The Campus Program Framework
The JED Campus Program is an excellent way to begin creating and implementing a strategic plan for mental health promotion, substance abuse and suicide prevention programming on campus.
The Campus Program Framework is a consolidation of factors known to help in promoting mental health, preventing suicide and limiting substance use. It draws significantly from The Comprehensive Approach to Mental Health Promotion and Suicide Prevention on College and University Campuses developed by The Jed Foundation and the Suicide Prevention Resource Center (for more information: https://www.jedfoundation.org/professionals/comprehensive-approach). The Campus Program Framework combines the content of the Comprehensive Model with expert recommendations regarding factors related to preventing substance abuse in young people.
1. Policy, Systems & Strategic Planning
Engaging in an active and dynamic strategic planning process is one of the most important things a school can do to ensure the future success of their mental health and substance abuse prevention programming. Strategic planning allows schools to anticipate and evaluate clinical and programming needs, examine how they deploy both personnel and financial resources to address challenges, coordinate efforts across campus, and evaluate programming effectiveness.
Campus policies are necessary in order to establish norms, build awareness, improve the quality of health services, protect students and discourage harmful behaviors across campus. Having comprehensive and clear policies around health, mental health and substance misuse are important ingredients in prevention. Policies, systems and strategic planning demonstrate that the school takes these issues seriously and addresses them in a thoughtful, pragmatic, and formal way.
- Emotional health should be seen as a campus-wide issue that requires the involvement of multiple campus departments/stakeholders (e.g., upper administration, student affairs, security, student groups).
- Schools should have an interdisciplinary task force or committee that works on campus wide strategy and planning related to emotional health and substance abuse prevention on campus.
- The school should initiate strategic planning activities that have identified national and campus-specific problems and trends, prioritized the problems to be addressed, used campus specific data to inform planning and programming, defined strategies and actions for addressing problems, developed a plan for assessing the interventions, and collected and analyzed campus-specific data to assess impact of actions.
- There should be a system in place to assess budgetary needs for programs or plans that emerge from the strategic planning process.
(Policies related to clinical services are addressed separately)
- All full time students should have health insurance.
- For those students not covered by family or other plans, the school should offer a student health insurance plan that includes comprehensive coverage for mental health and substance use disorder services.
- The school should have written and easily accessible medical leave of absence policies.
- The school should have protocols for managing mandatory leaves of absense.
- The campus should have an emergency/disaster plan which is shared with relevant campus offices and stakeholders.
- The campus should have a postvention protocol to deal with the aftermath of student death, suicide or other campus disaster, and this plan should be shared with relevant campus offices.
- The school should have formally written policies on alcohol or substance abuse, and these policies should include both illicit/illegal prescription drug abuse.
- Campus alcohol and drug policies should be explicit, clear and well publicized.
- Campus administrators should work with local/community authorities, shopkeepers and bars to promote enforcement of under-age drinking and other substance abuse prevention policies.
- The campus should have a well-publicized “medical amnesty” policy such that students who request emergency care or report a friend who is intoxicated and/or potentially overdosed will not be subject to disciplinary sanctions (or at least have limited sanctions).
- The school should have clear protocols for responding and transporting intoxicated, overdosed and/or distressed students for emergency care.
- The university should have a policy in place requiring students who have had an alcohol or drug infraction to have an evaluation for substance misuse.
- The university should have a policy in place requiring students who have had an overdose to have an appropriate clinical follow-up.
2. Develop Life Skills
The higher education experience is not just about academics. It is a time of enormous personal growth and adaptation. With this growth can come challenges like relationship difficulties and financial problems - all of which are risk factors for emotional health issues like depression and suicidal behavior. Supporting life-skills education is valuable in teaching healthy ways to cope with the stress of college life. Some of the life skills that are important to a student’s well-being include managing friendships and relationships, problem solving, decision making, identify and manage emotions, healthy living, and finding life purpose, meaning and identity.
Life-skills education can be implemented across campus through clinical and non-clinical staff such as health educators and student affairs staff. An increased focus on life skills development may also ease the burden on counseling centers, because it might limit or prevent some problems from emerging in ways that require clinical care.
