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Going through it all: an evaluation of medical leave policy impact on persistence rates for students with disabilities

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Going through it all: an evaluation of medical leave policy impact on persistence rates for students with disabilities

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“GOING THROUGH IT ALL”:
AN EVALUATION OF MEDICAL LEAVE POLICY IMPACT ON PERSISTENCE RATES FOR STUDENTS
WITH DISABILITIES

by
Antoinette L. Myers Perry

A Dissertation 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

December 2021

Copyright © 2021 Antoinette L. Myers Perry

ii

Epigraph

I been going through it all
Back all against the wall
Trying hard not to fall
All I wanted was to ball
I been going through it all
Back all against the wall
I only get one call
Who the f**k do I call?
~ Erykah Badu

I'm comfortably asocial - a hermit in the middle of a large city, a pessimist if I'm not careful, a
feminist, a black, a former Baptist, an oil-and-water combination of ambition, laziness,
insecurity, certainty, and drive.
~ Octavia E. Butler

"Only the BLACK WOMAN can say 'when and where I enter, in the quiet, undisputed dignity of
my womanhood, without violence and without suing or special patronage, then and there the
whole Negro race enters with me.'" ~ Anna Julia Cooper

iii

Dedication
For all the little black girls that grew up on the outskirts of USC, shiny gates, and
buildings amidst the backdrop of a dangerous ‘hood, smiling and working hard, hoping to get
the golden ticket out of the one-way track to generational poverty, this one’s for you. for all the
little homies, cousins, and OG family members who dreamt of going to the “university of south
central”, but whose dreams were interrupted, dashed, and disrupted because of life
circumstances such as, injury, sickness, illness, incarceration, police brutality, the school to
prison pipeline, this one’s for you. I know you’ll never read this, but I hope you know that I carry
all of you with me across this finish line along with it. I’ll meet you on the other side of the
tracks.

iv

Acknowledgements
Where do I begin when writing, what to me, is one of the most important sections of
this project? To think that I would have even made it this far, far enough to write the
acknowledgements section of a dissertation brings me tears of joy –I’m in utter disbelief! I have
come such a long way from being the curious little kiddo experimenting with microscope kits
and insects outside of a modest apartment complex in Inglewood, California. Every time my
mother drove past USC, I’d always wonder what it would take for me – a little hood from all
over L.A. – to be able to one day graduate from the esteemed institution. And with a doctoral
degree, no less? Wow. To be the first in my family to earn a bachelor’s degree, a master’s
degree, and now a doctoral degree is an honor, a blessing, and a testament to all those who
believed in me from the very beginning! The list is long and so the acknowledgements will be as
well.
Thank you, Mama and Daddy, for believing in me, always. You never gave up on me and
you’re still helping me to pursue all my dreams. I would be nothing and nowhere without you.
Your unconditional love for me and your pride in my accomplishments is surely what has made
me be successful thus far. I am forever indebted to you, Mom and Dad. I love you with all my
heart. Thank you for being my two biggest inspirations. Thank you, Arthur, Kaya, and Anthony,
for being the best siblings on the planet! I love you so much and I want you to know that I broke
the ceiling so you could go to outer space! Go for the stars, my babies!
Thank you, God! Is this real? Did I finish? It has only been thanks to the abundant
blessings of the universe that I have been fortunate to have a God that loves me so much that

v
in the middle of such an arduous degree program, I had time to fall in love. Thank you Lizz, my
love, my rock in the middle of the storm, my heart. Thank you for holding all my tears, all my
pain, all my joy, all my many emotions – ups and downs—that came with the three years I’ve
been enrolled in this program. What a way to cap off my roaring 20s! Without you Lizz, none of
this would have been possible, for I wanted to quit many times – even while writing the
acknowledgements. You never gave up on me and most importantly, you never let me give up
on myself. I could see the finish line through your eyes and for your love, I am eternally
humbled to receive it, grateful, and honored to love you in return. Thank you for your support.
There are really no words to describe what we’ve been through together on this journey to the
finish line – may the book that we write together tell the story with a pinch of sass and a whole
lot of jokes, because DAMN! Let’s celebrate, sweetie! WE did this. We did it.
The process of completing this dissertation was undoubtedly a labor of a revolutionary
love – one born from struggle and filled with cycles and stages of grief, anger, frustration,
irritation, apathy, complacency, excitement, boredom, and motivation. Thank you, Dr. Cash, Dr.
Ott, Dr. Muraszewski, and Dr. Lynch for your support. I would not have done this without each
of you believing in me, tempered radicals you were, enough to do whatever was necessary to
keep me enrolled in this program and academically successful in your courses. Dr. M, you are
my light and shining star as a chair. Without you cheering me along, lifting me up, and
encouraging me every step of the way, I doubt I would have made it this far. I thank you from
the bottom of my heart for all that you have done for me in this program. My deepest gratitude
also goes out to Dr. Lori, Dr. Nancy, zoé samudzi, Mark Jackson, Dr. Daryl Smith, Dr. anthony
antonio, and Dr. S. David Brazer for also believing in my capacity to be a scholar and researcher,

vi
when I didn’t believe in myself. Imposter syndrome is a hell of a drug, isn’t it?
How could I have done this without being triggered, whilst undergoing procedures and
invasive procedures? I couldn’t have done it without God and without the prayers of my
topmost prayer warrior, my Granny. Granny, I can’t type here what I want to say to you without
crying for hours, but I wish to thank you publicly for all you’ve done, sacrificed for us to give us
a better life. Granny, thank you for every prayer, every phone call, every bit of encouragement
you could muster – even when you were suffering, amid your own trials and tribulations. You,
like Job, still found time to pray for me and all our family. Granny, this dissertation is for you.

vii
Table of Contents
Epigraph .............................................................................................................................................................ii
Dedication ......................................................................................................................................................... iii
Acknowledgements ............................................................................................................................................ iv
List of Tables .................................................................................................................................................... xiv
List of Figures ................................................................................................................................................... xvi
Abstract .......................................................................................................................................................... xvii
CHAPTER ONE: INTRODUCTION .......................................................................................................................... 1
Background of the Problem ................................................................................................................................ 2
Importance of Addressing the Problem .............................................................................................................. 4
Description of Stakeholder Groups ..................................................................................................................... 5
Stakeholder Group for this Study ....................................................................................................................... 6
Purpose of the Project and Questions................................................................................................................. 8
Definitions ......................................................................................................................................................... 9
Organization of the Study ................................................................................................................................. 11
CHAPTER TWO: LITERATURE REVIEW ................................................................................................................ 13
Models of Disability .......................................................................................................................................... 14
Medical Model of Disability .................................................................................................................................... 14

viii
Social Model of Disability ........................................................................................................................................ 14
Minority Model of Disability ................................................................................................................................... 15
The Law and Students with Disabilities in Postsecondary Institutions ................................................................ 16
Avoiding Discrimination under the Law .................................................................................................................. 18
Retention and Persistence Rates of Students with Disabilities ........................................................................... 20
A Rise in Enrolled Students with Mental Health Conditions .................................................................................... 21
Academic Challenges Faced by Students with Disabilities ...................................................................................... 22
Stop-outs and Predictors of Discontinuous Enrollment ..................................................................................... 23
Medical leaves of absence ................................................................................................................................. 27
Re-entry................................................................................................................................................................... 29
Barriers to Providing Adequate Support Services.................................................................................................... 31
Promising Practices and Existing Models ................................................................................................................ 32
Exploring Clark and Estes’ Knowledge, Motivation, and Organizational Influences Framework ........................... 33
Knowledge and Skill Influences ............................................................................................................................... 34
Motivated Performance Influences ......................................................................................................................... 35
Organizational Influences ....................................................................................................................................... 36
Stakeholder-Specific Knowledge, Motivation, and Organizational Influences ..................................................... 36
Knowledge and Skills ............................................................................................................................................... 36
Professional Knowledge of Disabilities and Chronic Illnesses ............................................................................ 37
Intervals and Methods of Communication ........................................................................................................ 38
Topics of Communication .................................................................................................................................. 39

ix
Motivation and Related Attitudes ........................................................................................................................... 41
Student Professionals and Utility Value ............................................................................................................. 43
Self-Efficacy of Student Affairs Professionals ..................................................................................................... 45
Organizational Influences ....................................................................................................................................... 48
Cultural models .................................................................................................................................................. 49
Cultural settings ................................................................................................................................................. 50
Positive Beliefs in the Likelihood of Student Success ......................................................................................... 50
Positive Value and Regard for Training and Resource Allocation ...................................................................... 52
Positive Value and Regard for Data Collection .................................................................................................. 54
The Interaction of Stakeholders’ Knowledge, Motivation, and Organizational Context ....................................... 56
Conceptual Framework ........................................................................................................................................... 56
Worldviews ............................................................................................................................................................. 58
CHAPTER THREE: METHODS .............................................................................................................................. 64
Participating Stakeholders ...................................................................................................................................... 67
Demographic Data of Survey Respondents ........................................................................................................ 67
Survey Sampling Criteria and Rationale ............................................................................................................. 68
Interview Participation Criteria and Rationale ................................................................................................... 69
Data Collection and Instrumentation ................................................................................................................. 72
Surveys ............................................................................................................................................................... 72
Interviews ........................................................................................................................................................... 74
Data Analysis .................................................................................................................................................... 75
Credibility and Trustworthiness ......................................................................................................................... 76

x
Validity and Reliability ...................................................................................................................................... 77
Ethics ................................................................................................................................................................ 77
CHAPTER FOUR: RESULTS AND FINDINGS .......................................................................................................... 80
Knowledge Influences: Quantitative Findings .................................................................................................... 81
Participant Knowledge of Disability or Chronic Illness ............................................................................................ 82
Appropriate Intervals and Methods of Communication ......................................................................................... 83
Topics of Communication While on Leave .............................................................................................................. 84
Knowledge Influences: Qualitative Findings ....................................................................................................... 85
What Constitutes a Disability? ................................................................................................................................ 85
Intervals and Methods of Communication .............................................................................................................. 88
The Importance of Regular, Meaningful Connections with Students ................................................................ 88
Topics of Communication ........................................................................................................................................ 90
Helping Students Explore Their Options ............................................................................................................ 90
“You’re Only Human” and Empathic Response Strategies ................................................................................ 92
Motivation Influences: Quantitative Findings .................................................................................................... 95
Motivation Influence 1: Self-Efficacy....................................................................................................................... 95
Motivation Influence 2: Utility Value ...................................................................................................................... 97
Motivation Influences: Qualitative Findings ....................................................................................................... 99
Confidence in Advocacy Strategies ....................................................................................................................... 100
“No Questions Asked”: Valuing of Role in Facilitating Exit and Re-Entry .............................................................. 102
Asset or need? ....................................................................................................................................................... 103

xi
Organization Influences: Quantitative Findings ................................................................................................ 104
Organization Influence 1: Value and Positive Regard for Student Support .......................................................... 104
Vision statements............................................................................................................................................. 104
Departmental Meetings ................................................................................................................................... 105
Targeted Support Programs ............................................................................................................................. 107
Organizational Influence 2: Need to Express Positive Beliefs in Student Success ................................................. 108
Departmental Ability to Provide Adequate Support ........................................................................................ 109
Ease of Navigating Institutional Policies ............................................................................................................... 110
Organizational Influence 3: Positive Organizational Beliefs in Student Success ................................................... 112
Resource Allocation for Students on MLOA ..................................................................................................... 112
Organizational Influences: Qualitative Findings ................................................................................................... 113
“No Questions Asked”: The Flexibility of Leave Policies .................................................................................. 114
Providing Intensive Supports to Students Seeking Leave ................................................................................ 116
Additional Resource Allocation on MLOA ........................................................................................................ 118
Summary of KMO Influences Validated as an Asset or Need ............................................................................ 120
Chapter Five: Recommendations ..................................................................................................................... 122
Knowledge Influences and Recommendations...................................................................................................... 123
Sustaining Practitioners’ Knowledge about Intervals and Methods of Communication ................................. 126
Sustaining Practitioners’ Knowledge about Topics of Communication ........................................................... 128
Motivation Influences and Recommendations ..................................................................................................... 129
Maintaining Self-Efficacy in Case Management and Support Strategies ......................................................... 131
Self-Efficacy ...................................................................................................................................................... 132
Utility Value ...................................................................................................................................................... 133
Organizational Influences and Recommendations ............................................................................................... 134

xii
Sustain Institutional Value and Regard for Adequate Training, Resource Allocation, and Interorganizational
Collaboration .................................................................................................................................................... 137
Demonstrate Institutional Value and Regard for Data Collection and Benchmarking..................................... 140
Integrated Implementation and Evaluation Plan .............................................................................................. 143
Implementation and Evaluation Framework ........................................................................................................ 143
Organizational Purpose, Need and Expectations .................................................................................................. 143
Level 4: Results and Leading Indicators ................................................................................................................ 145
Level 3: Behavior ................................................................................................................................................... 147
Critical Behaviors .............................................................................................................................................. 147
Required Drivers .............................................................................................................................................. 148
Organizational Support .................................................................................................................................... 150
Level 2: Learning ................................................................................................................................................... 151
Learning Goals .................................................................................................................................................. 151
Program ............................................................................................................................................................ 151
Evaluation of the Components of Learning ...................................................................................................... 153
Level 1: Reaction ................................................................................................................................................... 155
Evaluation Tools .................................................................................................................................................... 156
Immediately Following the Program Implementation ..................................................................................... 156
Delayed for a Period After the Program Implementation................................................................................ 157
Data Analysis and Reporting ........................................................................................................................... 158
Summary ........................................................................................................................................................ 160
Limitations and Delimitations.......................................................................................................................... 162

xiii
Implications for the Student Affairs Participants and their Institutions ............................................................ 164
Implications for the Research Community ....................................................................................................... 165
Discussion and Future Research ...................................................................................................................... 165
Conclusion ...................................................................................................................................................... 166
References ...................................................................................................................................................... 168
Appendix A ..................................................................................................................................................... 182
Appendix B ..................................................................................................................................................... 191

xiv
List of Tables
TABLE 1 .......................................................................................................................................................................... 41
TABLE 2 .......................................................................................................................................................................... 48
TABLE 3 .......................................................................................................................................................................... 56
TABLE 4 .......................................................................................................................................................................... 68
TABLE 5 .......................................................................................................................................................................... 70
TABLE 6 .......................................................................................................................................................................... 82
TABLE 7 .......................................................................................................................................................................... 83
TABLE 8 .......................................................................................................................................................................... 84
TABLE 9 .......................................................................................................................................................................... 85
TABLE 10 ........................................................................................................................................................................ 96
TABLE 11 ........................................................................................................................................................................ 98
TABLE 12 ........................................................................................................................................................................ 99
TABLE 13 ...................................................................................................................................................................... 105
TABLE 14 ...................................................................................................................................................................... 106
TABLE 15 ...................................................................................................................................................................... 107
TABLE 16 ...................................................................................................................................................................... 108
TABLE 17 ...................................................................................................................................................................... 109
TABLE 18 ...................................................................................................................................................................... 110
TABLE 19 ...................................................................................................................................................................... 111
TABLE 20 ...................................................................................................................................................................... 112
TABLE 21 ...................................................................................................................................................................... 113
TABLE 22 ...................................................................................................................................................................... 120
TABLE 23 ...................................................................................................................................................................... 121
TABLE 24 ...................................................................................................................................................................... 121
TABLE 25 ...................................................................................................................................................................... 124

xv
TABLE 26 ...................................................................................................................................................................... 130
TABLE 27 ...................................................................................................................................................................... 136
TABLE 28 ...................................................................................................................................................................... 146
TABLE 29 ...................................................................................................................................................................... 148
TABLE 30 ...................................................................................................................................................................... 149
TABLE 31 ...................................................................................................................................................................... 154
TABLE 32 ...................................................................................................................................................................... 156

xvi

List of Figures
FIGURE 1 ........................................................................................................................................................................ 60
FIGURE 2 ...................................................................................................................................................................... 160

xvii
Abstract
This dissertation served as a pilot evaluation study that tested a set of ideas that were
drawn from literature in organizational theory, leadership theory, disability studies, and student
affairs literature, among others. The purpose of this project was to conduct a needs analysis in
the areas of knowledge and skill, motivation, and organizational resources necessary to
accomplish the goals of facilitating a successful medical leave or compassionate withdrawal
process, which also includes a holistic, re-entry process, and increasing the numbers of
retention and persistence to graduation for this student subpopulation.
This study addressed research questions that sought to find the current state of
stakeholder knowledge and motivation necessary to ensure that at least 60 percent of students
who take a medical leave of absence (or compassionate withdrawal) successfully navigate
reentry and reintegration on campus, and persist to graduation within 6 to 8 years, as well as
the interaction between organizational culture and context, and stakeholder knowledge and
motivation as it relates to ensuring that at least 60 percent of students who take a medical
leave of absence (or compassionate withdrawal) successfully navigate reentry and reintegration
on campus, and persist to graduation. The findings suggest that the role of student affairs
practitioners, the complex nature of medical leave policies, and the myriad of health factors
that impact students’ academic trajectory can create a series of circumstances that require
additional institutional resources to support the stakeholder goal. Implications for the field
include improving opportunities for professional development, data collection practices, and
job aids to help support practitioners in working with students on medical leave and during the
re-entry.

1
CHAPTER ONE: INTRODUCTION
One issue that colleges and universities in the United States have had to address is the
high levels of attrition for undergraduate students with psychological and physical disabilities.
Studies have shown that 86 percent of students with psychiatric disabilities withdraw from
college prior to attaining their degree (Hurst & Smerdon, 2000; Kupferman, 2014; O’Shea &
Kaplan, 2018; Snyder et al., 2016). In a report from the Center for Collegiate Mental Health
(2018), of those who dropped out of college or took academic or health-related leaves of
absences, 25 percent of students reported that at least one mental illness, such as anxiety or
depression, impacted their decision to voluntarily withdraw from their academic program
(Center for Collegiate Mental Health, 2018; NCD, 2017). In other studies, students with
disabilities—regardless of demographic characteristics and in-college experiences—have been
shown to be less likely to persist to graduation and more likely than their peers to leave college
at the end of their first and second years (Koch et. al, 2017; Raue & Lewis, 2011).
The aim of this study was to evaluate the capacity of student affairs professionals,
specifically those who support accessible education, to provide the supports needed to increase
the retention and persistence rates of students who choose to stop out or take a leave of
absence from school for medical reasons, either due to an emergent illness or a pre-existing
medical condition, also referred to in the literature as medical withdrawal. It should be noted
that some postsecondary institutions also refer to this policy as a compassionate withdrawal
when taken for mental health reasons or a medical leave of absence for general health-related
reasons.
Data analytics, promoting a sense of belong and a growth mindset, community

2
connections, and entry-level courses are all possible solutions that can remedy the issue of
student attrition and increase the persistence rates for students who are currently enrolled
(Belch, 2004; Hoyt & Winn, 2004; Tinto, 2012; Woosley, 2003). Few studies, however, outline
specific strategies for ensuring the academic success for students who have temporarily paused
their studies for health-related reasons. Supporting students who stop-out for medical reasons
is an important problem to address to increase the retention and persistence rates among all
college students, including those who choose to continue their course of study after
temporarily withdrawing from the institution.
Background of the Problem
An estimated 11% of undergraduate students in the U.S. report having some type of
disability (Belch, 2011; U.S. Government Accountability Office, 2009). The Americans with
Disabilities Act of 1990 (ADA), the Individuals with Disabilities Education Act (IDEA), and the
Rehabilitation Act of 1973, among others, are all statutes that require the use of reasonable
accommodations and prohibit discrimination against individuals with disabilities. However,
researchers have found that students with disabilities continue to face barriers to their
education. Some of the functional limitations that these students experience may be related to
short-term memory, critical thinking, and metacognition, as well as social isolation on campus,
uneven distribution of accommodations, and stereotypically negative attitudes and behavior
(Agarwal et al., 2015; Agarwal, 2011; Dowrick et al., 2005; Eckes & Ochoa, 2005; Hartley, 2010;
Stodden & Jones, 2002). Retention and persistence are strongly connected to financial benefits
for colleges and universities and data shows increased student retention leads to higher tuition
revenue (Eisenberg et. al., 2009). However, there is an educational attainment gap among the

3
U.S. adult population. In the United States, people with disabilities experience higher rates of
attrition from college programs and lower rates of employments than their peers without
disabilities.
The Bureau of Labor Statistics (2015) found that 27% of 25- to 64-year-olds with
disabilities were employed compared to 77% of 25- to 64-year-olds without disabilities.
Additionally, approximately, two percent of 25-34 years had completed a bachelor’s degree,
while only 1% of 25- to 34-year-olds completed a master’s degree or higher (Bureau of Labor
Statistics, 2015). When compared to the next age range (35- to 44-year-olds), the statistics
remain low. Only 5% of 35- to 44-year-olds completed a bachelor’s degree, while 2% of 35-to
44-year-olds completed a master’s degree or higher (The Condition of Education, 2017). Finally,
while 42.8 percent of all employed adults without disabilities had a college degree or higher,
20.4 of all adults with disabilities had attained a degree higher than a bachelor’s degree (Taylor,
2018).
According to researchers, intentions to return and previous experiences at an institution
are significant predictors of re-enrollment for students who have withdrawn from a college, but
subsequently re-enroll (Woosley et al., 2005). Hoyt and Winn (2004) argued that there are
differences among groups of non-returning students and that issues related to discontinuous
enrollment should be treated as a retention issue, not one of attrition. While on a medical-
related leave of absence, financial aid, student support services, and community connections
are held in abeyance until the student re-enrolls in a course of study. However, despite a lack of
continuation of aid and support services, previous studies found that students who took a
medical leave benefitted academically, as measured by rates of re-entry, graduation, and

4
grades (Meilman & Turco, 1992, 1995).
In a seminal study on college withdrawals and re-enrollments, Woosley (2004) found
that 34 percent of students who withdrew from their course of study prior to the end of the
term re-enrolled—registered for classes and paid tuition—following their withdrawal. At one
institution, it was reported that the six-year graduation rate for students who took a medical
leave was 38 percent (Gomez, 2017). Otherwise, there is a dearth of literature that focuses
solely on the rates of stop out and re-enrollment for students who opt-in to a medical leave of
absence. Therefore, this dissertation is focused on examining the needs and resources required
for postsecondary institutions to accomplish the goal of increasing the persistence rates for
students who are on leave of absence for medical reasons. In this study, students with mental
health conditions are also subsumed under the category of students seeking withdrawals for
medical reasons.
Importance of Addressing the Problem
The individual and societal long-term economic benefits of investing in a postsecondary
education include increased employment opportunities and higher incomes for individuals, and
societal benefits such as economic growth and lower unemployment rates (Koropeckyj et al.,
2017). Student persistence, thus, remains central to the mission, goals, and outcomes of
postsecondary institutions (Mamiseishvili & Koch, 2011). Research shows that while most
withdrawals are temporary, factors such as delayed matriculation, first-year financial aid
packages, marital and dependent status also affect students’ decisions to drop out either
temporarily or permanently (Stratton et al., 2007; Woosley et. al, 2005).
Given an industry trend towards incorporating diversity, inclusion, and equity into its

5
programming and educational missions, postsecondary institutions may be able to achieve
greater positive outcomes for diverse populations through an intentional financial investment
in mental health resources for all students (Eisenberg et al., 2009). Institutions, however, must
be careful to not focus narrowly on educational outcomes, as this approach can reinforce pre-
existing disparities (Hillman, 2016).
Description of Stakeholder Groups
There are several key stakeholders that play a major role in achieving the goal of
successful re-entry, retention, and persistence of students who take a medical leave of absence,
including senior administrators, counseling staff, student support staff and disability resource
officials, and their home-based communities of support. Senior administrators are often the
arbiters of institutional policies, and thus are tasked with approving programs and policies that
relate to leaves of absence and re-entry. Student affairs practitioners, including counselors,
student support service providers, and disability resource staff are all responsible for
advocating for students, managing policies and cases, analyzing attrition and retention data,
and providing wrap-around services for enrolled students. However, those services and
additional institutional resources are usually unavailable to students once they have officially
taken a leave of absence from their course of study.
Students are important stakeholders because they are responsible for initiating the
process for leaves of absence, attaining appropriate medical and institutional approval, and
providing documentation that validates their medical conditions and substantiates their ability
to return to campus. Additionally, students are responsible for enacting self-advocacy strategies
and exploring tools that support motivation, metacognition, and emotional well-being to

6
benefit from meaningful learning and persist to graduation. Home-based communities of
support (e.g., parents, spouses, children, friends) are key stakeholders who are also impacted
by the student’s choice to discontinue their enrollment. Family and friends can provide
financial, social, and emotional support to students on leave and may greatly benefit from
additional resources provided by the institution in which the student is enrolled.
Stakeholder Group for this Study
The research for this study was conducted with student affairs practitioners at
institutions that have established tripartite leave of absence policies: personal, medical, or
academic. The study analyzed the knowledge, motivation, and organizational elements related
to achieving field-based goals of increased student retention and persistence. While a complete
needs analysis would focus on all stakeholders, for practical purposes, student affairs
practitioners (including student health service professionals) were the stakeholder group of
focus. The rationale for focusing on institutional employees as the primary stakeholder group is
that at postsecondary institutions, student affairs practitioners, counselors, student health
service professionals remain central to the provision, oversight, and management of
accommodations, services, policies, and interventions that support the academic success of
students who self-report one or more disabilities.
The stakeholders’ goal, supported by senior administrators, is that at least 60 percent of
students who take a medical leave of absence will successfully re-enroll and persist to
graduation. This stakeholder group was chosen because they are the front-line experts that can
provide insight, policy details, and recommendations for creating successful programs and
support services for students who take a medical leave of absence. It was important to

7
ascertain their perspectives and collect data regarding the processes and systems they
implement to properly evaluate the successes or failures of existing policies and programs.
While senior administrators and other forms of institutional staff would also be key
stakeholder groups to focus on, most institutions rely on student affairs professionals to
provide ample resources and support services to students who are actively enrolled in their
course of study. Student affairs practitioners are the sole focus of this study because they
provide the resources that lead to successful re-entry, retention, and persistence of students
that experience discontinuous enrollment, which is informed by how well their institution: a)
meets their individual needs as a student; b) equips them with knowledge about available
resources and supports, and c) facilitates the community connections and peer networks that
might motive them to complete their course of study (Tinto, 2012; Woosley, 2003).
Though student affairs work is now framed by developmental theories and “critical
cultural perspectives,” the longstanding principle in higher education—in loco parentis—
continues to influence the ways in which faculty, deans, and student support staff act on their
responsibility to provide a nurturing community, services, and resources to students on the
behalf of the parents or guardians (Rhoads & Black, 1995). Acting as “transformative
educators”, student affairs practitioners, along with faculty and support staff, are tasked with
operating within an ethic of care and must “continually interpret and reinterpret the
organization so that they can understand how the organizational culture impedes the creation
of a caring, democratic community” (Rhoads & Black, 1995, p. 420). In providing institutional
resources to students with disabilities (psychiatric and physical), student affairs practitioners
can consider root causes and policy analysis in their investigation of the barriers to retention

8
that students with physical and psychiatric disabilities face while enrolled in undergraduate or
graduate academic programs.
Purpose of the Project and Questions
The purpose of this project was to conduct a needs analysis in the areas of knowledge
and skill, motivation, and organizational resources necessary to accomplish the goals of
facilitating a successful medical leave or compassionate withdrawal process, which also
includes a holistic, re-entry process, and increasing the numbers of retention and persistence to
graduation for this student subpopulation. The primary aim of this study is to utilize a
conceptual theoretical framework to illuminate strategies that would promote the successful
medical leave or compassionate withdrawal process, which also includes re-entry and
graduation of students who have taken a medical leave of absence. Although a more thorough
examination of this topic would include students, parents, faculty, staff, and external providers,
this study focuses on student affairs practitioners. This study addressed the following
questions:
1. According to the stakeholders in this study, to what extent are higher education
institutions able to provide programs, resources, and supports that ensure that
at least 60 percent of students who take a medical leave of absence (or
compassionate withdrawal) successfully navigate reentry and reintegration on
campus, and persist to graduation within 6 to 8 years?
2. What is the current state of stakeholder knowledge and motivation necessary to
ensure that at least 60 percent of students who take a medical leave of absence
(or compassionate withdrawal) successfully navigate reentry and reintegration

9
on campus, and persist to graduation within 6 to 8 years?
3. What is the interaction between organizational culture and context, and
stakeholder knowledge and motivation as it relates to ensuring that at least 60
percent of students who take a medical leave of absence (or compassionate
withdrawal) successfully navigate reentry and reintegration on campus, and
persist to graduation within 6 to 8 years?
These questions were designed to ascertain information about how student affairs
practitioners could best support students who are currently in the medical leave process
pipeline—that is, they have either begun the process, are currently on leave, or are currently
seeking re-entry into their institution. Medical leave of absence policies are often designed to
assist students who are unable to complete their programs without stopping out to receive
medical care for physical or psychological disabilities. In this study, the researcher argued that
qualitative and quantitative data collected from student affairs practitioners on this topic might
also enumerate policy solutions that could generate successful outcomes for all students,
regardless of disability status.
Definitions
Ableism: A form of social injustice against people with disabilities, perpetuated by institutional
policies and laws, cultural beliefs and norms, and societal forms of discrimination (Bell, Adams,
& Griffin, 2007).
Attrition: The unit of measurement used to determine the rate of dropout among students
who do not return for or leave during their first or second year of college (Martinez, Sher, Krull
& Wood, 2009).

