Benjamin D. Locke

Development and Initial Validation of the Counseling Center Assessment of Psychological Symptoms-34

A short version of the Counseling Center Assessment of Psychological Symptoms–62 (CCAPS-62) was created via three studies. The final short version (CCAPS-34), which contains 34 items and 7 subscales, demonstrated good discrimination power, support for the proposed factor structure, strong initial convergent validity, and adequate test–retest stability over 1-week and 2-week intervals.

The Center for Collegiate Mental Health: An Example of a Practice-Research Network in University Counseling Centers

This article presents a model of a practice-research network that offers benefits for clinicians working at college and university counseling centers. We briefly describe the basic components of this practice-research network, challenges in developing it, and some of the empirical studies that have resulted from this initiative. We also describe possibilities for future research that not only will foster further collaborations between clinicians and researchers, but also will enhance our ability to understand and improve mental health services for college students.

The Center for Collegiate Mental Health: Studying College Student Mental Health Through an Innovative Research Infrastructure That Brings Science and Practice Together

&NA; Available information about college student mental health has largely been anecdotal or based on information drawn from a single institution. This review examines ten studies published within the past 20 years that focused on college student mental health using data collected from multisite college or university counseling center clients or staff. This subset of research on college student mental health is important in view of the increased demands on counseling centers and the increased emphasis on evidence‐based practice. Collectively, these studies suggest that the presenting concerns of college students are changing, that those in treatment are more distressed than those who are not, that clients who identify as ethnic minorities appear to evidence slightly more distress than their white counterparts, that matching client and counselors relative to ethnicity does not appear to improve outcome, and that counseling services seem to improve outcome. While each study makes a unique contribution to the literature, this body of literature suffers from a common set of limitations that stem from the difficulties associated with multisite research, research taking place in active clinical work, and the time‐limited nature of data sets. Through our review and critique of these studies, we discuss the importance of establishing an infrastructure that helps researchers to elucidate trends, effective treatments, and risk factors that will be useful to clinicians treating this population. The Center for Collegiate Mental Health, a practice‐research network focused on college student mental health, is described and preliminary findings from this entity are presented.

Previous mental health service utilization and change in clients' depressive symptoms.

Although a potentially important factor in case conceptualization and treatment planning, the impact of previous treatment on subsequent counseling response has received little empirical attention. Using archival data, this study aimed to (a) report the prevalence of previous treatment utilization in a counseling population, (b) examine potential differences in symptom severity by treatment history, and (c) test whether the rate of change in symptoms over a course of counseling is moderated by previous treatment utilization, when also accounting for initial severity. A sample of 1,262 college students presenting for treatment in university/college counseling centers across the United States provided information on previous treatment history and completed the Counseling Center Assessment of Psychological Symptoms, administered at intake and up to 4 additional time points, with an average of 3-5 weeks between assessments. Data from the 13-item Depression subscale were used for the present study. Half the clients reported previous counseling, one third psychotropic medication, and one tenth psychiatric hospitalization. Previous treatment was associated with increased baseline depressive symptom severity. Results from latent growth curve models showed that previous counseling and medication correlated with a slower rate of symptom response, and previous counseling reduced the probability of being labeled a treatment responder. Previous counseling remained a significant predictor of counseling response when controlling for baseline severity. Hypothesized mechanisms through which previous treatment experience impacts subsequent treatment response remain largely theoretical and should be the focus of future research.

Meeting the Demand for College Student Concerns in College Counseling Centers: Evaluating a Clinical Triage System

University counseling centers, experiencing an imbalance between student demand and available resources, respond in various ways. The current mixed-method study evaluated one university counseling center transitioning from a wait-list system to a triage method of managing demand. Significant reductions in wait time and increase in attendance were found. Clients also reported significantly less distress after triage implementation. No reduction in wait time or increase in symptom severity were found for crisis clients. Qualitative methods assessed staff perceptions of triage, suggesting staff was satisfied with triage because of clinically informed scheduling and increased efficiency.

Are we in crisis? National mental health and treatment trends in college counseling centers.

The current state of college student mental health is frequently labeled a “crisis,” as the demand for services and severity of symptomatology have appeared to increase in recent decades. Nationally representative findings are presented from the Center for Collegiate Mental Health, a practice research network based in the United States, composed of more than 340 university and college counseling centers, in an effort to illuminate trends in symptom severity and patterns in treatment utilization for the campus treatment seeking population. Clinical data collected over 5 academic years (2010–2015) showed small but significantly increasing trends for self-reported distress in generalized anxiety, depression, social anxiety, family distress, and academic distress, with the largest effect sizes observed for generalized anxiety, depression, and social anxiety. On the other hand, a significantly decreasing trend was observed for substance use. No significant changes were observed for eating concerns and hostility. Utilization data over 6 years indicated a gradual yet steady increase in the number of students seeking services (beyond the rate expected with increasing institutional enrollment), as well as increases in the number of appointments scheduled and attended, with great variation between centers. Within the context of changing national trends, we conclude that it is advisable to consider the specific needs of local centers to best accommodate distinct student bodies.

