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Trainees versus Staff: Exploring Counseling Outcomes in a College Counseling Center

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Title: Trainees versus Staff: Exploring Counseling Outcomes in a College Counseling Center
Language: English
Authors: Ilagan, Guy, Vinson, Mike, Sharp, Julia L., Havice, Pamela, Ilagan, Jill
Source: Journal of College Student Psychotherapy. 2014 28(3):229-240.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 12
Publication Date: 2014
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Counseling Effectiveness, Outcomes of Treatment, Universities, Trainees, Counselors, School Counseling, Pretests Posttests, Mental Health, Readiness, Behavior Change, Graduate Students, Professional Personnel, Hypothesis Testing, Comparative Analysis, Questionnaires, Statistical Analysis
DOI: 10.1080/87568225.2014.915172
ISSN: 8756-8225
Abstract: Investigators compared counseling outcomes among nonpaid graduate-level trainees and professional staff at a college counseling center. Counseling outcomes for 331 college student participants were measured using the Outcome Questionnaire 45.2 (OQ45.2), employing a pretest--posttest design. The two groups of service providers did not differ significantly (p = .179; a > .05). A unique aspect of this study was the statistical control for the clients' readiness to change. The implications for practice in college counseling centers suggest the use of graduate-level trainees as effective counseling providers and a method to cope with high demand for services.
Abstractor: As Provided
Number of References: 28
Entry Date: 2014
Accession Number: EJ1031877
Database: ERIC
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  Value: <anid>AN0096732356;85y01jul.14;2019Feb14.13:24;v2.2.500</anid> <title id="AN0096732356-1">Trainees Versus Staff: Exploring Counseling Outcomes in a College Counseling Center. </title> <p>Investigators compared counseling outcomes among nonpaid graduate-level trainees and professional staff at a college counseling center. Counseling outcomes for 331 college student participants were measured using the Outcome Questionnaire 45.2 (OQ45.2), employing a pretest–posttest design. The two groups of service providers did not differ significantly (p =.179; α >.05). A unique aspect of this study was the statistical control for the clients' readiness to change. The implications for practice in college counseling centers suggest the use of graduate-level trainees as effective counseling providers and a method to cope with high demand for services.</p> <p>Keywords: college counseling center; high demand; outcomes; trainees; transtheoretical model</p> <p>University mental health clinics face high demand for services and limited resources. In light of the human resource limitations and increasing severity of students' concerns, effective, efficient, and prompt service delivery is more important than ever. There is a need to explore affordable ways to bolster services for students in need of counseling interventions. One potential solution for managing high demands for services is to utilize graduate level trainees.</p> <p>This study evaluated differences in mean counseling outcomes for trainees compared to professional staff working in the same college counseling center. The outcome of interest was symptom improvement. There were 331 service users, assessed by differences in pretest and posttest administrations of the Outcome Questionnaire 45.2 (OQ45.2)<emph>.</emph> Lambert, Burlingame, and colleagues (1996) reported that significant symptom improvement is shown by an OQ45.2 posttest score that is at least 14 points lower than the pretest score.</p> <hd id="AN0096732356-2">LITERATURE OVERVIEW</hd> <p>A 2012 survey conducted by The Association for University and College Counseling Center Directors (AUCCCD) indicated that high demand for services, coupled with limited resources, continues to be an obstacle for college counseling centers. Of the 400 college counseling center directors who participated in the study, 32% indicated that their centers need to utilize waitlists to manage the demand (Barr, Krylowicz, Reetz, Mistler, & Rando, [<reflink idref="bib2" id="ref1">2</reflink>]). Watkins, Hunt, and Eisenberg ([<reflink idref="bib27" id="ref2">27</reflink>]) found similarly that increased demand created obstacles in providing counseling services to students at college counseling centers.</p> <p>Data from the National Survey of College Counseling Center Directors (Gallagher, [<reflink idref="bib10" id="ref3">10</reflink>]) suggest that 2.2 million students in the United States sought mental health treatment during 2011, and the estimated counselor-to-student ratio was 1 to 1,600 on average (Gallagher, [<reflink idref="bib10" id="ref4">10</reflink>]). In addition to the high volume of students seeking services, an increase in severity of problems was noted (Kitzrow, [<reflink idref="bib11" id="ref5">11</reflink>]). Most college students who seek campus counseling services identify as concerns anxiety, depressed mood, and relationships, in that order (Barr et al., [<reflink idref="bib2" id="ref6">2</reflink>]). College counseling center directors reported an ongoing trend of increased volume and severity, noting that 39% of the students seen have "severe psychological problems" (Gallagher, [<reflink idref="bib10" id="ref7">10</reflink>]).