10
Disability: A physical or mental health condition that limits a person’s movements, senses,
activities, abilities to effectively participate in school or the workplace (“Disability: Definition of
Disability by Lexico”, 2020).
Drop out: Students who enroll in college but do not reenroll or do not complete their intended
degree program (Hoyt & Winn, 2004; Tinto, 1993).
Leave of Absence: A program option that allows students to temporarily withdraw from their
academic program of study (Mental Health America, 2020).
Marginalized: To be relegated to a marginal position within a society or group (“Marginalized”,
n.d.)
Medical (health-related) leave of absence: A temporary break in enrollment to physical or
mental health conditions that impact academic performance; often requires institutional
authorization and medical documentation (also compassionate withdrawal)
Mental health conditions: An umbrella term used to describe conditions that can affect all or
some of the following: reading, concentrating, thinking; executive functions, mood regulation,
and social interactions—is considered a disability if it impairs one’s ability to cope with major
life activities (Belch, 2011; Vaccaro, Daly-Cano, & Newman, 2015).
Minoritized: A term which connotes an understanding that “minority” status is socially
constructed in specific societal contexts (Stewart, 2013).
Persistence: The rate at which students who begin higher education at a specific point in time
continue in higher education, regardless of where they began their course of study or where
they eventually complete their degree (Tinto, 2012).
Retention: A campus-based phenomenon that focuses on the ability of a particular college or

11
university to successfully graduate the students who initially enroll at that institution (Berger,
Ramírez, & Lyons, 2012).
Student affairs practitioners: Professional staff that work to provide services, resources, and
supports for students that help them learn and grow outside of the classroom at postsecondary
institutions.
Stop-out: Students who leave college and re-enter later to complete their degrees (Woosley,
2003; Tinto, 1993).
Transfer: A term that refers to the movement a student makes from institution to another—
with or without overlapping dates of enrollment (Simone, 2014).
Organization of the Study
The overall structure of the study takes the form of five chapters. The first section of this
study will provide an overview of the study, including an introduction to the topic being
addressed, key ideas, stakeholders, and terminology involved in discussing barriers to
graduation for students who have taken a leave of absence for medical reasons. Chapter Two
provides a review of the current literature surrounding the scope of the study. Topics on
barriers to persistence, impacts of recidivism, economic and social instability that results from
stopping out, recommended supports, policies, and interventions for students at risk of
dropping out will be addressed.
Chapter Three draws together various findings and details the assumed needs for this
study. Additionally, this section describes the methodological framework and experimental
approach utilized in the study. Chapter Four analyzes the data gathered, results from the
finding, and addresses each of the research questions in turn. Finally, Chapter Five presents the

12
findings of the research, focusing on key themes that address potential solutions and
institutional recommendations based on data and literature, for addressing the needs of the
stakeholder group in this study.

13
CHAPTER TWO: LITERATURE REVIEW
This literature review will examine the existing literature on mental and physical health
conditions among students enrolled in postsecondary institutions, as well as the function of
medical leave and withdrawal policies as institutional supports, to inform the reader about the
problem of practice. The review begins with the historical and contextual background research
on retention and persistence in postsecondary institutions and a brief overview of psychiatric
disabilities and chronic illnesses that are prevalent among students who self-disclose during
their time of enrollment. Student affairs professionals, including disability service staff, and
their role in supporting students who have taken a medical leave of absence. This section
includes:
• A brief review of disability models (Marks 1997; Scotch, 2000)
• An exploration of research that demonstrate the barriers faced by students who
have disclosed disabilities while enrolled and institutional policies, such as medical
leaves of absence (Snyder et. al, 2016; Stewart, 2013).
• A discussion about barriers to success and potential practices that could improve the
outcomes for students with disabilities.
Next, the chapter will then provide an overview of Clark and Estes’ (2008) gap analysis
framework that guides this study—which examines the knowledge, motivation, and
organizational influences that lead to performance gaps in organizations. Finally, the chapter
presents an emerging conceptual framework that will be useful in its ability to inform the
research.

14
Models of Disability
The implementation of ADA policies with fidelity requires an understanding of how
disability is defined in society and the experiences, trials, and traumas faced by people who
identify as disabled (Scotch, 2000). Disability studies is an academic discipline that emerged to
both examine and theorize the social, political, cultural, and economic factors that define
disability (What Is Disability Studies? 2017). The disability rights movement included scholars,
activists, and practitioners who constructed debates around two distinctly different models of
understanding of disability - the social-political constructs of disability and the biomedical
models of disability (Adams et al., 2007).
Medical Model of Disability
According to research, the medical model of disability has primarily defined disability in
medical terms – terms that ultimately focus on disabilities as a set of chronic functional
incapacities that result in a limited or compromised ability to function independently in society
(Scotch, 2000). The medical model of disability views the disability as a problem of the person,
directly caused by disease, trauma, or other health condition, which therefore requires
sustained medical care provided in the form of individual treatment by professionals (Marks,
1997). Often, the medical model of disability relies on finding a cure or seeking treatment to
“fix” the disability.
Social Model of Disability
Social models of disability argue that a disabling society prevents the full integration of
individuals with impairments into society. In this model, disability is not an attribute of an
individual, but rather a complex collection of conditions, many of which are created by the

15
exclusive and oppressive social environment (Marks, 1997). This model emerged from the
struggles for independent living, citizenship, and civil rights for disabled people; thus,
addressing the problem from this framework requires direct social action (i.e., activism).
Marks (1997) argues that the social model sees the oppression of disabled people as
institutional in nature, rather than the product of a collection of individual actions on the behalf
of prejudiced people. From this standpoint, there is a critique about societal efforts to make
disabled people “normal”. In the social model, social change relies on the collective
responsibility of society to make the changes to the environment that allow for the full
participation of people with disabilities in all areas of social life. The most common example is
the construction of steps rather ramps at the entrance of buildings, in which case wheelchair
users are forced to depend on assistance to access the building (Marks, 1997). This issue is both
cultural and ideological, requiring individual, community, and large-scale social change.
Minority Model of Disability
The minority model of disability, also known as the sociopolitical model of disability, is
the idea that the category of “disability” is both created and that poverty among people with
disabilities exists because of prejudice, racism, and social and economic discrimination—not
because of the disability itself (Block et al., 2001). Scholars have used the minority group model
to explain systemic exclusion and discrimination based on gender, race, and sexual orientation
(Block et al., 2001). Identity politics are defined as the “politics based on the particular life
experiences of people who seek to be in control of their own identities and subjectivities, and
who claim that socially dominant groups have denied them this opportunity” (Block et al., 2001;
Sampson, 1993, p. 1219).

16
Although theories such as intersectionality now inform activism in disability circles, the
minority-group model focuses on a single identity category (race, gender, sexuality) to which
other identities are considered secondary or not salient at all (Block et al., 2001). Scholars argue
that despite the intent and regardless of the nature of the disability, labeling a person as
disabled results in stigma and social exclusion (Block et al., 2001).
The Law and Students with Disabilities in Postsecondary Institutions
Since the mid 90s, less than half a million college students enrolled in U.S.
postsecondary intuitions reported having a disability. According to the National Center for
Education Statistics [NCES] (2019), approximately 12 percent of postbaccalaureate students
reported having a disability compared to 19.4 percent of undergraduates (Hinz et al., 2017;
McFarland et al., 2019). Data collected by the National Council on Educational Statistics also
reveal a gap in persistence and attainment outcomes for students who report having a
disability. Students with disabilities in this report had one or more of the following conditions:
blindness or visual impairment; hearing impairment (e.g., deaf, or hard of hearing); orthopedic
or mobility impairment; speech or language impairment; learning, mental, emotional, or
psychiatric condition (e.g., serious learning disability, depression, ADD, or ADHD); or other
health impairment (NCES, 2019).
Previous studies show that 65 percent of 14- to 21-year-old students who received
special education services in school graduated with a high school diploma (Kena et al., 2016). IN
their report, Snyder et. al (2016) reported that only 45 percent of students with disabilities that
enrolled in a four-year university receive a degree or credential, compared with those who
enrolled in a two-year institution. Given the negative societal treatment, historical exclusion of

17
and discrimination against people with disabilities in the U.S., also known as ableism, students
with disabilities—especially those who are also members of other marginalized groups—could
be considered minoritized students (Bell et al., 2007; Stewart, 2013).
Federal involvement in the education of students with disabilities began in the late
1950s and early 1960s with the Education of Mentally Retarded Children Act of 1958, the
Training of Professional Personnel Act of 1959, and the Elementary and Secondary Education
Act of 1965 (Yell, 2012). These early laws provided funds for training teachers of children with
intellectual disabilities and served as precursors of direct aid apportioned to students with
disabilities, specifically students who attended state schools for the deaf, blind, and
intellectually disabled (Huefner, 2000). The first law to intersect with postsecondary institutions
was The Education of the Handicapped Act of 1970 (EHA) as it provided funding for higher
education institutions to develop programs to train teachers of students with disabilities, along
with funds to develop regional resource centers that provided technical assistance to state and
local school districts (Yell, 2012).
In the 1970s and 1980s, the U.S. Congress began to pass a slew of federal civil rights
laws to protect the rights of students and adults with disabilities and continue providing
support to teachers, school leaders, state, and local districts. In 1973, Congress passed the
Rehabilitation Act of 1973; Section 504 of this act was the first federal civil rights law to protect
the rights of persons with disabilities by prohibiting discrimination against any person with a
disability by any agency receiving federal funds (Yell, 2012). This act was followed by The
Education Amendments of 1974, The Education of All Handicapped Children Act of 1975, the
Handicapped Children’s Protection Act of 1986, and the Education of the Handicapped

18
Amendments of 1986, all of which provided financial incentives for states to make children with
disabilities eligible for services at the age of 3, required schools to develop individualized
education programs, and establish procedural safeguards for working with children who have
disabilities (Yell, 2012).
According to Yell (2012), in the 1990s and 2000s, the Americans with Disabilities Act of
1990 (ADA), the Individuals with Disabilities Education Act [IDEA] (1990), the Individuals with
Disabilities Education Act Amendments (1997) and Individuals with Disabilities Education
Improvement Act (2004) expanded definitions of disability to include traumatic brain injury and
autism, added transition requirements to education programs, and required that all special
education teachers be certified in special education and meet the highly qualified teacher
requirements of No Child Left Behind (NCLB) Act (2002). The Individuals with Disabilities Act
[IDEA] (1990) specifically requires school administrators and teachers to provide a free and
appropriate public education to any student with a disability under the age of 21 (Yell, 2012).
The combination of all these statutes required the use of reasonable accommodations,
prohibited discrimination against individuals with disabilities, and may have helped to increase
the population of students with disabilities who have enrolled in postsecondary institutions
over time (Belch, 2004).
Avoiding Discrimination under the Law
The loophole that perhaps exists among all these statutes is that they only provide
safeguards to students who fall under the 13 categories of disabilities set forth by the act and
whose disability adversely impacts their academic performance (Yell, 2012). It should be noted
that not all scholars support the idea that postsecondary disability services are driven by the

19
federal, legal mandates, such as IDEA (1975; 1990) and ADA (1990). Shaw and Dukes (2001)
argue that evidence-based, best practices have been more influential on the design and
implementation of disability services programs than the drive to meet the standards of legal
precedents. Additionally, their research showed that practitioners agreed that there were a
common set of essential disability services that should be provided “regardless of specific
institutional characteristics” (Shaw and Dukes, 2001, p. 2). Section 504 of the Rehabilitation Act
of 1973 and the Americans with Disabilities Act (ADA) of 1990 are civil rights laws that provide
safeguards against discrimination against students with disabilities enrolled in postsecondary
institutions, since colleges and universities are not subject to the mandates of the Individuals
with Disabilities Education Act (Madaus & Shaw, 2006; Yell, 2012).
Section 504 primarily protects qualified students with disabilities from being denied
admission, as institutions are prevented from inquiring about disability status at the time of
application, and provides equal opportunity to participation in physical education, athletics,
intramural activities, and clubs (Yell, 2012). Students with disabilities only receive protection
and services under these laws when they voluntarily disclose their disability and provide
medical documentation that they have a physical or mental impairment that substantially limits
one or more major life activities (Madaus & Shaw, 2006). Upon receipt of documentation,
colleges and universities are then obligated to provide students with disabilities the opportunity
to access alternative technologies, flexibility with exams and assignments, notetakers,
interpreters, tutoring, counseling, vocational, and placement services to the same extent as
those provided to students without disabilities (Hawke, 2004; Yell, 2012).

20
Retention and Persistence Rates of Students with Disabilities
Emerging studies have begun to include non-traditional students in their analyses of
postsecondary outcomes in the United States. Non-traditional students include those who
transfer among institutions, temporarily withdraw from their studies, and later re-enroll, or
enroll part-time (McFarland et al., 2019). Completion rates and postsecondary outcomes for
non-traditional and traditional undergraduate students vary by enrollment status (part-time,
full-time), enrollment type (first-time students, non-first-time students), and institution type
(public, private, 2-year, and 4-year). McFarland et al. (2019) report that about 60 percent of
undergraduate students who enrolled at a 4-year institution completed their degree at the
same institution within six years.
Among full-time students enrolled in 2-year public institutions in 2009: 30 percent of
first-time undergraduate students completed their degrees within eight years, while 38 percent
of non-first-time undergraduate students persisted until graduation. Additionally, among part-
time students enrolled in 2-year public institutions in 2009: 16 percent of first-time
undergraduate students completed their degrees within eight years, while 21 percent of non-
first-time undergraduate students persisted until graduation. McFarland et al. (2019) also
report that transfer rates were higher among non-first-time students (37 percent for part-time
students and 30 percent for full-time students) than among first-time students (24 percent for
both full-time and part-time students). After controlling for the type of institution, non-first-
time students are more likely to transfer out from public institutions than private non-profit
and private for-profit institutions (McFarland et al., 2019). Few reports, however, present
compelling data regarding the completion rates for traditional and non-traditional students

21
enrolled in postbaccalaureate programs.
A Rise in Enrolled Students with Mental Health Conditions
Several studies indicate that there is an increased interest in at-risk college students,
particularly those who have a psychological or psychiatric disability. Within this area of
investigation, there has been significant growth in the number of college students with mental
health issues. Reportedly, the prevalence of widespread mental health issues may be increasing
among college students (Hinz et al., 2017; McFarland et al., 2018; NCES, 2016; Oswalt et al.,
2018). Students with psychiatric and emerging disabilities often do not receive comprehensive
services, resources, and advising that are often important predictors of academic success and
equitable outcomes after graduation (Agarwal et al., 2015).
Scholars argue that educators, students, and social service agencies equipped with the
knowledge and resources to create and assess the impact of institutional policies, support
services, and interventions on the academic success, retention, and persistence of students
with disabilities (Padden & Ellis, 2015). In their survey, LeViness et al., (2017) found that
counseling services professionals reported that 48.2% of students are most frequently
concerned with anxiety, stress (39.1%), depression (34.5%), and suicidal ideation (25.2%).
In their study, Collette, Armstrong, and Bean (2018), using data from the National
College Assessment (NCHA), found that the most reported mental health conditions and
symptoms among college students were stress, anxiety, difficulties with sleep, and academic
distress (Collette, Armstrong, & Bean, 2018). In addition to an increasing demand of counseling
services reported by college campuses of varying sizes, several studies show a similar growth
pattern among undergraduate college students who report mental health conditions and

22
symptoms during their enrollment (The Steve Fund, 2018; American College Health Association,
2018; Center for Collegiate Mental Health, 2018).
A closer demographic analysis of the Steve Fund-Harris poll data reveals that 26% or
more of students who report having received a mental health related diagnosis are members of
racially minoritized groups, especially those who identify as African American/Black, Asian, and
Pacific Islander—a group that together makes up about 39% of the current total undergraduate
student population (McFarland et al., 2018; The Steve Fund, 2018). Students of color are also
less likely than their white peers to acquire mental health services and recommend help-
seeking behaviors to others (Coles & Schubert, 2015; Hunt, Eisenberg, & Gathright, 2014).
Additionally, youth who self-identify as lesbian, gay, and bisexual youth are nearly five times
more likely to have attempted suicide than their heterosexual peers (Center for Disease
Control, 2016).
Academic Challenges Faced by Students with Disabilities
Academic challenges for students with disabilities include functional limitations related
to short-term memory, critical thinking, and metacognition (Hartley, 2010). Interpersonal
challenges reported by students include social isolation on campus, uneven distribution of
accommodations, and stereotypically negative attitudes and behavior (Agarwal et al., 2015;
Agarwal, 2011; Dowrick et al., 2005; Eckes & Ochoa, 2005; Stodden & Jones, 2002). Studies
have explored the connections between academic workload and perceived stress, levels of
psychological distress and academic performance, and diagnoses of disorders and failure to
persist to graduation (Brachney & Karabenick, 1995; Kessler et al.,1995; Kausar, 2010).

23
Stop-outs and Predictors of Discontinuous Enrollment
Literature on college retention, attrition, and persistence highlights many factors that
can influence students’ decisions to temporarily withdraw from academic programs. Most
researchers emphasize the importance of distinguishing students who have taken a temporary
leave of absence from students who opt for a more permanent route and thus are referred to
as dropouts or stay-outs due to their disinclination towards re-enrollment (Hoyt & Winn, 2004).
However, students that begin an academic program only to temporarily stop out and re-enroll
to complete their plan of study are referred to in the literature as stop-outs or transfers (Hoyt &
Winn, 2004; McFarland et al., 2019).
Studies suggest that minoritized students may stop out because of homesickness,
institutional dissatisfaction, uncertainty or a change in career aspirations, financial stress, and
mental health issues (Ahson et. al, 1998; Cole, 2017; Hoyt & Winn, 2004). Other studies have
concluded that the withdrawals are temporary, factors such as delayed matriculation, first-year
financial aid packages, marital and dependent status also affect students’ decisions to drop out
either temporarily or permanently (Stratton et al., 2007; Woosley et al., 2005). Woosley (2003)
found that students who opt to temporarily withdraw from their academic programs do not
intend to do so permanently. In fact, her study showed that a significant number of students
who established a firm intention to re-enroll, reported long-term educational plans, and
expressed commitment to their institution tended to re-enroll (Woosley, 2003). Those who stop
out also tend to be older, working, married with children and more likely to attend part-time
due to financial restraints.
Terriquez and Guarantz (2015) found that students who tend to have difficulties paying

24
for school and balance financial obligations to their families are at a greater risk of temporarily
withdrawing from school. The study also indicated that some students who eventually stop-out
from academic programs are simply not financially equipped to pay for increased housing costs
or ever rising tuition rates (Terriquez & Guarantz, 2015). Additionally, without firm literacy and
skills in personal finances or capital management, students from lower economic backgrounds
find greater difficulty navigating the financial decisions associated with attending college and
completing their degree program in a timely manner (Jorgensen & Salva, 2010; Terriquez &
Guarantz, 2015).
Within education literature, researchers have explored predictors of discontinuous
enrollment, including minoritized racial/ethnic identities, gender identity and sexual
orientation, previous discontinuous enrollment, family income, high school academic and test
performance, illicit drug use and alcohol use (Arria et al., 2013; Chen & DesJardins, 2010;
DesJardins et al., 2006). In one multinomial study, students that received generous financial aid
packages, including grants, had a lower probability of dropping out. Additionally, the study
found that while most withdrawals are temporary, factors such as delayed matriculation, first-
year financial aid packages, marital and dependent status affected students’ decision to either
temporarily or permanently dropout (Stratton et al., 2007).
Stopping out: Medical and Mental Health Reasons. Since the mid 2000s, surveys of
college students have reported that students diagnosed with mental health conditions are less
likely to successfully persist to degree completion. Hunt et al. (2010) found that 52.4% of
students with comorbid diagnoses withdrew from college, while Unger et al. (2000) reported a
78.1% withdrawal rate for students with psychiatric disabilities who were enrolled part-time.

25
Arria et al. (2013) examined the prospective relationship of substance use and mental health
problems with risk of discontinuous enrollment in college. The authors found that students who
experience depressive symptoms or seek treatment during for depression during college might
be at risk of interruptions in their college enrollment (Arria et al., 2013). In their study, students
entering college with preexisting psychiatric diagnoses, such as anxiety or depression, were not
found to be more at risk for temporary withdrawal or dropout than their counterparts (Arria et
al., 2013). In another study, among students who dropped out of college or took academic or
health-related leaves of absences, 25% of participants indicated they had at least one
diagnosed mental illness, such as anxiety or depression; to add to that, substance use also
impacted their decision to voluntarily withdraw from their course of study (NCD, 2017).
Findings from the National Alliance of Mental Illness report, College Students Speak
(2012), show that, overall, more than 64% of the sample population indicated they had stopped
attending college to care for their mental health. Moreover, 45% of respondents stated that
they did not receive accommodations from their institution, while 50% reported that they did
not access mental health services and supports while enrolled (Gruttadaro & Crudo, 2012).
Researchers have shown that while students with disabilities report more anxiety and distress
around academic performance than students without disabilities, they are like their non-
disabled peers in other areas of their lives (Coduti et al., 2016). Additionally, Coduti et al. (2016)
also report higher levels of suicidal ideation, suicidal attempts, and non-suicidal self-injury
among students, regardless of use of counseling services. For college students, a psychiatric
diagnosis can negatively impact their academic performance, as well as their individual pursuit
of their own educational goals (Souma et al., 2002).

26
Stopping Out: Chronic Illness or Disease. Much of the available literature on
discontinuous enrollment deals with the question of discontinuous enrollment among students
with psychiatric disabilities. However, others propose that the needs of students with chronic
illnesses are overlooked, as they are not accurately reflected in the reported number of
students with health-related disabilities enrolled in postsecondary institutions (Jung, 2003;
Royster & Marshall, 2008).
Students with severe illnesses such as lupus, rheumatoid arthritis, cancer, heart disease,
chronic fatigue syndrome (CFS), cystic fibrosis, fibromyalgia, or multiple sclerosis, among
others, may not identify themselves as having a disability and are therefore not eligible to
receive accommodations and services at their institution (Royster & Marshall, 2008). Royster
and Marshall (2008) report that students with chronic illness have challenges that can impact
their ability to persist until graduation. Some of these challenges include unpredictable relapses
and flares of activity followed by periods of remission, an inability to qualify for financial aid,
loss of independence and control, reduced options for employment, and an inability to
complete their course of study (Royster & Marshall, 2008).
In her seminal article, Jung (2003) explored the way in which policies that provide
academic accommodations for students with disabilities fail to actualize support for students
with chronic illnesses in practice. Students with chronic illnesses require accommodations that
must be negotiated, adapted, and arranged with individual instructors, unlike students whose
disabilities can be accommodated through a singular expenditure of funds: building access;
adaptive technologies; or material resources (Jung, 2003). Jung (2003) identifies three
characteristics of most university policies for students with disabilities: 1) students must self-

27
disclose and identify as disabled; 2) they must provide medical documentation when requested;
and 3) they must individually arrange the accommodation with each instructor with whom they
are pursuing a course of study. As Jung notes, “the individualization of accommodation”
requires students to do the work of petitioning instructors, providing education on issues
related to their illness, and enduring the heightened visibility of their course work or their
physical bodies (Jung, 2003). Without proper institutional supports in place, chronically ill
students are thus at risk for discontinuous enrollment or permanent withdrawal during the first
year (Dutta et al. 2009; Jung, 2003; Royster & Marshall, 2008).
Medical leaves of absence
As scholars have noted, there is little literature on students who withdraw for medical
issues or for mental health reasons (Woosley, 2003). Health-related academic exceptions, such
as temporary leaves of absence, tend to work best for students who demonstrate a
commitment to receiving ongoing treatment from counselors and advisors (Meilman, 2011).
This, however, does not apply to students who may require psychiatric hospitalization at some
point during their enrollment. To return to some institutions following a leave of absence,
students are encouraged to pursue weekly medical treatment, completion of rehabilitation
programs, daily work, internship, or volunteer opportunities (Meilman, 2011).
Academic and psychological difficulties are interwoven, can be cyclical, and might
require therapeutic intervention to support student success (Meilman, 2011). Students who
take a medical leave of absence may do so because they can no longer function in school for
various physical health or mental health reasons (Meilman & Turco, 1995). Therefore, an official
medical withdrawal signals that a student is most likely experiencing severe psychological or

28
physical health stressors that require coordinated care and action plans by counselors, the
student, academic and student affairs deans, parents, and the student health center (Meilman,
2016).
At times, students with mild to moderate mental health challenges can receive
academic exceptions from the counseling center, so they can improve their academic
performance without penalty. At most institutions, students generally work with their assigned
advisors or counselors to discuss academic difficulties and if required, counseling center
practitioners will use discretion to justify individual needs for academic exceptions. However,
students must acquire formal counseling center recommendations and administrative approval
from deans to voluntarily withdraw for health reasons (Meilman, 2011).
Students who might present the need for a timed release from their course of study
may be hesitant to do so for both academic and social reasons. These reasons can include: a
desire to graduate on time with their class; fear of returning to a toxic home environment; loan
repayment or loss of scholarship funding; or disengagement from social activities and social
isolation (Meilman, 2016). Meilman (2016) also notes that though it can be beneficial for the
long-term, it is more difficult to persuade students who are performing well academically but
have substantial mental health concerns (e.g., eating disorders, non-suicidal self-injury, suicidal
concerns, and substance abuse) to opt for a health-related leave of absence. Students who
suffer relapse may have difficulties locating resources while off-campus, and so in this instance,
Meilman (2016) describes the ways in which his office assists students in connecting to
providers. Interorganizational communication and collaboration, in this case, were essential
factors in ameliorating the experiences of students who were most at-risk and likely to relapse,

29
despite completing all formal requirements for re-entry and re-enrollment.
Re-entry
There are few studies that focus on the re-entry experiences of students returning to
college following a leave of absence, regardless of the initial reason. In a study of people who
grow up overseas and return to the United States for college, Haines (2013) defines the re-entry
process as a combination of physical movement and cognitive adjustment to new
environments. As Haines (2013) writes, culture shock meant that a “differential configuration of
space or even the climate (p. 28)” could impact the ways in which students viewed themselves,
their home cultures, and the cultures of the geographic locations they visited. Furthermore, the
return process can include positive reunion experiences, reverse culture shock, fewer outlets to
discuss the experiences had away from campus, and profound personal change (Haines, 2013).
Lowe and Rhodes (2013) found that for students returning to postsecondary institutions
following a natural disaster, psychological distress upon returning had a negative impact on re-
entry. Buell (1999) found that family support was integral to the successful re-enrollment of
students who stopped out from their course of study. Walker (2014) demonstrated that
universities should create peer support groups for returning students to aid in successful
transitions.
The findings of a cross-sectional study by Nguyen et al., (2021) suggested that medical
students who took a leave of absence were less likely to graduate and more likely to withdraw
or be dismissed from medical school than their peers who did not take a leave of absence.
Students who identified as non-White individuals or were from households with incomes within
the lower 3 quintiles were more likely than peers in the upper quintiles to take a leave of

30
absence. Further review of medical leave research should account for the potential inflexibility
of institutional policies and clearance requirements and its potential impact on students’ ability
to return to campus (Meilman & Turco, 1995).
Woosley (2003) independently found that students who reported that their plans to
withdraw for medical reasons were significantly more likely than other participants in her study
to re-enroll. Participants who felt positively about their campus, attended cultural events,
individually met with instructors, and participated in student clubs or organizations, were also
more likely to re-enroll. Woosley (2003) thus argued that administrators who interact with
withdrawing students—including dropouts and stop-outs—should “encourage and educate
students about re-enrollment possibilities” (p. 301), since for many students, withdrawal does
not signal a permanent departure from campus. Shepler and Woosley (2012) found that
students, regardless of student disability status, have similar integration experiences: “social
integration, academic integration, homesickness-related distress, and institutional satisfaction”
(Shepler & Woosley, 2012, p. 47). Students with disabilities who perceived their campus
environment to be comfortable and accepting, as well as those who made friends, were less
likely to experience distress relating to missing family and friends in their home communities.
This is relevant because social integration (i.e., making friends) is a known variable in Tinto’s
(1993) classic model of student attrition.
In their study of the hospital-to-school transition process, Simon and Savina (2007)
found that adolescents require support to help them function outside of the hospital setting,
which should assist them in successfully transitioning from one setting to another. Avoid the
risk of re-hospitalization, school staff, hospital staff, and parents should actively create an

31
educational plan that provided for student needs as they reenter the school setting (Simon &
Savina, 2007). Clemens et al. (2010) conducted a qualitative investigation of the re-entry needs
of adolescents who are hospitalized for psychiatric reasons. Students who returned to school
following hospitalization were often concerned with their academic performance, peer
connections, coping skills, and relationships to school personnel; their abilities to cope with
academic, social, and emotional stressors associated with school reentry could also mitigate the
impact of those stressors (Clemens et al., 2010). These studies show that if students lack strong
forms of support in their home communities or a sense of belonging to their campus
community, the process of re-entry following a leave could be arduous, isolating, and
detrimental to their academic, socioemotional, and social readjustment.
Barriers to Providing Adequate Support Services
Following the passage of the Garrett Lee Smith Memorial Act (GLSMA) by the U.S.
Congress in 2004, funding was allocated to expand research, suicide prevention programs and
integrative services to support the overall health, well-being, academic success of college
students (Center for Collegiate Mental Health, 2016). Over time, postsecondary institutions
gradually increased identity-based centers and student programming, assessed the efficacy of
counseling centers, and published medical leave of absence or medical withdrawal policies
(Meilman, 2016; Meilman, 2011; Meilman & Turco, 1995). College counselors, however,
continue to report that their clients with disabilities show higher levels of suicidal ideation,
suicidal attempts, and non-suicidal self-injury. Students with psychiatric disabilities or chronic
illnesses may already have the interpersonal tools necessary to manage their symptoms while
enrolled in their course of study. However, they may encounter faculty and student affairs

32
professionals who are ill-equipped to support them after disclosure (Myer, James, & Moulton,
2011).
Institutional barriers also provide significant access challenges for students with
disabilities, limiting their abilities to acquire academic support accommodations, resources, and
services. Raue and Lewis (2011) found that among institutions that reported barriers to
Universal Design implementation, 52 percent named limited staff resources to provide faculty
and staff training on accessibility issues, 46 percent cited high costs of purchasing assistive
technology products, and 45 percent reported precedence of other institutional priorities.
The Equity Mental Health Framework [EMHF] (2018) found that there were several
common barriers preventing mental health providers, practitioners, and administrators from
creating, implementing, and assessing effective and sustainable intervention programs for
students with mental health conditions. According to the EMHF report, the most pertinent
barriers reported were time and financial constraints (76.9 percent), lack of staff (64.3 percent),
and a lack of diverse identities represented among professional staff (61.5 percent). In the
National Alliance on Mental Health study, Gruttadaro and Crudo (2012) found that 79 percent
of students felt that mental health training for faculty and staff was one of the most important
awareness activities that colleges could provide.
Promising Practices and Existing Models
Belch (2004) researched several programs and strategies at colleges and universities
that work to support the retention and graduation of students with disabilities. One such
program, the STAR (Student Transition and Retention) Program at the University of Georgia
confirmed that 94 percent of students with disabilities who participate in the program are

33
retained from first to second semester and an 88 percent retention rate from the first to the
second year (Belch, 2004).
Key components of the program included: training on study skills; use of adaptive
technology; career planning; and motivation and leadership development. Belch (2004) studied
another unique program, the Curriculum Transformation and Disability Project at the University
of Minnesota, which provided a 12-hour, two-day workshop that provided faculty with a variety
of tools: teaching methods; best teaching practices; and workshops on understanding
disabilities, legal issues facing students with disabilities, applying the principles of Universal
Instructional Design, and creating an action plan. Fox, Hatfield, and Collins (2003) also
conducted a formal evaluation of the program at the University of Minnesota and found that
faculty participation impacted their actions, attitudes, and awareness of the needs of students
with disabilities.
Exploring Clark and Estes’ Knowledge, Motivation, and Organizational Influences Framework
Clark and Estes (2008) provide a useful framework for improving organizational
performance--the gap analysis process. As a lens, this analysis can facilitate the improvement of
performance through goal-setting processes, the identification of performance gaps, and the
examination of stakeholder knowledge, motivation, and organizational influences. Research
shows that is often these influences that impact performance and present as barriers to goal
achievement (Clark & Estes, 2008; Pinder-Amaker & Bell, 2012). Krathwohl (2002) identified
four types of knowledge and skills that facilitate learning: factual, conceptual, procedural, and
metacognitive. This typology is often used to determine the ability of the stakeholder to meet
their performance goals.

