How NAU Streamlined Student Access to Mental Health Resources


How NAU Streamlined Student Access to Mental Health Resources

Episode 149. May 2, 2023.

Welcome to the Office Hours with EAB podcast. You can join the conversation on social media using #EABOfficeHours. Follow the podcast on Spotify, Google Podcasts, Apple Podcasts, SoundCloud and Stitcher or visit our podcast homepage for additional episodes.

EAB’s Katie Herrmann is joined by Dr. Carl Dindo, the Director of Counseling Services for Northern Arizona University, to discuss innovative approaches to meeting student mental health needs. Dindo and his team have focused on connecting students with the right information, counseling, and other mental health resources in places and ways that students find most helpful.

Among the strategies they’ve implemented is getting counselors out of their office more often and “embedding” them in places where students congregate naturally. Dindo and Herrmann discuss the success of these efforts and offer advice to other campus leaders about meeting the mental health needs of a diverse student population.



0:00:11.2 Speaker 1: Hello and welcome to Office Hours with EAB. Today, we explore innovative approaches being used to connect Northern Arizona University students with mental health resources. Our guests discuss the value of getting counselors outside their office and into places where students naturally congregate, as well as a tech-based strategy of posting QR codes. And many of those same public spaces to link students to information about campus-based mental health resources. Give these folks a listen, and enjoy.


0:00:49.0 Katie Herrmann: Hello and welcome to Office Hours with EAB. My name is Katie Herrmann, and I'm a Senior Research Analyst at EAB, and one of the areas where I've been spending a great deal of time lately is examining innovative approaches to meeting the student mental health crisis. If you're new to the world of higher ed, allow me to bring you up to speed on what's happening. So, virtually every poll and new research study confirms that the mental health struggle that students in their teens and early 20s are experiencing today, is more serious and more widespread than perhaps it ever has been. Prior to and across the pandemic mental health concerns among adolescents were progressively rising. From 2011 to 2021, the percentage of students who experienced persistent feelings of sadness or hopelessness steadily rose from 28% to 42%, and while many pandemic stressors have since declined, students are currently experiencing all-time rates of depression, anxiety and suicidality with no signs of slowing.

0:01:58.8 KH: And college and university counseling centers are definitely feeling the effects when it comes to increased student demand for their services, at the same time, staffing challenges at colleges and universities have reached critical levels, which means that there aren't nearly enough counselors at most institutions to effectively address the volume and complexity of student mental health needs. Joining me today to discuss this challenge is the Director of Counseling Services for Northern Arizona University, Dr. Carl Dindo. Carl, would you mind telling us a little bit about NAU and your role at the institution?

0:02:36.0 Dr. Carl Dindo: Sure, Katie. First, thank you so much for having me. This is lovely, I can't wait to have a nice conversation with you and really continue, I think the work that we did as a group through the EAB Collaborative last year. So this is really nice. My name is Carl, I use he/him pronouns. I am from the Director of NAU Counseling Services. I've been with counseling services for about 10 years, in a variety of roles clinically and administratively, and I think NAU for those who don't know, is located in Northern Arizona. It is not the desert, it is the pine tree forest and mountainous area of Northern Arizona, and so it's just a lovely place to be. But, yeah.

0:03:21.6 KH: Thank you. No, that's perfect. And yeah, as Carl said, one of the reasons we've asked him to join us today, it's because his team at NAU participated in EAB's Mental Health Collaborative, but they're also doing some really interesting and innovative work in terms of how they serve their students. So Carl, before we dig into your specific approaches or programs you've instituted, what would you say is the fundamental challenge or root issue that your team is attempting to tackle?

0:03:53.4 DD: Sure, that's a big question. It's such an important question, and I would say fundamentally, it is trying to figure out how we as a department with a mission to serve the students here at NAU really meet the needs of as many students as we can within the landscape that you just shared. This evolving context of mental health in a university setting, and it certainly can be challenging, and there are lots of universities doing some really innovative and creative things, and so we certainly are not unique in trying to think outside the box around that, but fundamentally, we've tried to do some really good work around figuring out how our traditional counseling services can meet the need, and as well as perhaps maybe some non-traditional mental health supports and programs.

0:04:45.3 KH: Great. Yeah, and I wanna break that down a little bit because I'm sure some of our listeners might be thinking, "Okay, mental health is in a crisis. Why can't we simply encourage those students who are struggling to call or walk into the counseling center for that support." And I'm curious, why isn't that enough or where are you seeing that fall a little bit short on your campus?

