Abstract This study proposes a model for meeting increasingly mandated outcome research objectives in a university counseling center setting. It is proposed that counseling centers utilize their existing intake forms, along with an annual satisfaction survey to determine the effectiveness of counseling services. Effectiveness is defined as improvement and measured by the reduction of the symptoms or presenting concerns with which the client initially presented. It also introduces the Relative-Change Index (R-Chi) as an objective way to quantify intra-individual change occurring as a result of therapy. This new mathematical procedure allows for a more meaningful assessment of the client's degree of improvement, relative to their potential for improvement. By re-administering the problem checklist, routinely included as part of the initial paperwork for each client at intake, again post-therapy, it is possible to quantify improvement by measuring the difference in distressing concerns. Additionally, including a subjective, retrospective survey question asking the client to indicate their perceived rate if improvement at follow-up provides construct validity and allows for correlational comparisons with R-Chi. Results suggest that student/client ratings of the degree to which the services they received satisfactorily addressed their presenting concerns were significantly rated to their R-Chi score. This model suggests that the framework guiding client outcome research should include measures of the client's level of distress, improvement in reducing the distress, and satisfaction with services.

D.Cur. / The purpose of this research study was to describe a model to facilitate collaboration between the institutions of higher education and psychiatric health care services in order to promote psychiatric clinical nursing education, with guidelines to operationalise the model. In spite of the calls by statutory bodies and contemporary legislation for collaboration between institutions of higher education and psychiatric health care services, there are few instances where formalised collaborative ventures exist to promote psychiatric clinical nursing education. Since the move of nursing education from hospital-based schools to colleges and universities, there was no attempt to redefine the most appropriate roles for nurse educators and clinical facilitators regarding student teaching and learning, given this realignment. The consequence was that the relationship between these institutions is characterised by territoriality; a lack of integration of knowledge and expertise of nurse educators and clinical facilitators; a lack of sharing the necessary resources to facilitate cooperative teaching thus increasing the existence of academia-service gap and/or theory-practice gap to develop. There was therefore a need to develop a model with guidelines for operationalisation of the model to facilitate collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education. The research questions that emerged were: • What is the meaning of collaboration between institutions of higher education and psychiatric health care services within psychiatric clinical nursing education? • How can collaboration between institutions of higher education and psychiatric health care services be facilitated to promote psychiatric clinical nursing education? To realise the aim of this research, the following objectives are formulated: • to explore and describe the meaning of the concept “collaboration” between the institutions of higher education and psychiatric health care services within a psychiatric clinical educational context (theoretical and empirical perspectives); • to explore and describe the perceptions of nurse educators, nurse managers, and (i) clinical facilitators with regard to how collaboration between institutions of higher education and psychiatric health care services can be facilitated to promote psychiatric clinical nursing education; • to conceptualise the identified concepts of the model for collaboration to facilitate psychiatric clinical nursing education; • to describe the model to facilitate collaboration between institutions of higher education and psychiatric health care services, evaluate the model and describe guidelines for its operationalisation. The study was conducted in four phases. Phase One of the study involved an exploration and description of the meaning of collaboration within psychiatric clinical nursing education in accordance with Rodgers and Knafl’s evolutionary method of concept analysis (Rodgers & Knafl, 1993:77-90) and empirical meaning description from the participants’ perspective. Integration of the theoretical and empirical meaning of collaboration formed the basis on which a conceptual map was designed. Content analysis of literature was done using deductive and inductive reasoning strategies, synthesis, and inference and derivation as described by Chinn & Kramer (1995:63-67), and Walker and Avant, (1983:58-62). Theoretical validity was ensured (Chinn & Jacobs, 1987:208). A conceptual map constituting the four phases of collaboration was described.

It is generally reported that around one in 10 children in the UK today suffer from some kind of mental health problem. It is of course compulsory for all children between the ages of five and 16 to partake in a certain amount of education, which in the vast majority of cases means school. Head teachers are statutorily obliged to safeguard the children in their care, which also means addressing their physical and mental health. Therefore schools are growing in their importance as sites of mental health care interventions. There is little or no published research which explores the phenomenon of on site mental health provision from the perspective of the head teachers, in terms of how it impacts them. For this study, five head teachers of mixed sex primary schools were interviewed about the mental health service that they had commissioned for their school. All five participants employed the same service. Using the interpretive phenomenological approach to analyse these interviews, five major themes were discovered: ambivalence towards the mental health service; mixed feelings towards mental health issues; that the mental health service helped alleviate heads’ sense of anxiety; the paradoxical nature of head teachers’ intersubjective experience; and that while head teachers like to describe themselves as part of a collective identity, they locate themselves as individuals when they feel the need to assert power. It is hoped that these findings might aid providers of mental health services to schools and children by providing a more sophisticated understanding both of head teachers’, and therefore commissioners’, anxieties and positive feelings about such services.

