedastheleaddivisionforthestudyandreport.1

Theopinionsexpressedinthisreportaretheauthors’aloneanddonotrepresenttheviewsoftheInstituteofEducationSciencesortheTrellisFoundation.MoreinformationaboutRANDcanbefoundat

.QuestionsaboutthisreportshouldbedirectedtoLisaPadillaat

lsontag@,

andquestionsaboutRANDEducationandLaborshouldbedirectedto

educationandlabor@.

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SocialandBehavioralPolicyProgram

RANDSocialandEconomicWell-BeingisadivisionoftheRANDCorporationthatseekstoactivelyimprovethehealthandsocialandeconomicwell-beingofpopulationsandcommunitiesthroughouttheworld.ThisresearchwasconductedintheSocialandBehavioralPolicyProgramwithinRANDSocialandEconomicWell-Being.Theprogramfocusesonsuchtopicsasrisk

factorsandpreventionprograms,socialsafetynetprogramsandothersocialsupports,poverty,aging,disability,childandyouthhealthandwell-being,andqualityoflife,aswellasother

policyconcernsthatareinfluencedbysocialandbehavioralactionsandsystemsthataffectwell-being.Formoreinformation,email

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Acknowledgments

ThisstudywouldnothavebeenpossiblewithoutclosecollaborationfromSaraGormanandherteamattheJedFoundationandLauraHorneandherteamatActiveMinds;fromoursenior

advisers,DanielEisenbergandWendyReinke;fromtheCollegeCompletionNetworkLead

teamandprogramofficer,JamesBenson;andfromRANDsupportstaffandpublishingstaff.Wearealsogratefulforthevaluablefeedbackonthereportthatwereceivedfromourpeer

reviewers,MichaelDunbarandSaraAbelson.Finally,wewouldliketothankourfunders,the

1Authoraffiliationsareasfollows:LisaSontag-Padilla(RANDCorporation);DeniseWilliams,HollyKosiewicz,andHeidiKane(UniversityofTexas,Dallas);SarahGripshover(StanfordUniversity);andTreyMiller(AIRandUniversityofTexas,Dallas).

v

U.S.DepartmentofEducation’sInstituteofEducationSciencesandtheTrellisFoundation,fortheirsupportofthisresearchandreportdevelopment.

Summary

vi

TheUnitedStatesfacesanunprecedentedmentalhealthcrisis,withyouthandyoungadults

atthecenter(U.S.DepartmentofHealthandHumanServices,OfficeoftheU.S.Surgeon

General,2021;WhiteHouse,2022).Evenbeforethecoronavirusdisease2019(COVID-19)

pandemic,nearly50percentofcollegestudentsreportedatleastonementalhealthconcern.

Withoutpropersupport,collegestudentsareatriskforavarietyofbothimmediateconsequences(e.g.,academicimpairment,substanceuse,suicide)andlonger-termones(e.g.,stop-out,drop-

out,andlowerlifetimeearningpotential).TheCOVID-19pandemicnotablyexacerbatedthese

issuesandunderscoredtheurgencytoidentifyandimplementsolutionstoamelioratetheyouth

mentalhealthcrisis.In2021,theNationalAcademiesofSciences,Engineering,andMedicine

(NASEM)calledonthefieldofhighereducationtoaddressgrowingconcernsaboutstudent

mentalhealthbyidentifyingandelevatingemergingandpromisingapproachesthatofferamoreholisticwaytosupportstudentmentalhealthinhighereducation(NASEM,2021).Servingasthemainentrypointformorethan40percentofstudentsseekingapostsecondaryeducationdegree,communitycollegesrepresentatremendous,untappedopportunitytobetteraddressmental

healthintheUnitedStates,particularlyforstudentswhohavebeentraditionallyunderserved

(e.g.,studentsofcolor,first-generationstudents,andlow-incomestudents).However,thereislimitedevidenceandguidancethatcollegescanusetoinformtheimplementationofmultilevel,holisticapproachestosupportstudentswithvaryingmentalhealthneeds.

