SAVE BOE HOUSE: Petition to maintain in-house counseling services at St. Olaf College.

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Dear St. Olaf alum, family and friends -

Throughout the year the college has been considering outsourcing Boe House, the college counseling center. The college’s response has been unclear as to why exactly this change is being proposed, but regardless of reasoning, it will impact students and our beloved community. You are welcome to read the letter in its entirety, or simply the synopsis below - all that is asked of you is that you take no more than a few minutes to sign your name to let the administration know that this change is unacceptable.

What’s happening?

The college is considering outsourcing counseling and health services to Allina.
This directly contradicts the mission of the college to be an inclusive community, and works against the directives set forth by the Diversity and Inclusion Initiative.
Student response to the proposal of outsourcing has thus far been overwhelmingly negative.

What does that mean for current students?

- Allina requires fee for service - meaning they will bill health insurance.
- Not all students have health insurance or are capable of affording it. Many international students or students from out-of state will not be covered by their insurance to seek services (currently roughly 1800 students are from outside Minnesota).
     - Therefore, students will be financially penalized for being uninsured, underinsured, or insured by high-deductible health plans, meaning they will likely be discouraged from seeking counseling services. This is inconsistent with the values of the college and the college’s mission, “To be an inclusive community.”
- Students on their parents’ health plan will lose privacy when seeking services.
     - This disproportionately impacts the most vulnerable students including: Queer students, students who have experienced sexual assault, clients struggling with highly personal issues, clients who have experienced abuse in families, clients who are having direct conflict with families, and clients whose parents or family are not likely to be supportive of their mental health struggles.
- Counseling services are directly linked to college success.

Are there alternative money-saving options for the college that do not reduce access?

Yes. Many colleges across the U.S. who are struggling with financial costs have implemented a student health services fee. There are several options for how this could be utilized outlined in the full report. The hope is to do so without financially burdening the least privileged students.

What can I do?

Become informed - read the full report.
Take less than one minute to sign your name at the link below letting St. Olaf know that you disagree with their decision to outsource.
Call or write your own letters expressing your concern

-------------------------READ BELOW FOR FULL PETITION-----------------------------

Petition to maintain in-house counseling services at St. Olaf College in Northfield, MN

President Anderson, Vice President and CFO Jan Hanson, Dean Rosalyn Eaton, Director of Boe House Steve O’Neill, and SRAP Director Roberta Lembke:

It has come to the attention of St. Olaf alum that throughout the year the college has been seeking opportunities to outsource Boe House. This action, though well-intended, reflects a lack of commitment to the St. Olaf community, in particular a commitment to supporting students who face systemic barriers to accessing mental health services. In the words of a current St. Olaf student who spoke at the Town Hall Meeting on February 20th, 2018 addressing the topic of mental health services on campus, “This move [outsourcing] would be classist, ableist, and racist.” Inconsistent and contradictory reasons for this action have been provided to the St. Olaf student body, and there is little transparency around why outsourcing is beneficial.

Given the college’s directives from the Diversity and Inclusion Initiative and desire to promote inclusivity and reduce barriers to students from marginalized communities, we the alum ask that your actions reflect your promises. Below we have outlined: 1) A response to the college’s statements concerning several “benefits” of outsourcing, 2) Research articles that include evidence of how outsourcing impacts access to services and retention rates, as well as examples of other colleges’ attempts to outsource services, 3) Potential impacts outsourcing will have on students’ access to mental health services, 4) Potential impacts outsourcing will have on the college, 5) Necessary questions that St. Olaf’s administration must understand and consider, and 6) An alternative plan that will maintain accessibility to and affordability of these services.

1. Addressing the College’s Desire for Outsourcing

Prior to addressing this, it must be stated that the college’s current statements about the rationale for outsourcing have been inconsistent. During the span of the Town Hall meeting on February 20th, for example, the college stated both the idea that outsourcing Boe House is not targeted at reducing costs and that the idea stemmed from the SRAP process, which is directly evaluating ways to save money. This inconsistency is concerning, and we demand greater transparency in the college’s reasoning.

