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Crisis intervention and mental health support services in online graduate degree programs: an evaluation study

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Crisis intervention and mental health support services in online graduate degree programs: an evaluation study

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Content Running head: CRISIS INTERVENTION ONLINE 1

CRISIS INTERVENTION AND MENTAL HEALTH SUPPORT SERVICES IN ONLINE
GRADUATE DEGREE PROGRAMS: AN EVALUATION STUDY

by

Lauren Elan Helsper

A Dissertation Proposal Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

August 2016

Copyright 2016 Lauren Elan Helsper
CRISIS INTERVENTION ONLINE 2

ACKNOWLEDGEMENTS
First and foremost, I dedicate this dissertation to my loving husband, supportive parents,
and adorable newborn son. I would not have been able to accomplish this goal without the
constant support of my husband who continually took care of all of the housework and additional
responsibilities so that I could dedicate every possible minute to my studies. I love you Z! I
appreciate my parents who have always been my #1 cheerleaders and assisted in providing
numerous meals and countless hours of childcare so that I could focus on my studies. Thank you
Mom and Dad! Most importantly, to my almost nine month old son, Evan, Mommy loves you
very much! Thank you for being patient with me while I worked tirelessly to complete my
dissertation. Thank you for spending weekends with Daddy and Mima and Saba so that Mommy
could write her dissertation. I promise that you now have your Mommy back! I would also like
to thank all of my friends and family members who have provided me with moral support and
encouragement throughout the past three years. I appreciate all of you!
I would also like to thank my dissertation committee members. Dr. Melora Sundt – thank
you for being a wonderful dissertation chair and a constant source of guidance and inspiration.
When life handed me lemons, you helped get me back on track and ensured that I was going to
meet my goal of graduating on time with a newborn in hand. Dr. Rob Filback- thank you for co-
chairing our thematic group and always being available for consultations. Dr. Ronni Ephriam-
Thank you for connecting me to various individuals who proved to be valuable resources
throughout my dissertation. Drs. Sundt, Filback and Ephriam, your unwavering dedication to
our thematic group has been inspiring.
Finally, I would like to dedicate this dissertation to my partner, Dr. Kyle Waterstone. We
surely make a great duo if I do say so myself. Thank you for pulling me through the last couple
months of this process and being a source of guidance and support. I will always look fondly
upon the dissertation process and the friendship that we established as a result.

CRISIS INTERVENTION ONLINE 3

LIST OF TABLES
Table 1. Summary of Assumed Assets for Knowledge, 59 & 81
Motivation, and Organizational Issues

Table 2. Summary of Assumed Knowledge Assets and 67
Their Validation

Table 3. Summary of Assumed Motivation Assets and 68
Their Validation

Table 4. Summary of Assumed Organizational/Culture/ 70
Context Assets and Their Validation

Table 5. Summary of Study Participant Demographic 73
Data

Table 6. Summary of Assumed Knowledge Assets Student 85
Counseling Center Staff Need to Support the Mental
Health of Distance Learners

Table 7. Summary of Validation Results for Assumed 93
Motivation Assets that Counseling Center Staff Need
in Order to Support the Mental Health of Distance
Learners

Table 8. Summary of Validation Results for Assumed 100
Organizational Assets that University Counseling
Centers Need in Order to Support the Mental
Health of Online Graduate Students

Table 9. Validated Assets Summary Table 117

Table 10. Summary of Validated Assets, Solutions, and 130
Implementation of the Solutions

CRISIS INTERVENTION ONLINE 4

LIST OF FIGURES
Figure 1. Gap Analysis Process 64

CRISIS INTERVENTION ONLINE 5

ABSTRACT
Numerous studies and surveys conducted in recent years have determined that there is an
increase of students with mental health diagnoses at institutions of higher education (“NSSE
Survey Instrument,” n.d.), university counseling centers strive to provide individualized and
group therapy for students, assess and mitigate crisis situations, provide outreach to the campus
community regarding mental health, and provide consultation to staff and faculty regarding
student needs (Ghetie, 2007). This study evaluated the practices university counseling centers
employ while supporting the mental health needs of online graduate students at eleven
institutions. This evaluation study discovered that the majority of universities are not adequately
supporting the needs of their distance learners for various reasons including a lack of experience
and understanding regarding the unique needs of this student population and licensure issues
preventing therapists from practicing in multiple states. The findings of this study highlighted
five specific assets and organized them using Clark and Estes’ (2008) gap analysis model in
terms of the Knowledge, Motivation, or Organizational dimension to which they aligned. The
overarching goal for this study was to identify what university counseling center therapists need
to know, what skills they need to possess, what motivates them to engage in these practices, and
what organizational factors contribute to the overall success of those practices. By identifying
the practices that contribute to a university counseling center’s ability to support the mental
health needs of online graduate students, this study benefits other institutions wishing to support
the wellbeing of their students and engage in successful online programs.

CRISIS INTERVENTION ONLINE 6

TABLE OF CONTENTS
Acknowledgements………………………………………………………………………..………2
List of Tables…………………………………………………………………….………………..3
List of Figures …………………………………………………………………….………..……...4
Abstract……………………………………………………………………………...…………….5
Chapter One: Introduction………………………………………………………………..…...…12
Introduction of the Problem…………………………………………………..……....….12
Student Counseling Centers in Institutions of Higher Education…………….….15
Organizational Context and Mission………………………………………………….…17
Organizational Performance Status……………………………………………….……...18
Background of the Issue: Related Literature………………………………………...…..18
Importance of this Study…………………………………………………………...…….22
Organizational Performance Goal and Current Performance……………………….…...23
Organizational Stakeholders…………………………………………………….……….24
Stakeholder for the Study……………………………………………………….…….….25
Purpose of the Project and Questions……………………………………………………26
Definitions………………………………………………………………………….…….26
Conclusion…………………………………………………………………………...…..26
Chapter Two: Review of the Literature…………………………………………………....…….28
Introduction…………………………………………………………………………..…..28
Effective Crisis Intervention…………………………………………………..…28
Standards of Best Practice……………………………………………………….28
Demand for Crisis Intervention and Counseling Online…………………………29
CRISIS INTERVENTION ONLINE 7

Learning and Motivational Theory………………………………………………………33
Knowledge and Skills……………………………………………………………34
Motivation………………………………………………………………………..35
Organization…………………………………………………………………...…37
Factors that Contribute to or Inhibit Effective Student Counseling Centers………….…38
Knowledge and Skills Causes…………………………………………………....38
Factual knowledge……………………………………………………….39
Conceptual knowledge…………………………………………………...40
Procedural knowledge…………………………………………………....41
Metacognitive knowledge………………………………………………..42
Knowledge summary…………………………………………………….44
Motivation……………………………………………………………………..…46
Motivation Summary……………………………….................................48
Organization……………………………………………………………………...49
Organization summary…………………………………………………...54
Personal Knowledge……………………………………………………………..54
Knowledge and skills…………………………………………………….55
Motivation……………………………………………………………..…55
Organization……………………………………………………………...56
Knowledge, Motivation, and Organization Factors that Directly Relate to Student
Counseling Center Therapists……………………………………………………………57
Summary…………………………………………………………………………59
Conclusion……………………………………………………………………………….62
CRISIS INTERVENTION ONLINE 8

Chapter Three: Methodology…………………………………………………………………….63
Purpose of the Project and Questions……………………………………………………63
Framework for the Study………………………………………………………………...63
Presumed Performance Assets…………………………………………………………...64
Validation of Performance Assets……………………………………………………….65
Validation of the Performance Assets: Knowledge……………………………...65
Validation of factual knowledge assets…………………………………..65
Validation of conceptual knowledge assets……………………………...66
Validation of procedural knowledge assets……………………………...66
Validation of metacognitive knowledge assets…………………………..66
Validation of the Performance Assets: Motivation………………………………68
Validation of Performance Assets: Organization/Culture/Context………………70
Participating Stakeholders……………………………………………………………….72
Data Collection…………………………………………………………………………..75
Surveys…………………………………………………………………………...75
Interviews………………………………………………………………………...76
Trustworthiness of Data………………………………………………………….77
Role of Investigator………………………………………………………………77
Data Analysis…………………………………………………………………………….79
Conclusion……………………………………………………………………………….79
Chapter Four: Results and Findings……………………………………………………………...80
Participating Stakeholders……………………………………………………………….80
Survey Results…………………………………………………………………………...83
CRISIS INTERVENTION ONLINE 9

Findings from Interviews………………………………………………………………...84
Results and Findings for Knowledge Causes…………………………………………….84
Knowledge Asset #1: Graduate Programs Need to Properly Educate
Clinicians………………………………………………………………………...86
Knowledge Asset #2: University Clinicians Need to Practice Multicultural
Competence………………………………………………………………………88
Knowledge Asset #3: University Clinicians Need to Know How to Utilize
Referral Processes………………………………………………………………..89
Synthesis of Results and Findings for Knowledge Causes………………………………91
Results and Findings for Motivation Causes…………………………………………….92
Motivation Asset #1: University Counseling Center Staff Meet the Needs of their
Increasing Caseloads……………………………………………………………..94
Motivation Asset #2: Counseling Center Administrators Assume Additional
Responsibilities…………………………………………………………………..95
Motivation Asset #3: University Counseling Center Directors Incentivize their
Staff………………………………………………………………………………96
Synthesis or Results and Findings for Motivation Causes……………………………….97
Results and Findings for Organization Causes…………………………………………..97
Organization Asset #1: University Counseling Centers Need to be
Restructured…………………………………………………………………….101
Organization Asset #2: Counseling Centers Need Additional Resources……...101
Organization Asset #3: The Stigmatization of Mental Health and Help-Seeking
Behaviors of Students…………………………………………………………..103
CRISIS INTERVENTION ONLINE 10

Synthesis of Results and Findings for Organization Causes…………………………...104
Results and Findings Determining Whether University Counseling Centers are Meeting
their Goal of Providing Mental Health Services to Online Graduate Students………...106
Additional Findings…………………………………………………………………….107
Summary………………………………………………………………………………..110
Chapter Five: Solutions, Implementation, and Evaluation……………………………………..113
Recommendations for Program Directors……………………………………………...113
Selection of Validated Assets and Rationale…………………………………………...117
Solutions for Motivation Assets………………………………………………………..121
Self-Efficacy……………………………………………………………………121
Attainment Value……………………………………………………………….123
Solutions for Organization Assets……………………………………………………...124
Resource Allocation…………………………………………………………….125
Contracting with Student Assistance Program…………………………………126
Solutions for Knowledge Assets………………………………………………………..127
Conceptual Knowledge…………………………………………………………127
Procedural Knowledge………………………………………………………….128
Implementation Plan……………………………………………………………………130
Solution Integration…………………………………………………………….130
Evaluation Plan…………………………………………………………………………134
Level 1: Reactions………………………………………………………………134
Level 2: Learning……………………………………………………………….135
Level 3: Transfer………………………………………………………………..135
CRISIS INTERVENTION ONLINE 11

Level 4: Results…………………………………………………………………136
Limitations and Delimitations…………………………………………………………..136
Limitations……………………………………………………………………...136
Delimitations……………………………………………………………………138
Future Research ……………………………………………………………………..…139
Conclusion……………………………………………………………………………...139
References………………………………………………………………………………………142
Appendix A: Survey Items……………………………………………………………………...153
Appendix B: Interview Items …………………………………………………………………..160

CRISIS INTERVENTION ONLINE 12

CHAPTER ONE: INTRODUCTION
Central to the success of any graduate program is an effective student counseling center
and crisis intervention program that identifies students in distress and provides resources for the
emotional, psychological, and physical wellbeing of students. One of the primary aims of
student counseling centers at universities is to partner with various campus resources in order to
assist students in achieving their personal and education goals by offering a variety of services
and interventions depending on the unique needs of each student (Counseling Standards, 2011).
For the purposes of this paper, a crisis will be defined as any critical incident within a student’s
life or in the community that has a stressful effect on the individual(s) and overwhelms one’s
ability to cope (Flannery & Everly, 2000). Effective crisis intervention strategies identify
students in distress and utilize strong leadership and responsibility to restore normalcy and a
sense of safety and security to the impacted individual(s) (Cornell & Sheras, 1998).
While much emphasis has been placed on brick and mortar campus resources, the online
educational world is now identifying the need to expand support services as well. Many
researchers predict that the expansion of online programs will result in the increasing presence of
online graduate students interested in pursuing advanced degrees (Samman, Omar, Belmasrour,
& Alijani, 2013). This study examined how university student counseling centers partner with
online graduate programs to implement services in order to identify students in distress and
provide them with relevant support resources.
Introduction of the Problem
Graduate students represent a large proportion of the higher education community. In
2012, the Council of Graduate Schools conducted the CGS/GRE Survey of Graduate Enrollment
and Degrees survey and discovered that there were approximately 1.74 million graduate students
CRISIS INTERVENTION ONLINE 13

enrolled in fall 2012 in the U.S. (Council of Graduate Schools, 2013). Various researchers have
demonstrated that graduate students have unique challenges in comparison to traditional
undergraduate students and thus need specific resources to support their needs.
Given the large number of graduate students enrolled in degree programs, many
researchers have conducted studies in order to determine the unique needs of this student
population. Turner and Berry (2000) for example, discovered that many graduate students tend
to experience mental health challenges and stressors that can result in increased drop-out rates.
Hyun, Quinn, Madon, & Lustig (2006) conducted a study of 3,121 graduate students and found
that nearly 50% of the students considered seeking mental health support and nearly 31% of the
graduate students had used mental health resources either on or off campus. Hyun et al. (2006)
discovered that the primary reason graduate students sought support was to cope with stressors
such as academic problems, career-related challenges, financial concerns, emotional problems,
and relationship issues. Peters (1997) suggested that current graduate students are more likely to
have competing familial and financial responsibilities and tend to have less program guidance
than was traditionally common in the past. As a result, graduate students need to be more self-
motivated to ensure their success in the academic progress (Peters, 1997).
While it appears that the majority of mental health challenges graduate students face
center around normally-expected stressors such as academics, financial pressure, and relationship
difficulties, there is a percentage of graduate students who suffer from more severe mental health
diagnoses. Numerous studies and surveys conducted in recent years have determined that there
is an increase of students with mental health diagnoses at institutions of higher education. The
National Survey of Student Engagement (NSSE), an annual survey administered to American
college students used to assess the extent to which students engage in various aspects of
CRISIS INTERVENTION ONLINE 14

collegiate life (“NSSE Survey Instrument,” n.d.), illustrates the rise of mental health issues on
university campuses. According to NSSE surveys, between 2009 and 2011, students who self-
identified as having a mental health disorder increased by about 57 percent (“NSSE Past
Summary Tables,” n.d.). Mowbray et al. (2006) conducted an analysis of studies and
determined that approximately 12-18% of college students have some form of mental health
condition. In Eisenberg, Gollust, Golberstein, and Hefner’s (2007) study of the mental health
needs of young adults, it was discovered that nearly 13% of graduate students tested positive for
a depressive or anxiety related mental health condition and 1.6% of the students involved in the
survey admitted to having suicidal thoughts within the past month.
Occasionally, students suffer such severe mental health conditions that they are driven to
engage in violence against others. On February 14, 2008, for example, Steven Kazmierczak, a
former sociology graduate student at Northern Illinois University, entered a lecture hall and fired
bullets into a crowd (Kalish & Kimmel, 2010). Kazmierczak injured 24 individuals and killed
five people before turning the gun on himself (Kalish & Kimmel, 2010). It is significant to note
that Kazmierczak had recorded mental health disorders and was familiar with therapy yet he was
still driven to violence and murder (Farrell, 2008).
Given the overwhelming evidence that graduate students struggle with mental health
issues and that some have the possibility of engaging in violence, the question that arises is how
are institutions of higher education identifying graduate students who are in distress and
providing them with the appropriate interventions and resources to prevent such tragedies and
ensure safety on campuses? In an era of increasing mental health diagnoses and increased
instances of mental health related violence on campuses, many American universities have
implemented means of identifying a person in distress and providing an appropriate response in
CRISIS INTERVENTION ONLINE 15

hopes of preventing similar tragedies. Many of these newer means of identifying students of
concern stem from university audits and increased governmental regulations (Rasmussen &
Johnson, 2008). In this landscape of identifying and supporting students in distress, the
university counseling center is proving to play a crucial role.
Student Counseling Centers in Institutions of Higher Education
University counseling centers strive to provide individualized and group therapy for
students, assess and mitigate crisis situations, provide outreach to the campus community
regarding mental health, and provide consultation to staff and faculty regarding student needs
(Ghetie, 2007). The demographics and organizational structure of student counseling centers
vary among universities and are often dependent upon the university size, mission, historical
background, and geographical locations (Bishop, 2006). Bishop (2006) illustrated that the
unique characteristics of each university often contribute to the composition of the counseling
center in terms of staffing models. Additionally, university counseling centers are utilizing
differing means of addressing the increasing demand for student support as a result of the
increasing presence of students with mental health needs on campus. Some university
counseling centers mandate session limits on “in-house” counseling and refer students to
community providers for additional support (Bishop, 2006). Other counseling centers are
implementing innovative ways to schedule appointments and manage waiting lists (Bishop,
2006). Regardless of the structure that each university counseling center has decided to
implement, it is evident that they all share the same goal of supporting students.
Irrespective of the necessary support that collegiate counseling centers provide to
students, the centers themselves are currently in the midst of a struggle as the mental and
emotional needs of students have increased yet the allocation of resources for counseling centers
CRISIS INTERVENTION ONLINE 16

has remained constant. According to Farrell (2008), university counseling center directors have
advocated for their centers highlighting their need for increased staffing and funding and
warning of the dangers of not increasing counseling center resources to fit the growing needs of
today’s students. University administrators and counseling centers often find themselves in the
middle of a debate as the counseling staff requests additional funding while institutions of higher
education administrations often choose to allocate additional monies to enhance academics as per
the mission statement of the university (Ghetie, 2007). The issue remains, however, that
counseling centers are still being asked to meet the demands of the student population. Mental
health professionals, including counseling center staff, are considered medical professionals and
are thus required to provide the best care possible to all of their clients. This requirement often
presents an ethical dilemma, as the counseling center clinicians are unable to provide adequate
therapy services to the large numbers of students requiring support (Ghetie, 2007).
The most effective university counseling centers are also cognizant of the unique needs
and challenges of the increasing online graduate population and learn how to support them as
well. For example, the “typical” online graduate student resides in a remote area and tends to be
older than most of the clients (undergraduate students) who utilize brick and mortar counseling
centers (Kretovics, 2003). Online graduate students tend to have non-traditional schedules as
they often have the added responsibilities of professional and familial commitments (Ludwig-
Hardman & Dunlap, 2003). As a result, it appears that university counseling centers need to
learn how to support these students as they often have challenges that differ from the traditional
students with whom counseling center staff are accustomed to working with.

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Organizational Context and Mission
This study researched eleven graduate schools that have successfully developed and
launched quality online graduate degree programs. Although the specific academic mission of
each of the programs varies, as do their institutional goals and objectives, common themes are
evident in the mission statements of all of the programs. Many of the programs involved in this
study pride themselves on academic rigor and on attracting top-tiered faculty to educate their
students. Additionally, many of the programs include a commitment to public service in their
local communities and to the global community. Finally, a theme of teamwork and collaboration
is evident in the academic endeavors of many of the programs as well.
Many of the universities in this study utilize the same software-as-a-service (SaaS)
provider. This SaaS provider partners with highly selective institutions throughout the United
States (R. Filback, personal communication, February 2015). Its mission is to provide a
comparable educational experience for online learners to their traditional brick and mortar
counterparts (“About,” 2015). As a result, students who enroll in such online graduate programs
find themselves engaging in “real time” classroom experiences via interactive chat features and
immersive content (“About,” 2015). Additionally, the capabilities of the SaaS provider allow
programs to provide students with extracurricular experiences such as social networking
opportunities and extensive student support services (“About approach” 2015).
The aim of this study was to assess the extent to which the university counseling centers
at the various institutions of higher education effectively implemented mental health support
services for online graduate students and provide suggestions for other institutions wishing to
enhance services. As a result the programs in this study have the potential to provide valuable
information regarding supporting the mental health needs of online students.
CRISIS INTERVENTION ONLINE 18

Organizational Performance Status
Many of the graduate programs included in this study identify as highly selective
institutions with high rankings in their respective fields (Best Colleges U.S. News Education,
2014). The educational achievements of the students who participate in these elite programs are
noteworthy. For example, one of the nursing programs that the software provider serves, claims
that 100% of their students pass the Family Nurse Practitioner certificate examination on their
first attempt. Additionally, one of the MBA programs was recently named the 2015 best online
business graduate program by the U.S. News and World Report (MBA Rankings and Reputation,
2015). The SaaS provider that some of the institutions in this study partner with has also
established itself as being a leader in the online graduate degree educational arena by winning
various awards such as being recognized by the Washington Business Journal as the 2014 Initial
public offering of the year (IPO), one of Glassdoor’s “best places to work” as well as one the 12
“U.S. Global Growth Companies” by World Economic Forum (“About Press,” 2015). It
becomes evident that combining the educational prowess and rigor of these academic programs
coupled with the highly selective nature of the cloud-based learning management service
provider creates a unique learning environment for students and produces highly educated
individuals who excel in their selected fields. Given the high academic achievements of the
students involved in these programs, these programs will provide strong cases to explore
regarding counseling services for online students.
Background of the Issue: Related Literature
The presence of online education and the opportunities available to students who wish to
pursue online degrees has greatly increased since the turn of the century (Dew, 2012). In 2008,
at least 25% of all postsecondary students had taken at least one course online (Christensen et al,
CRISIS INTERVENTION ONLINE 19

2011) and in the fall of 2010 nearly one-third of all students enrolled in institutions of higher
education were taking at least one online course (Hill, 2012). Institutions are taking note of the
increasing demand for online educational offerings and are creating innovative ways to utilize
online education for the betterment of the institution and students (Eisenhauer, 2013). For
example, many institutions of higher education have begun to realize that the inclusion of online
programs allows for increased admissions and diversity amongst the student body (Samman et
al., 2013).
Growth of the online educational world has also led to changes in the educational models.
Kretovics (2013) discussed the various modalities utilized by online programs such as
asynchronous platforms in which the students and instructors do not have to be present online at
the same time; distance programs that are operated solely via distance technology; and virtual
institutions who solely operate online and do not have any brick and mortar campus offerings.
School-as-a-service and educational partnerships entered the landscape in the early to mid-2000s
with for profit companies assisting colleges with the technologies needed to implement and
maintain online programs (Hill, 2012). A 1999 National Survey of Information Technology in
Higher Education revealed that 47% of colleges offered at least one distance learning course
(Kretovics, 2003).
With the changing modalities, online education gradually became more accessible in
higher education. During the fall of 2010, more than 6.1 million students were enrolled in at
least one online higher education course (Allen & Seaman, 2012). The increased presence of
online education brought about the additional challenge of supporting distance learners for
colleges and universities. Given these statistics, it becomes evident that colleges and universities
CRISIS INTERVENTION ONLINE 20

need to assess best practices in supporting online students which include the utilization of crisis
intervention models.
Having established an understanding of the history of online education and the various
modalities used, it is important to gain an understanding of the students who are drawn to online
programs. Prior to discussing the demographics of the online learner population, it is important
to note that the information below often pertains to the undergraduate student population as little
research has been conducted on the current online graduate student. According to Kretovics
(2003), students in distance learning programs are more likely to be older than the traditional-
aged college student. Distance learners tend to live in remote geographic areas that are not
located near colleges or universities that offer programs in which they are interested (Ludwig-
Hardman & Dunlap, 2003). Distance students also tend to have family and work responsibilities
that are not conducive to attending schooling on the traditional schedule and thus are drawn to
online degree programs (Ludwig-Hardman & Dunlap, 2003). Workman and Stenard (1996)
described distance learning students as more motivated and self-reliant than traditional students.
According to Seeman (2001), distance learners need to have the confidence in order to overcome
confusion and frustration on their own. Samman et al. (2013) predict that nontraditional college
age students will continue to enroll in distance education programs at increased numbers as a
result of the “flexibility and autonomy” that such programs provide. Some of the flexibility that
students in distance learning programs might experience includes their ability to complete tasks
on their own schedule and to attend to personal and family responsibilities in addition to
completing their coursework. In addition to the flexibility component, online degrees enable
students to enroll in institutions that are located at great distances from their places of residence
or employment (Kretovics, 2003).
CRISIS INTERVENTION ONLINE 21