Effectiveness of routine psychotherapy: Method matters

ABSTRACT Objective: Though many studies have shown that psychotherapy can be effective, psychotherapy available in routine practice may not be adequate. Several methods have been proposed to evaluate routine psychological treatments. The aim of this paper is to demonstrate the combined utility of complementary methods, change-based benchmarking, and end-state normative comparisons, across a range of self-reported psychological symptoms. Method: Benchmarks derived from randomized controlled trials (RCTs) and normative comparisons were used to evaluate the effectiveness of psychotherapy in a large (N = 9895) sample of clients in university counseling centers (UCCs). Results: Overall, routine psychotherapy was associated with significant improvement across all symptoms examined. For clients whose initial severity was similar to RCT participants, the observed pre–post effect sizes were equivalent to those in RCTs. However, treatment tended to lead to normative end-state functioning only for those clients who were moderately, but not severely, distressed at the start of psychotherapy. Conclusions: This suggests that although psychotherapy is associated with an effective magnitude of symptom improvement in routine practice, additional services for highly distressed individuals may be necessary. The methods described here comprise a comprehensive analysis of the quality of routine care, and we recommend using both methods in concert. Clinical or methodological significance of this article: This study examines the effectiveness of routine psychotherapy provided in a large network of counseling centers. By comparing multiple established methods to define outcomes in this sample we provide a detailed understanding of typical outcomes. The findings show that, across several different problem areas, routine psychotherapy provided substantial benefit, particularly to clients in the most distress. However, there is room to improve, especially by increasing the number of clients who return to normal functioning by the end of treatment. Using distinct methods provides complementary answers to the question: How effective is routine psychotherapy?

Mental health and professional help-seeking among college students with disabilities.

OBJECTIVE Research has demonstrated that providing appropriate supports and services on campus can improve both mental health and academic outcomes for students with disabilities (Emerson, Honey, Madden, & Llewellyn, 2009; Stumbo, Martin, & Hedrick, 2009), but little is known about the specific mental health needs of this population. The purpose of this exploratory study, therefore, was to identify the mental health needs of college students with various types of disabilities. METHOD Researchers analyzed data, collected by the Center for Collegiate Mental Health, of 5,696 students with, and without, disabilities who utilized counseling services on campuses in the 2013-14 academic year. A nonclinical (students not in counseling) sample of 1,620 students with, and without, disabilities was also explored. RESULTS Compared to students without disabilities, students with disabilities report more anxiety and academic-related distress, as well as higher rates of suicide ideation, suicide attempts, and nonsuicidal self-injury among both students in counseling and not in counseling. CONCLUSIONS Although in certain areas students with disabilities show similar levels of distress as students without disabilities, students with disabilities have higher levels of distress in areas which could impact their academic success. Self-harming tendencies are higher for students with disabilities overall, but more so for specific disability types. (PsycINFO Database Record

Therapist effects and the impacts of therapy nonattendance.

Although dropout from psychotherapy has received substantial attention, the impacts of nonattendance on client outcome across a course of psychotherapy have not been well researched. All in-person psychotherapy treatments require clients to actually attend sessions to generate positive symptomatic results, and missed sessions have at least a time and financial cost. Furthermore, it is plausible that therapist differences exist for client attendance rates. The present study examined impacts of nonattendance, particularly early in a course of treatment, comparing the effects of canceled and no-showed appointments on overall symptom reduction and rate of change while accounting for therapist effects. Using multilevel hierarchical regression, the impact of nonattendance on symptom reduction and rate of change was modeled on 5,253 clients (67.2% female, 72.3% white) across 83 therapists gathered from a practice research network. Results suggested that no-shows, but not cancellations, had negative impacts on the magnitude and rate of symptom change, with larger effects when occurring before the third session. Therapist effects on attendance also were identified; therapists varied greatly on nonattendance percentages of their clients after the third attended session.

Enhancing feedback for clinical use: Creating and evaluating profiles of clients seeking counseling.

The current study explored the reliability and clinical utility of a method designed to identify latent classes of students seeking counseling, based on 8 symptom domains and their interactions. Participants were over 50,000 college students in counseling, assessed with the CCAPS-62 and -34 as part of routine clinical care. Latent profile analysis was used to group an exploratory and confirmatory sample of students by reported symptoms across the 8 CCAPS subscales. Profiles were evaluated for reliability and clinical utility, in particular for risk assessment and the prediction of treatment duration and success. Nine reliably stable latent profiles, or groups of profiles, emerged from analysis. Profiles differed significantly in reported symptoms, demographic makeup, psychosocial history, and diagnoses. Additionally, profiles appeared to capture meaningful differences between clients that had implications for relative risk of suicide, self-harm, and violence toward others as well as significant differences in the number of sessions in treatment and the effect size of treatment. Latent profiles of patients appear to capture meaningful, stable differences that could be implemented in an automated system of evaluation and feedback, and that might be useful to clinicians, administrators, and researchers.