Below are reasons the college has given for why outsourcing to Allina would be beneficial, and our concerns with these claims.

1) Outsourcing will offer greater accessibility.
     - Allina is an existing community option that students are able to access. Outsourcing the counseling center to Allina would in fact do the opposite by reducing autonomy in student’s choice of services. The same is true of psychiatric services.
     - Allina requires reimbursement for services provided including either private insurance or fee for service, which means for individuals who cannot afford adequate insurance or the typical cost of a counseling session (typically over $100/session), outsourcing would eliminate the only option for counseling or psychiatric services.
     - The wait time in accessing services is consistent between Boe House and the community. Boe House maintains a wait of 2-3 weeks for appointments, whereas other practitioners in Northfield (including Allina) have a 3-4 week wait. Furthermore, Boe House maintains a commitment of triaging and prioritizing clients with the most critical needs by filling cancellations whenever possible. The same personal commitment and knowledge of students is not guaranteed within a larger organization operating under a medical model.
2) Outsourcing will offer services from counselors of color.  
     - Allina currently does not employ any counselors of color.
3) Outsourcing will provide a financial benefit.
     - All models of outsourcing would require similar reimbursement from the college unless insurance billing occurred, which would violate both the directives of the Diversity and Inclusion Initiative and the college’s mission.
     - The current college counseling service is underfunded given the demand of services from students. The amount of full-time employment has essentially remained constant for over a decade despite student demand increasing. In the last 15 years, full-time employees covered in Boe House’s budget have increased only 6.6%, whereas in the same time period the total number of sessions provided has increased from 2,280 to 3,009 and the total number of students seen has increased roughly 37% (data from the Student Government’s Resolution meeting in April of 2018). This represents a negligible increase in staffing for a significant increase in demand.
     - If the college is evaluating outsourcing due to the financial benefit, options that require massive changes and are likely to decrease utilization, should not be considered if the cost is nearly the same or greater than what is currently in place.
A current student at St. Olaf spoke at the Town Hall meeting, “You’re talking about SRAP and cost-benefit tradeoffs. When you say, ‘we need to look at the expenses and the cost-benefit,’ what students hear is, ‘is your mental health worth it?’”
4) Outsourcing will provide a higher quality of services.
     - If the issue is about the quality of services currently in place, these concerns should be addressed directly to the counseling center. From the Town Hall Meeting, the primary criticism of the counseling center from current students is related to the lack of funding, and thereby staffing, of the center. Boe House’s staff has received comparable training to that of Allina staff, but has also gained valuable insights into campus life as they remain a part of the campus culture.

2. Research on the Relevance of College Counseling Centers, Retention & Outsourcing

Because the reasoning has been relatively unclear as to why the college is looking into outsourcing, below are various studies that evaluate the impact college counseling centers have on students and retention rates. These indicate that providing accessible services to students increases retention, which directly impacts college revenue. There are also several articles that summarize the research and may be informative for the college to review. Finally, there are articles that discuss why outsourcing counseling services can be damaging to the community.

3. Examples of Other Colleges’ Attempts at Outsourcing

The current trend of other colleges is returning to college-operated counseling services. Many colleges that have attempted outsourcing have found that the utilization rates decrease by 50% as students are unable to afford services, and there has been little to no financial benefit to the college. These are only some of the colleges that have attempted doing so:

Denver University
Murray State University
Radford University
Thomas College
Bemidji State
Franklin Pierce College
Indiana University - South Bend
Grinnell College
Connecticut College - New London
Robert Morris University
Indiana University
Drexel University
Neumann University
Cabrini University
Immaculata University

4. Articles about Outsourcing

Bishop, J.B. (1995). Emerging administrative strategies for college and university counseling centers. Journal of Counseling and Development, 74, 33-38.

