On Mental Health, an Online Tool
I admit it. I’m trying to get it wrong. I want to see what happens (for reporting purposes, of course).
I start the conversation by asking Gwen if she has an anxiety problem. Then I follow up by inquiring why she’s freaking out about the exam.
We don’t talk long before a blue screen pops up. “You have compromised Gwen’s comfort to the point where she is leaving your office. Next time, try to show more compassion for her situation.”
Game over (or start over).That’s probably a good example of how not to use At-Risk, a simulated, online training program intended to help faculty and staff get it right -- or at least become sensitized to good strategies for identifying, conversing with, and referring mentally distressed students. “We're very clear that you're not going to change your personality in 45 minutes. What we're trying to do is make you aware," said Ron Goldman, CEO of Kognito Interactive, a New York-based simulation and games company that developed At-Risk in collaboration with the Mental Health Association of New York City. "What are the things that you need to be aware of in a conversation; what are the different tactics that don't work or do work? And awareness is the first step in behavioral change.”
Launched late in 2008, the program is gaining its first college customers. The first, City University of New York, is piloting the training program at four campuses. New York University plans to purchase 50 licenses of At-Risk for a limited test run with student affairs staff.
"It essentially allows you to role-play without having to feel like you're being judged and it gives you options that are relatively realistic about what kinds of things you may choose to do," said Henry Chung, associate vice president for student health and executive director of the student health center at NYU. Chung, a psychiatrist, has modified Kognito's own self-report survey in order to gauge the program's effectiveness.
"If the student affairs folks really feel like this kind of training is helpful to them, then we're going to move to the faculty," he said.
Attention to training the so-called gatekeepers – faculty and staff -- to identify and refer at-risk students to the counseling center is not new, but has increased in the wake of the Virginia Tech and Northern Illinois University shootings.
Typically, training is still done in-house by college counseling center employees who offer workshops or speak at faculty meetings. But vendors have identified opportunities to try to systematize training, online.
Another company, Outside the Classroom, launched MentalHealthEdu, an online training program for college personnel, in October 2007; it's been deployed at 35 campuses so far, according to the CEO. At-Risk is also very much a product of its time. Advertised benefits include the ability to “maintain a record of who has taken the training for compliancy and legal purposes.”
In short, here’s how At-Risk works: users (the intended audience is college faculty or staff) read the profiles of six studentsBased on that information, they choose which students they'd like to talk to.
In conversations, users assume the role of a professor. They choose -- from a number of options -- how they should open the discussion with the student. Throughout the conversation, they continue to choose, from a selection of available topics, which they should next broach. Some conversation topics put the virtual students seemingly at ease; others trigger them to cross their arms and sit back. "You're not talking about a very simple decision tree. ... The character has its own emotional state or memory so how it will respond to your question and the options you will have at that point depend on the decisions you’ve made before," Goldman explained.
“You get feedback along the way. So if you ask inappropriate questions, you’ll get feedback that way."
Ultimately, the goal is to identify and refer the at-risk students to the counseling center, either by walking them over, setting up an appointment for them, or giving them a number to call. "This is not about treatment" -- or diagnoses, Goldman stressed. "This is about identifying, approaching and if necessary referring the student."
“Once you find the three [of six] that are at-risk you have completed the game successfully."
At CUNY, "Most of the feedback we’ve gotten so far has been anecdotal, but preliminarily at least, it’s been encouraging,” said Chris Rosa, the university assistant dean for student affairs. “We’ve heard a lot of feedback that, if nothing else, these are very good conversation-starters among members of the faculty.”
“If it’s effective and if it assists faculty in reaching out to students to offer assistance, I think that’s a good thing," said Karen A. Bower, senior staff attorney for the Judge David L. Bazelon Center for Mental Health Law, which advocates for mentally ill students. She stressed that she couldn't answer the effectiveness either way. “If I were a faculty member and I wasn't sure how to approach a student, I might talk to someone at the counseling center. I might talk to colleagues. I might kind of role-play with someone. I don't know if this is as effective as those other strategies."
Greg Eells, director of counseling and psychological services at Cornell University and president of the Association for University and College Counseling Center directors, stressed a need to tie in any online training program with locally based resources. (On that note, At-Risk does offer colleges the option of purchasing a customized "My Counseling Center" page.)
“I think any of these programs can be helpful. $9.95 per user, that’s fairly pricey. But, hey, there may be some schools, Cornell not being one of them, that still have a lot of money," Eells joked. (The listed prices for At-Risk vary by number of users: It costs $24.95 per person to train 50 to 500 personnel, $9.95 per person to train 501 to 2,500 personnel, and above 2,500 the listed price is “contact us.”)
“A lot of counseling directors do this kind of work, they go out, they go to faculty meetings, they go to staff meetings, they talk about what services are available, what people should look for," Eells said.
The Role of Online Training
Pennsylvania State University has developed a series of video vignettes to support this sort of training. Just this fall, in cooperation with the local public broadcasting station, counseling center staff completed four vignettes on "Worrisome Student Behavior," The videos are posted online. (Before that, staff completed "Students in Distress," an online workshop complete with videos, in 2001-2.)
"We do workshops with faculty and staff and we've found that showing the video gives a little more life to it. At some point in the past, another staff member and I would act out the parts of student and faculty member, and people kind of liked that because we were the 'not quite ready for prime time players.' But I think this is a different level," said Mary Anne Knapp, a clinical social worker and therapist who coordinates outreach and consultation for Penn State's Center for Counseling and Psychological Services.
"One of the issues really for any of these products is how to pay for them. ... Our budget is primarily salaries so these kinds of things, unless you get some money from somewhere -- I don't know what other people's budgets are like, but I think a lot of people run into this as an issue, the money issue. And obviously we're not skilled at making movies. We know the content," said Knapp, who added that people outside Penn State have asked to use the videos. "We're fine with that. ... We feel like this exists. If they want to click into it and show it and apply it to their school, that's fine."
Brandon Busteed, founder and chief executive officer of Outside the Classroom, the Boston-based company that offers MentalHealthEdu (and is best known for the AlcoholEdu program), submitted that, “If schools are going to be effective in addressing mental health as a public health concern, they are going to have to turn to scalable programs and the only way you can do that is by integrating online work."
About a year and a half in, growth for MentalHealthEdu, however, is slower than he expected. “It’s growing for us although it was interesting -- given the amount of interest when we launched it, I’ve been surprised at how few have gone to an online program," he said.
At the vast majority of colleges, he said, "someone from the counseling center really does grass roots, 'train the trainer' work.”