Piloting a Walk-in Counselling Model...About SCD. OUR MISSION STATEMENT. Student Counselling & Development through its professional staff, strives to provide a range of essential

Piloting a Walk-in Counselling Model Student Counselling & Development, York UniversityLori WallsDirectorStephanie CheungPolicy/ Program Evaluation/ Data AnalystFatima KhanCounsellor/ Counselling Supervisor

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AgendaAbout SCD

Historical Intake Model

Walk-in Counselling Model

Service Delivery Model

Data Collection

Continued Improvement

Final Takeaways

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About SCDOUR MISSION STATEMENT

Student Counselling & Development through its professional staff, strives to provide a range of essential psychological services to the York University Community in order to optimize the quality of the scholarly and communal life of the university. The primary aim of SCD is to help students realize, develop, and fulfill their personal potential in order to maximally benefit from their university experience and manage the challenges of university life.

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Direct Service to StudentsAll registered students currently enrolled in courses at KeeleCampus are eligible.

About SCD

Counselling PracticumFor graduate students in the fields of social work, psychotherapy, and psychology

Consultation & OutreachTo faculty and staff regarding mental health services and supports on campus

*Hiatus in the 2019-2020 academic year

SERVICES WE PROVIDE

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About SCDDEPARTMENTAL VALUES

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PURPOSE: Crisis Counselling (team day model) On-going clients

PROCESS:1. Student arrives at SCD and an Intake Appointment is

scheduled to occur in 7-10 days2. Student returns to the clinic in 7-10 days and participates in an

in-depth interview3. If short-term therapy is deemed appropriate, the student is

placed on the waitlist Students may be waiting on the waitlist for 3-12 weeks


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Lori met with counsellors Caseload equity Staff morale Tackling the waitlist

Stephanie met with counsellors Internship Program Evaluation

Streamlining day-to-day operations Standardizing departmental processes More robust data collection

THE NEED FOR CHANGE


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PURPOSE:To provide students immediate access to a qualified counselling professional in a safe and positive space.

PROCESS:1. Student arrives at SCD and is usually seen within half an hour2. Fill out a demographics sheet & paperwork*3. Meet with counsellor for approximately 50 minutes4. The student and counsellor determine a goal for the session

and collaborate on concrete, tangible next steps 5. The student is welcome to return to SCD for additional support

but is also empowered with the skills they need to see if the problem resolves independently

*Students identified in the mild-to-moderate range by the GAD & PHQ9 are referred to OntarioShores or the Psychology Course

Walk-In Counselling Model

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NEXT STEPS SHEET


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Mon Tues Wed Thurs FriAkanksha Tiffany Akanksha Jocelyn SamuelDoris Michelle Doris Michelle BryanFelix Kurt Felix Kurt TiffanyValerie Eleanor Valerie Anna MoiraSally Anna Samuel Caroline EleanorStevie (pm) Jocelyn Moira Sally (pm)

IMPLEMENTATIONStaff On-Call ScheduleHalf of staff will take lunch from 12:00-1:00pm and the other half from 12:30-1:30pm. These lunches are unscheduled and will be regulated by front desk.

NOTES: Counsellors on-call are expected to see 3 clients per day Sept & Dec / Jan & Apr: 6 staff on-call / day = 18 clients Oct & Nov / Feb & Mar: 6 staff on-call / day + 3 walk-in counsellors = 27 clients Counsellors do not book follow ups or ongoing clients on their on-call days Cut-off for walk-in clients is 3pm (we close at 4pm)


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IMPLEMENTATION

Update Forms What brought you here today? What have you tried to address your concerns? What would you like to get out of today’s session?

