A Place of Help and Healing

The number of students seeking counseling and mental health assistance is rising on campuses across the nation, something also seen at the Baylor Counseling Center. Fortunately, recent improvements are helping the center expand and enhance the services available for students.

One way to measure the growth taking place at the Baylor University Counseling Center over the last few months would be to examine the many ways student services are being enhanced: additional staff counselors, specialists with expertise in a wider variety of mental health issues, expanded facilities and increased campus outreach to students.

These enhancements are the fruit of a focused action plan by Baylor University, affirmed and funded by the Board of Regents (BOR), to ensure that the educational, physical, emotional and spiritual needs of students, and especially survivors of interpersonal violence, are given priority attention.

"I know how much courage it takes for a student to come to the Counseling Center and ask for help. We go into this profession to make a difference in the lives of students," Dr. Jim Marsh, director for counseling services at Baylor, said. "Personally, it has been difficult when we haven't been able to offer resources a student needs. Having these additional resources and expanded access to the Counseling Center gives our staff a greater opportunity to do what we feel prepared for and called to do."

The Baylor Counseling Center has long offered students a wide array of services to support student wellbeing, but the University's action plan presented an opportunity to dramatically enhance Baylor's caring community and take mental health services to the next level.

"There has been a growing level of feedback from students that they would like greater access to the Counseling Center," Dr. Kevin Jackson, vice president for student life, said. "So the Board asked us the question, 'what do we need to do to be the gold standard in student counseling services?'"

For Marsh and his staff, that question presented an opportunity to take not merely another step forward to best serve students, but a jump toward excellence in their field.

A Growing Focus on Mental Health

When Marsh arrived at Baylor as a staff psychologist in 1999, he was one of three Counseling Center staff members. There are now 10, and will be nearly 20 this fall.

Like his colleagues at university counseling centers across the country, Marsh and his staff have consistently grown to address an ever-present modern reality: student demand for university counseling services has been increasing unabated for nearly two decades.

"There was a point in time where basically any student that walked into the university counseling center would be seen right away, and be seen for just about as long as they wanted," Marsh said. "But in the late 1990s and early 2000s, the demand exploded. The sheer numbers of students coming to counseling centers went way up, and the complexity and severity of issues we saw went way up."

The statistics show the growth. According to the American College Health Association's (ACHA) 2015 National College Health Assessment, nearly 58 percent of college students reported feeling overwhelming anxiety in the prior year, and 54.5 percent reported experiencing above average to tremendous stress. The range of issues students face go far beyond what many might consider typical collegiate stressors, such as classes, jobs or relationships. Many students faced complex issues related to trauma from interpersonal violence or sexual assault, eating disorders, addiction and more.

Mental health experts and college administrators and staff have studied the trends and have found many reasons for the uptick in mental health needs, but have not pinpointed a specific cause.

"There has been a lot written about these trends," Marsh said, "and a wide range of factors have contributed. But you do see things that can be somewhat unique, in our case, to a place like Baylor. When you combine the cost of an education with a high academic rigor, there's a noted increase in the demand for mental health services. They call it the Ivy League effect, and I think that's a piece of it here. There are also things unique to this generation. To sum up a lot of what's been written, students have had really high expectations. Whether they set those expectations for themselves or whether those come from elsewhere, they expect levels of success, grades and opportunity that doesn’t always add up."

In 1999, the Counseling Center treated approximately 350 students. By 2005, this number nearly doubled, to 610. That jump was only the beginning. In the 2015-16 school year, the Counseling Center served 1,300 students. In the last six years, Baylor's undergraduate population has increased by 2,000 students, a figure that accounts for only some of the uptick.

As the volume of students seeking counseling increased, Marsh said universities enacted strategies to see as many students as possible. The most common strategy was to limit the number of sessions a student could visit the counseling center. Baylor capped students at 12 sessions per academic year, a limit similar to or higher than many peer institutions. Students could return each academic year for an additional 12 sessions--roughly the length of a semester. Even with these adjustments, waiting lists were the norm for universities; backlogs of up to two weeks were common. Additionally, students seeking specialized treatment often were referred to outside agencies better equipped to treat more complex issues.

Baylor's Counseling Center continued to add resources through the years; however, the demand made it difficult to see students quickly after an initial consultation. Students would (and still do) come to the clinic during the Counseling Center's walk-in hours and visit with a staff counselor. From that initial visit, Counseling Center staff would consider the best next step for treatment. Students would get further treatment, although that next appointment often wasn’t available immediately.

"Baylor has consistently responded to beefing up the Counseling Center," Marsh said. "We care very deeply about students. We would always see students, but one of the big challenges for us was that we always operated with all of our slots to see students full. You have to have enough capacity in your agency to absorb the sheer numbers and to address the issues students face. Even at our busiest, we got students in, but it could often take two weeks."

Baylor has taken steps to stem the tide in recent years, adding additional staff, including specialists, and starting group therapy sessions to see more students. These changes began to alleviate the backlog, but for a university committed to supporting student wellbeing, taking steps to move into the top tier of university counseling centers nationally was prioritized.

Strategic Improvement

"Our philosophy here has always been a continuous improvement model," Jackson said. "We were continually assessing data on how well we were meeting the needs of our students and building the cases for what we needed to do next to improve the way we met those needs. What took place in February was a strategic movement that said we want to go to the next level. How can Baylor be the best at taking care of students?"

In February 2016, the Baylor BOR approved and funded an administrative action plan "to prevent acts of sexual violence on campus and to improve treatment and services for all those impacted by interpersonal violence." The Counseling Center was provided with additional funding for a two-fold purpose: to alleviate the immediate backlog of students waiting to see a counselor and to take steps to be the "gold standard" in university counseling centers moving forward.

Within two weeks of the announcement, Baylor had hired 11 part-time staff members, many of whom had their own private practices, to allow the students to be seen promptly. Those 11 counselors worked with the Counseling Center through the end of the semester and enabled the clinic to meet the immediate demands of both initial and follow-up visits.

"It's been nice," Marsh said, "to be able to offer students appointments very quickly after their initial assessment. That's what we were able to do, and that's what we are also going for in the future as well."

With the part-time staff in place, Marsh and his staff moved on to other purposeful steps to advance toward their aspiration of reaching the top tier of university counseling centers. These steps include new staff, staff specialization, increased outreach, expanded space and a sexual assault and trauma recovery team, resources that will both eliminate the waiting lists and session limits and allow the university to provide the types of specialized service previously found off-campus. As of June 1, the Counseling Center no longer has session limits or fees for service.

STAFF // As students return in the fall, they'll find several additional full-time staff members ready to serve. Currently, the Counseling Center has 10 full-time employees; that number will expand to nearly 20 when all final hires are made.

In the world of college counseling, the ratio of full-time staff to students serves as a benchmark. As Baylor's enrollment has increased, new hires were needed just to maintain their ratio, which had been about 1:1,660 (one full-time staff member for every 1660 students). New hires will reduce that ratio to 1:800, a level commensurate with many of the top private schools in the nation. Beyond the all-important ability to see more students and eliminate waiting lists and session limits, increased staffing will create a ripple effect throughout the Counseling Center.

SPECIALIZATION // In recent years, trends have shifted counseling centers away from hiring generalist practitioners to staff with specific areas of expertise. Several new positions approved in February include experts in working with victims of sexual assault and interpersonal violence, an addictive behavior specialist, an eating disorder specialist and a dialectical behavioral therapist, who specializes in working with students who engage in self-harmful behaviors or harbor suicidal thoughts.

In addition to providing specialized care for students on the Baylor campus, these specialists will raise the knowledge level of the entire staff.

"If you look at some of the schools that are in the range of service we're going for, that's what you see--increased levels of specialization," Marsh said. "You begin to hire more specialists, and they share and train everyone else on staff, and what happens is you bring up the overall experiential knowledge base of your entire staff."

The Counseling Center is expanding training and development of current employees with funds allotted by the BOR. For example, Dr. Edna Foa, a clinical psychology professor at the University of Pennsylvania and one of the nation's foremost experts on the treatment of post-traumatic stress disorder (PTSD), came to campus to speak to Counseling Center staff. The Counseling Center also welcomed Waco-area mental health professionals who work with victims of interpersonal violence to participate. The administrative action plan makes it possible for the Counseling Center to bring top-of-the-line training opportunities to Waco.

OUTREACH // For the Baylor Counseling Center, serving the wellbeing of students takes staff beyond the walls of the Counseling Center itself. By reaching students where they are, Counseling Center staff can make students aware of the services provided, educate students on mental health and help them grow comfortable with the idea of seeking care. If a student is aware of the Counseling Center and comfortable with visiting counselors early, he or she can sometimes keep a smaller problem from becoming a bigger one.