- This article comments on administrative strategies to cope with the changing financial demands and demands for greater services. In the mid-90s only 5% of colleges used health insurance payment plans, which was a 2/3rds reduction since the 1980’s. Only 7% charged fees per session. An alternative is discussed in that over 1/4th of college counseling centers utilized a mandatory student fee to at least partially fund the counseling center. This is more popular because it does not decrease access and is a relatively small cost per student.

Widseth, J.C., Webb, R.E., & John, K.B. (1997) The question of outsourcing: The roles and functions of college counseling services. Journal of College Student Psychotherapy, 11(4), 3-22.

- An extensive description of the pros and cons of outsourcing college counseling centers. Below are some of the takeaways quoted directly from the authors.
- On College Counseling centers being a part of the student body and culture:
     - “…each university more generally, is a unique institution with its own culture and that counseling and psychological services evolve as a part of that college culture. Therefore, it makes sense to maintain psychological counseling services as an element in the fabric of the college community.”
     - “Seasoned college counselors and psychotherapists tend to value the importance of context or “social milieu,” in contrast to the “biomedical view.” They see that giving informed advice and well-tuned consultation as requiring an understanding of “where the person is coming from.” Each college has a different ambiance, with different and peculiar values, beliefs and unwritten expectations. Colleges recognize that in having their students lead campus tours for potential students and their parents…Thus, it facilitates the process, especially when crisis interventions are necessary, to have a mental health practitioner who has an intimate knowledge of the student’s community. Without such understanding of context and institutional culture, off-campus professionals have a limited perspective for understanding. It is our [the author’s] experience and that of confiding colleagues from other institutions, that off-campus professionals either tend to overemphasize the psychopathology of students or to underestimate the factors of stress with which students must contend.”
- On the violation of college mission statements by outsourcing:
     - “…[Colleges] set up an expectation that they will provide a special and unique environment where students will be nourished and supported in their explorations into new and challenging worlds of knowledge and inquiry.”
- On the expectation of parents for the support available to their students:
     - “Parents have come to expect and rely on these services for the care of their children…”
- On the change in help-seeking behavior and confidentiality:
     - “Many students will initiate their contact with the counseling center by discussion issues of confidentiality and specifically clarifying the conditions under which their parents would be notified…They often take quick and firm umbrage at any system which too readily involves their parents…”
- On accessibility:
     - “The off-campus agency would do this most often by reducing services to time-limited psychotherapy or psychiatric crisis intervention…But this means of reducing costs may not even be the most significant loss. More importantly, the scope of counseling and psychological services on the campus would be reduced. A plan to outsource campus counseling services views the role of such services within a more narrow psychiatric/medical perspective and thereby omits any significant recognition of the broader educational and consultative roles that psychological services personnel play on campus.”
     - “On-campus services are highly accessible and that facilitates student usage.”

5. Articles about College Counseling Centers and Retention

Bishop, J.B., & Brenneman, K.A. (1986). An initial assessment of a counseling center’s role in retention. Journal of College Student Personnel, 27, 461-462.

- Evaluated students who were considering dropping out, transferring, or who were worried about failing out of school. More than 86% continued enrollment who also utilized counseling. Only three chose to leave voluntarily.

Bishop, J.B., & Walker, S.K. (1990). What role does counseling play in decisions relating to retention? Journal of College Student Development 31, 88-89.

- Followed “retention risks” who sought counseling. 80% remained enrolled and on follow-up surveys indicated that their continued enrollment was due to the counseling center sessions that helped them organize their thinking, provided support, and helped them cope with their fear of failure.

Body, V., Friesen, F., Hunt, P., Hunt, S., Magoon, T., & Van Brunt, J. (1996). A summer retention program for students who were academically dismissed and applied for reinstatement. (Research Report No. 13-96). College Park, MD: University of Maryland Counseling Center.

