Posts Tagged program

From ‘a dangerous wait’ to ‘weightless service’

Introduction

Student Assistance Programs (SAP) go a long way in addressing the concerns mentioned in Meg Bryant’s excellent article: Survey: Colleges struggling to meet mental health needs of students based on a recent report from STAT titled “A dangerous wait: Colleges can’t meet soaring student needs for mental health care.” Ms. Bryant brought up many issues: access, limited sessions, stigma concerns inadvertently setting students up not to be seen in a timely manner, high demand for service and limited resources, and finally the role telehealth may play in the future.

A growing problem

While the needs of university students have been recognized and provided for for years, the increased demand with a decreased stigma in accessing services and asking for help has led to a need for increased capacity for these services. There are many opportunities that moving to a larger, external network could afford.

Patient ratios

Many of the schools highlighted in the report had student:provider ratios that were quite high – ranging from the low end of 400:1 to over 1,500:1. While provider ratio alone does not determine quality or even capacity, it’s an indicator of potential. Given the average university size of approximately 4,200 students, MINES’ average student to provider ratio would be under 5:1.

Additionally, this breadth of coverage means increased specialization available to those students. MINES’ network can be searched based on type of provider, populations they work with, modalities of treatment, languages that they speak, and much more. This results in a better match in the provider/patient relationship from the beginning.

Fall-over capacity

Utilizing an external network also creates the ability to respond to increased demand on the university counseling staff for times when there is increased stress or pressure on the students, for example when there is a critical incident or even during midterms or finals when the added stress of accomplishment for the students may increase.

Integrated care

Using an external network also adds to capacity and expertise for referral after initial services are completed when a short-term therapy model will not resolve the issue the student is dealing with. Because MINES works with groups all across the country, with different health plans in place, our Case Management staff is adept at making referrals into those plans.

Student Health Plans

For some students with a university health plan, MINES can work directly with the plan to provide integrated care, supporting the other providers on the medical side of the plan with coordinated care planning and treatment adherence support.

ACA provisions

Following the passage of the Affordable Care Act in 2009, coverage for children under their parent’s plan up to age 26 means that a student’s health plan may be more difficult to access given a student’s school of choice when that school is in a different state from where their parent is employed. With MINES national presence, we can work with these students to help them access those services on their behalf.

The SAP model

Student Assistance Programs are based on an Employee Assistance Program (EAP) platform. These programs are cost effective; however, they do have session limits similar to college/university counseling center programs. The advantage of a SAP program is that it can be a service extender of the counseling center under ideal budget circumstances. A SAP could replace a campus-based counseling center similar to EAPs replacing internal company programs. Why would this happen? It can bring greater access to the students with lower costs for the organization. Additional services are also provided in a SAP that many counseling centers do not provide such as legal/financial services, 24/7 access, sessions offered outside regular counseling center hours, and online access to resources. Telehealth services are also available in a SAP, further improving access to care. Most SAPs built on an EAP platform have much lower counselor to student population ratios. This allows for faster access for most of the issues or concerns for which a student may be calling. Finally, as the student does not have to go to the counseling center for the appointment, where other students may see them and make inferences as to their mental health, they can go to a therapist or counselor off campus and have greater privacy. This reduces the stigma reluctance some students may have.

Cost as a barrier to entry

While many of the programs listed in the report have some number of sessions covered for the students, most of them were limited to only a very limited number of sessions being free with a nominal cost thereafter. Even such a nominal cost, however, could be a barrier to continued treatment, especially as the costs of access to higher education continue to outpace the cost of living here in the United States.

Engaged students starts with engaged clients

MINES believes that, as is true for engaged employees, engaged students need to be engaged clients. This means approaching all of the elements to engaging in total wellbeing. We use the SAMHSA model for approaching this subject and even coordinate our regular communications with our employers around this model.

Using this as a starting point, we can tailor our interactions with individuals to help increase their capacity for creating healthier lives from each of these perspectives. With a holistic approach to therapy and coaching, we can work with an individual on many layers, increasing their health and wellbeing. This also allows us to begin engaging with an individual from one element and build trust to engage in other elements.