"The goal is to try and catch things before they develop," Marsh said. "We can do that, and we actively try to reach out to do that. In the last two years, we've been averaging approximately 125 different outreach presentations across campus, in chapel, with student organizations, in trainings with residence hall staff and community leaders and other on-campus events."

Marsh has seen a cycle in outreach efforts many times throughout his 17 years at Baylor--Counseling Center staff do a great deal of outreach early in the semester. Deeper in the semester, however, demand for counseling services would grow to the point that staff needed to focus on seeing students in the counseling center, and the center’s on-campus visibility would drop.

As the Counseling Center staff doubles this year, Marsh says his team will no longer have to make that trade-off.

"Late in the semester is a key point for students," Marsh said. "We will be more present and visible now throughout the year. We will carry outreach all the way to the end of the semester. That's the advantage of having more staff. Before, we did what we could at the time and then shifted our resources because we didn’t want people having to wait for appointments. Now we don't have to shift resources."

EXPANSION // The Baylor Counseling Center will continue to be housed in the McLane Student Life Center (SLC), but in spring 2017, the center will gain office space in the Dutton Avenue Parking Garage.

In addition to offices for new staff members, the most notable feature of their second campus home will be a trauma recovery area.

"We're going to have an area where if the Baylor police department needs to bring a student over, or if the Title IX Office needs to bring a student over, they are going to have access to a private area just for them. It will be a place where individuals who have training can meet with these students and interact with them in these key moments."

Other new rooms in the Dutton offices will provide group therapy to students and house other resources that serve multiple students. The Dutton expansion will more than double the Counseling Center's space--from their current 4,250 square feet in the SLC to 11,880 square feet overall.

TRAUMA RECOVERY // Everyone currently on staff in the Counseling Center is trained and equipped to provide care to students dealing with a traumatic event, such as sexual assault. But with the addition of further skilled staff and the expansion in facilities, the Counseling Center will soon be taking their trauma care to the next level.

Dr. Cheryl Wooten, who joined the Counseling Center in 2011, will lead a team of three clinicians (currently being hired as of press time) in a specialized Trauma Recovery Team this fall.

"This Trauma Recovery Team will gain additional insight through training and conferences to make sure our department is constantly on top of the latest developments in this area," Marsh said. "We've asked, 'how can we be the best at this?,' and this is one way."

The Trauma Recovery Team will work closely with the Title IX Office and the Baylor police department to facilitate holistic care for victims. Additionally, the team will develop protocols and guidelines for the Counseling Center to share their knowledge with their colleagues and to ensure each staff member is constantly equipped to provide the best possible care.

Staff, specialization, outreach, expanded facilities and enhanced trauma recovery care: these are some of the visible ways the Counseling Center is taking a leap forward. To help measure the improvement, a team of seasoned professionals from universities like Cornell, Pepperdine, Houston and Washington University in St. Louis--a group dubbed the "gold standard team" by Marsh--has visited the Counseling Center and provided an appraisal of Baylor's progress at press time. No university counseling center can cover everything; some severe mental health concerns will always require a level of care not found on college campuses. But the Counseling Center's new resources will serve students with a level of prompt service and enhanced expertise that places Baylor in the top tier of collegiate counseling centers.

These steps are a way Baylor can channel a difficult situation into purposeful introspection and action to provide the best care for students. Marsh and Jackson see the investment made by the Board of Regents as a transformative opportunity for their office to provide Baylor students with the best mental healthcare possible as they strive to live out the Baylor Mission.

"Although this was in the midst of discussions around Title IX and interpersonal violence, this growth will speak to the needs of our entire campus," Jackson said. "We want to meet every student where he or she is and walk alongside them in this journey called the Baylor experience to help them become more and more the person God has assigned them to be. Because there is greater access to the Counseling Center and greater expertise, this is going to help all students at Baylor."

Marsh has seen firsthand the Baylor family's love for students in his 17 years here. As he and his staff work to make the action steps a reality, he requests that the Baylor family partner with the Counseling Center as well.

"In all sincerity, I ask for their prayers and support as we move forward," Marsh said. "There has been a tremendous response from the Baylor community who care about the university and our students. They have offered to help in many ways and we are open to feedback and ideas that can help us be one of the best counseling centers in the country."