Rebecca Scherer, Regina Moro, Tara Jungersen, Leslie Contos, Thomas A. Field
Initiating and sustaining a counselor education and supervision doctoral program requires navigating institutions of higher education, which are complex systems. Using qualitative analysis, we explored 15 counselor educators’ experiences collaborating with university administrators to gain support for beginning and sustaining counselor education and supervision doctoral programs. Results indicate the need to understand political elements, economical aspects, and the identity of the proposed program. Limitations and areas for future research are presented.
Keywords: counselor education and supervision, doctoral, university administrators, counselor educators, support
The Council for Accreditation of Counseling and Related Educational Programs’ (CACREP) 2009 CACREP Standards (2008) included a new requirement for core faculty in both entry-level (i.e., master’s) and doctoral programs. This requirement endured in the 2016 CACREP Standards (2015). Although West et al. (1995) predicted the necessity of growth of CACREP-accredited doctoral-level counselor education programs in the mid-1990s, it was not until 2013 that core faculty in all CACREP-accredited programs were required to possess doctorates in counselor education and supervision (CES; or be grandfathered in from previous employment experience; CACREP, 2008). Master’s-level programs that are seeking new CACREP accreditation, as well as existing programs that are seeking to maintain accreditation, must therefore hire faculty with doctorates in CES. This requirement has created a need for greater numbers of doctoral graduates in counselor education, and institutions with master’s-level programs may be seeking to establish new doctoral-level programs to meet this need.
The creation of a doctoral program requires intricate navigation of complex systems of administration, accreditation, funding, laws, facilities, infrastructure, and politics. Additionally, universities have different requirements and levels of approval for new program development (S. Fernandez, personal communication, November 27, 2017). Counselor educators proposing a CES doctoral program must have an understanding of the complexity of the specific university (e.g., its organization, the history of university support for doctoral programs, the mission of the institution, the needs of the surrounding community, and the resources required for program development and implementation). Furthermore, counselor educators must have a firm grasp of accreditation standards for both the university’s regional accreditation bodies (e.g., Commission on Colleges of the Southern Association of Colleges and Schools), as well as specialty CES accreditation through CACREP.
Structure of Universities
The hierarchical structure of universities varies from institution to institution. In this section, we provide a general outline of how universities are structured to help counselor educators who are interested in proposing a CES doctoral program. This information is very important when considering how to advocate for a doctoral program because of the many organizational layers and levels associated with an institution.
Typically, counseling programs are housed in a department, college, or school of the university (e.g., College of Education). The program is led by a program head, coordinator, or department chair. This person reports to the dean of the college. The dean reports to the provost or chancellor or chief executive officer. The president of the university then supersedes this level.
It is important for faculty members to assess the priorities of their institution for academic, student, and financial affairs. For example, a small private college in an urban area may have a mission to train adult learners and to provide access to education through lower admissions standards and flexible pathways to degree completion. In contrast, a large, public, research-intensive university may have a mission to support exceptional research and secure external grant contracts, and to raise college rankings through metrics such as low acceptance rates (The Carnegie Classification of Institutions of Higher Education, 2019). Based on administrative experience with doctoral program creation, structural information must be taken into consideration when advocating to administrators on behalf of CES doctoral program development.
Successful Initiation of Doctoral Programs
In the higher education literature, there are a few publications on the creation of doctoral programs. Researchers have proposed that doctoral programs can be successfully initiated in the context of three circumstances: (a) top-down initiation, (b) filling a need in the local area, or (c) focusing on new delivery methods (Brooks et al., 2002; Haas et al., 2011; Slater & Martinez, 2000). In regard to top-down initiation, some authors have proposed that doctoral programs are likely to be launched if the initial idea comes from the provost or president of the university. Slater and Martinez (2000) described the process of successful initiation of a doctoral program in a small institution in Texas. They reported that the president suggested the idea to the dean, with later onboarding of faculty members.
Doctoral programs also seem to be initiated successfully if a need exists for such a program in the local area (Brooks et al., 2002; Haas et al., 2011). Haas and colleagues (2011) emphasized the importance of faculty members and administrators assessing program fit within the region. In both the Brooks et al. (2002) and Haas et al. (2011) studies, the importance of current delivery modalities in successfully recruiting support for a doctoral program, including the use of online delivery and interdisciplinary studies, was presented.
Rationale and Purpose
At the time of writing, no studies could be identified in the CES literature regarding how to successfully gain administrative support for starting a doctoral program in CES. Another manuscript in this special issue (Field et al., 2020) illustrates a potential pipeline problem in counselor education, in particular the need for more CES doctoral programs in the North Atlantic and Western regions of the country. CES faculty members who are contemplating starting a CES doctoral program currently have little guidance on how to gain support for starting a program. In addition, no studies could be located regarding how to successfully sustain an existing doctoral program in CES. The purpose of this study was to collect and analyze qualitative data to address the research question guiding this study: Which strategies are helpful in gaining initial and ongoing support from administrators for a CES doctoral program, and how successful are those?
This study was conducted as part of a larger basic qualitative study sampling counselor educators. The purpose of the larger qualitative study was to identify perceptions of doctoral-level counselor educators regarding four major issues pertinent to doctoral counselor education: (a) components of high-quality programs, (b) strategies to recruit and retain underrepresented students, (c) strategies for successful dissertation advising, and (d) strategies for working with administrators. In order to explore these four major issues, four research teams were assembled, one of which included the authors of this manuscript. All four coding teams worked together to select these four issues, as it was felt that these issues were most pressing for faculty who were seeking to establish new doctoral CES programs and that little information and guidance existed in these areas. In-depth interviews were then conducted with doctoral-level counselor educators in CACREP-accredited programs to answer a series of research questions that addressed the issues above. Faculty from CACREP-accredited programs were selected because the focus of the larger project was to support faculty who intended to seek CACREP accreditation for new doctoral CES programs.
In the basic qualitative tradition, qualitative data were collected, coded, and categorized using the constant comparative method from grounded theory methodology (Corbin & Strauss, 2015; Merriam & Tisdell, 2016). Basic qualitative designs involve the collection and analysis of qualitative data for the purpose of answering research questions outside of other specialized qualitative focus areas (e.g., developing theory, understanding essence of lived experience, describing environmental observations). Because we were not seeking to develop theory, understand lived experience, or research any other specialized qualitative focus area with this study, and because the research question did not require a specialized approach to data analysis, the large research team selected the basic qualitative approach described above.
Each coding team designed interview questions to directly answer their specific research question. The research questions explored in this study were as follows: Which strategies are helpful in gaining initial and ongoing support from administrators when seeking to start a new doctoral program in CES, and how successful are those? The interview questions that were developed and used as the basis for data collection for this study were: 1) What guidance might you provide to faculty who want to start a new doctoral program in counseling, with regard to working with administrators and gaining buy-in? and 2) What guidance might you provide to faculty who want to sustain an existing doctoral program in counseling with regard to working with administrators and gaining ongoing support?
Participants met two inclusion criteria for entrance into the study: (a) current core faculty members in a doctoral CES program that was (b) accredited by CACREP. Email requests were sent to 85 CACREP-accredited programs; faculty from 34 programs responded (40% response rate). Interviews were conducted with 15 full-time faculty members at CACREP-accredited CES doctoral programs. Participants were each from separate and unique doctoral programs, with no program represented by more than one participant.
The 15 participants were selected one at a time, using a maximal variation sampling procedure to avoid premature saturation (Merriam & Tisdell, 2016). The authors used maximal variation to understand perspectives from faculty of diverse backgrounds who worked at different types of institutions. Participant selection was predicated on six criteria grounded in research data about factors that may impact perceptions about doctoral program delivery: (a) racial and ethnic self-identification (Cartwright et al., 2018); (b) gender self-identification (Hill et al., 2005); (c) length of time working in doctoral-level counselor education programs (Lambie et al., 2014; Magnuson et al., 2009); (d) Carnegie classification of university where the participant was currently working using The Carnegie Classification of Institutions of Higher Education database (Lambie et al., 2014); (e) region of the counselor education program where the participant was currently working (e.g., Field et al., 2020), using the regional classifications commonly applied in the counseling profession; and (f) delivery mode of the counselor education program where the participant was currently working, such as in-person or online (Smith et al., 2015). As an example of this procedure, the first two participants were selected because of variation in gender, years of experience, and Carnegie classification. The third and fourth participants were selected on the basis of differences from prior interviewees with regard to ethnicity and region. Interviews continued until data seemed to reach saturation and redundancy at 15 interviews.
Although unintended, participant characteristics closely approximated CACREP statistics for faculty characteristics. The demographics of counselor educators in the sample was 73.3% White (n = 11), with 73.3% (n = 11) of participants working at research-intensive (i.e., R1 and R2) institutions. The sample was highly experienced, with an average of 19.7 years (SD = 9.0 years) as a counseling faculty member, with a range of 4 to 34 years. More than half of the participants (n = 9) had spent their entire career in doctoral counselor education.
The last author of this manuscript sought IRB approval. Once we received IRB approval, potential participants were contacted from 85 CACREP-accredited programs with doctoral-level graduate studies in CES. Fifteen faculty were interviewed based on maximal variation sampling described above. All but one participant (n = 14) was interviewed via the Zoom video conference platform, chosen because of its privacy settings (i.e., end-to-end encryption). Interviews were recorded using the built-in Zoom recording feature. One participant was interviewed in person at a national counseling conference. This interview was recorded using a Sony digital audio recorder.
Each videoconference interview was begun by collecting demographics and informed consent. Following the introductory phase, interviewees were asked eight questions that addressed the research questions of the larger study. Two of the questions were specific to this sub-research team. Interview questions were developed using Patton’s (2015) guidelines to inform question development. Specifically, the questions were open-ended, neutral, avoided “why” questioning, and asked one at a time. The questions were piloted with peer counselor educators prior to the start of the research project in order to get feedback on clarity and ease of answering. Participants received the questions by email before their scheduled interview. The participants were identified using alphabetical letters to blind participant identity to all members of the research team.
Each semi-structured interview lasted at least 60 minutes, during which participants responded to questions that were evenly distributed among the four research teams. Participants were therefore able to respond to interview questions with significant depth. Data did not appear saturated until 15 interviews had been conducted. Each research team was asked to review the transcripts developed from the 15 interviews to deduce whether adequate saturation had been achieved and until consensus was reached.
All interview recordings were transcribed by graduate students. These students had no familiarity with the interviewees and were trained in how to transcribe verbatim. Once completed, each transcript was sent back to the interviewees to ensure accuracy. After all interviewees checked their document, the sections of the transcripts with the questions related to each team were copied and pasted into a document organized by the participants’ alphabetical identifiers. Each team was responsible for coding and analyzing the responses to their respective questions from the interviews.