34
Knowledge and Skill Influences
When Bloom et. al (1956) first launched the original taxonomy framework; it was
comprised of six categories and focused on three domains of learning: cognitive (knowledge);
affective (internal emotions); and psychomotor (skill application) (Rueda, 2011). Additionally,
the taxonomy framework was intended to serve as a tool to assist educators in creating relative
learning goals, align curriculum with appropriate educational standards, and facilitate a
common language used to convey the expectations of student outcomes. Anderson, Krathwohl,
et. al., (2001; as cited by Krathwohl, 2002) revised the framework to focus specifically on
knowledge and cognitive processes.
Within the knowledge dimension, there are four knowledge types: factual, conceptual,
procedural, and metacognitive (Krathwohl, 2002; Rueda, 2011). Factual and conceptual types of
knowledge refer to specific familiarity with contextual facts and terminology, and a knowledge
of complex models and classifications, respectively (Rueda, 2011). Procedural knowledge is the
capability to transform practical knowledge into action. It can also be expressed through a
mastery of skill or the utilization of specific techniques to complete a task. Metacognitive
knowledge, the fourth type, is defined as an individual, internal process that facilitates strategic
problem solving, self-reflection, and deliberate yet abstract thinking (Rueda, 2011).
Pintrich (2003) presents a metacognitive framework that includes strategic, cognitive
task knowledge, self-knowledge. Strategic knowledge covers general strategies that are easily
applicable across domains. Cognitive task knowledge informs the learner about the appropriate
reasoning, timing, and application of using tools for different tasks. Self-awareness or self-
knowledge, however, is one of the most important metacognitive concepts for understanding

35
why students stop out. It describes the knowledge an individual has about their own cognitive
strengths and areas of improvement, as well as their beliefs about their motivation (Pintrich,
2003).
Within each of these categories, there are more defined subcategories: recollection and
memory recall, construction of meaning, application of procedures, itemized, structural
analysis; criteria-based judgement, and innovation through cohesion and comprehension
(Rueda, 2011). According to Rueda (2011), it is critical for administrators to differentiate
knowledge, motivation, organization influences, so that services, programs, and curriculum
delivery can meet the diverse needs of both traditional and non-traditional students.
Instructors can utilize pedagogical tools that facilitate an acquisition of meaningful learning,
direct knowledge application, and knowledge transfer (Rueda, 2011). These tools, among
others, can encourage students to retain their individual agency in achieving their goals, which
may include an intentional decision to persist to degree completion.
Motivated Performance Influences
In their gap analysis model, Clark and Estes (2008) outline a second contributor to
performance gaps--motivated performance. The authors suggest that motivation is comprised
of active choice, persistence, and mental effort (Clark & Estes, 2008). As it relates to students
with mental health concerns, some motivational factors for health and mental health
practitioners may include: helping students learn to develop task specific self-confidence;
modeling self-advocacy by removing perceived organizational barriers to their academic goal
achievement; fostering a positive environment for all individuals; and aligning values, beliefs,
and reasoning with students’ individual goal achievement (Lindsay, Cagliostro, & Carafa, 2018;

36
Coduti, Hayes, Locke & Youn, 2016). Motivation is a combination of intrinsic and extrinsic
factors, that are inherently cultural, have sociocultural and ecological impacts, generate
movement, sustain organizational progress, and mediate the amount of effort spent on
accomplishing a task or achieving a goal (Mayer, 2011; Rueda, 2011).
Organizational Influences
Finally, the third cause of performance gaps comes from the lack of organizational
factors such as effective and efficient work processes, value chains and value streams, and
material resources that are critical to addressing performance gaps in the organization.
Furthermore, organizational health is achieved when there are effective, interactive, and
efficient organizational processes present at technical, managerial, and institutional levels to
facilitate greater goal achievement (Clark & Estes, 2008; Brown et. al, 2004). Though the
stakeholder knowledge, motivation, and organizational (K-M-O) factors and influences seem to
exist independently of each other, successful goal achievement requires that these influences
be brought into alignment through the gap analysis process.
Stakeholder-Specific Knowledge, Motivation, and Organizational Influences
Knowledge and Skills
Scholars have suggested that disability service professionals, specifically, need to
possess a unique set of knowledge, skills, and attitudes to support students with psychiatric
disabilities in postsecondary education (Collins & Mowbray, 2005; McEwan & Downie, 2013).
Despite institutional commitments to greater educational access, according to the National
Center for Education Statistics (NCES), only 60% of undergraduate students in the U.S. graduate
within six years (NCES, 2011). The global goal of postsecondary institutions is to ensure re-

37
enrollment of stop-outs of various demographic backgrounds and their persistence to
graduation.
Notwithstanding significant gains in diverse admission and recruitment initiatives, the
research on attrition, retention, and persistence continues to reveal historical trends of
inequitable outcomes—low retention and graduation rates across historically
underrepresented demographic groups, including students with physical and psychological
disabilities (Bensimon et al., 2006; DeAngelo et. al, 2011). Studies have shown that individuals
can grow and mature through the successful mastery of life challenges; therefore, taking a
health-related leave could result in opportunities to learn how to manage serious conditions
and develop holistic care strategies upon their return (Story et al., 2019). However, the
presence of stigma and misinformation regarding students with invisible disabilities can lead to
misunderstanding about the severity of conditions and a refusal among faculty to provide
flexible accommodations to students with mental health conditions (Barazandeh, 2014).
Professional Knowledge of Disabilities and Chronic Illnesses
Sharpe et al. (2004) suggest that many disability support services staff do not feel
adequately trained to address the needs of individual disabilities because they have been
trained in a disability area directly related to learning and instruction. Despite the dearth of
literature on students who defer their education for medical reasons, adequate support for
stakeholder goal achievement requires an assessment of knowledge influences that may impact
the overall stakeholder goal of re-enrollment and persistence after taking a voluntary leave.
Student affairs professionals must know what constitutes a disability or chronic illness to
provide the best support to students with disabilities or chronic illnesses who are opting to take

38
a health-related leave of absence. The specific knowledge type is factual, because practitioners
need to be able to recognize and understand the specific diagnoses and conditions that
students may self-disclose throughout the process of applying for medical leave and re-
instatement following withdrawal.
Intervals and Methods of Communication
Student affairs professionals should know the appropriate intervals and methods of
communications to use when interacting with students on medical leave of absence or referring
those students to resource providers. This specific knowledge type is conceptual, because the
conceptual ideas behind service provision hinge upon a foundational knowledge about
appropriate ways to communicate depending on each of the individual student’s academic and
socio-emotional needs.
Although a wide range of symptoms and conditions fall under the umbrella of chronic
illnesses, the unpredictable waxing and waning of illness, along with relapses and
hospitalizations are a shared characteristic (Royster & Marshall, 2008). It is this unpredictable
nature that necessitates ongoing and flexible accommodations for students with chronic
illnesses, as these students may experience distress due to incompletes, failing grades, or
temporary withdrawals (Royster & Marshall, 2008). These students may require additional
supports including a liaison to faculty and special advocates who manage administrative issues
that can be overwhelming for a person with an illness. When staff, faculty, and staff are better
informed about student disabilities and the appropriate accommodations, the more likely it will
be for students with disabilities to achieve their full educational potential (Barazandeh, 2005).
In partnership with their counselors and home practitioners, students can establish an

39
appropriate timeline for returning to campus, though some institutions have clearance
requirements and specific timelines for readmission.
Topics of Communication
Student affairs professionals need to know which topics to discuss with students
applying for a MLOA to best support their exit, re-entry, and re-enrollment. Sharpe et. al (2004)
found that although disability service professionals were adequately prepared to provide
services to students with learning and physical disabilities, they often lacked the competencies
necessary to provide services to students with psychiatric disabilities.
However, in the case of Georgetown, Meilman found that helping students to work
through their objections to taking a leave could provide students with an opportunity to
address any student needs that may require additional resources and services during the
medical leave of absence process. He proposed the following:
Many objections to taking a leave can be worked through. As to concerns about
graduating on time, we point out that 5 years from now it will make no difference
whether they graduated in one particular year or the next. Concerning missing
friends, we remind them they can always visit their campus friends if that is a priority
(and distance from campus permits).
Meilman continues to describe many of the topics that are covered as students weighed their
options to take a leave of absence.
As to the issue of a toxic home environment, we explore whether they can live nearby
the campus during the leave or live with relatives other than their parents; sometimes,
but not always, these alternatives are possible. As to finances, we encourage them to

40
discuss this issue with the financial aid office, as frequently there is a loan repayment
exception during the period of the leave, and scholarships can typically be held for their
return. With respect to visa concerns, we ask students to consult with the office
handling international issues. Regarding students’ concerns they will do nothing
productive while on leave, we discuss constructive options. In general, while taking
seriously students’ sometimes genuine concerns about leaving school, we help them
problem solve and work to reduce catastrophizing (Meilman, 2016, p. 58).
In his study, Meilman (2011) found that students quickly re-admitted to campus without proper
support may be at risk for repeated withdrawal—an experience that could trigger feelings of
failure, depressive episodes, and continued psychological distress.
The table that follows is the first of three that seeks to describe the knowledge,
motivation, and organizational influences related to this study’s problem of practice. The first
row in Table 1 lists the high-level summary of the field-based global performance goal for
reference. The field-based global performance goal, as stated, aligns with the research
questions explored within this study. The table also presents three knowledge influences with
their corresponding knowledge types (declarative-factual, procedural, and metacognitive) in
columns 1 and 2. In column 3, three knowledge influence assessment types are discussed as
methods to evaluate whether the knowledge influence is present with its corresponding type.
Table 1 shows the knowledge influences below.

41

Table 1

Knowledge Influence 1

Student affairs professionals must know what
constitutes a disability or chronic illness.

Factual
Survey items that require
participants to demonstrate
the ability to apply
knowledge, show they can
implement or execute a task,
or generate a product.
Knowledge Influence 2

Student affairs professionals should know the
appropriate intervals and methods of
communications to use when interacting with
students on medical leave of absence or
referring those students to resource
providers.

Conceptual
Use survey items that
require participants to list
terms, give short answers,
complete multiple-choice
questions, or recognition
tasks.
Knowledge Influence 3

Student affairs professionals need to know
which topics to discuss with students applying
for a MLOA to best support their re-entry and
re-enrollment.
Conceptual
Use survey items that
require participants to list
terms, give short answers,
complete multiple-choice
questions, or recognition
tasks.

Motivation and Related Attitudes
Motivation is just one key component to analyzing strategies that promote the
successful re-enrollment of students who have taken a voluntary, temporary leave of absence.
Motivation is a combination of intrinsic and extrinsic factors, such as expectancy, goal
orientation, self-efficacy, and social partnership, that are inherently cultural, have sociocultural
and ecological impacts, generate movement, sustain organizational progress, and mediate the
amount of effort spent on accomplishing a task or achieving a goal (Mayer, 2011, Rueda, 2011).

42
Rueda (2011) argues that four components of motivation (personal, activating, energizing, and
directed) allows individuals to persist to goal completion because they believe in their ability to
complete a task and reap successful outcomes from task completion.
According to Rueda (2011), motivation is a cultural dimension because it is derived from
others with whom people interact in certain social and ecological contexts. Expectancy theory
was developed to explain and predict behavior and motivation; motivation, as a process of
directing and sustaining goal-directed behavior, is a function of expectancy, valence (value), and
instrumentality (Weiss, 1996). Research refers to value as the level of importance attached to a
task (Rueda, 2011). Eccles and Wigfield (2002) propose four constructs that determine an
individual’s perceived value of work: intrinsic value; attainment value; utility value; and cost
value. Intrinsic value describes the perceived enjoyment in completing a task.
Eccles (2006) explain that expectancies and values are strong indicators for performance
and success in meeting goals. Attainment value is defined by an individual’s belief that task
completion will result in a stronger belief in skill development and increased self-value and self-
worth. Utility value assigns a positive or negative value to a task, depending on its relevance to
current and future goal achievement. Finally, cost value is one critical component of value, as it
is comprised of the negative aspects of engaging in a task, the amount of effort required to
succeed in goal achievement, and the missed opportunities that result in choosing one action
over another (Eccles & Wigfield, 2002).
Clark and Estes (2008) simplify motivation as a mechanism that generates movement,
sustains progress, and mediates the amount of effort spent on accomplishing a task. Using the
gap analysis framework, Clark and Estes (2008) identify three factors that have an influence on

43
active choice, persistence, and mental effort. As it relates to students, those factors include: 1)
helping students develop task specific self-confidence, 2) removing perceived organizational
barriers, 3) fostering a positive environment for individuals, and 4) aligning values and
reasoning with individual goal achievement. Clark and Estes (2008) identify three factors that
have an influence on motivation which include active choice, persistence, and mental effort.
Active choice occurs when the intention to pursue a goal is replaced by action, persistence is
the ability to pursue a goal despite distractions, and mental effort accompanies persistence as it
requires the ability to work smarter and develop new solutions to problems as they arise (Clark
& Estes, 2008). Finally, motivation acts as a mechanism that generates movement, sustains
progress, and mediates the amount of effort spent on accomplishing a task (Clark & Estes,
2008).
Student Professionals and Utility Value
Student affairs professionals, more broadly, need to see the value in providing support
to students with disabilities, as well as honing the skillsets necessary to ensure their successful
re-enrollment, retention, and graduation. The utility value of working with this population can
be linked to the positive benefits of creating support programming and flexible policies, as well
as fostering connections with external providers and support staff to ensure smooth transitions
back to campus. Cost value is the perceived cost of an activity in terms of time, effort, resources
(financial), or other dimensions (Rueda, 2011). Student affairs professionals must see the cost
value in helping students with disabilities successfully transition back to campus, following a
health-related leave of absence. In institutions where resources are limited, there are benefits
to incorporating student-led mental health programming, employing volunteers to work in

44
identity-specific centers, and engaging student peer organizations in supporting the unmet
mental health needs of college students (Belch, 2004; Sontag-Padilla et al., 2018).
Rueda (2011) defines attainment value as the relevance of the importance attached to
task completion. Several studies illustrate the importance of retention and persistence in higher
education and their links to employment outcomes and economic mobility, as it remains one of
the most significant challenges for colleges and universities (Chetty, et al., 2017; Eisenberg et
al., 2017). Student affairs professionals should value increasing their own skillsets by providing
direct support to students with disabilities. It is important they also feel that their work is a
positive step forward in increasing the rates of retention and persistence rates of such a
vulnerable population. These two tasks could provide the opportunity for professionals to
demonstrate their own commitment to their values or other salient aspects of their self-
schema.
Kupferman and Schultz (2014) found that disability service professionals, specifically
those who work to support students with psychiatric disabilities, need to have a desire to: a)
see those students succeed in college; b) accommodate the cyclical nature of psychiatric
disabilities; and c) develop the ability to assist students with their transition into college. It is
also important that these staff members (and administrators) reject the stereotypes and stigma
towards students with psychiatric disabilities and chronic illnesses, as this can lead to positive
beliefs about their own abilities to actively support the academic and socio-emotional wellbeing
of these students (Kupferman & Schultz, 2014).
Health-related leaves of absence as tools that may be offered involuntarily or voluntarily
to students in need must reflect the equitable treatment of students at risk who are known to

45
have disabilities (Lannon, 2014). Fostering an interactive system that allows for students to
voluntarily withdraw reduces the likelihood of discrimination claims and provides students with
opportunities to sustain positive relationships with the institution (Goodwin, 2016). Since those
students may be considered at-risk, there is some utility value in supporting those students to
achieve their long-term educational goals, while improving the retention and persistence rates
of the institution.
Expectancies and values are related to performance, persistence, and task choice, and
include perceptions of competence, task difficulty, and individual goals. Eccles and Wigfield
(2002) note that Heckhausen’s (1991) expectancy-value model outlined four types of
expectancies that result in individual choices and actions: situation-outcome; action-outcome;
action-by-situation-outcome; and outcome-consequence. In this case, if student affairs
professionals perceive that their motivation to act depends on the value attached to the
consequences of their behavior, then they might link the outcomes of re-entry efforts to their
own behavior within their organizational contexts. However, Schlossberg (2011) argues that
adjustment to transitions take time and the features common to transitions are: situation, self,
supports, and strategies. Therefore, understanding some of the issues around transitioning
between home, work, and school environments may illuminate a few motivational variables
that impact how professionals work to support the successful re-entry and re-enrollment of
students following a voluntary leave of absence.
Self-Efficacy of Student Affairs Professionals
Bandura (2006) defines self-efficacy as a distinct, internal belief in the capacity of an
individual to accomplish their goals. Powerful mastery experiences and overcoming

46
extraordinary circumstances, he argues, could also be transformative in their impacts on
singular self-efficacy. Self-efficacy is defined as an individual’s judgment and confidence in their
ability to organize and execute performance tasks. Outcome and efficacy expectations, though
they differ, can impact individual goal setting, effort, active choice, and persistence (Bandura &
Wessels, 1997; Eccles & Wigfield, 2002). Resources necessary to support student success might
include continued counseling services, disability accommodations, ongoing medical treatment,
and a case-management approach to academic advising from student support staff (McDonald,
2016; Woosley, 2003).
Successful re-enrollment relies on the need for students to have appropriate campus
supports and ability to acquire the appropriate financial, academic, and medical resources
while on leave. However, Hutcheon and Wolbring (2012) found that some students with
disabilities felt that disability accommodation processes were not easy and required students to
initiate and maintain accommodations on their own behalf. The authors reported that leave
policies were restrictive to their self-efficacy and goal attainment. Their belief in their capacity
to persist to graduation depended on a self-identification of disability through campus
resources that rely on biomedical frameworks of disability and mental health and require
medical documentation for clearance.
In a study of Black American women, Johnson-Bailey and Brown (1997) found that re-
entry occurred more often among those who felt a sense of belonging, received
encouragement from mentors and recruitment from their peers. Schlossberg (2011) argues that
adjustment to transitions take time and the features common to transitions are: situation, self,
supports, and strategies. Therefore, understanding some of the issues around transitioning

47
between home, work, and school environments may illuminate a few motivational variables
that impact re-entry and re-enrollment following a voluntary leave of absence. Additionally,
students need to consider the academic effects of taking a voluntary leave and determine if
time away can help them persist to graduation in the long term.
If student affairs staff wish to reach the stakeholder goal of assisting students in a
successful re-entry following a health-related leave of absence, they should be motivated to
develop the effective knowledge, skills, and work processes necessary to do so. Once student
affairs professionals are motivated to ensure the academic success of these students upon re-
entry, they will take the appropriate steps to learn more about the challenges that students
with disabilities face, foster connections with providers, staff, and faculty to coordinate
accommodations and services, and engage in constant professional development (i.e., training
and education) to generate novel solutions to any challenges that may arise in pursuit of goal
achievement. Thus, it is important to consider performance motivation when encouraging
student affairs professionals to create additional programming and flexible policies for students
with disabilities as they re-enter postsecondary institutions following a health-related leave of
absence.
The table that follows is the second of three that seeks to describe the knowledge,
motivation, and organizational influences related to this study’s problem of practice. Table 2
illustrates the two assumed motivation influences—self-efficacy and utility value—in column 1.
In column 2, two motivation assessment types are discussed, as they are ways to evaluate
whether the motivational influence is present and related to the research presented in this
study. Table 2 shows the organizational mission, global goal, stakeholder goal, motivational

48
influences and motivational influence assessments identified in this literature review.
Table 2

Organizational Influences
Culture, structure, policies, and practices are important components of organizations
and guide the ways in which organizations adapt to challenges and changes in the environment
(Rueda, 2011). Positive organizational changes result from a clear vision, commitment from
management, and widescale support of organizational systems and structures (Weiss, 1996).
Organizational performance gaps can result from inefficient and ineffective work processes and
material resources (Clark & Estes, 2008). Student affairs professional need to effectively re-
integrate students returning from leave and partner with external providers while doing so,
postsecondary institutions should conduct value stream analyses to understand how internal
Assumed Motivation Influences Motivational Influence
Assessment

Student affairs professionals
need to feel confident in their
ability to provide the initial levels
of support (referral, form
assistance, etc.) necessary for a
successful return from a MLOA.

Self-Efficacy
Likert-scale survey items

Student affairs professionals
should recognize the importance
of their role in facilitating the
MLOA process, to better inform
policy design, implementation,
review, and evaluation.
Utility Value Likert-scale survey items

49
departments operate and implement leave policies and processes.
Some researchers argue that organizations have cultures, while others argue that
organizations are cultures (Bolman & Deal, 2013). Organizational culture encompasses the
perceived values, performance, behaviors, goals, emotions, beliefs, assumptions, or general
processes developed and internalized over time within an organization (Schein, 2017).
Successful organizations are distinguished by cultures that encourage flexibility in processes,
organizational commitments to growth and learning, and adaptability (Senge, 1990; Schein,
2017). Clark and Estes (2008) argue that culture in the environment, culture in groups, and
culture in individuals are three common approaches to identifying culture in organizations.
The concept of organizational culture, particularly the study of cultural settings and
cultural models—can be a useful tool for practitioners who wish to improve the academic
achievement for all students, but specifically those who identify as ethnic minorities (Gallimore
& Goldenberg, 2001). Rather than relying on deficit-based explanations for underachievement,
researchers have contributed to an emerging category of difference-based explanations, some
of which include “norms of behavior, language usage, cognitive styles” among other ways of
being that students learn at home (Gallimore & Goldenberg, 2001, p. 46). Gallimore and
Goldenberg (2001) also posit that cultural models and cultural settings are cultural practices are
comprised of shared and normative understandings of how the world operates (behavioral,
cognitive, and affective).
Cultural models
Cultural models refer to cultural practices and shared mental schema within an
organization (Gallimore & Goldenberg, 2001). Cultural models are comprised of invisible norms,

50
behaviors, rules, and assumption that co-constructed within an organization and developed
over time through collectively transmitted information (Gallimore & Goldenberg, 2001; Schein,
2017). Evidence of a cultural model includes the ways in which groups of people unconsciously
do the following: interpret events and social actions; dictate participation and the rules of
interaction with settings individuals, or other groups, and assign value, reason, and meaning
(Gallimore & Goldenberg, 2001). When there is a conflict between organizational culture and
performance goals, individuals may not receive necessary resources to reach a goal or policies
may not be adequately supported by effective work processes or procedures (Clark & Estes,
2008).
Cultural settings
Cultural settings are concrete and include the employees, their tasks, how and why
tasks are completed, and the social context in which their work is performed. Cultural settings
are defined by the engagement and collaboration of two or more people who are working
towards a common goal. Moreover, cultural settings are often physical, tangible spaces where
cross-collaboration among individuals can lead to a shared accomplishment, with shared
meanings and contexts, that all participants value (Gallimore & Goldenberg, 2001).
Positive Beliefs in the Likelihood of Student Success
Colleges and universities need to express positive beliefs in the likelihood of student
success upon return from leave or withdrawal. Unger et al., (2000) found evidence that
students with psychiatric disorders can attend postsecondary institutions and successfully
complete their courses. Although all groups of students would benefit from academic
interventions, early warning systems for timely identification of academic challenges and social

51
maladjustment among at-risk subpopulations could reduce stop-out behavior (Hoyt & Winn,
2004). Colleges often have several conditions for re-entry following a medical leave which
include stringent documentation and approval from external providers, predetermined
amounts of time away from campus, participation in therapy, or participation in employment or
extracurricular activities (Meilman, 2016; Story et al., 2019).
Communication, education, and training. Before administrators can expect students to
successful transition back to campus, student affairs professionals should increase their
knowledge regarding the challenges that students with disabilities face through an evaluation
of data, strategic planning for targeted initiatives, and continued professional development on
relevant topic areas (Lipson et al., 2014). Communication with friends and families of students
with psychiatric disabilities can increase student likelihood of accessing formal and informal
sources of help amid crisis (Nam et al., 2018). Additionally, students who spent time with
families and friends away from campus and had access to external providers were likely to plan,
develop new coping, self-advocacy, and management skills, and experience a shift in
perspectives with respect to their potential to succeed once re-enrolled (Story et al., 2019).
In their randomized study of gatekeeper training programs, Lipson et al. (2014) found
that training increased participants’ self-perceived knowledge, self-perceived abilities to
identify students in distress, and confidence to provide additional supports to students in need.
Colleges and universities may need to increase awareness of campus resources and preventive
services among the general student population. This can include mental health training for
resident advisors and a coordinated support team for students re-entering college following a
health-related leave of absence (Story et al., 2019). Furthermore, combatting stigma and

52
fostering campus cultures that are inclusive of students with psychiatric and physical disabilities
through education and training is an effective method (Barazandeh, 2004; Story et al., 2019).
Faculty surveys continue to indicate unfamiliarity with health-related policies and
disability laws, appropriate provision of accommodations, and training in universal design
teaching methods (Barazandeh, 2004; Dutta et al., 2009). While it may not be possible for
student affairs professionals to be knowledgeable about all qualifying conditions, it is important
for faculty, staff, and administrators to receive training on disability awareness, the use of
people-first language, and ways to model inclusive behavior, so that the institution can foster
social inclusion, a sense of belonging, and equal opportunities for students with disabilities
(Belch, 2004; Sachs & Schreuer, 2011).
Positive Value and Regard for Training and Resource Allocation
Colleges and universities (the organization) need to convey value and positive regard for
supporting students returning from health-related leaves of absence through adequate
training, resource allocation, and interorganizational collaboration. Increasing the rates of
successful re-entry, retention, and persistence to graduation for students with disabilities
requires that student affairs professionals operate within a cultural model that promotes
integration and supported education models. Increased support for the health-related
educational needs of students with disabilities and/or chronic illness is a major component in
the academic performance and overall success of those students (Royster & Marshall, 2008).
Barriers to the management of disability-related services include: 1) a lack of
coordination regarding eligibility determination, information sharing, and communication
among agencies and target populations; 2) fragmented services among agencies with mutually

53
exclusive missions; and 3) a lack of resource mapping and coordination of individualized
transition services (Dutta el al., 2009). In institutions where there is a higher level of
cooperation between campus health services, faculty, staff, and external providers, students
with pre-existing diagnoses of psychiatric disabilities and/or chronic illnesses fare just as well as
their counterparts with respect to maintaining continuous enrollment when provided academic
assistance (Arria et al., 2013).
Garcia and Ortiz (2008) argue that there is a dearth of literature that fully examines the
impact of institutional climate and context, curricula, and instruction, differentiated learning
interventions, as well as teacher attributes and attitudes on the academic outcomes of students
with multiple, marginalized identities (Garcia & Ortiz, 2008, 2013). Counseling center directors
often are not medical professionals and report to the Division of Student Affairs in
postsecondary institutions (LeViness et al., 2017). Collaboration between counseling center and
health center professionals, regardless of the organizational structure, can be valuable in
providing students with holistic care along with additional resources (Mitchell et al., 2019).
Academic advisors, career service providers, and student health professionals need to
work collaboratively to assist students with disabilities in understanding the process involved in
career development; the importance of self-advocacy skills; the ability to articulate their social
and academic strengths, weaknesses, and strategies for success; and the ability to make
requests for information, accommodations, and assistance when necessary (Belch 2004). Belch
(2004) posits that a compilation of: models of successful practices; faculty/staff workshops;
inclusive methods, practices, and policies; enables the campus community to embrace the idea
of universal design in curriculum and co-curricular policies. Thus, interorganizational

54
collaboration can foster inclusivity and contribute to a transformation of culture on college and
university campuses (Belch, 2004). In summary, context, culture, and instructional
environments are critically important to student achievement and academic success.
Positive Value and Regard for Data Collection
The organization needs to demonstrate value and regard for data collection, to allocate
resources for students who take withdrawals, regardless of enrollment status, to facilitate re-
enrollment and reintegration to campus. Many leave policies require students to access
medical services while on health-related leaves of absences, which can pose challenges for low-
income students (Meilman, 2016). However, when required to participate in counseling during
their leave, students not only benefitted from the services but also wanted to continue
accessing therapeutic services upon their return (Story et. al, 2019). College students tend to
have greater service utilization while enrolled due to access to campus-based health and
counseling services, as well as university mandated health insurance (Nam et al., 2018).
However, in one study, students benefitted greatly from online access to staff, course
information, support services, and information about their rights and responsibilities while
away from campus (Martin, 2010). Martin (2010) also found that students placed significant
importance on remaining connected to the university while away, preferring to have one main
point of contact during their leave.
External services can be provided by general practitioners, special mental health youth
services, mental health crisis services, psychiatrists, psychologists, social workers, nurses,
counselors, and therapists (Martin, 2010). Innovative programs that approach health and
academic success holistically tend to integrate services between campuses and local

55
communities (Belch, 2004; Hunt & Eisenberg, 2010). Table 3 illustrates the two cultural model
influences and two cultural setting influences, along with their corresponding organizational
influence assessments in columns 1 and 2. For reference, the field-based global performance
and stakeholder goals are also listed.

56

Table 3

Organizational influence Influence Type Influence Assessment
Organizational Influence 1

Colleges and universities (the organization)
need to convey value and positive regard for
supporting students returning from health-
related leaves of absence through adequate
training, resource allocation, and
interorganizational collaboration.

Cultural Model
Survey items that require
participants to
demonstrate the
organizational ability to
convey value.
Organizational Influence 2

Colleges and universities need to express
positive beliefs in the likelihood of student
success upon return from leave or withdrawal.
Cultural Setting
Use survey items that
require participants to list
terms, give short answers,
complete multiple-choice
questions, or recognition
tasks.

Interview data
Organizational Influence 3

The organization needs to demonstrate value
and regard for data collection, to allocate
resources for students who take withdrawals,
regardless of enrollment status, to facilitate re-
enrollment and reintegration to campus.
Cultural Setting 2
Use survey items that
require participants to list
terms, give short answers,
complete multiple-choice
questions, or recognition
tasks.