While there are numerous attributes to enrolling in a distance education program,
research indicates that distance learners are often subjected to a unique set of challenges as well.
The dropout rates of distance learners are high, ranging from 20-50 percent (Carr, 2000). The
high attrition level is often attributed to a lack of interaction and support (Moore & Kearsley,
1996), a sense of isolation, and decreasing levels of motivation (Abrami & Bures, 1996).
According to Ludwig-Hardman and Dunlap (2003), distance learners often experience isolation
as a result of not being connected to their classmates, professors, and the campus community.
Finally, some students do not have the motivation and academic prowess to participate and
succeed in a highly independent academic setting (Ludwig-Hardman & Dunlap, 2003). As
online degree granting programs continue to expand and the demographics of the “typical”
distance learners are better understood, the need for increased student support services continues
to grow as well. Crisis intervention protocols is one such area that is becoming increasingly
important for institutions of higher education to address as a result of the rising mental health
needs of degree seeking students.
With the increasing growth of online programs, colleges and universities are beginning to
explore what systems must be implemented in order to adequately service this unique population.
As LaPadula (2003) expressed, it is imperative that online students receive access to the same
resources as their brick and mortar counterparts without hav to come to campus to utilize the
services. Raphael (2006) conducted a student of online students in order to determine what
services students are demanding access to via the Internet. Raphael (2006) discovered that
overall students perceived that the bookstore access and academic advising resources available to
them was subpar. The students who participated in Raphael’s study (2006) did not demand an
increased presence of mental health services online because the majority of the students who
CRISIS INTERVENTION ONLINE 22

participated were working professionals and utilized their employees assistance programs for
mental health services. Raphael (2006) explained the findings of the study by stating that the
results were merely based on perceptions of the participants and should only serve as guidelines
for universities.
As the enrollment of students with mental health needs grows on traditional university
campuses, so too is the online world experiencing an increase. While little research has been
conducted as of yet to highlight the rise of mental health concerns in online educational settings,
programs are currently facing such challenges. Crisis intervention online might appear to be
different than on brick and mortar campuses but both entities are plagued with emergency
situations such as students who display disruptive and threatening behaviors, students with
mental health needs, natural disasters effecting communities and student deaths. As a result, this
research will provide seminal information on effective student counseling and crisis intervention
services for online graduate students.
Importance of this Study
It is important to examine mental health counseling services for online graduate programs
for a variety of reasons. Programs have a vested interest in ensuring the academic success and
graduation of all of their students. Programs that are unable to adequately support their students
or provide interventions to a student in crisis, run the risk of having increased attrition rates. As
a result, this study is important as it highlighted the need for programs to support all students and
implement unique strategies to identify students in distress via the Internet and provide them
with the appropriate resources and referrals. Given that university administrators now have a
detailed understanding regarding the rise in mental health diagnoses, program administrators
now need to utilize successful practices to increase the retention and graduation rates of such
CRISIS INTERVENTION ONLINE 23

students. Additionally, the increased presence of students with mental health diagnoses on
campuses (and presumably online) requires the increased resources for university counseling
staff as well as increased trainings for university staff and faculty on how to identify a student in
distress and support that student appropriately.
Organizational Performance Goal and Current Performance
According to the gap analysis method of assessing performance status within an
organization, one must establish a goal that each organization is attempting to achieve in order to
assess their effectiveness (Clark & Estes, 2008). For the purposes of this study, the performance
goal that I seek to evaluate is if graduate degree programs are providing excellent student
counseling services to all online students at a reasonable cost to the institution. For the purposes
of this study, excellent student counseling services will be defined as services that successfully
identify students in distress, intervene as appropriate and refer students to the necessary
resources in order to ensure their support and continued successful enrollment in their university
program.
In order to successfully achieve this goal, institutions will need to overcome four
foreseeable challenges: identifying students in need of support; providing support to all students;
finding appropriate community based resources, and managing costs. Providing support to all
online students proves to be a challenge as 95% of university counseling center directors who
participated in a 2008 study indicated that they were experiencing an increase of students with
severe mental health diagnosis on their campuses (Gallagher, 2008) without the additional
resources needed to meet the increasing demands (Ghetie, 2007). Successfully providing
excellent mental health services to distance learners proves to be problematic as the counseling
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staff are experiencing difficulties in meeting the needs of the brick and mortar students and thus
one can assume that they are also struggling to meet the demand and needs of distance learners.
Equally challenging is the fact that distance learners are located throughout the world.
Mallen and Vogel (2005) discuss that while online counseling and therapy companies are rapidly
growing, more research needs to be conducted in terms of effectiveness and ethics. Since
collegiate counseling centers have already made it known that they are unable to support the
growing needs of the student population and the effectiveness of online therapy sessions are yet
to be determined, student counseling centers will need to develop a system of establishing
partnerships and referrals throughout the world to ensure that a student in crisis is receiving the
appropriate support from a resource that has already been deemed adequate.
Finally, in order to develop such resources, university administrators are going to need to
fulfill the requests of the counseling centers for additional funding (Farrell, 2008). University
budgets are going to need to determine what is a reasonable cost per student in order to ensure
the appropriate support. Meeting the performance goal of ensuring excellent support for all
online graduate students at a reasonable cost is not without its challenges but must be achieved in
order to successfully support the growing distance learner clientele.
Organizational Stakeholders
In order to assess effective crisis intervention strategies in online graduate programs, it is
necessary to have a detailed understanding of all stakeholders involved. The stakeholders
involved in online graduate crisis intervention services include program administrators, student
counseling center staff, central student affairs administrators, faculty, academic advisors and
SaaS personnel. For the purposes of this study, program administrators were defined as the
senior leadership within the graduate program who are responsible for ensuring the success of
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the program. They often supervise the student services staff within their programs and are
responsible for maintaining the financial viability of the program and the relationship with the
software platform provider. The student counseling center staff are crucial stakeholders in this
study. They are often called upon by various campus constituents to support students in distress
and consult with staff on how to work with disruptive students. Student counseling center staff
are also responsible for connecting students with appropriate treatment referrals and resources.
Other staff within the university supplement the work of student counseling centers.
Primary of these are student affairs staff. The central student affairs administration is composed
of the staff within the Vice President/Provost for Student Affairs division for the university that
often partner with individual programs to support students. Housed within central student affairs
divisions are departments such as the cultural centers, health centers, and career services.
Faculty and academic advising staff are important stakeholders in this study as they are the
people who often interact with students on a frequent basis and are the first to notice students
who are exhibiting behavioral changes or concerning behaviors. Finally, for the schools that
utilize the SaaS provider, the SaaS personnel are a key stakeholder as they have a vested
interested in ensuring student success and retention in order to maintain the partnership.
Stakeholder for the Study
While all stakeholders discussed above must collaborate in order to contribute to the
success of mental health support services, it is critical to understand the practices and strategies
utilized by student counseling center staff as they are the individuals who provide the initial
response and intervention to a student in distress.

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Purpose of the Project and Questions
The purpose of this project was to evaluate the strategies and protocols various university
counseling centers utilize in supporting their online graduate students. The analysis focused on
the assets of student counseling centers in the areas of knowledge and skill, motivation, and
organizational resources. As such, the questions that guided this study are the following:
1. To what extent are university counseling centers meeting their goal of providing mental
health support services to graduate students in online degree programs?
2. What are the knowledge, motivation, and organizational influences related to achieving
this goal?
3. What are the recommendations for organizational practices in the areas of knowledge,
motivation, and organizational resources?
Definitions
Crisis - Any critical incident within a student’s life or in the community that has a stressful effect
on the individual(s) and overwhelms one’s ability to cope (Flannery & Everly, 2000).

Crisis management – The guidelines for dealing with and responding to a crisis including
planning for a crisis and whom to communicate with in the aftermath (Coombs, 1995).

Crisis Intervention – Care and support given to victims to assist them in returning to normalcy
and to mitigate additional negative repercussions in the aftermath of an emergency or critical
incident (Everly & Mitchell, 1999).

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Critical incident - Any incident (ex. natural disaster or act of violence) that has the potential of
causing psychological trauma (Flannery & Everly, 2000).

First Responder – The person who first arrives on scene (or is first to intervene) during a critical
incident to provide assistance (Webster-Merriam, 2015).
Conclusion
In this chapter, I explained the purpose of my evaluation study on student counseling
centers and its importance to the realm of higher education. I provided a context and brief
history of the online graduate education sector as well as the current situation for university
counseling centers. I also defined the research questions that I seek to answer throughout this
study. In Chapter Two, I delve heavily into the literature and review the knowledge, motivation,
and organizational factors that contribute to or inhibit the effective of student counseling centers
in accordance with the Clark and Estes (2008) gap analysis model. In Chapter Three, I provide
an explanation of the knowledge, motivation, and organizational assets that I sought to validate
in my study as well as clearly laid the methodology for my study. In Chapter Four, I explain and
analyze the results of my study. Finally, in Chapter Five, I propose a plan for implementation
and evaluation of my proposed solutions.

