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Article 16

Promoting Mental Health Collaborations in Counselor Education Through the Use of Service-Learning

Ronica Arnold Branson, Lakitta D. Johnson, and Regina F. McMurtery

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Introduction

Mental illness has no preference for race, socioeconomic status, age, or gender and can affect anyone at any time. It is estimated that over 57 million Americans are affected by some type of mental disorder each year, with 1 in 17 living with a serious mental illness and one in ten children suffering from some type of significant mental impairment (National Institute of Mental Health [NIMH], 2011). Although recovery is possible, many individuals go untreated. According to the NIMH, only about 58% of adults diagnosed with a serious mental illness received treatment. Among these individuals, the most common types of treatment were outpatient services and medication, with the majority of these individuals (52%) using prescription medication as their form of treatment. With children, the numbers remain about the same. It is reported that only about 50% of children who were diagnosed with a mental disorder received treatment, with females being 50% less likely to use mental health services than males (NIMH, 2011).

According to the World Health Organization (2004), it is estimated that mental illness is one of the top leading causes of disability. It is also important to note that the effects of untreated mental illness is costing the nation over 100 billion dollars each year. For individuals who don’t receive treatment, issues such as homelessness, substance abuse, unemployment, incarceration, and other health issues are often unnecessary experiences that they endure. Because of the related consequences of these issues, not only on the individual, family, and community, but on the nation as a whole, mental health advocates must find better ways to reach underserved populations. One such way to address the issue is through the use of collaborations in the area of mental health.

Community Needs for Mental Health Services

Because mental illness is widespread and affects so many individuals and families, there is a great need for professionals across disciplines and settings to come together and collaborate in order to deliver more effective and efficient services to support mental health and wellness. These individuals affected with mental illness not only have behavioral concerns, but also many have other needs that have to be met as well. Therefore, it may be helpful to involve social workers, medical personnel, school and mental health counselors, as well as other helping professionals to meet the individual’s overall needs.

Many reasons have been cited as why individuals are not receiving the necessary services; from lack of knowledge about resources to insufficient support given by family and other caregivers. In addition, many individuals in minority groups are still going untreated because of the stigma attached to the diagnosis of a mental illness. Traditionally, in many minority communities, it has not been acceptable to “air your dirty laundry” or to share family “secrets” with others. But as the number of individuals with mental illness rises in many minority communities, it has become even more important for public awareness and acceptance for these services. The community must continue to let these individuals know that they are not alone and offer information to resources that are available.

Collaborations occur when individuals from various professions or organizations work together toward a shared vision or goal. In the context of this article, collaboration includes mental health workers, counseling students, counselor educators, schools, and community organizations coming together to help facilitate the improvement of a community or schools’ needs. It has been reported that successful collaborations can often be difficult to establish because of misunderstood goals, roles, and lack of communication (Mellin et al., 2009).

Benefits of Service Learning

Because of many new initiatives, there has been a growing interest in the use of service learning in education and training programs. Service learning has been shown to have a positive impact on student learning outcomes, improvement of skills, and overall involvement and advocacy in and for the profession in which they are serving (Burnett, Long, & Horne, 2005). Specifically, it enhances collaborations between the community and academic institutions and facilitates civic, professional, and social involvement among individuals. In the area of counselor education, service learning has been shown to have many beneficial qualities and outcomes. Positive results include the promotion of multicultural competence, advocacy within the profession, an increase in positive attitudes among students, and demonstration of more positive dispositions (American Association of Colleges for Teacher Education [AACTE], 2002; Burnett, Hamel, & Long, 2004). Service learning has also been shown to increase self-efficacy for beginning counselor trainees (Barbee, Scherer, & Combs, 2003); help students with the connection between theory and practice (Arman & Scherer, 2002); and increase students’ awareness of community and client dispositions and needs (Burnett et al., 2005).

Another benefit that can be gained from service learning in the counselor education curriculum is that Council for Accreditation of Counseling and Education Related Programs (CACREP; 2009) standards can be applied when integrating this component. For example, the use of service learning provides for the development of strategies for interagency/inter-organization collaboration (Standard G.1.b.); it can be used to enhance common core curricular experiences, and student knowledge of key information of core areas can be demonstrated (Standard G). These experiences also allow for opportunities for advocacy for the clients, community, and also the profession (Standard G.1.h.). It also offers for a better understanding of multicultural diversity (Standard G.2.) and experiential learning activities (Standard G.2.b.), and the development of the practice of social justice (Standard G.2.e. & f.).