Interview data

The Interaction of Stakeholders’ Knowledge, Motivation, and Organizational Context
Conceptual Framework
Merriam and Tisdell (2016) assert that theoretical frameworks are shaped by the
disciplinary orientation of the researcher and more broadly includes the “terms, concepts,
models, thoughts, and ideas as well as references to specific theories” contained within the
literature related to the topic of interest (Merriam & Tisdell, 2016, p. 84). Additionally, in
quantitative studies, the conceptual framework introduces the reader to concepts that are

57
central to the study and describes the process by which operationalization and measurement of
those concepts will occur in the research (Merriam & Tisdell, 2016).
According to Maxwell (2013), the conceptual framework can be described as the
“underlying structure (p. 1)”, scaffolding, or frame of a study, either constructed visually
represented or written, through which meaningful concepts or theories that greatly inform the
research are presented. It may be sourced from theoretical literature, empirical research, or
unpublished works; shaped by the personal beliefs, experiences, and ideas of the researcher;
and can be iterative, as it presents an emerging theory about the subject of the study (Maxwell,
2013). Furthermore, the conceptual framework of a study informs the rest of the research
process: problem identification, the formulation of research questions, and the selection of
appropriate strategies and procedures for data collection, analysis, and interpretation within
the study (Merriam & Tisdell, 2016, Maxwell, 2013).
The conceptual framework that will guide this study utilizes relevant research on
providing support to students with psychiatric disabilities and chronic illnesses, including those
who opt to take health-related leaves of absence during their academic career. This conceptual
framework integrates the Clark and Estes (2002) gap analysis model, which identifies the
knowledge, motivation, and organizational factors necessary for successful goal achievement.
This framework will serve as a roadmap for identifying conditions and generating solutions to
support and enable student affairs professionals in successfully completing their field-based
global goal of increasing the rate of successful re-entry, educational, and psychosocial
outcomes for college students who take a health-related leave of absence. Additionally, this
framework will guide the stakeholder group in nurturing solutions which include providing

58
adequate accommodations and supports to all students who take a health-related leave of
absence or withdrawal so that they may successfully re-enroll in academic programs and persist
to graduation.
Along with the conceptual framework at the center of this study, the research will be
informed by a philosophical worldview. While conducting studies, researchers must be
cognizant of and make explicit the worldviews that guide the research—as a set of beliefs that
guide action, worldviews can influence study design, methodology, evaluative instruments,
data analysis, the discussion of findings, and suggestions for potential implementation
(Creswell, 2018; Maxwell, 2013; Merriam & Tisdell, 2016). Creswell (2018) identifies four
commonly discussed worldviews in research literature: post positivism, constructivism,
transformative, and paradigm. Post positivism represents traditional forms of research (i.e., the
scientific method) and constructivism centers the specific contexts and settings of individuals to
assist the researcher in generating theories and deriving meaning from the historical and
cultural settings of the participants (Creswell, 2018).
Worldviews
Transformative worldviews emerged from researchers who felt that issues of power,
social justice, discrimination, and oppression needed to be addressed in the literature.
Researchers who utilize this worldview tend to embed an action agenda for reform in their
research and intertwine politics with research inquiry to confront social oppression within
organizations. Furthermore, the transformative worldview focuses on the needs of groups and
individuals in society that may be marginalized and disenfranchised (Creswell, 2018). Finally,
the pragmatic worldview is centered on actions, situations, and consequences, as researchers

59
who utilize this philosophical worldview tend to emphasize the research problem and use all
approaches to gain a clearer understanding of the problem (Creswell, 2018). The key to this
worldview is that it provides the researcher with the opportunity to explore multiple methods,
worldviews, assumptions, forms of data collection and analysis.
This study was designed utilizing a pragmatic worldview. Individuals that hold a
pragmatic worldview believe that research always occur in social, historical, political, and other
contexts (Creswell, 2018). In the case of this study, it is important to direct considerable
attention to the research problem at hand while using pluralistic approaches to derive further
knowledge about the cause of the problem. Thus, it is entirely possible to conduct this study
pragmatically, while utilizing a theoretical lens that is transformative in nature—that is, a lens
that is reflective of social justice, identifies historical or current oppressive practices, policies,
and power dynamics that further exclude the group of focus.
By doing so, the researcher can creatively utilize mixed methods in research design and
suggest changes that can lead to the development and implementation of inclusive policies
(Creswell, 2018). The conceptual framework for this study assumes that KMO influences –
knowledge, motivation, and organizational – interact for the benefit of the stakeholder, student
affairs professionals. This continuous and concurrent interaction among influences can enable
the progress of the stakeholder of the study towards field-based goal achievement. Figure 1
below illustrates the conceptual framework for this study.

60
Figure 1
Conceptual Framework

The figure above illustrates the ways in which organizational, motivation, and
knowledge influences converge and ultimately impact the ability of student affairs professionals
to coordinate resources, evaluate policies, and implement targeted programming in support of
students returning from health-related leaves of absence. It is assumed by the researcher that
by way of a thorough examination of the knowledge and influences, student affairs
professionals can foster organization settings that encourage cross-collaboration, resource

61
sharing, and external resource allocation to students with disabilities and chronic illness
throughout the health-related leave process.
The green circle represents the three knowledge influences: awareness of disabling
conditions and related challenges through declarative-factual knowledge (Belch, 2004;
Krathwohl, 2002; Royster & Marshall, 2008; Sharpe et al., 2004); how to provide adequate
services, coordinate resources, and ensure the provision of appropriate accommodations
through procedural knowledge (Barazandeh, 2005; Dutta et al., 2009; Krathwohl, 2002;
Meilman, 2011); and, knowledge of which topics to discuss with students applying for a MLOA
to best support their re-entry and re-enrollment. (Hartley, 2010; Kosyluk et al., 2016;
Krathwohl, 2002; Sachs & Schreuer, 2011).
The green inner circle also represents the two motivation influences: student affairs
professionals seeing the value in adequate service provision, accommodations, and resource
allocation through expectancy value theory (Belch, 2004; Eccles & Wigfield, 2002; Kupferman &
Schultz, 2014; Lannon, 2014; Rueda, 2011; Sontag-Padilla et al., 2018) and professionals
demonstrating increased motivation, learning, and performance because of their positive
expectations for success, i.e. self-efficacy (Clark & Estes, 2008; Downs et al., 2018; Pintrich,
2003; Rueda, 2011).
The blue outer circle represents the organizational influences: cultural settings. Cultural
settings are the “who, what, when, where, why, and how of the routines which constitute
everyday life—in essence, a more concrete version of a social construct” (Rueda, 2011, p. 57). C
Cultural models are “the shared mental schema or normative understandings of how the world
works, or ought to work” (Rueda, 2011, p. 55). In this study, these include the organizational

62
need to convey value and positive regard for supporting students returning from health-related
leaves of absence through adequate training, resource allocation, and interorganizational
collaboration; colleges and universities need to express positive beliefs in the likelihood of
student success upon return from leave or withdrawal; and the organization needs to allocate
resources for students who take withdrawals, regardless of enrollment status, to facilitate re-
enrollment and reintegration to campus.
A key assumption of the researcher is that the organization’s cultural models and
settings ultimately act as environmental influences that can impact and interact with the
stakeholder group’s comprehension and integration of the stated knowledge and motivation
influences. Integrating knowledge and motivation influences allows student affairs practitioners
to create a cultural model that fosters a culture of cross-collaboration between campus services
and external providers, which may include resource and information sharing (Clark & Estes,
2008; Barazandeh, 2004; Schein, 2017; Story et al., 2019; Unger, Pardee, & Shafer, 2000).
Further, student affairs professionals can create a cultural setting that produces education and
training materials relevant to providing resources, accommodations, and support services to
students with psychiatric disabilities and chronic illness (Clark & Estes, 2008; Hunt & Eisenberg,
2010; Martin, 2010). It is expected that once knowledge, motivation, and organization
influences are integrated and utilized that student affairs professionals can accomplish the
global field goal represented by the single-pointed arrow pointing to the text box, which
contains the field-based global goal. This study sought to understand how knowledge,
motivation, and organization influences intertwine to enable student affairs practitioners to
successfully complete the global field goal. Thus, Figure 1 illustrates the influences that must be

63
in place prior to successful goal completion. Further, the conceptual framework depicted offers
the expected outcome theory that if knowledge and motivation influences interact
simultaneously to lead to established organizational cultural settings and models, that
conditions will be set for student affairs practitioners to effectively engage with and achieve the
global field goal.
To inform this study, this chapter reviewed literature related to retention, persistence,
psychiatric disabilities, chronic illnesses, and a brief overview of the legal frameworks that
delineate the responsibilities of postsecondary institutions in supporting students with
disabilities (physical and psychiatric). The literature review also summarized the issues of
discontinuous enrollment of students with disabilities in postsecondary institutions, associated
institutional barriers to support services for those students, and re-entry experiences of
students returning from leave. The literature review also highlighted briefly known promising
practices and existing models of integrated support services and supported education models.
Chapter Three describes the methodological approach utilized in this study to validate the
interactions among the outlined influences.

64
CHAPTER THREE: METHODS

Student affairs has traditionally been a stand-alone division where the senior
administrator reports directly to the President, although there are differences in decision-
making authority and budget autonomy among departments (Dungy, 2003). According to
Dungy (2003), certain student affairs units may have certain core functions that include budget
management, personnel decisions, and management tasks that allow for department heads to
dually serve as senior administrators. Some institutions have combined student affairs with
academic affairs divisions, which enables student affairs practitioners to develop close
relationships with faculty (Dungy, 2003). This study focused on student affairs departments that
provide direct support to students who temporarily pause their course of study for health-
related reasons (i.e., medical leave of absence, compassionate withdrawal).
The purpose of this study was to explore how student affairs professionals provide
support to students who have taken an official medical withdrawal from college. Different
methods have been employed to capture the experiences of students who have opted to pause
their academic course of study for health-related reasons; however, few have focused on the
assumed knowledge and motivation of student affairs professions on this topic, and the related
barriers that may exist within postsecondary institutions. Clark and Estes (2008) proposed the
gap analysis method—a process that seeks to examine three critical factors that can lead to
performance gaps: knowledge and skills; motivation and goal achievement; and organizational
barriers, thereby expanding the literature on performance improvement in organizations. In
this study, the researcher focused on assumed knowledge, motivation, and organization-based
influences, which were generated from sourcing related literature, as well as professional

65
experiences in the field.
According to Creswell and Creswell (2018), research approaches are the procedures that
incorporate the philosophical assumptions of a researcher along with specific designs of the
study and methods of data collection, data analysis, and interpretation of findings. The three
main approaches to research—qualitative, quantitative, and mixed-methods—are not rigid
categories or dichotomies, but rather they represent “different ends on a continuum” (Creswell
& Creswell, 2018, p. 35). Quantitative research is often numerically based, relying on statistical
methods to assist researchers in investigating causal or correlational relationships between
variables (McEwan & McEwan, 2003). Qualitative research, however, utilizes observational and
descriptive data, often in the form of narratives, to assist researchers in developing deeper
explanations behind certain actions and their related outcomes (McEwan & McEwan, 2003).
Though there is value in various methods of research, the use of applied research cannot be
understated as it can provide both guidance and useful information for administrators, faculty,
and staff members to support systemic change and action-oriented problem solving.
Mixed-methods research involves collecting and integrating both quantitative and
qualitative data to gain further insight beyond the information gleaned from qualitative or
quantitative data individually (Creswell & Creswell, 2018). In this study, a mixed-methods
approach was chosen to conduct a needs analysis, which explored what student affairs
professionals need to successfully support students with disabilities who re-enter academic
programs following a medical leave of absence and/or compassionate withdrawal.
According to Creswell and Creswell (2018), mixed methods approaches are chosen
because of the inherent strength of the approach (i.e., the use of qualitative and quantitative

66
methods and the minimization of the limitations of both methods). The researcher chose this
approach because of the opportunity to blend transformative and pragmatic philosophical
worldviews during the data collection process. These two worldviews are different, however, in
that the transformative worldview is political, power, and justice oriented; and collaborative,
while the pragmatist worldview emphasizes the research problem, focuses on research
questions, and embraces the use of all available approaches to understand the problem of
practice (Creswell & Creswell, 2018).
The first phase of the explanatory sequential design involves quantitative sampling,
which is then followed by purposeful sampling in phase two, the qualitative phase (Creswell &
Creswell, 2018). Accordingly, the researcher gleaned information from institutional documents
and aggregate data, distributed a 46-item survey instrument to nine individuals, and conducted
five semi-structured interviews with a purposeful sample of survey respondents. Literature
from a wide and diverse set of fields guided the design of the interactive, conceptual
framework: organizational culture and leadership, disability studies, student development,
professional development, and administrative leadership in higher education institutions.
Additionally, the conceptual framework of the study served as a visual representation of
the observed interactions between implicit cultural models, mental models, and self-efficacy, or
“people’s judgments of their capabilities to organize and execute the course of action required
to attain designated levels of performances” (Bandura, 1986, P. 391). Finally, the researcher
reviewed 15 official college documents (i.e., medical withdrawal applications) and common
data sets, all publicly available on the internet. This allowed the researcher to triangulate the
data collected as additional evidence of the assumed knowledge, motivation, and

67
organizational influences on the problem of practice.
1. According to the stakeholders in this study, to what extent are higher
education institutions able to provide programs, resources, and supports that
ensure that at least 60 percent of students who take a medical leave of absence
(or compassionate withdrawal) successfully navigate reentry and reintegration
on campus, and persist to graduation within 6 to 8 years?
2. What is the current state of stakeholder knowledge and motivation necessary to
ensure that at least 60 percent of students who take a medical leave of absence
(or compassionate withdrawal) successfully navigate reentry and reintegration
on campus, and persist to graduation within 6 to 8 years?
3. What is the interaction between organizational culture and context, and
stakeholder knowledge and motivation as it relates to ensuring that at least 60
percent of students who take a medical leave of absence (or compassionate
withdrawal) successfully navigate reentry and reintegration on campus, and
persist to graduation within 6 to 8 years?
Participating Stakeholders
Demographic Data of Survey Respondents
Due to the small sample size, participants were asked to assign themselves as
pseudonym at the beginning of the survey. Among those surveyed, almost all study participants
reported to the Office of the Dean of Students; two respondents indicated that they worked in
the Office of Academic Affairs and the Office of the Title IX Coordinator but were considered
student affairs practitioners within their division/department. Five of the nine eligible survey

68
respondents held student support services specialists or coordinator roles. Additionally, five
respondents were employed at private, 4-year institutions and five survey participants worked
at postsecondary institutions that served 20,000 students or more. Table 4 shows a detailed
summary of the respondents’ demographic data. Questions that asked respondents about their
personal demographics were eliminated from the final instrument.
Table 4

Division/
Department
Job Title / Role Institution Type Institution Size
Student Affairs (Dean of
Students)
Student Support Services
Specialist/Coordinator
Public, 4 year 20,000 students or more
Academic Affairs
Student Support Services
Specialist/Coordinator
Public, 4 year 20,000 students or more
Student Affairs (Dean of
Students)
Student Support Services
Specialist/Coordinator
Private, 4 year <2,500 students
Student Affairs (Dean of
Students)
Student Support Services
Specialist/Coordinator
Public, 4 year 20,000 students or more
Student Affairs (Dean of
Students)
Dean of Students Public, 4 year 10,000-19,999 students
Student Affairs (Dean of
Students)
Assistant Dean Private, 4 year 20,000 students or more
Student Affairs (Dean of
Students)
Associate Dean Private, 4 year 5,000-9,999 students
Student Affairs (Dean of
Students)
Dean of Students Private, 4 year 10,000-19,999 students
Other Title IX Coordinator Private, 4 year <2,500 students

Survey Sampling Criteria and Rationale
Survey criteria one. Student affairs practitioners reported experience within a field of
disability services. All practitioners had established familiarity with medical leave of absence
processes and policies and had cleared access to student retention and persistence data.
Questions on the survey instrument required practitioners to access sensitive information
regarding students whose individual information is protected by the Health Insurance
Portability and Accountability Act (HIPAA), aggregate related data, and protect the privacy of

69
the subpopulation simultaneously while participating in the study.
Survey criteria two. All survey participants were employed at accredited, postsecondary
institutions located in the United States, although geographic regions varied greatly. Diversity
among stakeholders also applied to institution type. Two-year colleges were not represented in
the study. However, survey criteria were broadened to include employees at liberal arts
colleges, medium and large-sized private and public four-year universities. Though essential
services and policies were expected to be similar across institutions, the researcher
hypothesized that policy implementation would differ across institutional type.
Survey criteria three. Participants in the study needed to have some direct service
experience with re-entry processes and/or work with students who have opted to take a
medical leave of absence, either by using internal providers and resources or by outsourcing to
programs that are designed to provide additional supports to students while on leave.
Participants needed to be knowledgeable about the medical (or health-related) leave of
absence policy at their institution, as well as the related processes of re-instatement,
supportive programming for re-entry, and communication with inter-organizational
departments and divisions that provide students with campus-based resources.
Interview Participation Criteria and Rationale
Interview criteria one. Student affairs practitioners reported experience within a field of
disability services. All practitioners had established familiarity with medical leave of absence
processes and policies and had cleared access to student retention and persistence data.
Questions during the interview required practitioners to access sensitive information regarding
students whose individual information is protected by the Health Insurance Portability and

70
Accountability Act (HIPAA), aggregate related data, and protect the privacy of the
subpopulation simultaneously while participating in the study.
Interview criteria two. Participants in the interview portion of the study needed to
have some direct service experience with re-entry processes and/or work with students who
have opted to take a medical leave of absence, either by using internal providers and resources
or by outsourcing to programs that are designed to provide additional supports to students
while on leave. Participants needed to have direct knowledge about the medical (or health-
related) leave of absence policy at their institution, as well as the related processes of re-
instatement, supportive programming for re-entry, and communication with inter-
organizational departments and divisions that provide students with campus-based resources.
At the conclusion of the survey, participants were asked to indicate their interest and
willingness to participate in a follow-up interview (that would last approximately 45 minutes to
1 hour). Among the survey cohort who were eligible to participate, five out of nine survey
respondents agreed to a follow-up interview. In addition to their self-assigned pseudonyms,
gender-neutral pronouns were also assigned to all but one participant, at the participant’s
request, which can be seen in Table 5. At the start of each interview, participants were insured
of their right to withdraw their consent to participate in the study at any time and emailed a
copy of the information sheet.
Table 5
Pseudonym Pronouns Used School Type
JVN they |them | theirs Public, 4 year
Chris they |them | theirs Public, 4 year
Jane they |them | theirs Public, 4 year

71

For the interview phase of the study, the researcher utilized the USC licensed Zoom web
platform; all related transcripts, video, and audio files were stored internally on the platform
pending deletion upon the conclusion of the study (the option to download all files is disabled
by university administrators). The interviews were scheduled about one to weeks after each
interview participant concluded the survey phase of the study.
Each video interview was conducted in English, and each lasted approximately 45
minutes--with the exception of one, which lasted approximately 1 hour. Additionally, due to the
small sample size, other demographic details are not reported here to protect the
confidentiality of interview participants. Following each interview, the researcher collected
their notes and researcher memos in a separate word document and excel spreadsheet. Due to
administrative settings on the Zoom account, the researcher was not able to download
interview transcripts. As such, the researcher copied each interview transcript into a separate
word document for coding and analysis. Finally, the mixed methods approach provided the
researcher with an opportunity to triangulate data in two ways, a 45-item questionnaire and
follow-up interviews. Triangulation refers to the use of more than research method (i.e.,
surveying, observations) to answer research questions that are complex, nuanced, or require
multi-faceted data analysis (Gruda, 2011). The questionnaire was designed to collect initial on-
the-ground data from practitioners in an exploratory nature.

Alexandra she | her | hers Private, 4 year
Alicia they |them | theirs Public, 4 year

72
Data Collection and Instrumentation
The researcher chose two primary methods of data collection for this study: surveys and
interviews. These methods will be chosen because of their ability to provide the researcher
with insight—through both qualitative and quantitative data—into the knowledge,
motivational, and organizational influences that impact the persistence of students who take a
leave of absence during their course of study for health-related reasons.
Surveys
The researcher identified eligible participants by searching the site directories at
randomly selected institutions for individual staff members in the office of the Dean of
Students. The researcher entered search terms “medical leave”, “contact information”, in the
search bar to cross-check the contacts listed on each website. It was noted that medical leaves
of absence were also referred to as medical withdrawals or compassionate withdrawals at
some institutions.
During the first round of data collection, the survey was administered by email to
randomly selected student affairs professionals at accredited higher education institutions in
the United States. Purposeful sampling is a strategy used by researchers to gather additional,
relevant data--specific to the goals and research questions of the study--from respondents or
settings (Maxwell, 2013). This design was also chosen because of its alignment with the
researcher’s goal to achieve maximum variation in the collected data. According to Maxwell
(2013), conclusions drawn from such data would represent the entire range of variation among
respondents, rather than only the typical members or some “average” subset.
In the present study, the entire range of variation includes various institution types,

73
professional roles, institution sizes, and geographic locations. Finally, an additional justification
for selecting this approach is that it allows the researcher to adduce the variations among the
respondents. The small size of the sample in this study, for both phases, can best be explained
by two competing factors: the COVID-19 pandemic and data saturation. Due to the
exacerbating circumstances of the COVID-19 pandemic, which affected the researcher
personally, monetary incentives were not offered to participants who received the first survey
link. As a result, there were no survey respondents during the first round of data collection.
After a two-week adjustment period, the researcher followed IRB guidance, adjusted
the survey incentives, and made additional revisions to the study proposal to include a $20
Amazon gift card for all participants, regardless of survey completion. After doing so, the
researcher randomly emailed participants who met the established criterion with a direct link
to the Amazon Gift card; the link to the survey, along with an information sheet, was then
distributed after each participant agreed to voluntarily participate in phase one of the study. It
is important to note that all stakeholders who declined to participate in both rounds of survey
distribution cited the newly emerging COVID-19 pandemic, which had resulted in an
unprecedented increase in their workload.
Among the eligible participants who were sent an email, five people agreed to take the
survey. After agreeing to participate, respondents were asked to assign themselves a
pseudonym that would be used throughout the study. In qualitative research, researchers often
use pseudonyms or aliases to protect the identities of participants (Creswell, 2018). Snowball
sampling was also helpful at this stage, as one participant forwarded the survey link to
colleagues, which resulted in an additional four survey respondents. As such, in the second data

74
collection attempt, the final survey response rate was nine out of nine. Finally, during the data
analysis phase of the study, the researcher determined that there were little opportunities for
new themes or findings to emerge, otherwise known in the literature as data saturation. The
grounded theory concept of saturation holds that the researcher may cease collecting data
when there are no longer new themes or categories that emerge (Creswell, 2018).
Interviews
The COVID-19 pandemic has had deleterious effects on research projects and their
methodologies. Emerging research on the topic reveals the paradigmatic shift in societal
practices (physical distancing, lockdown periods and quarantine) has negatively impacted the
use of traditional to collect data (Sy et al., 2020). Consequently, for the interview phase of this
study, the researcher utilized the USC licensed Zoom web platform to conduct the interview
phase of the study; all related transcripts, video, and audio files were stored internally on the
platform pending deletion upon the conclusion of the study (the option to download all files is
disabled by university administrators). The interviews were scheduled about one to weeks
after each interview participant concluded the survey phase of the study.
Interviews were semi-structured, which allowed for the questions to be flexibly worded
and yet guided by specific data required from all respondents (Merriam & Tisdell, 2016). Each
interview was conducted in English (the primary language of the interviewer) and each lasted
approximately 45 minutes--with the exception of one, which lasted approximately 1 hour.
Additionally, due to the small sample size, other demographic details are not reported here to
protect the confidentiality of interview participants. Following each interview, the researcher
collected their notes and researcher memos in a separate word document and excel

75
spreadsheet. Due to administrative settings on the Zoom account, the researcher was not able
to download interview transcripts. As such, the researcher copied each interview transcript into
a separate word document for the coding and data analysis phase of the study.
Questions asked of participants spanned four major categories: hypothetical questions,
ideal position questions, interpretive questions, and devil’s advocate questions—all of which
can be useful in eliciting relevant and appropriate information from interviewees (Merriam &
Tisdell, 2016). The questions explored in the interviews related directly to the knowledge,
motivation, and organizational needs identified in the literature review and the constructed
conceptual framework of the study. The interview protocol can be found in Appendix B.
Data Analysis
According to Gruda (2011), questions that are complex, nuanced, or require multi-
faceted data analysis. For stakeholder groups of fewer than 20, the percentage of stakeholders
who strongly agreed or agreed will be presented in relation to those who strongly disagreed or
disagreed. The researcher documented, concerns, and initial conclusions about the data in
relation to the conceptual framework and research questions. Upon the conclusion of each
interview, the researcher transcribed and coded each one in a separate document. In the first
phase of analysis, the researcher used open coding to look for empirical codes and apply a
priori codes from the conceptual framework. During the second phase of analysis, empirical,
and a priori codes were aggregated into analytic/axial codes. In the third phase of data analysis,
the researcher identified pattern codes and themes that emerge in relation to the conceptual
framework and study questions.

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Credibility and Trustworthiness
According to Creswell and Creswell (2018), there are several strategies that researchers
can employ to increase the credibility of research findings within a study. Triangulation is one
such strategy—as it requires the use of multiple sources of data along with the process of
comparing and cross-checking data collected through surveys, documents, and both initial and
follow-up interviews (Creswell & Creswell, 2018). Respondent validation—or the solicitation of
participant feedback on preliminary or emerging findings—is another common strategy that
may be utilized in this study. Finally, there are inherent biases, dispositions, and assumptions
regarding the research topic that the researcher had and needed to explore, so that the
integrity of the study could be maintained. Researcher self-awareness is referred to in the
literature as reflexivity—or the mutually occurring process in which the researcher is affected
by the research process; and the research process is affected by the researcher (Creswell &
Creswell, 2018).
In addition to adhering to ethical guidelines and procedures, the researcher will
acknowledge that a collaborative relationship with participants that is rooted in
trustworthiness. This trustworthy and collaborative relationship promotes the well-being of
participants involved in a study and impacts the credibility of the study and research process
(Lawrence-Lightfoot & Hoffman Davis, 1997; Merriam & Tisdell, 2016; Patton, 2015; Tolman &
Brydon-Miller, 2001). As a result, both confidentiality of the data and the consent of the
participants was ensured at the beginning of and during the qualitative interviews, to increase
participant comfort and the likelihood of honest and thorough responses to interview questions
(Creswell, 2018; Rubin & Rubin, 2012).

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During the data collection and analysis phase of the study, the researcher was aware of
the appropriate ways to select data for inclusion. Maxwell (2013) argues that selectively
choosing data to include in the findings can impact the overall conclusions of a study, indicate
researcher bias, and reduce the credibility of a study. At the conclusion of the interviews in the
study, the researcher identified trends and research findings that might reflect a saturation of
data (Maxwell, 2013; Merriam & Tisdell, 2016).
Validity and Reliability
In this study, it was important to ensure the validity of the scores from the quantitative
measures and to discuss the validity of the qualitative findings (Creswell & Creswell, 2018). In
using a explanatory sequential, mixed-methods approach, the researcher acknowledges that
there may be some potential threats to validity. Unequal sample sizes could result and
therefore impact the interpretation of findings for both qualitative and quantitative data
collection. Further, the use of different concepts or variables no both sides, quantitative and
qualitative, could result in incomparable findings in the research (Creswell & Creswell, 2018). As
such, the researcher selected participants both randomly and purposefully, which is said to
increase reliability of the data, as well as reduce selection bias (Kreuger & Casey, 2009).
Ethics
This mixed methods study was submitted to the Institutional Review Board (IRB) of the
University of Southern California. The rules, guidelines, and recommended actions set forth by
the committee are designed to safeguard the rights and welfare of participants in this study.
The intended participants in this study were selected based on their level of responsibility and

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duties at the site. The target population were composed of student affairs practitioners—a
category that will be sourced and self-reported by participants in the study. Due to the history
of unethical and intrusive forms of research, ethical guidelines were established as
precautionary actions to avoid of the harm and confidentiality of study participants. Though an
informed consent does not create symmetry between the researcher and participants of the
study, informed consent can act as a tool of empowerment for participants in qualitative
research studies (Glesne, 2011). As a result, participants in this study were asked to read an
information sheet and consent to participation prior to accessing the rest of the survey. The use
of Qualtrics as a screening and information tool ensured that all potential participants were
aware of the bounds of the study and well informed of their right to withdraw from the survey
and interview phases of the study at any time.
The use of an information sheet is necessary in studies where participants may be
exposed to “physical or emotional risk” (Glesne, 2011, p. 166). The questionnaire in this study
asked participants several questions, which in theory, could have caused some degree of
emotional or mental distress, for example—questions related to policy implementation,
procedures regarding the support of students with disabilities, lack of professional support, etc.
As a result, research-based practices were utilized to reduce the risk of distress among
participants. Additionally, for certain interview protocol, participants of the study were
informed of their right to skip questions that are triggering or cause feelings of discomfort.
In research, maintaining the confidentiality and anonymity of sources is a recommended
field-based practice (Glesne, 2011). Actions were taken to ensure appropriate pseudonyms and
descriptions do not unnecessarily expose participants, data, and archival information used in

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the study. Participants were assigned pseudonyms, identification codes in spreadsheets,
offered flexible scheduling, and single-session, encrypted survey forms. Participants were
assured of their right to privacy prior to, during, and after completion of the survey.
Glesne (2011) argues that the non-local researcher may have an ethical obligation to
obtain “formal or informal community-based agreements that may go far beyond IRB
guidelines” (p. 165). Precautions were taken by the researcher to ensure that neither the site
nor individual participants can be easily recognized or identified by descriptions, or the
inclusion of data collected throughout the research process. All data collected for this
dissertation study was kept secure and stored internally on the Zoom.us website and an
external hard drive. Following collation, screening, and analysis processes, all confidential data
collected and formally used for research purposes was cleaned, encrypted, and stored as an
archival (.zip) file to be deleted after submission.