Toaddressthisknowledgegap,weexaminedqualitativedatafromeightcommunitycollegesattheforefrontofimplementingmultilevelapproaches(i.e.,acombinationofprevention,earlyintervention,and/ortreatmentservices)tosupportstudentmentalhealth.Specifically,thestudywasdesignedtodothefollowing:

1.describecommunitycollegeeffortstosupportmentalhealthonacontinuumofcarefrompreventiontotreatment

2.describehowthesecollegesareaddressingstudentmentalhealththroughthebroadercollegeenvironment

3.identifychallengesandfacilitatorsthatthesecommunitycollegesencounteredinaddressingstudentmentalhealth.

Methods

IncollaborationwithActiveMindsandtheJedFoundation,weidentifiedandrecruited

communitycollegesthatrepresentedaselectgroupthatwaslikely“aheadofthecurve”on

implementingmultilevelandholisticstrategiestosupportstudentmentalhealth.Inaddition,weselectedcollegesthatrepresentgeographicdiversityacrosstheUnitedStatesandservelarge

proportionsofstudentsofcolororlow-incomestudents.BetweenFebruaryandJuly2022,we

vii

conductedinterviewswithrepresentativesfromeachoftheeightcolleges(15interviewswith28

individuals,consistingof19mentalhealthcounselorsorimplementersofmentalhealth

programsandnineadministrators).Weanalyzedtheinterviewdatausingacombinationofdeductiveapproaches(comparingdataagainstfindingsfromtheexistingresearchbaseandinsightsfrommentalhealthexperts)andinductiveones(identifyingthemesandpatternsthatcouldnotbecategorizedbyaprioriknowledge).

LessonsLearnedandImplications

Ourfindingsfromtheseeightcollegeshighlightasetoflessonsforcommunitycollegesacrossthecountrytoconsiderwhenstrategizinghowbesttosupportstudentmentalhealth.Below,wehighlightfivekeylessonsandtheirassociatedimplicationsforeducational

institutions,practitioners,andpolicymakers.

Lesson1:Communitycollegesinourstudyareimplementingmultilevelmentalhealthsupports,thoughmostlackaclearorganizingframework.Wefoundthatcolleges

implementedawidevarietyofeffortstosupportstudentmentalhealthacrossthespectrumfromwell-beingtoillness.Theseeffortsincludedstudent-centricprograms(e.g.,stressreduction

seminarsoreducatingstudentsonavailableresources),faculty/stafffocusedefforts(e.g.,

gatekeepertrainingoreducatingstaffonthelinkbetweenmentalhealthandacademicsuccess),andinstitution-wideefforts(e.g.,formingmentalhealthtaskforcestodrivestrategiestosupportstudentmentalhealth).Yetmostcollegesdidnothaveaclearinstitutionalvisionorstrategic

planforhowmentalhealthsupportscouldbecoordinatedanddelivered.

.Implications:Communitycollegesshouldconsideradoptingandformalizingastrategicplanorframeworkgroundedinresearchevidencetoimprovecoordinationand

collaborationacrossefforts,reduceredundancies,andguidedecisionmakingon

allocatingresources.Suchaframeworkalsocouldcreateacommonlanguageamongpostsecondaryinstitutions,whichincreasesthelikelihoodthatcollegescanmoreeasilylearnfromeachothertoscalepromisingpracticestosupportstudentmentalhealth.

Lesson2:Communitycollegeshaveexpandedthereachoftheirmentalhealthsupportsthroughintegrationinthebroadercollegeenvironment.Allparticipatingcolleges

highlightedtheimportanceofconsideringthewholecollegeenvironmentandtheneedtodeeplyintegratementalhealthsupportsandserviceswithothercollegeactivities.Theseeffortsincluded(1)enhancingacademicenvironments,suchasintegratinginformationonmentalhealth

resourcesintocoursesyllabiorlessons,(2)staffeducationontheimportanceofstudentmentalhealthandwhattodowheninteractingwithadistressedstudent,(3)colocationofmentalhealthandacademicorbasicneedsandservices,(4)theestablishmentofcross-disciplinarytaskforces,and(5)moreexplicitreferralandscreeningprocessesandsupportsbetweeninstructors,

academiccounselors,andmentalhealthcounselingstaff.Participantsfromthosecollegesusing

viii

severaloftheseapproachessharedstoriesofsuccessinsupportingabroaderbaseofstudentsandfosteringasupportivecampusclimate.