- Evaluated a summer program for students who had been dismissed from a college for academic reasons. The voluntary program was held through the counseling center. 64% of those in the program enrolled again as compared to only 49% of students who did not participate in the program.

Frank, A.C., & Kirk, B.A. (1975). Differences in outcomes for users and nonusers of university counseling and psychiatric services: A 5-year accountability study. Journal of Counseling Psychology, 22(8), 252-258.

- Students who utilized counseling, psychiatric services or both had significantly higher graduation rates.

Illovsky, M.E. (1997). Effects of counseling on grades and retention. Journal of College Student Psychotherapy, 12, 29-44.

- 75% of students who received counseling services continued enrollment as compared to 68% of students who did not receive counseling services

Sharkin, B. (2004). College counseling and student retention: Research findings and implications for counseling centers. Journal of College Counseling, 7(2), 99-108.

- An informative review of the literature and research of the impact college counseling centers have on retention rates.

Turner, A.L., & Berry, T.R. (2000). Counseling center contributions to student retention and graduation: A longitudinal assessment. Journal of College Student Development, 41, 627-636.

- A cohort study that evaluated five groups of incoming students over a 6-year period. Students in each cohort had identified that personal problems or academic stress was interfering with their ability to stay in school. 85% who received services remained in school as compared with 74% of the general enrollment. 60% of these students identified that counseling was helpful in maintaining or improving their academic performance, and roughly half indicated that counseling helped them in deciding to continue their education.

Wilson, S.B., Mason, T.W., & Ewing, M.J. (1997). Evaluating the impact of receiving university-based counseling services on student retention. Journal of Counseling Psychology, 44, 316-320.

- Students who received counseling had higher retention rates than those who did not receive counseling. A 14% difference was found between the retention rates of students who received counseling services as compared to those who did not.

6. The Impact of Outsourcing on Students

The following are examples of how students will be impacted by outsourcing. To the college’s credit, outsourcing does maintain services – but for who? The greatest concern with outsourcing is that doing so will disrupt the ability of the most vulnerable and least privileged students to access services. It places an unjust financial penalty on individuals already facing systemic barriers and marginalization. If the least privileged, most vulnerable students do not have open access to counseling services, then what? (See Section entitled The Impact of Outsourcing on the College).

1) Individual counseling services will remain. However, students will be financially penalized for being uninsured, underinsured, or insured by high-deductible health plans, meaning they will likely be discouraged from seeking counseling services. This is inconsistent with the values of the college and the college’s mission, “To be an inclusive community.”
2) International and out-of-state students who are out of network or whose insurance plan will not cover services will lose access to counseling services. Current enrollment is 298 international students and an estimated 1,500 out-of-state students (a total of 1,798 students at risk of losing access).
3) Students who are on their parent/guardians’ health insurance plan will be discouraged from seeking services, as billing insurance will expose counseling sessions to parents. This disproportionately impacts the most vulnerable students including: Queer students, students who have experienced sexual assault, clients struggling with highly personal issues, clients who have experienced abuse in families, clients who are having direct conflict with families, and clients whose parents or family are not likely to be supportive of their mental health struggles.
4) For insurance reimbursement to occur, students would be required to have a psychiatric diagnosis. This would become a part of their permanent medical record. Many students seeking services for support regarding developmental issues may be pathologized and undeservedly receive a diagnosis that could be considered a pre-existing condition, thus limiting future healthcare options.
5) The following services are non-billable, and under a medical model would be lost:
- Let’s Talk campus outreach program
- Education and prevention for all students in study-abroad programs
- Providing training to JC/RA/AC positions
- Providing a multitude of presentations and outreach coordination
- Implementing annual depression screening for the St. Olaf community
- Consultation services to students, families, faculty and staff
- Addressing substance risk through the BASICS program
- Supporting SARN, the Wellness Center and other on-campus student resources
- Support groups for prevalent community issues
- An inability to access services is directly associated with a decrease in retention rates (see section on research).