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CHAPTER FOUR: RESULTS AND FINDINGS

Chapter Four presents the results and key findings of this study. Guided by the Clark and
Estes (2008) gap analysis model and K-M-O framework, the researcher collected data from a
variety of sources and used a two-phase, mixed methods approach--specifically, an explanatory
sequential design, which served three purposes: 1) to carefully explore institutional data
related to the persistence and graduation rates of students on medical leave; 2) to elaborate
upon the individuals results and findings of each independent method; and 3) to determine the
knowledge, motivation, and organizational influences on the stakeholder’s ability to ensure the
successful re-enrollment, re-integration, and graduation of 60% of students who take an official
medical withdrawal during their course of study.
The stakeholder group of focus were student affairs practitioners, a broad category of
professionals that are responsible for providing academic support services to students. In this
case, an additional emphasis was placed on those professionals that provide academic support
services to students who are in the stages of temporarily pausing their course of study for
health-related reasons (i.e., medical leave of absence, compassionate withdrawal). This chapter
provides detailed information on the findings of the study and offers an analysis of the
collected data which helped to answer the following research questions:
1. What is the current state of stakeholder knowledge and motivation necessary to
ensure that at least 60% of students who take a medical leave of absence (or
compassionate withdrawal) successfully navigate reentry and reintegration on
campus, and persist to graduation within 6 to 8 years?
2. According to the stakeholders in this study, to what extent are higher education

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institutions able to provide programs, resources, and supports that ensure that
at least 60% of students taking a medical leave of absence (or compassionate
withdrawal) successfully re-enroll in courses, reintegrate into the campus
community, and persist to graduation within 6 to 8 years?
3. What is the interaction between organizational culture and context, and
stakeholder knowledge and motivation as it relates to ensuring that at least 60%
of students who take a medical leave of absence (or compassionate withdrawal)
successfully navigate reentry and reintegration on campus, and persist to
graduation within 6 to 8 years?
Factual knowledge is demonstrated by performance that requires knowledge of basic
facts, information and terminology related to a topic (Krathwohl, 2002). Survey items used in
this study required participants to demonstrate the ability to apply knowledge, show they can
implement or execute a task, or generate a product. To assess the practitioners’ knowledge of
various data related to the medical leave/medical withdrawal policies, practices, and processes
at their respective institutions, the survey included an interspersed set of items that focused on
identifying institutional strategies, processes, and other related programs. In doing so, the
researcher was able to gauge the initial knowledge levels of study participants.
Knowledge Influences: Quantitative Findings
In this analysis, the focus was on survey items that assessed the interaction between
practitioners’ factual knowledge and the organizational context that supported the field and
stakeholder goals in this study. If 70% or more of the participants responded in a manner to
suggest they had the knowledge influence, then it is considered an asset. If 70% or less of

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participants lacked the knowledge influence, then it is considered a gap.
Participant Knowledge of Disability or Chronic Illness
In this study, survey items that require participants to list terms, give short answers,
complete multiple-choice questions or recognition tasks were used to assess factual knowledge
of participants. Student affairs professionals were asked to rate their level of agreement with
the following statement on Likert scale from 1 (strongly agree) to 7 (strongly disagree): “I know
the legal and institutional obligations related to providing educational services to students with
disabilities and/or chronic illnesses.” In response to Item 31, eight out of nine respondents
replied, “strongly agree,” “agree,” and “somewhat agree,” meeting the threshold of 70%.

Table 6

# Answer % Count
1 Strongly Agree 55.56% 5
2 Agree 22.22% 2
3 Somewhat agree 11.11% 1
4 Neither agree nor disagree 11.11% 1
5 Somewhat disagree 0.00% 0
6 Disagree 0.00% 0
7 Strongly disagree 0.00% 0
Total 100% 9

Student affairs professionals were asked to rate their level of agreement with the
following statement on Likert scale from 1 (strongly agree) to 7 (strongly disagree): “I am able
to recognize and understand the specific diagnoses and conditions that students may self-
disclose.” In response to Item 32, “I am able to recognize and understand the specific diagnoses

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and conditions that students may self-disclose,” seven out of nine respondents replied,
“strongly agree,” “agree,” and “somewhat agree,” meeting the threshold of 70%.
Table 7

# Answer % Count
1 Strongly Agree 22.22% 2
2 Agree 33.33% 3
3 Somewhat agree 22.22% 2
4 Neither agree nor disagree 0.00% 0
5 Somewhat disagree 0.00% 0
6 Disagree 11.11% 1
7 Strongly disagree 11.11% 1
Total 100% 9

Appropriate Intervals and Methods of Communication
Studies have shown that student affairs professionals should know the appropriate
intervals and methods of communications to use when advising students, as it can have an
impact on retention and persistence (Jordan, 2000; Tekian et al., 2000). High-risk students must
be identified on entry and their progress monitored (Jordan, 2000). An effective advising
program can identify these populations and provide more intrusive advising services for them.
Findings from one study showed that for every meeting with an advisor, the odds that a student
will be retained increase by 13% (Swecker et al., 2013).
In this analysis, the focus was on survey items that assessed the interaction between
practitioners’ conceptual knowledge (items 25a and 25b) and the organizational context that
supported the field and stakeholder goals in this study. If 70% or more of the participants

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responded in a manner to suggest they had the knowledge influence, then it is considered an
asset. If 70% or less of participants lacked the knowledge influence, then it is considered a gap.
In response to item 25a, three out of five respondents, who answered this question, indicated
that they interacted with students once a term, while one indicated that they spoke with
students monthly.
Table 8

# Answer % Count
1 Weekly 0.00% 0
2 Monthly 20.00% 1
3 1x a term (semester/quarter/trimester) 60.00% 3
4 Other 20.00% 1
Total 100% 5

Topics of Communication While on Leave
Item 25b asked respondents to indicate the topics covered when communicating with
students. Five participants indicated that the most common topic covered was personal
progress (well-being, check-ins), while four respondents indicated requirements for re-
instatement and re-enrollment were also covered during their communications with students.
Table 9 shows these results.

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Table 9

# Answer % Count
1 Academic accommodations 18.18% 2
2 Personal progress (well-being, check-ins) 45.45% 5
3 Requirements for reinstatement/re-enrollment 36.36% 4
4 Other 0.00% 0
Total 100% 11

Knowledge Influences: Qualitative Findings
What Constitutes a Disability?
The first knowledge influence in this study states that student affairs professionals must
know what constitutes a disability or chronic illness. Student affairs professionals in this study
were asked to describe the nature of their role, as well as the types of the students they served.
Many of them explained that they had worked with students who had several medical issues
resulting from car accidents and other injuries, and all reported experiences working with
students with mental illness. Most relied on anecdotal data, rather than readily accessible
information (i.e., numbers, tracking systems). Estimates of the enrollment population were
common throughout the interviews. For example, Alicia offered the following explanation:
Um, so generally when people do a leave of absence, it's for a religious, mission, military
service, something like that. Medical and compassionate withdrawals are given either
for medical reasons or compassion is kind of anything that doesn't fall in the medical
category. So, most I would say about 90% of the students in our school and generally it's

86
for mental health reasons.
One participant, Jane, explained that according to anecdotal data, many of the students that
end up seeking a medical leave of absence have depression and anxiety. Over time, Jane
noticed there had been a significant increase in the population of students who have the
specific diagnoses of anxiety and depression. In Jane’s description of the students, many of
them sought help only after the illness began to affect them academically.
Another participant, JVN, also described a lengthy professional experience of assisting
students who have had all types of medical conditions, temporary and permanent, through the
medical leave process. Participants in this study were able to describe the realities of the
diagnoses that each student might face and the ways in which their office ultimately provides
support to students seeking a medical leave of absence. For example, JVN explained:
Right, so we look the realities of the diagnosis and the realities of the student’s
situation. And then we determine what's going to be the best method. So, if a student
determines that withdrawal is what they think is best right now, then we're going to
help them with that. And then we're going to educate them on it [the process].
The confusion of bipolar disorder with schizophrenia disorder raised some doubt on the part of
the researcher that student affairs professionals in this study were familiar with specific
diagnostic criteria of each disability. In two instances throughout the interviews, participants
mentioned bipolar disorder specifically, describing the students’ symptoms in a way that
sounded like schizophrenia disorder. For example, participant Jane felt like “a lot of what I feel
like I was seeing was ‘I'm bipolar and sometimes, some skits a frantic episodes with it’,
depending on what type of delusions.” When, JVN described the scenario for students who

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both recommended for an involuntary leave and students who voluntarily opt-in to a medical
leave of absence, they said:
So, let's say a student with bipolar disorder is in a paranoid state in this convinced that
they're being followed. And so, they buy a gun to protect themselves. Now we've
crossed over into a behavior that could warrant safety to others. So now, then we're
looking at the behavior versus the condition.
Only one participant mentioned actively coaching a student through specific diagnoses. In her
interview, Alexandra mentioned:
When I'm talking with students, which, again, feel a lot of failure--you know, some have
co morbid issues going on, especially children who are diagnosed with ADHD in
childhood which oftentimes presents as anxiety and depression in adulthood. So, I end
up talking about those three things. And that kind of spiral that ADHD shame spiral that
happens to so many people.
Participants in this study, though not able to speak to the specificities of a diagnosis or medical
condition, did demonstrate awareness of what constitutes a disability or chronic illness. As JVN
said, “there isn't a health condition that we've encountered so far that our disability center
won't classify as a temporary or permanent disability.” Each participant seemed to have a
superficial understanding of disability and/or chronic illness through their interactions with
students themselves or through the process of filing medical leave requests.
The assumed knowledge influence in this section is factual. Throughout their interviews,
several themes emerged related to the culture of their respective organizations. To start, there
seemed to be a difference between larger universities and smaller colleges, in terms of what

88
was considered a “medical leave of absence” and what types of documentation were necessary
prior to both taking a leave and formal re-entry (or reinstatement). Despite the difference in
definition and qualifying requirements, five out of the five participants indicated they
possessed this factual knowledge influence, which is therefore considered an asset.
Intervals and Methods of Communication
Student affairs professionals should know the appropriate intervals and methods of
communications to use when interacting with students on medical leave of absence or referring
those students to resource providers. This knowledge influence type is conceptual. Conceptual
knowledge is described as the knowledge of underlying categories, principles, structure, or
theory of an area or field (Krathwohl, 2002). Appropriate methods and topics when working
with students emerged as a theme for many of the student affairs professionals interviewed in
the study. For them, it was important to work with students to find the best pathways forward
before the medical leave process and after, during the re-entry and re-enrollment process.
The Importance of Regular, Meaningful Connections with Students
A subtheme that emerged in this study is the importance of maintaining regular and
meaningful connections with students. Student affairs professionals in this study indicated an
importance of connection, relationship building, and communication with students on medical
leave. For participants in this study, there was no evidence of higher-level guidance on how
often to connect with students throughout the medical leave process. According to Alicia, it was
simply about scheduling important check-ins at specific intervals, as she would check in “around
through three around three times a semester”. Alicia further mentioned using her intuition,
professionalism, and personal experiences to guide her decision-making when working with

89
students throughout the medical leave process. “We don't really have any training around the
medical process. I guess it was intuitive”, she stated. They further described not having enough
training or resources on how to guide students through the medical leave process at their
institution. Additionally, for Alicia, it was also helpful to put notices on their calendar to check
in on all students, regardless of leave status. Alicia also believed that they had deeper
connections with students because they worked at a small school within a larger university. As
such, there were generally fewer students to work with, which provided greater opportunities
for establishing meaningful relationships. Alicia shared her reasons why she believed she
connected better with students:
Since we do have a small population of students, I know all our students. I've had
conversations with most of them out on other things other than just academics and
processes. And so, I know them on a personal level, and I'm able to speak to that when
we're having these conversations about troublesome times and how to recover from
that and what to do behind to, you know, all the steps that you need to take, aside from
filling out this form and submitting it, but it's also ensuring that you're doing all the
things that you need to do to take care of yourself and not feeling so bad about when
that when bad things happen…when sharing my personal experiences…I have the time
to do that.

JVN explained how their office not only communicates with students but also provides a
referral to the Disability Center so that students have legal protections that come with formal
disclosures. JVN discussed the importance of student engagement with the disability center at
their campus. Prior to the COVID-19 pandemic, students met with advisors face to face because

90
“we're giving so much information”. Follow-up after those meetings was another tool utilized
by participants to keep students engaged with their advisors throughout the leave process.
Prior to the pandemic, whenever a student was hospitalized, at the institution where
JVN works, student affairs case managers are notified. This allowed for an ease of
communication between students, staff, and hospital staff following the discharge of the
student. “Nothing applies related to COVID now. But when a student is hospitalized for medical
or mental health reasons, I keep that information and we know about it.” JVN adds, “We will go
out to the hospital and work with the students on transition, whether that be transition back
into the university or transition away from the University”.
Student affairs professionals should know the appropriate intervals and methods of
communications to use when interacting with students on medical leave of absence or referring
those students to resource providers. In the case of the second knowledge influence, five of the
five respondents indicated that they were aware of how often to schedule meetings with
students throughout the intake process for medical leaves/compassionate withdrawals. As
such, the threshold of 70% was met, therefore this conceptual knowledge influence is
considered an asset.
Topics of Communication
Helping Students Explore Their Options
Student affairs professionals need to know which topics to discuss with students
applying for a MLOA to best support their re-entry and re-enrollment. Like knowledge influence
2, this knowledge influence type is also conceptual. Conceptual knowledge is described as the
knowledge of underlying categories, principles, structure, or theory of an area or field

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(Krathwohl, 2002). Participants tended to describe their own offices as intimidating or even,
unknown, to students on campus. As such, participants in this study tended to take a very
friendly approach when first interacting with students, stated their roles at the institution and
explained what their position could do in support of the student. Participant CM explained, “My
role is we help a lot of students through that and help them understand there's like not a
formal process. It's all about like helping support them and being like, now, sometimes maybe
college right now is not your option.”
Participants emphasized the importance of carefully explaining the medical leave
process to students, as misinformation could adversely affect an effortless re-entry process
following the leave period. Certain details about registration or requirements for re-enrollment
might be overlooked, so participants were thorough in their explanations with students about
the medical leave process. According to JVN, certain institutional policies could impact whether
a student opts to take a medical leave. JVN explained:
If the student isn't registered for classes and withdraws, then we're going to educate
them on the intent to return, which again is ‘check, check, check’ a few boxes and
you’re admitted back in, but the order in which the student can register could change.
So, we want to make sure that they're educated on, ‘Okay if you withdraw before
registering, you could lose your place in line and go to the end of the pack for
registration’. So, we're going to talk to them about that.
According to Meilman (2016), students may experience resistance to taking a medical leave but
encouragement from student affairs professionals can help them see that their term progress
may result in poor academic standing and a medical leave of absence may be the students’ best

92
option. In this study, participants were clear about the ways in which they communicated with
students, established rapport during initial intake appointments, and followed up with
communications ensuring the students of their future success because of their decisions.
“You’re Only Human” and Empathic Response Strategies
Throughout the study, participants often used empathetic statements, “you know, we
all have struggles and we all go through stress and anxiety and that, but it's not a sign of failure
at all, or as a sign of weakness,” or “this is a sign of being human” when working with students.
In one interview, Alicia told a story about a student of how they provided support to a student
who was reluctant to take a medical leave of absence:
He seemed to feel like it was a sign of weakness. A sign of failure on his part. He was
having medical and mental health issues. And so, I think that's part of why he had that mindset
of weakness and failure, and he was aiming towards law school. So, I think that was part of the
stress as well. Having that blemish, so to speak on his transcript.
According to Alicia, it was important to help students visualize how the impact of not taking a
leave might impact their long-term academic performance. In one example, she explained to a
student:
You know, if you if you continue pushing down the road that you're going, you're not
going to get the result that you want. And if you just take a little pause and then come
back, feeling better and refreshed. And then you're going to get the results that you're
looking for, you're more likely to get that result that you're looking for’.
Alexandra, a student affairs practitioner at a small liberal arts college had a different approach.
In her role, Alexandra helped students to focus on how they would best use their time away

93
from campus and address the circumstances of their leave with their families. Alexandra often
spoke of her perceptions of how students with disabilities must feel when they seek a medical
leave of absence. She stated, “there's the sense that, ‘well, I failed because I'm bipolar’.”
Alexandra’s response to students who express this sense of failure typically sounded like “an
elevator pitch”, where she would coach students. For example, while describing how she would
coach the “bipolar student”, she gave an example of what she would say. “Know right now
you're going through a manic episode which is making it very difficult for you to be successful,”
she said. She continued her hypothetical speech, “This is a part of you. It's not all of you,
right?!” Despite the varied approaches that student affairs practitioners in this study took when
counseling students, each participant integrated empathic communication strategies into their
work with students and families.
Addressing Complex Topics with Students and Families. Some students begin college
during a peak period of vulnerability for the onset of several serious mental illnesses, including
depression, bipolar disorder, and schizophrenia (Pinder-Amaker & Bell, 2012). As such, those
students may require hospitalization one or more times during their course of study. For some
participants, discussions with students who were seeking a medical leave meant addressing
topics that were much more complex than just the schedule for the following term. These
discussions included topics that were sensitive in nature, ranging from housing instability to
situations of abuse. Alexandra shared the following reflection:
I'm talking about what this time away is going to look like. And not just talking with
them, but talking about it with their family, if possible. Because there is this, you know,
oftentimes I think especially with parents, there's this I'm going to come in. I'm going to

94
swoop in. I'm going to pull them home. I'm going to pull them back into the nest and
everything's going to be okay. Especially if this is something that hasn't ever been
verbalized before, especially if there has been something traumatic that has triggered
this.
Alexandra continued to describe the topics that may be discussed after a student is
hospitalized. Parents were not always positive about students receiving on-campus mental
health support. According to Alexandra, certain parents would say, “’I thought we were past
this. I thought they were better.’” In those cases, Alexandra attempted to reframe the
conversations so that they were once again student focused, holistic, and positive in nature.
She continued to describe those conversations:
We’re talking about what this time is going to look like and how to use this time with
parents. The leave is not just to pull them [students] back into the nest, but to help
them focus on what they need to focus on, to incorporate all those different parts of
themselves. So, then [we’re back to] talking about therapy talking about medication
management again.
In this study, participants noted that they often addressed personal issues, recovery strategies,
and navigating re-enrollment processes when meeting with students. However, when
describing their coaching strategies, participants focused on their methods of framing their
conversations when working with students seeking a medical leave of absence.
In this section, the qualitative and quantitative results, and findings for knowledge
causes show that the factual and conceptual influences in this study are assets. The five student
affairs practitioners interviewed for this study all identified, with facility, their methods, and

95
processes for supporting students who have expressed an interest in taking a leave of absence,
medical or compassionate, during their time of study. Throughout their interviews, several
themes emerged related to the culture of their respective organizations.
To start, there seemed to be a difference between larger universities and smaller
colleges, in terms of what was considered a “medical leave of absence” and what types of
documentation were necessary prior to both taking a leave and formal re-entry (or
reinstatement). Item 25b asked respondents to indicate the topics covered when
communicating with students. Five participants indicated that the most common topic covered
was personal progress (well-being, check-ins), while four respondents indicated requirements
for re-instatement and re-enrollment were also covered during their communications with
students. Since the threshold of 70% was met for each knowledge influence, the researcher has
concluded that all knowledge influences in this study are an asset.
Motivation Influences: Quantitative Findings
Motivation Influence 1: Self-Efficacy
In Bandura’s (1991) social cognitive theory, self-efficacy is defined as “the
judgments an individual makes about his or her capabilities to mobilize the motivation,
cognitive resources, and courses of action needed to orchestrate future performance on a
specific task” (Gist & Mitchell, 1992; Martocchio, 1994, p. 820). Researchers have argued that
self-efficacy has an impact on performance and effective leadership (Bandura, 1986, 1991,
1997; Boyatzis, 1982; Stajkovic & Luthans, 1998). To meet the goals of the study, student affairs
professionals needed to feel confident in their ability to provide the initial levels of support
(referral, form assistance, etc.) necessary for a successful return from a medical leave of

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absence.
Student affairs professionals in this study demonstrated high levels of confidence in
their ability to provide the initial levels of case management and individualized support to
students (referral, form assistance, etc.) seeking a successful return from a medical leave of
absence. In this study, case management is “a client-centered, goal-oriented process for
assessing the need of an individual for particular services and assisting him/her to obtain those
services” (Kingsley, 1989, p. 2). Higher education case managers “serve individuals by arranging,
coordinating, monitoring, evaluating, and advocating for individuals or the university
community who are in need of assistance” (Shayman, 2010). When case managers (student
affairs professionals) feel positive expectations for success, there is a greater outcome for
motivation, learning, and on-the-job performance (Bandura, 2008).
Participants were asked to rate their level of agreement with the following statement on
Likert scale from 1 (strongly agree) to 7 (strongly disagree): “I am confident that I can manage
individual caseloads of students on a medical leave of absence.” In response to Item 34, eight
out of nine respondents replied, strongly agree,” “agree,” and “somewhat agree,” meeting the
threshold of 70%, proving this motivational influence to be an asset. See Table 10 for results.
Table 10

# Answer % Count
1 Strongly agree 55.56% 5
2 Agree 33.33% 3
3 Somewhat agree 0.00% 0
4 Neither agree nor disagree 0.00% 0
5 Somewhat disagree 0.00% 0

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6 Disagree 11.11% 1
7 Strongly disagree 0.00% 0
Total 100% 9

Despite the one student affairs practitioner who lacked confidence in their case
management skills, eight of the nine surveyed participants indicated that they felt confident in
their skills on this item. This is likely due to the growing expectation that student affairs staff
members have case management skills (Adams et. al, 2014).
Motivation Influence 2: Utility Value
Motivation, learning, and performance are enhanced if person values the task (Clark and
Estes, 2008; Pintrich, 2003; Clark, 1999). This study focuses only on one type of task value:
utility value or the extrinsic value of a task. According to Rueda (2011), utility value refers to
how useful one believes a task or activity is for achieving a future goal. In this study, utility value
is best expressed by student affairs professionals valuing and believing in the importance of
their role in facilitating medical leave of absence processes. The field goal, in this case of this
study, is to ensure that 60% of students who take a medical leave of absence persist to
graduation. Some questions in the survey instrument were designed to assess the practitioners’
motivation and familiarity with the policies, services, and accommodations that are available to
students who are considering a medical leave of absence or a compassionate withdrawal.
In Item 33, student affairs professionals were asked to rate their level of agreement with
the following statement on Likert scale from 1 (strongly agree) to 7 (strongly disagree): “It is
important to connect students to local external community providers, organizations, and
resources available to them, while they are on a medical leave of absence.” In response to Item

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33, “It is important to connect students to local external community providers, organizations,
and resources available to them, while they are on a medical leave of absence,” nine out of
nine respondents replied, strongly agree,” “agree,” and “somewhat agree,” meeting the
threshold of 70%. See Table 11.
Table 11

# Answer % Count
1 Strongly agree 66.67% 6
2 Agree 22.22% 2
3 Somewhat agree 11.11% 1
4 Neither agree nor disagree 0.00% 0
5 Somewhat disagree 0.00% 0
6 Disagree 0.00% 0
7 Strongly disagree 0.00% 0
Total 100% 9

Student affairs professionals in this study demonstrated a value for the importance of
their role in facilitating the re-entry or re-admission process for students on a medical leave of
absence. In the next item, participants were asked to rate their level of agreement with the
following statement on Likert scale from 1 (strongly agree) to 7 (strongly disagree): “It is
important that I help to facilitate the re-entry and/or re-admission process for students on a
medical leave of absence.” In response to Item 36, “It is important that I help to facilitate the
re-entry and/or re-admission process for students on a medical leave of absence,” eight out of
nine respondents replied, strongly agree,” “agree,” and “somewhat agree,” meeting the
threshold of 70%, proving this motivational influence to be an asset. See Table 12 below.

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Table 12

# Answer % Count
1 Strongly agree 77.78% 7
2 Agree 11.11% 1
3 Somewhat agree 0.00% 0
4 Neither agree nor disagree 11.11% 1
5 Somewhat disagree 0.00% 0
6 Disagree 0.00% 0
7 Strongly disagree 0.00% 0
Total 100% 9

Motivation Influences: Qualitative Findings
Throughout the study, student affairs professionals spoke of their own experiences
providing support for students during the re-entry process. In each interview, participants
either recounted how they entered the field of student affairs or spoke about how the impact
of their institution’s policies motivated them to better support students. Adams et. al (2014)
argue that as a case manager, student affairs staff are responsible for advocating for students in
four ways: (a) coordinating services, (b) managing the system, (c) empowering students, and (d)
negotiating the system. These functions may mean that certain individuals make appointments
for students, intercedes with faculty demands, hosts coaching conversations about
communicating with family and friends, and serving as a life coach, among other duties (Adams
et. al, 2014). Adams et. al (2014) further state that while students may work with an

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administrator to accomplish their goals and measure progress, students are also simultaneously
learning to speak and act for themselves. Given the importance of their role in student success
and the challenging tasks of managing individual student caseloads, student affairs managers
should exhibit high levels of self-efficacy and confidence in their personal abilities to provide
adequate levels of student support.
Confidence in Advocacy Strategies
In this study, participants often mentioned their engagement with tasks and their
investment in their roles, despite the challenges that may emerge while advocating for
students. For Alexandra, it was priority to advocate for students who were not going home to
an “idyllic situation”, which she noted exacerbated disparities and inequitable learning among
students. She responded:
I think oftentimes faculty forget that students aren't going home to their idyllic situation
that the faculty may be going home to. This has highlighted so many of those issues and
those disparities and those gaps in equity. You know, and faculty who are flabbergasted
that students are going home and don't have internet access. So yes, so my advocacy
work has picked up during this period.
For some participants, confidence in their skillset meant being persistent when working with
students who were either unknowledgeable about resources or resistant to taking a medical
leave of absence. Throughout the interview, Alicia tended to emphasize the challenges that
students must face in seeking help from professionals. As such, her strategy was to demystify
the medical leave process, so that students could consider their full range of academic options.
Alicia explained, “It’s important that you explain this process to them. ‘I just need a doctor’s

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notation to support your claim. And then we withdraw you from this class. It doesn't affect your
financial aid, it doesn't affect your, your GPA, all those things.’” She continued, “And, and, you
know, you can imagine the suddenly, you know, you can see it. It's like, you know, somebody
pulled off a weight of bricks from the person's body.” Giving students a greater sense of the
scope and scale of the medical leave process can make it easier for them to weigh their options.
As researchers have noted, individuals with high levels of self-efficacy are more likely to
engage with tasks, persist at them for longer periods, and invest high levels of mental effort in
the task at hand (Bandura, 2008). In this study, participants exhibited high levels of self-efficacy
through their answers to interview questions that probed for evidence of task engagement,
persistence, and mental effort on the job. Self-efficacy, in this study, was demonstrated by how
the participants evaluated their own behavior and learning in their role. Many participants
talked about how they were confident in their abilities to properly support students during the
medical leave process.
Participant Alexandra described the importance of her role and the topics covered when
working with students. “In my role, I think really talking about habits and lifting the veil and sort
of getting it all out in the open, I think is really important.” Alexandra also described a major
increase in her workload because of the COVID-19 pandemic, but as she noted that she still had
the capacity to go above and beyond her normal levels of advocacy for students. When asked
to describe what she meant by “above and beyond”, Alexandra explained:
There was a student I once worked with. She came out [as trans] when she was a
freshman. She's now a senior. I took her to the hospital. Yeah, I met her at the hospital. I
sat in the hospital with her because I was, you know, we were at that point we were

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that I was that scared for her. She was transferred somewhere else. She was in touch
with me. I went and visited her a few days later. And her parents came in while we were
visiting and hearing them misgender her in front of me. I was adamant that they needed
to learn that they could have lost their child. They could have lost their daughter. I
remember having a follow up conversation with her mom and being very adamant
about you know the language that I was using. And it's a difficult line to walk because
ultimately, I work for the institution and therefore I work for the parents who are paying
bills. But really, I work for the students.
In Alexandra’s case, advocacy for students was an important factor in her work, and she had to
remain confident in utilizing that skillset when interacting with students’ families, especially
those who specifically identified as transgender. She explained, “I use my role really to help
educate and reinforce my students and their autonomy and their self-efficacy.”
For Alexandra, defining her role as a reinforcer and advocate meant creating a safe
space for students to seek resources at the last minute. She believed that an innovative
approach to supporting students was to provide them with housing options regardless of
enrollment status. Her perspective was not necessarily unique in this study, as other
participants also expressed a need to seek out additional resources on behalf of students. The
evidence shows that student affairs professionals in this study have demonstrated high levels of
factual knowledge, conceptual knowledge, self-efficacy, and utility value.
“No Questions Asked”: Valuing of Role in Facilitating Exit and Re-Entry
Participants in this study tended to exhibit high levels of importance on their ability to
facilitating the enrollment, exit, and re-entry process for students seeking a medical leave of

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absence. For some participants, their institutions did not rely on data (or numbers) to provide
students with services seeking a leave of absence. As such, leave processes were reported to be
less formal and structured. For example, CM shared that their job was reliant upon data
because, “Students can just take a semester off doesn't have to say because of medical or
because of that, and they can come back the next semester, no questions asked.” The “no
questions asked” theme also emerged at another participant’s institution. According to Alicia,
“You can take a leave of absence and they don't really care why it's just a leave of absence. And
that you only need to do a formal leave of absence if you're going to be gone for more than
three semesters.”
Participants also encouraged students to consider the positive influence of a leave, once
they agreed to take a medical leave of absence, despite their initial reticence due to a fear of
falling behind or graduating after their cohort. According to JVN, “I always tell students ‘You’re
not going to fall behind your graduating class when you graduate. And our institution will never
kick you out’, and then I emphasize that students for all sorts of reasons take time away from
school or take additional time to finish their degree”. For many participants, it was important to
encourage students to reach out anytime they were ready to re-enroll in school. JVN shared
that that the common refrain in the office was, “Call me I’ll help you get back in. And I’ll help
you get back in and make sure you're connected to the resources, so that you can be
successful.”
Asset or need?
Student affairs professionals in this study felt very strongly about the importance of
their role to students who were seeking re-entry into the school, following a medical or

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compassionate withdrawal. In response to Item 33, “It is important to connect students to local
external community providers, organizations, and resources available to them, while they are
on a medical leave of absence,” nine out of nine respondents replied, strongly agree,” “agree,”
and “somewhat agree,” meeting the threshold of 70%. In response to Item 36, “It is important
that I help to facilitate the re-entry and/or re-admission process for students on a medical leave
of absence,” eight out of nine respondents replied, strongly agree,” “agree,” and “somewhat
agree,” meeting the threshold of 70%, proving these two motivational influences to be an asset.
Organization Influences: Quantitative Findings
Organizations are made up of various social constructs called cultural settings. Cultural settings
are the “who, what, when, where, why, and how of the routines which constitute everyday
life—in essence, a more concrete version of a social construct” (Rueda, 2011, p. 57). Cultural
settings are shaped by individuals and groups and can impact behavior—and cultural models
can also impact the behavior of individuals and groups (Rueda, 2011). Rueda (2011) argues that
understanding the genesis of cultural models and settings can help explain the existence of
rules and policies, the uneven distribution of sanctions and rewards, and the drive behind
certain behaviors of individuals and groups.
Organization Influence 1: Value and Positive Regard for Student Support
Vision statements
The survey showed that institutions largely did not have vision statements that spoke
directly to the support of students navigating a leave of absence for health-reasons. When
asked if their institution had a formal vision statement, most participants responded, “definitely
not”. Eight of out nine respondents indicated that there were no formal vision statements for

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supporting students through the medical leave of absence process. As such, this influence
exceeded the 70% threshold, thereby qualifying as a gap or an institutional need. Table 13
shows these results.
Table 13

# Answer % Count
1 Definitely yes 11.11% 1
2 Probably yes 0.00% 0
3 Might or might not 11.11% 1
4 Probably not 22.22% 2
5 Definitely not 55.56% 5
Total 100% 9

Departmental Meetings
In higher education, it is important for the entire institution to assume responsibility for
student success (McClenney, 2004). For student affairs professionals, asking fundamental
questions about the real impact of their programs on learning is a part of defining an
institution’s role in supporting student success. Student affairs professionals were the chosen
stakeholder group of the study, as such, these questions focus on how organizational influences
impact their ability to achieve their goal. The survey showed that regarding the topic of student
success—as it relates to medical leaves of absence—was often discussed among student affairs
teams. When asked how often the topic of “student success—as it relates to supporting
students who take medical leaves of absences”—comes up in meetings, three of out nine
survey respondents indicated that the topic came up daily. Two respondents responded, “once

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a week”, while one answered “2-3 times a week”. Three respondents responded “never”. Table
14 shows these results.
Table 14

# Answer % Count
1 Daily 33.33% 3
2 4-6 times a week 0.00% 0
3 2-3 times a week 11.11% 1
4 Once a week 22.22% 2
5 Never 33.33% 3
Total 100% 9

Student affairs professionals in this study tended to also demonstrate their nuanced
knowledge of the difficult and dichotomous decision that students face as they apply to take an
official medical withdrawal or medical-compassionate leave of absence from their academic
programs. The researcher added this question to the protocol again seeking to illuminate the
potential for an interaction between knowledge influences and hidden organizational
influences on the stakeholder’s goal. Item 22 asks participants the following: “At your
institution, which of the following campus services are available to students who have taken a
medical leave of absence? (Please check all that apply)”. Student health insurance, dining
services, on-campus housing, and funding/financial aid, all emerged as resources available to
students on medical leave of absence. According to the data, student health insurance (n=5)
and funding or financial aid (n=4) were the most likely to be offered as a resource to students

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during their medical leave of absence. Participants in the survey indicated that all but one
option, subsidized off-campus housing, was provided as an option to students who take a
medical leave of absence. Table 15 shows these results.
Table 15

1 On-campus housing 6.25% 1
2 Subsidized off-campus housing 0.00% 0
3 Dining Services 6.25% 1
4 Student health insurance 31.25% 5
5 Counseling services 12.50% 2
6 Funding or financial aid 25.00% 4
7 Career Services or Employment opportunities 18.75% 3
Total 100% 16

Targeted Support Programs
The next question asked participants about the existence of targeted support programs
that specifically serve students with disabilities and/or chronic illnesses who plan to return from
a medical leave of absence. Six out of nine participants indicated “definitely yes”, while one
participant was unsure, and two others answered “definitely no.” While most participants did
affirm the presence of targeted support programs, it fell just below the 70% threshold,
therefore qualifying as a need. Table 16 shows these results.