- There should be programs/groups that address interpersonal/emotional awareness areas such as communication skills, identifying and regulating emotions/promoting resilience, conflict resolution (including bystander training programs), relationship skills (with emphasis on managing relationship breakups), Dialectical Behavior Therapy (DBT) groups, sexual harassment/relationship violence, stalking (your program should be compliant with the SAVE act:http://clerycenter.org/campus-sexual-violence-elimination-save-act), and bullying/hazing.
- There should be programs in place to help students manage financial aid and learn to manage finances in general.
Research has shown that loneliness and isolation are significant risk factors for mental health problems and/or suicidal behavior. Therefore, supportive social relationships and feeling connected to campus, family and friends are protective factors that can help lower risk. Efforts to facilitate social connectedness should go beyond simply encouraging students to get involved on campus. For example, some campuses have developed smaller “living and learning communities” where students have the option to live with other students who share their major or interests. Some campuses also have dedicated space in their student unions for student to meet and socialize together.
- Fraternities and sororities should be subject to careful and consistent oversight by the student affairs division.
- Peer mentoring programs, or programs to connect students to small peer groups, should be available to students.
- The school should have programs/activities that promote continuing communication between students and their families and connections to community-based, cultural, religious or national groups, where appropriate and accessible.
- RAs should provide group-building programming on their floors.
- There should be programs/activities provided to promote tolerance and inclusiveness on campus.
- There should be systems or strategies in place on campus to help identify and support disconnected and/or isolated students.
- There should be programs in place to support connectedness among high(er) risk student groups.
4. Academic Performance
Mental health is critical to student academic performance, and academic performance can impact stress levels and emotional health. Healthy living and academics can be thought of as two complementary ingredients that contribute to a healthy campus community and successful student body. Therefore, it is essential to take necessary measures to encourage and teach both academic and life skills. These measures can range from academic advisors and student services staff co-facilitating seminars focusing on study skills, healthy and effective sleep patterns and time management training for their advisees, to implementing a regular course evaluation system that students can access and contribute to anonymously. It is useful to develop early warning systems to help advisors and faculty to identify students who are floundering academically and examine causes and possible remedial steps. The implementation of these measures will yield compounded benefits both in and outside the classroom.
- There should be programs/groups offered to address study skills and test anxiety.
- Students should have access to academic support services, including free or inexpensive on-campus tutoring.
- There should be opportunities for students to do course evaluations which include information about workload and course stress level.
- There should be programs and campaigns to educate students about links between good physical and emotional health and academic success.
5. Student Wellness
Studies suggest that students who participate in regular exercise and other healthy behaviors enjoy improved mental health, better academic performance, stronger relationships and lower rates of drug abuse. Therefore it is important to encourage a healthy, balanced campus environment by employing health promotion and skills development tactics across campus. Some of these health promotion tactics include free health/fitness programs available to the entire student population and designated “stress-free” zones on campus.
- There should be programs/groups offered to address stress and time management.
- The school should offer programs that provide information about general physical health and wellness related to sleep, nutrition and exercise.
- There should be student-run campaigns to provide education to peers about mental health, substance abuse, general health, and relationship health and safety.
- Residential campuses should have a collegiate recovery community or substance-free housing for students in recovery on campus.
- Students should have free access to a gym with adequate time availability for non-athlete students.
- There should be programs at orientation to educate new student about school policies regarding substance use and the dangers of misuse.
- There should be strategically timed messaging campaigns to remind students about the risks and consequences of substance use/misuse.
- There should be messaging campaigns designed to educate students about the risks and dangers of opiate misuse—especially when used in non-pill form and/or when combined with other substances or alcohol.
- Schools should collect metrics on the reach of messaging campaigns (for example, the number or percentage of students impacted, the number of retweets, etc.).
- The school should establish defined spaces in student unions and/or other public areas for student groups to meet.
- There should be regular, alcohol free events and activities (music, food, etc.) that are available in the evenings and late night in well located campus areas.
- The school should have an active club and intramural program available to all students.
- There should be programs/campaigns to educate students about the links between substance use, poor academic performance, accidents and relationship violence.
6. Identify Students at Risk
Research shows that many college students who need help do not seek it out on their own. Therefore, it is important to take action to identify students at risk for mental health problems and/or suicidal behavior. Campus administrators should work together to make sure information about mental/physical health and student support are both accessible and available to those in a position to identify and intervene with students who may be struggling. It is also important to promote emotional health awareness among those who interact with students the most – “gatekeepers” such as residence hall staff, academic advisors, faculty and even fellow students – as it is vital for these people to be able to recognize and refer a student who might be in distress.
- Especially on residential campuses, incoming first year and transfer students should be asked to complete questions related to mental health and substance use history on medical history forms. Parents of incoming students should be encouraged to talk to their children about sharing this information with the school's counseling center or other relevant offices.
- There should be protocols in place for connecting students identified with mental health or substance use histories on admission to campus support services (Disabilities, Health Services, Counseling, Case Management and/or Health Education).
- There should be well advertised/promoted screening/wellness days held regularly, focused on issues such as substance use, depression, anxiety, eating disorders, and sexual/relationship violence.
- The school’s health service clinicians should routinely screen patients for substance use/misuse and common mental health problems.
- The campus should have a gatekeeper program to train relevant campus faculty and staff in identifying and referring at-risk students.
- Online resources should be available for faculty and staff to convey/reinforce/refresh their knowledge/information about identifying and referring at-risk students.
- Student leaders, such as resident advisors, peer advisors, student council leaders, fraternity and sorority leadership, student athletes, and grad student association leaders, should be trained in identifying and referring their friends who may be struggling with mental health or substance issues.
- There should be trainings available either in person or online for students in general to learn about mental health/substance use and to find out how to identify and refer at-risk students.
- Information should be easily available to parents/families about identifying substance or mental health problems and educating them about campus support resources.
- The campus should have a well-publicized/promoted and functioning “At Risk” or “Behavioral Intervention” Team (see: http://jedfoundation.org/professionals/programs-and-research/campus_teams) to collect and respond to reports of students of concern.
- There should be a system in place (either as part of “At Risk” Team or independently) to offer support to students who are on academic probation (and/or struggling academically) and to have academic advisors meet with them to explore for potential emotional or substance issues.
7. Increase Help-Seeking Behavior
Many students who need help may be reluctant or unsure of how to seek it out. Some of the obstacles to help-seeking include lack of awareness of mental health services, skepticism about the effectiveness of treatment, prejudices associated with mental illness and uncertainty about costs or insurance coverage. Campuses should engage in a variety of activities designed to increase the likelihood that a student in need will seek help.
- The counseling center and health education websites should be easily accessible from the university homepage.
- The school should have well publicized/easily accessible screening tools for depression, anxiety, and substance use disorders available on the counseling and/or health education websites.
- There should be easily accessible online information about substance misuse and mental health that is cross referenced/linked in the school’s counseling center, health services and health education websites, and the school should use other online information/programs or programs from other organizations or websites.
- The school should have a peer mental health education (or peer counseling—with appropriate training and supervision) program on campus to take advantage of students’ willingness to talk to their peers.
- The school should run campaigns that de-stigmatize mental health problems and encourage help-seeking.
- The school should run campaigns through varied conduits and media that inform students about campus resources for emotional support and substance education/treatment.
8. Provide Mental Health & Substance Use Disorder Services
Preserving student’s mental health is critical in preventing substance abuse and strengthening their academic success. Therefore, it is essential to offer accessible, consistent and high-quality mental health services to students. To make mental health and substance abuse care more comprehensive, it should include strong and flexible services, adequate staffing levels, flexibility in treatment approaches, and clinic hours that are reflective of student schedules. Since most college clinics are free, the length of treatment is often limited. Therefore, it is important that campus mental health services can assist students in finding off-campus resources that can provide long-term care if needed. Additionally, it is important to have adequate coordination between the campus medical services, mental health services and other campus and local clinical services. Substance abuse is a significant and common problem on campuses, so students should have access to a comprehensive array of assessment and treatment services on campus or in the local community. Since prescription opiates are a leading cause of student death, campuses should increase the availability of Naloxone, a drug that rapidly and safely reverses opiate overdose. Campus first responders and those at high risk should have access to Naloxone and be taught how to administer it (as permitted by local law).
