California Community College Students' Health: How to Understand and Use the HSA-CCC Survey Findings to Promote Your Students' Mental Health

Susan Quinn, MSN, FNP

Director Student Health Services

Santa Rosa Junior College

HSACCC Research Committee Chair

Assessing Student Health NeedsNational College Health Assessment Survey

National College Health Assessment National benchmark instrument for college student

health

Comprehensive assessment of the health – i.e. whole student

8 Content Sections:

• Health, Health Education and Safety

• Alcohol, Tobacco and Drugs

• Sex Behavior and Contraception

• Weight, Nutrition and Exercise

• Mental Health

• Physical Health

• Impediments to Academic Performance

• Demographics

Online or paper survey formats

Supplemental questions optional

How can we utilize NCHA Data? Health Status Trend Analysis

Comparative Analysis between local, CCC, and National Reference Groups

Assess student health indicators in relationship to Healthy Campus 2020 benchmarks

College Program Planning - Identify priority health issues for CCC students

Population based health support planning

State/National agencies and programs

Higher Education; links with UC/CSU systems

Advocacy for CCC student health support

Equity and Access to Health Services

Inform Student Success Initiatives

Legislative Activities

Policy development

Funding Requests for campus health centers

Grant applications

Support Research Projects, Dissertations, and Publications on CCC Students

Available Comparison Reference Groups

Summary data from 18 CCCs that conducted the NCHA during Spring ’13 and participated in the HSACCC Consortium Project.

Sample Size: 14,502 CCC students

Consortium data available from 2010 for trends.

CALIFORNIA COMMUNITY COLLEGES

HSACCC-NCHA Reference Group Spring 2013

AMERICAN COLLEGE HEALTH ASSOCIATIONNCHA Reference Group Spring 2013

Summary data from all 153 colleges in the United States and Canada that conducted the NCHA during Spring ‘13

Sample Size: 123,078 U.S. college students These Reference Groups are used for NCHA comparisons today

“Sister document” to Healthy People 2020

Created in collaboration with 25 higher education professional organizations, led by the American College Health Association

Identified health indicators included in Healthy People 2020 aligned with national NCHA data and set health objectives specifically for college students.

HEALTHY CAMPUS 2020 TARGETS

Health InsuranceTrend CCC Students 2010 to 2013* Comparison CCC/National 2013

College Plan

Parent's Plan

Another Plan

None Not sure

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

CCC 2013

CCC 2010

College Plan

Parent's Plan

Another Plan

None Not sure0%

10%

20%

30%

40%

50%

60%

70%

National CCC

Age Gender

Select Demographics

18-20 21-24 25-29 30+0%

10%

20%

30%

40%

50%

60%

National

CCC

Female Male0%

10%

20%

30%

40%

50%

60%

70%

National

CCC

Ethnicity

Select Demographics

Black

American Indian or Alaskan Native

Biracial or Multiracial

Other

Asian or Pacific Islander

Hispanic or Latino

White

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

CCC

National

Select Demographics

Disabilities – CCC/National 2013 Disabilities – CCC 2010/2013

Mobility/Dexterity Disability

Partial sightedness/Blindness

Other disability

Psychiatric condition

ADHD

0.0% 2.0% 4.0% 6.0% 8.0% 10.0%

CCC 2013

National 2013

Mobility/Dexterity Disability

Speech of language disorder

Partial sightedness/Blindness

Deafness/Hearing loss

Other disability

Chronic illness

Psychiatric condition

Learning Disability

ADHD

0.0% 5.0% 10.0%

CCC 2010

CCC 2013

Some Ethnicity Breakouts on Demographics

Aggregate

White

Latino

Multi

Black

Asian

Native American

Other

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

No Health Insurance

Some Ethnicity Breakouts on Demographics

Aggregate

White

Latino

Multi

Black

Asian

Native American

Other

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

Disability -ADHD

Some Ethnicity Breakouts on Demographics

Aggregate

White

Latino

Multi

Black

Asian

Native American

Other

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%

Learning Disability

Some Ethnicity Breakouts on Demographics

Aggregate

White

Latino

Multi

Black

Asian

Native American

Other

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%

Psychiatric condition

Academic PerformanceSome Different Ways to Look at It, and An Example of Diving Into the Detail on One Issue