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Table 16

# Answer % Count
1 Definitely yes 66.67% 6
2 Probably yes 0.00% 0
3 Might or might not 11.11% 1
4 Probably not 0.00% 0
5 Definitely not 22.22% 2
Total 100% 9

Organizational Influence 2: Need to Express Positive Beliefs in Student Success
Colleges and universities need to express positive beliefs in the likelihood of student
success upon return from leave or withdrawal. There was a clear demonstration, in this regard,
that student affairs professionals strongly believed in their organization’s ability to help
students be successful, regardless of the cause behind a student’s initial delay in academic
progress which is an organizational asset. Participants were asked to rate their level of
agreement on a Likert scale survey, 1 (Strongly agree) to 7 (strongly disagree) with the following
statement: I believe that my office can assist students who take a medical leave of absence,
regardless of the cause, and successfully persisting to graduation. Nine out of nine respondents
responded, “strongly agree,” “agree,” and “somewhat agree,” to the prompt: I believe that my
office/department provides adequate support to students who are currently on or have taken a

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medical leave of absence. Table 17 shows these results.
Table 17

# Answer % Count
1 Strongly agree 44.44% 4
2 Agree 44.44% 4
3 Somewhat agree 11.11% 1
4
Neither agree nor
disagree
0.00% 0
5 Somewhat disagree 0.00% 0
6 Disagree 0.00% 0
7 Strongly disagree 0.00% 0
Total 100% 9

Departmental Ability to Provide Adequate Support
There was also strong level of agreement among student affairs practitioners when
asked about their belief in their office and/or department’s ability to provide adequate support
to students who are currently on or who have taken a medical leave of absence. Several studies
conducted about the difficulties experienced by students with severe mental illnesses show
that these difficulties can include learning skills, management of academic tasks, concentration
problems, and a lack of confidence about their ability to cope with the demands of college
(Mowbray et al., 2001; Shor, 2015). As such, it is important that student affairs practitioners
feel strongly that their offices can provide adequate support to students with severe mental
illnesses who are seeking a medical leave of absence. In the present study, eight out of nine

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respondents responded, strongly agree,” “agree,” and “somewhat agree,” thereby meeting the
70% threshold, to the prompt: I believe that my office/department provides adequate support
to students who are currently on or have taken a medical leave of absence. Table 18 shows
these results.
Table 18

# Answer % Count
1 Strongly agree 44.44% 4
2 Agree 44.44% 4
3 Somewhat agree 11.11% 1
4 Neither agree nor disagree 0.00% 0
5 Somewhat disagree 0.00% 0
6 Disagree 0.00% 0
7 Strongly disagree 0.00% 0
Total 100% 9

Ease of Navigating Institutional Policies
Providing adequate support differs from ease of navigation, in that, the process of
applying to a medical leave can sometimes be wieldy and intimidating to students. According to
Shor (2015), it can be difficult for students to utilize institutional resources due to the dilemma
about whether to reveal a disability, which can be further linked to a culture within a university
that does not encourage vulnerability. Additionally, difficulty navigating university resources
can be a result of a physical environment that is not accessible to students with disabilities
(Shor, 2015). For this item, however, student affairs professionals in this study believed that

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the policies were inherently easy to navigate for students, from initial application to re-entry
from the period of absence. Table 19 shows these results.
Table 19

# Answer % Count
1 Strongly agree 44.44% 4
2 Agree 11.11% 1
3 Somewhat agree 22.22% 2
4 Neither agree nor disagree 11.11% 1
5 Somewhat disagree 0.00% 0
6 Disagree 11.11% 1
7 Strongly disagree 0.00% 0
Total 100% 9

Notably, the response patterns for these items are visually similar, regardless of
institution type and size, but the small sample size again poses a challenge to researcher
attempts to generalize these results. The outcomes reveal that those participants were also
employed at institutions that did not require any formal paperwork, disclosure of disability or
illness, or medical documentation for students to take a general leave of absence. Researchers
have shown that data collecting institutions generally have difficulty with capturing both
accurate and representational data from this subpopulation. One major challenge that
institutions face is an overreliance on students to self-report/disclose a psychiatric or physical
disability (Belch, 2011). Other challenges include the persistent, lack of universally accepted
categories of psychiatric and physical disabilities, and the unknown extent to which college
students are undiagnosed while enrolled (Eudaly, 2002; Wolanin & Steele; 2004). Despite the
limiting nature of the data (it is self-reported), results that demonstrate need represent

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performance gaps that pose significant challenges.
Organizational Influence 3: Positive Organizational Beliefs in Student Success
Resource Allocation for Students on MLOA
One of the ways that this study sought to examine the impact of organizational
influences on the goal was to encourage participants to identify examples of their institution’s
belief in student success. In this item, support and belief in student success is linked to resource
allocation for students and programs. Item 21 asks participants the following: “Which of the
following describe the implications of successfully applying for medical leave of absence at your
institution? (Please check all that apply). This question was created to ascertain the resources
that are no longer available to students once they have successfully opted into the medical
leave of absence process. Table 20 shows these results.
Table 20

# Answer % Count
1 Enrollment status 17.95% 7
2 Transfer of Credit from other institutions 5.13% 2
3 Off-campus Study Applications 2.56% 1
4 Course Registration 12.82% 5
5 Financial Aid Eligibility 12.82% 5
6 Tuition and Fee Refunds 15.38% 6
7 Student Health Insurance 7.69% 3
8 On-campus Housing 12.82% 5
9 Presence on campus / Receiving Campus services
12.82%

5

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Item 30 asks participants the following: “At your institution, is there funding allotted to
provide additional resources to students who are currently taking a medical leave of absence?”.
Seven out of 9 participants responded, “probably not” or “definitely not”, indicating that
additional resource allocation may be an organizational need. Since 7 out of 9 participants
indicated that institutional funding for additional resource allocation to students who are on a
medical leave of absence is not provided, this influence can be considered an organizational
need. Table 21 shows these results.
Table 21

#
Answer % Count
1 Definitely yes 11.11% 1
2 Probably yes 0.00% 0
3 Might or might not 11.11% 1
4 Probably not 33.33% 3
5 Definitely not 44.44% 4
Total 100% 9

Organizational Influences: Qualitative Findings
Organizational studies have shown that the key to long-range growth and survival is to
keep the needs of stakeholders in balance, through the mission of the organization, which
operates as a set of beliefs about the organizations core competencies and basic functions in
the society in which it exists (Schein & Schein, 2017). Organizational climate is comprised of
artifacts such as observed behavior routines, rituals, and structural elements such as charters,

114
organizational charts, and communication paths (Schein & Schein, 2004).
According to Schein and Schein (2017), there are three levels of organizational culture:
artifacts, espoused beliefs and values, and basic underlying assumptions. In this study,
participants were asked several questions about the organizations at which they were
employed. These questions sought to uncover both the levels of culture that are easy to
observe and “difficult to decipher” (Schein & Schein, 2017, p. 18). Cultural models are “the
shared mental schema or normative understandings of how the world works, or ought to work”
(Rueda, 2011, p. 55).
“No Questions Asked”: The Flexibility of Leave Policies
University procedures for handling mental health withdrawals and readmission are
important ways in which student affairs professionals can support the university’s academic
mission (Meilman et al., 1992). Participants seemed to appreciate the inherent flexibility of
their institutional policies because they felt it aligned with the mission of their institution:
access. For example, CM described the policy at their university as “no questions asked”. They
also explained that students can just withdraw from the institution because they “don't have to
say that it’s because of this medical reason or that”. Instead, at CM’s institution, students are
only required to declare a medical leave when they apply for tuition refunds. Otherwise,
according to CM, students can just say, “’ Hey, I need to leave’ and I say, ‘cool. Here's some
paperwork. Withdraw. Come back next semester. Let's get you back on, maybe take a semester
off and come back’”.
In their comments, JVN revealed that students do not have to fill out paperwork in
person to receive services because everything is uploaded online. For example, JVN explained:

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It's not paperwork anymore. It's all on the computer all online but um, and then they
have one year to return to the university with doing what's called an intent to return
versus an application process, the intent to return only has to do with residency. And so,
they have one year to return with no issue if after that one year they want to return
they would have to do the application process again.
Not all participants, however, indicated a level of ease for students navigating the medical leave
of absence process. In their interview, participant Alexandra only referred to medical leave
policies as “mid-semester withdrawals” and described their process of working with students to
withdrawal during their academic program. Unlike other policies discussed in this study, though
there was some flexibility in the initial enrollment process for students at Alexandra’s
institution, there were some additional requirements that could prevent a student from
returning. For Alexandra, however, delaying a student’s return was only considered if it were in
their best interest. She explained:
Um, what I say is that what we're looking for is that, and this is in the policy that
students have taken you know enough time to address whatever it is that they need to
address and that they are coming back able to be successful. At school, whenever it is
that they do return and if a medical provider says yes, they're ready. I'm not going to
question that I'm not going to fight against that. The only caveat to that would be if a
medical provider really didn't provide very much documentation. I could reach out to
them and ask for more information or, you know, a student was coming from very far
away and didn't have any continuing care set up.
JVN, another student affairs practitioner, described the policy at their university similarly as

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aligned with the institutional mission of greater access and inclusion. JVN believed that the
levels of support provided by the institution, in addition to the flexibility of the policy, led to the
high retention percentages for the division/department, which had surpassed their university
average. “Our retention rate for students who work with our office is 79.85% so we have
students who worked with case management have a higher retention rate than our university
average”, they said.
In JVN’s opinion, their mission of access behooved them to grant entry to all students
who sought re-admission. She explained, “What I can tell you is that if a student is in good
standing and even if they're on academic probation or something, they're still in officially in
good standing. We don't deny anyone entrance back into the university.” In this section,
participants were proud of their institutions’ ability to accommodate students without
restrictive requirements. For them, the most important part about working with students on
leave was ensuring that those students had all the resources they needed to successfully re-
enroll following the leave.
Providing Intensive Supports to Students Seeking Leave
Another theme that emerged from the interviews was the need to provide intensive
support to students seeking a medical leave of absence. Participant Alexandra felt that the
traditional aged college student required more support overall with navigating bureaucracies to
find additional resources.
Oftentimes, I will offer them help finding a provider. That's something that I do a lot for
students. I, find out what their insurance is, search around to try and find something
that will be a good fit for them and then provide several different referrals in the area. I

117
even go so far as coaching them through the appointment making process and how to
get on waitlist and things like that. If you think about you know developmentally you
know this. I know this, you know, a 19- or 20-year-old doesn't know how to make a
doctor's appointment. Oftentimes, much less than 18 or 19- or 20-year-old who's living
with, you know, a debilitating depression. Or anxiety that's preventing them from
leaving their house or leaving their, their room. So, I’m supporting students through that
process again to make sure that it happens.
In this study, student affairs professionals like Alexandra demonstrate a willingness to go the
extra mile to support students in finding additional resources that may not be provided by the
institution during their medical leave of absence. For Alexandra, it seemed that a major
motivator of her approach was the recognition of where college students may be in terms of
their development. As she stated, the average college student may feel uncomfortable or
anxious when self-advocating with external providers. In this case, Alexandra provided direct
assistance to students by coaching them through the intake process and appointment
scheduling.
Despite her limited resources, Alexandra still provides a 1:1 service for students during
the medical leave process. In response to the pandemic, Alexandra wanted to increase student
support services. She explained, “My solution is to hopefully, with the help of lots of colleagues,
to call every single student who's going to be returning and have a conversation about their
health and wellness and what they need this fall--so that we can hopefully as best we can get in
front of those students who are going to need more support.” Regardless of financial
limitations and institutional barriers, Alexandra sought to partner with other colleagues across

118
departments to increase outreach to students on leave.
Additional Resource Allocation on MLOA
CM described the resources allocated to students, regardless of their enrollment status,
which changes once a student declares a medical leave of absence or compassionate
withdrawal. Often students must weigh the risks of losing access to certain university resources
and that can impact their decision to apply—even if the medical leave of absence is the best
course for success. They stated, “If they withdrew from on-campus housing, they would have to
move out. But there is a form that they can fill out to take a formal leave of absence.”
At CM’s institution, students must move off-campus once they complete their paperwork for
medical withdrawal. However, according to CM, students do not lose all their resources; in fact,
students can retain important resources such as health insurance and access to recreation
centers and libraries for up to one year. This policy is a great example of the organization
providing wellness resources, despite enrollment status, to students who have taken a medical
leave of absence.
Alexandra expressed a fervent belief that higher education institutions should look to
margins for the most at-risk and underrepresented students when considering policies around
additional resources for students taking a medical leave.
The reality is, for most students and that's changing a lot, um, both because it needs to
change. And, because in a lot of places and a lot of ways higher education offers not just
opportunities but safety and community in a way that the communities themselves
don't offer, you know, again, think about a young trans person of color, living in
Lexington, Kentucky. For them getting to come to a liberal arts college on the east coast

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could literally save their life. And so, you know, do we have a responsibility to serve
them, even if they can't be academically successful for any you know for a portion of
time. Well, what does it mean to be academically successful and what does it mean to
be academically successful if you have been you know, abused, and hurt and
traumatized repeatedly throughout your entire life?
Alexandra continued to describe the hypothetical student of color and the challenges they
might face at her institution. She spoke about innovative ideas for offering additional
institutional resources, but ultimately, she focused on her own contributions to student success
at her institution:
The work that you are doing as an under resourced trans person of color in order to get
an A in a class or get D in a class is very different from you know your lily white, rich girl.
So, I love the idea of being able to offer stable housing to individuals, regardless of
whether or not they're enrolled in a given semester, whether or not they take a medical
withdrawal. And it's definitely something you know, being able to have a student take a
medical withdrawal on the very last day of the semester is something that I have
allowed you know students to do because I know that this is a safe place in a way that
other places or not.
For the participants in the study, it was important to have adequate resources, administrative
assistance, and time to provide the intensive support needed to usher students successfully
through the medical leave of absence process. In some institutions, students received
important resources to sustain their livelihoods while on leave. In others, there were many
implications of taking a medical leave of absence, including losing access to health insurance,

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housing, and food stability. Should institutions have medical leave processes that allow
students to continue receiving services and support while on leave? In this study, student
affairs professionals were most appreciative and proud of their institutions because they
believed that their policies were flexible, accessible, and inclusive to students seeking a medical
leave of absence.
Summary of KMO Influences Validated as an Asset or Need
In the present study, there are three knowledge influences that meet the threshold of
70%, thereby proving to be assets in the study. Additionally, there are two motivational
influences that meet the threshold hold of 70%, also proving these influences to be an asset in
the study. Finally, there are two of out three organizational influences that were proven to be
assets in the study. One organizational influence was determined to be a need based on the
participant responses in the survey. Upon further investigation based on the interviews, the
third organizational influence was determined to be a need in some institutions and an asset in
others. Table 22, 23, and 24 show the knowledge, motivation and organization influences for
this study and their determination as an asset or a need.

Table 22: Knowledge Influences

Assumed Knowledge Influence Asset Or Need?
Student affairs professionals must know what
constitutes a disability or chronic illness.

Asset
Student affairs professionals should know the
appropriate intervals and methods of
communications to use when interacting with
students on medical leave of absence or referring
those students to resource providers.

Asset

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Student affairs professionals need to know which
topics to discuss with students applying for a MLOA
to best support their re-entry and re-enrollment.
Asset

Table 23: Motivational Influences

Assumed Motivation Influence Asset Or Need?
Student affairs professionals need to feel confident
in their ability to provide the initial levels of support
(referral, form assistance, etc.) necessary for a
successful return from a MLOA (self-efficacy).
Asset
Student affairs professionals should value the
importance of their role in facilitating MLOA
processes to better inform policy design,
implementation, review, and evaluation.
Asset

Table 24: Organizational Influences

Assumed Organizational Influence Asset Or Need?
Colleges and universities (the organization) need to
convey value and positive regard for supporting
students returning from health-related leaves of
absence through adequate training, resource
allocation, and interorganizational collaboration.

Asset
Colleges and universities need to express positive
beliefs in the likelihood of student success upon
return from leave or withdrawal.
Asset / Need
The organization needs to demonstrate value and
regard for data collection, to allocate resources for
students who take withdrawals, regardless of
enrollment status, to facilitate re-enrollment and
reintegration to campus.
Asset / Need

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Chapter Five: Recommendations
Recommendations from this study demonstrate the effectiveness of the following
actions that postsecondary institutions can take to address the problem of practice: a) training
and professional development for student affairs professionals, b) professional opportunities to
explore the differential needs of the population through data analysis and collection; c)
launching targeted, re-entry programming for students returning from a leave of absence; and
d) sustaining flexible, leave policies that do not inhibit academic success following re-entry.
In the U.S., colleges and universities have seen a marked growth in enrollment among students
with disabilities.
A report released by the National Center for Education Statistics (NCES; 2019) indicated
that 19% of undergraduates and 11.9% of post-baccalaureates attending college in the U.S. self-
reported having a disability. In addition, postsecondary counseling centers have noted an
increasing proportion of students with psychiatric disabilities (also referred to as mental health
conditions); approximately 39% of all students enrolled in postsecondary institutions self-report
a psychiatric disability. Data from the national Healthy Minds Study (HMS), along with other
reports, suggest an increasing prevalence of bipolar disorder, anxiety disorders, depression, and
posttraumatic stress disorder, among college students (Gruttadaro & Crudo, 2012).
Policies regarding medical leave, involuntary and voluntary withdrawal, the student
code of conduct, and parental notification are critical to ensuring the successful persistence and
retention of students with disabilities (Belch, 2011). According to Stevenson (2010), students
with mental health conditions--anxiety and depression, especially--tend to feel ashamed and
embarrassed about their presumed disposition towards a “cap-in-hand” approach towards

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asking for accommodations and additional resources while enrolled in their programs. Those
students then tend to find difficulty in asking for help, navigating the bureaucracy of large
institutions and personal isolation, regular attendance in classes, and difficulty in coping with
unexpected life events (Stevenson, 2010). As a result, there is an enormous need for
postsecondary counseling center staff and disability service providers to create policies and
facilitate procedures that are inclusive, responsive, and supportive of students with disabilities,
particularly those with psychiatric disabilities, comorbid disorders, and chronic illnesses (Belch,
2011; Stevenson, 2010).
Few studies have investigated the knowledge, skills, and motivation that student affairs
professionals need to support the successful re-entry of students who have taken a medical
leave of absence and/or compassionate withdrawal. This purpose of this study is to conduct a
needs analysis to determine the recommendations for stakeholders to achieve the field goal of
graduating 60% of students who take a leave of absence for health-related reasons within 6 to
8 years of matriculation. While the data results for this study indicated most influences were
assets, this chapter will also present recommendations that will be beneficial. For the
institutions were there may exist gaps, below some recommendations are presented.
Knowledge Influences and Recommendations
The knowledge influences and recommendations listed in the table are aligned with the
gap analysis framework (Clark & Estes, 2008) and the revised Bloom’s taxonomy (Anderson &
Krathwohl, 2001; Krathwohl, 2002). Furthermore, given the context of the study and its sub-
focus on expanding resources for marginalized students, the recommended interventions for
each knowledge influence reflect a suggested combination of approaches—sociopolitical,

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organizational, and social constructivist-- to address the validated causes, if there are any (Clark
& Estes, 2008). Table 25 highlights the assumed knowledge influences situated alongside the
hypothesized validity levels of each knowledge gap identified in this study. The validated
knowledge influences were declarative-conceptual and procedural in nature, as conceptual
knowledge includes the theories, models, and principles necessary to effectively solve problems
and procedural knowledge is demonstrated by the application of methods of inquiry,
techniques, and specific skills (Krathwohl, 2002; Rueda, 2011[3]).
Table 25

Assumed Knowledge Influence

Principle and Citation Context-Specific Recommendation
Student affairs professionals must
know what constitutes a disability or
chronic illness.

How individuals organize knowledge
influences how they learn and apply
what they know (Schraw &
McCrudden, 2006).

Break down complex tasks and
encourage individuals to think about
content in strategic ways (Schraw &
McCrudden, 2006).

Training:
Senior administrators should provide
cooperative learning and culturally
responsive training on how to
interact with students outside of the
medical model of disability (i.e.,
social model of disability)

Job aid: Senior administrators should
provide accessible lists that
enumerate, describe, and
contextualize disabilities and/or
illnesses – perhaps those most
reported at the institution—to new
hires.
Student affairs professionals should
know the appropriate intervals and
methods of communications to use
when interacting with students on
medical leave of absence or referring
those students to resource providers.

Information learned meaningfully
and connected with prior knowledge
is stored more quickly and
remembered more accurately
because it is elaborated with prior
learning (Schraw & McCrudden,
2006).
Training:
Senior administrators should
incorporate training modules to
include interactive opportunities for
practitioners to model how best
practices around appropriate time
intervals for communication.

Job aid:
IT Department should create an
interactive dashboard and tracking
system that helps student affairs
professionals identify and monitor
the overall academic progress and

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outcomes for students who have
taken a medical leave of
absence/medical withdrawal.

Job Aid:
Senior administrators should provide
job aids (i.e., templates, call scripts)
to serve as visual cues and reminders
about phone/email outreach to
students as takeaways from training.
Student affairs professionals need to
know which topics to discuss with
students applying for a MLOA to best
support their re-entry and re-
enrollment.
Have learners identify prior
knowledge (what they know and
what they do not know about a
topic) before a learning task (Mayer,
2011).

Meta-strategies, or strategies used
for managing other strategies and
knowledge, are useful for evaluating
solutions or processes related to a
given task (Mayer, 2011).

Training:
Student affairs professionals should
be trained on which topics to discuss
with students applying for a medical
leave of absence by senior
administrators and senior colleagues.

Senior administrators should provide
support/training on meta-strategies
to not only understand the topics to
discuss with students, but also the
best ways to discuss them outside of
the medical model of disability.

Developing Knowledge of Disabilities and Chronic Illnesses. The findings of this study
suggest that student affairs professionals should know what constitutes a disability or chronic
illness. Knowledge of what constitutes a disability along with the varying models of disability
prove important to the success of student affairs practitioners. Among college students, there
has been a steady increase in mental health diagnoses and treatment. Oswalt et al. (2018)
showed that there was a consistent rise in students’ willingness to seek mental health support;
one study referenced found that the increase in students seeking mental health services was
more than five times the growth rate of institutional enrollment (Oswalt et al., 2018).
One way to simply address a gap in knowledge around disabilities and chronic illnesses
is to provide job aids to employees. These job aids could be accessible lists that enumerate,
describe, and contextualize disabilities and/or illnesses – perhaps those most reported at the

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institution. Another way to address any potential gaps of knowledge in this area, especially for
new hires, is to provide cooperative learning and culturally responsive training on how to
interact with students outside of the medical model of disability (i.e., social model of disability).
While it is important to understand the medical conditions that students experience, disability
studies scholars also argue that a general lack of sensitivity to and awareness of the seriousness
of the need for accommodating students with disabilities is a more significant concern than the
availability of funds at postsecondary institutions (Dutta et al., 2009).
Sustaining Practitioners’ Knowledge about Intervals and Methods of Communication
The results and findings of this study indicate that student affairs professionals should
be familiar with the appropriate intervals and methods of communications to use when
interacting with students who have taken a leave of absence for health-related reasons. Given
that disclosure is often, but not always, required during medical leave processes and that
clinical expertise varies among practitioners, it is important for student affairs professionals to
have the adaptive skills and emotional intelligence necessary to build strong interpersonal
relationships with their students.
BrckaLorenz et al. (2017) argue that interactions between faculty and staff “lead to
greater student motivation and achievement, increased student retention, and improved
student performance in the classroom” (p. 352). Findings from a previous study also suggested
that faculty and staff who continuously met with students with psychiatric disabilities--outside
of formally defined spaces--helped to retain students who were at risk of dropping out (Hartley,
2010). To address this need, information processing theory proves useful for sourcing
recommendations, which are presented below in no order of importance.

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Student affairs professionals should be trained on which topics to discuss with students
applying for a medical leave of absence. Researchers have proven that meta-strategies, or
strategies used for managing other strategies and knowledge, are useful for evaluating
solutions or processes related to a given task (Mayer, 2011). Singer et al. (1989) conducted an
experimental study to examine the efficacy of a five-step motor learning strategy--readying,
imaging, focusing, executing, and evaluating--in developing skills towards performing a new
task. According to their pivotal study, during the “Readying” stage, the learner must first
prepare themselves mentally and physically to try in earnest to complete a new task. In the
“Imaging” stage, the learner must imagine the process of completing the action.
When “Focusing”, the learner must remove distractions to truly focus on the relevant
features of a task. In the “Execution” stage, learners then attempt the skill without overthinking
the process. According to Singer et al., the final stage— “Evaluating”—requires the learner to
complete the task with a self-evaluation of the effectiveness and quality of their performance.
Using control and randomized groups of 20 adolescents, the researchers found that participants
in the randomized group performed better than the control group, and thereby concluded that
the use of specific motor learning strategies can improve motor performance and transfer of
learning. This study supports the recommendation to include interactive modules that teach
practitioners meta-strategies to practice different communication strategies.
Another way to address this need is to incorporate training modules to include
interactive opportunities for practitioners to model how best practices around appropriate time
intervals for communication. According to Clark and Estes (2008), learning is best assessed by
asking someone to apply what they have learned and explain why they are doing it.

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Additionally, information, job aids, and training should replicate the tasks of communication
and goals as they are performed on the job. As such, providing opportunities for student affairs
practitioners to be observed and given corrective feedback when communicating with students
can be just as effective as computer or web-based training modules (Clark & Estes, 2008).
Following the training, the use of job aids (i.e., templates, call scripts) can serve as helpful visual
cues and reminders about phone/email outreach to students as takeaways from training,
thereby bolstering learning outcomes. Additionally, institutions can measure the effectiveness
of their departmental/divisional communication strategies by creating an institutional
interactive dashboard and tracking system that helps student affairs professionals identify and
monitor the overall academic progress and outcomes for students who have taken a medical
leave of absence/medical withdrawal.
Sustaining Practitioners’ Knowledge about Topics of Communication
Mpofu and Wilson (2004) found that students with disabilities drop out during the first
year due to various reasons which include the lack of transitional student support. Student
affairs practitioners in the study were mostly aware of the appropriate topics to cover when
communicating with students seeking to take a medical leave of absence. Social and structural
supports may also promote recovery (Mezzina et al., 2006; Myers et al., 2016). For example,
mental health training for resident advisors in dormitories, increased awareness of campus
resources for wellness, and a coordinated support team for students re-entering college
following a leave may help students continue to build on the strengths learned during a medical
leave (Story et al, 2018). Jordan (2000) argues that “as much substance as possible should be
brought to the connections advisors make with students” (p. 21).