0:05:08.6 DD: Absolutely. Again, really important questions. And so I think in order to answer that, it's probably important to contextualize, I think, at least in my opinion, working in higher education mental health for over a decade now, I think what I've seen in terms of that changing landscape, and just a couple of important bullet points that might resonate with the people, first is that we know more and more students are coming into college either having been in mental health treatment and counseling, previously diagnosed with a mental health issue or disorder, or even perhaps even taking medications to help manage symptoms of a mental health disorder, so we know more and more students are coming in and they're gonna need and require services to help them successfully get through the next four or five, potentially six years of their college career. And coupled with that, I think we've seen a reduction in stigma for mental health.

0:06:03.0 DD: I think over the years, through the pandemic, it was talked about at length. I think the impact it was seen across all age groups, and so fundamentally, again, there's this impetus placed on, we need to address, I think the needs that are coming out of people being more willing to share and be vulnerable about mental health issues and concerns and challenges and how they're also intersecting with just their ability to function here in the college environment, which is so important. It also contextually, as you mentioned too, staffing levels.

0:06:37.0 DD: I think, somewhere over the last probably 5, 10 years, I think a lot of us in university settings have realized that the demand is gonna continue to grow, and we've seen data that suggests it's outpacing enrolment in most universities, and so understanding that it places a big charge to how do we staff as many folks in the counseling center and mental health resources as possible, but obviously university systems, like many systems have finite resources and mental health being what feels like an infinite problem, so how do we address something it's infinite with finite resources? And so we've just really started thinking outside the box of what other programs and initiatives and ways of supporting a more holistic view of mental health that we could bring to the table. And so, certainly, I think that just helps to contextualize that when administrators, faculty and staff say, I'm encountering a student who's in distress or has a mental health concern, go to the Counseling Center, reach out to them, we certainly want them to do that.

0:07:42.7 DD: That is our message as well, as we want students, staff, faculty, administrators to utilize and leverage the resources that they have on campus for that. But in doing so, we also recognize that staffing, for instance in NAU, we have maybe 15 to 20 counselors, trainees, providers at any given time in our center, for a community of 25000 to 30000 across all of Arizona. And so we recognize that just staffing is not necessarily going to solve the issue, so to speak. And so it really, again, forces us, I think, to think outside of the traditional model of counseling in higher education and start to explore and innovate around serving mental health and perhaps even changing our perception of mental to be a little bit more holistic and about the whole person rather than just maybe what's going on from a mental health perspective.

0:08:43.1 KH: Absolutely, and I know that we've had conversations previously that along with this holistic view of mental health comes that students are different, some of them are gonna be really comfortable turning to their counseling center and saying, "Yeah, I'll walk in there in front of my peers and nobody can stop me," but I know that you all have been really intentional about reaching those students who might be a little more hesitant to do that. Can you speak a little bit on that?

0:09:11.7 DD: Absolutely, I think a couple of things we implemented over the last few years, again, thoughtfully and intentionally was, in an effort to recognize that if students maybe felt reticent or apprehensive of coming to the counseling center for a variety of reasons, how could we come to them in essence, and that's looked like a couple of different things, I think we have done some really good work establishing great partnerships with different departments on campus that serve perhaps communities or individuals that historically wouldn't have access to mental health services who would have been maybe disenfranchised or marginalized in terms of their ability to get mental health support. So we really felt like it was important to do some proactive and intentional outreach to these communities through our partnerships across campus. And so that really evolved into having counselors come outside of the office here at the center and go and establish embedded offices in these departments, which a lot of universities do, and I think is really, really valuable for meeting students where they're at, and also establishing connections with students that wouldn't historically or traditionally, maybe access services otherwise. So that's been one way we've done that and been really, really thoughtful about that.

0:10:29.5 DD: I think another thing that we've done is we've really tried to market, I think, in a way that's meeting students where they're at technologically right now. And I know we've also talked a little bit about the use of things like QR codes. And so a couple of years ago, we really establish a plan that we're gonna start to use QR codes as a really quick streamlined way to get maybe students connected to a lot of information, and so what that looked like was us establishing QR codes across our website, QR codes across banners, flyers, we utilize them on faculty syllabus. So it was really trying to get this streamlined way of getting a lot of information to students, but meeting them, again, outside of campus community, so they wouldn't necessarily have to just come to our website or our center to see this. And we established also a way of connecting those QR codes to things like web booked appointments and students didn't have to call, they could actually make an appointment online for a couple of our programs, like case management and substance use disorder, and again, streamlining that process, reducing barriers to accessing the services and supports is so vital.

0:11:41.7 DD: And, I know Katie, we've seen over the last few years QR codes being utilized in a lot of different contexts, and so we felt like this might be a great avenue to get students to just, "Hey, I'm just curious, where does this QR code lead me to?" We found some pretty impressive results from that, frankly.

