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Mental Health

US Supported Education Models to Learn From

Sarah Hamid-Balma

Reprinted from "Supported Education" issue of Visions Journal, 2003, No. 17, pp. 22-25

Although not exhaustive, the list below describes a range of supported education models and prototypes that have sprouted up across the US. Most began as re- search demonstration sites and grew from there, others faded away once the funding and coordination disappeared. Lessons, though, can be learned from both varieties.

Existing Programs

California

Over the past ten years of operation, the College of San Mateo’s Transition to College Program has provided help and accommodation to more than 400 college students with mental illnesses. The educational support services include specialized courses in disability management; college orientation and peer counselling; assistance with registration and financial aid; disability related, academic and career counselling; supporting relationships with instructors; a peer support system with study labs; and low-stress test accommodations. Most of the students had a diagnosis of severe mental illness for more than 10 years, usually with repeated or long-term hospitalizations. More than 75% of the students have attempted college unsuccessfully before enrolling in the award-winning program which documents a retention rate of 83%.

For more info, read Marshall, L. (1997). “The journey from patient to student.” California Alliance for the Mentally Ill (CAMI) Journal, 8(2), 17-22. and Rades, D. “A teacher’s perspective.” 46-48 of the same resource.

Illinois

Thresholds Psychiatric Rehabilitation Centers in Illinois offers the Community Scholar Program, a supported education model for college-bound adults with mental illness. The Community Scholar Program offers six off-site college preparatory classes, an extensive individualized tutorial program, a support group, academic and career counselling, and on-site advocacy and linkage for students who have entered the college setting. Scholarship opportunities are available for qualifying members at Thresholds. Program staff are also able to provide training on working with students with a psychiatric disability to Chicago area college and trade school faculty and staff. Since its creation, the program has seen over 400 students, almost half of which have pursued post-secondary education. A similar percentage of alumni were found to be working.

Web site: www.thresholds.org

For more info, see Kerouac, J. (1997). “‘Off the road’: Supported education for college students with psychiatric disabilities.” CAMI Journal, 8(2), 41-43.

Michigan

Michigan’s Supported Education Program (MSEP) is a collaboration of the University of Michigan, two area community colleges and local mental health service providers. Like several other initiatives, it began several years ago as a federally-funded research demonstration project. Short-term results indicate positive improvements in self-concept and social efficacy, increased support from mental health workers, and increased enrollment in post-secondary education.

Students in the program receive supportive services using a specially-designed method combining classroom and group formats, on-site at both Wayne State University and Henry Ford Community Colleges. Academic support, stress management and vocational exploration are the topics primarily addressed. The program meets twice a week for a two-hour session over 28 weeks (two semesters). For those not able or wishing to meet the prescheduled group format, students can also receive individual assistance to address their educational goals. This may involve working one on one with a staff person.

To qualify for the supported education program, a student must have or be nearing completion of a high school diploma or equivalent, have had their psychiatric illness for at least one year and be currently receiving mental health services.

The program attributes much of its success to the way it began: building awareness of consumers’ potential throughout the community via the media and presentations; and working in collaboration with mental health, rehabilitation, consumer, family, advocate and academic communities. For instance, the advisory council for the project includes representatives from Michigan Rehabilitation Services, Community Mental Health agency sites, the Alliance for the Mentally Ill, participating academic sites, MSEP consumers, and their family members.

For more info, see Megivern, D. (1997). “Barriers to higher education for persons with serious mental illness.” CAMI Journal, 8(2), 23-24. and Mowbray, C.T. (1999). “The benefits and challenges of supported education: A personal perspective.” Psychiatric Rehabilitation Journal, 22(3), 248-254.

New York

At Ulster County Community College in Stone Ridge, New York, the Academic Coaching for Educational Success (ACES) program has been helping students for 7 years. The ACES program currently helps 72 students who suffer from mental illness cope with the demands of going to college. The current program director was herself an ACES student.

Students in the ACES program range in age from 19 to 58 with a range of mental disorder, substance abuse and even criminalization histories. Approximately three quarters of the ACES students have been on government income support. Most are taking medication, are seeing a psychiatrist, and face financial difficulties. Of the 32 graduates over the past two years, 18 are studying at 4-year colleges and 13 are working.

The program helps students’ college life with a long list of services: a 25-hour orientation, tutoring and teaching students how to study, facilitating workshops on decreasing anxiety and improving coping skills, helping fill out admission and financial aid forms, helping students and teachers get along together, and enhancing social and communication skills for people who may have been lonely and isolated before they entered college. There is also practical assistance available such as transportation to medical appointments or referrals to housing specialists or other community services. The program is sponsored by the Ulster County Mental Health Association and began as one of the national research sites selected by Boston University’s Center for Psychiatric Rehabilitation.

For more information on this program, also see Cooper, L. (1993). “Serving adults with psychiatric disabilities on campus: A mobile support approach.” Psychosocial Rehabilitation Journal, 17(1), 25-39.