Reaching millennials

Millennials now make up the majority of students in higher learning institutions and there is a different set of expectations in working with this generation compared to generations before. Part of that change has to do with the use of technology, but what might be even more important than the technology itself is the way that technology can be applied to change entire models. There are examples of national suicide lines using texting to successfully intervene. Of course there are clinical limitations that need to be understood before SAP programs incorporate them to improve access.

Telehealth

Telehealth (which comes in many forms from texting a dedicated provider, requesting a prescription, or even videoconferencing!) has taken a major leap in recent years with legislative changes from state-to-state and technology companies attempting to pick up the slack in the emerging market. Millennials, in particular, want these solutions to improve communications with providers, for both qualitative and quantitative reasons.

New models

And telehealth also means new opportunities to change the traditional treatment model. With improved security (especially identity management) and mobile data capacity, these telehealth solutions could result in a greater reliance on asynchronous communications with students. Relying on higher frequency of communication with lower time needs per communication, the traditional 50-minute model no longer has to be the default for treatment, allowing the provider to engage in treatment at episodic highs and without needing to rely on waiting for the next appointment.

Further, while most mental health centers provide access to counseling, a Student Assistance Program can also have an expanded role for those students including financial coaching and legal assistance, which are typically included in an Employee Assistance Program. This is an even broader set of problem resolution options that could be made available to students.

Why we think we can help

We have a robust psychological services platform that could be applied to Student Assistance Programs. Furthermore, we already serve many college students through our Employee Assistance Programs and managed mental healthcare services under their parent’s benefits. By working directly with universities, MINES is well-positioned to provide more robust support to these mental health centers in serving their populations.

Want to learn more?

Reach out to us to discuss how MINES can help support your organization by calling 800.873.7138 or emailing us at info@minesandassociates.com

To your health,

Ryan Lucas
CIO

Robert Mines, Ph.D.
Chairman & Psychologist

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Health inSite: Breaking the Fifth Wall

A refresher on Alternate Reality Games, Transmedia Storytelling, and Engagement

While I highlighted the opportunities with Alternate Reality Games and Transmedia Storytelling in my last post, I wanted to take a moment to share a recent production that I’ve been looking into that really highlights how this format works: The Lizzie Bennet Diaries. The Lizzie Bennet Diaries (LBD) is a modern retelling of Jane Austen’s Pride and Prejudice.  The characters in the story have their own online presence within various social media outlets and interact with one another through Twitter, Tumblr, YouTube, ThisIsMyJam, Websites, and more (various examples shown).  The characters share their stories with one another through these dynamic media and oftentimes interact with the audience as well.

While this has engaged a pretty significant audience (fandom), what is really incredible is the way in which the audience has begun to participate with one another.  A recent update to the story included new information that Lydia Bennet (Lizzie’s youngest sister in the updated version) has been caught up in a sex tape scandal (remember, this is not meant to be perfectly along the storyline that Jane Austen wrote, but one that resonates with the audience of this retelling).  There was a huge outcry from the audience expressing dismay at this turn of events.  So much so, that that there was discussion the fandom should look for a hacker who would be willing to hack the website on which the video’s seller was collecting interested buyers with a countdown clock.  This created an immediate problem for the producers/writers of the story.  If the site indeed had been taken down, the team would have to develop a way to get around the change in the storyline created by the audience, and at great expense.  In this way, the audience collaborated to solve the problem of the character, rather than maintain their understanding that this was simply part of the story for consumption.

Let’s start with the Fourth Wall

In theater, the Fourth Wall is the theoretical veil between the audience and the stage.  Breaking the Fourth Wall happens when the players on the stage actively communicate directly to the audience.  There are countless examples in which the magic of the story playing on any stage (screen applies here too) is broken in this way, but the practice is increasing with evermore prevalent new media projects.  In my last post, I described Transmedia Storytelling and Alternate Reality Games as a way of telling a story through multiple media streams and its ability to engage an audience in new and immersive ways.  But breaking the Fourth Wall can be used to engage the audience in participating in the story through these methods to expand the value of the experience that the audience has.  For more on the Fourth Wall, check out Wikipedia for a quick overview, or TV Tropes for all kinds of cool information about the idea and the way that the  this device may be used.