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CHAPTER TWO: REVIEW OF THE LITERATURE
Introduction
This chapter will provide an overview of the literature that serves as the background for
this study. First, I will review what is known about effective university counseling centers and
standards of best practice. Next, I will provide a detailed description of learning and motivation
theory. Finally, I will implement a modified version of the Clark and Estes (2008) gap analysis
model to illuminate the knowledge, motivational, and organizational factors or inhibitors to
successful university counseling centers.
Effective Crisis Intervention
As defined in Chapter One, a crisis is a critical incident within a student’s life or
community that has a stressful effect on the individual(s) and overwhelms one’s ability to cope
(Flannery & Everly, 2000). For the purposes of this evaluation study, a crisis intervention is
defined as the strategies implemented by the student counseling staff in order to respond to, and
mitigate an individual in crisis. Standards for university counseling centers provide insight about
the factors that contribute to or inhibit the success of effective crisis intervention strategies. The
following sections outline “best practices” regarding student counseling centers as well as the
guidelines that have been developed to assess student counseling center performance.
Standards of Best Practice
There are various organizations and accrediting bodies that provide guidelines for best
practices and set the standards for student services in colleges and universities. The Council for
the Advancement of Standards in Higher Education (CAS) is the primary body that creates
regular definitions and suggestions regarding best practices in Student Affairs. University
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administrators frequently review CAS to ensure that their departments are appropriately meeting
the needs of their students.
CAS has created a best practices model for university counseling centers (Counseling
Standards, 2011). According to the CAS standards for counseling services, the primary mission
of a student counseling center should be to assist students in accomplishing their personal,
academic, and career goals (Counseling Standards, 2011). In order to reach their goals of
supporting the holistic wellbeing of students, the CAS standards for counseling encourage
individual and group counseling sessions for psychological, behavioral, and learning challenges;
education for the campus community regarding the developmental needs of students, appropriate
referral systems, threat assessment and crisis response (Counseling Standards, 2011).
Additionally, the International Association of Counseling Services, Inc. (IACS) is an accrediting
agency for university counseling centers. The IACS suggests that the counseling center’s role on
a campus is to provide therapy to students; assist students in identifying the skills necessary to
achieve their academic goals; and to provide outreach to the community to promote healthy
lifestyles, and contribute to campus safety (Standards, 2010). Assessing the guidelines as
proposed by CAS and IACS, identifies that the basic aims of university counseling centers are to
identify students in need of support, educate campus constituents on how to appropriately guide
students, and intervene during crisis situations. With the growth and development of distance
learning programs, various agencies are now producing guidelines for online programs.
Demand for Crisis Intervention and Counseling Online
Colleges and universities are seeing an increased demand for student services by both
distance education students and brick and mortar students (Moneta, 2005). As a result, student
services personnel are increasingly assessing their technological competence and developing new
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ways of communicating with all students via technology (Moneta, 2005). As Ardaiolo, Bender,
and Roberts (2005) describe, when students at one institution learn about a successful technology
being implemented at another school, they begin to demand similar services. For example,
college campus student health centers are increasingly utilizing online appointment management
and scheduling systems to better serve their student constituents (Moneta, 2005). Some student
counseling centers are implementing new technologies that enable students to complete online
“self-help” tutorials addressing common student concerns, complete self-assessments and utilize
an “ask a counselor” chat feature (Moneta, 2005). It thus becomes evident that the increased
demand for online services for student counseling centers is being seen both in the on-campus
and virtual sectors.
LaPadula (2010) discovered that students who enroll in distance learning programs tend
to have limited access to counseling services even though it has been demonstrated that
counseling services are critical to student success. Additionally, students need assistance coping
with various aspects of their life in order to deal with different situations and succeed (LaPadula,
2010). LaPadula (2010) surveyed distance learners in order to assess their satisfaction with
various online services as well as to determine areas for expanded student support. She
suggested placing self-help materials on the web, using a community based referral system, and a
system of submitting confidential questions to a counselor (LaPadula, 2010). LaPadula (2010)
discovered that between 25-34% of the students she surveyed expressed interest in additional
mental health services such as seminars on parenting and time-management, phone numbers for
hotlines (depression, substance abuse, etc.), and access to an online therapist. While LaPadula’s
(2010) research has been focused on brick and mortar students, I speculate that the same factors
impact online students as well. Using LaPadula’s work as an example, it becomes increasingly
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clear that online students are needing increased mental health support and resources from their
institutions.
Farrer, Gulliver, Chan, Bennett, and Griffiths (2015) conducted a study of college
students to ascertain students’ sentiments on virtual mental health services. The researchers
determined that student support services (like student counseling services) offered via the
Internet have the potential of reaching a vast array of students (Farrer et al., 2015). Various
studies have been conducted and demonstrate that Internet-based interventions offer the
advantages of 24-hour access, anonymity, and an alternate way to access support services for
students who are plagued by the stigma surrounding mental health (Farrer et al., 2015). Internet-
based mental health services often stress self-care, provide information, encourage peer-to-peer
support and involve accessing professionals (Farrer et al., 2015). The researchers discovered that
students wanted to have the ability to schedule appointments with clinicians via the web and
preferred to communicate with the therapists via chats, emails, and the telephone (Farrer et al.,
2015). The students in the study preferred not to communicate via Skype or similar video
technologies as they considered it to be “too intrusive” (Farrer et al., 2015). It is significant to
note, that Farrer et al. (2015) also discovered that although the student participants enjoyed
Internet-based mental health support, they were apprehensive regarding privacy issues,
questioned the trustworthiness of the providers, and fearful that they were not receiving the same
level of care that traditional, in-person counseling provides.
Several researchers and authors document the positive impacts and benefits of web-based
mental health interventions. First, Internet-based counseling has the potential to assist people
who might not otherwise have access to mental health services as a result of cost, distance,
illness, transportation challenges, or familial obligations (Maples & Han, 2008). Andersson and
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Cuijpers (2009) stated that web-based interventions are successful at reducing symptoms of
depression and anxiety in college students. Some of the advantages of online mental health
services include 24-hour accessibility and anonymity (Cassell, Jackson, & Cheuvront, 1998)
which can be enticing to individuals who fear the stigma associated with mental health (Berger,
Wagner, & Baker, 2005). Additionally, it has been discovered that college students are more
likely to be “honest” with a mental health professional when they do not have face-to-face
contact with the counselor and thus feel less vulnerable (Maples & Han, 2008). Internet-based
therapy also provides clients the opportunity to search for a counselor that meets their needs
based on expertise, education, and licensure without first engaging with the therapist (Maples &
Han, 2008).
Internet-based counseling is not without its challenges and shortcomings however. Most
obviously, virtual therapy does not provide the personal, human connection that is present in
face-to-face (Maples & Han, 2008) and does not enable the treating counselor to read and assess
the nonverbal cues of the client (Law, 2002). Other challenges include the fact, that clients can
monitor their responses before sending them to the therapist (e-mail or chat forums) and thus
the authenticity of the responses and reactions might be impacted (Maples & Han, 2008). Godin
(2005) questioned the reliability of clinical assessments conducted over the Internet and
suggested that standards for web-based assessments might be necessary. Rochlen, Zack, and
Speyer (2004) suggested that challenges with Internet-based therapy can also arise from clients
who are unable to effectively communicate in text and thus misinterpret what is actually being
communicated.
Having now gained a detailed understanding of what an effective crisis intervention
strategy and protocol looks like, the strengths and weaknesses of Internet-based therapy services,
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and the demographics of the students who are attracted to online programs, I will next describe
the learning and motivational theory that is needed in order to understand the theory behind what
is required to appropriately implement such protocols. In assessing the applicability and
effectiveness of Internet-based therapy one needs to keep in mind the unique characteristics of
the online student population. Online students tend to be older than traditional students
(Kretovics, 2003) and reside in remote areas without directs access to universities (Ludwig-
Harding & Dunlap, 2003). Distance learners tend to have responsibilities in addition to their
coursework such as family and work that require flexibility in their school schedule (Ludwig-
Harding & Dunlap, 2003). Then, I will review the literature to determine the knowledge,
motivational, and organizational factors that contribute or impinge on the successful
implementation of these practices at university student counseling centers.
Learning and Motivational Theory
In order to determine the primary factors and inhibitors that contribute to the success or
demise of online crisis intervention services in graduate degree programs, I employed the gap
analysis process as described by Clark and Estes (2008). Clark and Estes (2008) provide a
detailed description of the gap analysis process as a means of assessing an organization to
determine why the organization is not achieving its goals. Clark and Estes (2008) provide a
framework for analyzing the performance of an organization to determine whether knowledge,
motivation and/or the structure of the organization is the cause of the gap in desired performance.
The authors suggest that improving the knowledge and motivation of key stakeholders as well as
assessing related organizational assets and barriers can improve performance (Clark & Estes,
2008).
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This gap analysis study looked at the knowledge contributing to university counseling
center performance through the lens of Bloom’s Taxonomy as proposed by Krathwohl (2002). In
order to uncover the potential motivational issues impacting the performance, this paper used the
motivational framework as presented by Rueda (2011). In addressing organizational barriers
impacting performance, I turned to the work of Gallimore and Goldenberg (2001) regarding the
impacts of culture on an organization.
Knowledge and Skills
Knowledge and skills are the first area of focus in Clark and Estes (2008) gap analysis
model. Clark and Estes (2008) suggest one first determine the knowledge needed by a
stakeholder to achieve the desired performance goal. To make this determination, Krathwohl
(2002) provides a framework for analyzing the various levels of knowledge.
Krathwohl (2002) proposes a three-tiered level of knowledge and describes the various
components of each level. The three levels of knowledge proposed by Krathwohl (2002) are
declarative, procedural, and metacognitive. Declarative knowledge is often divided into two
components, factual and conceptual knowledge (Krathwohl, 2002). Factual knowledge can be
assessed by determining whether constituents have the basic information necessary to complete
the task (Krathwohl, 2002). Conceptual knowledge is an understanding of the theories,
principles, and concepts needed to complete a task (Krathwohl, 2002). Procedural knowledge
can be defined as having an understanding of how to accomplish the desired outcomes and
includes the order of operations that must be followed in order to achieve the desired results
(Krathwohl, 2002). Finally metacognitive knowledge requires an individual to reflect on his/her
approach, modify things that need improvement and tailor it as necessary to achieve the desired
outcomes (Krathwohl, 2002). According to this framework, effective counseling centers would
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be characterized by the staff’s knowledge of specific factual information, relationships between
concepts, resources, and procedures.
Motivation
Motivation is the second component of Clark and Estes (2008) gap analysis framework.
Motivation is the study of what causes people to engage in certain activities or efforts (Mayer,
2011). Many researchers including Clark and Estes (2008), Rueda (2011) and Mayer (2011)
have studied motivation and the reasons people might participate in certain activities or
endeavors. Motivation is the often the fundamental factor determining why people do certain
tasks, their willingness to continue doing the task, and the level of effort they commit towards
the task (Clark & Estes, 2008). Motivation theorists have come to the conclusion that people’s
motivation levels can be measured using three main indexes: active choice, persistence, and
mental effort.
Active choice is when a person chooses to engage in a certain activity/task (Clark &
Estes, 2008). Active choice goes beyond intending to do something and instead is when the
individual commits to doing the task. In other words, the individual has “chosen” to participate
in the activity and has made a determination to follow all of the specifications and requirements.
Persistence is the second motivation index and refers to an individual’s ability to remain
engaged in the task (Clark & Estes, 2008). Persistence is defined as the commitment an
individual is willing to invest in completing the task (Clark & Estes, 2008). In order to
determine the level of persistence, one might consider how long and to what extent an individual
is willing to persevere through a task. In other words, is the individual willing to exert additional
energies in the face of challenges or will the individual merely give up on the task if things
become difficult?
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Mental effort, the third motivational index, is displayed when an individual applies new
learning to a challenging or new task (Clark & Estes, 2008). Individuals often display mental
effort when new information is presented. Mental effort is how much cognitive innovation the
individual is willing to invest in the activity or task at hand (Clark & Estes, 2008). Mental effort
differs from persistence as mental effort is the ability to complete the challenging task while
persistence is an individual’s willingness to engage in the task.
Motivation as defined above, is composed of active choice, persistence and mental effort
all of which can be influenced by self-efficacy, values, attributions, interest, and goals (Clark &
Estes, 2008). Self-efficacy greatly influences an individual’s motivation. Ambrose, Bridges,
DiPietro, Lovett, and Norman (2010) state that in order for individuals to be motivated to engage
in or complete a task, they must expect that they will be able to succeed at it. It is important to
note that one or a combination of the motivational indicators might be occurring in an
organization at any given time contributing to a lack of motivation amongst constituents.
The concept of value is another factor that impacts and individual’s motivation. Rueda
(2011) discusses that value is the importance individuals assign to the task they are performing.
Value is often divided into the categories of intrinsic, extrinsic, attainment, and cost. Intrinsic
value refers to the personal interest that an individual has in a given task. Extrinsic value refers
to the utility that the task has for the individual. Attainment value refers to the importance that
the individual associates with the task. Finally, cost value is the individual’s internal analysis of
the personal benefits gained from achieving the task (Rueda, 2011). Without having an intrinsic,
extrinsic, attainment, or cost value, the individual is less likely to be motivated to complete the
task.
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Attribution is another influence on an individual’s motivation. According to Rueda
(2011) attributions refer to how an individual assigns failures or success of a task to the level of
effort used rather than one’s ability. In simpler terms, attribution is the process of assigning
cause to a certain behavior or event. Thus, an individual’s causal attributions of achievement
influence subsequent behaviors and motivation (Rueda, 2011).
An individual’s level of interest within a specified task is the fourth influence on
motivation. In this context, interest is also aligned with choice. An individual’s level of interest
towards a certain task influences one’s motivation to engage in that task.
The final influence on an individual’s motivation is goals and goal setting. Rueda (2001)
stressed the importance of goals and goal setting as having clear, relevant, and challenging goals
that encourage continued engagement and mastery of the task. Goals are the standard of best
practice for which an individual strives.
It is important to note that one or a combination of motivational indicators might be
occurring for an individual at any given time contributing to a lack of motivation amongst
stakeholders.
Organization
In order to effectively determine best practices as they relate to crisis intervention
protocols for online graduate programs, one must also analyze the organizational barriers and
assets that might be contributing to or impacting performance. When analyzing an organization
it is important to consider both the cultural models and cultural settings that affect the specific
organization to determine both the visible and invisible structures in place (Rueda, 2011).
According to Rueda (2011), cultural models are the shared beliefs and understandings and are
evident in the practices of the constituents in the organization while cultural settings are the
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social contexts in which the cultural models (beliefs) are enacted. Cultural models are the
values, beliefs, and attitudes of an organization that are generally invisible to insiders and are
often automated (Gallimore & Goldenberg, 2001). Some examples of cultural models might be a
lack of trust, a culture of competition, or negative attitudes. Cultural models contribute to the
structure and policies of an organization (Gallimore & Goldenberg, 2001). Cultural settings on
the other hand are manifestations of the cultural models in daily life (Gallimore & Goldenberg,
2001). Examples of cultural settings might be a lack of effective role models, a lack of
communication, or a lack of resources within an organization. In essence, cultural models are
the invisible aspects of the organization and the cultural settings are apparent.
Factors that Contribute to and Inhibit Effective Student Counseling Centers
In the remaining components of this chapter, I will present the evidence from the
literature regarding components of successful student counseling centers or aspects that inhibit
performance. The literature presented is organized in accordance with the knowledge,
motivational, and organizational factors that either contribute to or impinge upon successful
crisis interventions.
Knowledge and Skills Causes
Given the increased presence of students with mental health diagnoses in institutions of
higher education and the increased pressure to adequately support the needs of all students,
counseling center staff need to maintain an appropriate level of knowledge and skills. As a result
of the increasing demands for student services (as well as the increasing complexity of mental
health challenges on campuses), university counseling centers, and their staff, need to maintain
various levels of knowledge in order to appropriately support student needs. Equally important
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to assessing organizational performance, as defined by Clark and Estes (2008), are the inhibitors
to knowledge that student counseling centers need to overcome in order to ensure effectiveness.
Factual knowledge.
In order to successfully support the needs of students in the current climate of increasing
mental health needs (Fombonne, 1999) and rise of young adults pursuing postsecondary degrees
(Digest of Education Statistics, 2003) university counseling staff need to maintain certain factual
knowledge as defined by Krathwohl (2002). Studies on university counseling staff have
indicated that the staff are fearful that they lack the training needed in order to properly service
students with severe mental health needs (Kiracofe, 1993). In other words, counseling center
staff need to know how to properly assess and diagnose students who have severe mental health
conditions. As the demographics of the student population change with more students having
mental health diagnoses attending institutions of higher education, effective student counseling
centers need to know how to work with such a population. Similarly, university administrators,
mental health professionals, and researchers are concerned about the adequacy of mental health
providers at institutions of higher education. Mowbray et al. (2006) discuss the ability of
campus counseling centers to support students with serious mental health diagnoses. Many of
the concerns center around the training and preparation of staff, their ability to use
assessment/diagnostic tools, and understanding of referral procedures and treatment planning
(Mowbray et al., 2006).
In order to cope with the growing demand for collegiate mental health services, many
university counseling centers have resorted to hiring trainees or per diem therapists to assist in
the therapy of their students (Guinee & Ness, 2000). (A trainee can be defined as a pre-doctoral
intern, extern, or, postdoctoral resident/fellow or practicum student (Boyd et al., 2003). A per
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diem therapist can be defined as a licensed therapist who serves as an independent contractor and
is hired by a university on an “as needed” basis to assist in counseling). Given the fact that the
literature suggests, that fulltime university counseling staff are feeling inadequately prepared to
treat students with severe mental health diagnoses, one might wonder if the trainees and per diem
therapists also lack the factual knowledge needed to properly assess and diagnose students.
Similarly the effectiveness of doctoral psychology programs have recently been called
into question (Bishop, 2006). It has been suggested that psychology doctoral programs need to
partner with counseling centers at local colleges and universities to ensure that their graduates
are learning the skills necessary in order to be successful employees in such working
environments (Bishop, 2006). Guinee and Ness (2000) state that interns are becoming
increasingly important in such centers. Counseling center staff need to have experience in
supervising interns. Smith et al., (2007) surveyed various counseling center staff and inquired
about what skills they needed from their graduate programs that would have better prepared them
for working in a university counseling center. Respondents stated that they would have
benefitted from increased multicultural training (factual and conceptual knowledge), applied
clinical experience (group therapy and brief therapy) (procedural knowledge), crisis management
(factual knowledge), spirituality and religious issues (factual knowledge), the structure of higher
education (conceptual knowledge) and substance abuse counseling (factual knowledge) (Smith et
al., 2007).
Conceptual knowledge.
In alignment with Krathwohl’s (2002) definition of conceptual knowledge, researchers
have made suggestions in regards to the theories that effective counseling center staff must
possess. Cornish and Riva (2005) advocate for counseling center staff to have experience in
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supervising staff and an understanding of developmental theories and consultation training which
was argued should be developed in their graduate degree programs. Additionally, Webb,
Widseth, and John (1997) postulate that university therapists need specialized training in the age
appropriate development of their clientele as well as the unique university counseling
environment.
Procedural knowledge.
Murphy and Martin (2004) and Cornish, Kominars, Riva, McIntosh, and Henderson
(2000) suggest the importance of training counseling center staff on how to effectively and
appropriately utilize referral protocols for students who require extensive and/or long-term care.
Additionally, student counseling staff must be educated as to the referral systems and processes
when sending students off-campus for mental health care. Mowbray et al. (2006) suggest that
the referring clinician maintain communication with the off-campus mental health provider to
ensure that the student receives the most appropriate care and that the transition is seamless.
Additionally, Mowbray et al. (2006) encourage university counseling centers to implement
systems of “follow-up” which would ensure that the student visited the off-campus mental health
provider and is satisfied with the prescribed treatment plan. The suggestions as proposed by
Murphy and Martin (2004), Cornish et al. (2000) and Mowbray et al. (2006) serve as examples
of the procedural knowledge that a university counseling staff member would need to provide
effectively for student clients. To best serve the online graduate student population, university
counseling staff need to be familiar with networks around the world and understand how to refer
students to various forms as treatment as the expanding geographical locations of students is a
new factor.
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Crisis management and disaster planning appear to be areas in which university
counseling staff are lacking procedural knowledge. Approximately one-third of the participants
in the Smith et al. (2007) study stated that while initial actions had been taken in the event of a
critical campus incident, no formalized plans had been developed. Only one-quarter of the
participants in the study stated that their counseling center had clearly defined plans in the event
of an emergency (Smith et al., 2007). While 19% of the respondents stated that they had
received specialized training in the event of a campus crisis, nearly 21% stated that they did not
have any formalized training in that arena or were not involved in the planning for emergencies
(Smith et al., 2007).
Metacognitive knowledge.
Multicultural competence is another knowledge component that effective student
counseling center therapists use to successfully engage with and meet the needs of their student
clientele (Vera & Speight, 2003). Multicultural competence can be defined as possessing the
necessary self-awareness, knowledge, and skills to work with clients of diverse backgrounds
(Arredondo et al., 1996). In Krathwohl’s (2002) definitions of knowledge, multicultural
competence falls within the factual, conceptual, and metacognitive realms. In order to be
multiculturally competent, a therapist must be self-aware of one’s attitudes and values in regard
to race, ethnicity, and culture as well as have an understanding of one’s own group membership
and privilege (or lack thereof) in terms of the American social structure (Constantine, Hage,
Kindaichi, & Bryant, 2007). The ability of therapists to employ critical consciousness will prove
to be essential for counselors as it enables them to become increasingly self-aware regarding
their own privilege and the identity (Freire, 1990). This internal self-awareness and reflection on
one’s own identity as well as in relation to others, is an example of metacognitive knowledge as
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defined by Krathwohl (2002). Multicultural competence also requires factual knowledge as the
counselor must be aware of the histories of oppression that various identities have been subjected
to (Constantine et al., 2007).
Effective therapists must also have a social justice perspective in order to understand the
institutionalized oppressions that run rampant in American culture and contribute to the
experiences of marginalized identities in society (Vera & Speight, 2003). Vera and Speight
(2003) advocate for counselors to serve as social justice advocates in addition to providing the
necessary support to their clients. As such, the authors suggest that when working with a
culturally diverse clientele, a seasoned therapist assesses the needs of the individual and serves
as an “…adviser, advocate, self-help group facilitator, facilitator of indigenous support and
healing systems, consultant, change agent, counselor, and psychotherapist” (Vera & Speight,
2003, p. 263). In other words, the therapist reflects metacognitively and determines what support
networks or referrals will be most culturally appropriate for the individual at that point. It
appears that such metacognitive reflections are necessary attributes for university counselors to
obtain as they work with an increasingly diverse and global student population. As such,
effective university counseling centers foster relationships with community based agencies
(locally and globally) to ensure that community empowerment is a factor in the support of
students who come from cultures that value such support (Vera & Speight, 2003). Additionally,
university counseling staff must be aware of the multicultural competencies as stipulated by the
American Psychological Association in order to avoid unintentionally marginalizing clients
(Constantine et al., 2007).
Research has shown that multicultural competence effectively meets the needs of
students of color (Smith et al., 2007). A survey of college students of color indicated that
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students perceptions regarding the effectiveness of the therapeutic services they received were
closely tied to the students assessment of the therapist in terms of the therapists multicultural
competence (Constantine, 2002). Given the increasing global society, Fuertes and Brobst (2002)
illuminate the reality that counselors must become increasingly adept at working with various
cultures and ethnicities. According to Smith et al. (2007) a survey of student counseling center
staff indicates that many campuses are making concerted efforts to increase the multicultural
competence of their staff. Additionally staff reported that it is now increasingly commonplace to
recruit interns and staff members of various racial/ethnic groups (Smith et al., 2007).
Knowledge summary.
Factual knowledge according to Krathwohl (2002) assesses whether individuals have the
necessary information to complete a task. According to the literature, the factual factors that
contribute to or impede the effectiveness of university counseling centers include that student
counseling center staff do not know how to properly assess and diagnose a student with severe
mental health symptoms. Similarly, university administrators, mental health practitioners, and
researchers are concerned about the adequacy of the staff at university counseling centers in
terms of their ability to utilize diagnostic tools, and have a comprehensive understanding of
referral procedures and treatment planning. Another factual knowledge asset that needs to be
assessed includes the preparedness and knowledge/skill level of per diem and trainee staff who
are increasingly being hired to provide diagnosis, treatment, and referrals at student counseling
centers. Finally, it is important to assess the effectiveness of doctoral programs in psychology
and similar fields to determine whether the graduates of such programs are equipped to succeed
in the university counseling arena.
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Conceptual knowledge is the theories and principles that individuals need to know in
order to be successful (Krathwohl, 2002). According to the literature, it appears that a factor that
could be contributing to or impinging upon the effectiveness of student counseling centers
includes the fact that university counseling staff need to have a detailed understanding of student
development theories in order to support the needs of all students.
According to Krathwohl (2002), procedural knowledge is an individual’s understanding
of how to accomplish a desired task as well as the order of operations that must be followed in
order to achieve the desired results. The literature discusses the importance of having university
counseling center staff who are educated in referral systems and processes when sending a
student outside of the university for treatment and support. In terms of the online graduate sector
of the population, this includes the need for student counseling center staff to have a breadth of
referral avenues across the world in order to support student’s in their various hometowns.
Additionally, crisis management and disaster planning is another aspect of procedural knowledge
that needs to be properly understood in order to have effective counseling centers so that staff
are familiar with emergency protocols and how to implement them when necessary.
Metacognitive knowledge is defined as one’s ability to self-reflect on what is occurring
and determine how to appropriately modify ones approach (Krathwohl, 2002). According to the
literature, the ability for university counseling staff to have multicultural competence is crucial in
order to understand one’s own identity as well as the societal factors impacting a student’s
experience and sense of self. Additionally, utilizing the literature as presented in Chapter Two, it
appears as though the largest metacognitive impeding asset is students choice not to utilize
student counseling services as a result of the negative stigmas that are often associated with
mental health support services.
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Motivation
Given the fact that mental health cases amongst students is on the rise which is resulting
in an increased demand for services at university counseling centers, one might assume that there
would be significant motivational issues among counseling center staff. However, the literature
paints a different picture of the student counseling staff. Regardless of their increasing caseload
and limited budgets, counselors in general place much value in their work and have made the
active choice, to engage in the necessary effort and persistence to support their students.
Guinee and Ness (2000) conducted a survey of university counseling centers and
discovered that regardless of the increased student demand counseling centers were
experiencing, the performance of the professional staff, and the quality of the service being
offered, remained the same. Additionally, it was discovered that counseling center directors are
intentional in protecting their staff from being overworked and attempt to provide them with
small incentives to maintain the strenuous workload (Guinee & Ness, 2000). Counseling center
directors appear to be cognizant of the fact that university budgets are constrained and thus
providing staff with salary increases is not realistic (Guinee & Ness, 2000). As a result however,
counseling center administrators have incentivized their staff by setting caseload limits, offering
flexible schedules, and providing funds for professional development opportunities (Guinee &
Ness, 2000). These gestures appear to keep motivation levels high among counselors as they
have the strong levels of self-efficacy which enables them to believe that they will be successful
in their work which motivates them to continue to perform. Additionally, in terms of the
motivational language factors as described by Clark and Estes (2008), it appears that regardless
of the increased workloads, university counseling staff are motivated to continue to perform as
they are making an active choice to meet the increasing demands.
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Smith et al. (2007) conducted a study comparing counseling center staff to counseling
center administrators in hopes of determining their overall workloads and job satisfaction.
According to the survey participants it was discovered that in general counseling center staff
spend about 81% of their time providing therapy to students in personal or group settings.
Counseling center administrators on the other hand spend about 62% of their time providing
therapy with the rest of their time allocated to administrative functions. Smith et al. (2007) also
found that 85% of survey participants rated their job satisfaction as being high despite their high
caseloads and stressful situations. In accordance with Rueda’s (2011) motivational indicators,
the counseling center administrators have associated high attainment value to their increasing
administrative functions and lessening therapy caseload as they are able to lessen the
administrative pressures on their workforce. Lessening the administrative responsibilities of the
therapists enables them to increase their caseload productivity and results in high levels of self-
efficacy for the counselors who then feel as though they are able to meet the demands of their
job.
It is significant to note however that even though the majority of counseling center staff
feel satisfied with their employment experience and have made the active choice to persist
regardless of the high caseload, there is a constituency of the university counseling population
who feel overwhelmed which negatively impacts motivation. The increased demand on
counseling services has created additional stressors for the staff who work and support students
in distress. For example, Gallagher (1996) surveyed counseling center directors and found that
60% of them stated that their stress levels as a result of their job had increased over the past five
years. In their study of student counseling center staff and administration Smith et al. (2007)
found that most respondents claimed that workload was an issue and expressed the need for
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additional staff members. While the counseling center staff highlighted the need for additional
employees in their centers they also remained realistic given the current higher education
financial situation and also suggested using waiting lists, session limits, community referrals, and
group counseling sessions (Smith et al., 2007).
Motivation summary.
Clark and Estes (2008), Mayer (2011) and Rueda (2011) proposed assessing the
motivational factors needed in order to determine what causes individual’s to engage in certain
activities or efforts. Motivation theorists have determined that motivation levels can be assessed
via active choice, persistence, and mental effort which can be influenced by self-efficacy, values,
attributions, interest, and goals (Clark & Estes, 2008). According to the literature described
above, it appears that university counseling center staff have made the active choice to engage in
the effort and persistence needed to support the growing student demand regardless of increasing
caseloads (Smith et al., 2007) and constraining budgets (Guinee & Ness, 2000). Similarly, the
literature suggests that counseling center administrators are ensuring the self-efficacy of their
clinicians by offering incentives such as flexible schedules and professional development
opportunities (Guinee & Ness, 2000). This causes the counseling center administrators to
experience high levels of attainment value as the administrators assume additional administrative
responsibilities to ease the pressure from their therapists which allows the therapists to
effectively work through their increased caseloads and feel as though their job requirements are
manageable. The literature did discuss however, that while the majority of student counseling
staff have made the active choice to persist at their jobs regardless of the increased caseload,
there is a constituency of therapists who are feeling overwhelmed and less motivated to perform.

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Organization
The literature suggests that there are various organizational factors at play that serve as
assets or inhibitors to the effectiveness of university counseling centers and their staff. Some of
the factors appear to be cultural models and settings that are internal to counseling centers
themselves, while others are situated within the institution itself. There also seems to be cultural
settings (Rueda, 2011) within American society that also impact the effectiveness of university
counseling centers. Using the work of Rueda (2011) and Gallimore and Goldenberg (2000) I
will uncover the organizational factors that impact counseling centers at institutions of higher
education.
Murphy and Martin (2004) suggested various ways for university counseling centers to
attempt to meet the increasing demand for services by their students. The authors suggest
organizational changes to the structure of the counseling centers which include offering briefer
therapy sessions (Murphy & Martin, 2004) on campus; which might include implementing
session limits for on-campus treatment, or shortening the length of therapy sessions. Murphy and
Martin (2004) also suggest utilizing improved scheduling methods for appointments which
would ideally limit the number of missed appointments by students. The authors also suggest
increasing group therapy opportunities for students (Murphy & Martin, 2004). It seems that the
increased usage of group therapy options would enable more students to be seen in a short period
of time. The suggestions proposed by Murphy and Martin (2004) regarding improvements to
appointment length and scheduling serve as examples of cultural models (Gallimore &
Goldenberg, 2001).
Guinee and Ness (2000) discovered that counseling centers have become more successful
in providing campus outreach and consultations. The increased campus outreach has improved
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the organization as various campus constituents now increasingly view student counseling
centers as partners in promoting student success (Conyne, 1997). Mukenhoupt (2000) suggested
educating campus constituents on mental illness, techniques for communicating with a student in
distress, and provided ideas on how to lessen stress levels on students. This increasing exposure
does come with added challenges; as the people who were once hesitant to utilize mental health
support services, or refer students as a result of stigmas, are now demanding services as well
(Guinee & Ness, 2000). Similarly, such additional campus consultations and outreach, often cost
money that comes out of the student counseling center budget rather than the benefiting
department (Guinee & Ness, 2000), which further constrains the tight financial situation of
university counseling centers. A review of the literature supports the allocation of additional
resources from the campus administration to counseling centers as more funding would enable
additional community presentations and workshops, thereby indicating that there is a resource
issue at play.
In addition to becoming more visible within the campus community, university
counseling centers are seeing the correlation between their roles as it relates to student retention.
Nearly a quarter of students who enter a four-year college do not return for their second year and
more than 40% of all college enrollees leave without obtaining a degree (Tinto, 1993). Various
studies have been conducted and collected data reveal that students who use counseling services
regarding retention related issues are more likely to continue their academic endeavors (Sharkin,
2004). According to a six-year study by Turner and Berry (2000), students who received
counseling services, were more likely to remain in school as compared to the general college
population. Blom and Beckley (2005) discovered that as a result of the increased usage of
psychiatric medications, students who were not previous able to attend institutions of higher
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education, now have the ability to do so. Giddan and Weiss (1990) suggest that it will become
increasingly important for university counseling centers to be able to demonstrate their role in
student retention to campus administrators for funding purposes and resource allocations. In
order to determine the impact of counseling services on student retention, Sharkin (2004)
suggests assessing which counseling interventions are most effective: workshops, individualized
or group therapy sessions. Once that data has been gathered, Sharkin (2004) suggests the
importance of publishing reports and presenting to various campus constituents and national
agencies in order to clearly depict the importance of university counseling in terms of student
retention.
Colleges and universities are complex entities that house many departments and
programs. While many of the offices/departments within institutions of higher education
function as independent entities in completing their daily work, they are often reliant upon the
central governing board and senior administrators for resources and policies. Some institutional
challenges that negatively impact the functioning of student counseling centers include financial
difficulties and the stigmatization that surrounds mental health.
Many colleges and universities are currently being faced with increased budgetary
restrictions that result in budget cuts for many aspects of collegiate life. As a result, while
university counseling centers are experiencing increased student demand, they are not
experiencing an equitable level of budget increases (Smith et al., 2007). Gallagher (2004)
conducted a study of student counseling center directors and discovered that only 5% of the
participants believe that their current resource allocation was “adequate.” Instead, counseling
center staff who already have high caseloads, are now being required to generate reports and data
to prove their effectiveness (Smith et al., 2007). The fact that the counseling center staff are
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expected to complete reports in addition to their excessive caseloads, indicates that there is a
resource issue within the counseling centers. If the counseling centers were able to hire
additional staff members (or create another method of generating reports) therapists would be
able to focus their attention on supporting students.
Students utilizing counseling centers on university campuses also complain about the
lack of availability of the counseling centers (Mowbray et al., 2006). Most counseling centers
maintain a “traditional business hours” model that is often not conducive for students who have
classes during the day (Mowbray et al., 2006). Mowbray et al. (2006) stated that some
counseling centers offer limited hours of operation and do not account for high stress times of the
year when increasing amounts of students need to access their services. Mowbray et al. (2006)
discovered that in addition to varying times between scheduling appointments and actually
meeting with a clinician, many students only receive brief sessions which do not allow for full
psychological assessments. Additionally, many students require continued care and treatment
but the structure of the university counseling center environment is not equipped for that
(Mowbray et al., 2006). Finally, some students complained that campus mental health resources
are not centrally located and thus they are forced to visit numerous offices in order to obtain the
assistance and support that they need (Mowbray et al., 2006). The literature suggests that an
effective student counseling center will have assessed its organizational structure and created a
cultural setting that has determined the appropriate hours of operation, length and frequency of
counseling sessions, as well as accessibility for the campus constituents.
Another factor that is inhibiting the effectiveness of university counseling centers is the
hesitancy of students to seek mental health support services. Blacklock, Bension, Johnson, &
Bloomberg (2003) stated that many students are hesitant to disclose their mental health status as
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a result of perceived social stigmas. Mowbray et al. (2006) found that students with mental
health diagnosis often feel shameful or guilty which lessens their likelihood of seeking support
from family and friends (Blacklock, et al., 2003). Loewen (1993) discovered that students
diagnosed with mental health conditions felt that their faculty members, advisors, and peers
lacked understanding regarding their needs. This is yet another prime example of a cultural
model because counseling centers have to overcome the challenge in which members of the
campus community appear resistant to utilizing their services, as a result of socialization and
stigma.
University counseling centers have the added pressure of dealing with the undefined
standards of care when it comes to mental health coupled with the strict regulations of the
Americans with Disabilities Act (Hodges, 2001). According to Crawford (1994) standards of
care can be defined as the conduct of professionals who have completed training for the
diagnosis and treatment of clinical issues. However, standards of care can vary from region to
region and therefore are not overtly clear (Swenson, 1993). As a result, university counseling
centers do not have a “defined” system in place across the nation and thus each counseling center
has implemented their own policies in regard to session limits, credentials needed to provide
therapy (i.e. per diems, licensed social workers, therapists, etc.), and appropriate assessment
tools (Hodges, 2001). Thus, without strictly stipulated guidelines, university counseling centers
create their own policies and standards of care which potentially expose themselves up to
litigious issues (Hodges, 2001). This lack of clarity is an example of what Rueda (2011) refers
to as a cultural setting organization barrier.