Massachusetts

Sponsored by the Quincy Mental Health Center, CAUSE (Consumers and Alliances United for Supported Education) provides a wide range of services to encourage individuals with psychiatric disabilities to enter or re-enter college or technical school programs. Services by professional staff and peer counsellors include academic and career counselling, assistance with finding financial aid, study skills, stress control, tutoring/coaching, and assistance with crisis while hospitalized. One hundred students are on a waiting list for services from the CAUSE program. For more information, contact Elsa Baldwin Ekblaw, Director of Consumer Affairs, Quincy Mental Health Center, 460 Quincy Avenue, Quincy, MA 02169, (617) 337-2685.

Massachusetts

The Harvard Mental Health Awareness and Advocacy Group (MHAAG) is not a supported education program in a traditional sense but it does provide a unique, on-campus support and education service for students with psychiatric disabilities and the broader community.

MHAAG is an undergraduate organization at Harvard University, officially recognized in 1997, and one of the first groups of its kind on a college campus. MHAAG is dedicated to increasing awareness of the issues surrounding mental health and mental illness, and to improving the services offered those suffering from mental illness at Harvard University. The group has operated on the premise that mental illness should be addressed aggressively, compassionately and without shame. MHAAG contributes to the public understanding of mental health issues and reaches out to students who would otherwise suffer alone and in fear of the stigma of mental illnesses. MHAAG also serves as a source of information for members of the community.

Members of MHAAG include people who have mental illnesses, friends and relatives of people with mental illnesses, and other members of the Harvard community who are interested in issues related to mental health.

Early in 2002, as part of the Provost’s Caring for the Harvard Community initiative, MHAAG participated in a panel with the aim of educating tutors and House Masters about the needs of students struggling with mental illness. As a result, the group has been invited back to help with tutor training in the fall.

Connecticut

The southwestern part of the state features two supported education programs both of which were initiated in 1989 and still continue. One is the Kennedy Center’s Supported Education Program, a rehabilitation facility serving people with a range of disabilities, and Laurel House’s Supported Education Program, a much smaller agency operating from a clubhouse model of psychosocial rehabilitation. Similar to other programs already described, both programs offer assistance in adjusting to the school environment and choosing career-oriented courses, practical support in navigating the admissions and financial aid processes, counselling, academic support and peer meetings. The two pilot programs were established and implemented in just over a year, with students demonstrating early success with course work and attaining good grades three-quarters of the time.

More information can also be found in Pettella, C. & Tarnoczy, D. L. (1996). “Supported education: Functional techniques for success.” Psychiatric Rehabilitation Journal, 20(1), 37-42; Wolf, J. & DiPietro, S. (1992). “From patient to student: Supported education programs in southwest Connecticut.” Psychosocial Rehabilitation Journal, 15(4), 61-69. and Dougherty, S. J. (1997). “The chance to go to school.” CAMI Journal, 8(2), 36-38.

Washington

Community Colleges of Spokane’s PACE Services (People Accessing Careers and Education) assists individuals to achieve in dependence, employment and ongoing education. Their program for mental health consumers is called Supported Education Enhancing Rehabilitation or SEER for short. SEER non-credit classes work on the transition into college, job training or employment. The program also provides peer supports through the Eagle/SEER support group, mentoring, and even musical theatre in addition to the vocational, educational and mental health supports.

Web site: ielhp.spokane.cc.wa.us/abe/pace.htm For more info, also check out Turner, J. R. (1997). “SEER: A supported education program for building consumers’ careers.” CAMI Journal, 8(2), 49-50.

Time-limited Research Projects

Philadelphia

The National Institute on Disability and Rehabilitation Research (NIDRR) recently funded the Matrix Research Institute to undertake a research project on School-to-Work Transition Services for Youth with Emotional Disturbances in Philadelphia. The research project is designed to evaluate the outcomes of a model that promotes collaboration among the Philadelphia Board of Education, the Philadelphia Office of Mental Health, a citywide network of provider agencies, and the Philadelphia Office of the State Vocational Rehabilitation system. The model, based on an earlier funded pilot study, the Young-adult Employment Supports project, provides intervention through each of three stages for youth in transition:

  • identification and engagement of youth leaving school

  • the implementation of services focused on assessment, interest and skills identification

  • the development of individualized supports in post-transition activities.

The project is built upon a model designed to develop intersystem collaboration in the operation of a school-to-work transition program for young adults with serious emotional disturbances. The project tests the pilot model by evaluating, through a randomized design, the intervention’s impact on the vocational, academic, social, personal, and behavioural outcomes of 200 participants.

New York

Project CHANGE (College Helps Adults Needing Growth and Education) was a joint program of Rockland County Department of Mental Health and Rockland Community College that ran for several years in the late 1980s. The project offered special supports and an initial closed-classroom format to facilitate mental health clients’ re-entry into the college mainstream when ready, while at the same time, monitoring related stress. The students — referred mainly from local day-treatment programs and outpatient clinics — took six credits worth of courses per semester offered at Rockland Community College — courses chosen for their appeal, practical value and relatively low academic stress (e.g., vocational assessment, art course, physical education course etc.). A group of 12 to 20 students per semester took these courses together. In addition to the group format, support included help with registration and financial aid forms, pre-registration orientation, ongoing coordination and personalized attention, weekly or biweekly support group meetings, and even initial help with transportation if needed.

Concerns that led to the dwindling of the program included logistics and motivation for students traveling between the treatment facility and the campus, lack of connection with the campus disability office, lack of sustained marketing, and a prime desire of consumers for support towards a paid-work role. A more comprehensive evaluation of what worked and didn’t work with the program is detailed in: Ryglewicz, H. & Glynn, L. (1993). “Project CHANGE revisited: An experiment in entry or re-entry into college.” Psychosocial Rehabilitation Journal, 17(1), 69-82. The authors do close the article with a checklist for agencies interested in implementing such a program:

  1. Is there a sufficient number of potential students with compatible needs and levels of functioning?

  2. Are there mental health and college staff members with time and capabilities to serve as coordinators and teachers?

  3. What training, experience, motivation and personal qualities equip such staff members to deal with this student population?

  4. Is additional orientation and training in mental health issues needed for college staff members?

  5. Are there appropriate credit-bearing courses in the college curriculum?

  6. How many students does the college require for a closed classroom course in the program?

  7. Are college and/or mental health staff members available to develop specially-tailored courses as the program continues?

  8. Are remedial and other specialized services available as needed?

  9. Is there a coordinated mental health system in the local community?

  10. How will the college and mental health staff work together to ensure an early warning system and ongoing monitoring of students’ educational and mental health needs, especially in response to impending crisis or failure?

  11. Are there mental health case managers and/or specially assigned college counsellors to help with registration and financial aid?

  12. Is there an effective local transportation system? If not, how will transportation be handled?

  13. Is there solid administrative and other staff support for the program at both the college and the mental health agency?

  14. If not, how will such support be developed?

  15. How will concerns about providing adequate support be balanced with concerns about student autonomy, self-determination and absence of stigma in the operation of the program?

  16. How will the program respond to incidents of dangerous or erratic behaviour of a student?

  17. What special procedures may be needed to arrange a student’s time-out and return to the program?

  18. How will the program respond to indications of substance use on the part of one or more students?

California

In the early 90s, the California Community Colleges’ Chancellor’s Office initiated a research study in response to data that in one year, more than 3100 students with mental illness had received educational accommodations at college campuses throughout the state. At the same time, another report on college concerns revealed a widespread perception that “as a group, this student population [with psychiatric disabilities] is too ill, unmotivated, disruptive, or academically unprepared to be successful in the role of college student and that the nature of the disability-related accommodations they require are psychotherapeutic in nature and therefore not appropriate to the educational mission of the colleges.” Ensuing research over 18 months revealed these perceptions to be unfounded. The four colleges chosen — Kings River Community College, College of San Mateo (the only program still existing, see above), Santa Barbara City College, and San Diego City College — varied in their size, geography, and the ethnicity and socioeconomic backgrounds of the student populations. A three-pronged approach was used for each college:

  1. educational support services equivalent to those provided to students with other disabilities: access to adapted equipment, job placement/development, registration assistance, parking accommodation, supplemental orientation, test-taking facilitation, disability-related counselling, mobility assistance, note-taker and reader services and special tutoring.

  2. special classroom instruction to provide students with necessary transition skills related to being a successful student.

  3. a temporary crisis intervention mechanism: few of the students ended up experiencing crisis although quick and early intervention by the student’s therapist in cases of panic or anxiety probably averted a few.

A full evaluation of learnings from the California college site interventions is described in Parten, D. (1993). “Implementation of a systems approach to supported education at four California community college model service sites.” Psychosocial Rehabilitation Journal, 17(1), 171-188. and Parten, D. (1997). “Incorporating students with psychological disabilities: An assault on stigma at California community colleges.” CAMI Journal, 8(2), 14-16.

Texas

With temporary grant funding and technical support from Boston University’s Center for Psychiatric Rehabilitation, the Houston Community College System and the local county’s Mental Health and Mental Retardation Authority partnered in a supported education demonstration site in the early to mid-90s. Key features of the program included:

  • a work training program culminating in a paid internship as case manager aides at the Mental Health Authority

  • establishment of an on-campus Office of Supported Education for Psychiatrically Disabled Students

  • specialized case managers who traveled to the student

  • a peer support group

  • entry/re-entry program focusing on self-management of one’s disability, study-skills training, confidence-building refresher courses in basic English and math, vocational exploration, peer-support-network-building, and assistance in dealing with college administrative requirements. Evaluation of the program noted that the coursework in disability self-management, in particular, appeared to be a fundamental need of students transitioning to the college environment. Specific topics include symptom recognition, symptom monitoring, medication management, individualized coping skills, and general stress management including test anxiety.

For more info, see Housel, D.P. & Hickey, J.S. (1993). “Supported education in a community college for students with psychiatric disabilities: The Houston Community College Model.” Psychosocial Rehabilitation Journal, 17(1), 41-51.

 
About the author
Sarah is Public Education and Communications Coordinator at CMHA BC Division and Visions’ Production Editor

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