0:12:00.5 KH: Awesome, yeah, I love the QR codes. I just think it's really smart to be playing to that, even when I think about the number of restaurants that have turned to totally paperless menus, students are so used to using the QR code as a means of getting more information on demand, that I just think that's really unique and smart to be playing too. And I know you mentioned you all have had some fairly good results with your use of those QR codes, do you have any metrics that you could speak to in terms of how many students are interacting with your QR code or the website?

0:12:36.2 DD: Absolutely, yeah, and I think I have a couple of different data points I'm happy to share. First, we noticed just including more QR codes and more, almost, links to other website where a lot of information is housed, the rumor we kept hearing from people is students don't go to websites. They don't go to websites. And I can appreciate evolving in times we dabbled with the idea, should we be making TikTok videos or be on Instagram more? And we did, we established a social media presence in an effort, again, to meet students where they were at, and started placing some of our QR codes on there that students could access pretty quickly. But I think what we found was just maybe shifting our marketing strategy a little bit.

0:13:17.7 DD: Branding, maybe a little bit differently. We found over the course of a year, we found a 16% increase in website visits alone, and that's through Google Analytics. Our telehealth and technology coordinator was able to find that, yeah, we actually have more students visiting our website, so that just means more students potentially accessing the resources and the guides and handouts and information that they needed, which was amazing. And so that was really helpful, and then I think we partnered with another group to offer some supplemental counseling services, and they used a QR code and we marketed that far and wide, and we found just through that, we had 903 different website and/or app registrations, people downloading the app and getting the information, we had almost a couple hundred articles being reviewed and mental health assessments being taken, so this resource, which we didn't have access to prior to last fall really became, I think, a hub for a lot of information to students. And again, a QR code being a really streamlined way of accessing that information.

0:14:18.2 KH: Yeah, absolutely. Wow. Yeah, what great results. I'm sure it must feel good sometimes, I feel like, especially with new technology, you're like, "Is it gonna work?" And then it must feel great for that to pay off. That is great to hear. Awesome. Well, I'm curious, outside of your marketing and QR codes, what other changes are on your radar or have you all already implemented on campus?

0:14:45.4 DD: Yeah, I think we wanna continue to build on some of the partnerships and relationships that we've built. I think this evolving landscape and context of mental health has really led me, and I know a lot of people smarter than me, frankly, in this field, to understand is that mental health in a college setting is really a community-based issue. And by a community, we could be talking about just a university, but we could also be talking about a university based in city or town. And so I think that's an important piece of a road map perhaps moving forward for us, is thinking about establishing more relationships and partnerships with people around campus. And frankly, student affairs leadership that is committed to mental health. I think it feel inescapable for most of us that mental health will cut across so many different dimensions of the live experience for college students, so faculty and staff and administrators are gonna see that popping up in classrooms or emails or social media. And so really, for us, it's about how do we leverage, I think, those relationships. And I think that commitment, that passion that we see across our student affairs folks here at NAU at least.

0:15:53.7 DD: And so the other thing that I think we've realized is, again, if we can't just throw a bunch of staff at this because they are finite resources, how do we leverage resources that we have. And so, as I mentioned earlier, we established a partnership with a group, last fall, and piloted out starting in August, a supplemental counseling resource for students. But it's far more than just really counseling, I'm oversimplifying, as I said, there is an app, there's a phone number, this is a full robust set of services that NAU students can access, 24/7 anywhere they are across the world. This group that we've partnered with, LifeWorks, which is actually becoming TELUS Health, has really done some unbelievable work establishing a student focus, a college student-focused set of services to meet the needs of students in this day and age. And so we were able to establish a great partnership with them, with support from our university leadership, and we've piloted that out, and they have served over 450 unique students here at NAU alone over the past eight or nine months. And so that has felt huge in terms of just some support for the counseling center staff here, as well as support for students in terms of getting maybe some accessibility out there to the students that wouldn't have had that otherwise, or who might have been waiting on a waitlist because of a bottleneck and demand that always seems to happen in the fall.

0:17:18.0 DD: So that was really something that we, again, innovatively sort of thinking outside the box, like a lot of universities to say, "What else can we do? How else can we support our students?" And our leadership, I think has been really committed to and well-positioned to say, "Yes, we wanna support these initiatives because the mental health for students here at NAU matter." So it always makes our job a little bit easier to get those resources in place when we have that kind of support.