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Organization summary.
Rueda (2011) and Gallimore and Goldenberg (2001) offer theories on the cultural models
and cultural settings that effect an organization. Cultural models are the values, beliefs and
attitudes of an organization that are generally invisible to insiders and are often automated
(Gallimore & Goldenberg, 2001). Cultural settings on the other hand are the manifestation of the
cultural models in daily life (Gallimore & Goldenberg, 2001). Utilizing the literature discovered
in Chapter Two, both cultural models and cultural settings impact the university counseling
center arena. For example, organizational changes within the university settings must occur
which would implement session limits for on-campus treatment, improved scheduling
techniques, increased hours of operation, and additional group therapy options. Another cultural
model impacting student counseling centers include resource allocation (or the lack thereof) and
the added pressure for university counseling centers to provide trainings and consultations for
various campus constituents. Additionally, counseling centers are impacted by the American
social stigma surrounding mental health and seeking treatment which cause some students to shy
away from counseling, or faculty and staff members hesitant to refer students for services.
Lastly, university campuses are faced with a lack of professional standards of care which results
in each campus developing its own protocols and an absence of standardization across the
American higher education system.
Personal Knowledge
Personal knowledge is the understanding and information that I have gathered throughout
my experiences as a student affairs professional at various colleges and universities throughout
the United States. The information that I have obtained is divided and categorized using the
knowledge, motivational, and organization framework as proposed by Clark and Estes (2008).
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Knowledge and skills.
Often times, counseling center staff are not the first people in the university environment
to notice a student in distress. Other university staff and faculty are frequently the first point of
contact for a student in distress or notice a student demonstrating concerning behaviors. Take for
example, faculty members and academic advisors, who often view their roles in academia as
teaching classes or conducting research and providing academic guidance to students. When
such individuals notice or become aware of a student in distress, the staff/faculty member can be
placed in a tenuous and uncertain situation as they might be forced to intervene without having
the appropriate training and confidence needed to facilitate a successful intervention and referral.
As a result, it is crucial that all university staff and faculty members who interact with students,
receive adequate training on how to help a student in distress and provide appropriate support.
Motivation.
Serving as a student counseling staff member or crisis intervention specialist is a
“thankless job.” People who typically engage in this line of work are dedicated to supporting
individuals in duress and want to ensure the student’s success. People who choose such work are
often “in the trenches” with a student in need and are sometimes subjected to the harsh criticisms
of family and friends who do not recognize that their loved one is in crisis. Additionally, such
individuals are often called upon to make difficult decisions in regard to calling law enforcement
personnel for assistance or involuntarily hospitalizing a student. While all such decisions are
made in the best interest of the student, it can be challenging to have others constantly question
the individual’s motivation. As a result, the phenomenon of “compassion fatigue” is prevalent
among crisis intervention specialists and student counseling center staff at institutions of higher
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education. Therefore, it is important for student counseling staff to practice self-care in order to
prevent burnout.
Organization.
Based upon my experiences as a student affairs professional and former crisis manager, it
has become increasingly clear that the university counseling centers with whom I have worked
lack the funding and appropriate resources in order to support the growing needs of their
students. University administrators appear to be in agreement that counseling centers are in need
of additional resources that would provide for additional outreach services and clinicians.
Regardless of this necessity however, institutions of higher education are faced with the current
dilemma of tightening budgets. As a result of the overall financial crisis in higher education,
student counseling centers are unable to receive the additional funding that they need. Similarly,
as the public understanding regarding mental health grows, university counseling centers are
expected to provide programs and educational workshops for various campus constituents on
identifying and supporting students in distress. While educating the general campus community
in regards to how to appropriately refer and support students is a worthwhile initiative, it is
placing additional pressures on an already lean staff who are often times working over their
desired caseloads as it is. It therefore appears that an increased allocation of resources would
prove to be instrumental in continuing to meet the expanding needs of students and enable
counseling centers to hire individuals who could fully dedicate themselves to outreach and
community education.

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Knowledge, Motivation, and Organization Factors that Directly Relate to Student
Counseling Center Therapists
After reviewing the literature on effective university counseling centers and the factors
that contribute or inhibit success, it seems that there are three main factors that directly affect
performance. These three factors will be the focus of the remainder of this study. First, the
literature emphasizes the importance of knowledge of the counseling center staff in regard to
assessing and treating students in distress appropriately. This includes the factual knowledge as
stated by Kiracofe (1993) and Mowbray et al. (2006) in regard to the counseling center staff’s
ability to correctly identify and support students with severe mental health diagnosis.
Additionally, university counseling center staff must have factual knowledge in regards to being
multiculturally competent and understand the histories and experiences of marginalized groups
within our society (Arredondo et al., 1996) as well as the metacognitive knowledge of how to
self-reflect and view their own privilege when interacting with clients (Constantine et al., 2007).
Finally, counseling staff must have the procedural knowledge necessary in order to properly refer
students to community based mental health providers when treatment needs exceed the services
of the campus counseling center (Mowbray et. al., 2006; Murphy & Martin, 2004; Cornish, et. al.
(2000).
University counseling therapists, must obtain high levels of self-efficacy in order to
effectively meet the demands of their jobs. As Smith et al. (2007) found, regardless of the
increasing caseload and demand for services, student counseling center therapists maintain high
levels of job satisfaction and believe that they are able to accomplish the demands of their
position. Throughout my study, I sought to validate if the self-efficacy that counseling center
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therapists at the seven participating programs maintain enables them to stay highly motivated in
their positions regardless of their caseloads.
The final performance factor that I sought to validate in my study is the organizational
challenge of resources. Many researchers such as Smith et al. (2007) and Gallagher (2004) have
highlighted the tenuous financial situations plaguing university counseling centers. Regardless
of the increased client caseload and demand for consultation services, student counseling centers
are not seeing a comparable increase in their resources (Smith et al., 2007; Gallagher, 2004). As
a result, through my study, I attempted to validate that this is a challenge throughout all of the
participating programs as well.
As I sought to validate whether these assumed assets are factors that either contribute to
or impinge upon the effectiveness of counseling centers at institutions of higher education, I tried
to determine how the online graduate student sector is impacted. I sought to ascertain whether
the assumed skills that counseling center staff need to support brick and mortar staff remain the
same for distance learners or whether there is a unique skill set that counselors cultivated as well.
For example, it seems that some of the unique skills that therapists who support the distance
learning population will need to know is how to access mental health resources throughout the
world in order to appropriately refer students to providers. Throughout this study, I hoped to
uncover the additional skills that counseling center staff must have in order to effectively and
appropriately support the online graduate student population.

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Summary
Table 1. Summary of assumed assets for knowledge, motivation, and organizational issues.

Assets
Sources
Knowledge Motivation Organizational
Processes
Personal
knowledge
• First-responders
(ex. advisors,
professors, various
staff) are often the
first line of
communication for
a student in crisis
and need to know
how to respond
appropriately and
refer student to
counseling centers
for assistance
• Student
counseling staff
often feel as
though their work
is a “thankless
job”

• Staff are subjected
to harsh criticisms
as a result of their
decisions in crisis
situations

• Compassion
fatigue is
prominent among
• Funding for
university
counseling
centers has not
increased to
match the
growing
demand for
therapeutic
services and
campus
outreach
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counseling center
staff
Related
literature
• Per diem therapists
and trainees do not
have the
skills/understandin
g needed to work
with university
students (F)

• Therapists lack the
ability to properly
assess severe
mental health
diagnoses (F)

• Effectiveness of
psychology
doctoral programs
at preparing
graduates to work
with university
• Counseling center
staff are willing to
persist even with
increasing
caseloads and
constrained
budgets

• Administrators
incentivizing staff
(flexible hours,
professional
development)

• Administrators
assuming
administrative
responsibilities

• Increased
• Changes need
to be made to
internal
organizational
structure
(increased
hours, group
therapy
sessions,
improved
appointment
scheduling,
etc.)

• Resource
allocations
must increase

• The American
stigmatization
of mental
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students (F)

• Understanding of
student
development theory
(C)

• Counselors do not
know how to use
referral systems
and processes (P)

• Counselors need to
know how to
implement crisis
intervention teams
and protocols (P)

• Counseling staff
must be
multiculturally
competent (M)
caseload is
causing some
therapists to feel
overwhelmed
health, effects
help-seeking
behaviors

• Counseling
centers have
undefined
standards of
care and
practice

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Conclusion
In this chapter, I examined the literature surrounding counseling centers at institutions of
higher education. The literature was organized through the lens of learning theory and applied
using Clark and Estes’ (2008) gap analysis framework. This chapter assessed the factors that
contributed to the effective implementation of university counseling centers as well as those that
served as inhibitors.
Using the knowledge, motivation, and organization model as a guide I was able to
identify several assets and inhibitors to the success of effective university counseling centers.
Some of the assets that a successful university counseling center must embody include
counseling center staff who are knowledgeable about how to appropriately diagnosis severe
mental health conditions (Mowbray et al., 2006; Kiracofe 1993); psychology graduate programs
that properly prepare students for the rigors of a career in collegiate mental health (Smith et al.,
2007; Bishop, 2006); partnerships and referrals with community based mental health providers
(Mowbray et al., 2006; Murphy & Martin, 2004; Cornish et al., 2000); and counseling center
staff who demonstrate high levels of multicultural competence (Constantine et al., 2007; Smith et
al., 2007). Some of the factors that inhibit the success of university counseling centers include
constrained counseling center budgets (Smith et al., 2007; Gallagher, 2004; Guinee and Ness,
2000) increased demands for services for students (Smith et al., 2007; Murphy & Martin, 2004;
Guinee and Ness, 2000); and the stigmatization associated with mental health across the
American society (Mowbray, et al., 2006; Blacklock, et al., 2003). I also provided information
regarding standards for university counseling centers (CAS and IACS) as well as information
regarding the strengths and weaknesses of Internet-based mental health services.

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CHAPTER THREE: METHODOLOGY
Purpose of the Project and Questions
The purpose of this project was to study university student counseling centers and the
protocols they utilize in order to support online graduate students. The analysis focused on
assets in the areas of knowledge and skill, motivation, and organizational resources. As such, the
questions that guided this evaluation study are the following:
1. To what extent are university counseling centers meeting their goal of providing mental
health support services to graduate students in online degree programs?
2. What are the knowledge, motivation, and organizational influences related to achieving
this goal?
3. What are the recommendations for organizational practices in the areas of knowledge,
motivation, and organizational resources?
Framework for the Study
The framework for this study was based on the gap analysis model as proposed by Clark
and Estes (2008). As discussed earlier, the gap analysis model assesses the performance of an
organization via the desired goals the organization is attempting to achieve. Using the ideal
performance goal as the basis for the assessment, the gap analysis model determines where the
organization is falling short in terms of its performance. Once the gaps in desired performance
have been identified, one can then look for the knowledge, motivational, and organizational
barriers that are negatively impacting the success of the organization. A detailed understanding
of the causes/facilitators leading to the gaps enables one to then implement solutions in hopes of
improving the knowledge, motivation, and organizational gaps in order to achieve ideal
performance. It is significant to note that the gap analysis processes is cyclical and requires the
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constant assessment, evaluation, and enhancement of intervention strategies in order to achieve
the desired goal (Clark & Estes, 2008). The methodology for this study utilized various data
collection modalities including surveys and interviews. All of the collected data was analyzed to
ensure a thorough assessment of the data.
For the purposes of this study, the performance goal that I sought to evaluate is: are
university student counseling centers providing excellent services to all online graduate students
at a reasonable cost to the institution. (For the purposes of this study, excellent crisis
intervention services was defined as services that successfully identify students in distress,
intervene as appropriate, and refer students to the necessary resources in order to ensure their
support and continued successful enrollment in their program).
Figure 1. Gap analysis process
Presumed Performance Assets
When conducting a gap analysis assessment in accordance with the framework as
proposed by Clark and Estes (2008), it is necessary to validate that the assumed causes or
facilitators contributing to the gaps in knowledge, motivation, and organization are correct.
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Without a thorough assessment of the causes that are contributing to the performance gap,
relevant solutions will not be implemented as the crux of the problem is not appropriately
identified. As a result, this study ensured thoroughness by investigating the causes of the
performance gap. The causes as identified by the literature were discussed in detail in Chapter
Two.
Validation of the Performance Assets
Having established an understanding of the knowledge, motivation, and organization
assets that the literature says contribute to or inhibit the achievement of a performance goal, the
next step was to validate the assets that the programs, themselves, identified. The remainder of
the information in this chapter will therefore focus on describing the methods used for assessing
the performance indicators discussed.
Validation of the Performance Assets: Knowledge
Krathwohl (2002) provides a framework for analyzing the various levels of knowledge.
Using Krathwohl’s (2002) level of knowledge, one can assess the knowledge and skills needed
to develop promising practices in university counseling services for online graduate programs.
Validation of factual knowledge assets.
According to Krathwohl (2002), factual knowledge is defined as the information one
requires in order to complete a task/job. This knowledge can take the form of facts and
terminologies. In order to validate factual knowledge one can administer assessments that require
participants to answer questions in order to assess their level of knowledge or interview them in
regard to basic information. For the purposes of this study, in order to validate the factual
knowledge causes, I surveyed and interviewed therapists and inquired as to their experiences
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working with university students prior to working in university counseling centers. Also in the
interviews, I inquired as to the frequent mental health diagnoses prevalent on their campuses.
Validation of conceptual knowledge assets.
According to Krathwohl (2002), conceptual knowledge is related to one’s ability to
understand the principles or theories in place in order to function properly or effectively.
Conceptual knowledge can be assessed via surveys in which participants are asked to identify
and categorize theories or compare various concepts. It can also be assessed via interviews in
which participants are asked to paraphrase key concepts or operating procedures. For the
purposes of this study and in order to assess the conceptual knowledge of counseling center staff,
staff was surveyed as to their understanding regarding student development theory and then
followed up with interview questions regarding how their graduate programs prepared them to
work with university students.
Validation of procedural knowledge assets.
According to Krathwohl (2002), procedural knowledge is an individual’s ability to
comprehend and articulate the order of operations necessary in order to complete a task. The
procedural knowledge of the counseling center staff was assessed in regards to their
understanding of referral systems and processes by interviewing clinicians and asking them to
explain their referral procedures for online students.
Validation of metacognitive knowledge assets.
According to Krathwohl (2002) metacognitive knowledge is one’s ability to assess one’s
approach, reflect upon it, and alter it as necessary. In order to validate the assumed factor of
multicultural competence and that counseling center staff need to reflect on their privilege (or
lack thereof) as well as that of their clients in addition to their innate privilege based on the
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American society social structure, staff was surveyed and asked to rate the importance of
multicultural competence in their daily interactions with students as well as asked them to
provide their definition of multicultural competence and how they implement it.
Table 2. Summary of assumed knowledge assets and their validation.
Assumed Knowledge Asset How was it validated?
Per diem therapists and trainees need to
know how to work with university
students. (F)
No per diem therapists or trainees
participated in my study and thus I was
unable to assess this asset.
Therapists need to know how to properly
assess severe mental health diagnoses. (F)
Respondents elaborated on:
• Their confidence level in
diagnosing mental health
conditions.
Psychology doctoral programs need to
prepare graduates on how to work with
university students. (C)
Respondents elaborated on:
• If they felt prepared for working
with university students as a result
of their education.

University counseling staff need to
understand student development theory.
(C)
Respondents elaborated on:
• Their understanding of student
development theory
• How they gained their
understanding
• How they implement student
development theory in their daily
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interactions.
University counselors need to know how to
refer students to off-campus mental health
treatment providers and resources. (P)
Respondents elaborated on:
• Their understanding of their
campus referral processes and the
unique nature of referrals for
distance learners.
University counselors need to be
multiculturally competent and self-reflect
on their own privilege when working with
clients. (M)
Respondents elaborated on:
• Their definitions of multicultural
competence
• The impact of their identity on the
therapeutic relationship
• How they practice multicultural
competence in their daily
interactions.

Validation of the Performance Assets: Motivation
Table 3. Summary of assumed motivation assets and their validation.
Motivational Asset Type of
Indicator
Possible
Cause(s)
How was it validated?
University counselors
are motivated to perform
regardless of their
increasing caseload and
Mental effort;
persistence
Self-efficacy Respondents elaborated on:
• Willingness to persist
and engage in their
jobs
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constrained budgets. • Incentivizes to
perform
• Personal struggles
University counseling
center staff feel as
though they are able to
meet the demands of
their caseloads
successfully.
Active choice Self-efficacy Respondents elaborated on:
• Ability to meet the
needs of their
students

University counseling
center administrators
assume additional
administrative
responsibilities to ease
the burden of their
clinicians.
Task value Attainment
value
Respondents elaborated on:
• Easing the
administrative
responsibilities of
their staff

Clark and Estes (2008), Rueda (2011) and Mayer (2011) provide frameworks for
assessing motivation and explaining why individuals are driven to begin, persist, and complete
the tasks in which they are engaged. In order to validate the assumed motivational factor that
university counselors are motivated to perform their job responsibilities regardless of their
increasing caseload and constrained departmental budgets, I surveyed and interviewed the
university counselors. In the interviews, participants were asked how they feel about their
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ability to meet these increasing demands. In order to validate the next assumed motivation
factor, that university counselors feel as though they are able to meet the demands of their
caseload, therapists were surveyed via Likert scale questions. Participants were asked to rank
whether or not they feel that regardless of the increased caseloads, they are able to successfully
meet the demands of their clients.
Finally, in order to validate the final assumed motivational factor that counseling center
administrators have assumed additional administrative responsibilities in order to allow their
therapists to focus on serving the students, counseling center directors were surveyed and
interviewed. First, the directors were surveyed via Likert scale and inquired as to whether or not
they find value in assuming administrative duties. Then follow up interviews were conducted in
which directors were asked them to reflect on how valuable their completion of administrative
duties is to the department and the support of the counselors.
Validation of the Performance Assets: Organization/Culture/Context
Table 4. Summary of assumed organizational/culture/context assets and their validation.
Organizational Asset Possible Organizational
Causes
How was it Validated?
The structure of student
counseling centers needs to
be altered to better meet the
increasing demands of
students.
Cultural model Respondents elaborated on:
• The current structure of
the counseling center
and offered suggestions
for improving visibility
and services.
University counseling centers Cultural setting Respondents elaborated on:
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require additional resource
allocations.
• Financial resources
needed to improve
services
• Compensation for
staff
University students are
hesitant to seek mental health
support as a result of social
stigmas.
Cultural setting Respondents elaborated on:
• Stigmatization of
mental health in the
United States
• Help-seeking
behaviors of
university students

Using the concepts of cultural models and cultural settings as described by Rueda (2011),
and Gallimore and Goldenberg (2001), I sought to validate the assumed organizational factors
that are effecting the success of university counseling centers in supporting their online graduate
student population. In order to validate the assumed factor that the structure of college
counseling centers must be improved in order to better serve the student clientele, college
counselors were asked to participate in a survey. Using a Likert scale, participants were asked to
rank whether the hours of operation for their center need to be enhanced and if increased group
therapy options should be implemented. In order to validate the assumed organizational factor
that counseling centers are experiencing financial constraints, first counseling center therapists
were asked to complete a Likert survey question regarding the appropriateness of the funds they
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are currently receiving in regards to the student populations that they serve. Next, follow up
interviews were conducted with participants as to what (if any) additional resources they seek in
order to better serve their students. During interviews with the counseling center staff, they were
asked questions regarding whether or not they feel that the visibility of the counseling center
needs to be enhanced on campus and how they would suggest such measures take place. Asking
such a questions enabled me to validate the assumed organizational factor that counseling centers
need to improve their visibility on university campuses. Finally, in order to validate the assumed
organizational factor that university students are hesitant to seek mental health services as a
result of the stigmatization surrounding mental health, counselors were first asked to complete a
Likert scale question on a survey assessing whether they believe this is an issue on their campus.
In follow up interviews, counselors were then asked how they seek to address this issue on their
campus and what suggestions they have for improvement.
Participating Stakeholders
The population for this evaluation study was drawn from eleven universities throughout
the United States. The participating institutions all share the following principles with respect to
online graduate programs: a) a brick and mortar campus offering undergraduate and graduate
degrees, b) a student counseling center providing mental health support services to students on
the brick and mortar campus and c) online graduate programs. Additionally, many of the
institutions utilize a common cloud-based software-as-a-service (SaaS). The sampling technique
strategically identified key administrators at many institutions who attempted to assist in making
connections with the counseling center director at each institution. Often times however, the
program administrators were unable to assist in forging connections with the counseling center
directors and thus the researcher sent introductory emails to the counseling center directors.
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Through email communications with the counseling center directors, it was requested that they
assist in recruiting their clinicians to participate in the study. After the completion of the survey,
telephone interviews were conducted with various respondents. Through the phone
conversations with counseling center staff and program administrators, referrals were made to a
SaaS corporate partner and a private company who provides mental health services to distance
learners and subsequent interviews were conducted with them as well. The study participants’
demographics and statistics are summarized in Table 5.
Table 5. Summary of study participant demographic data.