The subject of drug and alcohol abuse on college campuses across the country is the concern of many college administrators. There exists a relatively high consumption pattern of drug and alcohol abuse among college students when compared to the general population. This pattern of alcohol abuse has remained stable despite the presence of substance abuse programs on campuses that are specifically targeted toward the student population. There exists little research on how these programs operate and how they address the problem of substance abuse on campuses. Most of the research that exists is of survey design. This study examined through a descriptive case study, the substance abuse programs in three public universities in Oregon. The study used descriptive case study to describe what components comprised the programs as well as how the programs functioned under the various organizational structures. Three organizational structures were identified. The first university's organizational structure was under the health center, both administratively and physically. The second university studied had part of the program under the counseling center and other components under the athletic department and the health center. The third university had what was termed as a de-centralized structure, with the treatment component under the health center, the prevention component under an academic department, and the peer education component under the health center. The various organizational structures were also examined for their influence on the respective program. The 1989 Drug-Free Schools and Campuses Act Amendment, required institutions of higher education receiving federal funds to have programs. The impact of the Act on both the program and the organizational structure of the program was also examined. The study demonstrated an impact of the legislation on the programs in the form of funding that made possible new services. The study also suggested an influence of the organizational structure on the programs in the form of the funding of new program components that changed the organizational structure. Implications for programming as well as research as a result of this study's findings are presented. Recommendations for program models are also presented. / Graduation date: 1994

This study was designed to better understand psychological support services available and desired for students and group leaders of study abroad experiences. It was hypothesized that study abroad group leaders 1) would witness psychological distress among their students and 2) would not have an action plan addressing psychological distress while abroad. The participants consisted of thirty-seven faculty and staff members who led a study abroad excursion in the past five years at a mid-sized, public university in the Midwest. Each participant answered an online needs assessment comprised of questions regarding demographics, trip logistics, and mental health concerns. The results indicated that nearly 50% of all study abroad trip leaders reported a student with a mental health issue and 75% of these group leaders believed that the students either did not have access to mental health services or only had medical assistance available. Limitations and recommendations for future studies are reported. / Department of Counseling Psychology and Guidance Services

There is a significant gap between the numbers of college students who experience a diagnosable psychological problem and those who seek psychological treatment for these problems. One explanation for this gap may be that many college students may be unaware of free mental health services available at the university counseling center on campus. Thus, use of these resources is not a viable option. These concerns were addressed in the current study via a posttest-only experimental design by creating a video in line with the Theory of Planned Behavior (TPB; Ajzen, 1985; 1991) and assessing its effects on college students attitudes towards psychological help seeking (PHS), subjective norms associated with PHS, perceived behavioral control over PHS, and PHS intentions. Mixed support was found for the video’s impact on TPB variables in a PHS context. In addition, the utility of the TPB model for explaining PHS in college students was examined. Based on model fit statistics the TPB adequately explained PHS in college students, but only after modifications were made to the measurement model. / Department of Counseling Psychology and Guidance Services

Professional nurses working at a campus health service have to cope with challenges such as staff shortages and budgetary constraints associated with working in a complex environment providing primary health care. The aim of primary health care includes promoting health, preventing disease and the early detection and treatment of illness. Mental health services form an integral part of the integrated primary health care package as implemented in the campus health service. Students attend the Campus Health Service for help related to their health. Health care is provided by professional nurses and counsellors through a comprehensive primary health care service which serves students as well as staff. Some students may state that they experience feelings of being stressed or depressed. Other students may complain of physical symptoms such as headache or upper backache. Upon further investigation emotional problems may be identified as the cause of the psychosomatic symptoms. The professional nurses working in the campus health service verbalised that it is sometimes difficult to identify a mental illness or mental distress as there is no effective assessment tool that they can use. Management of conditions is also problematic as there are no protocols indicating the therapeutic interventions that can be taken. The research question in this study was therefore: What information should be included in a protocol to assess and manage a student experiencing mental distress that can be used by professional nurses working in a Campus Health Service? The aim of this study is to develop a mental health care protocol for campus health service professional nurses to assess and manage university students who are experiencing mental distress. The research design of this study was qualitative, explorative, descriptive, explanatory and contextual. In this study the Delphi research technique was used to create an instrument to standardise mental health care in a campus health service. The Delphi technique is a series of sequential questionnaires or “rounds” interspersed with controlled feedback that seeks to gain the most reliable consensus of opinion of a group of experts. A questionnaire was developed based on an extensive literature review. The research population of this study consisted of two groups: professional nurses with knowledge of student health care needs and expert psychiatric nurses. The study was conducted at the Campus Health Service at a university in the Eastern Cape. The data collection and analysis was done utilising the Delphi technique. Trustworthiness was ensured by using the Lincoln and Guba Model utilising the criteria of credibility, applicability, dependability and conformability. In this study the ethical principles of beneficence, non-maleficence, justice and self determination were applied to ensure that participants are treated with respect and consideration and ensured high ethical standards. Informed consent was obtained from the participants in this study. The findings of this research were utilised to assist the researcher in developing a protocol for mental health care of students in campus health service settings.