Communication We don’t assume that short-term counselling is wanted or needed

Meeting the Demand Walk-in counsellors during peak times/ months

Data Collection Revisit our data collection procedures Ensuring labels match our updated service delivery framework


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IMPLEMENTATION


Challenges

Additional roles for front desk staff Greeting students Managing flow of clients Ensuring equity between counsellors Data entry/ verification Filing

Staff adapting to a new model

Updating our website

Tempering expectations with community partners Students (though presentations, fairs, tabling events) The Centre for Sexual Violence Response, Support & Education Office of Student Community Relations Off-campus partners (e.g. Counselling Practicum)

Grey areas (e.g. “what do we do if…)

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IMPLEMENTATION


Successes

Additional roles for front desk staff Creation of a Reception Manual

Staff adapting to a new model Provision of in-house training:

Single Session Therapy with Complex CasesSafeGuards Training for Children and Adult Services

Updating our website Work in progress New discoveries (e.g. online potential, advertising on campus)

Tempering expectations with community partners Partners have been responding positively to change Invitation for presentations to department members

Grey areas Biweekly staff meetings Continue to work with staff to test new ideas

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STAFF EXPERIENCE


Team 15 Permanent Counsellors 3 Casual Staff 1 Psychologist in Supervision

Diverse theoretical orientations, educational background and work experience Range in years of services at SCD

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STAFF EXPERIENCE


Challenges One size does not fit all – students with trauma histories or

complex mental health presentations Lack of continuity of care Different theoretical orientations informing practice and

adjustment to single session & brief short-term therapy model Possible barriers and questions of equity with asking students

to return for a follow up vs booking ongoing sessions

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STAFF EXPERIENCE


Successes Clearer expectations communicated to students Minimal to no waitlist – less pressure for staff Use of Scales: PHQ- 9 and GAD – 7 Works well for students with mild symptoms or situational

presenting issues High survey ratings

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Shorter wait times

Smaller wait list

Fewer students in crisis

Walk-In Counselling ModelOUTCOMES

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Pilot Walk-In Model

Dates Prior to December 2018

December 2018 onwards

Dates for comparative analysis Sept. – Nov. 2018 Jan. – Mar. 2019

Same-day service None Average 12 a day

Wait time until 1st session 7-10 days 30 minutes

No. students on the waitlist (who have yet to receive service) 125 38*

Wait time average 74 days 15 days

Wait time range 52 – 108 0 – 63

Wait time median 68 12

Number of crisis sessions 224 17

Walk-In Counselling ModelCOMPARING MODELS

*16 of these individuals were clients of a SCD counsellor who left the department and thereforetransferred to the wait list, resulting in an inflation.

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September2019

October2019

November2019*

Total walk-in sessions 267 330 257

Average walk-ins per day 14.8 15 16.1

Wait time until 1st session 40 minutes 33 minutes 39 minutes

# Students on the waitlist 4 11 5

Wait time average 5 days 7.3 days 2.2 days

Wait time range 0-9 days 1-21 days 0-5 days

Wait time median 5.5 days 5 days 2 days

Number of crisis sessions 3 5 10

Frequent Walk-ins 0 6 15

Top 3 Presenting Issues AnxietyAcademic

Depression

AnxietyAcademic

Interpersonal/Relationship

AnxietyAcademic

Interpersonal/Relationship

Walk-In Counselling ModelDATA COLLECTION FALL 2019

*As of November 25

2020

9.3“I was able to talk

about what is important and helpful

to me”

8.2“I have a clearer

understanding of what I want – my goals”

8.4“The session helped me move

towards an acceptable solution”

8.1“I feel more confident that I can reach my short-term goal(s) and

work towards my preferred future.”

85.2% Prefer walk-in services to booking an appointment

9.4“I felt heard,

understood, and respected”

QUANTITATIVE FEEDBACK (Dec ‘18 - Jun ’19, n= 697)


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“I feel these kinds of services are very important to students like us. I feel incredible after

this session.”

“This is great service. I feel better walking

home.”“I felt heard and accepted. I

was also shown valuable resources and give tools to help

me through my situation.”

