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Jack.org’s Campus Assessment Tool 2019-2020

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Introduction.

The Campus Assessment Tool (CAT) is a youth-led participatory research project created to support the advocacy work of student-run Jack Chapters. Ten post-secondary chapters across Canada were invited to take part in the pilot project last year, which launched in December 2018. This year, six chapters participated in the project for its second year: University of Prince Edward Island (UPEI), Mount Allison University (MTA), University of Toronto, Scarborough Campus (UTSC), McMaster University, Laurentian University, and Algoma University.


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Why the Campus Assessment Tool?

Young people in the Jack.org network are increasingly paying attention to the larger systems that influence mental health or service provision on their campuses. These include wait times for mental health services or academic curricula that influence mental health stress. If post-secondary students are to engage decision makers in their community, they must first understand how their systems function and what gaps need to be addressed. To help with this, Jack.org developed the Campus Assessment Tool (CAT) in 2018. The tool is made up of questions and surveys to gauge programs, policies, and services offered on campus. As a participatory tool, the purpose of the CAT is to transfer power to youth voices across Canada, determine systems-level priorities for change on individual post-secondary campuses, and facilitate collaboration between students and institutional decision-makers.

Campus Assessment Tool Outline

Each section of the CAT involves a different area of focus:

Section 1: seeks to gain an objective understanding of what key resources exist on each post-secondary campus. Chapters conducted online research and connected with administrators on campus who held key information.

Section 2: assesses if the resources available on campus are broadly accessible, including for members of equity-seeking groups (e.g. low-income students, students identifying as LGBTQ2S+, international students, visible minorities). Chapters conducted online research and connected with campus administration to find answers to research questions.

Sections 3 and 4: survey students to ask how aware of, satisfied, and comfortable students are with services. These sections used a survey tool, and individual CAT chapters invited peers to complete this brief survey (Appendix, Sections 3 and 4).

 

Section 5: addresses upstream factors that can inhibit or promote positive youth mental health on campuses. CAT Chapters conducted online research and engaged a wide variety of faculty and staff on campus (beyond health services).

 

Section 6: provides an overview of student-identified gaps, next steps, and potential future partnerships. Chapter students reflected on and summarized their key learnings from the CAT process during a discussion with Jack.org program staff, rather than having chapters fill out another directive or survey with their responses.

Survey Methods and Background

As mentioned in the outline above, Sections 3 and 4 of the CAT involve surveying students about mental health services on campus. Survey responses were collected by both student CAT teams and a third party survey partner using convenience sampling. 836 students responded to the survey from campuses that completed the full CAT. Likert scales were used as survey measures throughout the CAT survey, with students rating their agreement on a five-point scale, unless otherwise specified. We report agreement throughout the report as the proportion of those who rated a 4 (agree) or 5 (strongly agree) and disagreement as a 1 (strongly disagree) or 2 (disagree). Additionally, this report includes a number of responses to qualitative questions that asked student participants to expand on their likert scale responses.
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Student Life Network Partnership

Through a partnership with the Student Life Network (SLN), some survey respondents participated through the SLN platform. SLN provided additional marketing and incentivization of the survey in order to gain more responses from participating campuses.

 

Respondent Demographic Information

Student Participation in Survey by Campus

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[Fig. 1 - Graph showing student participation in the campus assessment tool surveys by campus name.]

 

Student Survey Participation by Demographic Group

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[Fig. 2 (above) - Table and chart showing percentage of student representation of different demographic groups]

COVID-19 Context and Challenges

Six campuses had completed the majority of the CAT when the COVID-19 pandemic emerged in March 2020. At this point in the year, four additional campus Chapters that had expressed interest in the project were no longer able to undertake it, and additional data gathering for the remaining six campuses became extremely difficult. As a result, we were unable to gather findings from a broad enough cohort to present a larger data set or to do further research that would allow us to share more detailed information on a campus-by-campus basis. Notwithstanding data collection challenges, we have identified several key learnings that reinforce and build on the results of the pilot year. The data that is summarized in this report was largely gathered before the onset of the COVID-19 pandemic and, as such, presents a comprehensive picture of in-person mental health services and student perceptions prior to the shift to primarily remote service delivery for many campuses. We have also made adjustments to the project for the coming year to reflect these current circumstances, which we detail in the conclusion.