Now, to the Fifth Wall

There is another proposed wall which has been less well explored, and often debated as to its name: The Fifth Wall.  The operational definition that I like is the veil that separates members of the audience from one another.  For a long time, the audience has been the passive observer of entertainment with notable exceptions of breaking the Fourth Wall.  But, rarely does a media experience really ask for members of the audience to work with one another.  This concept of the Fifth Wall could have significant implications in the sharing of narrative within an Alternate Reality Game with a true Transmedia Story backbone.  Consider the opportunities of having participants in the audience that can help guide the story cooperatively; sharing goals, pushing one another toward success, battling challenges together.  If your friends’ friends impact your health in positive and negative ways (see previous posts about link influence here), what about engaging a first node relationship more directly to change the perception of the second or third node to ripple back through the network to you.  In this way, the network then begins to course with change and as you make changes that influence others, their responsive changes come back to you.  In this way, helping others get healthier helps you get healthier.

The Walls and their implications within LBD

The surprising situation that happened within the LBD is that while the narrative has been so clearly billed as a story, with many instances of the Fourth Wall being broken (the producers actually have entire blog postings dedicated to talking about the production process as it is occurring), it turns out that the Fifth Wall nearly took down the production.  The audience reverted to a sense of belief as they interacted with one another.  The characters, then, are part of the audience – and the audience part of the characters.  This creates a shared experience where the audience felt that they were responsible for helping solve the problem for the character.

Summary

The investment of the audience in their shared experience (this includes characters, as mentioned above) has huge implications for health programming.  Imagine a story with so much motivation and movement as LBD written to achieve Salutogenesis by creating a shared landscape around health behaviors.  If we know that education, knowledge, and external incentives are not motivations for behavior change, is this the next landscape to try?  We think it is.

To our health,

Ryan Lucas
Marketing

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Health inSite: Social Media Access at Work

Let’s take a moment to discuss the great ‘Social Media at Work’ debate.  You’re familiar, I’m sure, with this concept.  It starts with a question like this:

“Why would we allow our employees to spend ‘work time’ doing things other than work?”

or another popular alternative,

“Do we want to allow employees to engage in social networking where they could release PCI (a play on PHI in the health world, Protected Health Information: Private Corporate Information).”

or the myriad other great arguments for canning social media in the workplace.

In 2011, MINES had the great honor of presenting at the EAPA International Conference on Wellness Programs where we posited an alternative to traditional wellness programs that relied on the value of social media with employees as a means to increasing adoption, bolstering adherence through social relationships, and positioning health as a social venture where people are spending increasing amounts of their free (and yes, even work) time engaging in health.  The core of most Wellness programs is similar to that of traditional EAP; a sort of ‘we’re there when you need us’ or ‘wait-and-see’ approach.  Wellness programs, however, often incentivize participation through monetary carrots or sticks.  This is a one-to-one approach to health.  Those of you that get to play with relational databases, however, recognize that there are many ways to connect entities (data, people, sites, etc.).

Social Media has the ability to act in a many-to-many way; that is, connecting me to my friend, and my friend’s friend, and all of us to an expert (be it a website, user, resource, or anything else) to engage on a topic.  This is an extremely powerful tool that is starting to be leveraged by a handful of companies – similar to the group therapy model where part of treatment is engaging with other individuals that are currently in treatment, rather than solely with the doc, therapist, CAC, or sponsor.

At the conclusion of our presentation, an attendee posed the following question during the Q and A:

“My company doesn’t allow access to Social Media at work, what recommendation do you have for a company that wants to consider leveraging Social Media but its’ employees don’t have access to it.”

The answer from our CEO went something like

“At MINES, we’ve created a culture wherein every employee is expected to do their best.  I trust that my employees are doing just that and see that they do their best every day and until I see different results, I trust my employees to not abuse the system.”

Let me take a quick moment to highlight this infographic from the University of Melbourne (et. al.) which highlights some of the points on this subject.  Restricting Social Media at Work has many great arguments on its side; potentially lethal viruses, decreased bandwidth (the tech kind, not the personal productivity kind), and even legal concerns regarding PCI.  Productivity is a really common go-to, however, and the others are extremely valid.  Further, I don’t have good arguments against them (besides increasing your company’s bandwidth, installing good anti-virus software, and educating your employees on safe browsing habits), so let’s talk about the increased productivity experienced by those with unfettered access to Social Media.  Could these quotes be right?

“Short and unobtrusive breaks, such as a quick surf of the Internet, enables the mind to rest itself, leading to a higher total net concentration for a days’ work, and as a result, increased productivity.”

That’s pretty interesting and kind of common sense when you think about it.  Looking to an interview with the guru of productivity, Tim Ferriss, on LifeHack is the argument that we should…

“Take frequent breaks and strive to constantly eliminate instead of organize.”

So, despite all of the many reasons to not allow employees onto these Social Media sites, here we see the interplay of increasing productivity by taking breaks, and Social Media as an opportunity to boost creativity and rest the mind.  It’s certainly interesting.

Keep in mind; we’re not suggesting that every company, organization, or government entity allow unfettered access to social media sites.  We recognize that many of the groups that we work with each day have significant and valid arguments to be made as to why they do not allow access from a workstation provided by their IT department; but most arguments are worthy of reexamination as new information becomes available and the growing trend in BYOD (Bring Your Own Device) will have significant consequences as well when it comes to the Social Media, or WILB (Workplace Internet Leisure Browsing), debates – a topic we’ll tackle in the next iteration of Health inSite.

To Our Health,

Ryan
Marketing

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Health inSite: Wellbeing or Wellness?

We provide wellness sessions for a number of our clients, integrating the wellness component into the overall Employee Assistance Program (EAP).  To recap what MINES considers an EAP to be:

  • An employee benefit: Free-to-the-client counseling or coaching sessions for the employee and their household members on topics ranging from workplace to personal issues.
  • A management benefit: Supervisor / Manager training, work-performance referrals, and management consultations that help management work more effectively.  (For some of our clients, this is like adding a part-time HR assistant!)
  • A work/life component: Including access to an online behavioral health portal with articles on all aspects of work/life balance, concierge referral services for help in finding and accessing resources like college planning, legal and financial coaching, and trainings related to interpersonal, stress, and other wellbeing topics.

This layering of benefits is more robust than a typical “embedded” EAP that is offered as part of a health plan.   These do not usually provide heavy promotion and oftentimes do not extend to the many management benefits that MINES includes in our EAP.

But a few months ago we were preparing for a presentation of this more integrated model and discussing the unique selling proposition of this program and how we wanted to position it in juxtaposition to our other Employee Assistance offerings.  When we charted out the program, we found that we had two very large changes that were being considered under this new program proposal: 1, we were looking at a more holistic approach to the health of the employee that honed in on outcome-focused behavioral change, rather than just incentivizing program participation (meaning that we were giving employees the opportunity to affect many dimensions of their health from the emotional to the physical to the financial and occupational); and 2, we were offering a way for management to interact with their employees in a way that was much more integrated than many wellness programs typically do.

By creating an offering that was integrated into the social fabric of the company, rather than simply proposing a commoditized offering, we uncovered a significant change in the way that we wanted to present this program.  We changed the program from an EAP with a wellness component to an Organizational Wellbeing System.

To distinguish these two terms from one another, and why we thought we needed to change our language for the proposal: wellbeing is differentiated from wellness, as defined by Merriam-Webster, by the former term’s incorporation of total prosperity.  Prosperity, we thought, had the added quality of openness to more dimensions than wellness had available to it.

We believe that this difference is significant, especially when considering the future of healthcare in the United States.  Regardless of what the Supreme Court decides about the legality of the Affordable Care Act, there are changes coming in the landscape of health and we at MINES believe that we are moving in the direction of a more integrated, network-based HEALTHcare as opposed to single person SICKcare.  As we’ve mentioned in some of our other postings recently (PPACA Roundup: Part IICommunity is the Key to healthHalo effects and Link Influence), the brief therapy model has significant implications for treatment adherence in more than just substance abuse and mental health issues and we’re prepared for a more involved role with the whole wellbeing of the individual, their social network(s), and the population as a whole.

To our health,

Ryan
Marketing

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