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Cooperative learning and culturally responsive training on how to interact with students
outside of the medical model of disability could be provided for student affairs practitioners
who are new to working with students with disabilities. This is a helpful strategy because
research shows that modeling to-be-learned strategies or behaviors improves self-efficacy,
learning, and performance (Denler et al., 2009). O’Brien and Kuhaneck (2019) define mental
practice as the process that occurs when individuals try out a skill mentally before actualizing
the skill in a real-life situation (e.g., role-playing, watching a video, imagining). Mental practice,
when combined with physical training, can prove especially effective for adult learners when it
is task-specific and task-oriented (Bovend Eerdt et al., 2012). Training modules or sessions could
include case studies that allow for professionals to hone their communication skills through
role-playing possible scenarios with their colleagues or volunteers. Meaningful learning occurs
when learners can identify prior knowledge (what they know and what they do not know about
a topic) before a learning task (Mayer, 2011). Therefore, the recommended training should also
draw upon realistic scenarios sourced from participants or reputable sources in student affairs
through a pre-training survey so that participants can make use of prior knowledge during the
training session. Additionally, job aids such as communication scripts and templates are all
additional tools that are recommended solutions for sustaining this asset.
Motivation Influences and Recommendations
Motivation—the study of action in relationship to one’s beliefs, values, and goals—has
long been a topic of research in developmental, educational, and organizational psychology, as
it serves as the source of inertia that drives learning, skill-building, and task-completion (Eccles
& Wigfield, 2002; Mayer, 2011; Rueda, 2011). Motivational influences affect individual beliefs

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about one’s own skill sets and competencies, expectations for success or failure, and sense of
control over outcomes (Eccles & Wigfield, 2002). Therefore, without explicitly addressing the
ways in which motivational influences (what humans do) impacts mental effort, persistence,
and self-guided productivity, the knowledge influences (what humans know) could be rendered
ineffectual (Clark & Estes, 2008).
Table 26 highlights the assumed motivational influences of this study, validity
estimation, related principles, and citations, as well as relevant, context-specific, site-based
recommendations. The related principles and citations shown in the table are drawn from
sources that were previously cited within the literature review. Given the identity-based
context of the study, the recommended interventions reflect a suggested combination of
approaches—sociopolitical, organizational, and social constructivist—proposed to address the
validated causes (Clark & Estes, 2008). Additionally, the assumed motivational influences in this
study with the highest likelihood of being validated—self-efficacy and expectancy value—are
listed alongside the estimated validity levels of each motivational gap; remaining influences
included in the table were not validated or viewed as priorities for the purpose of this study.
The listed motivational influences and recommendations are framed by the gap analysis model
(Clark & Estes, 2008) and the revised Bloom’s taxonomy (Anderson & Krathwohl, 2001;
Krathwohl, 2002).
Table 26

Assumed Motivation Influence

Principle and Citation Context-Specific Recommendation
Student affairs professionals need
to feel confident in their ability to
provide the initial levels of support
(referral, form assistance, etc.)
High self-efficacy can positively
influence motivation (Pajares,
2006).
Student affairs professionals will
practice implementing initial levels
of support with a more
experienced mentor/supervisor.

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necessary for a successful return
from a MLOA (self-efficacy).

Provide SA professionals with
decision-tables or flow chart job
aids that make it easier for them
to recall appropriate protocols and
seek corrective feedback without
fear of negative consequences,
critical responses, and overly
competitive behavior
Student affairs professionals
should value the importance of
their role in facilitating MLOA
processes to better inform policy
design, implementation, review,
and evaluation.

Rationales that include a
discussion of the importance and
utility value of the work or
learning can help learners develop
positive values (Eccles, 2006;
Pintrich, 2003).

Student affairs professionals
should regularly gather in
communities of practice to
observe, critique, and assess their
own pre-existing policies as well as
those at comparative institutions
within their own setting.

Student affairs professionals
should be encouraged to share
past successes when policies areas
have been followed.

Senior administrators should host
regular meetings to discuss the
importance of the work.

Maintaining Self-Efficacy in Case Management and Support Strategies
According to Clark and Estes (2008), motivation is controlled by the human desire to be
effective, and it is driven by self-efficacy, or the belief that one has the skills required to
successfully complete a task (Clark & Estes, 2008; Pajares, 2006). Research has shown that
people who are positive and have confidence in their abilities, effectiveness, and competencies
are more likely to actively pursue work goals, persist beyond distractions, and invest significant
and sustained mental energy when completing tasks (Bandura et al., 2001; Ryan & Deci, 2000).
In other words, individuals tend to persist and expend greater mental effort on activities that
have the most meaning, value, or impact. In this study, it was hypothesized that self-efficacy
and utility would emerge as motivational gaps among survey and interview respondents.

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Consequently, the results and findings of this study suggest that student affairs professionals
should continue to feel confident in their ability to provide the initial levels of support (referral,
form assistance, etc.) necessary for a successful return from a leave of absence for medical
reasons--and eventual persistence to graduation.
Self-Efficacy
In his seminal article, Bandura (1986) suggested that four categories of experience are
used in the development of self-efficacy: enactive mastery, vicarious experience (modeling),
verbal persuasion, and physiological arousal (Gist & Mitchell, 1992). Individual perceptions of
self-confidence (specifically, task-specific confidence) and emotional regulation are deeply
intertwined with individual belief systems. It is those individually constructed beliefs about
competence, capacity, and community that could affect employee work performance and
organizational outcomes. Studies have demonstrated that employee attitudes—particularly
feeling as though they matter, and their work makes a difference—are correlated with
numerous organizational outputs (Buckingham & Coffman, 1999; Harter et al., 2006;
Schlossberg, 1989). Kimball et al. (2016) suggested that despite feeling unprepared to support
students with disabilities, student affairs professionals often desire more education and skill
development (Kimball et al., 2016). Therefore, there is demonstrable value in attending
professional development workshops and conferences, where administrators and case
managers alike can further refine or develop their case management and data analytics skills.
One way to change self-efficacy is to intervene in the attributional process, where
people interpret performance feedback when successful and unsuccessful (Gist & Mitchell,
1992). To this end, student affairs practitioners can increase their self-efficacy with the help of

133
frequent and detailed feedback on task performance (Gist & Mitchell, 1992). Student affairs
professionals can achieve this by practice implementing initial levels of support with a more
experienced mentor/supervisor. It may also be helpful to conserve the high costs of retraining
newer student affairs professionals by providing them with decision-tables or flow chart job
aids that make it easier for them to recall appropriate protocols and seek corrective feedback
without fear of negative consequences, critical responses, and overly competitive behavior.). It
may also be helpful to conserve the high costs of retraining newer student affairs professionals
by providing them with decision-tables or flow chart job aids that make it easier for them to
recall appropriate protocols and seek corrective feedback without fear of negative
consequences, critical responses, and overly competitive behavior. This not only will ensure
high levels of self-efficacy and lower levels of burnout and compassion fatigue when working
with high-need students, but it will also reduce hiring costs due to constant employee turnover
(Newell & MacNeil, 2010).
Utility Value
Student affairs professionals will share past successes when policies areas have been
followed. Practitioners can interact with another to share strategies, compare policies, and
expand their social networks within communities of practice, which make them a valuable
opportunity for collaborative meaningful learning. Fostering professional communities of
support can be done by providing regular, cost-effective opportunities for student affairs
professionals to gather in communities of practice to observe, critique, and assess their own
pre-existing policies as well as those at comparative institutions within their own setting.
Communities of practice are places where learning occurs as a shared, social act, mediated by

134
cultural tools and artifacts (Wenger, 1998). Furthermore, communities of practice could
provide opportunities for student affairs professionals to meet established colleagues, discuss
evidence-based strategies for supporting students with disabilities, and compare high-impact
practices, policies, and procedures. Since, arguably, student affairs practitioners are held to
standards of collaboration and supported education, the recommendation for communities of
practice is grounded in the principle that materials and activities should be relevant and useful
to the learners, connected to their own interests, and based on real-world tasks (Pintrich,
2003).
Organizational Influences and Recommendations
Researchers Clark and Estes (2008) hold the view that effective organizational change
begins by first, addressing the knowledge and motivational factors that lead to performance
gaps and then, examining the organizational culture for potential barriers to goal achievement.
Culture and cultural processes—which are often invisible, automated, dynamic, and value-
based—can pertain to both individuals and organizations and include the core values, beliefs,
collective goals, and cohesive processes developed in home and workplace settings (Rueda,
2011; Schein, 2004). According to Schein (2004), organizational culture is established through a
reinforcement of shared beliefs about “the importance of individual initiative and competition,
and the value of group process and collaboration” (p. 111). This is exemplified in the work
undertaken by Gallimore and Goldenberg (2001) on cultural settings and cultural models.
Cultural models are the shared mental schema and cultural practices—that is, collaborative
thinking, knowledge construction, and behaviors—that help shape the structure of an
organization (Gallimore & Goldenberg, 2001, Rueda, 2011). These models include the values,

135
priorities, practices, procedures, policies, and reward structures that are deeply embedded into
an organization and constantly reified by its members. Relatedly, cultural settings are specific,
dynamic social contexts that impact the behavior, thoughts, and attitudes of individuals and
groups; in other words, they are the visible, concrete manifestations of cultural models
(Gallimore & Goldenberg, 2001; Rueda, 2011).
Organizational gaps--the final component of the gap analysis framework--are caused by
a lack of adequate, efficient, and effective organizational work processes and tangible resources
(Clark & Estes, 2008). Work processes are critically important to organizations as they delimit
the necessary interactions between people, equipment, and materials to achieve results. When
work processes are misaligned, equipment is missing or non-existent, and resources are
inadequate (funding, staff, facilities), attempts to achieve organizational performance goals will
be delayed or unsuccessful. Table 27 summarizes the organizational influences (cultural models
and cultural settings), related principles and citations, and the context-specific
recommendations appropriate for each assumed gap. In this study, institutions that address
these organizational gap influences are well-poised to provide adequate resources and support
services to students who are preparing to temporarily withdraw from their academic programs
of study.

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Table 27

Assumed Organization
Influence*

Principle and Citation

Context-Specific Recommendation
Colleges and
universities (the
organization) need to
convey value and
positive regard for
supporting students
returning from health-
related leaves of
absence through
adequate training,
resource allocation, and
interorganizational
collaboration.

Cultural
Model

Effective change efforts
ensure that everyone has the
resources (equipment,
personnel, time, etc.) needed
to do their job, and that if
there are resource shortages,
then resources are aligned
with organizational priorities
(Clark and Estes, 2008).

High levels of resource
provision among staff are
correlated with increased
student learning outcomes
(Waters et al.,2003).
Senior administrators should
develop training modules that cover
medical leave enrollment processes
and strategies to connect with
internal/external providers.

Senior administrators should utilize
a shared advocacy approach that
can be thought of as a hybrid,
external-internal accountability
system that further drives internal
accountability and organizational
capacity (Norton, Grubb, & Badway,
2005).

Senior administrators establish a
routine communication process that
solicits needs and establishes
priorities for budgeting purposes.
Colleges and
universities need to
express positive beliefs
in the likelihood of
student success upon
return from leave or
withdrawal.
Cultural
Setting
Effective organizations ensure
that organizational messages,
rewards, policies, and
procedures that govern the
work of the organization are
aligned with or are supportive
of organizational goals and
values (Clark & Estes, 2008).
Senior administrators should
develop job aids and training
modules that cover communication
strategies for student support
service providers.

The organization needs
to demonstrate value
and regard for data
collection, to allocate
resources for students
who take withdrawals,
regardless of
enrollment status, to
facilitate re-enrollment
and reintegration to
campus.
Cultural
Setting
Effective organizations ensure
that organizational messages,
rewards, policies, and
procedures that govern the
work of the organization are
aligned with or are supportive
of organizational goals and
values (Clark & Estes, 2008).

Scorecards can be used for
community accountability
measures and as a tool to
detect and bring attention to
inequalities (Bensimon, 2007).
Senior administrators should
establish the need for a shared
advocacy approach between
internal units and community
providers.

Senior student affairs
administrators should use the
balanced scorecard approach, which
is recommended to close this
organizational influence gap.

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Sustain Institutional Value and Regard for Adequate Training, Resource Allocation, and
Interorganizational Collaboration
According to Clark and Estes (2008), organizational goals are achieved by a system of
interactive processes that require specialized knowledge, motivation, and skills to achieve
successful operations. The authors argue that training is necessary whenever employees are
learning to accomplish job tasks that require higher level thinking and skill than can be provided
by job aids. Qualitative data from the study revealed that a higher level of thinking is required
for student affairs professionals who provide support to students taking a medical leave of
absence. Only one participant explicitly mentioned not having formal training for their work.
Although many disability service staff have received training in learning and instruction, studies
report that they do not feel adequately trained to address the needs of students with
psychiatric disabilities (Sharpe et al., 2004). Blacklock et al. (2003) advocate for promoting
access to resources for all key stakeholders through the dissemination of information and
training efforts.
Resource Allocation and Interorganizational Collaboration. Quantitative data from the
study revealed that resource provision among and for support services staff was highly
dependent upon the financial resources available at the institution. Yet it is known that high
levels of resource provision among staff are correlated with increased student learning
outcomes (Waters et al., 2003). Increasing student learning outcomes should be a driver of
institutional priorities, policy creation, and policy implementation. McEwan & Downie (2013)
argue that in a shared advocacy model should include:
1. aggressive outreach program targeting current and prospective students, ensuring

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students are aware of their right to services.
2. providing integrated support services between postsecondary and community mental
health (a wrap-around model of care).
3. coupling front-end loaded supports like functional academic and psychosocial
assessments with proactive academic planning for student who are unaware of how
their disability impacts their learning.
4. implementing early-stage contingency planning for times of individual student crisis.
5. developing disability-specific accommodations and supports (p. 242).
In their study, Sharpe at al., (2004) found that focus group participants identified a lack
of coordination and communication between service providers on and off campus as addition
barriers that students with disabilities face at the postsecondary level. In their seminal article,
Blacklock et al. (2003) advocate for improving clarity, coordination, and communication with all
key stakeholders, including inter-organizational and community-based service providers. In
some cases, this influence proved to be an asset, while in other institutions it was a need.
Information gleaned from participant interviews show that there are wide-ranging financial
contexts and commitments at their institutions to provide clear communication systems,
adequate training and on-boarding programs for new hires, and additional case management
staff to support students taking a medical leave of absence.
The Dangers of Limited Case Management Resources and Staff. Numerous scholars
have considered the implications of limited resources and the necessary corollary of articulating
the role of funding considerations in the design and implementation of accountability systems.
According to research, effective change efforts ensure that everyone has the resources

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(equipment, personnel, time, etc.) needed to do their job, and that if there are resource
shortages, those resources are aligned with organizational priorities (Clark & Estes, 2008).
Though not immediately obvious from the quantitative data, data from the participant
interviews suggested that student affairs professionals who worked at institutions with greater
financial resources, increased staffing, and inter-office collaboration reported higher retention
rates for students who took medical leaves of absence than those who remained continuously
enrolled.
According to McEwan and Downie (2013), even in larger, well-resourced institutions,
disability service models are often unable to provide timely and effective services for students
with serious or persistent psychiatric disabilities. In these instances, students with severe
disabilities are less likely to self-advocate and are therefore at greater risk of dropping out. By
ensuring that staff resource needs are met, upper-level student affairs administrators will be
able to observe increased learning outcomes (Waters et al., 2003). Senior level student affairs
administrators should establish a routine communication process that solicits needs and
establishes priorities for budgeting purposes. Effective leaders share power appropriately and
consider equity in the process of allocating resources (Johnson, 2006). Even with additional
support services, students without disabilities take longer to complete their degree than their
non-disabled counterparts and require significant time, energy, and resources. Leaders should
be encouraged to review objective key performance indicators (i.e., time to degree completion)
to identify any pre-existing strategies and targeted programs that promote increased retention
rates among students with disabilities.
Prior to this study, researchers had already established the need for a shared advocacy

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approach between colleges and community providers. There have been extensive studies on
the effectiveness of coordinated management of mental health care in community settings;
emerging research on models of community care suggest that public health models of practice
such as supported education and Cornell University’s Mental Health Framework are more
comprehensive, collaborative, and responsive to students with psychiatric disabilities (Cornell
University, 2004; as cited in McEwan & Downie, 2013). In this approach, community-based care
managers coordinate with students to provide treatment, rehabilitation support (i.e., housing),
community involvement, opportunities for relationship building and life skills development—all
of which are resources that are often key barriers to success for students with physical and
psychiatric disabilities.
A shared advocacy approach can be thought of as a hybrid, external-internal
accountability system that further drives internal accountability and organizational capacity
(Norton et al., 2005). Negotiating shared community services does require that senior higher
education leaders remain aware of the historical and socio-cultural context of their institutions
before creating partnerships (Chavez et al., 2008). However, as stated before, building the
learning capacity of an organization is crucial to improving its performance.
Demonstrate Institutional Value and Regard for Data Collection and Benchmarking
Building the capacity of an organization is crucial in fostering goal achievement, high
levels of performance, and improved accountability systems. As mentioned in the literature
review, postsecondary institutions tend to be concerned with improving accountability systems
as they compete for high-achieving prospective students, talented faculty, and the status
afforded to them through positions on national rankings lists. However, despite the extensive

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amount of literature on the efficacy of data-driven benchmarking, quantitative and qualitative
data collection seem intimidating to practitioners for whom the skillset is new or unfamiliar. In
a study examining high-quality assessment practices, Green et al. (2008) found that even within
divisions that valued high-quality assessment programs, there were lower levels of
commitment to assessment practices among student affairs professionals--only 50% of
respondents indicated that they were highly committed to assessment. Other researchers have
concluded that a lack of commitment from leadership, along with inadequate funding sources,
time restrictions, limited expertise, and a fear of failure are other reasons why student affairs
professionals avoid routinely engaging in assessment practices (Hoffman, 2015).
Researchers have shown that people are more productive when benchmarking is
essential to evaluating progress and driving organizational performance in accountability
(Dowd, 2005; Levy & Ronco, 2012). An important finding that emerged in this study is that 57%
of the respondents indicated that their institutions did not collect, analyze, and dis-aggregate
demographic data (i.e., race/ethnicity, gender) of students who have taken a leave of absence
from their academic program for health-related reasons. Additionally, when asked specific
questions regarding the rates of attrition for students on leave, 28% of respondents, including
senior administrators, indicated that they were unsure of the data.
This finding is not fully representative of an inadequate knowledge and a lack of
motivation on the part of the practitioners; however, it does suggest a perceived institutional
lack of value and positive regard for data-driven benchmarking, a tool that can prove useful in
tracking efforts to improve organizational performance with respect to student retention and
persistence rates. It is therefore recommended that student affairs administrators develop key

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performance indicators to reflect various measures of academic performance outcomes (e.g.,
persistence rates) for students with disabilities who have taken or are currently taking a
medical leave of absence.
Accountability is increased when organizations adopt a balanced scorecard approach to
assessing performance. Effective leaders use disaggregated data to make informed decisions
and to track the impact of their decisions on equity and access within their organizations
(Bensimon, 2005). Additionally, different types of benchmarking can contribute data to improve
organizational performance (Bogue & Hall, 2003; Marsch, 2012). As such, a balanced scorecard
approach is recommended to close this organizational influence gap. Scorecards can be used
for community accountability measures and as a tool to detect and bring attention to
inequalities (Bensimon, 2007). According to Bensimon (2007), an equity scorecard can be used
to measure community accountability against intended outcomes. Additionally, it is widely
accepted in the research that equity, diversity, and access are important goals in private and
public sectors, and therefore systems of accountability should also address equity, diversity,
and access within those various sectors (Darling-Hammond, 2007; Lim et al., 2013; Trenerry &
Paradies, 2012).
Students with disabilities are a vulnerable population that require intensive support
services and meticulous tracking to ensure they do not fall through the cracks (Kimball et al.,
2016). As such, student affairs practitioners should become more comfortable with
manipulating data from multiple sources (internal/external, empirical, and anecdotal) and
tracking student learning outcomes. The documented information on re-enrollment, retention,
and graduation rates could be distilled into procedural job aids for newer student affairs

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professionals and case managers who are learning how to support students with disabilities.
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
According to Kirkpatrick and Kirkpatrick (2016), a thorough evaluation of training
programs can lead to an improvement in training programs, a demonstration of training value
added, and a maximization of learning transfer and results. The New World Kirkpatrick Model
guides the evaluation of the proposed solutions to the knowledge, motivation, and
organizational gaps, and the model will be used to assess the proposed programs’
effectiveness, usefulness, and credibility to the stakeholders. As a tool, the New World
Kirkpatrick Model is a four-level evaluative framework that measures the reaction (level 1),
learning (level 2), behavior (level 3), and results (level 4), of talent development and
performance improvement programs (Kirkpatrick & Kirkpatrick, 2016). The model is designed to
guide the planning process through the four levels in reverse order from Level 4 to Level 1 so
that the focus is on the “program outcome that is accomplished through improved on-the-job
performance of training graduates” (Kirkpatrick & Kirkpatrick, 2016, p. 31).
Organizational Purpose, Need and Expectations
To sustain learning communities that prepare graduates adequately, postsecondary
institutions must commit to fostering inclusive campus communities that are welcoming,
supportive, understanding, and caring (Belch, 2011; Chan, 2016; see also Kezar, 2004).
Additionally, as both public and private institutions compete in the marketplace to prove the
worth of higher education, it is important that students are provided the tools they need to
achieve their individual goals, in both academic and workplace settings. Arguably, the demands

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of the U.S. economy, considering the pandemic, elicit even more urgency that institutions
ensure the retention and graduation of all students, especially those with pre-existing and
emerging disabilities. The focus of this study was to examine the knowledge, motivation, and
organizational influences that might adversely impact the goal of closing the persistence gap
between students with disabilities and their non-disabled peers.
In this study, the stakeholder group of focus is student affairs professionals, particularly
those who manage health-related leave of absence policies at their institutions. As a matter of
supporting retention efforts, student affairs professionals will need to provide adequate
accommodations and resources to all students who take health-related leave of absences or
withdrawals so that they may successfully re-enroll in academic programs and persist to
graduation within eight years of matriculation. The specific goal for this stakeholder group is to
ensure that:
1. By 2020, 60% of students who take a leave of absence for health-related reasons will
graduate from their academic program within six to eight years.
For this study, the researcher selected the first goal based on national benchmarks and data on
retention and persistence rates for college students with disabilities and their non-disabled
peers. Studies have shown that colleges and universities have seen a massive rise in the
numbers of students who are self-reporting mental health conditions such as anxiety,
depression, and bipolar disorder among others (Koch et al., 2018). Among those who have
disclosed mental health conditions, there is a significant percentage of students who withdraw
from college for mental health reasons (Gruttadaro & Crudo, 2012).
Though it is important to encourage students to pursue their care externally and focus

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on their recovery process, institutions must also realize that these conditions are often acute,
chronic in nature, spontaneously occurring, and routinely underdiagnosed or untreated;
therefore, they may not be neatly resolved (Stevenson, 2010). As such, the desired outcomes
are that postsecondary institutions must not only have policies and procedures in place that
allow students to temporarily leave college to seek medical care and additional resources from
external providers, but also that student affairs professionals are able to provide the necessary
resources for those students to successfully re-enroll and persist to graduation within eight
years of matriculation.
Therefore, the success of proposed outcomes will be measured by greater levels of data
collection and tracking of outcomes for students with disabilities (regardless of leave status,
continuous workshops on utilizing data for program and policy design, as well as trauma-
centered communication strategies, and the wide-spread use of institution-specific job aids
(templates, scripts, dashboards) that facilitate the ease of information recall and reduce the
amount of working memory necessary to successfully complete goal-related tasks.
Level 4: Results and Leading Indicators
According to Kirkpatrick and Kirkpatrick (2016), Level 4 measures the impact the
recommended solutions will have on organizational goal achievement. The authors suggest that
Level 4 is often misunderstood and is defined as “the degree to which targeted outcomes occur
because of the training and the support and accountability package” (Kirkpatrick & Kirkpatrick,
2016, p. 31). Table 28 presents the external and internal outcomes.

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Table 28

Outcome Metric(s) Method(s)
External Outcomes
Increased Institutional
Recognition:

Narrowing of the achievement
gap between diverse student
populations regardless of self-
reported disability status.
● Moving up in ranking
among U.S. World
News Rankings
● AHEAD member
institutions listings
● Positive news
coverage of
advancements
● Outreach to relevant
organizations that routinely
publish, and rank institutions
based on accessibility and
diversity, equity, and inclusion
metrics.
● Highlight data on a website
with an embedded dashboard
and media package.
● Review news reports, including
The Chronicle of Higher
Education
Competitive Edge:

Increase in applications from
first-time and transfer applicants
who have self-disclosed in their
admissions materials.
● Number of inquiries
about program
aspects during
admissions events
● Re-enrollment rates
● Increased application;
potential for high
yield applicants
● Partnerships with organizations
like College Re-Entry
● Presentations at selected
partner organizations specific
to students with disabilities
● Dedicated admissions team
panel procedures that
incorporate relevant student
affairs departments after
enrollment.
Meaningful Relationships with
Local Providers:

Increase in institutional capacity
to serve students who are on
leave due to a widened network
of providers, practitioners, and
student support services near
campus.
● Number of listings
available to students
● Number of referrals
to external providers
● Availability of on-
campus services
○ Wait times
○ Time to
reschedule
● College-provider conferences,
town halls, and summer
meetings
● Departmental referral lists
● Shared resource database
(supported education model)

Internal Outcomes
Institutional Self-Awareness &
Accountability:

Student affairs staff within the
institution can provide sufficient
information about the outcomes
related to students who have
taken a leave of absence for
health-related reasons.
● Number of student-
facing student affairs
staff that are familiar
with the outcomes for
students by relevant
input
● Visibility on website
● Accessibility of data

● Aggregated data reports
● Interactive dashboard (w/
filters)
Higher Retention Rates:

Increased measures of adequate
Organizational key
performance indicators such
as:
● Program reviews
● Call logs
● Enrollment Data (End of Year)

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communication and case
management workflows used to
track and follow up with
students as they enter the
leave/withdrawal process.
● Re-enrollment rates
● Retention rates
● Time-to-graduation
measures
● Student satisfaction
dashboards
Inclusive, Campus Environment:

Students who disclose a mental
disorder or a physical condition
(to an advisor or dean) feel
comfortable advocating for
themselves, meeting with
professional staff, and
developing strategies for their
academic success prior to,
during, and after a leave of
absence for health-related
reasons.
Organizational key
performance indicators such
as:
● Re-enrollment rates
● Retention rates
● Time-to-graduation
measures
● Student satisfaction
● Extended resources and
identity-based programming
● Common Data Set
● Internal Retention Reports
● Student Satisfaction surveys

Level 3: Behavior
Critical Behaviors
According to Kirkpatrick and Kirkpatrick (2016), behavior is the third level, and it
describes the degree to which participants in a training program apply what they have learned
within their own environmental context. In the New World Kirkpatrick model, Level 3 consists
of critical behaviors (high impact practices), required drivers (extrinsic motivators), and on the
job learning. Table 29 presents those critical behaviors alongside their metrics, methods, and
timing for evaluation.

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Table 29

Critical Behavior Metric(s) Method(s) Timing
1
Student affairs
professionals regularly
communicate with
students as advisors
while they are on leave
to connect them with
additional resources
and assist them with
the re-enrollment
process.
Number of communication
logs entered
Anecdotal data collection
Appointment data
Student satisfaction surveys
Methods of communication
include:
● LMS/Portals
● Virtual office hours
● Phone calls/texts
● Emails
Bi-weekly,
1x a month
2
Student affairs
professionals regularly
collect and
disaggregate relevant
data to identify
patterns or trends in
withdrawals among
student populations.
Visibility of data on internal
or external websites

Tracking reports from
analytical dashboards; pre-
existing software
Minimum:
Yearly

3
Student affairs
administrators and
teams conduct regular
internal reviews of
leave policies from a
diversity, equity,
access, and inclusion
lens.
Number of reviews, public
availability

Consistent, clear positive
trends in retention data
among student groups,
regardless of background
Review by committee, task
force
Accreditation pre-review

Minimum:
Yearly
Maximum:
Quadrennia
l (4 years)
4
Student affairs
professionals
demonstrate effective
use of feedback to
determine when/if
improvement is
happening by regularly
reviewing quantitative
and qualitative data
collected from students
and alumni.
Number of reports publicly
available

Attendance at public
forums, town halls

Amount of feedback
(quantitative, qualitative
data)
Public-facing interface
Internal tracking dashboard
Spotlight on website
Context-specific
programming (e.g., town
halls, community forums)
Yearly,
Biennial

Required Drivers
Often challenged with budgetary concerns and limited resources, leaders of
organizations often view training as an expense and subsequently expect programs to

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demonstrate value and provide realistic returns on investments after a training is conducted.
Therefore, participants in training programs must prove their effectiveness, efficacy, and worth
by demonstrating applied knowledge and skill development on the job. According to Kirkpatrick
and Kirkpatrick (2006), organizational leaders, managers, and supervisors rely on required
drivers to reinforce, monitor, encourage, and reward the critical behaviors of employees that
contribute to and are necessary for goal achievement.
Higher levels of employee performance and success have been tied to the use of
required drivers in organization, as they reinforce skills learned during training with support
systems and measures of accountability. Since the current study was field-based and did not
focus on a singular institution, it should be assumed that senior-level administrators (e.g.,
presidents, vice presidents, provosts) will provide the required drivers necessary to ensure the
stakeholder goals of the study. Table 30 displays the required drivers necessary in this study to
support the critical behaviors alongside the associated method and appropriate timing intervals
for implementation.
Table 30

Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Reinforcing (Support)
On the job training Yearly 1, 2
Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Reinforcing (Support)
Communities of practice
On-campus: by term, minimum:
yearly
Off-campus: yearly, Biennial
(every two year)
2, 3

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Reinforcing (Support)
Job aids Bi-annually (2x a year) 1, 2
Encouraging (Support)
Coaching Ongoing, as needed 1, 2
Rewarding (Support)
Recognition
Biennial
Minimum: Yearly
1, 2, 3, 4
Monitoring (Accountability)
Action-plan monitoring
Yearly, Biennial, Quadrennial (4
years)
1, 2
Dashboard Ongoing 2, 3
Surveys, work review Bi-annually 3, 4

Organizational Support
The critical behaviors identified in this study—when aligned with key performance
indicators, required drivers, and on-the-job learning—are the most important levers for
achieving stakeholder goals (Kirkpatrick & Kirkpatrick, 2006). To facilitate higher levels of
productivity and improvement in organizational performance, postsecondary institutions
should make concerted efforts to frame their own accountability measures by goal setting and
benchmarking. First, boards of trustees, leaders, and senior administrators should develop
robust goals and key indicators to reflect various measures of academic performance outcomes
(e.g., persistence rates). After goals and indicators are clear and agreed upon by appropriate
stakeholders, administrators, managers, and coordinators should establish the procedures for a
rigorous, systematic collection of data from multiple sources (internal/external, empirical, and
anecdotal). Then, senior level student affairs administrators should establish a routine
communication process that solicits feedback from a wide range of stakeholders and
establishes priorities for budgeting purposes.