</p> <p>One way that many college counseling centers have coped with this demand has been to utilize graduate level trainees to provide counseling services to students. A study conducted at a college counseling center yielded unexpected and encouraging counseling outcome results for a group of trainee counselors. Using the OQ45.2 to measure outcomes, Minami and colleagues ([<reflink idref="bib17" id="ref8">17</reflink>]) found that clients of the trainees showed greater counseling outcomes than those of the center's professional staff. Those investigators suggested caution with their findings, however, because clients with more severe concerns were reassigned from the trainees to professional staff.</p> <p>Similarly, Nyman, Nafziger, and Smith ([<reflink idref="bib21" id="ref9">21</reflink>]), presenting findings at a university counseling center on outcomes across clinicians' training levels, employed the College Adjustment Scales (CAS; Anton & Reed, [<reflink idref="bib1" id="ref10">1</reflink>]) and the OQ-45 (Lambert, Hansen et al., [<reflink idref="bib15" id="ref11">15</reflink>]) to measure client outcomes. On the whole, clients experienced moderate symptom relief independent of the clinicians' training level. The authors reported that their findings contradicted basic assumptions that more experienced counselors would be more effective in achieving positive counseling outcome scores.</p> <p>Budge and colleagues ([<reflink idref="bib6" id="ref12">6</reflink>]), using the Behavioral Health Measure-43 (BHM-43; Kopta & Lowry, [<reflink idref="bib12" id="ref13">12</reflink>]) and Behavioral Health Measure-20 (BHM-20; Kopta & Lowry, [<reflink idref="bib12" id="ref14">12</reflink>]), reported findings from a study conducted at a college counseling center that showed no statistically different outcomes among clinicians of differing experience levels. Forand, Evans, Haglin, and Fishman ([<reflink idref="bib8" id="ref15">8</reflink>]) conducted a study on mental health counseling trainees' effectiveness in a cognitive therapy clinic, measuring outcome via the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, [<reflink idref="bib4" id="ref16">4</reflink>]) and the Beck Depression Inventory II (BDI-II; Beck, Steer, & Brown, [<reflink idref="bib5" id="ref17">5</reflink>]). The results showed that the trainees were as effective as professional clinical staff in this setting. Based on their findings, those authors asserted that cognitive behavioral therapy can be provided effectively by trainees.</p> <p>A few earlier studies compared experience levels of therapists but focused on outcomes other than symptom reduction or increased reports of well-being. Those studies painted a weaker picture of trainees' performance, showing that the experience of the professional clinical staff afforded them greater case conceptualization skills, including perceiving significant patterns, than trainees (Eells, Lombart, Kendjelic, Turner, & Lucas, [<reflink idref="bib7" id="ref18">7</reflink>]), as well as having fewer clients discontinue counseling prematurely (Swift & Greenberg, [<reflink idref="bib24" id="ref19">24</reflink>]). The earlier studies that focused on symptom reduction did not find client outcomes for trainees to be less than those of clinical staff, but instead presumed that the trained clinical staff should have clients who showed greater outcomes (Lambert, [<reflink idref="bib13" id="ref20">13</reflink>]).</p> <hd id="AN0096732356-3">METHOD</hd> <p></p> <hd id="AN0096732356-4">Participants</hd> <p>The participants were 331 clients of a college counseling center at a public, medium-sized university in the Southeast during the academic years 2007–2009. All counseling center clients who attended between three and seven sessions and were over age 18 were evaluated. The time frame of academic years 2007–2009 was selected because it was then that the research site began using the instruments pertinent to this study. Nearly one third of the participants lived on campus and 70% were female, which matched the demographics for the counseling center clients and the university. The university mental health clinic conducted over 5,600 counseling sessions per year in academic years 2007–2008 and 2008–2009. The total number of clients was 1,910. The study received approval from the institution's Institutional Review Board.</p> <p>Each counseling case file showed the clinicians' status as professional staff or trainee. The professional staff included 12 professional counselors holding state licensure, counselors who have graduated and are working towards state licensure as professional counselors, social workers and psychologists. Approximately one half of the professional staff consisted of part-time contractual employees.