1
Many university counseling centers were invited to participate in the study but chose not to participate and sent a
brief email explaining their interactions (or lack thereof) with online graduate students. These individuals were not
counted in the response rates.
Total
Number of
Participants
Response Rate Employment Types
Average Years
of University
Counseling Staff
Working with
University
Students
15
1
Survey – 11
individuals from
schools began
the survey and 6
completed the
survey
Interview- 10
 University Counseling Center
Director
 University Counseling Center
Assistant Director
 University counseling center
full-time therapist
 University counseling center
8.9
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The researcher invited eleven institutions to participate in the study. Of the eleven
invited institutions, the exact number of the participating universities is difficult to ascertain
based on the anonymity of the survey responses. It is significant to note, that of the eleven
institutions invited to participate in the study, four universities elected to not participate in the
study as they indicated that the counseling center staff do not support the mental health of
distance learners. Ten individuals participated in the study by beginning the survey but only six
individuals completed the survey in its entirety. Additionally four of the survey questions were
geared solely towards counseling center directors. Interviews were conducted with eight
counseling center staff varying from counseling center directors to social workers and therapists.
Additionally, the researcher conducted interviews with an Executive Dean, Director of Student
Services, Associate Dean, and two staff members from a third party corporate vendor. These
interviews were unanticipated prior to beginning the study as the researcher was unaware of the
relationship between one of the distance learning graduate programs and the third party vendor.
Once it became clear that the corporate partner was providing mental health support services to
individuals were
interviewed (5
were mental
health
professionals)
intern
 Executive Vice Dean
 Director of Student Services
 Associate Dean
 SaaS corporate partner
 Accounts manager at
corporation

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students in one program, the vendor was quickly identified as a key stakeholder in the study and
was subsequently interviewed.
Data Collection
Prior to conducting the study, permission was obtained from the University of Southern
California’s Institutional Review Board (IRB). In order to validate the knowledge, motivation,
and organizational causes that were assumed (as stated above), various methods of data
collection were employed including surveys and telephone interviews. This study was structured
to include various methods of data collection in order for triangulation to occur and ensure the
trustworthiness of the data. The anonymity and confidentiality of respondents was of utmost
importance throughout the study. As a result, all surveys were conducted online anonymously
prior to speaking with the interviewer. No identifiable information was collected in the
anonymous surveys. Since anonymity is not possible in one-on-one interviews, identifiable
information was safeguarded via a password protected document. Information regarding the
participants was only shared with my teammates and faculty advisors. The document with all
identifiable information was destroyed at the culmination of the study. Additionally, when the
findings were reported, all identifiable characteristics were removed and pseudonyms were used
to protect participants.
Surveys
Surveys were an important means of data for my evaluation study on university
counseling centers and their ability to support online graduate students. Once USC IRB approval
was received, contact was made with the program administrators at each partner campus (when
applicable) and sent an email with my Internet-based survey to university counseling center staff.
The anonymous survey was 31 questions in length for therapists and 40 questions in length for
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counseling center directors and it is estimated that it took participants about thirty minutes to
complete. The questions in the survey were based on the assumed knowledge, motivation, and
organization assets listed above. Prior to asking questions relating to the assumed causes, the
participants were asked to provide some basic demographic information including the title of
their current position, to identify the school in which they work, and how long they have worked
at that institution. In order to recruit additional participants to complete the survey, the
counseling center director was used as the “gatekeeper” at each site as that individual was able to
send my survey out to their staff. Throughout the data collection process, additional emails were
sent out reminding people about the survey and requesting their participation. At the completion
of the survey, there was an optional space for respondents to enter their email address if they
were willing to be contacted for a follow-up interview. In order to ensure the anonymity and
confidentiality of all of the surveys and participants, all responses were stored on a password
protected website and were destroyed at the completion of this study. Additionally, in order to
ensure that the data is accessible, a copy of the survey results was also stored on an external hard
drive that was stored in a locked drawer. The survey instrument can be found in Appendix A.
Interviews
Interviews served as the second main source of data for my evaluation study on
university counseling services for online graduate students. I was intentional with the interview
protocols that I created and the questions I asked were based upon assumed factors that
contribute to or impinge upon university counseling center effectiveness when supporting online
graduate students. The interviews were composed of 20 questions for counseling center directors
and 16 questions for clinicians. The interviews lasted approximately 45 minutes. Prior to the
interview, each respondent was emailed an informed consent form as requested by USC IRB.
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The interviews were administered via telephone. In order to recruit participants, the counseling
center director was contacted at each institution and it was requested that they forward a
recruitment email to their staff. As a result, the participants were recruited on a convenience
sample basis. All of the interviews were transcribed. Each interview was conducted following a
semi-structured interview protocol beginning with demographic questions and then transitioning
into questions related to validating the assumed knowledge, motivation, and organization factors
effecting university counseling centers as listed above. While I closely adhered to my interview
protocol, I asked probing questions if I needed additional clarification or information from a
participant. The distinguishing factor between survey and the interview was that the interview
provided me with the opportunity to further probe my respondents and get additional
information. The interview protocol can be found in Appendix B.
Trustworthiness of Data
Ensuring the trustworthiness of data is crucial to all forms of inquiry and research. In
order to ensure that my data is trustworthy the data sources were triangulated to ensure that the
conclusions drawn are based in the literature and the interviews and surveys conducted. All
survey and interview questions were based on proven validation measures from Clark and Estes
(2008) gap analysis model and the Learning and Motivational Theory framework. The utmost
levels of anonymity (whenever possible) were adhered to and confidentiality was guaranteed in
order to encourage participants to openly and safely share their experiences.
Role of Investigator
I am a doctoral student in the University of Southern California Rossier School of
Education. Additionally, I am also an employee at the University of Southern California. I
served as a student crisis case manager at USC for three and a half years before recently
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transitioning to a new position involving discrimination and harassment claims and managing
our university threat assessment team. As a former student crisis case manager, I was
responsible for serving as a first-responder to students in crisis for a variety of reasons: mental
health, financial concerns, family emergencies, academic stressors, or any other issues that were
preventing a student from being successful on campus. I partnered with numerous departments
on campus to identify students in distress and provided them with the appropriate support and
referrals. One of my primary campus partners was the USC student counseling center and thus I
know the staff at the center on both a personal and professional basis. It is important to note
however, that I am not a mental health professional as my role required that I was not bound by
confidentiality laws as stipulated by HIPPA. While I am no longer in a crisis management role, I
continue to work with various first-responders as I assist in facilitating the USC threat
assessment team and therefore remain privy to confidential information and potentially
threatening situations and individuals.
While a study of this kind regarding promising practices of online graduate programs has
not yet been conducted on the USC campus, our staff and faculty members are accustomed to
receiving requests to participate in various surveys. As a result, an additional request promising
anonymity was unusual to the staff at the USC student counseling center. All of the counselors
with whom I work and opted to participate in the study, were made aware of my role as an
investigator and steps taken to ensure their anonymity. I reassured the participants that
participation was voluntary and there would not be consequences for opting out of the study or
providing me with negative information regarding my (or my colleagues) job performance. I
also ensured that all participants understood that these data were being collected in my role as a
doctoral candidate and thus my faculty advisors will determine how best to utilize my findings.
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Individuals who are interviewed were promised confidentiality as all identifying
information was removed. Once an individual agreed to participate in an interview, I offered to
provide him/her with the opportunity to have another interviewer from my team present during
our conversation if they chose.
Data Analysis
In order to interpret the data obtained via surveys and interviews, I engaged in a
meticulous process of data analysis. Once all of the data were collected, a process of
triangulation ensued to determine whether various data points corroborated with other data points
(Miles, Huberman, & Saldaña, 2014). For the survey data, I utilized frequency analysis to depict
the percentage of the stakeholders who were in agreement with certain statements or shared
common experiences. I organized the interview data that I collected via a priori coding methods.
The a priori codes were extracted from the literature as well as via the empirical codes that I
discovered in the interviews (Harding, 2013). The a priori codes from the literature were based
on the knowledge, motivational, and organizational facts that contribute to or impinge upon
student counseling centers. As Miles et al. (2014) discuss, the data coding process was
multifaceted as I engaged in first cycle coding, where data points are categorized and second
cycle coding, where data points were combined and the creation of patterns and themes emerged.
Conclusion
In this chapter, I reviewed the knowledge, motivational, and organizational literature that
directly relates to student counseling center staff. I then discussed the assumed causes which I
seek to validate through this study. Finally, I provided a detailed explanation of the framework
and methodology I used in implementing my study.

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CHAPTER FOUR: RESULTS AND FINDINGS
The purpose of this study was to identify the processes and protocols university
counseling centers utilize in order to support online graduate students. The study focused on the
knowledge, motivation, and organizational factors that counseling center staff confirmed either
facilitated or hindered the mental health support of online graduate students. These questions
guided the inquiry:
1. To what extent are university counseling centers meeting their goal of providing
mental health support services to graduate students in online degree programs?
2. What are the knowledge, motivation, and organizational influences related to
achieving this goal?
3. What are the recommendations for organizational practices in the areas of knowledge,
motivation, and organizational resources?
In order to assess and validate the knowledge, motivational, and organizational assets that
university counseling centers need in order to support the mental health of graduate distance
learners, a modified version of Clark and Estes’ (2008) gap analysis framework was used.
Participating Stakeholders
Eleven universities were invited to participate in this study. The exact number of
universities that chose to participate in the study is difficult to determine given the anonymity of
the survey. The participating institutions all share the following principles with respect to online
graduate programs: a) a brick and mortar campus offering undergraduate and graduate degrees;
b) a student counseling center providing mental health support services to students on the brick
and mortar campus; and c) online graduate programs. Additionally, many of the institutions
utilize a common cloud-based software-as-a-service (SaaS). Each institution is differentiated by
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factors such as the geographic location of the institution, the relationship between each program
and the university counseling center associated with that campus, and state standards/laws
regarding mental health treatment. All of these factors are examined in this study using a
modified gap analysis (Clark and Estes, 2008) through the perspective of counseling center
clinicians and directors as well as program administrators as they are the individuals responsible
for supporting the mental health of students.
This chapter presents the results of the data collection process outlined in Chapter Three.
As a reminder, a summary of the assumed causes from the research is outlined in Table 1.
Table 1. Summary of assumed assets for knowledge, motivation, and organizational issues.

Assets
Sources
Knowledge Motivation Organizational
Processes
Literature • Per diem
therapists and
trainees need to
know how to
work with
university
students

• Therapists need
to be able to
assess severe
mental health
conditions

• University
counseling
center staff are
willing to
persist even
with increasing
caseloads and
constrained
budgets

• University
counseling
center directors
incentivize staff
• University
counseling
centers need
restructuring
(additional
resources,
alternate hours,
etc.)

• University
students are
hesitant to seek
counseling as a
result of the
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• The
effectiveness of
psychology
graduate
programs at
preparing
clinicians to
work with
university
students

• University
counseling
center
clinicians need
an
understanding
of student
development
theory

• University
counseling
center
clinicians need
to understand
how to use
referral systems

• University
counseling
center directors
assume
administrative
roles to ease the
burdens of their
staff

• Increased
caseload is
causing some
therapists to
feel
overwhelmed

American
stigmatization
of mental
health

• University
counseling
centers have
undefined
standards of
care and
practice
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• University
counseling
centers need to
implement
crisis
intervention
teams and
protocols

• University
counseling
center
clinicians need
to be
multiculturally
competent

Survey Results
Eleven universities throughout the United States were recruited to participate in the
study. Of the eleven institutions contacted, the survey was completed anonymously by ten
individuals. The number of participating institutions is impossible to establish as the survey was
anonymous in nature. Of the ten individuals who began the survey, six of them completed the
survey in its entirety. The survey consisted of forty questions asking participants to rank their
agreement with the particular statement. There were also four questions that were geared solely
to counseling center directors. A critical aspect of the survey was to identify whether the
assumed knowledge, motivational, and organizational factors were contributing to or impinging
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upon the success of the counseling center and provide a framework for the interviews that
followed. A result was considered validated if the majority of the respondents were in agreement
in their responses. (It is significant to note, that not all of the questions had the same number of
responses as some participants declined to answer certain survey items for unknown reasons).
The specific survey protocol may be seen in Appendix A.
Findings from Interviews
The interviews were conducted over the telephone and scheduled privately with each
participant. Each interview was approximately forty-five minutes in length. The full interview
protocol may be seen in Appendix B. The primary reason for issuing the survey before the
interviews was to establish a context of information that would influence the interview process.
Thus, the critical next step of the study protocol was to delve deeper into the participants’
knowledge and skills regarding the mental health needs of university students in order, to better
understand what motivates clinicians to engage in such work, and to identify the organizational
factors contribute to those processes.
Results and Findings for Knowledge Causes
According to the literature, there are numerous knowledge assets that counseling center
staff must obtain in order to support the needs of university students. In this study however, the
emphasis was placed on the following knowledge and skill set that the literature suggests that
counseling center staff must obtain: a) counseling center clinicians need to have attended
graduate preparation programs that prepared them for working with the university-aged
population (Bishop, 2006); b) have a detailed understanding regarding the unique needs of
college students (Mowbray, et al., 2006), c) engage in multicultural competence (Freier, 1990;
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Constantine, 2002; Fuertes & Brobst, 2002; Smith, et al., 2007) and d) understand how to and
appropriately use referral processes (Cornish, et al., 2000; Murphy & Martin, 2004).
The assumed knowledge assets and their corresponding results from the survey and
interviews are summarized in Table 6.
Table 6. Summary of assumed knowledge assets student counseling center staff need to support
the mental health of distance learners.

Assumed Knowledge Asset Results of Survey – Validation

University counseling staff need to attend
graduate school programs that prepare
them to work with university students and
understand their unique needs.

 Asset Validated - Participants
expressed that their graduate programs
prepared them for working with
university students yet many were
unfamiliar with the concepts of student
development theory at the time of the
survey. Those that were familiar with
student development theory appear to
have gained that knowledge as a result
of their own research and practice in
the field indicating that it is a
necessary skill but is not taught in
graduate programs. Similarly, many
of the participants commented that
much of their knowledge regarding
working with students came from
internships and years of experience.

University counseling staff need to have a
detailed understanding of multicultural

 Asset Validated – Participants
expressed the importance of
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competence and practice it in their
interactions with students.

multicultural competence and the role
that intersecting identities has on one’s
development. They also mentioned the
importance of being aware of their
own identities and how that impacts
their relationship with clients.

University counseling staff need to know
how to utilize the referral process.

 Asset Validated - Most participants
expressed that they lacked resources
for online students yet were able to
clearly articulate the referral
procedures for brick and mortar
students. Those respondents who were
knowledgeable about resources for
distance learners acquired that
knowledge as a result of conducting
their own research.

Knowledge Asset #1: Graduate Programs Need to Properly Educate University Clinicians
The literature discussed the importance of graduate programs properly preparing
clinicians to work in the university counseling center realm (Bishop, 2006). Working in the
college sector is unique and requires clinicians to have an understanding of student development
theory (Webb, Widseth, & John, 1997). The literature unveiled that university counseling center
clinicians are often not prepared to work with university aged students as their graduate degree
programs do not prepare them for the unique needs of this population (Kiracofe, 1993; Mowbray
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et al., 2006). As a result, the surveys and interviews conducted in this study sought to explore
the experiences of university counseling center clinicians in their graduate programs and whether
their educational careers translated into a breadth of understanding regarding university students.
The survey inquired about whether or not the participants felt as though their graduate
programs prepared them to work with university students as well as asked about their
understanding of student development theories. The assumed asset that university clinicians need
to be educated on how to work with university students was validated because participants
reported that they believed that their graduate degree programs provided them with the
knowledge necessary to work with university-aged students. It is important to note however that
while the respondents believed that they had the educational background necessary to work with
university students, many did not know about student development theory indicating that many
participants are unaware about the limitations of their knowledge in this realm. For those
respondents who did understand student development theories and attempt to utilize the concepts
in their work with patients, they commented that they engaged in their own research to learn
about it via seminars, practicum experience, and by work experiences.
Similarly, the interview protocol explored the experiences of respondents in their
psychology graduate programs. All of the respondents in the study were content with their
graduate programs (be it social work or doctoral programs) and believed that they were
adequately prepared to work as mental health providers. Interestingly enough however, nearly
all of the respondents noted that while their programs prepared them for a career in mental health
services, they were not prepared to work with the college sector. As one respondent explained,
“my college student training came on the job and from my own figuring out best interventions.”
Another respondent stated that he/she believes that those interested in working in the university
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mental health sector should be required to enroll in classes on substance abuse education and
personality disorders in order to better be prepared for the common issues facing college
students. Thus, while this knowledge asset was validated in that the respondents were prepared to
work in the mental health field, it appears that most of their knowledge in regards to supporting
the university aged population came from internships, on-the-job training and years of
experience. One respondent stated, “I think my program prepared me for the field (of mental
health) but not uniquely for students…I felt prepared because of my internship…and previous
experience.”
Knowledge Asset #2: University Clinicians Need Practice Multicultural Competence
The second asset that the survey sought to validate was the importance of multicultural
competence in a therapeutic relationship. According to the literature, successful clinicians need
to be aware of their own identities and how they might be perceived by their clients
(Constantine, et al., 2007). Additionally, a successful clinician takes into consideration various
aspects of the student’s identity that might be impacting his/her response to a situation
(Arredondo, et al., 1996). The survey respondents were in agreement with the literature
regarding the importance of multicultural competence in establishing credibility and rapport with
clients and attempt to implement it in his/her daily interactions with students. All participants
reported familiarity with the term multicultural competence and provided written explanations of
their definitions of the term and how they choose to use it in their daily practice. As one
respondent wrote in an open-ended short answer question, multicultural competence is “being
knowledgeable and versed on the uniquely-complex experience, needs, values, traditions and
history of diverse groups…” Another respondent answered the same question by explaining that
multicultural competence is, “being aware of the various aspects of our identities…and how
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these may impact our interactions…” This finding validated that clinicians are required to and
possess a strong knowledge base in regard to multicultural competence that is similar to what
was described in the literature.
Knowledge Asset #3: University Clinicians Need to Know How to Utilize Referral Processes
The literature identified the need for clinicians to have a detailed knowledge of referral
processes in order to ensure that students are being sent to the appropriate off-campus mental
health providers (Cornish et al., 2000; Murphy & Martin, 2004). This finding was important as
the survey indicated that four of the respondents felt they were well versed in mental health
resources for online students yet when it came time to explain their response in short answer
form, a few responded that their knowledge of resources for online students stems from their
own personal research or the public services available to all individuals. Additionally, nearly
half of the respondents answered that they were unaware of mental health resources for students
who resided outside of the local university community. This result suggests that while
counseling center staff believe that they have knowledge about resources for the distance
learners, their knowledge has been developed as a result of their own research and is limited for
students who do not reside in the immediate community. Thus the results imply that counseling
center staff have knowledge about referrals for brick and mortar students who reside in the local
vicinity but are unaware of resources for distance learners other than the services available to all
people via the Internet.
All of the counselors who participated in the interview component of the study were able
to quickly and thoroughly explain their referral policies and procedures for brick and mortar
students. In fact one respondent explained that at his/her university not only do clinicians assist
students in getting connected with mental health providers in the local community for prolonged
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treatment but they also follow up with the students to ensure that they have fostered a therapeutic
relationship with the off-campus provider.
When respondents were asked about their knowledge of referral resources for distance
learners however, all of them explained that they did not have adequate knowledge of resources
for the students. Some of the respondents stated that while they are unable to provide treatment
to online students for a myriad of reasons (ex. cross-state licensure issues, insurance issues, etc.)
they still offer initial consultations to online students who contact their centers for support and
try to assist them in getting connected to mental health providers in their local communities. As
one clinician stated:
With online out of the area students, we go online and try to find resources in
their area that they can access through their insurance or community mental
health programs and then we give it to them. It takes extra research for the
clinician. That is it at that point and it is up to the student to follow through…To
go online and look (up resources for distance learners) was a decision made by
our director because the university was making it clear to us that online students
should have access to the same services as brick and mortar but we can’t give
them the same support as if they came in (to our center).

Another clinician explained that since he/she has an ethical obligation to help a student in
distress even though the student might not be entitled to campus services he/she has used
creative measures to connect that student with a therapist in the local community. For example,
that therapist has called university counseling centers close in proximity to where the online
student resides and requested a list of their off-campus referrals and provided that to the student.
Additionally, the therapist also explained that on certain occasions he/she utilizes an
“online site” to look up therapists in a specific country or region and refers a student there. This
clinician cautioned that he/she was unsure of the reputability of therapists found on this site.
Thus, while it was validated that university counseling center staff need to have knowledge of
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referral processes and procedures, it appears that there are not standardized referral processes for
distance learners and thus counselors are forced to conduct their own research and share
resources amongst each other.
Synthesis of Results and Findings for Knowledge Causes
All of the three main assets that this component of the study: a) that graduate programs
properly prepare future clinicians to work with the unique needs of university students, b)
therapists need to practice multicultural competence and c) clinicians need to understand how to
utilize referral networks and processes were validated. It is significant to note however, that
while the clinicians felt that they had the knowledge to necessary to work with university
students, it appears that most of that knowledge was elicited through their own endeavors and
was not taught to them in their graduate studies. Equally important is the fact that while the
clinicians felt confident in their ability to refer students to outside providers in the local
community, many of them forged their own networks and referral resources for distance learners
as a result of personal research. Thus, it seems that the clinicians who maintain the knowledge
assets as described in the literature, have done so through their own personal inquiries and quest
to provide the best care for their students.
Finally, and arguably, most significant, is the fact that much of the knowledge regarding
the skill sets of clinicians working with online graduate students is unable to be assessed as many
of the respondents commented that they do not work with distance learners. Similarly, a few
counseling center directors opted to not participate in the study at all as they do not have the
ability or licensure to support online students. Thus, a common theme that emerged throughout
the interviews and surveys was the fact that many university counselors are unable to provide
support for distance learners as clinicians are allowed to practice only in the state in which they
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are licensed and therefore providing therapy to those who reside elsewhere would be a breech of
their licensure. In such cases, it appears that the role counseling centers take in supporting
distance learners is to provide consultations to faculty and staff who encounter students who may
need mental health support on how to engage with such students.
Results and Findings for Motivation Causes
Motivation, or the study of why individuals choose to engage in certain activities, is the
second component of Clark and Estes (2008) gap analysis framework. The notion of motivation
is broken down into three indices: active choice, persistence and mental effort. Active choice is
defined as one’s decision to engage in a certain task (Clark & Estes, 20080. Persistence is
defined as an individual’s ability to engage in the task through its completion (Clark & Estes,
2008). Finally, mental effort can be defined as how hard one is willing to work in order to
accomplish a difficult task (Clark and Estes, 2008). Active choice, persistence and mental effort
can be influenced by self-efficacy, values, attributions, interest, and goals (Clark & Estes, 2008).
Motivation of the counseling center was critical to this study as it assessed whether the
counseling center staff were willing to engage and persist in the rigors of their job given the
increasing caseload and increasing severity of mental health cases.

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Table 7. Summary of validation results for assumed motivation assets that counseling center staff
need in order to support the mental health of distance learners.
Assumed Motivational
Asset
Type of
Indicator
Survey Results – Validation

• University
counseling center
staff believe they
are able to meet the
demands of their
caseloads.

• Active
choice
• Mental
Effort
• Persistence

• Asset Validated – Nearly all of the
participants believed that they are
meeting the needs of their students
regardless of their increased caseloads
and that their motivation was not
effected. Many of the respondents
explained however that the increasing
workload was causing personal
struggles.

• University
counseling center
administrators
assume additional
administrative
responsibilities to
ease the burden of
their clinicians.

• Task value

Asset Validated – The respondents believed
it was important to assume additional
responsibilities in order to limit the
additional responsibilities of clinicians so
that the clinicians could spend additional
time with clients.
• University
counseling center
directors incentivize
their staff.
• Task
Value

• Asset Validated – The counseling center
directors who participated in the study
stated that they find unique ways to
incentivize their staff.