Coding and Analysis
The first, second, third, and fourth authors served as coding team members. The fifth author conducted the interviews as part of the larger study and assisted with writing sections of the methodology only. The demographics of the coding team were as follows. Team member ages ranged from mid-30s to 40s. All four identified as White cisgender females. Two of the coding team members were employed as full-time counselor educators, one identified as an administrator and counselor educator, and one coding team member was completing doctoral training as a counselor educator. Two participants had worked in doctoral counselor education programs, and two had not. We have served on both sides of the faculty–administrator relationship. These differences in backgrounds allowed for both etic and emic positioning pertinent to the topic of working with administrators to start and sustain doctoral programs in CES.
Because of the nature of both insider (emic) and outsider (etic) perspectives, the authors used a memo system when coding the manuscripts. This memo system involved three components. First, we created a blank memo every time a transcript was coded. Second, each time an interviewee’s transcribed response provoked some response within one of us, we raised it to the group and reflected on our individual experience. This response was documented in a memo. Third, one of us took notes to bracket any biases that might have been present. Identified biases often stemmed from our own experiences as faculty members talking to administrators, our service in an administrative role, or our own personal experiences developing doctoral programs. This occurred during joint coding team meetings and individual coding meetings once the open coding had been solidified into a set of codes. The memos were kept in a shared, encrypted, electronic folder for later review.
The following steps were followed by the coding team in the current study to ensure trustworthiness of analysis. The four coding team members jointly coded the first three participant transcripts to gain consensus. Following this open coding process, the second author condensed the open codes for the next phase of analysis. The coding team members then reached consensus on the condensed codes. Following agreement, we used the condensed codes to continue the coding process for the next two transcripts in joint coding meetings. This process allowed for discussion to assist with consistent understanding of the codes across the team. Following the joint open coding of the fifth transcript, the remaining 10 transcripts were assigned to one of us for open coding to be completed independently. After the open coding process was completed, the fourth author proposed a framework of the emerging themes. She examined the open codes and considered discussions that emerged throughout the team process to identify the emergent themes from the data. Open codes were only included in the analysis if they emerged in at least four transcripts, which resulted in the removal of three codes from the final results. All team members reached consensus for the themes that were originally identified by the fourth author.
The data analysis process resulted in three emergent themes regarding strategies for gaining initial and ongoing support from administrators for CES doctoral programs and the level of success of those strategies. The three themes were political landscape, economic landscape, and identity landscape. Each theme had five associated subthemes. Each theme and subtheme are discussed in more detail below, and brief participant quotes are inserted to highlight the experiences of the participants in their own words for the purpose of thick description (Merriam & Tisdell, 2016).
Considering the political landscape appeared to be a crucial strategy for recruiting administrative support when having conversations with administrators about CES doctoral programs. Participants described the importance of understanding the context of conversations with administrators within the larger political system of higher education institutions. The subthemes represented factors that influenced political decisions.
Political Endeavor: “Watching Your Politics”
Participants reported that conversations with administrators were highly political in nature and having these conversations was a form of political endeavor. One example of political endeavor was to ensure that other academic units and programs were in support of a CES doctoral program. As one participant stated, “First make sure that you’ve got your politics in order, so social work agrees with you and psychology agrees with you. So, you’ve got support of any competitor on campus.” If other academic units or programs are opposed to a CES doctoral program, it may result in administrators being cautious about supporting the program because of fears that they may be caught in the middle of a turf battle.
Gaining administrative support seemed to be predicated on the ability to “strategically build relationships” with administrators, as one participant put it. One participant commented on the complexity of developing these relationships with administrators. This participant believed that faculty needed to strike a balance of being flexible and adaptive to the administrators’ agenda and “order of the day,” while also retaining one’s “own ideology and belief systems.” Building relationships with administrators also seemed to involve avoiding unnecessary conflict that may reduce administrator support for faculty ideas. One participant cautioned that “watching your politics” and “keeping your mouth shut when you know you shouldn’t be speaking up against key administrators” was important during conversations with administrators to avoid unnecessary conflict that could “hurt your own doc program.” Learning this form of engagement seemed to be a struggle for some participants. One participant stated that they “don’t know how to navigate those conversations effectively” and felt “saddened and frustrated” as a result.
Status, Prestige, and Recognition: “A Huge Feather in One’s Cap”
Participants conveyed that CES faculty could gain administrative support through the strategy of arguing how a doctoral program could enhance status, prestige, and recognition for an institution. One participant commented that “all university presidents want doctoral programs. They want them because of the prestige.” This participant elaborated that faculty should therefore “show them how doctoral programs bring recognition, how it raises you in the rankings, and all of those kinds of things.” Some participants noted that the degree to which administrators cared about enhanced status, prestige, and recognition depended on the type of institution. For example, administrators who work at an institution that is less concerned with college rankings may be unpersuaded by the potential for enhanced status and recognition.
Participants also encouraged CES faculty to strategically engage in actions that increase recognition for the program and university. Some potential strategies that may appeal to administrators include being “identified as an expert, and to go out and do public radio broadcasts and be featured in the newspaper. Be featured in national publications.” This recognition helps with both program and university visibility, which participants believed was important to administrators. Participants also shared that visibility can help to protect the program from losing administrative support. As one participant stated, “If you’re invisible in the eyes of the administrators, they’re not going to think of you if some opportunities are coming to the fore.” This participant further commented that administrators needed to be reminded of the doctoral program through continual visibility efforts, as administrators often operate from an “out of sight, out of mind” position.
Demonstration: “Wanting Empirical Evidence”
Participants identified the strategy of sharing evidence with administrators to support and sustain doctoral programs. As one participant stated, “Once you get to the doctoral level, then we’re talking about people wanting empirical evidence.” In the early stages of program formation, this evidence might be a comprehensive proposal that is supported by data. As one participant stated, faculty need to develop a “solid plan” and be “as prepared as possible” for conversations in which administrators will “ask a ton of questions.”
Once a program is formed, it seems crucial that programs continuously provide updates to administration about program successes to sustain administrative support. Participants identified several approaches to demonstrating the success of a program. Some participants indicated that it was important to keep administration informed about student successes that occurred during doctoral study. One participant reported that their program kept administration informed via email about “every little success of the doctoral program” and provided the following examples: “Every time somebody successfully defends a dissertation, every time somebody presents at a conference, every time somebody gets a job congratulated, the president knows about it.” Other participants believed that it was helpful to report program outcomes such as graduation rates and employment statistics, which requires faculty to maintain contact with alumni to understand where they are working after graduation. It therefore seems possible that administrators may differ in which types of evidence they value, requiring faculty to carefully consider which information their administration most values when sending them updates of program successes. As one participant stated, “I think the question is, what information do you need to feed to administration to be convincing?”
Scrutiny: “Internal Credibility Is Super Important”
Participants reported that program faculty should understand the different ways that administration will scrutinize the credibility of a doctoral program. One participant defined credibility as, “Do what you’re doing well.” Administrators might withdraw support for a program that is perceived as not producing quality graduates or has problems such as not graduating students. Administrator scrutiny of the program’s financial situation also appears to be an important consideration. Administrators who are concerned about the financial viability of the program may withdraw their support.
Timeline and Trajectory: “It’s a Long Journey”
Participants reported that political decisions, such as starting and sustaining academic programs, particularly doctoral programs, may be influenced by unique timelines and trajectories. Participants encouraged faculty to develop the strategy of thinking long-term about cultivating administrative support for a doctoral program. One participant emphasized the need to “work together” with administrators in a collaborative fashion and make compromises so that administrators will support the doctoral program throughout the “long haul” and “long journey” of the program.
The length of administrator tenure at the university is another factor that faculty are advised to consider. One participant stated that faculty tend to have longer tenure than administrators at their university. As a “lifer,” this participant saw “a lot of rotation in and out of leadership.” Administrator turnover can result in changes to administrative priorities and agendas, which can impact support for a CES doctoral program. This participant encouraged faculty to “be cognizant of the fact that winds change.”
Considering the economic landscape and economic realities of starting and sustaining a doctoral program was the second main overarching theme. Developing an understanding of the economic landscape is important context for faculty when preparing for discussions with administrators. Several subthemes comprise the economic landscape, each detailed below.
Financial Aspects: “It Takes a Lot of Money”
Of utmost importance when discussing starting and sustaining CES doctoral programs with administrators is understanding the financial resources required. Many participants spoke about the cost of CES doctoral programs for universities. Participants believed that a crucial strategy to gaining administrator support was being able to explain how programs can be at least revenue-neutral or even generate revenue for the university, as administrators are less likely to support a CES doctoral program that is a drain on financial resources.
Participants varied in their perceptions of whether CES doctoral programs could generate revenue for the university. The key distinction between these participants seemed to be whether they believed doctoral programs should charge students tuition or fully fund them. Some participants believed that “high-quality doc programs do not make money for institutions” because they should be fully funding doctoral students rather than generating tuition revenue. These participants proposed that faculty should instead be “thinking creatively about funding sources” and seeking alternative methods of offsetting the financial burden on the institution. Examples of identified alternate funding sources included grants and undergraduate teaching opportunities for doctoral students.
Others were aware of this prevailing belief that doctoral programs do not generate revenue and argued the opposite: “Most faculty, when they want to start a doctoral program, they repeat this thing that they hear, which is ‘doctoral programs cost money, they don’t make money.’ And that’s not true.” These participants proposed that student tuition should be used to fund doctoral programs. One participant argued that if tuition exceeded the cost of faculty salaries, the program was likely to be generating revenue. This participant believed that counseling programs could generate money because they were relatively inexpensive. Unlike hard science disciplines, CES doctoral programs do not require expensive lab equipment, and CES faculty salaries are “lower compared to other programs.”
Tangible Benefits to Ecosystem: “How Do We Help?”
Participants discussed that administrator support for a doctoral program can be bolstered through demonstrations of how the program is supporting the local community. One participant shared that their program provides data to administrators about the number of hours of free counseling that the program provides to the community, which in turn helps the dean to gain the provost’s support for the program. Such data can help administrators when they conduct a cost–benefit analysis for whether to start a new program or sustain an existing program. Likewise, another participant encouraged faculty to take an “ecological view” and consider “how do we help . . . the surrounding communities?”
Need for Resources: “Pit Bulls in a Fighting Ring”
Participants discussed the need to address the competition for resources when attempting to gain administrator support. Participants mentioned the scarcity of resources that included faculty positions (i.e., lines) and physical building space. This scarcity resulted in programs needing to compete for resources. One participant stated, “I think we’re all going to be like pit bulls in a fighting ring over resources at this point.” Another participant shared a similar statement: “Once we get outside of our building, it is very territorial. So, we have to basically anticipate resistance from other pockets in the university if we want a new program at the doctoral level.” This participant elaborated that the provost needs to be aware of these dynamics and that faculty should attempt to make a strong case for needing resources if they are in competition with other programs.
Competition for resources seemed to occur not only within a university’s departments but also between CES programs at different universities. Doctoral applicants appear to be increasingly making enrollment decisions based on tuition costs and graduate assistantships, which increases the pressure for programs to provide financial support packages. One participant reported that it is becoming less feasible to operate a doctoral program without “some form of stipend or assistantship” because “if you don’t, there’s too many other programs that do.” This participant elaborated that administrators must support the program with assistantships and concluded, “I wouldn’t try to start a program without it.”