</p> <p>The trainees consisted of 16 supervised graduate students enrolled in a masters or doctoral level practicum or internship from counseling or psychology programs. Trainees were placed at the research site for either one or two semesters. The research site did not pay the trainees. The trainees were required to engage in weekly group and individual clinical supervision sessions with professional staff serving as supervisors.</p> <hd id="AN0096732356-5">Measures</hd> <p>The outcome data were collected from the OQ45.2 (Lambert, Hansen, et al., [<reflink idref="bib15" id="ref21">15</reflink>]). The OQ45.2 is a 45-item self-report questionnaire which assesses therapeutic change throughout the course of treatment, as well as at termination (Mueller, Lambert, & Burlingame, [<reflink idref="bib18" id="ref22">18</reflink>]). The OQ45.2 provides a total score based on all 45 items, as well as scores for three subscales—individual, interpersonal, and social role functioning. All items are on a 5-point Likert scale, scored from 0–4, with higher scores indicating higher severity of mental health symptoms.</p> <p>Pretest and posttest administrations of the OQ45.2 provide an accurate measurement of mental health counseling outcome (Vermeersch et al., [<reflink idref="bib25" id="ref23">25</reflink>]). To create pretest and posttest OQ45.2 scores, clients either complete the questionnaire at each visit to the mental health clinic, or at the first and last counseling session (Lambert, [<reflink idref="bib13" id="ref24">13</reflink>]). The OQ45.2 has high internal consistency, Chronbach's alpha <emph>=</emph> 0.93, and test–retest reliability of 0<emph>.</emph>84 (Miller, Duncan, Brown, Sparks, & Claud, [<reflink idref="bib16" id="ref25">16</reflink>]; Whipple et al., [<reflink idref="bib28" id="ref26">28</reflink>]).</p> <p>The participants' stage of change readiness was indicated by a self-report item on the counseling centers' intake forms. At the time of this study, there were no documented studies on this item of clients' self-report of change readiness, and the authorship of this item was not documented. The item was adopted for use in 2007 by a former research site director, who noticed it on the AUCCCD Listserv; queries to the AUCCCD on the authorship or use of the item were not successful.</p> <p>The client self-report of change readiness item was on the Counseling Intake Form, a self-report questionnaire that all clients completed prior to beginning mental health counseling, and was used to place students into the five ordered Transtheoretical Model stages of change categories: precontemplation, contemplation, preparation, action, and maintenance (Prochaska & Norcross, [<reflink idref="bib23" id="ref27">23</reflink>]). The item contains five statements corresponding to the Transtheoretical Model's stages of change, with the precontemplation stage indicating the lowest motivation to change and the maintenance stage indicating the highest motivation to change. This item was used for all clients starting in August 2007 as a brief alternative (M. Vinson, director of the research site mental health clinic, personal communication, March 2009) to the traditional 32-item Stages of Change Questionnaire, which was deemed to be time prohibitive. The client self-report of change readiness item reads as follows:</p> <p>Which <emph>one</emph> of the following statements most accurately characterizes you?</p> <p></p> <ulist> <item> As far as I'm concerned, I do not have any problems that I need to change.</item> <p></p> <item> I am aware of some problems and am considering beginning to work on them.</item> <p></p> <item> I have worked on problems unsuccessfully but intend to continue trying.</item> <p></p> <item> I am currently taking steps to overcome the problems that have been bothering me.</item> <p></p> <item> I have already overcome some problems and want help now to avoid backsliding.</item> </ulist> <hd id="AN0096732356-6">Procedure</hd> <p>At the first visit to the counseling center, the student participants, like all clients, completed the pretest administration of the OQ45.2. For all clients, the OQ45.2 was then administrated prior to each counseling session, allowing the investigators to have OQ45.2 results for the first and last sessions of treatment.</p> <p>Data were collected only for students attending at least 3 sessions. Selecting a lower cutoff of two sessions would have allowed only one therapy session between the pretest and posttest; the lower limit of three sessions allowed the outcome data to reflect the initial brief triage session and two full-length sessions. The mean number of sessions at the research site was 6.1. We selected the upper limit cutoff of seven sessions in order to include the research site's mean number of sessions as well as mean number of sessions (6.2) for U.S. university mental health clinics (Gallagher, [<reflink idref="bib9" id="ref28">9</reflink>]).