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Motivation Asset #1: University Counseling Center Staff Meet the Needs of their Increasing
Caseloads
In accordance with the motivational assets drawn from the literature student counseling
center staff remain motivated to complete the rigors of their job regardless of their increasing
caseloads (Guinee and Ness, 2000). This mindset was an asset attributed to whether or not
participants were willing to put in the necessary effort to meet the increasing demands and
persist regardless of the increasing caseloads. It is significant to note that the literature also
demonstrated that there was a small percentage of counseling center staff who were becoming
disenfranchised with the increasing caseloads and were losing their motivation. The participants
in this study however, agreed that while their caseloads were increasing, they remained confident
in their ability to meet the demands of their jobs and provide appropriate support for each client.
Two-thirds of the survey participants in the study agreed or strongly agreed that they were being
expected to meet with additional students with greater frequency and all but one of the
respondents was confident in his/her ability to complete all job responsibilities while adequately
supporting each student. Therefore, this asset was validated as regardless of the increasing
caseload and job pressures, university counseling center staff maintained high levels of self-
efficacy in terms of their abilities to keep up with the increasing work pressures. The effects of
the increased caseloads on the motivation of clinicians was further explored in follow-up
interviews.
Similar to the findings from the survey, the interview findings also highlight that the
counselors are not experiencing decreased levels of motivation. All of the participants responded
affirmatively that they were experiencing increasing caseloads yet did not feel that their
motivation to perform was impacted. Three of the respondents commented that while their
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motivation to perform and self-efficacy regarding their ability to perform their jobs were not
impacted, the larger caseloads were resulting in emotional and personal struggles. The
respondents explained that as a result of the increased caseloads, they were feeling overwhelmed,
exhausted and concerned that they were not providing the best case to their clients as they were
rushing to the next meeting. “(Staying motivated) was tough. I was tired, I felt like my
attention, concentration, and focus were impaired. There was too much to juggle…my personal
life suffered.” One respondent explained that this increasing caseload was making it “incredibly
hard for me to do my job” and could result in “burn-out or me not being as effective or thorough
as I want.” Another counselor commented that he/she was now experiencing competition
amongst colleagues for scarce resource as each faction of the counseling center was being taxed
with more students yet they were not seeing an increase of funds. As a result he/she explained,
“…morale is impacted …when we are overwhelmed and there is no way to get more
resources…It feels like we are getting competitive with each other to fight for resources. (The
competition) is not normal for our department which is usually super supportive.” One
respondent summed up the general sentiment of the counselors by saying, “I am motivated (to do
my job) and passionate but it is becoming more difficult to do it.” Thus, while this particular
motivational asset was indeed validated as the respondents explained that regardless of the
increased caseloads, they remained motivated and confident in their abilities to do their job, but
at the cost personal wellbeing.
Motivation Asset #2: Counseling Center Administrators Assume Additional
Responsibilities
The second assumed motivational asset was that university counseling center directors
assume additional administrative responsibilities to ease the burden of their clinicians as the
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clinicians experience increasing caseloads. This type of motivational issue was tied to the
associated value that individuals assigned to the specific task. Smith et al. (2007) conducted a
study in which they discovered that counseling center administrators tend to allocate more of
their time to administrative functions in order to lessen the burden on their therapists who are
expected to operate in accordance with their increased caseloads. According to Rueda's (2011)
motivational indicators, the rationale as to why counseling center administrators would assume
additional administrative functions ensured that their staff was not bogged down with
administrative functions and instead felt confident in their ability to meet the demands of their
job. This assumed motivational asset was validated because the counseling center directors who
agreed to participate in the study strongly agreed that they assumed additional administrative
functions in his/her department with the intentions of ensuring that his/her staff could instead
focus on the mental health needs of their students.
Motivation Asset #3: University Counseling Center Directors Incentivize their Staff
The interview protocol also allowed for further excavation of the task value motivational
asset from the literature in which counseling center directors are assuming additional
administrative responsibilities and engaging in unique ways to incentivize their staff (Guinea &
Ness, 2000). One of the counseling center directors explained that he/she does not need to
motivate his/her staff as they are “internally driven” to complete the tasks. The respondent
further explained that he/she does not have the financial resources to be able to incentivize
his/her staff monetarily so instead tries to provide unique opportunities for the clinicians that
they would not experience in private practice. Additionally, he/she explained that he/she is often
displays “gratitude and appreciation” for the work of the staff and tries to create a “fun”
atmosphere.
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I suppose I incentivize them with my good will. I am really big on the team
aspect of working as a team-solving problems and celebrating victories together.
They can all make more money in private practice, so I think about why they are
here: we have a training program, they like working as a team, and solving
systemic issues. They get to do a lot of cool things and do more than clinical
services. I am direct with my gratitude and appreciation for those that work
here…I let them know I appreciate them and they have fun and they can see the
fruits of their labor.
The respondent also explained that he/she tries to decrease the stress of his/her therapists
by being realistic about the “ebbs and flows” of the academic year. He/she acknowledges to the
staff that certain times of the year tend to be more stressful than others and as a result he/she
“plan(s) for hard times (by) creat(ing) space for self-care and care for us as a team.” He/she
explained that he/she sometimes surprises the staff with fun activities like cupcake decorating
instead of a meeting and offering “comp time” when possible. He/she also explained that during
the slower summer months they often watch movies and discuss “cultural competence.” “We are
thoughtful about when it is hard and we have a party after.” Another counseling center director
explained that while limited financial resources makes monetary rewards difficult, he/she instead
is able to incentive staff by enhancing their job titles and allowing them to engage in collateral
assignments of their choice. Thus, it appears that the motivational asset of college counseling
center directors incentivizing their staff is validated as the respondents explained that they find
creative ways to motivate and decrease the stress of the staff without using many resources.
Synthesis of Results and Findings for Motivation Causes
All three of the assumed motivation assets were validated through the study. Analyzing
the survey and interview data together shed light into the motivational assets that effect
counseling center staff and ultimately impact the staff’s ability to provide treatment to students.
The assets that this survey validated are: a) university counseling center staff are motivated to
perform regardless of their increasing caseloads and have the self-efficacy to do so, b)
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counseling center directors assume additional administrative duties to ease the burden on their
clinicians and c) counseling center directors incentivize their staff.
The majority of the respondents made it clear that that they are experiencing increased
student demands for services at their respective universities are therefore being asked to meet
with a greater number of students on a regular basis. While one might assume that this increased
workload would negatively impact motivation, this does not appear to be the case. Instead,
university counseling center clinicians report being “passionate” about their jobs and are
motivated to provide the best care to their students. This increased workload is not without
added struggles however as the counselors report feeling “overwhelmed” and report being “too
rushed” to adequately service each student. Some of the respondents even commented that the
increasing caseload is coming at the expense of their personal wellbeing. Thus, while the
motivational assets of self-efficacy, persistence, and mental effort were validated in this study, if
the current pace at counseling centers continue, it seems reasonable to assume that counseling
center clinicians might experience decreasing levels of motivation.
The motivational assets of task and attainment value were also validated in this study by
the actions of counseling center directors. The counseling center directors chose to assume
additional administrative responsibilities and incentivize their staff to keep them motivated and
mitigate their stress. The center directors commented that while they did not have financial
resources to motivate the staff, they were able to incentivize them through other methods. The
directors explained that they assumed a more administrative role in the department and provided
“fun” activities for the staff whenever possible. One director stated that he/she was intentional in
expressing gratitude and appreciation for the staff and provided opportunities for the staff to
engage with students outside of traditional therapy. It is significant to note that the same director
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explained that he/she felt that the staff did not require much motivation or incentives as the
therapists enjoyed the additional perks that come with college counseling such as training
programs and team work. Thus it appears that the individuals who are driven to work in
counseling centers have high levels of self-efficacy and remained dedicated to their work
regardless of its increasing rigors.
Results and Findings for Organization Causes
Rueda (2011) discussed the importance of analyzing both the cultural models and cultural
settings that are inherent in a specific organization in order to discover both the visible and
invisible factors impacting performance. The cultural models are the shared beliefs and
understandings that are evident within the organization whereas the cultural settings are the
social contexts in which the cultural models are demonstrated (Rued, 2011). Examples of
cultural models include lack of trust, culture of competition, or negative attitudes, cultural
settings include environments filled with effective role models, a lack of communication, or a
lack of resources. The survey and telephone interviews sought to uncover the organizational
assets and culture that were impacting the knowledge and motivational of counseling center staff
at each university. The organizational findings gleaned from the survey and interviews are
summarized in Table 8.

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Table 8. Summary of validation results for assumed organizational assets that university
counseling centers need in order to support the mental health of online graduate students.
Organizational Asset Possible
Organizational
Causes
Survey Results – Validation

• Student counseling
centers need to modify
their structure in order
to better meet the needs
of their students.

• Cultural Model

• Asset Not Validated – The
respondents were not in
agreement regarding the need to
expand counseling center hours
and provide group therapy
sessions for online students.

• University counseling
centers require
additional resource
allocations.

• Cultural Settings

• Asset Validated - Participants
do not believe that their
counseling center has the
appropriate financial and other
resources necessary to meet the
needs of their students.

• University students are
hesitant to seek mental
health support as a
result of social stigmas.

• Cultural Settings

• Asset Partially Validated –
Most participants believed that
the students at their institutions
were reticent to seek mental
health support because of the
stigmatization surrounding
mental health. Interestingly
enough however, many
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participants felt that students
were more apt to practice help-
seeking behaviors on campus
than compared to the general
public.

Organization Asset #1: University Counseling Centers Need to be Restructured
The first assumed organizational asset was that in order to successfully meet the
increasing needs of today’s university students, college counseling centers need to alter their
operating procedures by expanding hours and providing expanded treatment options (Murphy &
Martin, 2004). Half of the respondents in the survey mentioned that they would be in support of
increasing the hours of operation of their respective counseling centers. Two-thirds of the survey
respondents were neutral however in regards to whether or not their counseling centers should
offer group therapy options for distance learners. Additionally, it is significant to note that while
only one respondent answered the Likert scale question regarding whether or not his/her school
prioritized improving mental health services for online students that his/her university, this
individual strongly felt that the institution was not prioritizing the improvement of student
mental health for distance learners. Thus, the assumed asset that an organizational restructuring
of the counseling center was needed was not validated as there were mixed answers by the
respondents.
Organization Asset #2: Counseling Centers Need Additional Resources
The second assumed organizational asset was that university-counseling centers required
additional resources in order to improve their services for students. Two-thirds of the survey
respondents believed that their counseling centers did not have the appropriate amount of
financial and other resources in order to meet the needs of their population. One respondent
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commented in a short answer question that his/her counseling center would be able to improve
student support services at his/her institution, “…would require the university to extend financial
resources to service providers such as the counseling center.” It therefore appears that the
cultural settings at the partner universities included a shortage of funds and resources for student
services. Thus it appears that scarce resources and financial allocations are prevalent in nearly all
of the partner schools, and are negatively impacting the services that counseling centers and
other departments are able to provide their students. Similarly, a lack of financial resources
allocated to student support services might also explain why one respondent commented that
his/her university does not prioritize improving services for distance learners.
Similar to the survey results, the assumed organizational asset that university counseling
centers needed additional resource allocations was validated. When asked about what resources
their center would need to improve the services they provide to students, all of the respondents
mentioned increased financial allocations. Many of the financial responses centered around
increasing the salaries of the current staff to make the compensation more competitive as staff
attrition rates are problematic. One participant commented, “staff need raises, we need to be
compensated for the work that we do. Our salary is not competitive and this is how we lose
stellar staff.” Another respondent succinctly stated, “We are so underpaid.” A third participant
explained that as a result of the financial situation at his/her counseling center they are
experiencing “retention issues. The attrition rate is high because of low salaries...My hope is that
(counseling center staff) staff gets in the category or things that they (university administration)
want to keep for a long time.” It is significant to note that this respondent is vacating his/her
position shortly to pursue a more lucrative position. Additionally, it appears that case manager
and referral coordinator positions are hard to fill when they become vacant. This is adding to the
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stress of the remaining counselors as they are then forced to create their own referral networks in
addition to providing therapy to their clients. Other respondents included additional space
allocations and increased staffing models as organizational barriers to their success as well.
Thus, this asset was clearly validated as all of the respondents mentioned finances and employee
salaries as a large organizational challenge.
Organization Asset #3: The Stigmatization of Mental Health and Help-Seeking Behaviors
of Students
The third organizational asset that the survey sought to address was whether the cultural
setting of the stigmatization of mental health in American society was impacting students
willingness to seek mental health services. Two-thirds of the respondents agreed that their
students were hesitant to seek mental health services as a result of stigmatization. It therefore
appears that the cultural setting of the stigmatization of mental health treatment serves as an
organizational barrier to university counseling centers.
Overall, the interview respondents commented on the stigmatization of mental health
within American society as a whole. In regards to the stigmatization of mental health services
within their respective institutions, most of the respondents believed that their students were
more apt to engage in help-seeking behaviors than in the general population. Some of the
participants felt that the stigmatization of mental health on their campus was comprisable to that
of the general society whereas other believed that help seeking behaviors are more prevalent on
their campus than within society as a whole. As one participant commented, “I don’t think
[mental health services] are more stigmatized than in the general population.” Another
respondent explained that the university culture is beginning to change and that students are
being encouraged to utilize counseling services by various campus constituents, “Departments
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are more so saying utilize counseling and are bringing and connecting students.” Another
participant stated that the stigmatization on his/her campus is improving as the counseling center
on that campus is engaging in more outreach. Additionally, one of the respondents did not feel
prepared to appropriately answer the question. As another respondent commented, “We have
high utilization of our services….it is tough to answer. The policy and the practice of the
university and its entities is to reduce the stigma and they have been successful.”
Finally, it is significant to note that some of the respondents commented on the
differences of help-seeking behaviors and the stigmatization of mental health as a cultural
phenomenon that varies across populations. As one counselor explained, hesitancy to seek
mental health services is more apparent among international students. The same counselor noted
that brick and mortar students utilize the counseling center at higher rates but speculated that if
his/her counseling center increased their outreach and publicity to online students, the online
students would be more prone to use the counseling center services as well. Another counselor
stated that while the stigmatization of mental health has decreased as a whole, the athletes and
veteran students at his/her institution are less likely to seek support than other students. This
counselor added that he/she believed that if the counseling center were to employ former student
athletes and veterans in the counseling center, students who identify with such clinicians would
utilize the center in greater numbers as they would find therapists with shared experiences.
Synthesis of Results and Findings for Organization Causes
The findings from the survey and interviews validated three of the organizational assets
and partially validated a fourth. It is interesting to note that all of the validated organizational
assets are cultural settings. Thus when it comes to resource allocations and the destigmatization
of mental health, it appears that counseling center staff believe that increased priorities must be
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dedicated to these areas. It is significant to note that financial struggles appear to be an issue for
counseling centers across the board.
The organizational asset regarding the stigmatization of mental health services impacting
students help-seeking behaviors was met with mixed results. While many of the respondents felt
that stigmatization of mental health is an issue plaguing the American society, they noted that
students appear to be more apt to seek out resources than others. I therefore speculate that the
insular campus environment and support services available to students in the university settings
have helped to destigmatize mental health treatment. Additionally, counseling centers appear to
be increasing their relationships with various campus constituents and are conducting more
outreach to students in distress. It is significant to note however that this asset was only partially
validated however as various institutions are witnessing differing levels of destigmaziation.
Finally, it is significant to note that certain student populations are less likely to seek out mental
health services as a result of the cultural messages and stigmas attached including international
students and veterans. Interestingly enough however, often times it is international students and
veterans who are drawn to distance learning programs given their flexibility and ease of access.
Thus the mental health and help-seeking behaviors of such students in online programs need to
be further explored.
This study did not validate the cultural asset regarding increasing the hours of service for
university counseling centers and expanding group therapy options for distance learners. The
counselors who responded to this study had differing views regarding increasing hours and
services for distance learners. The fact that the majority of the counselors did not believe that the
hours of the counseling centers needed to be modified to better meet the needs of distance
learners leads me to believe that the student counseling center staff do not understand the needs
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of these students; this is in stark contrast to the literature which suggests that the hours of
counseling centers must be adjusted to ensure that students located in geographically diverse
locations have access to the services. It is also significant to note that many of the therapists
were unable to comment on the need for online group therapy options for distance learners as
many of the universities are not currently providing mental health services to distance learners
and others are hesitant to engage in virtual therapy as it might impact the therapeutic
relationship. Thus without a strong consensus regarding improving and/or expanding services, I
am unable to validate this cause.
Results and Findings Determining Whether University Counseling Centers are
Meeting their Goal of Providing Mental Health Services to Online Graduate Students
According to IACS, the role of a university counseling center is to provide therapy to
students; assist students in identifying the skills necessary to achieve their academic goals; and to
provide outreach to the community to promote healthy lifestyles, and contribute to campus safety
(Standards, 2010). Given this industry standard as stipulated by an accrediting body for
university counseling center, one might assume that counseling centers are striving to provide
services to their distance learners. The data collected from the surveys and interviews as
discussed above however, illustrate a different picture. The survey and interview data in this
study suggest that university counseling centers are not meeting their goal of providing mental
health services to their distance learners. It became evident that university clinicians are unable
to meet the needs of distance learners for a plethora of reasons which include: 1) a lack of
experience working with (and understanding the unique needs of) this unique population; 2) a
lack of knowledge regarding referral best practices for individuals living away from the brick
and mortar campus; 3) therapists’ license stipulations prohibiting therapy across state boundaries
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and; 4) little institutional support to expand the services of counseling centers to meet the needs
of the distance learner population.
It is significant to note however that while the counselors are not able to provide
the quality of services to distance learners that is offered to the brick and mortar students, it is
not for a lack of interest in supporting this population. In accordance with the Gap Analysis
process as described by Clark and Estes (2008), there are some major (and unanticipated)
knowledge, motivational, and organizational issues identified that appear to be affecting the
quality of services provided to distance learners.
First, it appears that the university clinicians are uneducated about the needs of the
distance learners and therefore, “don’t know what they don’t know.” It is significant to note
however that the clinicians who have engaged with distance learners are motivated to support the
needs of this students as was evidenced through the interviews when clinicians indicated that
they conducted their own research (Google searches) to identify mental health support services
for students residing in various areas. Finally, and arguably most significant is the fact that
clinicians do not have the organizational support of senior administration in order to work around
licensure issues and resource challenges.
Additional Findings
Throughout the data collection phase of this study, it became evident that most of the
universities that participated in the study are unable to support the mental health needs of their
distance learners. Four of the universities that were contacted were unable to participate in the
survey or interviews as they did not have any resources available to distance learners and, at
most, assist in providing referrals to local providers. Of those university counseling centers that
did participate in the survey, the majority of the respondents indicated that they were unable to
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provide mental health services to their distance learners as a result of legal issues. I discovered
that mental health practitioners are licensed to provide treatment only in the state in which they
are licensed and as a result are unable to treat students who reside elsewhere as it is a violation of
their licensure. As a result of this barrier, many university counseling centers have been unable
to address the mental health needs of distance learners.
One online graduate degree program that participated in the study implemented a unique
means of addressing the mental health needs of their students when they noticed that the
clinicians at their university counseling center were unable to support the distance learners. As
one senior administrator commented, “When we started the program, [the students]…had no
access [to resources] and the university did not take into account that these students were not on
campus…we were getting calls [from students] and could not get [the students] services because
they were not on campus.” As a result, this specific program outsourced their mental health
treatment with a third party vendor. The corporate vendor that they hired serves as an Employee
Assistance Program for various large organizations throughout the United States. The vendor
was willing to tailor their services for the students. This vendor provides online resources such
as webinars and information for students and family members on various topics including legal
guidance and family and relationship issues. The services are available via the Internet year
round. Additionally, students and family members are able to call the service for up to three
mental health sessions per episode/event. In other words, students are able to utilize the phone
therapy resources for three sessions per topic/life event but for an unlimited amount of topics.
All of the clinicians who answer the phone are licensed and are able to refer students to long
term care options. The corporate vendor has a network of providers throughout the United States
and is able to refer students to a mental health provider in their local community. In an interview
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with a senior administrator from the corporate vendor I inquired as to how this company is able
to circumvent the state licensing issues that university counseling centers face and provide
therapy to individuals throughout the world. He/she explained to me, “We don’t do counseling.
We do consultations and we don’t provide treatment. We assess for safety but we do not start
the therapeutic relationship.” In other words, this vendor has found a “loop hole” and is able to
provide students “consultations” regarding the issues that they are facing and then connect them
to a local provider for the therapy. The administrator further explained that when the student is
referred to a local provider, the student becomes financially responsible. The vendor ensures that
prior to referring a student to a specific provider, that provider accepts the student’s insurance
and is in a location accessible to the student. All of the services offered by the vendor are free to
students.
After consulting with the administrators at the university and the vendor, it became
evident that the program and the vendor have a relationship built upon frequent communication.
The vendor shares aggregated data regarding the utilization of the services and the types of
issues students are presenting with the program administration on a regular basis. The identities
of the students are confidential and thus the academic program does not know which students are
using the services and why. The vendor also conducts regular trainings for staff in the program
so they are educated about the services provided and able to refer students appropriately. The
vendor explained that due to privacy issues, they are unable to have a comprehensive list of all
students and communicate with them directly. Thus, all communications between the student
population and the vendor is done in conjunction with the university. In order to ensure that
students are educated about the resources available to them, the vendor sends out monthly
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emails, via the university, focusing on topics that are relevant to students. Students are also
informed about the vendor during orientation, via brochures, and from faculty referrals.
I spoke to various administrators in the program in order to gauge their satisfaction with
the corporate vendor and the Student Assistance Program and discovered that the staff appear to
find this resource successful and beneficial to the students. One administrator explained that
they are seeing a 12-16% utilization rate of their students which he/she explained is “a little
higher than normal.” It is also significant to note that the program entered into this contractual
relationship with the vendor in 2014 and thus is relatively new. The administrator further
explained using this program is, “all about retention management because when [the students]
have issues, this is a time to lose them so this is good for us.” Another administrator described
the vendor as “a real accessible resource.” Additionally, given the success of this program, the
SaaS provider, that many of the participating institutions use, assumed the contract with the
vendor and is beginning to offer it as part of the package with various institutions. Thus given
the success of the partnership, the outsourcing of mental health services to a Student Assistance
Program is a promising practice that could be emulated by other institutions.
Summary
The participants in this study provided insight into the assets and challenges that impact
university counseling centers and their ability to support the mental health needs of their
students. The findings from this study were thought provoking. One of the most significant
findings from this study is the fact that university counseling centers are unable to meet the
mental health needs of their distance learning populations. It was inspiring to discover the
commitment that university counseling center therapists have towards their clients and their
willingness to persevere regardless of the increasing demands of their jobs. It was disappointing
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to learn however, that university counseling centers are not compensating their staffs
appropriately and are operating under tight financial constraints. This chapter outlined the
results of the survey and follow-up telephone interviews and highlight the key findings.
Ultimately this study validated seven of the nine assets that contribute to the effective university
counseling centers. One of the assets in this study was only partially validated and the ninth was
not validated through this study:
1. Knowledge Asset – University counseling center therapists need to attend graduate
degree programs that prepare them to work with students and educate them about student
development theories.
2. Knowledge Asset – University counseling center therapists need to understand
multicultural competence and practice it throughout their interactions with students.
3. Knowledge Asset – University counseling center therapists need to know how to utilize
referral processes and networks for students who need to seek mental health treatment
off-campus.
4. Motivation Asset – University counseling center clinicians are willing to persist at their
jobs regardless of their increasing caseloads.
5. Motivation Asset – University counseling center directors need to assume additional
administrative responsibilities to ease the burden of their staff and allow them to meet the
increasing student demands.
6. Motivation Asset – University counseling center directors need to incentivize their staff
in unique ways to keep them motivated.
7. Organizational Asset - University counseling centers need additional financial
allocations.
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The following asset was partially validated:
8. Organizational Asset – The stigmatization of mental health in American society impacts
students help-seeking behaviors to a lesser extent than in the general public.
The following asset was not validated:
9. Organizational Asset – University counseling center staff do not believe that the
organizational structure of their center needs to be modified to better meet the needs of
students.
In the following chapter, the seven validated assets will be analyzed and organized into
practical solutions. These solutions will be divided into knowledge, motivation and organization
categories. A plan for implementation will be provided as well so that other universities may
emulate the assets needed to support the mental health of distance learners. Finally,
opportunities for future research will be discussed.