0:17:46.9 DD: A couple of other things I mentioned, the embedded counselors, I think we're continuing to establish those relationships and almost like satellite locations for our counseling center across the university here at NAU. We have a pretty intentional relationship that we're building with our success center where we're gonna be establishing a physical direct office on our South Campus, and if you don't know anything about NAU, our campus is very long it's... And so we hear a lot of feedback from students, of even just all of my classes, my life is on south campus, I can't make it in North Campus where you all are located. So it's, again, trying to hear that feedback and think through, Well, how can we establish our presence down there through you? How can we support you all down there too. And I think beyond that it's building out services that really, again, tap into the holistic experience for students, the live experience of what it means to be a college student beyond just mental health, and so we've been very intentional about growing our case management program here, we have the case management coordinator, who is fantastic and passionate, and she has a couple of GAAs that will be working with her, and the idea is how do we get connected... Or how do we connect students to resources across the university, perhaps in Flagstaff community or even all over Arizona, that might go beyond just mental health support.

0:19:00.9 DD: We're talking things like food insecurity, housing insecurity, financial insecurity, the basic needs that are so fundamental to a student just being successful in college. And so building out that program has been really fantastic, and we've seen some unbelievable results just from students who maybe they don't need mental all support, but they certainly benefit from case management. That's one too. And the last thing I'll mention, Katie is, we're really exploring this idea now, perhaps even getting a mobile unit in place where our counselors can get out of our offices and go meet students where they are at, in a pretty intentional way as well. Setting up either services or outreach or workshops, or even just meet and greets and tabling events with a mobile van to just get out into the community, which I think humanizes us for students, which can be helpful, it demystifies perhaps a little bit of just who we are and what we do. And we're hoping that that creates a sense of accessibility for students as well.

0:20:02.1 KH: Absolutely, no, I feel like that physical and technological presence and just really that approachability, it sounds like you all are hitting on so many different levels of, "Okay, I'm gonna meet you where you are, whether that's via our website, whether that's in a physical campus location that we know there's traffic there and we don't have supports there currently," I think, yeah, that for your students just does so much for your approachability and accessibility. One thing I'm curious about, I know something that my team has been thinking a lot about is peer support, I know it inevitably comes up, especially when we talk about our staffing shortages and how can we really get mental health support out there, how are we going to scale our efforts. And I know that at other institutions, they've had a lot of success, they've found that students now are, because of the destigmatized nature of mental health challenges, and that more generally, they're eager to talk to their peers about their challenges now, so I think it's a really unique time to be playing into the peer support, and I'm curious if this is a conversation at NAU or how you all have built that out.

0:21:23.3 DD: Absolutely, well, and Katie, I'm happy to answer your question. And honestly, I have a kind of follow-up question maybe for you, because I know with the work you've done, what I found so valuable about the collaborating and was really hearing from so many different folks around what are they doing, and really pulling ideas from them and so... Maybe I'm happy to speak to your question if you're okay with me asking you a question.

0:21:42.2 KH: Absolutely.

0:21:44.7 DD: Yeah, the peer-to-peer program in support, I think has been a big part of conversation recently, and so a couple of years ago, as a matter of fact, our former director really saw kind of a void in that area. And I think coming from this evolving perspective of mental health being a community-wide issue and challenge, it really felt like we would be doing a disservice to students if we didn't include them in our community-based solutions, and so the idea was, "Great, let's pilot a peer-to-peer mental health support program. Let's see what that's like, and do students really benefit from talking to peers, perhaps rather than the professional support." And as you alluded to, and I think a lot of universities have done this, they've piloted this out, and I think for us at least, and it sounds like a number of other universities.

0:22:32.8 DD: Yeah, it's been wildly successful. Beyond our expectations, frankly, we hired a dedicated person to manage that program, and she grew this in the last two, three years, really from just a small handful of folks who were trained in mental health and how to support a student in distress, and now it's growing to her teaching a three-credit class where students can come in to be taught kind of more in-depth mental health training and education and how to support students based on a variety of presentations and needs and concerns, and it's grown into now over 50 to 60 mentors a year with 50 to 60 mentees, I mean, people who just want support from their peers, it's been wildly successful, and I think its something that we will continue to put our energy to, because we do realize that for some students is by far the best resource that they might have and their preferred method of getting mental health support. And so, yeah, that has been something that we didn't even anticipate, but has been unbelievable.

0:23:35.7 KH: Awesome. No, I love to hear that, and I also love that you mentioned just the educational component of that, because I think that piece is so important that it's not that we're asking our students to feel uncomfortable and throwing them into these situations, but if we can really give them the confidence and assurance that they really can be successful in supporting their peers, I think that, yeah, that's when we really do see these programs take off.

0:24:04.7 DD: Absolutely, yeah. Now, do you mind if I flip this a little bit and ask you a question?

0:24:08.3 KH: Of course.

0:24:11.3 DD: Right. Thank you. I think one of the things that NAU and my participation may be collaborative value from was really hearing these perspectives of other folks, but a lot of the times if we're not involved in a collaborative or a program like that regularly, it's hard for us to get the pulse of, "What's really happening out there and what other programs are people aware of, and what other innovative cool ideas are out there that we could be perhaps taking advantage of or bringing to campus here?" And so I'd be curious, are there things that you're hearing about and that your group is working to universities around, that do seem kind of on the cutting edge that maybe we should know about here?

0:24:48.8 KH: Yeah, no, that is such a great question. And yeah, obviously, you mentioned that you've piloted out your peer program and are feeling good about results so far, I feel like one institution in particular that comes to mind, especially with that peer support component, is the University of Michigan, and if you have not explored the Wolverine Support Network, would definitely recommend doing it. There are so many resources there, but I think they get at a lot of what we talked about previously, of just recognizing that even when it comes to peer support, students are gonna be different. So students who wanna talk to their peers might wanna do that one-on-one, or they might be more comfortable doing that in a group setting, and I think that having that differentiation and those different experiences available to students, even when it comes to, "Okay, here are your peers," has been so important for them because then... Right, it's this whole new avenue that you're even using your peers, but then from there, we have so many different branches that we can tap into those different student preferences at that lower level down. And I love hearing about the Wolverine Support Network.

0:26:03.7 DD: Oh, that sounds amazing. I don't know if I should mention this, I grew up in Ohio, so there's a part of me that kind of has a traditional Ohio State thing and...

0:26:13.7 KH: Fair, sorry, touchy subject.

0:26:15.8 DD: I think you got that right, that's no problem. Yeah, that sounds amazing. Yeah, and I appreciate that information. We're always looking for... We know there's so many different universities that really are trying to think outside the box, we're all in a very similar place of trying to do what's best for our students, so it's always nice to hear about other programs and ideas out there.

0:26:34.6 KH: Yeah, of course, and happy to share them. But yeah, Carl, I know that you and I could probably talk about this subject for many, many hours, but I do wanna be respectful of your time, so before you go, can I ask you to sum up your top two or three pieces of advice for Student Affairs leaders at other institutions who might be struggling to meet the mental health needs of their students more effectively?

0:27:05.0 DD: Sure. Oh, what a good question. Yeah, as a psychologist, I hesitate to give advice, but I think my recommendations, just again, based on my experience here and what we've been doing at NAU and I think the way we've been able to leverage relationships is for student affairs, and especially those folks that are really deeply committed to understanding that mental health as a community-based issues, I think we need to be involved in conversations around university level support, in policy change, protocols, I think just the idea of, this isn't just a counseling center problem, it goes kinda far and wide. And I think once all of us begin to share that responsibility, it actually lessens the burden on all of us as well, because we get to have this team-based approach to supporting students, which is ultimately, I believe why we're all here anyway, at least, hopefully, right? Why we're choosing to work in this environment. And I think the other thing that I have just learned, frankly, and it's been very humbling over the last couple years, Katie, is that we've been challenged a lot as a center, and as a department, and as a staff, to go beyond lip service when it comes to culturally responsive, inclusive services and programs.

0:28:26.0 DD: And that challenge is, we've gone through the whole stages of defensiveness and questioning, but I think we have come to a place of accepting that the traditional model of just waiting for students to come to us, isn't going to work anymore, I think that time is coming on, and now it's really about looking at innovative non-traditional ways to support student mental health, and so I think a huge piece of that is the intentional and inclusive services that we're gonna offer to students, especially students that when they get to college, maybe for the first time in their lives, have access to mental health services, supports and resources, case management, peer support, psychiatry, medical services, and I think just this idea of, "We want to go beyond that lip service," we wanna actually live that out and demonstrate our commitment through our behavior and our actions. And so I think student affairs can get behind that, and really see a way for that and in their environments, in their departments, I think that goes a long way to show students that it's more than just us wanting to talk, we're to demonstrate this beyond, I think in a really intentional, importantly.

0:29:40.8 KH: Awesome, I completely agree with you, and that is as good a place as any to wrap up this conversation. Carl, thank you so much for joining me today on Office Hours at EAB.

0:29:52.8 DD: Thank you, Katie, I really appreciate the opportunity and thanks for the conversation.


0:30:02.9 Speaker 1: Thank you for listening. Please join us next week to hear special guest, Jon Marcus from the Hechinger Report, who will expand on some of his recent reporting about the problems, many of them self-inflicted that play community colleges. Until then, thank you for your time.

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