</p> <p>The investigators identified three possible confounds: clients' readiness to change, percentage of counseling appointments attended, and compulsory counseling. The data for each of these variables were contained in the counseling case files.</p> <p>Clients' readiness to change is a potential confounding variable because a client's stage of change readiness offers insight into whether a university student is likely to benefit from campus mental health counseling (Norcross, Krebs, & Prochaska, [<reflink idref="bib20" id="ref29">20</reflink>]). Compulsory counseling is a possible confound because data show that, on average, university students attending compulsory counseling do not achieve significant symptom reduction (Mun, White, & Morgan, [<reflink idref="bib19" id="ref30">19</reflink>]). Compulsory attendance was indicated as 1 and noncompulsory status was assigned 0 in the statistical analyses.</p> <p>The third variable controlled for in the statistical analyses, the percentage of counseling appointments attended by the study participants, was selected because nonattendance at scheduled counseling appointments is associated with poor clinical outcome (Barrett, Chua, Crits-Christoph, Gibbons, & Thompson, [<reflink idref="bib3" id="ref31">3</reflink>]). The percentage of appointments attended was calculated as a ratio of appointments attended over appointments scheduled.</p> <hd id="AN0096732356-7">Statistical Analysis</hd> <p>The hypothesis of the current study was: Counseling outcomes (difference in pretest and posttest OQ45.2 scores) for graduate trainees and for professional staff are similar. Clients' readiness to change, percentage of counseling appointments attended, and compulsory attendance were controlled for in the analyses.</p> <p>Mean group difference in pretest and posttest OQ45.2 scores was the primary dependent variable. The independent variable was treatment by a graduate trainee or a professional staff member. A multiple regression analysis was conducted to compare counseling outcomes for graduate trainees and professional staff. A significance level of 0.05 was used for all tests of significance. SPSS v 21 (IBM, Armonk, NY) was employed for all analyses.</p> <hd id="AN0096732356-8">RESULTS</hd> <p>Table 1 shows the mean difference of OQ45.2 pretest and posttest for all study participants was 13.27 (SE = 0.95), slightly below what is considered a significant symptom reduction, that is, an OQ-45.2 posttest score of at least 14 points lower than the pretest score (Lambert, Burlingame, et al., [<reflink idref="bib14" id="ref32">14</reflink>]). Table 1 also shows unadjusted and adjusted group means and standard errors for OQ45.2 means for clients of trainees and professional staff. Although the mean differences (symptom reductions) were slightly greater for trainees than professionals, the differences in mean counseling outcomes between them, after controlling for clients' readiness to change, percentage of counseling appointments attended, and students compulsory counseling attendance, were not significant, <emph>F</emph>(<reflink idref="bib1" id="ref33">1</reflink>, 323) = 1.82, <emph>p</emph> =.179. In other words, there was no significant difference in overall symptom improvement between clients treated by professional staff and clients treated by graduate trainees.</p> <p>TABLE 1  Unadjusted and Adjusted Mean Changes and Standard Errors for OQ45.2 Using Readiness to Change, Percentage of Counseling Appointments Attended, and Students' Compulsory Counseling Attendance as Control Variables</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td /><td>Unadjusted</td><td>Adjusted<sup>+</sup></td></tr><tr><td>Staff</td><td><italic>N</italic></td><td>M</td><td>SE</td><td>M</td><td>SE</td></tr></thead><tbody><tr><td>Total</td><td>331</td><td>13.27</td><td>0.95</td><td /><td /></tr><tr><td>Graduate trainees</td><td>184</td><td>14.64</td><td>1.27</td><td>10.36</td><td>1.74</td></tr><tr><td>Professional staff</td><td>147</td><td>11.56</td><td>1.42</td><td>7.79</td><td>1.75</td></tr><tr><td>Stage of change*<sup>§</sup></td><td /><td /><td /><td /><td /></tr><tr><td> Precontemplation<sup>a</sup></td><td>19</td><td>4.71</td><td>3.90</td><td>5.42</td><td>3.90</td></tr><tr><td> Contemplation<sup>a</sup></td><td>122</td><td>14.04</td><td>1.54</td><td>11.28</td><td>2.01</td></tr><tr><td> Preparation<sup>b</sup></td><td>82</td><td>17.24</td><td>1.88</td><td>14.78</td><td>2.20</td></tr><tr><td> Action<sup>a</sup></td><td>83</td><td>12.33</td><td>1.87</td><td>9.74</td><td>2.18</td></tr><tr><td> Maintenance<sup>a</sup></td><td>25</td><td>6.10</td><td>3.40</td><td>4.16</td><td>3.55</td></tr><tr><td>Compulsory Status*</td><td /><td /><td /><td /><td /></tr><tr><td> Compulsory</td><td>43</td><td>6.19</td><td>1.63</td><td>6.05</td><td>1.37</td></tr><tr><td> Not Compulsory</td><td>288</td><td>14.33</td><td>1.05</td><td>12.10</td><td>2.63</td></tr></tbody></table> </ephtml> </p> <ulist> <item>5 <emph>Note:</emph> Symptom improvement is shown by an OQ45.2 posttest score that is at least 14 points lower than the pretest score (Lambert, Burlingame et al., [<reflink idref="bib14" id="ref34">14</reflink>]).