Negative Impact on Academic Success

Concern for a troubled friend/family

Relationship Difficulty

Internet Use/Computer games

Finances

Depression

Cold/Flu/Sore Throat

Anxiety

Sleep Difficulties

Work

Stress

0% 5% 10% 15% 20% 25% 30% 35%

CCC

National

Academic Performance Healthy Campus 2020 Targets

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%Negative Impact on Academic Performance

National CCC HC 2020 Target

Aggregate

Latino

Black

Native American

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

ANXIETY negatively impacting academic performance - by ethnic-

ity - CCC students

Conditions Diagnosed and/or Treated Within the Last 12 Months – CCC- Physical and Mental Health (Top 20)

Obsessive Compulsive Disorder

Other mental health condition

Other sleep disorder

High cholesterol

ADHD

Bronchitis

High blood pressure

Insomnia

Ear infection

Panic attacks

Broken bone/fracture

Strep throat

Asthma

Migraine Headache

Urinary Tract Infection

Sinus infection

Depression

Anxiety

Back pain

Allergy problems

ANXIETY – Diagnosed and/or Treated in the Last 12 Months CCC Students by Ethnicity

Male

Aggregate

Latino

Black

Native American

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0%

Anxiety/Depression – Of Students With A Diagnosis Made, The % Receiving Treatment of Any Kind

Anxiety

Depression

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

HC 2020 Target

CCC

National

Anxiety and Academic PerformanceSRJC NCHA Data 2013 – by EthnicityResults were obtained using a series of cross tabulations with chi-square analysis

Hispanic Populations

The following issues displayed significant or approaching-significant results for the relationship between the issue and academic performance (Question 45):

Anxiety (very strong indicator of significance p<.001)

Concern for family (p=.025)

Death of a family member (p=.05)

Depression (p=.024)

Sleeping difficulties (approaching significance p=.051)

Issues were also examined by gender within the Hispanic population to see whether specific issues pertain more to one gender or another. The following results showed a significant relationship with a specific gender within the Hispanic sample:

Anxiety, females (p=.002)

Concern for family, female (p=.017)

Death of a family member, female (p=.048)

Depression, male (p=.047)

Finances, female (p=.045)

Other Data of Interest

Relationship Violence

Sexual touching without consent

Sexual penetration without consent

A physical assault

Physically abusive relationship

Emotionally abusive relationship

Sexually abusive relationship

0.0%

2.0%

4.0%

6.0%

8.0%

10.0

%

12.0

%

14.0

%

HC 2020 Target

CCC

National

Negative Consequences of Drinking Alcohol

Had Sex Without Getting Consent

Had Sex Without Giving Consent

Seriously Considered Suicide

Drove Car After 5 or More Drinks

Physically Injured Another

Trouble with the Police

Being Physically Injured

Unprotected Sex

Forgetting location/actions

Doing something they regretted

0.0% 10.0% 20.0% 30.0% 40.0%

CCC

National

Substance Abuse - Marijuana

Never Ø Last 30 Days

Used 1-9 Days

Used 10-29 Days

Used All 30 Days

Any use within the

last 30 days

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

6.2%

National CCC

An example of the value of local data, compared with national and state data, by gender breakout (males only)

Never Ø Last 30 Days Used 1-9 Days Used 10-29 Days

Used All 30 Days

Any use within the last 30

days

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

16.1%

34.5%

National CCC

SRJC

Traumatic/Difficult to Handle Last 12 Months

Other

Death of family member or friend

Personal health issue

Health problem of family member/partner

Other social relationships

Personal appearance

Career-related issue

Intimate relationships

Sleep difficulties

Family problems

Academics

Finances

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

National

CCC

Suicide

Seriously considered suicide

Attempted suicide

0.0% 2.0% 4.0% 6.0% 8.0% 10.0%

HC 2020 target

CCC

National

Dissemination of Health Information Percent of students that received information from the college on the following….