.Implications:Consideringmajorstridesinsupportingstudentmentalhealth,communitycollegesshouldcontinuetointegratementalhealthsupportsintothebroadercollege

environment(i.e.,classrooms,academicadvising,basicneedssupport,financial

assistance).Inaddition,collegesmaybenefitfromidentifyingandpubliclypromoting

studentmentalhealthasacampus-widepriority.Together,theseeffortshavethe

potentialtodemonstratetostudents,faculty,andstafftheinstitution’scommitmentto

studentmentalhealthand,inturn,tohelpfosterasupportivecampusenvironmentforall.

Lesson3:Strongleadershipsupportandbroadbuy-infromstafftoprioritizestudent

mentalhealthisimportant.Supportfromleadership(e.g.,presidents,vicepresidents,deans)

andbroadbuy-infromfacultyandstafftoprioritizeandsupportstudentmentalhealthwerekeyfacilitatorsforestablishingarobustsetofmentalhealthsupportsforcollegesinthisstudy.

Havingthepresident,deans,andotherleadershiprolesprioritizeandelevatetheimportanceofstudentmentalhealthwasreportedaskeytoincreasedfinancialsupportforprograms,

institutionalizationofmentalhealthcounselorpositions,andenhancedparticipationfromfacultyandstaffineducationseminars,gatekeepertrainings,andintegrationofmentalhealthsupportsintotheclassroomenvironment.However,manyparticipantsnotedthatfacultyandstaffoutsidefieldsrelatedtomentalhealth(e.g.,psychology,socialwork,nursing)havenotwidelyadoptedtheideathatsupportingmentalhealthispartoftheirroleineducatingstudents.

.Implications:Institutionalleaders(e.g.,presidents,deans,departmentchairs)mayneedtodomoretoelevateinstitutionalprioritiesaroundmentalhealth.Forinstance,

institutionalleadersfromallsegmentsofthecollege(e.g.,president,boardoftrusteesorregents,deans)shouldconsidercommunicatingpubliclytheimportanceofcreatinga

cultureofwell-beingoncampus.Additionally,institutionscouldestablishand/or

maintainateamthatinvolvesallsectorsofthecollegethatcoordinates,reviews,and

addressesmentalhealth,substanceuse,andwell-beingconcernsandefforts.Those

collegesthatreceivedsupportfromleadershiporestablishedsimilarcross-disciplinetaskforcessaidthatthesefactorswerecentraltotheirsuccessineffectivelyaddressing

studentmentalhealth.

Lesson4:Communitycollegesstruggletomeetstudents’mentalhealthneedsbecause

oflimitedresources.Atmostoftheparticipatingcolleges,mentalhealthcounselorsworemanyhats,jugglingdeliveryofcounselingservices,supportgroupsforstudents,staffeducation,and

orientationweeksessionsonmentalhealth.Thoughavarietyoffactorsareatplay(e.g.,

leadershipsupport,limitedfinancialresources),limitedstaffcapacityto“doitall”emergedasaprimarychallengetomeetingtheincreasingdemandformentalhealthservicesandprograms

designedtobolsterafoundationofmentalwell-being.Additionally,despitetheuseofavarietyofapproachestoexpandaccesstomentalhealthservices(e.g.,useoftelehealth,grantfundingtohiremorecounselors,community-basedpartnerships),manyparticipantsexpressedchallengesin

ix

reachingtraditionallymarginalizedandminoritizedpopulationswhomayneedadditionalsupport.

.Implications:Toaddressthesechallenges,communitycollegesshouldconsider

reallocatingexistingfinancialresourcesorseekingopportunitiesforadditionalfinancialresourcestoincreasecapacitytodeliversufficientstudentmentalhealthsupportsand

services.Inadditiontoinstitutionalfunding,counselingcentersandstudentsuccessstaffshouldcontinuetothinkcreativelyabouthowtoreachstudentswhoneedthemmostandrootdecisionsaboutprogramsandengagementindataontheirtargetpopulations.To

helpstreamlineprocessesandalleviatesomeoftheburdensencounteredbymentalhealthcounselors,communitycollegesshouldconsiderconductinganauditorneedsassessmentofcurrenteffortstoreduceredundancyacrossprogramswhilesimultaneouslyimprovingintegrationofsupports,elevateeffortsthathavebeenmostsuccessfulatreaching

students,andidentifykeyareasforopportunitytobetterengageandsupportstudentsmostatrisk(e.g.,studentsofcolor,queerstudents,first-generationstudents,andlow-incomestudents).