Some participants discussed strategies to maximize resources across the college or school in which the program exists, such as with college-wide methodology courses. Such strategies seemed particularly important when adapting to the pressure of accepting more students to make the program revenue-neutral. One participant suggested that such resource sharing was “of utmost importance… in the early beginnings of programs.”
Faculty and Program Responsibilities
Faculty have more complex responsibilities when operating a doctoral program compared with a master’s program, such as attending conferences with students and engaging in the larger campus community. As one participant stated, “It’s also being at events, interacting with administrators, making sure when walking around campus or buildings that they know who you are and that they can connect with what you’re doing.” Participants explored the economic aspects of the responsibilities that individual faculty members and the larger program have when responsible for the doctoral education of counseling students: “At our institution, you don’t get a lot of credit per se, or release time or extra pay for all of the work it takes to mentor doctoral students.” This credit that is or is not allocated to doctoral education impacts faculty members’ well-being. Another participant cautioned faculty to be aware of “faculty burnout” that accompanies tensions around adequately funding faculty positions: “If you shrink, and you still maintain the same number of students, there is simply not enough time, not enough emotional capacity, to do the good work.” Another participant shared that their doctoral programs felt like “hell on wheels” because “we ended up with a program that had more than 100 students with two real tenured faculty running the program.”
Influence of University: “Know the Size and Culture”
This subtheme represented faculty considerations of the larger university system context where the counseling program is situated. As one participant summarized, “part of it is looking at the context of the program in the university.” Participants particularly referenced size as an influencing factor. As one participant stated, “Know the size and culture of your institution.” University size influenced participants’ access to decision-makers: “We’re so small that I could literally walk out of my office and two minutes later I can be in the provost’s office. I can ask a question. They’re very approachable, and so I don’t feel intimidated.” Understanding the institution’s mission and its funding priorities is crucial to forging successful alliances with administrators regarding whether to start and sustain a CES doctoral program. Understanding where a CES doctoral program fits within the institution’s academic structure therefore helps faculty to effectively communicate with administrators, and consistently reviewing this can help inform ongoing dialogues with administrators.
The overarching identity landscape theme represents how programs both understand their internal identity regarding doctoral education, as well as the external identity factors that contribute to the program. Each subtheme is detailed below with participant quotes.
Operationalize and Define Commitment: “Faculty Have to Buy In”
Gaining faculty buy-in prior to conversations with administrators and gaining approval for a doctoral program was a consistent message relayed by participants. One participant reflected, “Everybody has to be on board and has to buy in to the concept that the mission can’t be the mission of one person.” Another participant recommended that faculty leadership (e.g., program directors) need to operationalize this commitment through intentional dialogues with faculty. This participant stated that “the evidence for faculty buy-in isn’t always there until you probe.” They elaborated that faculty leadership can facilitate discussions around the following questions: “Are you willing to do X, are you willing to do Y?” and “If we start a doctoral program, do you feel like you have the skills you’ll need or do you fear that you’re going to be left behind?” Such conversations appeared important to developing a unified collective commitment to the doctoral program, which was critically important when challenges arose. Other participants reflected on personal buy-in and encouraged self-reflection in this regard: “Things to consider including one’s own personal meaning making.” Participants reflected that doctoral education was significantly different than master’s-level education and required a different level of commitment. Administrators are unlikely to support a doctoral program if the faculty are divided in their commitment to the program.
Understanding Differences: “Know What Your Program Is Worth”
Participants spoke about the need for faculty to possess knowledge about multiple aspects of doctoral education when conveying information to administrators. Faculty should be familiar with the differences between master’s and doctoral education, between doctorates in other disciplines within the university, and among doctoral programs at different universities in the state. This information assists faculty “to really know what your program is worth and to be able to explain it.” For example, faculty should make administrators aware of how doctoral education can enhance master’s-level training rather than result in master’s students being “ignored” and treated as “second class citizens.”
Participants indicated that administrators may not be familiar with the counseling profession and thus may need education. Participants reported the need for “educating your administrative colleagues about what counselor ed is, what they do, how we train.” Another participant stated that “even at the dean level, they don’t know what the heck a mental health counselor is. Not a clue.” Consistent with this, administrators may also need information about other aspects of the profession, such as the value of specialized accreditation. One participant reported, “I think that we can do a better job of telling our admin the pros of CACREP versus the cons.” Education about CACREP accreditation was important because of the costs associated with accreditation fees and hiring core faculty to meet the CACREP doctoral standards.
Quality in Programs: “High-Quality Output”
Participants reflected on the importance of program quality as a reflection of the programs’ overall identity. Program outputs seemed to be a particularly important measure of program quality. Some participants, particularly those at research-intensive universities, emphasized the importance of research-related outputs such as “grants, high-quality output, and visibility.” Across participants, employment rates were a particularly important measure of program quality, especially employment in academic and administrative jobs post-graduation. Participants reported that such metrics were useful as a “selling point” to administrators, especially if needs existed for doctoral-level graduates in the local area. As one participant stated, “Some of those outcomes become really important to administrators, and I think that we need to be good at putting those outcomes in front of them.”
Participants also shared concerns with program quality. These concerns often centered on admitting more students than can be adequately mentored through the dissertation process. One participant was “concerned about doc programs that bring in cohorts of 20 and churn them out” because they feared that “big doc programs” are “just course-based models without a whole lot happening outside of that. . . . And, you know, I worry about dissertation mentoring.”
Program accreditation was explored as an influencing factor in program quality that ultimately influences the overall program identity through reputation. One participant stated, “We built the program around the accreditation standards and took those standards very seriously.” Another participant explored how the accreditation process can influence administrators’ opinions of the program: “If we had bombed that visit, from the president to the vice president on down, we would have looked really bad.”
Advancing the Institutional Mission: “It Has to Match”
Study participants commented on the importance of the identity of the doctoral program connecting to the mission of the larger institution. One participant encouraged faculty to consider the institutional mission when communicating with administrators: “When we advocate for programs, we need to understand the mission of the institution.” This participant reported that administrators in a university that values community service may be in favor of doctoral programs that “create more service providers for the local community.” Another participant stated that “it has to match the university’s mission. I hear that more and more and more.” This participant acknowledged that a proposed doctoral program would only receive administrative support if it “fits with the strategic plan of the university.” Participants indicated that the program should align not only with the institutional mission but also with the mission of the college or school where the program is housed.
Stakeholder Dynamics: “Making the Administrators Happy”
Participants discussed the variety of stakeholders that faculty should consider when developing a CES doctoral program. Such stakeholders include the students being educated, faculty in the program, administrators who make decisions about the program, and employers of future program graduates. Participants reflected that each stakeholder group can contribute meaningfully to the identity of the program.
At times, a stakeholder group’s contributions and agendas may be at odds with those of another stakeholder group. This is particularly problematic when tensions exist between a stakeholder group and administrators. For example, faculty may prefer a smaller program than administrators. One participant stated that “one of the things that I’ve fought with faculty about my whole life, has been that [faculty] want small classes and they want few students.” This participant added that administrators tend to close smaller programs when pressured to cull the number of doctoral programs at an institution, and thus smaller size represents a potential threat to the program: “Any time an administrator is going to cut a program or deny resources to a program, they do it with the program with the least number of students in it. It’s just the absolute way it’s done.” This participant proposed that faculty stakeholders must therefore understand the dynamics of higher education administration when advocating, as “making the administrators happy with the numbers” is an important priority.
In this study, we conducted a qualitative analysis of interviews with 15 experts in the field to examine the research question. We identified participant-reported strategies for gaining initial and ongoing support from administrators for a CES doctoral program. The overarching themes of political, economic, and identity landscapes emerged from the data, alongside associated strategies necessary for gaining support. Navigation of complex university systems, including accreditation, finances, legal concerns, infrastructure, and politics, seem to be required for successful initial administrator approval of a CES doctoral program. Awareness of institutional mission and history, purpose, community needs, fiscal realities, and the university’s organizational chart also can facilitate approval and successful program sustenance.
Implications for CES Faculty
The findings from this study may be utilized by existing master’s degree counseling program faculty who want to create a CES doctoral program. Faculty should embark on a data-driven process to inform administrators of tangible benefits across multiple systems and articulate the financial resources necessary for long-term success. As new CES doctoral programs are proposed, faculty should ensure that university administrators are aware of the relative worth of counselors and counselor educators, particularly in contrast to other mental health disciplines that may exist on campus. They may need to document the tangible benefits that CES programs bring to the university that are in alignment with the university’s mission and strategic plan. In 2013, Adkison-Bradley noted, “As universities change and grow, academic programs are often required to justify their request for resources or asked to explain how they uniquely contribute to the overall mission of the college and surrounding communities” (p. 48). Faculty could benefit from open dialogue with administrators and mentors about what it costs the institution to have a doctoral program compared to what revenue and resources a doctoral program can generate. CES faculty also can provide data to explain how accreditation requirements that may appear expensive to administrators (e.g., 1:6 faculty–student ratios in practica; 1:12 faculty–student ratios) do benefit students, clients, and communities, including protection of “broad public interests” (Urofsky, 2013, p. 13).
Faculty must engage in systemic thought that goes beyond the program and department. Bronfenbrenner’s (1979) ecological systems model provides a useful model for program faculty to understand. This model includes four main systems in which individuals exist—microsystem, mesosystem, exosystem, and macrosystem, with each system growing in size and complexity. Faculty without this perspective risk experiencing their department in a bubble and may not realize how their smaller microsystem (i.e., program, department) fits within the larger macrosystem of the university. The political landscape can become entangled in the developing exosystem where these systems overlap. This exosystem includes considerations for the college’s or school’s strategic priorities where the doctoral program is located. Faculty also should consider larger systemic interactions, such as the doctoral program’s relationship with the local community, with other master’s and doctoral programs in the state, and with other doctoral programs nationally.
The 2016 CACREP Standards (2015) require doctoral education to focus on leadership. However, the standards require this education to be in relation to counselor education programs and in professional organizations, not specifically in institutions of higher education as larger systems. It is unknown how or if students receive formal education about how to navigate university systems, as it is not typically included in CES doctoral program curricula. However, in our own personal experiences as faculty members and doctoral students, we have found that this knowledge seems to be acquired through observation, experience, and on-the-job mentoring. Unfortunately, this learning may occur when new and junior faculty are under pressure to establish themselves for tenure and promotion. Senior faculty, including those nearing retirement, are likely to possess this systemic knowledge and understanding. This knowledge could be conveyed via formal or informal mentoring programs; however, junior faculty in counselor education programs report a lack of mentoring experiences (Borders et al., 2011). The lack of mentoring could be from a variety of reasons, as junior faculty members may be intimidated by senior faculty (Savage et al., 2004), or senior faculty may lack the commitment to put forth the long-term effort to gain support for a new CES doctoral program.
Faculty must be willing to invest in learning about the processes involved in doctoral program creation—to listen, be respectful, and exercise patience for the time required for program approval, funding, and development. The results of this study indicate that program generation is a political process, and junior faculty must be aware of their environment. Faculty have different levels of input and leadership at different institutions, such as with different forms of shared governance (Crellin, 2010). Faculty who do not understand political savviness, the role of fiscal constraints, and the historical precedents for doctoral program initiation may struggle more than those who understand the lens by which individual institutional decisions are made.