“I feel confident to begin my healing process and I am really happy with the

outcome of this session.”

“I've never been to therapy; this was incredibly helpful to know what I can do to help myself.”

““Keep up the amazing work!”

“The person I met with was extremely kind. I felt well heard

and respected. Thank you.”

Walk-In Counselling ModelQUALITATIVE FEEDBACK (Fall ’19, n= 168, 93% positive feedback)

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Case Consultation

Clinical Advisory for Policy Development

Digital Initiatives

Psychological Assessments

Public Presence on Campus

Workshops & Groups

Service Delivery ModelSUMMER PROJECT GROUPS

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Service Delivery ModelWalk-in

Counselling

• Likely the students’ first encounter with SCD• May refer to Ontario Shores, York Psychology Class, Process Group• Receives next steps sheet

Walk-in counselling occurs from 9:00am – 3:00pm daily. Emergency support is offered from 3:00 – 4:00pm

Emergencies include (but are not limited to): Feeling highly suicidal & at risk of acting on these feelings Recent sexual or physical assault Struggling with thoughts that you might severely hurt another

person(s)

Emergency Support:1. Request support 2. Meet with a counsellor3. Return for walk-in counselling

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SCD Skills Workshop

Walk-in Counselling


• Student participates in workshop & obtains USB with resources, OR• Student is emailed link to BounceBack & student journal

Goal: To provide participants with skills to help them better manage stressors and to reach academic potential. Benefits of the workshop include psychoeducation, skills learning, insight development, and experiential application

Topics Include: Workshop take place every What is Stress Monday, Tuesday, and Wednesday Signs of Stress Burnout Stress Management Challenging Unhelpful Thoughts Changing Unhelpful Behaviours

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Walk-inCounselling

SCD Skills Workshop

Walk-in Counselling



• Review work completed to date• Asses fit for short-term counselling

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Short-termCounselling

Walk-inCounselling

SCD Skills Workshop

Walk-in Counselling




• Aiming for short-term therapy (6-8 sessions)• Implement outcome measures/ pre-post tests (e.g. GAD & PHQ9)

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Closed File

Short-termCounselling

Walk-inCounselling

SCD Skills Workshop

Walk-in Counselling




• Aiming for short-term therapy (6-8 sessions)• Implement outcome measures/ pre-post tests (e.g. GAD & PHQ9)

• Client files are closed at the end of each semester (or earlier)• Complete a termination sheet & print out appointment history

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Clinical ConsultationDedicated time for clinicians to convene to discuss cases and share best practices.

Consultation takes place every Tuesday & Wednesday.

Letters Protocol Documentation (e.g. petitions) will not be provided at walk-in sessions.

SAS and SCD Assessment PartnershipSAS will refer students to SCD for diagnostic clarification to support academic accommodations

Evaluating Service DeliveryEvaluating service delivery will occur on an ongoing basis to ensure that the department continues to be agile and responsive to meeting student needs.

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Service Delivery Model PROCESS GROUPS & SUPPORT GROUPS

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Data CollectionPURPOSE:SCD’s objectives when it comes to data collection are twofold:

1. To gain insight into how we can make ongoing improvements to our service delivery model so that we can better serve students

2. To effectively communicate the work we are doing to internal and external stakeholders by way of referencing timely, and accurate information

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Data Collection

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Data Collection

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Data Collection Flexibility and real-time data means we can be more responsive

to problems and adapt to student need

Some examples of the data we track: Peak months and times Average clients per day Frequent walk-in students Wait list (e.g. time between referral and pick-up) Top 3 presenting issues Referral streams Feedback (e.g. Walk-in, SCD Skills Workshop, Process Group) Outcomes (e.g. PHQ/GAD, Ongoing Counselling Outcomes

Questionnaire) SCD staff and Walk-in Counsellors caseloads Cancellation and no-show rates

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Data collection process & potential errors

Form Creation

• Field not specified (e.g. Next Steps Sheet included… Workshop, BounceBack, etc.)