- Broad-ranging mental health services should be available to students.
- The staff to student ratio for the services offered should be adequate to address clinical need
- There should be access to psychiatric medication management when indicated.
- Student should have access to substance abuse clinical services.
- Campus mental health clinicians should be trained to identify and manage a full range of clinical conditions using appropriate modalities of care. This could include referrals to off-campus services when appropriate.
- Primary health care providers on campus should be formally trained to assess and refer for basic mental health, substance abuse and behavioral related concerns.
- Schools should offer clinical services outside of typical “business hours” (to allow for students who work or participate in varsity athletics to have access to treatment) when this is appropriate to their setting.
- Counseling services should be provided outside of the counseling center office in dorms, athletic areas, and student centers, among others where appropriate.
- The counseling center should have a triage system for quick assessment, thereby reducing wait times for those in serious/urgent need of care.
- The service should employ strategies (in addition to triage) to accommodate new students coming in for care during busy periods so as to limit wait lists/wait times.
- There should be services or protocols to assess and manage after-hours care/emergency situations.
- There should be linkages with local community services to provide ongoing care for those who need longer term mental health care than provided on campus and for those who need substance use disorder care not available on campus.
- Relationships should exist with local emergency services to provide and coordinate care in medical, mental health and substance related emergencies.
- There should be coordination of activities and programming between the counseling service and offices responsible for substance abuse education and treatment and health education, as well as between campus behavioral intervention team (BIT), counseling, substance abuse services and discipline office (as clinically and legally appropriate).
- Coordination and opportunities for training between campus clinical and services offices (counseling, health, health education and substance abuse services and disabilities offices) and relevant campus academic departments and programs (social work school, psychology department, psychiatry department, health education training program, etc.) should be present when appropriate.
- The counseling center and health center should have clear information on their website homepage(s) about how to respond to a health, mental health or substance related emergency for both daytime and after-hours.
- The campus should have access to a (well publicized) 24/7 crisis phone and/or chat line either through campus resources or local/national services.
- There should be a process in place to share information (as legally appropriate) between local ERs and school health and/or counseling services.
- The health service and counseling services should have clearly defined and implemented policies around prescription of opiates, tranquilizers (benzodiazepines and sleep medicines) and stimulants.
- Student health and mental health services should assure that clinicians follow state requirements for prescription drug monitoring.
- When students receive prescriptions for stimulants, tranquilizers/sleep medications, or opiates at the health or counseling services, they should routinely receive information about the dangers, risks and consequences of drug misuse and diversion.
- Students should be given the smallest quantity of pills that is clinically necessary when prescribed controlled or potentially dangerous/abused medications.
- Emergency Naloxone doses should be provided to those at risk for overdose (as permitted by local law). For further explanation, see page 28-29 of the report, “Prescription Drug Abuse: Strategies to Stop the Epidemic” located at: http://healthyamericans.org/reports/drugabuse2013/
9. Means Restriction & Environmental Safety
It has been well established that if the means to self-harm are removed or limited in an environment, it can prevent suicide and even limit accidental deaths. This is called “means restriction.” Limiting students’ access to weapons, poisonous chemicals and roof-tops, windows or other high places are all means restriction activities. Each campus should do an environmental scan for potential access to lethal or dangerous means. Further information on conducting environmental scans and about means restriction can be found on the Means Matter Campaign’s website (http://www.hsph.harvard.edu/means-matter/).
- Schools should complete a campus “environmental scan” for potential access to lethal means on a regular basis.
- There should be appropriately restricted access on campus to rooftops, windows, balconies, atriums, bridges, toxic substances, and medication storage.
- Campus residence halls and apartments should have break-away closet rods (to limit risk of hanging).
- There should be a policy limiting or containing firearms on campus.
- Toxic substances found in laboratories should be tracked, monitored and controlled.
- Campuses should have prescription drug collection/drug return programs that are well publicized and regularly run.
- The school should have a policy regarding the use or sale of energy drinks.
- The school security department (or student group) should offer a late night transport or escort system to decrease risk of accidents and assaults, as appropriate.