Implications for University Administrators
University administrators could utilize the results of this study to understand how to work with faculty who are requesting the initiation of a new doctoral program. Administrators could consider establishing dedicated time and orientation to new and junior faculty to assist them in conceptualizing how faculty requests are prioritized within the institution, perhaps via a formal mentoring program (Savage et al., 2004). For example, if the university’s current vision is to respond to the lack of STEM (science, technology, engineering, and mathematics) graduates in the local job market, counseling faculty could better manage their expectations about the estimated timeline of new degree program creation while aligning their new CES doctoral degree proposal to a more attainable target date. Communication about the timeline of decisions and the patience involved in systemic change (e.g., state legislature involvement) could also benefit the faculty perspective. Opportunities for learning about the organization are a crucial ingredient in organizational change (Boyce, 2003).
Although it is the responsibility of deans and department chairs to communicate the university’s vision and strategic plan, administrators should also trust the CES faculty’s distinct knowledge of the field and dynamic accreditation standards. Faculty are uniquely qualified to anticipate shifts in the profession that could impact their programs. From our experience, CES faculty who serve as internship clinical supervisors may also possess unique knowledge of the needs of the surrounding communities through their supervisees’ reports of client needs.
It is suggested that administrators include a university organizational chart in new faculty orientation or in the faculty handbook so that faculty can be aware of the hierarchy within the university. The orientation should include a clear explanation of how the particular institution prioritizes agendas and provide a history of the institution, with specific examples of prior program creation in the face of competing needs (e.g., missions, financial). Faculty can then understand how the university invests in its future.
Limitations and Suggestions for Future Research
Several limitations exist with qualitative research in general, and with this unique project specifically. In general, qualitative research is limited by researcher bias, interviewer bias, interviewee bias, and participant demographics (Corbin & Strauss, 2015). To control for potential bias during the analysis process, the coding team used several strategies to enhance trustworthiness, including recruiting coding team members who had identities as both CES faculty and administrators, bracketing biases throughout coding, using consensus to resolve discrepancies in coding, and using memos to document decisions. Future studies could seek to triangulate the data from this study to determine whether the findings are transferable to the perspectives of other faculty in CES doctoral programs.
The focus of this particular research study was to explore faculty perspectives regarding how to gain administrative support for initiating and sustaining CES doctoral programs. As such, the perspectives of administrators were not surveyed regarding how to gain administrative support for CES doctoral programs (beyond those counselor educator faculty participants who have served in administrative roles). Future studies, perhaps in the form of quantitative research, could include these perspectives to determine whether the perspectives of CES doctoral faculty are consistent or divergent with administrator experiences regarding how to work effectively with administrators.
We sought to understand strategies for successfully gaining initial and ongoing administrative support for a CES doctoral program. This exploration included both participants who had recently started new programs and those who had long worked in CES doctoral programs. However, an analysis of thematic differences between participants who had and had not spearheaded the creation of a CES doctoral program was not conducted. Future research could explore whether strategies varied for those who had recently started a CES doctoral program versus those who had not. In addition, data were not organized and analyzed by differences in participants’ institution type (i.e., private or public), because it was outside the scope of the research question. Finally, the study focused solely on faculty at CACREP-accredited institutions. It is unknown whether the perspectives of participants in this study would be consistent with faculty at non–CACREP-accredited institutions.
The counseling profession continues its efforts to address the pipeline shortage of doctoral-level CES faculty to meet CACREP accreditation requirements. To meet this need, some master’s-level programs are seeking to start CES doctoral programs. The findings from this study may be useful to CES faculty when planning a strategic approach for collaboration with administrators regarding the initiation of new CES doctoral programs. This strategic approach will involve exploring political elements, economical components, and the identity of the proposed program. The findings of this study indicate these areas of knowledge promote a more comprehensive planning process to help prepare for working with administrators on the creation of a doctoral program.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Rebecca Scherer, PhD, NCC, ACS, CPC, is an assistant professor at St. Bonaventure University. Regina Moro, PhD, NCC, BC-TMH, LPC, LMHC, LCAS, is an associate professor at Boise State University. Tara Jungersen, PhD, NCC, CCMHC, LMHC, is an associate professor and department chair at Nova Southeastern University. Leslie Contos, NCC, CCMHC, LCPC, is a doctoral candidate at Governors State University. Thomas A. Field, PhD, NCC, CCMHC, ACS, LPC, LMHC, is an assistant professor at the Boston University School of Medicine. Correspondence may be addressed to Rebecca Scherer, B43 Plassman Hall, 3261 West State Road, St. Bonaventure, NY 14778, email@example.com.
Hannah Brinser, Addy Wissel
Students in foster care frequently experience barriers that influence their personal, social, and academic success. These challenges may include trauma, abuse, neglect, and loss—all of which influence a student’s ability to be successful in school. Combined with these experiences, students in foster care lack the same access to resources and support as their peers. To this end, school counselors have the opportunity to utilize their unique position within the school community to effectively serve and address the complex needs of students in foster care. This paper addresses the current research, presenting problems, implications, and interventions school counselors can utilize when working with this population.
Keywords: students, foster care, school counseling, support, interventions
In 2017, there were a total of 442,995 children and youth in the foster care system (U.S. Department of Health and Human Services, 2018). Given the number of these students in schools and communities, school counselors have the opportunity to utilize their position within the school system to identify, respond to, and advocate for the needs of students in foster care to ensure equity and access in all areas. Although all students need positive relationships and stability to be successful, students in foster care often lack the same access to support, resources, and opportunities as their peers (McKellar & Cowen, 2011; Palmieri & La Salle, 2017). These barriers and challenges contribute to gaps in achievement, relationships, and skills for these students (Palmieri & La Salle, 2017). Compared to their peers, students in foster care are more likely to be absent from school, repeat a grade, and change schools (Cutuli et al., 2013; Palmieri & La Salle, 2017; Unrau et al., 2012), which ultimately impacts their ability to establish and maintain relationships. Additionally, students in foster care are twice as likely to receive out-of-school suspensions, over three times as likely to receive special education services, and over 20% less likely to graduate from high school (National Working Group for Foster Care and Education [NWGFCE], 2018).
When it comes to higher education, students in foster care are less likely to enroll in college preparatory classes, attend college, and obtain a 4-year degree when compared to their peers (Kirk et al., 2013; Unrau et al., 2012). Research suggests that as little as 3%–10.8% of youth previously in foster care attain a 4-year degree, compared to the national college completion rate of 32.5% (NWGFCE, 2018). However, it is important for school counselors to realize that between 70%–84% of students in foster care desire going to college (Courtney et al., 2010; NWGFCE, 2018). Although students in foster care feel motivated to attend and complete college, academic achievement can easily become another barrier. On average, students in foster care receive both lower ACT scores and high school GPAs and perform lower on standardized tests compared to their peers—all of which influence one’s admission to college (O’Malley et al., 2015; Unrau et al., 2012).
Unfortunately, it is also common for students in foster care to experience other challenges that influence their success in school, such as trauma. Trauma can include abuse; neglect; and the loss of family members, friends, and communities (Scherr, 2014). Without adequate support, trauma can impact a student’s executive functioning and memory, ultimately affecting their ability to learn (Avery & Freundlich, 2009). Additionally, separation from family members, disrupted relationships, and frequent transitions lead to an increased risk for difficulties in expressing and regulating emotions, tolerating ambiguity, and problem-solving (O’Malley et al., 2015; Unrau et al., 2012). These interrelated and complex factors contribute to the achievement gap experienced by students in foster care as evidenced by lower academic achievement and less engagement in school (Pecora et al., 2006; Unrau et al., 2012).
Importance of Serving This Population
When considering interventions to support students in foster care, it is important to explore what they believe will be helpful for their growth and success. It is likely that the majority of students in foster care already feel a lack of control over what occurs in their lives (Scherr, 2014). Therefore, this is an opportunity to encourage student involvement while increasing student self-efficacy. Clemens et al. (2017) found that students in foster care emphasize the importance of having opportunities to connect with others in similar situations, learning practical skills, and implementing different strategies to better their lives. To provide a sense of normalcy and belonging, school counselors can advocate for interventions that promote connectedness and engagement with other students (Unrau et al., 2012).
Removing barriers, improving access to services, maintaining enrollment, improving attendance, and facilitating academic progress is critical in promoting success for students in foster care (Gilligan, 2007). Therefore, school counselors should be aware of the barriers related to access that exist for students in foster care and should be intentional in taking steps to remove any inequities. Working proactively and using a strengths-based approach that acknowledges the skills, strengths, and resiliency of students are ways in which school counselors can effectively meet the needs of students in foster care (Gilligan, 2007; Scherr, 2014). To illustrate, a strengths-based approach can be utilized with students who have anxious attachment patterns by acknowledging their ability to care for others, rather than focusing on the negative aspects of their attachment behaviors (e.g., being too “needy”). Although it can be easy to focus on the behaviors and disruptions that occur, school counselors have the opportunity to instead focus on these students’ accomplishments, strengths, and dreams. Ultimately, it is evident that students in foster care face many challenges that influence their ability to be successful. In an effort to address this need, the following section outlines interventions for school counselors to use when working with students in foster care.
Positive school relationships are an essential part of school climate and can serve as a protective factor for students experiencing adversity (Furlong et al., 2011; O’Malley et al., 2015). Therefore, focusing on school climate may be an effective approach in supporting students in foster care, as positive school relationships can also help close achievement gaps between these students and their peers (Clemens et al., 2017). For example, positive school climate decreases rates of disruptive behaviors, truancy, fights, and suspensions at school (Hopson & Lee, 2011). In addition, Voight et al. (2013) found that students’ positive school climate perceptions also contributed to academic achievement as indicated by state standardized test scores. School counselors can enhance school climate by allowing student voices, utilizing empowerment strategies, implementing evidence-based programs, providing adult mentoring (O’Malley et al., 2015), and working to create a positive peer culture (Bergin & Bergin, 2009).
It is particularly important to pay attention to school culture, as these shared norms, beliefs, and behaviors affect perceptions of school climate (MacNeil et al., 2009). To create a positive school culture, Ziomek-Daigle et al. (2016) recommended that school counselors implement interventions using a multi-tiered system of supports. For example, providing classroom lessons on topics such as kindness, empathy, and acceptance are Tier 1 interventions that work to cultivate a positive school culture (Bergin & Bergin, 2009; Ziomek-Daigle et al., 2016). Additionally, school culture can be influenced by creating shared values and expectations for students throughout the school community (MacNeil et al., 2009). For example, school counselors can utilize empowerment strategies when teaching students in foster care to advocate for themselves and find autonomy in meeting their needs. The school counselor might say, “Last week, you worked so hard at learning to use ‘I statements’ when expressing your needs and feelings to others! In class, I even saw that you raised your hand to ask for a break when you started to get overwhelmed in math. How might you use similar skills to advocate for yourself when you get frustrated in social studies?” In this way, the school counselor is improving school culture by creating a shared expectation among students, teachers, and staff.
Moreover, school counselors can enhance school climate by facilitating enriching educational experiences that contribute to academic success (Gilligan, 2007). To ensure that students in the foster care system receive the same educational experiences as their peers, school counselors can screen, monitor, plan, communicate, and collaborate with other stakeholders (e.g., teachers, administration, staff, and foster families) to ensure equity and access for students in foster care (Palmieri & La Salle, 2017). Educating stakeholders about working with students in foster care can encourage inclusive assignments, promote an understanding of potential responses and reactions from students, and decrease negative behavioral perceptions (McKellar & Cowen, 2011). Additionally, including students in decisions about their education, where they attend school, and the support they receive can increase their self-efficacy, goal development, and self-advocacy skills (Palmieri & La Salle, 2017). This intentionality can also help them feel welcome, respected, and important—all of which increase their school connection.
Collaborating With Stakeholders
School counselors should plan to accommodate and work with students who may enter school in the middle of the year, as 34% of students in foster care experience five or more school changes by the time they reach the age of 18 (NWGFCE, 2018). When these students arrive at school, it is important that school counselors welcome them, explain classroom and school procedures, show them around the school, and facilitate connections with other students (Palmieri & La Salle, 2017). From the beginning, school counselors can prioritize involving the foster family by calling to welcome them, answering any questions they have, providing them with helpful information (e.g., teacher contact information), and following up with them after a few weeks. For example, packets can be sent home with students so foster families have access to any relevant documents or previous newsletters containing helpful information (McKellar & Cowen, 2011). Additionally, it may be beneficial for school counselors to invite the foster family to meet with them in person to create a stronger foster family and school partnership. Furthermore, incomplete student records can have a significant effect on academic services for students in foster care. Therefore, school counselors should work diligently with other school districts to retrieve and maintain these records (McKellar & Cowen, 2011).
Along with planning, school counselors can provide all stakeholders with evidence-based information to effectively serve and address the needs of students in foster care (Kerr & Cossar, 2014). With this purpose in mind, school counselors can provide training to stakeholders on topics such as reflective listening, creating secure attachments, recognizing and responding to feelings and behaviors, and setting limits and boundaries (Kerr & Cossar, 2014). Informed stakeholders can more effectively support and respond to the unique needs of students in foster care, and in turn, students may be more successful in managing their emotions and behaviors (Palmieri & La Salle, 2017). This awareness can also strengthen relationships that promote school success (Kerr & Cossar, 2014). Additionally, school counselors can be proactive in collaborating with stakeholders to create structured and supportive classroom environments where students in foster care feel safe while learning. For example, working with teachers to modify assignments that have the potential to be triggering (e.g., family-based assignments) is essential in promoting student–teacher relationships and academic achievement (C. Mitchell, 2010; Palmieri & La Salle, 2017).
Students in foster care often experience triggers at school, whether it is from an assignment (e.g., family-based assignments), a topic discussed in class, or a community event that seems to be exclusively for biological parents (West et al., 2014). When these experiences occur, students in foster care do not always have the ability to self-regulate and utilize healthy coping skills (West et al., 2014). For this reason, it is essential to not only advocate for inclusive assignments and events but to also help students effectively manage their triggers so they can be academically and relationally successful. Additionally, it may be helpful to provide stakeholders with information about why certain activities lack inclusivity for students in foster care and offer possible alternatives or modifications for these experiences. To illustrate, events such as “Muffins with Moms” and “Donuts with Dads” can be altered for inclusivity by expanding the population to include anyone in the student’s support system (e.g., “Floats with Friends” or “Popcorn with Important People”).
Additionally, an assignment about creating a family tree could be modified for inclusivity by focusing on the diversity of family structures. C. Mitchell (2010) offers the alternative of creating “The Rooted Family Tree,” in which the roots represent one’s birth family, the student as the trunk, and the foster or adoptive family filling in the branches. Similarly, “The Family Houses Diagram” utilizes houses instead of trees to allow for multiple places of living and the option to form a connection between birth, foster, or other family types (C. Mitchell, 2010). Another common assignment given in schools is to bring a baby picture to share with the class. This lacks inclusivity for students in foster care, as they might not have these pictures or there may be difficult memories attached to them. Additionally, this puts the student in the painful position of having to explain why they do not have these pictures (C. Mitchell, 2010). As a result, C. Mitchell (2010) recommends framing the assignment as a choice: Bring a picture of yourself as a baby or at a younger age, on a vacation or holiday, or engaging in any activity that you enjoy.
Knowing how to cultivate secure attachments with students in foster care is especially relevant for stakeholders, as positive student–adult relationships can influence other relationships in the student’s life by altering their internal working model (Bergin & Bergin, 2009; Sabol & Pianta, 2012). Although it can be difficult to create and maintain secure relationships with students who experience insecure attachment (Bergin & Bergin, 2009), stakeholders have the opportunity to fill in attachment gaps that may exist for students in foster care. Secure attachment is related to higher grades and standardized test scores, increased emotion regulation, and higher self-efficacy (Bergin & Bergin, 2009; Golding et al., 2013). Moreover, students with insecure attachment tend to show less curiosity (Granot & Mayseless, 2001), have poorer quality friendships, and exhibit behavior problems (Bergin & Bergin, 2009; Golding et al., 2013).
Importantly, attachment to teachers, rather than just biological parents, is linked to school success (O’Connor & McCartney, 2007; Sabol & Pianta, 2012). When students have healthy relationships with their teachers and perceive them as supportive, they show greater interest and engagement in school, which leads to improvements in academic achievement (Bergin & Bergin, 2009; Golding et al., 2013). Additionally, students who experience insecure attachment crave positive, warm, and trusting relationships but often lack the skills to create them. For this reason, stakeholders can help nurture secure relationships by being genuine, maintaining high expectations, and providing as much choice and autonomy as possible (Bergin & Bergin, 2009). Furthermore, noticing when these students are not at school, or when they return after an absence, can help them know they are valued and cared for.
To advocate, school counselors can help stakeholders understand why students with insecure attachment are behaving and reacting in certain ways, while also helping staff to respond in ways that disconfirm students’ insecure working models (Bergin & Bergin, 2009). In this way, staff can show that students’ particular beliefs about relationships with others may not always be true. To illustrate, not asking for help in the classroom, ignoring the teacher, or denying the need for assistance could be a manifestation of an insecure avoidant attachment style (Golding et al., 2013). This student does not want to become close or show vulnerability, as they fear that the teacher will reject or separate from them (e.g., their internal working model). For these students, it can be easier to not ask for help or engage in classroom projects at all than risk the hurt of rejection (Golding et al., 2013). A teacher who misunderstands this might believe they are unable to adequately support the student. As a result, they may stop trying to help, which confirms the student’s internal working model of fear and rejection. Instead, the teacher can disconfirm this student’s internal working model by providing reassurance of their consistency and availability (Golding et al., 2013). For example, the teacher conveying that they want to help, while also asking how they can help, offers healthy choice and autonomy. Encouraging small changes in how stakeholders respond to students in foster care provides a space for positive and secure relationships to develop.
Skill Development and Addressing Unique Experiences
Behavior Management, Emotion Regulation, and Social Skills
Difficulties in behavior management, emotion regulation, and social skills are common among students in the foster care system, as they lack control over many events that occur in their lives (Octoman et al., 2014; Scherr, 2014). These students’ unique and complex experiences can impact their ability to appropriately manage their emotions, behaviors, and interactions with others. Unfortunately, these extreme emotions and behaviors often result in several different placements, the loss of relationships, and the loss of school and community connections (Octoman et al., 2014).
Given this information, school counselors can contribute to student success by collaborating with stakeholders to communicate appropriate behavior, identify boundaries, and explicitly state expectations. Providing behavioral support, management, and individual attention can help students engage in positive behaviors that facilitate their success at school and in the classroom (Palmieri & La Salle, 2017). Additionally, working with students to identify and manage emotions decreases externalizing behaviors, reduces stress levels, and improves relationships. Likewise, providing education about control, acceptance, coping skills, and distress tolerance are applicable emotion regulation interventions to utilize with students in foster care (Benzies & Mychasiuk, 2009). Groups and interventions on topics such as social skills, problem-solving, making and keeping friends, and appropriate behaviors can help students develop healthy interpersonal relationships (Scherr, 2014; Zins & Elias, 2007).
Grief and Loss
Additionally, it is crucial that school counselors intentionally address the unique and complex experiences of students in foster care. For example, these students often experience non-death losses that go unacknowledged, including the loss of parents, siblings, friends, and communities (M. B. Mitchell, 2018). These losses may involve a lack of clarity and create confusion about a loved one’s physical or psychological presence, commonly referred to as ambiguous loss (Boss, 1999; Lee & Whiting, 2007). To illustrate, being separated from one’s family and placed into foster care can generate grief and loss reactions, including confusion, isolation, distress, uncertainty, helplessness, denial, extreme behaviors, and guilt (Lee & Whiting, 2007; M. B. Mitchell & Kuczynski, 2010). Disenfranchised grief occurs when others disregard and do not acknowledge a loss (Doka, 1989; M. B. Mitchell, 2018). Unfortunately, it is common for the child welfare system and society to ignore experiences of grief and loss in foster care (M. B. Mitchell, 2018; M. B. Mitchell & Kuczynski, 2010).
In an effort to address this, school counselors can begin by identifying, acknowledging, and validating losses that are not caused by death but produce many similar grief responses (M. B. Mitchell, 2016, 2018). Additionally, school counselors can educate stakeholders about ambiguous loss and disenfranchised grief, as it is important for the entire school community to have an understanding about manifestations of grief and loss when working with these students (e.g., internalizing and externalizing). In general, school counselors can advocate for students in foster care by validating their experiences, equipping them with education and resources, helping others understand why their experiences embody grief and loss, and acknowledging the inherent confusion involved in their unique situations (Lee & Whiting, 2007).
Accessing School and Community Resources
Students involved in their school community through extracurricular activities, leadership, and positions of responsibility often experience more motivation and engagement in learning (Gilligan, 2007). Additionally, such engagement is beneficial in creating a sense of normalcy, belonging, and community with other students. Unfortunately, these opportunities can seem limited to students in the foster care system because of cost, timing, and transportation barriers (Palmieri & La Salle, 2017). Therefore, it is critical that school counselors collaborate, advocate, and act to remove these barriers, as engagement in the school community can result in academic, social, and behavioral improvements (Scherr, 2014). School counselors can facilitate this involvement and engagement in the school community by collaborating with other stakeholders to provide opportunities. For example, encouraging and assisting students in foster care to navigate and obtain leadership positions (e.g., student government) will not only improve their engagement in school, but also increase their self-efficacy and sense of belonging within the school community. Additionally, school counselors can collaborate with other professionals (e.g., social workers, school psychologists, and school nurses) to identify and address different areas of support, resources, and opportunities for these students.
