Examining How The Ratio of Students on Campus to Counseling Center Staff Relates to Dosage and Counseling Center Treatment Effectiveness
Open Access
- Author:
- Elreda, Danny
- Graduate Program:
- Counseling Psychology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- April 22, 2014
- Committee Members:
- Jeffrey Hayes, Dissertation Advisor/Co-Advisor
Jeffrey Hayes, Committee Chair/Co-Chair
Kathleen Bieschke, Committee Member
Benjamin D Locke, Committee Member
Louis Georges Castonguay, Committee Member - Keywords:
- Counseling centers
dosage
treatment
effectiveness - Abstract:
- It has been more than 30 years since the International Association of Counseling Services (IACS) established the student to staff ratio that defines the “standard of care” in university and college counseling centers. Since publication of this ratio in 1982, counseling centers have been advised to maintain minimum staffing ratios of one full-time equivalent (FTE) staff member to every 1,000-1,500 students on campus (Spivack et al., 2010). Yet the large majority of today’s counseling centers have ratios above those cutoffs, and the implications of this ratio for college students’ mental health have never been empirically assessed. This dissertation was the first to examine whether student to staff ratios were predictive of the number and frequency of clients’ sessions (dosage), and counseling center treatment effectiveness in reducing student distress. This dissertation employed data from the Center for Collegiate Mental Health (CCMH), a collaborative practice-research network that currently comprises more than 250 college counseling centers that use a common data management system (Hayes, Locke, & Castonguay, 2011). The present study focused on data from 2,041 students and 37 counseling centers from the 2010-2011 academic year. For each counseling center that participated in CCMH data collection, student to FTE staff ratios were computed as the total student population relative to number of full-time professional staff and paid trainees per counseling center. Change in student distress from intake to final session, as measured by the CCAPS-32, was used to quantify centers’ treatment effectiveness. Number of sessions that clients received from FTE staff, as well as the average length of time between sessions, were used to quantify center-level mean dosages. In general, findings indicated no significant associations between ratio, dosage, and effectiveness, though post hoc analyses provided some interesting, preliminary evidence about potential differences between public and private schools. Specifically, while private schools showed no relation between ratio and treatment effectiveness, public schools demonstrated the hypothesized relation: public schools with larger ratios saw a lower percentage of clients receiving effective treatment. Moreover, findings suggested that the majority of schools were able to provide relatively effective treatment despite falling outside of recommended ratio ranges. More broadly, results suggest that the relations between student to staff ratios, dosage, and counseling center treatment effectiveness are multi-faceted, likely influenced by an array of factors requiring further consideration.