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CHAPTER FIVE: SOLUTIONS, IMPLEMENTATION, AND EVALUATION
The purpose of this chapter is to present recommendations for universities and program
directors wishing to implement mental health support services for distance learners.
Additionally, this chapter will also address the validated knowledge, motivation, and
organizational assets that contributed to university counseling center’s ability to support the
mental health of graduate distance learners as outlined in Chapter Four. In total seven assets
were validated and one asset was partially validated and analyzed in Chapter Four. These assets
were validated through the analysis of survey and interview data as a result of recurring themes
and commonalities between participant responses. However, to more precisely describe
actionable solutions for institutions seeking to develop and/or enhance mental health support
services for distance learners; the seven assets will be synthesized and consolidated into five,
empirically supported, solutions that are categorized by their associated knowledge, motivation,
or organizational dimension. The selection of these five solutions is described in the following
section. Additionally, the five solutions will be prioritized in congruence with the proposed
implementation plan. Finally, this chapter concludes by designing a plan to evaluate the
effectiveness of each proposed solution using Kirkpatrick’s (2006) model for evaluation.
Recommendations for Program Directors
Prior to discussing the proposed solutions for the validated knowledge, motivational and
organizational assets necessary for counseling centers in order for them to adequately support the
mental health needs of online graduate students, it is necessary to address some systematic issues
that were identified as a result of this study. The systematic issues identified are geared towards
senior university administration and program directors who are considering implementing online
graduate degree programs in their universities. One of the most apparent findings in this study is
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the fact that the majority of universities currently engaging in online programs, are simply not
supporting the mental health needs of their graduate distance learners. The results of the surveys
and interviews illuminated the fact that university counseling centers are unprepared (and
unable) to support the needs of the distance learning community and do not have any support
mechanisms in place. It therefore appears that while universities taut themselves as providing
the same services for distance learners as they do for their brick and mortar learners in reality
this is not the case.
The universities that participated in this study that utilize the same SaaS provider
promote their online graduate programs to perspective students as providing a comparable
experience to their brick and mortar counterparts. In actuality however, this study revealed that
this is not the case. Many of the program directors with whom I spoke, did not know who to
refer me to in their respective counseling centers to gather information on support for their online
students. The fact that the program directors were unable to provide me with contacts in their
counseling departments is concerning as it illuminates the fact that there is a lack of
communication between counseling centers and program directors for distance learning degrees.
As a result it became increasing clear that the fostering of relationships between counseling
center staff and program directors is crucial in the supporting of the mental health needs of
distance learners.
Similarly, the quality of services provided to distance learners appears to be questionable.
It seems reasonable for the distance learners to assume that they are entitled to various university
services as is promoted via the SaaS provider. This study however revealed that the distance
learners are not being offered the same quality of care as their brick and mortar counterparts. As
a result, I speculate that universities (and the SaaS provider) might encounter scrutiny and
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lawsuits since the quality of services are not comparable. If for example, a brick and mortar
student has suicidal ideations, there are protocols in place to ensure the safety and support of the
student. This study made me question however what occurs when distance learners experience
suicidal ideations and the support they receive from their respective universities. Thus, it
appears that this is a risk management issue that must be addressed to ensure that standards of
care are standardized for all students. If however, it is not possible for universities to provide the
same level of care for distance learners as for their brick and mortar students, senior
administrators and program administrators must ensure that this information is properly
articulated to the students and the SaaS provider to create appropriate expectations.
I therefore propose that senior university administrators and online program directors
engage in the following action plan in order to ensure that they have the appropriate mechanisms
in place to support the mental health of distance learners prior to offering such degrees:
1. Program directors and senior university administration acquire knowledge
regarding the unique mental health needs of distance learners.
2. Program directors and senior university administration engage in dialogue with
university counseling centers regarding ways to support the mental health of
their distance learners and circumvent licensure issues (i.e. contracting with a
third party Student Assistance program, finding clinicians in the communities
in which their students reside, offering “consultations” to distance learners,
etc.)
3. Once a proposal regarding supporting the mental health of distance learners has
been adopted by the institution, the program administrators can implement
orientation materials geared towards online students that explain how to access
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the resources available to them. Similarly, the faculty in the online programs,
as well as the counseling center staff must be educated about the resources so
that they can refer students appropriately.
4. An educational campaign throughout the university could be implemented in
order to train various staff (academic advisors, counseling center clinicians,
financial aid staff, career counselors, etc.) regarding the unique needs of
distance learners as well as the challenges that they face. Staff need to be
trained on how to interact with students who are not face-to-face.
5. Finally, program administrators and senior university administration could be
flexible in this process and understand that supporting the mental health needs
of their distance learners is a new phenomenon that might require various
iterations prior to it becoming fully addressed.
In summation, prior to engaging in online education, program administrators on senior university
administration need to be cognizant of the unique challenges surrounding the mental health
support of distance learners and implement strategies to ensure their success. In order to
implement the four-pronged solution listed above, senior administrators need a detailed
understanding of their university context including the organizational structure of their
counseling center. Additionally, the licensure issues between states should be taken into
consideration to ensure that clinicians are supporting the needs of their students while remaining
in compliance with their certifying body. Finally, senior administrators and program directors
should foster internal and external relationships to ensure that all constituents collaborate to
support the needs of their students.

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Selection of Validated Assets and Rationale
In Chapter Four, seven of the assumed assets were validated as contributing to university
counseling center’s ability to support the mental health of graduate student distance learners.
The validated assets stem from the knowledge and skills, motivation, and organizational factors
that were thoroughly analyzed in Chapter Four. In order to identify the knowledge and skills
required of university counseling center clinicians, what motivates them to persist at their jobs
regardless of the increasing stressors, and what organizational restructuring is needed in order to
improve the services of such centers, the remainder of this study presents the validated assets and
their associated solutions through the lens of motivation, organizational, and knowledge
dimensions. Clark and Estes (2008) explain that the order of the asset and its associated solution
is critical to understand the interconnectedness of each solution. Therefore, as this study seeks to
provide a framework for institutions in order effectively implement mental health services for
online graduate students, it is important to consider the order in which assets are analyzed and
solutions implemented. The list of all five validated assets and the order in which they will be
discussed is displayed in Table 9
Table 9. Validated Assets Summary Table.
Gap Analysis Dimension Validated Asset

Motivation
(Self-efficacy, Attainment Value)
 University counseling center directors
implement unique ways of
incentivizing their staff.
 University administrators need to
allocate additional funds and resources
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Organizational

to counseling centers to meet the
increasing demands of their student
populations.

Organizational
 Program administrators will partner
with corporations and outside vendors
to offer Student Assistance Program
resources to distance learners.

Knowledge
(Conceptual)
 University counseling center clinicians
must have a detailed understanding
regarding working with the university-
aged population and their unique needs.

Knowledge
(Procedural)
• University counseling center clinicians
need to have a breadth of knowledge
regarding off-campus referrals and have
a network of providers nationwide.

These five validated assets were chosen for further discussion and analysis in order to
provide a model for university counseling centers to utilize as they strive to support the mental
health needs of online students. The seven validated assets and the one partially validated asset
were combined into five tangible assets in order to ease university administrators in the
implementation of this framework. According to Mayer (2011) individuals are only able to
comprehend a limited amount of information before their cognitive load is overwhelmed and
therefore, five actionable assets were chose to not overwhelm the cognitive load of the
individuals implementing this blueprint. It is significant to note that while selecting these assets,
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the generalized needs of all university counseling centers (i.e. additional resources) were
considered as well as the unique aspects of servicing distance learners (i.e. licensure issues
across state boundaries). With this information, solutions with the potential for the greatest
impact to close any knowledge, motivation, and organizational gaps were chosen. The rationale
for the prioritization and selection of these five validated assets is addressed in the remainder of
this section. The solutions proposed for the validated assets follow this brief overview and the
proposed sequence of addressing them.
The first validated asset that will be investigated further is that university counseling
center directors found unique way of incentivizing their staff given budget constraints. This
specific asset derives from a motivational dimension related to goal setting. Clark and Estes
(2008) recommend that practical solutions begin with the motivational dimensions of an
organization’s constituents because motivation is at the core of why people engage in certain
tasks, their willingness to continue doing the task, and the level of effort they commit towards
the task (Clark & Estes, 2008). Therefore, the concept that an individual will take action towards
a specific task is first rooted in his/her underlying motivation to engage that task, particularly as
it relates to the value that the individual places on achieving the task. For this reason, the
validated asset that university counseling center clinicians are willing to engage in and persist at
their jobs regardless of the increasing caseloads is of the utmost importance.
After addressing the motivational dimensions, Clark and Estes (2008) recommend
focusing on the organizational assets. Here, the cultural models and cultural settings of an
organization can be leveraged to build upon the motivational dimensions already in play. Thus,
the second selected validated asset is that university administrators need to allocate additional
resources to university counseling centers.
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Another validated organizational asset that university administrators and online program
directors might want to implement is the “outsourcing” of mental health support services. As
was discussed in Chapter Four, university counseling centers are faced with the legal issues
surrounding their licensure which prohibits them from providing mental health treatment to
individuals outside of their state. As a result, institutions might consider hiring vendors that
offer Student Assistance Program services to provide the “consultations” and mental health
referrals for distance learners in distress.
Next, Clark and Estes (2008) suggest focusing on the specific knowledge and skills
required to complete the tasks being recommended. For purposes of this study, the first selected
validated knowledge asset is that university counseling center clinicians understand the unique
needs of university students and have the knowledge necessary to support those needs. As
discussed in Chapter Four, many respondents explained that their graduate programs did not
prepare them for the rigors of working with the university aged population and they instead were
forced to conduct their own research and learn “on the job.”
Finally, once it is confirmed that university clinicians know what the unique challenges
facing college students and distance learners, they must then be able to appropriately support the
students. Thus, the final validated asset that will be considered for potential solutions is that
university counseling center clinicians understand how to access and utilize referral networks for
individuals residing far from the brick and mortar campus and are able to communicate that
information to the students.
In summation, five validated assets have been chosen for potential solutions. Per Clark
and Estes’ (2008) recommendations for implementation, the motivational factors will be
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addressed first followed by the organizational assets and finally the knowledge and skills
components necessary to achieve the desired support services for distance learners.
Solutions for Motivation Assets
The following section delves into the validated motivation assets and their associated
solutions. In Chapter Four, participants outlined some of the factors that contributed to their
willingness to persist at their jobs regardless of their increasing caseloads. These motivational
factors are categorized into active choice, persistence, and/or mental effort and can be diagnosed
using the underlying psychological constructs of self-efficacy and attainment value. As such, the
validated assets reported in Chapter Four align with one or more of these constructs.
Self-Efficacy
The triangulation of survey results and interview findings validated the motivational
assets associated with the underlying construct of self-efficacy. More specifically, the data
collected and analyzed in Chapter Four depicts that university counseling center clinicians have
the self-efficacy to persevere at their jobs regardless of the increased rigors. In order to ensure
the self-efficacy of counseling center clinicians remains high, counseling center directors have
employed various methods to ensure its continuation.
Given the motivational importance of self-efficacy (Clark & Estes, 2008), it is suggested
that university counseling center administrators engage in the practice of enhancing the
confidence levels of their clinicians. In order to increase motivation Clark and Estes (2008)
suggest developing self-confidence and team-confidence. Clark and Estes (2008) suggest
increasing self-confidence through education and incentives. Therefore the solution for ensuring
that college counseling center clinicians have the self-efficacy needed to meet their increasing
caseloads requires a three-tiered approach. First, counseling center directors will praise their
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individual employees for their hard work and successes. Clark and Estes (2008) stress the
importance of “catch(ing) people doing a good job or making progress on a very challenging
task” (Clark and Estes, 2008, p.91). In other words, individual’s motivation will be enhanced if
they believe they can do the work and receive positive feedback from their supervisors on a job
well done.
Secondly, college counseling center administrators will ensure that their staff have the
access to the trainings and the necessary information to succeed in their jobs (Clark and Estes,
2008). In other words, if the staff feel that they have the ability to succeed at their jobs (and
access to the tools that they need), they will be willing to persist and assume the added
responsibilities and cope with the stressors. In the case of counseling center staff, clinicians need
to have access to training and job aids that will enhance their understandings regarding working
with the university-aged student population and referral processes for off-campus mental health
providers. (Additional information regarding enhancing the knowledge and skills of the college
therapists, will be discussed in the knowledge skills below). Once the clinicians have a greater
breadth of understanding, they will have higher levels of self-efficacy and therefore a stronger
motivation to do persist at their jobs.
Finally, and most importantly according to the survey and interview data discussed in
Chapter Four is the providing of incentives to counseling center clinicians. Clark and Estes
(2008) discuss that the incentives do not have to take financial forms and instead can be
“intangible” yet still increase motivation. Therefore, effective college counseling center
directors implement a plan that incentivizes their staff in various ways. One simple to implement
suggestion for incentivizing staff might be allowing counseling center clinicians to decorate their
own offices as long as the decorations do not interfere with the therapeutic relationship.
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According to Scheiberg (1990) and Donald (1994), individuals who are permitted to personalize
their own spaces tend to have greater job satisfaction and higher levels of performance.
Similarly, Sundstrom (1986) stated that the personalization of one’s work space leads to greater
contentment within that space and ultimately higher job satisfaction. Additionally, university
counseling center directors need to develop personal relationships with their clinicians to
understand what interests them and therefore encourage them to engage in collateral assignments
or committees that adhere with their passions or desired skill sets. Therefore it appears that
encouraging people to engage in tasks that they are excited about in an environment that is
comfortable to them motivates them to perform.
Attainment Value
Additionally, survey results and interview findings validated the motivational assets
associated with the underlying construct of attainment value. More specifically, the data
collected indicates that university counseling center directors have decided to assume additional
administrative responsibilities in order to allow the clinicians to focus on providing treatment
and mental health support to students.
The solution is drawn from the principle that higher levels of value motivate individuals
to engage in tasks with more persistency and effort (Clark & Estes, 2008; Pintrich, 2003). In
other words, by the counseling center directors choosing to engage in additional administrative
responsibilities, the counseling center therapists are more likely to persist at their student
caseloads.
The task value for the student counseling center therapists meeting their increasing
caseloads is enhanced by the counseling center directors assuming additional administrative
responsibilities and therefore encouraging the therapists to engage in therapeutic relationships
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with students instead. Once the counseling center administrators place the appropriate level of
value on assuming additional administrative responsibilities, they will be more willing to take the
risks associated with achieving those goals because they understand the ultimate value of having
the counselors able to spend more time doing therapy (Ambrose et al., 2010). Additionally, task
value is enhanced when information related to the program goals of servicing the mental health
needs of more students is relevant to the administrators, connected to their interests, and
transferable to their constituents (Rueda, 2011). As such, the recommended solution for creating
a willingness for the counseling center directors to assume additional administrative
responsibilities is as follows. First, counseling center directors will decrease their individual
student caseloads so they have the bandwidth to assume other tasks. Then the counseling center
directors will involve themselves in more of the daily operations of the center such as managing
online services, developing training systems and completing necessary reports thereby releasing
the clinicians to focus on their student caseloads instead. Additionally, the counseling center
director’s will serve as advocates for the needs of their staff to the greater campus community
and garner greater university support for these individuals.
Solutions for Organization Assets
Next, using the results and findings reported in Chapter Four for validating organizational
assets, I will propose solutions relating to the organization, context, culture, and resource assets
identified. Culture, identified by cultural settings and models (Rueda, 2011), is understood by
examining the larger contextual dynamics of a situation. This underlying culture and its
associated belief patterns and social systems influence nearly every aspect of an organization and
how it conducts its affairs (Ambrose et al., 2010). Chapter Four provided insight into the
organizational assets that contribute to successfully supporting the mental health needs of
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distance learners in online graduate programs. The following section seeks to identify the
underlying organizational culture and context that facilitates the promotion of the prioritized
validated organizational assets that university administrators allocate additional resources to
university counseling centers and that online graduate programs partner with a Student
Assistance Program to provide mental health services to its students.
Resource Allocation
Rueda (2011) posits that cultural models are the shared beliefs and understandings
evident in the practices of the organization’s constituents while cultural settings are the social
contexts that the cultural models (beliefs) are enacted. Cultural models are the predisposed and
automated values, beliefs and attitudes of an organization that contribute to the structure and
policies of an organization (Gallimore and Goldenberg, 2001). Cultural settings are
manifestations of the cultural models in daily life (Gallimore and Goldenberg, 2001).
Additionally, Clark and Estes (2008) describe a six-pronged approach to organizational change
which includes the formation of achievable goals, strong communication, the involvement of
senior administration, and the adequate knowledge of front-line staff. Utilizing the work of
Rueda (2011) and Clark and Estes (2008) as a framework, one can create a means of improving
the resource allocation for university counseling centers.
The results validated in Chapter Four highlight the need for increased resources in
university counseling centers. In order to achieve this goal, the following solution is proposed.
According to Clark and Estes (2008), organizations need clear and measureable goals.
Therefore, the first step in increasing the resource allocation is for the counseling center to
articulate their goal of meeting the increasing demands of their student population to the senior
administration of the university. In order to do this, the counseling center director will prepare a
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report documenting the current demand for their services and the difficulties that the staff is
facing in meeting those needs. The report will include a proposal requesting the increased
resource allocation and explain that the requested monies will be earmarked for the hiring of
additional clinicians to ensure a reasonable counselor to student ratio, training opportunities for
counselors to ensure that they are well versed on the needs of university students and increasing
the compensation for clinicians to make their salaries more competitive and ensure the retention
of quality therapists. Clearly articulating these goals and illuminating the realities of the
counseling center situation to senior university administration will prove to be crucial as these
administrators are the individuals who are in the position to increase resource allocations. Once
the additional funds have been allocated to the counseling center, it will be important for the
counseling center directors to ensure transparency in the usage of the funds and involve senior
administration in discussions regarding improved counseling services as is suggested by Clark
and Estes (2008).
Contracting with a Student Assistance Program
In order to improve the organizational structure of university counseling centers, I also
propose contracting with a third party vendor that will serve as the mental health resource for
distance learners. As various respondents depicted throughout interviews and surveys, providing
mental health treatment to distance learners is an insurmountable challenge for numerous
universities. Excluding the controversies of Internet-based therapy for a moment, universities
are still plagued with their reality that counselors are unable to provide mental health treatment
in a state other than the one in which they are licensed. As a result, even with increased funds,
the clinicians would be unable to provide treatment to the distance learners. Therefore,
universities might consider contracting with third-party vendors who have Student Assistance
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Programs and are able to provide “consultations” to individuals regardless of their location. In a
study by Laamanen, Simonsen-Rehn, Suominen, Ovretveit, and Brommels (2008) the
researchers discovered that outsourcing the health services provided in Finland decreased the
cost and increased the effectiveness of health services in that region. Outsourcing the mental
health consultations of distance learners would be a tremendous organizational shift and require
additional resources in order to fulfill the terms of such contracts; however it would prove to be
beneficial as universities would be ensuring that they are meeting the mental health needs of
their distance learners. Additionally, contracting with a Student Assistance Program for distance
learners would decrease the stress (and thereby increase the motivation) of the counseling center
staff as they would not be spending time researching referrals for distance learners and could
instead focus solely on the needs of their brick and mortar students.
Solutions for Knowledge Assets
Using Anderson and Krathwohl’s (2001) knowledge types and cognitive processes
framework, the validated knowledge assets are organized and categorized by their associated
factual, conceptual, procedural and metacognitive knowledge types. The following section
identifies solutions for two of the prioritized validated knowledge assets and the appropriate
ways to provide the particular knowledge based on Clark & Estes (2008) Gap Analysis
Framework.
Conceptual Knowledge
The solution designed to address the validated asset that university counseling center
clinicians need to have an understanding of the unique needs of the university students is rooted
in conceptual knowledge. Rueda (2011) highlights that conceptual knowledge includes an
understanding of theories and models. Thus, in order for counseling center clinicians to obtain
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an understanding of student development theory and the unique attributes of university students,
I propose the implementation of a multi-tiered approach in accordance with the principles Social
Cognitive Theory (Denler, Wolter, and Benzon, 2013). Social Cognitive Theory posits that
individuals learn from credible and effective models, practice self-regulatory behaviors, and have
high levels of self-efficacy (Denler, Wolter, & Benzon, 2013). University counseling center staff
need to be educated about student development theories. In order to educate current staff
regarding their student clientele, I suggest that university counseling center directors assess their
staff to have a detailed understanding about what they currently know about student development
theory. According to the Information Processing Theory (Schraw & McCrudden, 2013)
identifying the prior knowledge of leaner’s, before conducting any sort of training can increase
learning outcomes. Using this information, the counseling center director will hire a well-
respected Student Affairs practitioner to conduct training for staff regarding Student
Development Theories. The training should include an explanation of various student
development theories and the key features of each theory. During the training, the presenter
should include vignettes in which behaviors are demonstrated so that the clinicians can observe
how such behaviors manifest. Additionally, at the conclusion of the training, the counseling
center directors will provide staff with a handout that briefly describes each theory and the key
elements. This job aid will serve as a quick reference that clinicians can keep in their offices as a
refresher when needed.
Procedural Knowledge
The next step in the process is the validated knowledge asset that counseling center
clinicians have access to a network of off-campus mental health providers as well as how to refer
students. According to Rueda (2011), procedural knowledge refers to knowing how to do
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something. As a result, the proposed solution to address the procedural knowledge regarding
referral networks is to create job aids. First, the counseling center directors need to ensure they
have a detailed protocol regarding when it is necessary to refer students off-campus and how that
process works. Once there is an established protocol, the counseling center directors will need to
document that protocol via an “easy-to-use” flow chart and provide it to all clinicians. Lastly,
the counseling center director should consider to hiring a Community Partnerships Director
whose sole purpose is to foster relationships with mental health providers in the local
community. The Community Partnerships Director will be responsible for educating local
providers about the university population, discussing their area of expertise, and understanding
their health insurance policies. Once the Community Partnerships Director is confident that this
individual will serve the university students well, he/she will invite them to an event with the
counseling center staff so that the referring clinicians will know the individual as well.
Additionally, the Community Partnerships Director will be responsible for maintaining a
database of all current local providers and thereby assist clinicians in finding the most suitable
provider for each student.
The solution explained above for the validated procedural asset utilizes the Cognitive
Load Theory. In situations where there is a lack of procedural knowledge, solutions should be
rooted in the principles of Cognitive Load Theory. Ambrose, Bridges, DiPietro, Lovett, and
Norman (2010) explain that Cognitive Load Theory enhances learning by segmenting complex
material into manageable parts, often called “chunking.” Cognitive Load Theory is an
information management strategy that enables learners to process relevant information in
personally meaningful and understandable ways (Ambrose et al, 2010).