With a national student–school counselor ratio of 455:1 (American School Counselor Association, 2019), group counseling is a promising approach to help school counselors meet the complex needs of students who are in foster care. Additionally, this is an effective way to encourage involvement and connectedness with students who have similar backgrounds, while providing these students with the skills that they need to be successful (Palmieri & La Salle, 2017). Involvement in group counseling can help create a sense of normalcy, belonging, and community with other students (Alvord & Grados, 2005) and can also result in academic, social, and behavioral improvements (Scherr, 2014).
Hambrick et al. (2016) found that children in foster care experienced improvements in behavior, academics, quality of life, attachment, placement stability, and emotion regulation following their participation in group-based interventions. Although participating in a small group with other students in the foster care system may provide the opportunity to feel understood and less alone, students may also benefit from engaging in group activities with typical peers. For example, students in foster care might participate in a “lunch bunch” group where they eat in community with the school counselor and other like-age peers. In these groups, students can play, learn from watching the interactions of peers, and develop the skills necessary for initiating and maintaining positive peer relationships.
Utilizing a reality therapy approach for group counseling seems particularly beneficial, as it addresses choice, control, and healthy ways of getting one’s needs met—all common issues students in foster care may struggle with (Benzies & Mychasiuk, 2009; Cameron, 2013; Kress et al., 2019). These components are essential in empowering students to choose how they respond to and face the challenges in their lives (Benzies & Mychasiuk, 2009). In this approach, school counselors can assume the roles of teacher, advocate, and encourager by educating about responsibility, choices, and the importance of meaningful relationships (Kress et al., 2019). Utilizing the WDEP system (i.e., wants, doing, evaluation, and planning) to explore questions, including “What do you want?”, “What are you doing?”, and “Is it working?”, helps students assess if their current behaviors are getting them what they desire, and if they are not, how they can change in healthy ways (Wubbolding, 2011).
Because behavior is intentional, it is beneficial to look at each student’s behavior as an attempt to satisfy their needs (Glasser, 1984, 2000). Additionally, focusing on the here and now is helpful in guiding and educating students about effective and appropriate ways to get their needs met by others (Glasser, 1992, 2000). As many students in foster care have not always had their needs met in the past, they must learn to have their needs met in healthy and effective ways (Octoman et al., 2014). For example, a student who is grabbing and touching other students might be trying to get their need of love and belonging met. In this situation, it would be a helpful learning experience to guide this student to meet this need in a different way, such as asking the peer permission for a hug or setting aside time to spend with them later (Octoman et al., 2014).
When using this approach, school counselors can reframe behavior to emphasize student strengths, identify and celebrate students’ acceptance of choice and responsibility, create anticipation for change, and communicate hope about success (Kress et al., 2019). School counselors can also prioritize rapport building; creating safety through rules, goals, and expectations; and helping students realize that they are not alone in their experiences (Alvord & Grados, 2005; Gladding, 2016; Kress et al., 2019). Other small groups that address issues such as social skills, making and keeping friends, and college and career exploration may also be helpful for students in foster care.
Students in the foster care system experience many transitions and losses, which can result in disruptions to the adult and peer relationships that support educational success. In this way, mentorship programs work to reduce risk and provide protective support to students in foster care (Scherr, 2014). These students value having a mentor who provides support and encouragement on topics related to academics, college, and life (Clemens et al., 2017; Dworsky & Pérez , 2010) and benefit from having a consistent, trustworthy, and non-familial adult in their lives (Benzies & Mychasiuk, 2009). Mentorship programs contribute to fewer behavior referrals, less school mobility, and improved graduation rates (Salazar et al., 2016). Additionally, the accountability of mentorship can motivate students to improve their attendance, achievement, and engagement in school. Given this information, facilitating connectedness and mentorship for these students is crucial in providing them with the support, consistency, and encouragement they need to accomplish their goals.
The Check and Connect Model is evidence-based and targets students who show warning signs of disengaging from school such as poor attendance, behavioral issues, and low grades (Tilbury et al., 2014), all of which are particularly relevant for students in foster care. Potential mentors can be natural (e.g., someone already present and supportive in the student’s life) or someone from the community interested in volunteering (Salazar et al., 2016). Utilizing natural mentors, if available, is beneficial in acknowledging the natural supports that already exist in students’ lives. For example, if a student already has a trusting relationship with a staff member, it is important to utilize this connection to maintain stability. However, if a student is unable to identify any natural mentors, working with volunteers in the community is also an excellent option. Both are impactful in different ways, and the quality of the connection is what is really crucial (Salazar et al., 2016).
It is essential that mentors are consistent, empathetic, authentic, and committed to supporting students in foster care. Mentors not only serve as a relational connection for these students but also help youth expand their social support networks, set goals, explore postsecondary options, and increase involvement in the school community (Salazar et al., 2016). School counselors can work with mentors to monitor student performance variables, such as absences, behavioral referrals, and grades, while helping students solve problems, identify skills, and reach their goals (University of Minnesota, 2019). Mentorship programs should be flexible and tailored to the needs of each student and their mentor, as some pairs might benefit from more or less time to connect (Salazar et al., 2016). Ultimately, these programs can be helpful in providing students in foster care with the connection and support they need to be successful, while also contributing to the development of other secure relationships in their lives (Palmieri & La Salle, 2017).
For students in foster care, it is essential that support extends beyond the school community. To do this, school counselors can establish relationships and collaborate with the student, foster family, school, and foster care system (Palmieri & La Salle, 2017). These home–school partnerships are critical in meeting the needs of students in foster care. Additionally, foster families feel more supported when they are involved and their input is valued (Palmieri & La Salle, 2017). Utilizing and forming plans around academic and behavioral expectations, attendance, flexibility with requirements, and communication with stakeholders can be helpful in promoting success (McKellar & Cowen, 2011). Furthermore, tangible and emotional support can act as protective factors and meet the needs of students through the provision of goods and services (Piel et al., 2017). For example, school counselors can create or utilize community-based food and nutrition programs to ensure that basic needs are being met.
Mental Health Services
Equally important, students in foster care often experience difficulties that affect their mental health. Evidence-based treatments such as trauma-focused cognitive behavior therapy (TF-CBT), behavior therapy, cognitive behavior therapy (CBT), and parent–child interaction therapy can be adapted for the school setting (Landsverk et al., 2009). These models of counseling are helpful in addressing symptoms, while also promoting healthy behavior and functioning. Combined with this, school counselors can also provide outpatient information to foster families and case workers about local resources and services available to students in foster care. In these cases, it is helpful to collaborate with the designated outpatient counselor to provide the most effective support and generalize learned skills across settings (Landsverk et al., 2009).
Students in foster care experience a number of barriers and challenges that influence their success in school, both academically and socially, as well as in adulthood. In addition, students in foster care lack the same access to resources and support as their peers, which contributes to gaps in academic achievement, relational success, and overall well-being. By enhancing school climate, planning, providing training to stakeholders, and promoting positive educational experiences, students in foster care can receive the foundational support they need to begin learning. Additionally, by utilizing group counseling, implementing mentorship programs, targeting specific behavior, addressing experiences of grief and loss, and accessing community resources, students in foster care can gain the skills they need to be successful in all areas. Despite the many challenges students in foster care face, school counselors have the opportunity to utilize their unique position in their schools and communities to advocate for these students, reach them through evidence-based interventions, remove barriers to learning, and ultimately equip them with the tools and skills they need to experience greater success.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Hannah Brinser is a master’s candidate at Gonzaga University. Addy Wissel, PhD, is an associate professor and program director at Gonzaga University. Correspondence may be addressed to Hannah Brinser, 502 E. Boone Ave., Spokane, WA 99258, firstname.lastname@example.org.
John McCarthy, Michelle Bruno, Teresa E. Fernandes
The prevalence of depression increases markedly during adolescence, yet many youth are not receiving the support that they need. One factor that has been speculated as contributing to low rates of care is a lack of mental health literacy about depression and viable sources of support. This pilot study focused on mental health literacy as it relates to adolescent depression and suicidality and represented a pseudo-replication of Burns and Rapee (2006). Overall, participants (N=36) in this study were able to differentiate depressed vignettes from non-depressed vignettes and identify common symptoms of depression in their assessments. Also, sources of optimal help identified by participants varied upon the perceived degree of seriousness of the difficulties. Such results offer implications regarding the potential benefit of including adolescents in a more direct way when providing outreach or offering services.
Keywords: adolescents, mental health literacy, depression, suicidality, support
Depression in adolescence is of particular relevance, as it can continue into adulthood yet often goes undiagnosed and untreated (Wagner, Emslie, Kowatch, & Weller, 2008). According to the Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-IV-TR) (APA, 2000), the diagnostic criteria and duration mirror adult depression in many respects. As in adult depression, adolescent depression can include a variety of symptoms, at least one of which must be either depressed mood or loss of pleasure/interest. Furthermore, the DSM-IV-TR stipulates that, if depressed mood is chosen, it may be substituted by irritable mood in adolescents.
The rate of depression increases six-fold between the ages of 15–18 (Hankin, 2006). Approximately eight percent of teenagers—an estimated two million youth from 12–17 years of age—suffered at least one major depressive episode in 2007. Only 39% received some form of treatment for depression in the preceding 12 months. The rate of receiving professional help was much lower among those youth without health insurance (17%). Among all teenagers who obtained treatment, over half (59%) saw a counselor for assistance with their depression. Nearly 37% and 27% of youths saw a psychologist or general practitioner/family doctor, respectively (Substance Abuse and Mental Health Services Administration, 2009).
Given the prevalence of mental illness and its impact on society, it is no surprise that there is a growing interest in mental health literacy, a term first used by Jorm et al. (1997). Defined as the “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (p. 182), mental health literacy also includes knowledge about treatment and from whom to seek help. It has been found, for instance, that family and friends can be vital in the recognition of depressive symptoms (Langlands, Jorm, Kelly, & Kitchener, 2008a). However, Highet, Thompson, and McNair (2005) saw that family members usually recognized symptoms of the individual in hindsight. The general public often does not possess the knowledge base to help someone who is developing a psychotic illness (Langlands, Jorm, Kelly, & Kitchener, 2008b). Kitchener and Jorm (2002) found that individuals who took part in their Mental Health First Aid course showed improvement in recognizing disorders, and their views about treatment of disorders became more in line with those of professionals in the mental health field. In addition, the course reduced their stigma attached to mental disorders, increased their feelings of confidence in providing help, and increased the help provided to others.
Few studies have been conducted on younger populations and mental health literacy. Burns and Rapee (2006) noted, “While there is growing literature on the mental health literacy of adults, to date there has not been a parallel interest in the mental health literacy of young people” (p. 227). Wright et al. (2005) looked at young adults’ (ages 12 to 25) ability to pinpoint depression and psychosis and their recommendations for help to be sought. Nearly half of the participants were able to label the depressed vignette as depressed, but only a quarter of participants were able to label psychosis. People who were given the depressed vignette were less likely to choose a correct form of treatment than those given the psychosis vignette. Psychologists and psychiatrists were recommended more frequently for the psychosis vignette than for the depressed vignette, and a family doctor or general practitioner was chosen more often for the depressed vignette than for the psychosis vignette.