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Level 2: Learning
In the New World Kirkpatrick Model, learning (Level 2) is measured by the acquisition
and application of knowledge, skills, and commitment gained through relevant training
programs (Kirkpatrick & Kirkpatrick, 2016). Compared to previous iterations, the newer version
added commitment and confidence to address performance issues among experienced
employees as well as to bridge the theoretical gap between gaining relevant knowledge and
applying it on the job. The following section covers the learning goals for Level 2, as well as the
accompanying training program.
Learning Goals
By the end of the program, student affairs professionals will be able to:
1. Clarify, carry out, and integrate appropriate intervals and methods of communications
when interacting with students on medical leave of absence or referring those students
to resource providers. (Conceptual)
2. Feel confident in their ability to provide initial levels of support to students who are on
leave or have indicated a desire to re-enroll (Motivation, self-efficacy)
3. Justify the value and importance of evaluating the MLOA process to inform policy
design, implementation, review, and evaluation (utility value)
Program
According to Kirkpatrick and Kirkpatrick (2016), having clearly defined results that are
linked to the four levels prior to the design, development, and delivery of a training increases
the value of the program and the likelihood that its resources will be used effectively. This
professional development and training program is grounded in all four levels of the New World

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Kirkpatrick model. It is based on the idea that collaborating with the stakeholders in
determining metrics of success will increase on-the-job application of learned materials,
organizational achievement of program outcomes, and the value of the program itself. The
training program will span the course of eight weeks, allowing space for participants to reflect,
actively participate in communities of practice, and practice applying skills learned on the job
over a period with guided observation and coaching.
To accomplish the learning goals, student affairs practitioners will be invited to
participate in a series of brown-bag workshops that are designed to increase their knowledge,
skills, and confidence in managing the caseloads of students with disabilities who have
expressed an interest in or an intent to temporarily withdraw from college for health-related
reasons. Prior to the start of the training program and before the start of the first session,
participants will complete a pre-test survey to assess their knowledge, confidence, and comfort
with vocabulary related to disability theory, disability models, and the high-impact practices
recommended by the Association on Higher Education and Disability (i.e., data collection,
tracking outcomes, etc.). At the start of every session, the facilitator will be sure to co-create
norms for the space so that each participant feels comfortable and safe in their learning
environment.
Learner interaction and collaboration, in any setting, but especially online, is the key to
an effective online course. According to Weimer (2002), power should be shared in an online
setting as it energizes learners who are motivated to remain actively engaged throughout the
course. Online learning that encourages interaction and collaboration may be challenging for
some participants, but participants will be encouraged to participate in group work, which will

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contain context-specific, relevant team-building activities. The first half of the program is
designed to draw participants into a discussion that relates to their practice and is learner
focused. Participants will engage in large group discussions about the importance of data
collection as well as the beneficial and equitable outcomes of disaggregating data. In each
session, participants will have the opportunity to practice their skills with one another in virtual
breakout rooms. They will have had the opportunity to review all session materials as they
were uploaded to a Google folder prior to the start of the program.
This is important, as each participant will be assigned roles in case studies and role-
playing scenarios where they will practice their communication skills with a newly fitted equity
lens. In the second half of the program, participants are encouraged to practice data
manipulation with a test dashboard. This session will test their ability to interpret data, spot
trends, and identify students who may need additional support services. Finally, the training
program will conclude with three engaging activities: a draft action plan, a commitment to
continue meeting in their communities of practice, and a reflection on their intention to apply
what they have learned in their own context.
Evaluation of the Components of Learning
Kirkpatrick and Kirkpatrick (2016) assert that evaluation is a necessary component that
should be integrated into the learning and development process. Furthermore, the authors
recommend continuous evaluation of the program as it can maximize program value. At Level
2, the program evaluation should measure the degree to which student affairs professionals
acquired from the learning program the relevant knowledge, skills, attitudes, confidence, and
commitment necessary to achieve their divisional and institutional retention goals. Table 31

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provides a visual display of the activities that are core components of the learning program as
well as the intervals at which they will be used to measure participants’ achievement of the
intended learning outcomes.
Table 31

Method(s) or Activity Timing
Declarative Knowledge “I know it.”
Breakout group vocabulary exercises, group share out of
responses
Pre-test, post-test
Large group discussion about importance of data
collection
Session 1
Competitive, team building activities to reflect
comprehension of terms, concepts, or procedures.
Follows major block of learning concepts; at
minimum, 1 during first half of each session, 2
total per session if time permits
Procedural Skills “I can do it right now.”
Interactive Nearpod or other activity that tests
knowledge about data collection strategies and
implementation
Session 2

Procedural Skills “I can do it right now.”
Real-time practice on a sample dashboard, group
discussion of how to enter, retrieve, and interpret data
Middle of session 2 (in a series), after break
Team co-design of departmental/institutional values,
retention goals, context-specific equity framework
Middle of session 1 (in a series), before break
Team co-design of department guidelines for
communication intervals, checkpoints, and data review
Middle of session 2, after break
Attitude “I believe this is worthwhile.”
Facilitator co-creates norms with training participants At the beginning of each workshop
Facilitator observation of behaviors and verbal/non-
verbal statements during large group discussions
During each session/workshop

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Session evaluation End of each workshop, end of program
Confidence “I think I can do it on the job.”
Mid-session formative assessment, mid-session
reflection shares
During each session/workshop
Modeled practice: case studies During each session/workshop
Modeled practice: role-play, scenarios During each session/workshop
Session feedback (Likert survey question) End of each session/workshop
Commitment “I will do it on the job.”
Create draft action plan for data collection Penultimate & final sessions, closing activity
Establish a regular interval of meeting times (cross-
divisional and interdepartmental participants)
Final session, penultimate closing activity
Exit survey: Ask each participant for one action step they
will take upon returning to their setting.
Final session, closing activity

Level 1: Reaction
The concluding step in the New World Kirkpatrick Model is to evaluate the reactions of
learners (engagement, relevance, and customer satisfaction) who have participated in a
recommended training program (Kirkpatrick & Kirkpatrick, 2016). Level 1 is the simplest level to
evaluate, and it is often distributed immediately after the training session because the response
rate for evaluation forms is likely to be higher. Table 32 displays a list of components that may
be useful in obtaining accurate measures of stakeholder reactions, alongside the appropriate
timing intervals at which they should occur within the skill-building program.

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Table 32

Method(s) or Tool(s) Timing
Engagement
Quick poll pulse checks (sli.do, zoom polls) At the beginning or end of a class break
Facilitator observations, chat windows (virtual
sessions)
Ongoing (duration of session)
Evaluation comments and responses Summative evaluation
“Parking Lot” for overflow of ideas Ongoing or embedded in summative evaluation
Relevance
Facilitator observations, chat windows (virtual
sessions)
Ongoing (duration of session)
Evaluation comments and responses Summative evaluation
Customer Satisfaction
Facilitator observations, chat windows (virtual
sessions)
Ongoing (duration of session)
Evaluation comments and responses Summative evaluation

Evaluation Tools
Immediately Following the Program Implementation
During the evaluation stage, qualitative and quantitative data can be used to
demonstrate the value of training programs (Kirkpatrick & Kirkpatrick, 2016). There are several
summative evaluation methods that could provide robust data about the experiences of the

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participants. At the conclusion of the program, participants were asked to draft an action plan
that signifies commitment. Ideally, participants would share those action plans with their
supervisors who could then act as coaches, accountability partners, or models for learning.
After the conclusion of the training sessions, participants will measure their own progress
through a short post-survey related to the learning objectives that were set at the start of the
session. Additionally, participants will be asked to construct their own equity and accessibility
“frameworks,” or examples of action learning, to keep as a reflection and to serve as a useful
tool for the next evaluation.
Delayed for a Period After the Program Implementation
According to Kirkpatrick and Kirkpatrick (2016), a delayed evaluation focuses on how
training graduates have applied what they learned, how they are being supported in the
workplace, and what they have achieved since attending the training. Following a 30-day
period, participants will receive a survey instrument that asks them to rate a series of Likert
scale questions that range from strongly disagree (1) to strongly agree (5); participants will
receive the same survey for a second time at the six-month mark. These survey items are
aligned with each of the four Kirkpatrick evaluation levels and are designed to capture the
narratives, artistic expressions, and authentic reinterpretations of their learning; when
participants submit their survey responses, they will be asked to submit copies of their
frameworks (their names can be redacted). These frameworks will not only serve as mementos
and physical reminders of the concepts that they have learned, but they will become tools that
can guide conversations with supervisors and colleagues about equity, accessibility, and
inclusion at their institutions.

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Data Analysis and Reporting
Kirkpatrick and Kirkpatrick (2016) offer a helpful framework in their Blended Evaluation
tool to guide the data collection, analysis and reporting following this workshop. Immediately
following the training, participants and their managers will be invited to hear a report-out of
the training outcomes; digital and large-print versions of the report will be made available in
advance. Kirkpatrick and Kirkpatrick (2016) warn against waiting until the end of a program to
gather data and to analyze it. Instead, they recommend gathering and analyzing data along the
way. Given these recommendations, the facilitator will be sure to consistently gather and make
use of the valuable sources of data provided during the program (e.g., focus groups,
interviews). One way to do this is to utilize intermediate and follow-up interviews to probe for
evidence of new learning or other outcomes; these interactions can provide rich data on areas
of improvement for the training program or validation of program success.
Dashboards are visual displays that act as valuable information flow systems for
effective decision-making and organizational action by translating raw archival data into easily
accessible imagery. Effective dashboards are useful tools for identifying patterns, trends, and
anomalies—a skill which can help student affairs practitioners think critically and improve their
own learning (Smith, 2013). As such, the recommendation is for student affairs professionals,
especially those at upper administration levels, to make use of a well-designed, interactive
dashboard and tracking system (job aid) that helps student affairs professionals identify and
monitor the overall academic progress and outcomes for students who have taken a medical
leave of absence/medical withdrawal.
As procedural and conceptual job aids, dashboards can be used with both quantitative

159
and qualitative data. This format was chosen because presenting information in auditory and
visual formats has been proven to maximize working memory capacity (Baddeley, 1992; Mayer,
2011). Shraw and McCrudden (2006) suggest that individuals acquire meaningful learning when
their complex tasks are divided into manageable pieces, and they are encouraged to think
about content in strategic ways (Schraw & McCrudden, 2006). Dashboards are useful for
strategic, analytical, and operational purposes (Smith, 2013). This seems to suggest that there is
some importance of collecting, analyzing, and cross-tabulating relevant data from all students
who have taken a leave of absence with other categories (i.e., disability status, time to
completion) as it might illuminate gaps in policy implementation that require further
investigation.
Figure 2 shows the “LUCIDUS” dashboard project, a feature of the training program
created by the researcher, which serves as a visual example of an immediately tangible way to
report outcomes of the training program to a wider audience. Participants will share their own
feedback with their respective colleagues about their experiences learning to: a) interact with
descriptive statistics and data, b) lightly experiment with software programming, c) discuss
issues of equity, accountability, and access, and d) use data-driven benchmarking as a common
approach to assess the institution’s progress towards narrowing the accessibility equity gap and
achieving its goals of higher retention rates for students with disabilities.

160
Figure 2
Dashboard Example: LUCIDUS

Dashboard mock-up designed and created by Antoinette Myers Perry ©
Summary
Effective training programs provide relevant knowledge and skills that inspire
confidence and commitment in participants and program graduates (Kirkpatrick & Kirkpatrick,
2016). The New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) is a widely used and
reliable framework for designing effective, educational training programs for organizations. It is
especially helpful to those that are seeking to make use of valid and reliable research evidence
to address validated performance gaps (Clark & Estes, 2008). The New World Kirkpatrick Model
differs from the original Kirkpatrick model (1998), in that training programs are first created by:
planning the intended outcomes of the training (Level 4); identifying critical behaviors
necessary for success (Level 3); designing the learning goals that demonstrate learning (Level 2);

161
and finally, assessing the reactions (Level 1) of training program graduates for evidence of
engagement and meaningful learning. Senior-level administrators need to demonstrate their
willingness to provide mid-level administrators (i.e., deans) and case managers with relevant
professional learning opportunities. The new model progresses from Level 4 to Level 1 to
emphasize the importance of setting intended outcomes in the planning phase, prior to
conducting training programs, to avoid creating programs that do not provide a return on
investment to the organization.
By using the New World Kirkpatrick model, the researcher can facilitate a valid and
reliable training program that is interactive, responsive, continuously assessed and refined for
the maximum learning of student affairs professionals who support students with disabilities.
Many who work in student affairs divisions may not see training programs as necessary unless
they specifically address their department. Given that the data collection process is both
formative and summative in nature, the training program is fluid in nature and responsive to
feedback from participants and other stakeholder groups. In doing so, the model provides a
foundation upon which the training program can demonstrate and maximize its effectiveness
and value to all who are committing to ensuring the retention and graduation of all the
students with disabilities.

162
Limitations and Delimitations
There are several limitations that may have had implications for the data collected in
the study. Remler and Van Ryzin (2014) argue that all studies have underlying assumptions that
are implicit. First, given the nature of the study, it was assumed that the knowledge,
motivation, and organizational influences that impact the persistence and retention rates of
students who take a leave of absence for health-related reasons would be identified. The
second assumption is that the participants of the study would answer the questions in the
surveys and interviews truthfully and with transparency. The researcher also assumed that the
information gleaned from survey items would be accessible to the participants in the study,
either through data collection systems or records. The assumptions that inform the study
design and research process thus lead to a series of limitations. Some anticipated limitations
identified in this study included:
• The number of survey items likely precluded certain respondents from
thoroughly completing the survey within the time allotted to the research
process.
• The study was conducted within a relatively short period of time.
• The study had a relatively small survey and interview sample size, which limited
the ability to generalize the findings of the study.
• Certain factors that involve the problem of practice were not identified during
the instrument development process and thus not subjected to data analysis and
inclusion in the study.
Delimitations of a study limit the scope and define the boundaries of a study (Creswell et al.,

163
2011). Further, delimiting factors in a study might include the objectives of a study, research
questions, variables of interest, theoretical perspectives put forth in the research, and the
chosen population of investigation (Creswell et al., 2011). In this study, the delimitations
included:
• The study only included one stakeholder group—student affairs professionals, broadly
defined, at postsecondary institutions.
• The COVID-19 pandemic presented enormous challenges with participation rates of
survey respondents, thereby reducing the sample size and target population response
rate.
• The study did not focus on a narrowly defined subpopulation (i.e., LGBTQ students,
students of color, LGBTQ students of color, etc.), as it might present difficulties in data
collection and/or analysis.
• Data from each of the quantitative and qualitative phases were collected concurrently.
• The geographical context of the study was contained to accredited colleges and
universities in the United States.
• The study excluded individuals that are employed at vocational/technical colleges and
community colleges/two-year institutions.
• The study was bound by the Clark and Estes’ (2008) gap analysis framework.

164
Implications for the Student Affairs Participants and their Institutions
The findings for participants in this study offer one implication for student affairs
practitioners and their work to support students through the medical leave of absence (MLOA)
process. It is important to state that not all student affairs practitioners are afforded quality
tools, databases, and dashboards that allow them to collect, analyze, and track students who
have taken a medical leave of absence. Additionally, institutional approaches to handling MLOA
processes—including offices to which cases are assigned—vary widely by institutional size and
type in the U.S. Nonetheless, Davar (2010) discusses a need for clinicians at counseling centers
to process return evaluations for students returning from MLOA. Schlossberg (2011) argues
that adjustment to transitions take time and the features common to transitions are: situation,
self, supports, and strategies. Therefore, understanding some of the issues around transitioning
between home, work, and school environments may illuminate a few motivational variables
that impact how professionals work to support the successful re-entry and re-enrollment of
students following a voluntary leave of absence.
Downs et al. (2018) argue that the perceived benefits of and motivation for resource
integration include opportunities to provide holistic care; improved continuity of care; the goal
of positive clinical outcomes through resource integration; and an institutional need to
streamline resources while reducing barriers to services available to students with disabilities
(psychiatric and physical). Recommendations from this study demonstrate the effectiveness of
the following actions that postsecondary institutions can take to address the problem of
practice: a) training and professional development for student affairs professionals, b)
professional opportunities to explore the differential needs of the population through data

165
analysis and collection; c) launching targeted, re-entry programming for students returning
from a leave of absence; and d) sustaining flexible, leave policies that do not inhibit academic
success following re-entry.
Implications for the Research Community
The findings in this study point to one implication for the educational research
community interested in persistence and graduation rates of students on voluntary medical
leave of absence (MLOA), an area that according to Meilman (2016) continues to be a new area
of inquiry. Researchers have yet to study the emerging complexities of medical leave of
absence and compassionate withdrawal policies at postsecondary institutions and how those
policies lead to the possibility of improving institutional retention and persistence rates for
students that stop-out during their program of study. This is an area of inquiry that provides a
rich opportunity for learning more about how various subgroups of students navigate MLOA
processes and how student affairs practitioners work to support each of those students with
the institutional resources provided to them.
Discussion and Future Research
There were many questions that emerged for the researcher at the conclusion of this
study. Was institutional funding, type, and size, in relationship to the student medical leave of
absence process, really a determinant and a predictor of student success? Many of the
participants in this study were employed at large universities (public and private); only one
participant worked a private liberal arts college. In many of the items, the student affairs
practitioner employed at the smallest institution also seemed to have the most challenges with

166
regards to providing adequate support to students taking a medical leave of absence and upon
their re-entry. This participant indicated that their institution had a less than 40% graduation
rate, and in their interview, asserted that the institution at which they worked could do more to
support students throughout the MLOA process, including re-instatement and re-entry. Future
research on medical leave policies should continue to focus specifically on liberal arts colleges
and the persistence rates for students who have taken a medical leave of absence.
Further research may also focus solely on, or at the very least include the student
perspective in the research. Students’ perspectives on perceived levels of institutional support
and interpersonal support from student affairs staff might provide comparative and contrasting
narratives that could be revelatory for research in the field. The original group of stakeholders
considered for this study were queer and trans students of color at liberal arts colleges. At that
time, the researcher had hoped to illuminate the experiences of that subpopulation, while also
conducting a needs analysis of the institutions they attended. Future studies may consider
expanding stakeholder groups, or only focusing on collecting one type of data for a more in-
depth exploration of the problem of practice.
Conclusion
The purpose of this project was to conduct a needs analysis in the areas of knowledge
and skill, motivation, and organizational resources necessary to accomplish the goals of
facilitating a successful medical leave or compassionate withdrawal process, which also
includes a holistic, re-entry process, and increasing the numbers of retention and persistence to
graduation for this student subpopulation. The study analyzed the knowledge, motivation, and
organizational elements related to achieving field-based goals of increased student retention

167
and persistence. While a complete needs analysis would focus on all stakeholders, for practical
purposes, student affairs practitioners (including student health service professionals) were the
stakeholder group of focus. The rationale for focusing on institutional employees as the primary
stakeholder group is that at postsecondary institutions, student affairs practitioners,
counselors, student health service professionals remain central to the provision, oversight, and
management of accommodations, services, policies, and interventions that support the
academic success of students who self-report one or more disabilities.
The results of this study suggest that the role of student affairs practitioners, the
complex nature of medical leave policies, and the myriad of health factors that impact students’
academic trajectory can create a series of circumstances that may require additional
institutional resources to support the stakeholder goal. The stakeholders in this study proved to
have the necessary knowledge, skills, and attitudes to meet the stakeholder goal, however,
retention rates and student success following medical leaves require substantial institutional
resources and flexible policies. Implications for the field include improving opportunities for
professional development, data collection practices, and job aids to help support practitioners
in working with students on medical leave and during the re-entry process.

168

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182
Appendix A

SURVEY PROTOCOL

Research Questions
1. According to student affairs professionals and administrators, to what extent are
postsecondary institutions able to provide programs, resources, and supports that ensure that
students who take a leave of absence for mental health related reasons (medical leave of absence)
successfully navigate re-entry and re-integration on campus, and persist to graduation?
2. What is the current state of stakeholder knowledge and motivation related to ensuring that
students successfully navigate re-entry and re-integration on campus, and persist to graduation
following a medical leave of absence?
3. What is the interaction between organizational culture and context, and stakeholder
knowledge and motivation as it relates to monitoring and assessing the outcomes of the medical
leave of absence process?

Research
Question/Data
Type
KMO
Construct
Survey Item Scale of
Measurement/Potential
Analyses
Visual
Representation
Demographics-
Sample
Description
Division / Department
Student Affairs
(Dean’s Office)
Student Affairs
(Student Health
Services)
Student Affairs
(Counseling Center)
Student Affairs
(Disability
Services/Accessible
Education)
Academic Affairs
Other (fill in)

Nominal Table, Pie
Chart
Job Title
Assistant Dean
Associate Dean
Counselor
Dean of Students
Title IX
Coordinator
ADA/504
Coordinator
Academic Advisor
or Academic
Counselor
Table, Pie
Chart

183
Director of Campus
Life
Director of
Disability Support
Services/Accessible
Education
Disability Support
Services
Coordinator
Student Support
Services Specialist
Other (fill in)
Demographics-
Sample
Description
Please describe your
gender identity?
(Optional; if you wish you
may instead or also pick as
many as desired from the
following terms.)
Agender
Woman
Man
Non-binary,
genderqueer,
and/or gender
fluid
Questioning
Prefer to self-
describe ______
Prefer not to
answer
Nominal Table, Pie
Chart
Demographics-
Sample
Description
Please describe your
Race/Ethnicity? Check all
that apply.
American Indian or
Alaska Native
Black or African
American
White or Caucasian
Hispanic, Latino/x/
Asian or Asian
American
Multi-racial
Other (fill in)
Nominal Table, Pie
Chart

184
Prefer not to
answer
Demographics-
Sample
Description
Type of Institution
Public, 4 year
Private, 4 year
2-year
Other
Nominal Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
Postsecondary Minority
Institution (U.S.
Department of Education)
No
Yes
If yes:
Historically
Black College
or University
(HBCU)
Hispanic-
serving
Institution
(HSI)
Asian American
and Native
American
Pacific
Islander-
serving
Institution
(ANAPISI)
Tribal College
or University
Native-
American, Non-
tribal
Institution
Other (fill in)
Nominal Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
Campus Size
< 2,500 students
2,500 – 4,999
students
5,000 – 9,999
students
10,000- 19,999
Nominal Table, Pie
Chart

185
students
20,000
students or
more
Demographics-
Institution
(Setting)
Description
Campus Setting
Very large city
(population over
500,000)
Large city
(population
250,000-499,000)
Small city
(population
50,000-249,999)
Large town
(population
10,000-49,999)
Small town
(population 2,500
– 9,999)
Rural community
(population under
2,500)
Nominal Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
O Overall School Retention
Rate
40 % or less
50 – 60 %
60 -75%
75 – 90 %
90% or higher
Nominal Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
O How many students take a
medical leave of absence
each year (at your
institution)?
0 – 10
10 - 20
20 – 30
30 – 50
50 – 100
100 – 500
500 – 1,000
1,000 or more
Unknown
Table, Pie
Chart

186
O What percentage of
students successfully re-
enroll following a medical
leave of absence?
40 % or less
50 – 60 %
60 -75%
75 – 90 %
90% or higher
Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
O –
CM1

Which offices do you
collaborate with in order
to provide specialized
resources for students
who take/return from a
medical leave of absence?

(Check all that apply;
naming conventions may
vary at your institution)

Residential
Education & Dining
Services
Student Health
Center
Counseling Center
Career
Development
Center
Multicultural
Centers
Disability
Services/Accessible
Education
Office of Campus
Activities
Office of
International
Services
Office of the
Registrar
Financial
Aid/Financial

Nominal
Table, Pie
Chart

187
Services
Other (fill in)
O –
CM2
Does your institution have
targeted support
programs that serve
students with disabilities
and/or chronic illnesses?
Yes
No
Table, Pie
Chart
Does your institution
allow students who
formally withdraw from
their course of study for
health-related reasons to
re-enroll at a later date?
Yes
No
Table, Pie
Chart
Does your institution
impose readmissions
requirements on students
who take a leave of
absence for health-related
reasons?
No
Yes
If yes: (Check all that
apply)
Medical
authorization
Completion of
coursework
elsewhere
Employment (part-
time)
Employment (full-
time)
Other (fill in)
Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
O – CS1

Is there a minimum
period required for
students who go on leave
for health-related
reasons?
Yes

Nominal
Table, Pie
Chart

188
No
Demographics-
Institution
(Setting)
Description
O – CS2 Are services such as
housing, financial aid,
student health insurance,
and/or counseling
available to students while
on leave?
Yes
No
Unsure/unknown
Nominal Table, Pie
Chart
Demographics-
Institution
(Setting)
Description
O – CS1 Does your institution
collaborate with external
programs and providers to
support students who
take a medical leave of
absence?
Yes
No
Unsure
Nominal Table, Pie
Chart
O – CS2 At your institution, is
there funding allotted to
provide additional
resources to students on
leave?
Yes
No
Unsure/unknown
Nominal Table, Pie
Chart
Please indicate your level of agreement with the following statements:
O The leave of absence
policy at my institution
is easy for students to
navigate.
Ordinal
Likert
Strongly Disagree
(SD) – Strongly
Agree (SA) _

O My office/department
provides adequate
support to students
who take a leave of
absence for health-
related reasons.
Ordinal
Likert
Strongly Disagree
(SD) – Strongly
Agree (SA)

K I am aware of the legal
and institutional
obligations related to
providing services to
Ordinal
Likert
Strongly Disagree
(SD) – Strongly

189
students with
disabilities and/or
chronic illnesses.
Agree (SA)
K I am aware of the
diagnostic criteria
related to students with
disabilities and/or
chronic illnesses.
Ordinal
Likert
Strongly Disagree
(SD) – Strongly
Agree (SA)

K I am aware of local
external community
providers,
organizations, and
resources available to
students who are on
leave for health-related
reasons.
Ordinal
Likert
Strongly Disagree
(SD) – Strongly
Agree (SA)

K I am aware of the
challenges that
students face while on
leave for health-related
reasons.
Ordinal
Likert
Strongly Disagree
(SD) – Strongly
Agree (SA)

O I have enough
resources available to
provide additional
support to students
who are on leave for
health-related reasons.
Ordinal
Likert
Strongly Disagree
(SD) – Strongly
Agree (SA)

In your opinion, how important is it for your department/division to:
M Identify opportunities for
continued collaboration
among
divisions/departments
regarding leave policies
and related processes.
Ordinal
Likert
(1: Not at all – 5:
Very)

M Provide clear and timely
communications to
students on leave of
absence for health-related
reasons.
Ordinal
Likert
(1: Not at all – 5:
Very)

M Provide the right level of
resources at the
appropriate time to
students on leave of
Ordinal
Likert
(1: Not at all – 5:
Very)

190
absence for health-related
reasons.
O Conduct campus needs
assessments related to
improving the success for
students who take a leave
of absence for health-
related reasons?
Ordinal
Likert
(1: Not at all – 5:
Very)

M Facilitate the re-entry
and/or re-admission
process for students on
leave for health-related
reasons?
Ordinal
Likert
(1: Not at all – 5:
Very)

K Understand the impact of
the ADA when
administering services
related to medical leave
processes.
Ordinal
Likert
(1: Not at all – 5:
Very)

M Administer training to
faculty and other staff
regarding frequently
reported disabilities
and/or chronic illnesses.
Ordinal
Likert
(1: Not at all – 5:
Very)

M Interact with my
organization’s internal
departments regarding
student case
management.
Ordinal
Likert
(1: Not at all – 5:
Very)

191
Appendix B
INTERVIEW PROTOCOL
Research Questions
1. According to student affairs professionals and administrators, to what extent are
postsecondary institutions able to provide programs, resources, and supports that ensure
that students who take a leave of absence for mental health related reasons (medical leave
of absence) successfully navigate re-entry and re-integration on campus, and persist to
graduation?
2. What is the current state of stakeholder knowledge and motivation related to
ensuring that students successfully navigate re-entry and re-integration on campus, and
persist to graduation following a medical leave of absence?
3. What is the interaction between organizational culture and context, and stakeholder
knowledge and motivation as it relates to monitoring and assessing the outcomes of the
medical leave of absence process?

Research
Question/Data
Type
KMO
Construct
Interview
Question
Scale of
Measurement/Potential
Analyses
Visual
Representation
Before we
begin, do you
have any
questions for
me?
Table of
themes/codes
M/O Can you tell
me a little
about your
background
and
professional
role?
Table of
themes/codes
O -
CS2
What, if any,
resources are
available from
the institution
to support
students who
are on leave
for health-
related
resources?
Table of
themes/codes
O Please
describe any
Table of
themes/codes

192
challenges or
barriers to
providing
services to
students on
leave for
health-related
reasons.
K Please
describe the
process of
taking a leave
of absence for
health-related
reasons.
Table of
themes/codes
K Please
describe the
process of
reinstatement
following a
leave of
absence for
health-related
reasons.
Table of
themes/codes
K Please
describe the
campus-based
resources
available (if
any) to
students who
are on leave
for health-
related
reasons.
Table of
themes/codes
O What
information is
necessary to
make an
informed
decision to
allow a student
on leave for
health-related
Table of
themes/codes

193
reasons to
resume their
course of
study?
O How does your
institution
record a leave
of absence for
health-related
reasons on
student
transcripts?
Table of
themes/codes

Abstract (if available)

Abstract This dissertation served as a pilot evaluation study that tested a set of ideas that were drawn from literature in organizational theory, leadership theory, disability studies, and student affairs literature, among others. The purpose of this project was to conduct a needs analysis in the areas of knowledge and skill, motivation, and organizational resources necessary to accomplish the goals of facilitating a successful medical leave or compassionate withdrawal process, which also includes a holistic, re-entry process, and increasing the numbers of retention and persistence to graduation for this student subpopulation. ❧ This study addressed research questions that sought to find the current state of stakeholder knowledge and motivation necessary to ensure that at least 60 percent of students who take a medical leave of absence (or compassionate withdrawal) successfully navigate reentry and reintegration on campus, and persist to graduation within 6 to 8 years, as well as the interaction between organizational culture and context, and stakeholder knowledge and motivation as it relates to ensuring that at least 60 percent of students who take a medical leave of absence (or compassionate withdrawal) successfully navigate reentry and reintegration on campus, and persist to graduation. The findings suggest that the role of student affairs practitioners, the complex nature of medical leave policies, and the myriad of health factors that impact students’ academic trajectory can create a series of circumstances that require additional institutional resources to support the stakeholder goal. Implications for the field include improving opportunities for professional development, data collection practices, and job aids to help support practitioners in working with students on medical leave and during the re-entry process.

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Asset Metadata

Creator Myers Perry, Antoinette L. (author)

Core Title Going through it all: an evaluation of medical leave policy impact on persistence rates for students with disabilities

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 11/10/2021

Defense Date 06/10/2021

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

Tag medical leave,medical leave of absence,OAI-PMH Harvest,persistence,policies,policy implementation,students with disabilities,underrepresented minorities

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Muraszewski, Alison (committee chair), Seli, Helena (committee member), Stowe, Kathy (committee member)

Creator Email almyers@alumni.stanford.edu,antoinem@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC17138513

Unique identifier UC17138513

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Document Type Dissertation

Rights Myers Perry, Antoinette L.

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