</item> <item>6 <sups>+</sups>All means adjusted using the average percentage of appointments attended (67%).</item> <item>7 <sups>§</sups>The same superscript letter indicates that the means in those stages do not differ significantly (Fisher's Least Significant Difference, <emph>p</emph> <.05).</item> <item>8 *<emph>p</emph> <.05.</item> </ulist> <p>Mean changes in pre–post OQ.45.2 scores for the "stage of change" control variable were significant <emph>F</emph>(<reflink idref="bib4" id="ref35">4</reflink>, 323) = 2.58, <emph>p =</emph>.037 (Table 1). The mean change in symptom severity was highest for students who indicated they were in the preparation and contemplation stages of change readiness. The lowest adjusted mean change was observed for students who self-reported as being in the maintenance stage. This result was expected, because students in the maintenance stage presumably have made many of their changes prior to beginning counseling and sought assistance to maintain their progress.</p> <p>Mean changes in pretests and posttests on OQ45.2 scores for compulsory attendance status are also depicted in Table 1. This confounding factor was significant, <emph>F</emph>(<reflink idref="bib1" id="ref36">1</reflink>, 323) = 4.08, <emph>p</emph> =.044, meaning that the mean changes in pre–post OQ.45.2 scores were significantly lower for participants attending counseling on a compulsory basis. The covariate percentage of counseling appointments attended was not significant, <emph>F</emph>(<reflink idref="bib1" id="ref37">1</reflink>, 323) = 0.026, <emph>p</emph> =.873. On average, the 331 participants attended 67% of their scheduled appointments. The trainees' clients attended 72% of their scheduled appointments. Clients of the staff attended 62% of scheduled appointments.</p> <p>The numbers and percentages of the students in each stage of change readiness category, for trainees and staff, are shown in Table 2. The data revealed that 184 (55.6%) of the 331 subjects received counseling from trainees versus staff members. The trainees provided counseling to more clients in the precontemplation stages (53%) than those of the staff (47%). However, a Chi-square test indicated no significant difference in the distribution of responses of readiness to change stage for graduate trainees and professional staff, χ<sups>2</sups> (<reflink idref="bib4" id="ref38">4</reflink>, _I_n_i_ = 331) = 1.42, <emph>p</emph> =.84.</p> <p>TABLE 2  Frequencies for Each Self-Report Stage of Change among Participants Receiving Counseling from Trainees and Staff</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td /><td>Number of Cases</td><td>Percentage of Cases</td></tr><tr><td>Client Motivation</td><td><italic>N</italic></td><td>Trainees</td><td>Staff</td><td>Trainees</td><td>Staff</td></tr></thead><tbody><tr><td>Total</td><td>331</td><td>184</td><td>147</td><td>56%</td><td>44%</td></tr><tr><td>Precontemplation</td><td>19</td><td>10</td><td>9</td><td>53%</td><td>47%</td></tr><tr><td>Contemplation</td><td>122</td><td>67</td><td>55</td><td>55%</td><td>45%</td></tr><tr><td>Preparation</td><td>82</td><td>45</td><td>37</td><td>55%</td><td>45%</td></tr><tr><td>Action</td><td>83</td><td>50</td><td>33</td><td>60%</td><td>40%</td></tr><tr><td>Maintenance</td><td>25</td><td>12</td><td>13</td><td>48%</td><td>52%</td></tr></tbody></table> </ephtml> </p> <p>Table 3 shows the number and percentage of participants for each of the stages of change who were attending campus counseling on a compulsory basis. Participants in the precontemplation stage, showing the lowest readiness to change, included the highest percentage of students attending compulsory counseling. The proportion of participants that attended compulsory counseling within the stages of change categories differed significantly, χ<sups>2</sups> (<reflink idref="bib4" id="ref39">4</reflink>, _I_n_i_ = 331) = 26.64, <emph>p</emph> <.001. Only 13% (<emph>n</emph> = 43) of the participants attended counseling on a compulsory basis, and those participants were seen by both trainees and staff. Trainees provided counseling to 19 of the participants attending compulsory counseling, and staff provided counseling to 24 compulsory clients. The proportion of clients attending sessions on a compulsory basis did not significantly differ between graduate trainees and staff, <emph>Z</emph> = 1.61, <emph>p</emph> =.106.