Injury Prevention

Violence Prevention

Suicide Prevention

Tobacco Use

AOD Use

Pregnancy Prevention

STD/I Prevention

Nutrition

Physical Activity

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

HC 2020 Target

CCC

National

Next Steps Additional trend and comparison data from Executive Summary

reports is easy and accessible to all! 2007, 2010 and 2013 CCC Consortium Executive Summaries are all available for these relatively simple reports.

If you did a local NCHA survey, do your own comparison analysis.

You may request a customized SPSS file or other report from the HSACCC Consortium Database to support your more focused and in-depth research questions, for a specific project or dissertation. Complete a HSACCC research request form (on web site)

Submit to Research Committee for review.

SRJC’s Office of Institutional Research will prepare this once approved by HSACCC.

Dissertation topics?

Health Services Programs within the CCC SystemHSACCC Annual Survey

HSACCC Annual Survey

Benchmark survey for CCC Health Services Started 2008-2009 academic/fiscal year Administered online via Survey Monkey 81 Questions 7 Sections: Demographics, Compliance,

Funding , Staffing, Scope of Service, Outcomes, Mental Health

30 colleges participated in 2012-2013 Survey for the 13-14 Academic/Fiscal Year

is out and ready to be completed (by November 14th)

Uses of HSACCC Annual Survey

Collects organized and easily reportable data on the infrastructure and program activities of Health Services in the CCC system.

Assists in orienting health services professional staff coming into the CCC system, regarding compliance, program development and administrative issues in our setting.

Provides ongoing informational support to Health Services personnel on program models throughout the state for CCC health services, to assist in local program development and advocacy efforts.

Identifies training needs, and professional development topics for HSACCC’s and MHWA’s conferences and meeting.

Reduces the number of emails from our listservs asking for information on topics we already have!

Uses of HSACCC Annual Survey

Offers trend analysis and reporting on the status of our health centers and services

Preserving and enhancing the fiscal health of our services, through collaboration with relevant agencies, grantors, and health partners.

Demonstrates how our services and system are dynamic and changing quickly

Provides a snapshot of what areas of support are needed for our health centers, and helps prioritize system response.

Contributes to your Program Review and Accreditation requirements.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Health Fee Trends

2011-2012 2012-2013

Student Governement

Family Pact Billing

Donations

Other Grant Funding

MAA Revenue

MHSA Grant Funding

District Funds

Student Charges

Health Fee Revenue

0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0%

Student Health Funding Source Trend2012-2013 2011-2012 Colleges with

a Health

Services

Advisory

Committee,

overseeing

Health Fee

fund and

program

planning,

remains low,

at only 20%

during 12-13.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Sexual Assault Prevention and Response Fully Compliant

2011-2012 2012-2013

Clinical Social Worker

Medical Assistant

Health Educator

Marriage & Family Therapist

Psychologist

Nurse Practitioner

Registered Nurse

Physician

Director/Coordinator

Administrative Support Staff

Staffing and Employment Classi-ficationManager Faculty Classified Contracted

Full Time Equivalency Staff

Average 6.1FTE per college

Range 1.65 to 21.35 FTE.

Temporary, Hourly, Contract Workers = 53.3% of the

workforce.