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Implementation Plan
Solution Integration
Research indicates that isolated interventions will not be as effective as those that are
relevant, connected, and linked to goals, interests, and prior experience (Ambrose et al., 2010).
For university counseling centers to successfully meet the increasing demands of their student
populations and provide mental health services for their distance learners, it is essential to follow
an integrated plan that combines each solution within the dimensions of knowledge, motivation,
and organization and recognizes the underlying learning theories that increase the likelihood of
achieving success. As previously discussed, the solutions are prioritized based on the
sequencing of how each solution is built upon a previous solution. Thus, the process for
implementing the solutions is as important as the solutions themselves (Clark & Estes, 2008).
A summary of the validated assets, their associated proposed solutions, and the
implementation of those solutions is outlined in Table 10.
Table 10. Summary of validated assets, solutions, and implementation of the solutions
Knowledge & Skills Motivation Organizational
Assets • Clinicians possess
knowledge and
understanding of
student development
theories and unique
needs of college-
aged students

• University
counseling center
directors
incentivize their
staff

• Additional
resources are
allocated to
university
counseling
centers

• Universities
contract with
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• Clinicians
understand and
know how to utilize
off-campus referral
networks

Student
Assistance
Programs for
mental health
service for
distance
learners

Solutions • Create training
programs for
clinicians modeling
the theories with
vignettes and
providing a job aid
handout

• Create and provide
job aids to clinicians
explaining how to
refer students to off-
campus providers

• Counseling center
directors develop
the self-
confidence and
self-efficacy of
their clinicians
through education
and assuming
additional
administrative
responsibilities
• Create clear and
measurable
goals to
demonstrate
how the
additional funds
will be used

Implementation • Administrators and
program directors
will work closely
with the provider
and key stakeholders
to develop an on-
• Counseling center
directors will
enhance clinician
self-confidence
by assuming
additional
• Counseling
center directors
will create a
detailed report
explaining the
current demand
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boarding process for
new staff and a
training process for
current staff that
includes a
discussion of student
development theory
and information
regarding referral
processes

administrative
responsibilities
and praising their
staff members

for services and
how the new
funds will be
utilized to meet
student need
and retain
quality staff

Implementing the proposed solutions for each validated asset again comes back to
process and prioritization (Clark & Estes, 2008). This study has highlighted the uniqueness of
higher education and how the process for implementing specific solutions is directly correlated
to this context. Solutions are prioritized based on the order of requirements, skill development,
timing, and task difficulty (Clark & Estes, 2008). Additionally, many of these solutions are
interrelated and influence the success or failure of one another. Therefore, when implementing
the proposed solutions, there are also political and organizational challenges to consider.
For purposes of implementing the proposed solutions to the validated assets needed to
support the mental health needs of online graduate program, the motivation of university
counseling center clinicians is paramount. University counseling centers will first have to ensure
that the self-efficacy of their clinicians remains high so that the staff are confident in their
abilities to meet student demands. The high level of self-confidence and self-efficacy can be
enhanced through incentives and offering praise as was discussed above. Once the motivational
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asset of enhanced self-efficacy has been supported, the university can then engage in strategic
planning in order to ensure the organizational and knowledge assets are developed as well.
Strategic planning is necessary in order to successfully implement change. In the initial
strategic planning sessions regarding support services for distance learners communication is
crucial between counseling center staff, program administrators and senior university leadership.
As a result of open communication, the institutional leaders, program directors, and university
counseling center staff will be able to reach an agreed upon vision for the support services for
distance learners. Having “buy-in” from various constituents will enhance the confidence of the
clinicians as they will feel better supported and therefore increase their motivation. Thus, the
organization of the program and institution influences the motivation of participants.
Lastly, a comprehensive training program will be developed to ensure that the current and
new clinicians are adept at meeting the needs of the student population. For new staff, this on-
boarding process, often referred to as organizational socialization, is a process through which
new employees become acculturated into the organization (Bauer & Erdogan, 2011). For
returning staff, the education process will include in-service trainings. More precisely, it is
process that helps employees learn the context-specific knowledge, skills, behaviors, attitudes,
and belief systems that will foster both individual and organizational success (Bauer & Erdogan,
2011).
During these initial on-boarding training sessions, counseling center directors will have
the opportunity to provide the new and current clinicians with information regarding meeting the
needs of their students and how to utilize campus referral networks. The trainings serve to
increase the knowledge and skill level of constituents as well as their associated motivation to
develop those skills. Again, Clark and Estes (2008) reiterate that an individual’s motivation to
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engage a task, his/her knowledge and skill to complete the task, his/her motivation to
communicate the benefits of completing the task, and the organizational culture that promotes
that sort of communication are all related.
Evaluation Plan
After implementing an integrated solution plan, an evaluation plan is critical in
determining the effectiveness and potential impact of each proposed solution (Clarks & Estes,
2008). In order to successfully evaluate all of the components of the implementation plan, a
multifaceted evaluation plan is needed. Kirkpatrick (2006) proposed a four-tiered system of
evaluation that accounts for all of the necessary components of an evaluation technique. The
remainder of this section will use Kirkpatrick’s (2006) model for evaluation to describe the four
levels of evaluation needed to fully determine the effectiveness of the integrated solution plan.
Level 1: Reactions
According to Kirkpatrick (2006), the first tier of evaluation focuses on the initial
responses of those directly impacted. This level of evaluation considers the perceptions of the
stakeholders (e.g. university counseling center clinicians and counseling center directors) who
participated in the implementation and how effective they thought it was (Clark & Estes, 2008;
Kirkpatrick, 2006). For the previously described integrated solution process, one must evaluate
reactions of counseling center clinicians. The questions used in the evaluation plan will gauge
the reaction of the clinicians and directors to the trainings and job aides they were provided in
order to better understand effectiveness and potential influence on their motivation. These
questions will be administered through a survey. The survey would include a Likert Scale to
determine rankings and various levels of agreements with certain statements as well as several
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open-ended questions. In sum, the results of the survey will indicate the motivational impact of
the education provided to the clinicians (Clark & Estes, 2008).
Level 2: Learning
Kirkpatrick’s (2006) second tier of evaluation focuses on gaining an understanding of
what the participants of the intervention actually learned. Rueda (2011) highlights the
importance of second level evaluation when determining if the solution resulted in any
noticeable change(s). In order to measure learning, it is best to utilize a direct assessment to
determine what learning has occurred (Clark & Estes, 2008). The direct assessment for
counseling center clinicians would ascertain if their knowledge related to the student
development theories and referral processes increased as a result of their education. The
assessment would be administered after the trainings and job aids were in place (Kirkpatrick,
2006).
Level 3: Transfer
Kirkpatrick’s (2006) third tier of evaluation focuses on the concept transfer; which
determines if the individual is able to “transfer” the learning into work place setting (Clark &
Estes, 2008; Kirkpatrick, 2006). According to Kirkpatrick (2006) the transfer of the skills is
measured through ongoing evaluation and observation. Ideally, university administrators would
also be able to observe counselors as they interact with students, but given the confidential and
private nature of the therapeutic relationship, observations might prove to be a challenge. Thus, it
is important to survey university counseling center clinicians regarding their interactions with
students at various checkpoints through the year. Therefore, the third level of evaluation will
have to rely heavily on the survey responses of clinicians and limited observations when
CRISIS INTERVENTION ONLINE 136

available. The triangulation of surveys and observations will determine if the counseling center
clinicians effectively transferred the skills learned from the training into their program.
Level 4: Results
The fourth and final level of Kirkpatrick’s (2006) evaluation model addresses impact
(Clark & Estes, 2008; Kirkpatrick, 2006). It is critical that in the final stage of the evaluation
plan, the potential impact of the trainings on the ability of counseling centers to support the
mental health needs of distance learners be measured (Rueda, 2011). As such, this level of
evaluation will consider the mental health support services being offered to distance learners and
determine if the implemented solutions had any bearing on the current outcome. Third tier
evaluations will be conducted throughout the year whereas the fourth tier evaluation will be
measured at the end of each academic year prior to strategizing for the upcoming year.
Limitations and Delimitations
Limitations
After completing the study, analyzing the data, synthesizing potential findings, and
proposing actionable solutions, it is necessary to revisit the limitations of this study.
Understandably, the credibility and trustworthiness of this study is critical to its qualification as
valuable qualitative research (Maxwell, 2013). Thus the limitations outlined in Chapter One
were the relatively small sample size, the potential influence of the researcher, and the potential
dishonesty of participants. All of these limitations are still cause for concern and should be
considered when evaluating the usefulness or generalizability of this study’s findings.
Additionally, this study did not take into consideration the size of the university
counseling centers and how long the university has been engaging in online education. Through
the various survey and interview responses, it became evident that counseling centers have
CRISIS INTERVENTION ONLINE 137

differing staffing ratios and funding allocations and therefore structure their organization
differently. Similarly, this study did not take into account how long each institution has been
offering distance-learning programs. It quickly became clear however, that some universities
have more experience working with distance learners while others are still in the early
implementation stages. Finally, this study did not account for the relationship that the online
degree program administrators have with their respective counseling centers. It appears that
program directors who are in closer communication with counseling center staff tend to have
more resources available to their students than those who are not. As a result, those universities
with greater experience in the realm of online education appear to have more elaborate structures
in place to support students. Looking ahead to future research opportunities, I suggest that
researchers analyze the organizational structure of each counseling center, the tenure of distance
learning programs at that university, as well as the relationship between the program director
and the counseling staff.
Nevertheless, the findings of this study can be still be valid knowing that it was
conducted in such a way that guarded against and mitigated the influence of the limitations.
First, qualitative research is defined by its depth and not necessarily breadth (Maxwell, 2013).
This study based its findings on the survey and interview results from roughly fourteen
participants. The data from those participants was first-hand, thorough, and delved into the
specific nuances of mental health support services at each institution. Second, Maxwell (2013)
considered internal generalizability to be within the community of study. Therefore, for
institutions that use a similar, SaaS provider, the results of this study can serve as a guide of best
practices for how peer institutions can provide resources for their online students. Third, not
only was the data collected through two instruments, it was also analyzed after conducting
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numerous scanning interviews that provided rich commentary and contextual information. The
role of the researcher, as Maxwell (2013) insists, was merely to be a conduit of collecting and
transferring information from participants to reader.
Delimitations
There are a few delimitations to my research that result from the generalizability of this
study as well as the external validity based on the study design that I have chosen to utilize. The
delimitations focus on my choice of partner sites as well as the stakeholder group I chose to
focus on. The focus of this study was to develop a promising practices framework based on my
analysis of universities that participated. It is possible that the information obtained might not be
generalizable to other colleges and universities who cater to a different caliber of students or who
utilize a different Internet-based modality. Regardless of the fact that all of the data might not be
generalizable to other campuses, this study provides a framework based on Clark and Estes
(2008) gap analysis method that will be useful to other institutions in regards to performance
improvement.
Additionally, my data is limited by the honesty of my study participants. Ideally, the
participants provided appropriate and accurate answers in reference to their experiences and
knowledge working in university student counseling centers, but it must be noted that there is a
possibility that they skewed their answers to what they assume is the “appropriate” response.
Participant honesty and accuracy is a factor that could have effected the quality of both my
survey and interview responses. Another factor that could have impacted the quality of my data
is the possibility that some of my participants misinterpreted my survey or interview questions or
had someone else fill out the survey for them which also would skew the results.

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Future Research
Despite the small sample size of this study, the information presented regarding the
mental health support services for online programs at these particular institutions warrants
consideration; particularly from institutions seeking to launch online programs of their own.
However, the realm of online education is still relatively novel and future research is needed.
After considerable reading of the current literature and evaluating the potential impact of this
study, opportunities for future research exist in several key areas. Mainly, further attention needs
to be given to the organizational structure of the counseling center in question including their
staffing model, resource allocations, and partnership with academic units. Additionally, the
relationship between the counseling center and the program administrator should be explored to
determine whether the counseling center staff was involved in discussions prior to the program’s
implementation. Also, the resources of the counseling center need to be investigated to
determine if the additional programs result in additional staff. Finally, additional research must
be conducted on the use of Student Assistance Programs and how they mitigate or exacerbate
challenges for distance learners seeking mental health support from their university.
Conclusion
In summation, this study sought to identify what university mental health providers and
administrators need to know; what skills they need to possess; what motivates them to engage in
these practices; and what organizational factors contribute to the overall success of their centers.
By identifying the characteristics of a promising counseling center, this study may benefit other
institutions as they determine how to support the needs of their students.
This study investigated the practices of eleven institutions that are engaging in distance
education. Each of these institutions were faced with the challenge of how best to support the
CRISIS INTERVENTION ONLINE 140

mental health needs of their distance learners while still being in compliance with the licensure
stipulations of the treating clinicians. In order to better understand the rationale for each
institution’s decisions related to its support services for online students, this study focused its
analysis on the counseling center staff and counseling center directors at each partner site.
The findings of this study highlighted five validated assets and organized them in terms
of the knowledge, motivation, and organization dimension to which it aligned. The five assets
and their associated solutions, although very specific and contextualized, can be simplified to
five basic requirements for implementing a university counseling center that supports the mental
health needs of distance learners:
1. University counseling center directors assume additional administrative responsibly.
2. University administrators allocate additional funds and resources to counseling centers.
3. Universities contract with a Student Assistance Program to support the mental health
needs of their students.
4. University counseling center clinicians are knowledgeable regarding the unique needs of
clientele.
5. University counseling center clinicians understand the process for referring students to
off-campus mental health providers and have a vast referral network.
By identifying the knowledge, motivation, and organizational assets that contribute to the
mental health support of online graduate students and proposing solutions for achieving those
assets, this study hopes to benefit other institutions that wish to engage in student-centered
programs of their own. Online education is a burgeoning realm of higher education that
necessitates further inquiry and research. However, this study, and its counterparts, provides a
CRISIS INTERVENTION ONLINE 141

blueprint for how online graduate programs can be leveraged for the academic and
administrative betterment of the student and the institution.

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APPENDIX A
Survey Items
Email that will be sent with the survey link:
Dear University Counseling Center Staff:
I am currently a doctoral student in the Rossier School of Education at the University of
Southern California (USC). For my dissertation I am evaluating the practices used by
counseling centers in support of online graduate students. I have identified seven schools that
utilize the same online learning software platform as your University which will serve as the
sites for my study. Please note that this survey has been vetted by USC’s nationally accredited
IRB process. I would be very grateful if you could complete the questionnaire through the
following link. All of the information provided will be securely stored and all identifying
information (should you choose to provide any) will remain anonymous and confidential.
Additionally any identifying information connected to your University or counseling center will
remain confidential. The survey should only take several minutes of your time to complete. If
you have any questions regarding my study, the content of the survey or would be interested in
learning about my findings, please do not hesitate to contact me at elan@usc.edu.

Thank you for your time and consideration,

Lauren Elan Helsper

Q1. What is your current role in the counseling center?
o University student counseling center director
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o University student counseling center fulltime therapist
o Post-doc at a university counseling center
o Per diem therapist at a university counseling center
o Intern at a university counseling center
o Other (Please specify)__________________________
Q2. How many years have you been working with university students? __________

Please answer the following items as candidly as you can.

Q3. I am seeing an increase in students with severe mental health conditions attending my
university.
o Yes
o No
o Unable to judge

Q4. I am familiar with the term, “multicultural competence.”
o Yes
o No

Q5. If you answered yes to Q4, please explain what multicultural competence means to you.

Q6. If you answered yes to Q5, please explain how you practice multicultural competence in
your interactions with students.
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Q7. If you answered yes to Q5, briefly describe the best example of multicultural competence
that you have used or have seen used by a counselor.

Q8. I consider various aspects of my identity and how that might impact the therapy I provide to
a student.
o Yes
o No

For the following statements, please indicate the degree to which you agree or disagree using the
scale below.

Scale of 1-5: Strongly Disagree (1) – Disagree (2) – Neither Agree nor Disagree (3) – Agree (4)
– Strongly Agree (5)

Q9. I am familiar with academic resources for online students.

Q10. I am familiar with mental health resources for online students.

Q11. Please briefly explain your answer to Q10.

Q12. I am knowledgeable regarding mental health resources for students who reside outside of
the local community.
CRISIS INTERVENTION ONLINE 156

Q13. Please briefly explain how you gained your knowledge.

Q14. I think my counseling center needs to improve our mental health support of online students.

Q15. Please briefly explain your answer to Q14.

Q16. I am confident in my ability to diagnose a student regardless of the presenting symptoms.

Q17. I believe that my graduate school program prepared me for working with college students.

Q18. I am familiar with student development theory.

Q19. Please briefly explain your answer to Q18 in terms of how you gained your student
development theory knowledge.

Q20. I consider student development theory in my daily interactions with students.

Q21. Please briefly explain your answer to Q20 in terms of how you do or do not consider
student development theory in your daily interactions with students.

Q21. I am being asked to meet with more students on a regular basis.

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Q22. I am confident in my ability to support each student and meet the demands of my job.

Q23. The hours of operation for the counseling center need to be expanded.

Q24. More group therapy options should be offered for online students.

Q25. Please briefly explain your answer to Q24 and provide suggestions on to implement such
groups.

Q26. Students at my university feel as though our counseling center is meeting their needs.

Q27. I believe that my counseling center has the appropriate amount of financial and other
resources necessary to meet the needs of our population.

Q28. University students at my campus are hesitant to seek mental health services as a result of
the stigmas attached to mental health.

Q29. I consider myself to be multiculturally competent.

For the following statement, please indicate the degree to which you agree or disagree using the
scale below.

Scale of 1-4: Never (1) - With some clients (2) - With most clients (3) - With all clients (4)
CRISIS INTERVENTION ONLINE 158

Q30. I practice multicultural competence in your daily interactions with your clients?

Q31. Please explain what you believe the biggest challenge is regarding supporting the mental
health of online students.

Q32. If you are willing to be contacted for a follow up interview kindly provide me with your
name and email.

The following statements are for counseling center directors only:

Please indicate the degree to which you agree or disagree using the scale below.

Scale of 1-5: Strongly Disagree (1) – Disagree (2) – Neither Agree nor Disagree (3) – Agree (4)
– Strongly Agree (5)

Q33. As the counseling center director, it is important for me to assume administrative functions
in my department.

Q34. As the counseling center director, I assume administrative functions because it allows my
staff to focus on the mental health needs of our student clientele.

Q35. The university has prioritized improving services for online students.
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Q36. Please briefly explain your answer to Q35.

Q37. I and my center have what we need to provide services for online students.

Q38. If you marked disagree or strong disagree with Q37, please briefly explain your answer and
what you need to improve your services for online students.

Q39. Prior to the implementation of online degree programs at my university, the counseling
center staff was consulted.
o Yes
o No

Q40. If you answered yes to Q39, please explain how you were consulted and what measures (if
any) you put into place prior to the start of the program?

If you are willing to be contacted to participate in a follow-up interview please provide your
email address: ______________________________

Thank you for your time and participation! Please either forward this survey to any of your
colleagues who might be interested in participating in this study or provide them with my contact
information.

CRISIS INTERVENTION ONLINE 160

APPENDIX B
Interview Items
Hello and good afternoon. First off, I want to thank you again for your willingness to participate
in my research study. I am interested in learning about your experience working as a clinician at
a student counseling center. As the information sheet explains, I am interested in how counseling
centers are adapting to serving graduate students in online degree programs. I am interested in
learning about how your center works with online students, in particular, any strategies you have
developed and any concerns or challenges you face. Do you have any questions regarding the
focus of my study? (Allow time for response). I want to make sure that you feel comfortable
with and understand the purpose of this interview. Just to reiterate, the information that you
share with me will be anonymous. Any reports I write will not identify you personally as I will
use a pseudonym for you. Do you have any questions about the promise of anonymity? (Allow
time for response).
(For staff members who work at the USC Student Counseling Center): Additionally, if you are
interested in participating in my study but feel uncomfortable with me being the interviewer, feel
free to let me know at any point and we can halt this interview and I will have my partner
interview you at your convenience.
Lastly, if you are comfortable with it, I would like to audio record our conversation today so that
I can revisit your words at a later time. The purpose of my recording our conversation is so that I
am able to devote my entire attention to you right now and not focus on note taking. Please note
that upon the completion of this dissertation all audio recordings will be destroyed. If at any
time, you wish to stop the recording, we can do so. Do you have any further questions before we
proceed?
CRISIS INTERVENTION ONLINE 161

Participant Name:_____________________________________________________

Date:___________________________________________

Interview modality (phone, skype, in-person, etc.):________________________________

Interviewer:________________________________________________

University:_____________________________________________________________

Q1. Did you participate in the survey that I sent via email?

Q2. What is your current position?

Q3. How long have you been in that role?

Q4. How long have you been working with university students?

Q5. Do you work with graduate students?
About what percentage of the students you work with are graduate students?

Q6. Do you work with students in online degree programs?
If yes, about what percent of the students you work with are online students?
CRISIS INTERVENTION ONLINE 162

If no, why don’t you work with online students? Do your colleagues work with online
students? Who supports the needs of online students?

Q7. Tell me about the kinds of issues your graduate students raise with you.
How do you approach helping them when they bring those kinds of issues to you?

Q8. Tell me about any observations you have about the severity of mental health diagnoses on
your campus—I’m wondering if you are seeing any patterns or trends?

Related to the issue of diagnoses, to what extent do the needs of students in online
programs resemble those of on campus students, or are they very different?

(Note: if they answer that they see an increase in mental health diagnosis, ask: on a
similar note, how does the increase in caseload effect your ability (if any) to support your
students? Are you finding an increase of work? Is your motivation effected?)

Q9. Tell me about your referral process – when and how is a student referred to an off-campus
provider, if ever?

Relatedly, how does that referral process work for students who are located further away
– out of state, for example?

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(Note: if they say they also refer them to community resources, ask: How do you learn
about those resources?)

(Note: if possible, ask about how they help students who are far away who are in crisis)

Q10. Tell me about any challenges you are facing with respect to serving online students – if
there are any challenges.

Q11. What are you most proud of about the way your Center serves online students?

Q12. Talk about your graduate program and how it prepared you for working with university
students. (What is your degree in?)

Q13. What additional resources (financial or otherwise) are necessary in order to improve the
services your department offers?

Q14. How do online students become aware of your center and its services?
Probe to see if they think that’s adequate. What other measures can be implemented?

Q15. To what extent do you think mental health services are stigmatized on your campus – is
that an issue at all? Do you find any differences in help seeking behaviors among your online
graduate students vs other students?
Probe: what additional measures can be implemented? What have you seen that works?
CRISIS INTERVENTION ONLINE 164

Q16. What do you view as the biggest challenge in working with online students?

Q17. For university counseling center directors: To what extent do you find the professional
associations addressing the delivery of mental health services for online students as a topic?
Probe: How do you think that can be improved?

Q18. For university counseling center directors: tell me about the responsiveness of the
institution to your center’s needs, particularly around serving online students.
Prompt: they may have had to do more educating of senior administrators, or presenting
more data to make a case for increasing resources to the center

Q19. For university counseling center directors: How do you incentivize your staff to meet the
increasing student demands?
Relatedly, what steps, if any, do you take to lessen the stress on your counseling staff?
How do you keep them motivated?

Q20. Is there any else I should have asked? Any additional information that you would like to
share with me?

Thank you so much for time and participation! Please feel free to contact me at any point if you
would like to share additional information.

Abstract (if available)

Abstract Numerous studies and surveys conducted in recent years have determined that there is an increase of students with mental health diagnoses at institutions of higher education (“NSSE Survey Instrument,” n.d.), university counseling centers strive to provide individualized and group therapy for students, assess and mitigate crisis situations, provide outreach to the campus community regarding mental health, and provide consultation to staff and faculty regarding student needs (Ghetie, 2007). This study evaluated the practices university counseling centers employ while supporting the mental health needs of online graduate students at eleven institutions. This evaluation study discovered that the majority of universities are not adequately supporting the needs of their distance learners for various reasons including a lack of experience and understanding regarding the unique needs of this student population and licensure issues preventing therapists from practicing in multiple states. The findings of this study highlighted five specific assets and organized them using Clark and Estes’ (2008) gap analysis model in terms of the Knowledge, Motivation, or Organizational dimension to which they aligned. The overarching goal for this study was to identify what university counseling center therapists need to know, what skills they need to possess, what motivates them to engage in these practices, and what organizational factors contribute to the overall success of those practices. By identifying the practices that contribute to a university counseling center’s ability to support the mental health needs of online graduate students, this study benefits other institutions wishing to support the wellbeing of their students and engage in successful online programs.

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Asset Metadata

Creator Elan Helsper, Lauren Dana (author)

Core Title Crisis intervention and mental health support services in online graduate degree programs: an evaluation study

School Rossier School of Education

Degree Doctor of Education

Degree Program Education

Publication Date 07/05/2016

Defense Date 05/02/2016

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Counseling,Mental Health,OAI-PMH Harvest,online,student assistance program,University

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Sundt, Melora (committee chair), Ephraim, Ronni (committee member), Filback, Robert (committee member)

Creator Email elan@usc.edu,lhelsper@hr.usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-261738

Unique identifier UC11280553

Identifier etd-ElanHelspe-4512.pdf (filename),usctheses-c40-261738 (legacy record id)

Legacy Identifier etd-ElanHelspe-4512.pdf

Dmrecord 261738

Document Type Dissertation

Format application/pdf (imt)

Rights Elan Helsper, Lauren Dana

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA