EXECUTIVE SUMMARY

Some colleges created case management positions to help troubled students in the years following the 2007 Virginia Tech gun massacre.

  • Case managers help students with crises, emergencies, and medical and behavioral health problems.
  • College students experience high levels of depression and anxiety, according to the Student Experience in the Research University Consortium survey.
  • Case managers can help students, who are hospitalized for mental health issues, to catch up with their classwork and return to the campus.

When a troubled college student opened fire on people at Virginia Tech in Blacksburg, VA, on April 16, 2007, killing 32 students and faculty, the shocking tragedy changed college campuses forever.

Students now receive text messages instructing them to shelter in place if someone appears on campus with a weapon. Mobile apps let users report crime and safety issues. Colleges installed locks on the insides of classrooms, ran emergency notification drills, and even began using sirens to signal a serious campus threat. (More information is available at: https://www.usnews.com/news/national-news/articles/2017-04-14/virginia-tech-10-years-later-whats-changed-on-campuses-since-the-2007-shooting.)

One change that has not been as widely reported as the major changes to campus safety protocols and programs involves case management, which has become a new service at universities and colleges.

“The position of case manager developed after the Virginia Tech incident where universities went back to see what happened in that situation and what went so wrong,” says Katherine Hettinger, LPC, manager of Auburn Cares at Auburn University. “They found that so many offices on campus had contact with [the shooter] and were concerned about him, but there was no place to report their concerns. It was all siloed within those offices, and no one was communicating that there was this student who said this and that.”

After the massacre, college administrators realized they needed an office to which troubled students’ behavior and words could be reported, she explains. They needed someone to connect students with resources and provide follow-up. One aspect was threat assessment, and another aspect involved mental health, she adds.

The solution was to create a campus office, such as Auburn Cares, that provides case management support and resources to students who have experienced a crisis, emergency, or who are navigating a complex situation.

“We encourage students, if they have a problem and don’t know where to go, to contact our office,” Hettinger says. “We talk them through the policies and connect them with resources. We help them explain and advocate for themselves.”

The office receives many mental health referrals, including referrals from parents, faculty, staff, and even from other students. “A lot of times, they call and say, ‘My student needs help. What are our options? How do we navigate this situation?’” Hettinger says. “We help get them connected with mental health resources and are always trying to make sure students are aware of the resources available to them.”

Student Depression, Anxiety on the Rise

College case management has been extremely useful in an era in which young people experience increasingly high rates of anxiety and depression. According to the Student Experience in the Research University (SERU) Consortium survey of more than 45,000 university students, 35% of undergraduates screened positive for major depressive disorder, and 39% of all students screened positive for generalized anxiety disorder. (More information is available at: https://escholarship.org/uc/item/80k5d5hw.)

The survey, conducted from May to June 2020, also revealed the prevalence of depression among graduate and professional students was two times higher in 2020 compared to 2019, an increase attributed to the COVID-19 pandemic and to some students not adapting well to remote instruction. (See story on college case management during the pandemic in this issue.)

“There’s an increase in anxiety, depression, and suicidal ideation. A lot of universities are scrambling, trying to have enough services on campus,” says Jessica V. Lombardi, MA, LPCC, associate director for care and crisis management with University Health and Counseling Services at Case Western Reserve University in Cleveland. “The number of students who seek care is pretty high, and that’s a national trend. Is this a stigma reduction in mental health, or is it an increase in pathology?”

This generation of college students knows how to advocate for their mental health, Lombardi adds. Also, college students who are hospitalized for mental health issues do not need to drop out of school. Instead, case managers can work with students to help them catch up on their work. For example, case managers can help students gain accommodations through disability resources, which could give them more time on exams, Lombardi says.

Although Lombardi has not seen data on students, she has noticed that this has changed: “When I first started, there was a lot of involuntary withdrawals happening — way more than happens now,” she says. “We rarely do involuntary withdrawals now.”

College case managers can be focused on clinical and/or nonclinical issues. “At Case Western, the best practice is to have a clinical case manager, as well as a nonclinical case manager,” Lombardi says.

Nonclinical case managers might deal with academic issues, talking with college advisors and faculty. They are more inward-facing and can help students navigate difficulties within the university setting, Lombardi says.

Clinical case managers are outward-facing. They help with discharge planning of students from inpatient units, including medical hospitals and psychiatric hospitals. They also help with coordinating referrals and helping students access healthcare services in the community.

“Clinical case managers [might] have a really good connection with the emergency psychiatric access team in the emergency department of a university hospital,” Lombardi says. “If a student seen at the university’s counseling services cannot agree to keep themselves safe, our care managers can kick into action with calling the emergency psychiatric access team and talking with the team about what’s going on.”

The team will assess the student and recommend either an inpatient stay or discharge the student with a plan of care. Either way, they communicate with the college case manager to share the decision.

Several college case managers also work with organizations that provide psychiatric and substance use recovery services across the United States. “I have made presentations on over 500 campuses in the past 15 years,” says Tom Bennett, higher education recovery coordinator with Acadia Healthcare of Franklin, TN. Acadia started as acute behavioral health facilities. Now, the organization offers residential treatment programs, including assistance for issues related to mental health.

“A large percentage of the referrals I get to help students come from case managers,” Bennett says. “I see the case manager as like an employee assistant professional (EAP): If an employee is in trouble financially, mentally, the employee can go to the EAP, who will direct them to the services they need.”

In cases referred to outside services, such as Acadia Healthcare, students will sign Family Educational Rights and Privacy Act (FERPA) and Health Insurance Portability and Accountability Act (HIPAA) releases so the university can share their academic and clinical files.

“That information helps me determine what kind of program we need to place them in, including substance use, mental health, eating disorder, trauma, low self-esteem, and others,” Bennett says.

Some parents will contact Bennett directly. He asks the family about the student’s experiences and issues, as well as the family’s troubles.

“When I talk to the family, I find out issues the university doesn’t know about,” he says. “I was working with one student where there had been sexual abuse of the child by a neighbor, and this manifested into trauma once this individual came of age.”

This psychosocial history plays a big role in recommendations for the student’s treatment. The family’s insurance and other financial resources also factor in, he adds.

Case managers will contact students when they are concerned about the student’s safety and well-being, Hettinger says. In times of crisis, case managers will tell a hospital about a student’s situation.

“I’m biased, but I think the value of hiring case managers is so underscored,” Hettinger says. “We’re the people reaching out to students, making sure they’re OK, and connecting them with resources and providing support.”

Sometimes, students are overwhelmed with their issues, and it means a lot to them to have someone reach out.

“We call and say, ‘We heard you went to the hospital yesterday,’ and the student will say, ‘Thank you. That’s so nice. Thank you for calling,’” Hettinger says. “We’re the first line of defense for students.”