</p> <p>TABLE 3  Frequencies and Relative Frequencies of Participants' Stage of Change Readiness and Students' Compulsory Counseling Attendance Status</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Motivation Groups</td><td><italic>n</italic></td><td>Number of Compulsory Cases</td><td>Percentage of Compulsory Cases</td></tr></thead><tbody><tr><td>Precontemplation</td><td>19</td><td>12</td><td>63%</td></tr><tr><td>Contemplation</td><td>122</td><td>8</td><td>7%</td></tr><tr><td>Preparation</td><td>82</td><td>9</td><td>11%</td></tr><tr><td>Action</td><td>83</td><td>10</td><td>12%</td></tr><tr><td>Maintenance</td><td>25</td><td>4</td><td>16%</td></tr><tr><td>Total</td><td>331</td><td>43</td><td>13%</td></tr></tbody></table> </ephtml> </p> <hd id="AN0096732356-9">DISCUSSION AND IMPLICATIONS</hd> <p>The purpose of this study was to examine differences in client outcomes for supervised graduate-level trainees compared to professional staff. The counseling outcome of interest was symptom improvement, as measured by the difference in pretest and posttest administrations of the OQ45.2. The mean outcome scores did not differ for the two groups. Participants receiving counseling from trainees did not have a different mean symptom improvement score than students receiving counseling from a professional staff member. In order to isolate possible confounds, the researchers controlled for clients' readiness to change, percentage of counseling appointments attended, and students attending compulsory counseling.</p> <p>What accounts for the similarities in improvement for clients of staff and trainees? Although the present study did not assess the reasons, other studies comparing client outcomes attributed similarities to easier client assignments for the trainees (Minami et al., [<reflink idref="bib17" id="ref40">17</reflink>]) and to client expectancy factors (Nyman et al., [<reflink idref="bib21" id="ref41">21</reflink>]). Thus, Minami and colleagues noted that at some sites clients with more severe concerns are diverted to professional staff rather than being assigned to trainees. In the present study, however, there was no such assignment based on type of case; trainees engaged in triage with any students who presented to the clinic. When faced with clients with more severe concerns, trainees were expected to utilize frequent supervision throughout the course of treatment, rather than referring these clients to professional staff.</p> <p>It should also be noted that clients' change readiness, a possible confound, showed stage of change readiness distributed equally among the clients of the professional counseling staff and trainees. Statistical control for change readiness further equalized the effects of client's readiness to change as a confounding variable. In other words, a client who was not highly motivated to change was just as likely to receive treatment from a trainee as from professional staff. Therefore, the lack of difference in treatment outcomes between professional staff and trainees cannot be explained by trainees having "easier" or more motivated clients. The effects of the remaining two confounds, compulsory status and percentage of counseling appointments attended, were also controlled for, ruling these out as possible explanatory factors.</p> <p>Another group of researchers, Nyman and colleagues ([<reflink idref="bib21" id="ref42">21</reflink>]), suggested that equal outcomes for trainees and staff might be attributed to clients of trainees recognizing trainees' limitations and therefore restricting discussions to superficial concerns. While this is theoretically possible, it seems unlikely. Another possibility is that certain students feel more comfortable opening up to counselors closer to their age and life experience. This possibility may account for why some students at the research site were reported to have requested counseling from a trainee. An exploration of the reasons for the effectiveness of the trainees compared to staff is an interesting topic for future research.</p> <p>At our research site, certain features may have contributed to the trainees' success. Trainees were required to participate in weekly individual and group supervision in addition to weekly group supervision from their graduate programs. These supervisory arrangements, allowing trainees multiple opportunities to ask questions and express concerns, presumably contributed to trainees' treatment success. We acknowledge, like Watkins ([<reflink idref="bib26" id="ref43">26</reflink>]), that additional research is needed to clarify empirically the ideal components and structures of clinical supervision.</p> <p>One obvious implication of these findings for counseling centers is to consider the use of trainees to assist in providing effective, prompt and efficient mental health service delivery to college students. Utilizing trainees can also provide an effective method for coping with high demand for services. At the same time, of course, using trainees does require time by qualified staff to provide adequate clinical supervision to the trainees and, of course, available office space.</p> <p>Trainees can also provide additional services beyond individual counseling. Supervised trainees can help meet the university students' needs by providing group counseling or psychoeducational groups pertaining to stress, anxiety, relationships, adjustment to college, and homesickness. Similarly, trainees can be invaluable in assisting counseling centers with outreach, providing workshops in classrooms, residence halls, student groups, or new student orientation. Workshop topics can include stress-coping skills, how to access university support systems, and a variety of wellness topics.