% of Directors that are Nurse Practitioners

% of Directors that report directly to VP

0%

10%

20%

30%

40%

50%

60%

Health Services Director/Coordinator Tidbits

Psychiatrist

Drug/Alcohol Counselor

Registered Dietitian

Medical Assistant

Mental Health Trainee/Intern

Licensed Mental Health Provider

Physician

Health Educator/Health Promotion Specialist

Nurse Practitioner

Other

Registered Nurse (not NP)

20,000 40,000 60,000

Professional Service Visits by Type

22 colleges reporting132,867 service visitsAverage 7849

64.3% of colleges provide Nurse Practitioner Services

62.1% provide direct care physician services in health centers

* “Other” includes service visits by colleges without capacity to report by provider type

Mental Health ServicesIncrease in direct mental health servicesPaid for by the (diminishing) Health FeeMajority of services are under the supervision of Health Services Directors/Coordinators

2011-2012

2012-2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Other model

MH contractors/em-ployees reporting to Other

MH employees report to HS Director/Coor-dinator

MH contractors report to HS Director/Coor-dinator

NO; 19%

YES; 81%

Mental Health Services Paid for by Health Fee

2011-2012

2012-2013

74% 76% 78% 80% 82% 84% 86% 88%

% of Colleges Providing Psychotherapy

Mental Health Internship Programs

% of colleges with MH in-

ternship pro-gram

% of colleges w/Psychology

interns

% of colleges w/MFT interns

% of colleges w/LCSW interns

0%

10%

20%

30%

40%

50%

60%

70%

80%

2011-20122012-2013

Colleges Providing Psychotropic Medications

2011-2012 2012-201316%

18%

20%

22%

Colleges with a Behavioral Intervention Team (BIT)

Colleges with a well defined threat assessment protocol

2011-2012 2012-20130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0%

10%

20%

30%

40%

50%

60%

70%

Yes No

CCC BIT Functions 12-13

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

We don't have a team

Other

Team is developing, scope not clear

District Policy and Procedure review,…

Participate in student conduct code hearings

Provide threat assessements

Student case management

Attend/facilitate faculty-student meetings

Staff development trainings

Receiving, responding, tracking BIR

Faculty/Staff consultations

CCC Mental Health Services 12-13 82% of mental health counseling services report sessions limits for

students.

64% of mental health counseling services report weekly therapy sessions (almost always)

51% of mental health counseling services report having a wait list. (average wait time from 1 day to two weeks = most within a few days)

32% of mental health counseling services report they provide mandated therapy.

18% of mental health counseling services report they provide psychological testing.

15% of mental health counseling services report charging a fee for services.

Health Promotion and Education 100% of health services provide classroom presentations 97% of health services provide health awareness events 86% of health services provide open workshops and seminars 45% of Student Health Services departments have a Facebook

page. 37% of colleges utilize the Student Health 101 online

magazine 35% of health services work with faculty on curriculum infusion

projects 31% of health services have certified health educators and/or

prevention specialists working 14% of colleges reported a structured peer support/education

program

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

Internet AddictionInjury Prevention

CancerEating Disorders

Suicide - QPRYoga, Meditation

ACASleep

Fitness, ExerciseHealth Fair

ImmunizationsSubstance Abuse

Colds and FluHealthy Relationships

Suicide -OtherViolence

Diet / NutritionStress

TobaccoDepression/AnxietyContraception-STIs

Seminars and Workshops Offered 12-13

Thanks to everyone that participated in our data collection projects!

Let’s all put it to good use!

Nuesoft Technologies; 4.2%

Pyramed; 12.5%

Point and Click; 12.5%

Medicat; 20.8%

MedPro; 12.5%

SARS; 37.5%

If you have a healthcare information system, which one do you utilize?

We do not utilize an electronic information system

Types of Appointments

Medical Diagnostic Codes (ICD-9 or other)

Mental Health Diagnostic Codes (DSM-IV or V, or other)

Procedures (CPT codes or other)

Visits by provider type (MD, RN, MFT, etc.)

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

During the 2012-2013 year, what type of service contact information have you been able to collect, by any kind of data system, in your health center?

(Check all that apply)