Two-Year Trends

Given that we had a smaller cohort of campuses this year with six schools participating in the full CAT, throughout the report we have made comparisons to last year’s 10 pilot schools. We would like to acknowledge that many of these schools may have made changes since the previous year; however, in the interest of comparing year-over-year changes to post-secondary school policies, we have not adjusted the results of these surveys to reflect the current state of CAT campuses from the previous year. Thus, the information included from previous years may not reflect the current state of post-secondary mental health policies.

Key Learnings.

Summary:
  • Most students are generally aware of campus services but far fewer report feeling comfortable accessing these services
  • Students continue to identify long wait times as the most significant barrier that prevents them from seeking help, followed by perceived stigma and poor perceptions of campus service quality
  • Wait times continue to be a major challenge across all campuses, and a majority of students identify this as a barrier to accessing services

Wait times continue to be a major challenge across all campuses, and a majority of students identify this as a barrier to accessing services.

The median reported wait time for on-campus counselling services for those who indicated they had used these services (N = 235) was two weeks. More respondents reported waiting two weeks (22%) for an appointment than any other length of time, and there was a significant drop-off in students reporting wait times beyond four weeks and five weeks, from 12% for a four-week wait time to just under 2% for five weeks. While 13% said that they waited 1-2 days for an appointment, 6% of participants said that they waited 8 weeks or more for an appointment. On all individual campuses (excluding Algoma due to a low response rate), respondents reported a wide range of wait times, from as low as one day and up to 6-8 weeks.

Nearly 55% of respondents agreed that wait times were a barrier to accessing services. A quote by a student participant in the CAT survey emphasizes the importance placed on on-campus services for students:

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Participating campuses have explored different offerings to address this issue. Three of the six CAT campuses offer walk-in appointments at designated times on a weekly basis. Notably, the Mount Allison CAT chapter leader reported that the addition of walk-in hours at their counselling centre has reduced wait times. In the literature, ‘Walk-In’ or single session counselling have been shown to be promising interventions to addressing access issues related to wait times in mental health care (Riemer, 2019). UTSC offers same-day intake appointments, while McMaster reserves urgent or crisis appointments for students who need immediate (generally, within 24-hours) access to counselling.

The CAT survey collects aggregated data on experiences of wait times for any students who respond that they have previously accessed services on campus at any time; as such, these numbers do not necessarily define current wait times and do not represent experiences of accessing crisis support separately from regular wait times for counselling services. More information is needed to distinguish any differences in wait times that may exist, depending on different types of appointments.

Students continue to be more aware of campus mental health services than they are comfortable accessing them.

Reported Awareness of Mental Health Services vs. Comfort Accessing Services

services_awareness-1.png[Fig. 3 - Reported level of awareness of mental health services compared with comfort seeking mental health services]

Student Levels of Agreement: Awareness, Comfort, Quality

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[Fig. 4 - Student-reported levels of awareness of mental health services, comfort seeking mental health services, sense of need to seek services outside campus, and sense that services are of high quality]

As shown above [Fig. 4], 56% of respondents reported being aware of their school's mental health resources, while 22% said they were not (N=863). However, a much smaller number (39%) indicated that they were comfortable accessing these services. The CAT offers some clues as to why comfort levels may be low despite high levels of self-reported awareness, as outlined in the next finding.

Over half (four out of six) of participating chapters said they planned to use their CAT findings to help increase both awareness of and comfort with resources on campus in tandem. Some hope to work with their campus to help ensure students can access resource information on websites and social media.

Stigma remains a barrier to student help-seeking, although it may be declining over time.

Many respondents still report the presence of stigma in their communities. When asked whether they felt there was stigma on campus associated with struggling with mental health or talking about mental health broadly, 35% of respondents agreed while 43% disagreed. Additionally, when asked if they felt that their peers (i.e. other students) would think differently of them if they knew the student was accessing mental health support, 37% agreed and 46% disagreed (n=455).

Some quotes by student respondents to the survey outline the links between stigma and help seeking behaviour. When asked what might prevent one from seeking help, many students reported that stigma would be a key factor in the decision to access care (in addition to wait times, negative perceptions of quality, and availability of services.)