Lesson5:Financialsupportforstudentmentalhealthshouldextendbeyondthe

postsecondaryinstitutions.Communitycollegesstruggletofindfinancialresourcestosupporttheirefforts(evenamongasampleofcommunitycollegeslikelyaheadofthecurveon

addressingstudentmentalhealth).Participantsfromafewcollegessharedsuccessesinobtaininggrantfundingfromlocal,state,andfederalagenciesthathaveearmarkeddollarstosupport

mentalhealthandpostsecondarystudentsuccessefforts.Althoughtheseresourcesarehelpful,theydidnotappearsufficienttomeetthecapacityandfinancialneedsofthecollegesto

adequatelysupporttheirstudents’mentalhealth;asaresult,thisresponsibilitytomaintainaconstantflowofgrantdollarsplacesatremendousburdenoncounselingandstudentsuccessstaff.

.Implications:RecognizingthattheU.S.highereducationenterpriseisundertremendousfinancialstress,findingnewfundstoprovideadditionalresourcesforstudents

experiencingmentalhealthproblemsmayprovetobechallenging.Nonetheless,

establishingconsistent,long-termfundingsourcestosupportcommunitycollegesmaybenecessarytocreatesustainable,comprehensivementalhealthsupportsforstudents.

Governmentagenciesandphilanthropicentitiesshouldconsiderincreasingthepriority

giventofundingmentalhealthsupportsandservicesoncommunitycollegecampuses.

Additionally,national,state,andlocalfundersofhighereducationshouldconsider

incentivizingcommunitycollegestoprovidesupportforstudents’mentalhealthacross

thecontinuumofcare(preventionthroughtreatment).Finally,statesshouldconsider

modifyinginsurancelawsorregulationstoenableinstitutionstousegeneralfundsand/ordesignatedhealthfeesforexpensesthatarenotcoveredbystudents’personalinsurance.

Contents

x

AboutThisReport iii

Summary vi

FiguresandTables xi

Chapter1.Introduction

1

Chapter2.EvidenceandFrameworksforSupportingStudentMentalHealthinCommunity

CollegeSettings

4

FrameworksforSupportingStudentMentalHealth

5

EvidenceonApproachestoSupportingStudentMentalHealth

8

ContributionsoftheCurrentStudy

9

Chapter3.Methods

11

DataCollection

11

AnalyticApproach

15

Chapter4.Results

17

ApproachestoSupportingStudentMentalHealth

17

IntegratingMentalHealthSupportintotheCollegeEnvironment

23

BarrierstoandFacilitatorsforSupportingStudentMentalHealth

27

SummaryofFindings

29

Chapter5.LessonsLearnedandImplications

31

Lesson1:CommunityCollegesAreImplementingMultilevelMentalHealthSupports,ThoughMost

LackaClearOrganizingFramework

31

Lesson2:CommunityCollegesHaveExpandedTheirReachofMentalHealthSupportsThrough

IntegrationintheBroaderCollegeEnvironment

33

Lesson3:StrongLeadershipSupportandBroadBuy-InfromStafftoPrioritizeStudentMentalIs

Important

34

Lesson4:CommunityCollegesStruggletoMeetStudents’MentalHealthNeedsBecauseofLimited

Resources

35

Lesson5:FinancialSupportforStudentMentalHealthShouldExtendBeyondPostsecondary

Institutions

36

Considerations

37

Conclusions

38

AppendixA.Pre-InterviewSurvey

39

AppendixB.SemistructuredInterview

44

Abbreviations

48

References

49

FiguresandTables

xi

Figures

Figure2.1.PublicHealthPreventionFramework

6

Figure2.2.EcologicalSystemsTheoryforCollegeMentalHealth

7

Tables

Table3.1.CharacteristicsofParticipatingCollegesandMentalHealthSupportsOffered

14

Table4.1.CommunityCollegesReportingEffortstoPromoteOverallStudentMental

Health

18

Table4.2.CommunityCollegesReportingEffortstoSupportHighRiskStudents

20

Chapter1.Introduction

1

TheUnitedStatesfacesanunprecedentedmentalhealthcrisis,withyouthandyoungadultsatthecenter(U.S.DepartmentofHealthandHumanServices,OfficeoftheU.S.Surgeon