7. The Impact of Outsourcing on the College

- The inability of students to afford counseling resources may have a ripple effect on other college services. Students no longer able to attend counseling services may instead require greater support from:
     - Resident life staff including JCs, RAs, and ACs
     - Deans
     - Professors
     - Chaplains
     - Coaches
- Students unable to afford counseling services may not receive the emotional and psychological support they need. This may increase the amount of unrest on campus including disruptions in classrooms, student organizations, sports teams, choirs, and general social life.
- The public perception and opinion of the St. Olaf community and culture of The Hill may shift dramatically. Parents may question if their students are supported, alumni may choose to donate to other organizations that support their values, and students may lose faith in the administration’s commitment to them and their wellbeing.
- Based on the research findings, retention rates for students who are no longer able to afford counseling services will decrease significantly.
- “There is some kind of odd math in legislators’ heads that somehow equates cutting or outsourcing mental health services with cost savings or risk reduction...In the end, it does neither. What it really does is pass the cost to various departments like residential life, faculty in the classroom and front office who are now working with students struggling with mental health problems without proper access to care.” - Brian van Brunt, former President of the American College Counseling Association (from Grasgreen, 2012).

8. Reasons to Maintain the Current Services at Boe House

The following are adapted from Milstone (2010) and Grasgreen (2012) and comment on the reasons continuing to operate the college counseling center is beneficial for colleges/universities.

1) The college maintains oversight of services provided.
2) Current costs are maintained and do not increase overtime with contracts.
3) The center is able to better align with the college’s mission.
4) Public opinion of the college does not shift.
5) The college is able to maintain quality control over services.
6) The college experiences a loss of mission, vision, and values.
7) Outsourcing can cause negative employee morale and campus climate.
8) Outsourced services are scrutinized and evaluated differently.
     - Outsourced services are money-driven, whereas college operated centers are people-driven.
9) Counselors are able to collaborate, participate and be aware of campus culture and engage on committees and with organizations.
10) “Outsourcing became trendy in the 1990s, Appalachian State’s Jones said, when many colleges were wooed by private companies that promised they could provide counseling services for less than it cost for the institution to employ staff itself. But the staff they provided tended to be trained and paid less, and their unfamiliarity with student issues and the ins and outs of college counseling (like outreach and consultation) ultimately drove many centers back in the other direction.” - from Grasgreen (2012).

Grasgreen, A. (March 26, 2012). Georgia State University Outsources Counseling Center’s Clinical Staff. Inside Higher Ed.

Milstone, D. (2010). Outsourcing Services in Higher Education: Consider the Campus Climate. Associations of College Unions International (ACUI): The Bulletin, 78(2).

9. Questions that Need to be Addressed

As you may know, ‘complex’ does not begin to describe the considerations a college must take for outsourcing to occur. Given the answers at the Town Hall Meeting in February, the alum believe that there are a multitude of questions that need to be answered transparently prior to making a decision with such large implications for the community. Furthermore, the reasons the college has provided to outsource are insufficient and do not answer the most important question: How will outsourcing impact the most vulnerable and least privileged students? Beyond this, the college must also be able to provide answers to the following (adapted from Milstone, 2010):

1) Who will supervise counseling? Does that person have training in a College Counseling Center? Will the supervisor be housed here on campus observing daily interactions with students? Is the agency accredited for college counseling?

2) Who will hire the counselors? Will you have any input in those decisions? What will be your process if you are dissatisfied with a counselor? Will the counselors be professionals trained to understand the college system so they can integrate other college services into their plans for working with individual students?

3) If the agency agrees to provide “value added” (outreach, prevention, programming, consultation) services, how will you determine what portion of their time they will devote to these services? How will you measure their efforts? Will they provide the services with a sense of loyalty to St. Olaf’s mission? Even if the quality of service is very good, what will be the cost to St. Olaf for these services? Will you really save money by paying the agency for this level of services?