Adolescents have been found more likely to consider themselves “very confident” (Jorm, Wright, & Morgan, 2007a, p. 67) to help a peer in need with girls rating themselves as more confident than boys. In addition, across vignettes, confidence in providing help to a peer with a problem was higher for depression (without alcohol misuse) and social phobia than for psychosis and depression with alcohol misuse (Jorm et al, 2007a).
Jorm, Wright, & Morgan (2007b) found differences among Australian youth in the type of help sought for mental disorders. Participants were read vignettes describing youth of similar ages who were experiencing various disorders, then were asked a series of questions that included where they would turn with similar problems. For the vignette describing a teen suffering from depression, adolescents aged 12–17 chose family (54%) most often as a source of help and opted for mental health professional or service most infrequently (2%). Nearly one-third of young adults ages 18–25 selected family (31%) or a general practitioner/medical doctor (31%) on a similar vignette regarding depression. Overall the perceived barriers to help-seeking were personal in nature and did not relate to systemic characteristics, as they noted, “For young people, it is embarrassment or concern about what others think…” (p. 559).
Burns and Rapee (2006) used a vignette-based approach to measure mental health literacy among high school students in Australia. In their study, they utilized the Friend In Need questionnaire, created by the authors for that specific study. This instrument offers five short vignettes of teenage students, two of whom (“Tony” and “Emily”) represented youth meant to be clinically depressed. One of the two vignettes (“Emily”) offered a reference to suicidal ideation. The remaining three vignettes were of students facing difficulties, though were not intended to reflect depression.
They found that over two-thirds of participants (68%) accurately labeled “Emily” as depressed, while about one-third (34%) recognized “Tony” as depressed. Female participants were more likely to make a depressed diagnosis in both the “Tony” and “Emily” vignettes than the male participants. Female participants also showed more worry for the depressed vignettes than male participants. Among help-seeking sources, counselors were chosen most often for the helpers of the depressed teens, and this category was followed by friends and family/relatives.
To our knowledge, no study has been conducted on the mental health literacy of U.S. teens as it pertains to adolescent depression. With this point in mind, the current study represents a replication of Burns and Rapee (2006) and offers an initial sample involving older adolescents’ perspectives in the assessment, recovery time, and help-seeking recommendations regarding depression. Our central study questions were consistent with Burns and Rapee and the questions posed by the Friend in Need Questionnaire.
Both prior to and after receiving approval by the university’s institutional review board, two of the authors met with the principal of the school where the data was collected. It was determined that eight sections of the school’s psychology and anthropology classes would be appropriate to the topic of study and ages of interest, and the primary author contacted the teachers and shared the following information with them: the parental/guardian consent form, the student consent form, details concerning the data collection process, and pertinent dates of the consent form deadlines and actual administration of the instrument used in this study. Teachers distributed the consent forms to students, who, if interested in possibly participating in the study, took them to their parents/guardians. Signed parental/guardian consent must have been completed and returned to the teachers in a four-day time period, which occurred prior to the date of the administration of the instrument. In both the parental/guardian and participant consent forms, it was made clear that the questionnaire was not a formal test and would take an estimated 25–40 minutes to complete.
On the day of the data collection, one of the two primary authors (JM and MB) went to the classroom, collected the completed parental/guardian consent form, read an abbreviated student consent form to the potential participants after giving a hard copy to them, and asked for questions at the conclusion. Students with unsigned parental/guardian consent forms were given an alternate class assignment, while those students who consented to be in the study completed the Friend in Need Questionnaire. No extra credit was granted for participation in the study. Participants completed the questionnaire in their classrooms. In a few instances, participants and the author/administrator were asked to move to a nearby vacant room for the data collection.
Approximately five classes were visited for data collection, and a total of 36 students, 21 of whom were young men, participated in the study. Most participants completed the questionnaire in approximately 20 minutes. The questionnaires were completed in an anonymous manner. In the coding process, a number was given to each questionnaire for tracking purposes only. Finally, the two authors also offered to return to the class after the data administration to further discuss the study; however, no teachers chose this option.
Adolescents’ mental health literacy was assessed using the Friend in Need Questionnaire (Burns & Rapee, 2006). As previously described, the questionnaire presents five vignettes of young people experiencing various difficulties and solicits both close-ended and open-ended responses from participants. Specifically, participants are instructed to read each vignette and respond to the following general questions: (a) How worried would you be about the person’s overall emotional well-being? (b) What do you think is the problem of the person? (c) What aspects of the vignette provided the strongest hints that the person was having difficulties? (d) How long will it take this adolescent to feel better? and (e) Does this person need help from others to cope with his/her problems? The final question also has a supplemental, open-ended question regarding who the helper would be. The respondents are posed with all of these questions for each of the five vignettes. The complete Friend in Need Questionnaire can be found in Burns and Rapee (2006).
A coding system was devised for the open-ended responses, specifically on the responses asking about the youth’s problem, aspects of the vignette that provided hints, and the appropriate helper. For the question concerning the youth’s problem, the responses were filtered into two categories: “depressed” or “not depressed.” To qualify as “depressed,” the respondents needed to write the words “depressed/depression” or “suicide/suicidal.” Any other problems listed were considered to be “not depressed.” On the question regarding hints of the problem in the vignette, the coder was looking for responses that fit into diagnostic criteria for depression. The two depressed vignettes each had five diagnostic criteria imbedded in them, and this question tried to tease out whether respondents could identify these key criteria. Hence, the responses were categorized into the five diagnostic criteria of each vignette, with other responses not qualifying. The question that asked about the appropriate helper was split into nine possible categories of helpers. A few respondents, whose answers occurred rarely, were not included in the analyses.
The findings are described in order of the items presented in the Friend in Need Questionnaire. The first question assessed whether adolescents could label a cluster of depressive symptoms in a case vignette as depressed. Respondents were asked, “What do you think is the matter with [name]?” This open-ended question elicited a variety of responses from respondents. Only responses that included “depressed,” “depression,” “suicide,” or “suicidal” were coded as a label of depression. In reviewing the responses to the two vignettes concerning students (Tony and Emily) depicted as depressed, it was evident that the majority of participants accurately labeled the vignettes, as 75% accurately identified Emily as depressed and 58% accurately labeled Tony as depressed.
The majority of respondents also accurately identified the non-depressed vignettes as such. Specifically, over 94% of respondents accurately identified Mandy as not being depressed. All participants (100%) accurately identified Jade as non-depressed, and over 97% accurately identified Nick as not being depressed. Frequencies of depressive codes for all vignettes are included in Table 1. Separate chi-square analyses were conducted to examine any differences in ratings of each vignette between male and female participants. Results indicated that no such differences exist on any of the five vignettes.
Second, in regard to respondents expressing greater worry for youth in the depressed vignettes versus the non-depressed vignettes, the Friend in Need Questionnaire instructed participants to rate their concern on a five-point scale with higher scores indicating more worry. The scores for the depressed vignettes (Emily and Tony) and non-depressed vignettes (Mandy, Jade, and Nick) were collapsed to produce mean scores of level of worry. A general linear model was used to compare sex differences (participant) in the intensity of worry scores for depressed and non-depressed vignettes. Results indicate that no significant differences existed between male (M = 3.40, SD = .38) and female participants (M = 3.45, SD = .33) regarding ratings of worry for the depressed (p < .58). No significant differences were found regarding male (M = 1.80, SD = .41) and female participants’ (M = 1.81, SD = .39) ratings of worry of the non-depressed vignettes either (p < .82).
The third question pertained to the length of recovery in the depressed and non-depressed vignettes. The respondents rated each vignette on the perceived length of time it would take the character to feel better on a four-point Likert scale from 1 (one or two days) to 4 (longer than a few months). Higher scores indicate a perception that more time is needed to feel better. Despite the use of a Likert scale, some respondents chose two answers or marked in between two options. When this occurred, the score was adjusted to reflect an average. For example, if someone circled, both “3” and “4,” a score of “3.5” was entered. This decision was made to maintain as many respondents as possible, given the small number of the sample. Overall, the respondents rated the depressed vignettes with a mean score of 3.67 (SD = .37), which indicates a recovery period of between “one or two months” and “longer than a few months.” This finding compared to a lower mean score of 1.97 (one or two days, SD = .45) for the non-depressed vignettes. Scores on the two depressed vignettes and scores on the three non-depressed vignettes were collapsed to create a composite mean score of recovery time for depressed (dependent variable) versus non-depressed vignettes (dependent variable).
A two-way MANOVA was conducted to determine if sex differences (of respondents) made a difference in the length of the recovery for both scenarios (depressed versus non-depressed). The overall model was statistically significant for the recovery time between the depressed and non-depressed vignettes F (1, 34) = 651.31; p = .01. The MANOVA did not reveal a significant interaction between participant gender and recovery time of vignettes (p < .27). Female respondents rated both the depressed vignettes (M = 3.82, SD = 24) and non-depressed vignettes (M = 2.03, SD = .43) higher than male respondents who rated the vignettes as 3.57 (SD = .53) and 1.93 (SD = .47) respectively, but this difference was not statistically significant.
Fourth, participants were asked to identify the elements of the vignette that demonstrated whether the fictitious teens were having emotional troubles. The two depressed vignettes (Emily and Tony) contained criteria of a Major Depressive Episode as described in the DSM-IV-TR (APA, 2000). In the case of Emily, respondents readily identified indicators of suicide (91%) and self-worth (72%). Respondents were less likely to identify symptoms of loss of interest (19%), fatigue (22%), and mood (19%) in this case. (See Table 2 for more complete results.) In the case of Tony, a majority of respondents identified loss of interest (75%) and weight loss (58%). Respondents were less likely to identify Tony’s fatigue (44%), insomnia (39%), and diminished ability to think or concentrate (39%).
Finally, after noting which symptoms were strong indicators of problems, respondents answered an open-ended question about sources of help to aid the person in the vignette. For all five vignettes, participants answered whether they thought the person in the vignette needed help from another person. The options included “no,” “yes,” or “don’t know.” If the respondents endorsed that the person did need help, they were asked to answer a follow-up question indicating who they think should help the person. For the depressed vignettes, 58% of respondents indicated that Tony needed help, and 75% indicated the same for Emily.
In regard to the type of helpers, participants’ responses were broken down into nine categories of helpers, including counselor; friends; family; professional; psychologist; psychiatrist; doctor; teacher; and someone who has had the same difficulty. Some coding decisions included how to categorize responses not explicitly in the list. Some of these included counseling, school counselor, and guidance counselor, which were included in the category of counselor. For the friend category, other responses included “peers” and “someone who knows him/her well.” For family, “parents,” “relatives,” “siblings/brother/sister” also were included. Non-specific terms were included in the professional category, including specialist, shrink, therapist, psychotherapist, and family therapist. Other responses included in the psychiatrist category were “doctor for depression/depressed kids” and “doctor who prescribes antidepressants.” Some responses that were not coded included third party, new people, anyone, role model, someone he/she doesn’t know, and everyone.