As an example, one student noted the desire for anonymity as an important factor in whether they would choose to seek help or not, which can correspond with students feeling that they do not want others to know they are seeking help:

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Additional responses related to stigma included not wanting family or friends to know if one were to seek help and uncertainty around confidentiality (including limits of confidentiality and when/if emergency services would be contacted). Interestingly, all participating chapters noted that their schools in some way advocated for mental health on campus - including dedicated anti-stigma education and awareness campaigns - however, despite these efforts, they feel that stigma persists on campus.

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Students are generally split or uncertain about the perceived quality of campus mental health services, with only one-quarter expressing a favourable opinion.

While mental health services are available to all students at the six participating campuses, many students continue to express concerns about the quality of services themselves. For example, only 28% of survey participants agreed that on-campus services were of high quality. Similarly, only 26% of survey participants (N=830) agreed that on-campus services meet the needs of young people in post-secondary institutions. In qualitative responses, many students shared that they developed this negative impression of service quality from conversations with friends and classmates, and it would be a key reason they might not seek help on campus.

A worthwhile comparison is the rating of the quality of services from CAT Sections 3 and 4 between those who report using mental health services on campus versus those who have not. Out of survey participants who attended CAT schools, 143 had accessed on-campus mental health services, while 695 had never accessed services (or chose not to disclose that they had).

Experience Accessing Mental Health Services Compared with Awareness, Comfort, Quality Ratings

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As seen above, those who have accessed mental health services understandably reported a higher level of awareness of mental health services on campus than their peers who had not. Similarly, the average response to their level of comfort seeking school mental health resources was higher for those who have accessed services than those who have not. Despite higher levels of comfort accessing on-campus services, students who have accessed services before on average report that they need to seek services off-campus more than their counterparts.

In terms of perceiving on campus services as high quality, the response was very similar for those who have accessed services and those who have not; however the average response was higher for those who have accessed services in response to believing services on-campus were adequate and met their needs. This points to students who are likely more knowledgeable about the services having some concerns that their resources do not currently meet their needs.

Peer support programs tend to be well-received by students, but not all schools offer them

Consistent with last year’s pilot report, some schools provide peer support services to students, but these programs tend to fall in and out of favour due to funding cuts and changes to programming. In total, four out of six schools this year noted that they had peer support services available. Certain schools had only recently opted to provide peer support, while others offer specific services to different equity-seeking groups in addition to general peer support programs—such as at McMaster, which offers peer support services out of their Pride Centre (LGBTQ2S+) and Maccess (for students with disabilities). Algoma’s peer support program was in transition as student success staff were redeveloping the program when students filled out the CAT directives. UTSC’s Peer Support group program was on pause due to COVID-19 but the campus has a number of peer support and advisory programs in place. As detailed in the 2019 Youth Voice Report, research indicates that peer support can be an effective and empowering treatment option for young people.

Mental health policies are more common among the new CAT cohort, although postvention plans continue to be lacking

Mental health policies are used to inform decision making on structural and individual levels. All but one campus noted that they had some form of mental health policy or strategy at their school. However, chapter students at UTSC reported their framework was difficult to find and access. Schools such as McMaster and Mount Allison had published Mental Health Strategies that were easily accessible to students online. UPEI’s counselling centre has a preference for creating internal protocols over broader policies for their flexibility and fluidity as mental health changes and shifts on campus, so they have not developed a broader mental health policy for the school as yet.

Notably, no schools have published widely-available standalone suicide postvention plans or policies. This said, some schools, including McMaster and Mount Allison, have developed and made widely available Student of Concern or Student in Distress policies, which outline steps to take and emergency services to contact if a student is in crisis. These public documents generally address how to respond to the student who is at risk of suicide iminently, and do not cover how the university would respond to meet the needs of students more broadly after a suicide has been completed by a student on campus (i.e. postvention). McMaster’s strategy mentions the completion of a postvention plan as a priority.

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Mandatory mental health training for staff continues to be correlated with less perceived stigma towards students.

Student chapters that participated in the CAT were also asked about the training opportunities provided to students, faculty, and staff on campus and whether or not they were mandatory. While all campuses have options for faculty and/or staff training, these tend to be optional. Conversely, all campuses mandate mental health training for Residence Assistants.

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