4) How will this agency make their profit on counseling St. Olaf students? Will they make money by billing the students’ insurance? Will they funnel students into their profit-generating off-campus clinics?

5) What kinds of psychological labels will they attach to the problems students experience? What effect will these labels have on students in the future? How will their parents/guardians react?

6) What will happen to the students who do not have insurance? Will they receive the same level of attention and care as the students holding insurance cards? How will you know what actually happens to them since all of the services will be confidential?

7) What departments in the college will have to help the students who are not well served by your hired agency? What will be the cost to those departments in time and effort?

8) How will outsourcing affect St. Olaf’s image as an honest, supportive, growth-oriented environment in which students can receive direct, consistent support for their development?

9) How does outsourcing really fit in with St. Olaf’s mission and the directives of the Diversity and Inclusion Initiative?

10) How will the community perceive St. Olaf’s priorities if you choose to outsource critical services?

10. An Alternative Plan

Given the extensive information and research, it seems obvious to the alum of St. Olaf that outsourcing is contradictory to St. Olaf’s mission statement and the directives from the Diversity and Inclusion Initiative and prioritizes financial gain over student wellbeing. The act would disproportionately affect students from marginalized communities. It would be extremely detrimental to students of color, students from low socioeconomic backgrounds or without financial means to secure adequate health insurance, queer students, international students, out of state students, students with disabilities, and overall would be harmful to the St. Olaf student body. Outsourcing decreases access to counseling by eliminating free services and limiting the autonomy of students to choose the type of service they prefer.

Instead, we believe the following options would maintain the college’s commitment to its community, mission, and students:

1. Maintain the status quo. The counseling center is underfunded given the demand for services. If the college’s statement that outsourcing services has nothing to do with financial benefit is accurate, then this option appears to be the most reasonable, as major shifts will harm the most vulnerable and least privileged students. If anything, we believe that more financial support should be given to the counseling center to increase services for students, which is the only consistent criticism of the current available services by the college community via the Town Hall Meeting. Furthermore, the current trend across the U.S. is to increase services funded by the college or a mandatory fee (see below). According to the Association of University and College Counseling Center Directors (AUCCCD) annual report from 2017, 35.3% of centers added staff during the 2016-17 academic year, and the net number of FTE positions gained during this time was 215.8 across 439 institutions. Furthermore, the 2015-16 report identified that over half of centers had increased their budget for the counseling center during that academic year.

2. If finances are of concern to the college, then the following is proposed to maintain accessibility to services while minimizing financial hardship to students:
- Implement a mandatory student fee or health services fee that at least partially covers the cost of the counseling center.
     - $100/student per year would cover $304,000 of the counseling center’s budget. The remainder could be continued to be paid for by the college.
     - $165/student per year would completely cover the cost of the counseling center.
- If this option is considered, we ask that the college take into consideration the financial burden that may be placed on students and offer financial aid to students who could not afford the additional fee. A $200/student per year fee for those that can afford it may help cover the additional cost of said financial aid to students.
- According to the AUCCCD’s annual report from 2017, 53.3% of colleges at least partially fund their counseling centers with a mandatory student fee. Over the last thirty years, this has continued to be a growing trend as colleges move away from outsourcing (see: Bishop, 1995).

The alum of St. Olaf demand that the administration upholds the values on which this community was built. We demand that the college have transparency in the rationale behind the desire to outsource the counseling center. Finally, we demand that the college find alternative means in order to maintain accessibility to and affordability of services. Anything less is unacceptable.

The action of outsourcing the counseling center, although with non-malicious intent, will directly oppose the values St. Olaf has been founded upon - a mission created on the basis of being an inclusive environment; one that promotes and inspires meaningful vocation, engages in global discourse, and above all else develops integrity in the values of the students. We understand that it may become increasingly difficult to maintain financial security when there is a lack of funding for and emphasis on education in the greater society, however, we firmly believe (and hope that you do as well) that there is no profit to be gained in sacrificing the core values of our community.