Using a collaborative care model for the treatment of eating disorders on college campuses

Presented by Dr. Eric Wood and Dr. Cait Scafati

Dr. Eric Wood devised the Comprehensive Collaborative Care Model (CCCM) to help improve college counseling services for both students and care providers. 

Dr. Wood believes that no student counseling center should be expected to treat all mental health disorders, but it shouldn’t simply refer them elsewhere. This led to a collaborative approach, which involves Texas Christian University (TCU) partnering with off-campus facilities to provide on-campus services, such as dialectical behavioral therapy.

Additionally, students are offered peer support groups, which are modeled on recovery groups, that are largely student-led. They provide a sense of community and a group of like-minded individuals to talk to when individuals need some support. 

In his presentation at the 2023 Within Health Summit, Dr. Wood highlighted the opportunities campus mental health centers provide, how changing campus dynamics have presented new challenges to college counseling services, and details of his Comprehensive Collaborative Care Model, as well as its potential impact on students. 

Opportunities provided by campus mental health counseling

Putting aside the negative press and stereotypes, campus mental health counseling provides opportunities that no other healthcare system in the world can offer. 

1. Reach a vital demographic

Most college students are aged between 18 and 25, which is a key demographic for many factors. For example, they are the second leading demographic for suicide attempts, have a high prevalence of eating disorders, and are a common age range for the emergence of mental health disorders.

2. Reduced barriers to accessing treatment

1. Location: Mental health counseling is located at the center of where students live and work.‍
2. Reduced stigma/increased help-seeking: College students typically use mental health services more than their peers. Plus, they’re often encouraged by fellow students who have had a positive experience accessing the service, e.g., at Dr. Wood’s center, 80-85% attended the center because someone asked them to.‍
3. The natural desire for peer support
4. Reduced cost for services: At most colleges, the cost of mental health services is included in tuition fees. Typically, in remaining colleges, there is a nominal charge, which is usually cheaper than a co-pay.

3. Utilize an established infrastructure 

Campus counseling centers have the necessary infrastructure in place, such as overheads and IT. When this infrastructure is combined with a service that has mental health treatment programs, the potential is huge. 

4. Impact 

Counseling services being available to students on campus can have a significant impact on student’s lives and the community as a whole.

What campus counseling centers were traditionally designed for

College counseling centers are not designed to treat students with high mental health needs. Rather they are designed to:

• Help students through the significant amount of change that occurs at this point in the developmental lifespan.
• Help students cope with the stressors associated with change, which is linked to university retention. 
• Reduce and prevent high-risk behaviors among students.
• Treat emerging and/or acute mental health concerns. 

Changing campus dynamics

In recent years, campus dynamics have changed, presenting challenges to college counseling services, including:

• A growing number of students on campus with high mental health needs
• More students requesting repeat and/or long-term counseling
• A high rate of burnout among overworked counseling center staff
• A growing number of students presenting to counseling centers with sub-clinical needs

These new dynamics do not match up with what college campus services were designed for. This leads to the dangerous narrative that presents college counseling centers as inadequate and ill-equipped, and it doesn’t tell the full story.

Key data points

There are some important statistics which shed more light on the story of college counseling centers:

• The Center for Collegiate Mental Health found that about 50% of all campus counseling center services nationwide are utilized by about 20% of clients. This is likely because students with high mental health needs are repeatedly presenting to campus counseling services. The first time they present they are issued with an off-campus referral to address their complex needs. The client fails to attend the referral, and the cycle repeats. How can campus counseling services help these students? Is collaboration the answer?‍
• Many current counseling clients are former clients who have returned to seek services again.  College counseling services don’t typically provide aftercare. Usually, mental health symptoms are treated until they are in remission, and then the client is released from care to free up a space for another student in need. However, without aftercare, the episodic nature of mental health disorders often leads to clients returning to counseling centers. What if aftercare services were available following counseling, such as peer support services and communities?‍
• Counseling center staff often report high levels of burnout and rate unscheduled appointments and crisis response as the largest source of this burnout. Staff are often unable to check up with crisis clients promptly due to scheduled appointments. What if staff were split, so there is a team to deal exclusively with crisis work and a team for scheduled appointments only?‍
• Many clients are meeting with a licensed provider for sub-clinical needs, even though individual counseling is not the most effective intervention. Examples of sub-clinical needs include homesickness, social isolation, and difficulty focusing. Instead of presenting to the counseling center, could these students be more effectively helped by providing student activities, communities, and academic coaches?

TCU’s Comprehensive Collaborative Care Model

The Comprehensive Collaborative Care Model (CCCM) was founded in 2019 by Dr. Eric Wood, Director of Counseling and Mental Health at Texas Christian University, to address the shift in campus dynamics mentioned previously.  The CCCM consists of four key objectives:

1. Collaborate with community partners to provide specialized services on campus for clients with high mental health needs, such as intensive outpatient programs.
2. Foster peer support communities and recovery services in a wide range of mental health domains, including eating and body image issues, grief, depression, and anxiety, to name just a few. 
3. Split counseling center services with teams dedicated to triage and crisis response and regular scheduled appointments. 
4. Work with on-campus partners to better serve students with sub-clinical needs. 

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Within University: Supporting students in remote eating disorder care

Research shows that there is a high prevalence of eating disorders on college campuses. Between 11 and 17% of females and 4% of males on college campuses screen positive for clinical eating disorder symptoms.¹ However, only 20% who screen positive go on to receive treatment, which is hardly surprising considering the average ratio of students to counselors on campus is 1731:1.¹

The Within University is a safe place for students to recover from their eating disorders while continuing their education and day-to-day life. They offer high levels of care for students, including intensive outpatient programs and partial hospitalization programs, which include families and loved ones every step of the way.

By delivering treatment remotely, Within University can meet students where they are located and integrate into their student life. Services include:

• One-on-one group therapy sessions
• Customized and flexible scheduling
• 24/7 connectivity SMS chat, self-reporting check-ins, and digital tools
• Community “living room” off-hours distress support
• Group meals, nutritional oversight, and meal delivery
• University-specific programming
• Remote patient monitoring tools
• Coordination with university services.

Student outcomes are measured regularly during treatment—from admission to discharge—and there have been life-changing outcomes for students, including a:

• 40% decrease in eating disorder symptoms
• 40% decrease in eating depressive symptoms
• 20% decrease in eating anxiety symptoms
• 50% decrease in impact on quality of life

The ability to remain on campus during treatment and to remain in treatment during breaks in the semester are major advantages of virtual treatment. Furthermore, pre-admission treatment and preparation allow students to know what to expect when undergoing treatment in the college environment. 

Resources

1. Grammer, A. C., Fitzsimmons-Craft, E. E., Laing, O., De Pietro, B., & Wilfley, D. E. (2020). Eating disorders on college campuses in the United States: Current insight on screening, prevention, and treatment. Current psychopharmacology, 9(2), 91-102.