Identifying & Responding to the Distressed Student

1. Identifying & Responding to the Distressed Student A Guide for Faculty & Administrators

2. This Presentation Includes • Your Role as a COE Member • Scenarios & Responses • Recognizing a Distressed Student • Addressing Distressed Behavior • Making a Referral • Utilizing Campus Resources • Worst Case Scenario: Suicide • Confidentiality • A Snapshot of Engle Center Clients

3. Your Role as a COE Member

4. Your Role as a COE Member • Recognize that students may need different levels of care and assistance • Establish and maintain appropriate learning environment • Have knowledge of Messiah, legal guidelines and campus resources

5. As a COE Member • You are more available and more knowledgeable about the college environment than a student’s previous support system of friends and family • You may be the first to recognize something is wrong • You are in an excellent position to identify and respond to students in distress

6. Scenarios & Responses What would you do?

7. Scenario #1 You observe that a student in your class appears disheveled, unshaven, and has stopped participating in class. His grades and attendance have dropped. You are concerned about him and want to contact the counseling center or discuss the situation with your department head. Would you be violating FERPA?

8. Response: • No. FERPA covers academic records, and observations are not “records.” Even so, FERPA allows for the release of records without student consent to employees of the college with a legitimate interest. Discussing a student of concern with those in a position to assist the student, or assist you in helping the student, is clearly allowed under FERPA

9. Scenario #2 A student turns in a writing assignment which contains disturbing content such as: violence, cruelty, paranoia, despair. You are unsure whether this simply an assignment to the student or insight into their psychological state of mind. What might you do?

10. Response: • If the material contains any direct threat or plan of harm, contact the Department of Safety. • If there is not a clear threat, a first step might be to ask to speak with the student privately. Be direct. “When I read these passages in your work, (give specific examples), I was wondering if you are talking about yourself. Do you feel as angry/vengeful/hopeless as this sounds?” • You might also consult with the Director of Counseling for another professional’s opinion and for guidance about how to handle the conversation and to inquire about appropriate follow-up for the student.

11. Scenario #3 You receive a note from one of the counseling center staff stating that a student is having difficulties this semester, (which does not qualify as a psychiatric disability covered under ADA). To what lengths should you go to assist this student?

12. Response • We send such notes only when we deem that the student’s difficulties warrant some flexibility, but your judgment as the faculty member is always of primary importance. • We will give you as much information as the student allows, but in some cases (assaults, etc.) the student may not feel comfortable disclosing the reasons for the difficulty. • You are not being asked to re-teach the class to the student or to unfairly disadvantage other students. • If there are ways to assist the student without compromising the integrity of the class, we appreciate you doing so.

13. Scenario #4 You have developed a good relationship with a student, who has then disclosed that she is having personal difficulties. She schedules time to talk with you frequently during office hours. You are glad to listen and have suggested counseling to her to deal with the matters on her mind. She continues to request to see you often and/or stop you after class. You begin to feel burdened.

14. Response It is appropriate to set professional and personal boundaries with students. • You may not always be best suited to assist students, their concerns may be too severe. • Their requests for your time may interfere with the ability of other students to access you. • Their request of you may go beyond what is appropriate for the role of faculty. Tell the student plainly how you can and cannot help. Be firm and gentle. Suggest counseling again.

15. In Summary… Each student situation is unique and complex. Whenever you feel the need, contact the Engle Center. We are glad to help.

16. Recognizing a Distressed Student

17. The Distressed Student How to recognize? • Excessive absences, especially if attendance was previously consistent • Marked changes in personal hygiene • Falling asleep in class • Poor attendance with little or no work completed • Weight gain or loss

18. The Distressed Student How to recognize? • Unusual or exaggerated emotional responses • Markedly changed patterns of interaction (avoiding participation or dominating discussion) • Communicates problems in essays or emails • Repeated requests for special consideration, extensions, etc. • Serious grade problems

19. The Distressed Student How to recognize? • Evidence of self-injury • Talk of harm toward self or others • Loss of contact with reality • Seeing/hearing things that do not exist • Strange remarks or disjointed thinking • Indicates immediate intervention needed

20. Addressing Distressed Behavior

21. Addressing Distressed Behavior Many of us already know this, but remind yourself of these principles: Give your full attention. • Don’t try to have a private conversation in the classroom while others students waiting to talk with you. • Don’t stand with your hand on the doorknob. • Don’t multi-task, put down what you are working on. • Sit down somewhere private.