</p> <p>Future research can identify clinical supervision approaches that promote effectiveness among trainees in college counseling centers. One area where trainees may need assistance is with the dropout rates of clients, which according to one study exceed those of more experienced staff (Powell, Hunter, Beasley, & Vernberg, [<reflink idref="bib22" id="ref44">22</reflink>]). Additionally, both college counseling centers and graduate counseling programs may benefit from additional data on factors that influence trainees' outcomes in a college counseling center.</p> <ref id="AN0096732356-10"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref10" type="bt">1</bibl> <bibtext> Anton, W. D., & Reed, J. R. (1991). College adjustment scales: Professional manual. Odessa, FL: Psychological Assessment Resources.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref1" type="bt">2</bibl> <bibtext> Barr, V., Krylowicz, B., Reetz, D. R., Mistler, B., & Rando, R. (2012). The 2011 Association for University and College Counseling Center Directors annual survey. Retrieved from <ulink href="http://files.cmcglobal.com/Monograph%5f2012%5fAUCCCD%5fPublic.pdf">http://files.cmcglobal.com/Monograph%5f2012%5fAUCCCD%5fPublic.pdf</ulink></bibtext> </blist> <blist> <bibl id="bib3" idref="ref31" type="bt">3</bibl> <bibtext> Barrett, M. S., Chua, W.-J., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008). Early withdrawal from mental health treatment: Implications of psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45, 247– 267.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref16" type="bt">4</bibl> <bibtext> Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref17" type="bt">5</bibl> <bibtext> Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI–II, Beck Depression Inventory: Manual (2nd ed.). Boston. MA: Harcourt Brace.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref12" type="bt">6</bibl> <bibtext> Budge, S. L., Owen, J. J., Kopta, S., Minami, T., Hanson, M. R., & Hirsch, G. (2012). Differences among trainees in client outcomes associated with the phase model of change. Psychotherapy, 50(2), 150–157.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref18" type="bt">7</bibl> <bibtext> Eells,T. D., Lombart, K. G., Kendjelic, E. M.,Tumer, L. C, & Lucas, C. P. (2005). The quality of psychotherapy case formulations: A comparison of expert, experienced, and novice cognitive-behavioral and psychodynamic therapists. Journal of Consulting and Clinical Psychology, 73, 579–589.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref15" type="bt">8</bibl> <bibtext> Forand, N. R., Evans, S., Haglin, D., & Fishman, B. (2011). Cognitive behavioral therapy in practice: Treatment delivered by trainees at an outpatient clinic is clinically effective. Behavior Therapy, 42(4), 612–623.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref28" type="bt">9</bibl> <bibtext> Gallagher, R. P. (2009). National survey of counseling center directors. Alexandria, VA: International Association of Counseling Services.</bibtext> </blist> <blist> <bibtext> Gallagher, R. P. (2012). National survey of counseling center directors. Alexandria, VA: International Association of Counseling Services.</bibtext> </blist> <blist> <bibtext> Kitzrow, M. A. (2009). The mental health needs of today's college students: Challenges and recommendations. The National Association of Student Personnel Administration Journal, 46, 646–666.</bibtext> </blist> <blist> <bibtext> Kopta, S. M., & Lowry, J. L. (2002). Psychometric evaluation of the Behavioral Health Questionnaire-20: A brief instrument for assessing global mental health and the three phases of psychotherapy outcome. Psychotherapy Research, 12, 413–426.</bibtext> </blist> <blist> <bibtext> Lambert, M. J. (2005). Early response in psychotherapy: Further evidence for the importance of common factors rather than "placebo effects." Journal of Clinical Psychology, 61, 855–869.</bibtext> </blist> <blist> <bibtext> Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Yancher, S. C., Vermeersch, D., & Clouse, G. C. (1996). The reliability and validity of a new psychotherapy outcome questionnaire. Clinical Psychology and Psychotherapy, 3(4), 249–258.</bibtext> </blist> <blist> <bibtext> Lambert, M. J., Hansen, N.B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G. M., ... Reisinger, C. (1996). Administration and scoring manual for the OQ 45.2. Stevenson, MD: American Professional Credentialing Services.</bibtext> </blist> <blist> <bibtext> Miller, S. D., Duncan, B. L., Brown, J., Sparks, J., & Claud, D. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2(2), 91--100.</bibtext> </blist> <blist> <bibtext> Minami, T., Davies, D. R., Tierney, S. C., Bettmann, J. E., McAward, S., Averill, L. A., ... Wampold, B. E. (2009). Preliminary evidence on the effectiveness of psychological treatments delivered at a university counseling center. 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Journal of Counseling Psychology, 51, 38--49.