PhD (Health Sciences) / Department of Advanced Nursing Science

Sexual and gender minority (SGM) emerging-adult college students experience unprecedented rates of psychopathology. They are also more likely to experience barriers to accessing traditional mental health resources and spiritual support groups and are more apt to seek support in alternative ways, such as through campus LGTBQIA+ support groups and online communities. Spiritual-mind-body (SMB) group wellness programming may fill an important role as a more accessible service for SGM students and as an adjunct to individual mental health services. The primary aim of the present study is to investigate the utility of Awakened Awareness for Adolescents and Emerging Adults (AA-A), a group SMB wellness intervention designed to support spiritual individuation and mental health, to support SGM college student spirituality, mental health, psychological, and psychosocial wellness. A secondary aim was to examine differences in SGM students’ response to AA-A when delivered online versus in-person using exploratory analyses. Participants were 116 non-clinically referred, self-selected undergraduates aged 18-25. Self-report measures captured spiritual well-being, psychological well-being, psychosocial well-being, and symptoms of psychopathology. SGM students’ rate of enrollment in AA-A was compared to broader university and national college demographics using chi-square analyses. SGM and non-SGM student engagement in AA-A was measured by the average number of sessions attended and compared using an independent sample t-test. SGM and non-SGM student pre-intervention wellness was compared using independent sample t-tests. Changes in wellness at post-intervention were assessed using paired sample t-tests, and differences in post-intervention changes in wellness were analyzed as a function of ethnicity and SGM status using independent sample t-tests and ANOVAs of change scores. Exploratory two-way ANOVAs were conducted and interactions between SGM status and AA-A delivery method on well-being change scores were analyzed to determine whether SGM students responded uniquely from their peers to the online delivery format. SGM students had greater spiritual and wellness support needs at pre-intervention as compared with their non-SGM peers and were twice as likely to enroll in AA-A, and more likely to stay and engage in the program. SGM students had statistically parallel rates of improvement across most measures of well-being, and statistically even greater rates of improvement on some psychological and psychosocial measures of well-being capturing negative self-talk and self-concept. Among students who participated in AA-A delivered online and during the COVID-19 pandemic, SGM students benefitted more than their non-SGM peers. Findings support the feasibility and acceptability of the AA-A intervention to support SGM college student spiritual well-being and mental health across both in-person and online delivery methods, and exploratory analyses indicate that the online delivery method may be a particularly helpful format for SGM students to engage.

Outreach is recommended as an intervention for racial and ethnic minorities who underutilize traditional mental health services (e.g., Brinson & Kottler, 1995). Yet, the availability of outreach services at university counseling centers for students of color has not been studied. In addition, no study has examined factors influencing the availability of outreach services for racial and ethnic minorities. The primary purpose of the current study was to investigate the availability of outreach for racial and ethnic minorities and how these services are influenced by institution size, staff size, institution type, accreditation, and organizational cultural competence. One hundred and fifty one counseling center directors completed an online survey. It was hypothesized that counseling centers’ organizational cultural competence would predict the availability of outreach services for racial and ethnic minorities beyond that of institution size, staff size, institution type, and accreditation. The results supported this hypothesis. Among the variables examined, organizational cultural competence was the greatest predictor of the availability of outreach for students of color. The results suggested that counseling centers with greater levels of organizational cultural competency also had a greater availability of outreach services for students of color. The implications of these findings for theory, research, and practice are discussed. / Department of Counseling Psychology and Guidance Services