22. Addressing Distressed Behavior Look directly at the student. Express your concerns in behavioral, specific, nonjudgmental terms. I've been noticing … (specific things you have observed) and I’m concerned because….”

23. Addressing Distressed Behavior – Helpful Conversation Starters “Tell me how things are going?” “You have a number of missing assignments lately. Is there something preventing you from getting them done?” “You seem very quiet and distracted in class. That’s not like you. Is there something going on that you would like to talk about?”

24. Addressing Distressed Behavior Listen first. Don’t assume you know what the student is going to say. If you have been working with students long enough, you may feel you have heard it all. But this student is unique and wants to be heard in order to trust you with their problem. “People don’t care about what you know until they know how much you care.”

25. Addressing Distressed Behavior – Unhelpful Conversation Stoppers "Why did you wait so long to ask for assistance?” "You had better get your act together if you expect to pass my class." “It’s time to grow up and start taking responsibility for your life. You’re not in high school anymore."

26. Addressing Distressed Behavior • Listen first, without interrupting. • Focus on listening, not on what you will say next. • Acknowledge the student with attending behaviors, (nodding, “Ok”, “I see”, “uh-huh.” Even if you don’t agree, you are communicating that you are listening and understand what the student is trying to say.

27. Addressing Distressed Behavior Communicate understanding by summarizing what the student has said. Avoid judging, evaluating, or criticizing. Respect the student’s point of view, even if you disagree with it.

28. to Make a Referral WHEN • You feel overwhelmed or unsure of how to proceed. • Assisting this student is compromising your time and attention to other students. • You believe the concern is outside expectations for your position. • You want consultation; the behavior does not need to be severe.

29. to Make a Referral HOW “Sounds like you are really struggling with________. That’s really a lot to deal with, Talking it over with a counselor might help you sort through it all.” “Give counseling a try. You have nothing to lose.” “These are services your tuition pays for; take advantage of them.” Let the student know that it is not necessary to know exactly what is wrong in order to seek assistance. Assure the student that seeking help does not necessarily mean their problems are unusual or extremely serious. Be frank about your own limits of time, energy, training, and objectivity.

30. If the Student Is Reluctant • Normalize help-seeking. • “Hundreds of students use the Counseling Center every year.” • Services are confidential, and will not go on a student’s academic record. • Engle Center is for medical and psychological concerns. • “No one needs to know why you are there.”

31. If the Student Is Reluctant • Counselors can teach self-help strategies. • “They can teach you ways to solve your problems yourself.” • No commitment, no cost: • “Give it a try, you have nothing to lose.” • Be honest: • “What you’re doing now is not working /is not healthy.”

32. I suggested counseling, but they didn’t go! Change is a process, not a single decision. Where is this student in this process? How can you help move the student forward at each stage?

33. I suggested counseling, but they didn’t go! Stage 1- Not interested in counseling Student thinks: “The relationship with you is safe and familiar, why involve someone else?” • Encourage re-evaluation of current behavior and its effectiveness

34. I suggested counseling, but they didn’t go! Stage 2- Considering Counseling Student thinks: “Maybe counseling could help, I’ll think about it.” • Encourage evaluation of pros and cons of counseling

35. I suggested counseling, but they didn’t go! Stage 3-Getting ready for counseling Student thinks: “I want to sign up for counseling, but what will I say when I walk in the door?” • Encourage small steps and assist in problem solving.