</bibtext> </blist> <blist> <bibtext> Watkins, C., Jr. (2012). Educating psychotherapy supervisors. American Journal of Psychotherapy, 66(3), 279–307.</bibtext> </blist> <blist> <bibtext> Watkins, D. C., Hunt, J., & Eisenberg, D. (2011). Increased demand for mental health services on college campuses: Perspectives from administrators. Qualitative Social Work, 11(3), 319–337.</bibtext> </blist> <blist> <bibtext> Whipple, J. L., Lambert, M. J., Vermeersch, D. A., Smart, D. W., Nielsen, S. L., & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment failure and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50, 59--68.</bibtext> </blist> </ref> <aug> <p>By Guy Ilagan; Mike Vinson; Julia L. Sharp; Pamela Havice and Jill Ilagan</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib27" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib10" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib17" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib21" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib15" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib12" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib24" firstref="ref19"></nolink> <nolink nlid="nl9" bibid="bib13" firstref="ref20"></nolink> <nolink nlid="nl10" bibid="bib18" firstref="ref22"></nolink> <nolink nlid="nl11" bibid="bib25" firstref="ref23"></nolink> <nolink nlid="nl12" bibid="bib16" firstref="ref25"></nolink> <nolink nlid="nl13" bibid="bib28" firstref="ref26"></nolink> <nolink nlid="nl14" bibid="bib23" firstref="ref27"></nolink> <nolink nlid="nl15" bibid="bib20" firstref="ref29"></nolink> <nolink nlid="nl16" bibid="bib19" firstref="ref30"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref32"></nolink> <nolink nlid="nl18" bibid="bib26" firstref="ref43"></nolink> <nolink nlid="nl19" bibid="bib22" firstref="ref44"></nolink>
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  Data: Trainees versus Staff: Exploring Counseling Outcomes in a College Counseling Center
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  Data: <searchLink fieldCode="AR" term="%22Ilagan%2C+Guy%22">Ilagan, Guy</searchLink><br /><searchLink fieldCode="AR" term="%22Vinson%2C+Mike%22">Vinson, Mike</searchLink><br /><searchLink fieldCode="AR" term="%22Sharp%2C+Julia+L%2E%22">Sharp, Julia L.</searchLink><br /><searchLink fieldCode="AR" term="%22Havice%2C+Pamela%22">Havice, Pamela</searchLink><br /><searchLink fieldCode="AR" term="%22Ilagan%2C+Jill%22">Ilagan, Jill</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+College+Student+Psychotherapy%22"><i>Journal of College Student Psychotherapy</i></searchLink>. 2014 28(3):229-240.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
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  Data: 12
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  Data: 2014
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Counseling+Effectiveness%22">Counseling Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Universities%22">Universities</searchLink><br /><searchLink fieldCode="DE" term="%22Trainees%22">Trainees</searchLink><br /><searchLink fieldCode="DE" term="%22Counselors%22">Counselors</searchLink><br /><searchLink fieldCode="DE" term="%22School+Counseling%22">School Counseling</searchLink><br /><searchLink fieldCode="DE" term="%22Pretests+Posttests%22">Pretests Posttests</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Readiness%22">Readiness</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Change%22">Behavior Change</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Students%22">Graduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Professional+Personnel%22">Professional Personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Hypothesis+Testing%22">Hypothesis Testing</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+Analysis%22">Statistical Analysis</searchLink>
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  Data: 10.1080/87568225.2014.915172
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  Data: 8756-8225
– Name: Abstract
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  Data: Investigators compared counseling outcomes among nonpaid graduate-level trainees and professional staff at a college counseling center. Counseling outcomes for 331 college student participants were measured using the Outcome Questionnaire 45.2 (OQ45.2), employing a pretest--posttest design. The two groups of service providers did not differ significantly (p = .179; a > .05). A unique aspect of this study was the statistical control for the clients' readiness to change. The implications for practice in college counseling centers suggest the use of graduate-level trainees as effective counseling providers and a method to cope with high demand for services.
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        PageCount: 12
        StartPage: 229
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      – SubjectFull: Counseling Effectiveness
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      – SubjectFull: Universities
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