General,2021;WhiteHouse,2022).Evenbeforethecoronavirusdisease2019(COVID-19)

pandemic,researchindicatedariseinthepercentageofcollegestudentsreportingfeelingsof

hopelessness(53percentofundergraduatestudentsin2017,upfrom47percentin2008),feelingsodepressedthatitwasdifficulttofunction(40percentin2017,upfrom31percentin2008)

andseriouslyconsideringsuicideinthepast12months(12percentin2017,upfrom6percentin2008)(AmericanCollegeHealthAssociation,2008;AmericanCollegeHealthAssociation,

2017).2TheCOVID-19pandemicnotablyexacerbatedthenumberofstudentsreportingmentalhealthchallenges(Czeisleretal.,2020;Ezarik,2021;McGintyetal.,2020;TimelyMD,2020).Withouttreatment,theconsequencesofmentalillnessfortheindividualandsocietyare

staggering,withuntreatedmentalhealthdisordersassociatedwithlowerpersistenceandcollegecompletionrates,higherratesofsubstanceuse,andlowerlifetimeearningpotential.Mental

illnessisalsoreportedtobetheleadingcauseofdisabilityandlostworkplaceproductivity

(Alonsoetal.,2018;Arriaetal.,2013;Breslauetal.,2008;Bruffaertsetal.,2018;CollinsandMowbray,2005;Drussetal.,2009;Keyesetal.,2012).

In2021,theU.S.SurgeonGeneralissuedanadvisoryunderscoringtheurgentneedto

identifyandimplementsolutionstoaddresstheyouthmentalhealthcrisis,particularlyforracialandethnicminorities,LGBTQ+(lesbian,gay,bisexual,transgender,queer,and/orplus)youth,andlow-incomeyouthwhoareatincreasedriskformentalhealthchallenges(U.S.DepartmentofHealthandHumanServices,OfficeoftheU.S.SurgeonGeneral,2021;Abelson,Lipson,andEisenberg,2022;EisenbergandResnick,2006;Eisenberg,Hunt,andSpeer,2013;Lipsonetal.,2022).Thesegroupsmaybeespeciallyvulnerablebecauseofvariousfactors,suchas

experiencingmicroaggressions,uncertaintyabouttheirbelonging,andbasicneedsinsecurity(Goldrick-Rab,2016;Nadaletal.,2014;WaltonandCohen,2007).Inaddition,theNationalAcademiesofSciences,Engineering,andMedicine([NASEM],2021)calledonthefieldofhighereducationtoaddressgrowingconcernsaboutstudentmentalhealthbyidentifyingand

2DatafromtheAmericanCollegeHealthAssociation’sNationalCollegeHealthAssessmentarebasedonaself-

selectedsampleofU.S.postsecondaryinstitutions(28campusesand16,024studentsinthefirstsurveyinspring

2000).Arandomsamplingtechniquewasusedtorecruitparticipatingstudents.ThoughtheAmericanCollege

HealthAssociationrecognizesthatthesampleisnottechnicallygeneralizabletoallU.S.collegestudents,ithas

concluded,usingrigorousanalyses,thattheNationalCollegeHealthAssessmenthasbeenfoundtobeareliableand

validrepresentationofcollegestudentsintheUnitedStates(AmericanCollegeHealthAssociation,“Generalizability,Reliability,andValidityAnalysis,”undated).

2

elevatingemergingandpromisingapproachesthatofferan“all-hands”multilevelapproachtosupportstudentmentalhealth.

Communitycollegesservemorethan7millionstudentseachyear,makingthemthemain

entrypointformorethan40percentofstudentsseekingapostsecondaryeducationdegree

(CommunityCollegeResearchCenter,undated).Althoughtheprevalenceformentalhealth

problemshasremainedcomparableforcommunitycollegeandfour-y