36. I suggested counseling, but they didn’t go! If you choose to continue your discussions with the student ask yourself the following questions: • Do you and the student believe the talks are helpful? Is the situation getting better? • Do you believe the situation and problems mentioned are within your ability and background to appropriately assist the student? • Are you able to commit to the student in this way? Consider the time commitment, your availability, emotional investment and the potential impact on your other students. • Are you in danger of developing a “dual relationship” with the student that could lead to future complications?

37. I suggested counseling, but they didn’t go! It is appropriate to establish firm boundaries with students and let them know that you are no longer able to best help them. Let them know that referring them does not mean that you will have no further contact with them. You will continue to be concerned and caring in a way that is appropriate for you. No one wants to feel “dumped,” especially when most in need of support. Provide a clear statement about what you can and cannot do.

38. Campus Resources • Engle Counseling and Health Center • Counseling and appropriate outside referrals. • Website resources (psycho-educational) • Office of Community Development • ext. 5380, Doug Wood • Office of Disability Services • ext . 5382, Keith Drahn • http://www.messiah.edu/offices/disability/ • Support from Residence Life Staff. • Formation of multi-disciplinary CARE TEAM for some students needing support from several areas. • Generous medical leave policy.

39. Suicide:What we fear the most

40. SuicideNational Statistics • Second leading cause of death among North Americans of college age. • For every successful suicide, there are 40 failed attempts. • 1 in 12 college students makes a suicide plan. • More teenagers and young adults die from suicide than from all medical illnesses combined. (Sources: Kadison, 2004 & Seaman, 2005)

41. Students in Crisis:Signs of a Student Needing Immediate Assistance • Evidence of self injury such as cutting or burning. • Suicidal statements, gestures, or attempts. • Acts or threats of harm to other individuals or property. • Extremely disruptive behavior, such as outbursts, aggression, or hostility. • Loss of contact with reality, disoriented thought or hearing/seeing things that are not present. • Homicidal threats (written or verbal), or attempted homicide or assault.

42. Intervening with a student in crisis • Ensure everyone’s safety, including your own. • Talk to the student in a calm manner. • Share your concern and belief that the student needs assistance. • Avoid touching the student if he or she is agitated, violent, or intoxicated. • Do not threaten the student. • Avoid arguing with the student.

43. Intervening with a student in crisis • Talk to the student sympathetically. • Do not promise confidentiality to a student who may be considering suicide. • Do not avoid discussing the topic of suicide. Asking the student about suicide won’t "put the idea into his/her head." • Recommend that the student seek help from Counseling Services immediately.

44. Intervening with a student in crisis • If the student agrees to seek help, recommend that he/she contact Counseling Services right away from your office/classroom. After regular office hours, contact the Department of Safety • If the student is reluctant to call, offer to call and make arrangements for them, or offer to walk the student over to the Engle Center. • If the student refuses, it is important not to let the issue "resolve itself." Let the student know that you will be contacting Counseling Services. Call us immediately so we can contact the student. • If you are concerned that the student is at imminent risk, do not leave the student alone. Contact the Department of Safety immediately. • Contact Us

45. Confidentiality HIPAA, FERPA and Codes of Professional Ethics

46. Playing by the Rules • While not technically bound by HIPPA regulations, Counseling Services does follow the APA code of ethics which informs our policy on confidentiality. • FERPA regulations apply primarily to college faculty and administration and address, among other things, disclosure of educational records within the college. • The APA code of ethics, which the Engle Center follows, and FERPA regulations, which faculty and administration must follow[1], have very different rules regarding the release of information. [1] FERPA does not consider counseling records part of a student’s “educational record.”

47. Confidentiality Q and A If I refer a student for counseling will I be notified when the student makes an appointment?

48. Confidentiality Q and A If I refer a student for counseling will I be notified when the student makes an appointment? It is our policy to notify you when a student you have referred makes an appointment; however we must ask the student’s permission and they can choose to refuse.

49. Confidentiality Q and A Could I inquire at the counseling center about whether a student is receiving counseling?

50. Confidentiality Q and A Could I inquire at the counseling center about whether a student is receiving counseling? No. We can disclose that information to you only in those situations where you have referred the student and the student gives us permission to speak to you about the treatment.