Nearly half of the participants (47%) identified the family as the suggested primary helper for Tony, while over one-third (36%) of participants suggested a counselor. The same percentage (36%) identified the family and a psychiatrist, respectively, for Emily, as the best sources of help (see Tables 3-4 for more complete results).
The primary purpose of this study was to examine the level of teenagers’ mental health literacy specific to adolescent depression. Because it was a pilot study that involved a relatively small sample size, the findings are admittedly limited in generalizability. However, even with the small sample size, the results offer initial points of comparison to Burns and Rapee’s (2006) larger scale study. First and perhaps foremost, the level of detection of adolescent depression was relatively high in the present study, yet no significant differences were found as they related to gender. Over half of the participants correctly labeled both depressed-based vignettes (Emily and Tony) as being depressed, and three in four participants indicated that Emily was depressed. To their credit, participants rated both depressed vignettes as highest in terms of depression.
This finding is noteworthy. In Burns and Rapee (2006), the corresponding findings of correctly identifying depression in Emily and Tony were 68% and 34%, respectively. The higher rating of Emily as depressed was similar in both settings, yet the rating of Tony as depressed was sizably different with American participants being more inclined to have viewed the fictitious student as depressed.
A closer investigation of this finding points to critical symptoms chosen in the participants’ assessment. The vignette of Emily featured pointed comments of suicidality, and, to no surprise, it was this characteristic that was almost uniformly (92%) expressed by participants when asked about the “strongest hints that something was wrong.” The element of suicidality also was foremost in Burns and Rapee (2006) in reference to Emily, but its expression was lower (77%) among the Australian sample. At least two possibilities are present. First, it is conceivable that the Australian teenagers were not as concerned about the suicidal ideation as the U.S. participants in the present study. A second possibility is that the awareness of suicidality among adolescents has increased in more recent years in the U.S., prompting a higher rate among the U.S. teenagers.
Suicidality was absent in the vignette of Tony. However, other signs of depression were present, and these symptoms included anhedonia, fatigue, weight loss, insomnia, and diminished ability to think/concentrate. Both U.S. participants in the present study and Australian participants in Burns and Rapee (2006) placed “diminished loss of interest” as the primary symptom of an emotional difficulty at nearly identical rates (73% and 75%, respectively). The same held true for the second-rated symptom (weight loss) in both samples, again expressed by nearly the same percentage (58% in the present study and 61% in Burns and Rapee). The consistency in the ranking and percentages of both samples reflects the teenagers’ recognition of lowered interest levels and appetite difficulties leading to weight loss when an adolescent is experiencing depression. In actuality, both behaviors do indeed tend to be two of the six most frequent symptoms among teenagers who are depressed (Roberts, Lewinsohn, & Seeley, 1995).
To their credit, participants in the present study also were able to differentiate the depressed vignettes from the non-depressed vignettes. Mandy was feeling upset over a relationship termination initiated by her former boyfriend that occurred three days prior. Jade expressed family disruption and had become intoxicated at a recent party. Meanwhile, Nick was coping with the loss of a grandparent. None of these vignettes offered significant amounts in the way of genuine depression, and by and large, the majority of participants detected that their respective problems were not severe. A mere 6% of participants indicated that Mandy was depressed. Similarly, none of the participants indicated that Jade was depressed, and only 3% of them assessed Nick to be depressed. This finding offers support for the overall level of mental health literacy of the sample as it pertains to adolescent depression. Moreover, in comparison to the Australian participants in Burns and Rapee (2006), the American sample fared somewhat better: They found that, though none of their participants found Jade to be depressed, 11% and 9% of teenagers in their study did relate Nick and Mandy, respectively, to be depressed.
The participants in the present study demonstrated significantly more concern and anticipated a longer recovery period for the students in the depressive vignettes than in the non-depressed vignettes. In our study, a significant difference was accurately found in estimated recovery time.
The average duration of an initial depressive episode is eight months when no treatment is received (Brent & Birmaher, 2002). These findings add support to the conclusion that the sample possessed a considerable level of literacy. Given the fact that, to our knowledge, this pilot study is the first to assess mental health literacy for adolescent depression among American teenagers, no point of comparison exists. With this point in mind, the finding was relatively surprising. The adolescents in the present study were astute in their detection, concern, and estimated time of recovery, which could be related to a knowledge set based on their classroom education or acquired in other ways (i.e., having a friend who was depressed). Regardless of the mode of acquisition, the adolescents in this study offered greater concern for the fictitious students in the midst of a depressive episode and estimated their recovery more accurately than those students in the non-depressed vignettes.
It was mildly surprising that, unlike Burns and Rapee (2006) and Gifford-May (2002), no significant difference was found in regard to gender and mental health literacy. Burns and Rapee found that girls “clearly demonstrated” higher literacy in their abilities to not only correctly label the depressed vignettes, but also in their expression of greater concern over the students in those same vignettes (p. 232). One point of speculation on their part dealt with the higher levels of depression experienced by young women in later adolescence (Lewinsohn, Rohde, & Seeley, 1998). However, given the absence of significant differences in gender within the sample in the present study, it raises the possibility that young men in the U.S. are more insightful regarding adolescent depression than anticipated.
Burns and Rapee (2006) indicated that the primary reason for raising the mental health literacy of adolescents “is to increase the likelihood that young people can access the most appropriate help when needed” (p. 233). Taken from combined data from 2005 and 2006, an estimated 12% of American youth aged 12–17 obtained professional help for emotional or behavioral problems, and females were more likely than males to receive professional help (Office of Applied Statistics, 2008). However, the literature points to the fact that many other teenagers in need of mental health assistance for various disorders do not receive it. In fact, a mere 39% of those adolescents suffering a depressive episode receive treatment (Office of Applied Statistics, 2009).
The recommended sources for help in our sample were family and counselor, respectively, for Tony, and family and psychiatrist, both at equal percentages, for Emily. For the vignette of Emily, counselor ranked sixth of the nine helping sources. This finding is in contrast to the real-world conditions where nearly 60% of those teenagers with depression in 2007 saw or talked to a counselor in their treatment (Office of Applied Statistics, 2009).
Though the reasoning behind the choices of the helping sources was not sought, the selections lead to intriguing possibilities. First, in the case of Tony, the primary helping source was family, despite information in the vignette that the family system was deteriorating over a parental separation. Even if that played no role in the participants’ responses, the choice of family in soliciting help is striking in that parent-adolescent conflicts increase during early adolescent years (Laursen, Coy, & Collins, 1998). Suicidal adolescents reported difficulty in communicating with parents, tremendous stress in their home life, and a distressed relationship with one or both parents (Bostik & Everall, 2006). However, this finding is consistent with a qualitative study (McCarthy, Downes, & Sherman, 2008) pointing to beneficial parental partnerships that developed during depressive episodes and were instrumental in the teenager getting professional help. Counselor, the second recommended helper choice in the vignette of Tony, may not be as surprising. The school from which the data were collected does have a staff of professional school counselors, and this finding may speak to the participants’ level of comfort with counselors.
The topic of recommended helper was much different in the vignette of Emily, as the choices were much more equal in terms of the percentages. The selection of psychiatrist as the second recommended helper may point to the participants’ perception of the potential for harm and their connotation that a physician with mental health expertise and prescription privileges was needed. In a similar vein, the designations of psychologist and professional were closely behind psychiatrist in recommended helpers, again suggesting the participants’ notion that highly trained professionals who likely have a doctoral degree were needed to aid Emily. This finding mirrors recent research, as 27% of those adolescents having a depressive episode saw their family physician or a general practitioner. Roughly the same number sought help from a psychiatrist or psychologist (Office of Applied Statistics, 2009).
Surprisingly, friends were the third most common choice of helper in a case of a student marked by suicidal ideation. With the potential for harm in this student, friends may not be the best source for initial help. However, participants in the present study may have thought that friends would be supportive during an emotionally difficult period. Finally, the lower ranking of the counselor designation may be connected with a perception that a counselor is sought for less complex difficulties.
Burns and Rapee (2006) found that counselor and friend were the two primary overall recommended sources of help. In regard to counselors, they noted that this finding may be reflective of the “access and familiarity” that adolescents in many Australian schools possess with this type of professional (p. 233). Overall, however, the participants in their study offered far lower rankings of a psychologist, professional, or psychiatrist as a source of help in the depressed vignettes. This finding could point to a familiarity by American teenagers with medical professionals, particularly with the prevalence rate of medication prescribed to this population in the U.S. compared to European countries (Levin, 2008).
Limitations are clearly evident in this study. As previously noted, the small sample size that is consistent with pilot studies restricts generalizability. The sample size also may have been composed of more sophisticated students in mental health, as many students in the sample were enrolled in a psychology class. Burns and Rapee (2006) pointed out that the vignette-based instrument of the Friend in Need Questionnaire is consistent with the manner in which other mental health literacy studies have been conducted. However, they added, “The extent to which such data can be translated into what actually is likely to happen in the real world is unclear” (p. 234). They also noted that a subsequent challenge for research in this area includes the development of research modalities that examine literacy in a naturalistic setting, such as interviews with adolescents. This suggestion connects to Dundon’s (2006) call to bring forth the “voice of the adolescent” that has been lacking in the research on adolescent depression (p. 384).
This pilot study represents a point of entry in studying American teenagers’ mental health literacy in regard to teen depression. Participants in this study showed the ability to correctly differentiate depressed vignettes from non-depressed vignettes and, in their assessment, indicated relevant symptoms of depressive symptoms faced by adolescents. Overall they also expressed sources of help that varied upon the perceived degree of seriousness of the difficulties. The outcomes offer implications regarding the potential benefit of including adolescents in a more direct way when providing outreach or offering services. They demonstrated an accurate understanding of when more intense levels of care could be beneficial.
The study produced results that also warrant further exploration of the relationships between youth and parents during adolescence. Although this developmental period can be marked by tumultuous relationships between them, there may be wisdom in providing communication skills to strengthen such relationships. Such efforts could result in more disclosure of depressive symptoms to parents, which may expedite the process of getting help as opposed to sharing such struggles only with peers. In addition to implications for teens and parents, this research can help shape additional studies in expanding the understanding of literacy.
Future research calls for additional mental health literacy investigations marked not only by larger sample sizes, but also by an in-depth investigation of adolescents of various racial/ethnic differences within the sample. Higher rates of adolescent depression have been found in youth of Latino descent (Guiao & Thompson, 2004; Twenge & Nolen-Hoeksema, 2002), for instance, and it would be important to evaluate the mental health literacy levels among respective backgrounds. With teenage depression being a pressing matter in adolescent mental health, the domain of mental health literacy in regard to this disorder is a vital one that merits additional research.
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John McCarthy, NCC, is a Professor in the Department of Counseling at the Indiana University of Pennsylvania (IUP). Michelle Bruno is an Assistant Professor in the same department at IUP. Teresa E. Fernandes, NCC, is a counselor at the Meadows Psychiatric Center, Centre Hall, PA. Correspondence can be addressed to John McCarthy, Indiana University of Pennsylvania, Department of Counseling, 206 Stouffer Hall, Indiana, PA, 15705, email@example.com.