Information Gathering

• Wrong information (e.g. Date)

• Information not captured/ sheet left blank

• Missing Client Data Sheet

• Additional information not specified is included

Data Entry

• Student names/ numbers typed in wrong

• Non-alignment with ClockWork (appointment, time, counsellor)

• Wrong appointment label on ClockWork

• Losing data sheets

• Front desk unable to follow-up with counsellors

Data Analysis

• Difficulty aggregating information due to having to go back to the original file to verify information

Data Collection

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In September 2019 there were 267 walk-in sessions**Recorded on Excel spreadsheet. Mainly reflects true walk-ins as opposed to booked (some overlap)

Average per day

Peak Times (/265)

Mon Tues Wed Thurs Fri

No. Days 4 3 3 4 4

Avg 17 13.6 15.3 17 11

Data Collection

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Presenting Issues

PI 1 PI 2 PI 3

Total 249 232 169

First Anxiety (27%)

Anxiety (19%)

Self-Esteem (11%)

Second Academic (16%)

Depression (13%)

Interpersonal (10%)

Third Depression (10%)

Academic (10%)

Depression (9%)

Anxiety(9%)

Data Collection

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Of the 267 Walk-ins, what Next Steps were recommended?

Total # students recommended to workshop in Sept: 113 (42%)Total # students attended workshop in Sept: 18 (16% of those recommended)

# %

Blanks 28 10%

Lost file, Next Steps Review, Next Steps Sheet, No record, No sheet, N/A, Not Assigned

26 10%

Neither* 42 16%

BounceBack 58 22%

SCD Skills Workshop 85 32%

Both 28 10%

Data Collection

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ClockWork Labels Red- Outdated [DO NOT USE] Green- Data Collection

Admin Campus Outreach Community Outreach Lunch Meeting Not in the Office PCS - Admin PCS - Campus Outreach PCS - Closed Files PCS - Community Outreach PCS - Consult External RE Student PCS - Consult Internal RE Student PCS - Emergency Support PCS - Booked Walk-in PCS - F2F Crisis PCS - F2F Personal Counselling

PCS - Intake PCS - LGBTQ+ Support Group PCS - Lunch PCS - Meeting PCS - Not In The Office PCS - Ongoing Counselling PCS - Process Group PCS - Psych-Assessment PCS - Psych-Report Writing PCS - Review of Next Steps Sheet PCS - SCD Skills Workshop PCS - Staff Called CAS PCS - Student Was Hospitalized PCS - Supervision with Intern PCS - Team Day PCS - Walk-in Counselling

Data Collection

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Continued ImprovementMILESTONES:

Files that have surpassed 15 years of age have been shredded

Files that are within 15 years of age are being digitized

A Policy/ Evaluation/ Data Analyst has joined the team

Conducted an evaluation of the internship program

Reviewed existing job descriptions

Updated all departmental forms SAS Assessment Partnership

FUTURE DEVELOPMENT:

Replace ClockWork with a new Electronic Medical Record (EMR)/ Practice Management Software (PMS)

Approval for a nurse practitioner Continue review of departmental

data collection procedures Review new service delivery

model Update our website Evaluate current job specs Review current staffing model

for service gaps Resume Counselling Practicum

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Final Takeaways Continuous improvement to service delivery Approach service delivery and data collection from a student

perspective/ walk-through the system Identify the needs and interests of your audience Start by looking at data you are already collecting, what you

can collect with some tweaking, and what problems do you want to solve Explore anecdotes from staff about what they want changed Create staff buy-in & empower departmental champions Establish clarity at reception Maintain consistent communications with students, faculty,

staff, on-campus and off-campus partners

Documents

Piloting a Walk-in Counselling Model...About SCD. OUR MISSION STATEMENT. Student Counselling & Development through its professional staff, strives to provide a range of essential