Integrating It Into the Curriculum

Benefits of Partnerships or Collaborations

There are many important benefits as a result of partnerships and collaborations of integrating service learning into the counseling curriculum. These partnerships and collaborations are formed between professors, students, community organizations, schools, and clients. Many of these collaborations and partnerships are long term and generate innumerous benefits for all involved. Some of the positive benefits of these partnerships and collaborations are as follows:

• Allows for greater understanding of community needs and issues.
• Resources are pooled together to offer more alternatives to problem solving and client needs.
• Allows for greater understanding of community needs and issues.
• Resources are pooled together to offer more alternatives to problem solving and client needs.
• Students have an opportunity to practice skills learned in the classroom and apply theory to practice.
• Community members and clients have an opportunity to see resources that are available and gain better understanding of mental health services and opportunities.
• Incorporated into places where students might not normally go for internships. Exposes students to diverse clients, environments, and other professionals.
• Allows for cross discipline experiences such as school counselors in mental health settings, and clinical mental health students in school settings.
• Allows for opportunities to work with different client populations, adults, and youth.

Lessons Learned

It has been noted in the literature that in order for collaborations to be effective, there must be communication, respect among participants, an understanding of goals, shared responsibilities and participation, and opportunities for reflection and evaluation (Anderson-Butcher & Ashton, 2004; Hilton, Sohani, Fellow-Smith, & McNeil, 2006; Weist, Ambrose, & Lewis, 2006). Therefore, when planning a service learning experience, it is essential to integrate basic components into the program. As with any project, one must plan, prepare, communicate, collaborate, act, reflect, and evaluate. The following section gives examples of how service learning is being integrated into counselor level courses at different stages. The authors taught graduate level counselor education courses and implemented service learning into Introduction to Professional Counseling and a practicum course.

Introduction to Professional Counseling

Service learning was implemented into an entry level counseling course to maximize students’ learning experience. It also helped in promoting experiential learning experiences and providing students with a realistic view of counseling. Specifically, the service learning activities were designed to assist students in becoming aware of the special needs of the types of populations that counselors serve, to become sensitive to the needs of culturally diverse individuals, to become familiar with settings in which counselors work, to follow ethical codes, and to deal with any issues related to bias, prejudice, stereotypes, or fears that they may have regarding counseling. Students were also given the opportunity to act as advocates of the counseling profession through their task of being asked to seek information from a student’s perspective as to their views of counseling, qualities they feel a counselor should possess, and services they feel are needed to improve their situation or life. Additionally, student objectives for this course were aligned with CACREP standards. After providing service learning, the students wrote a reflective paper describing their experience and presented it to the class. Also, the students completed a questionnaire designed by the instructor regarding their views of service learning before and after completion of their project.

The students completed service learning at a community organization and a substance abuse treatment facility. At the community organization, the students worked with the agency’s Christmas present drive. Students were assigned to complete intake paperwork and to interview parents regarding their children’s Christmas wish list and input the information into the computer. Students helped participants cope with feelings of anger, embarrassment, and frustration. Students explained program rules and that their children may not be selected for a gift. Students also helped participants to prioritize the needs of their children and to make a realistic wish list. One student commented on her experience:

This was a very rewarding experience for me because I got a chance to help people that were really in need. My heart really went out to some of the people after listening to their stories. You never really know what a family maybe going through!

Another student described her experience: “This experience helped me to become more sensitive and aware of the elderly population and their needs as well as those with job loss as a result of the recession.” Another student said:

Prior to completing community service, the thought was never so alive in my heart as it was afterwards of a parent not being able to provide a gift at Christmas for their child, so I am even more aware now of the great impact that the economy has had on so many.

While at the treatment facility, students conducted two groups, one with the professor and one without. The students educated the group on job readiness skills including how to dress, how to complete applications, resume writing, dos and don’ts of interviewing, and common interview questions. During the second group, students educated the group on stress management and relaxation skills. The group members were very receptive and the class thoroughly enjoyed the experience. Their expectations of people in recovery from addiction were very dismal and they had a negative view of the type of individuals who they thought abused drugs. One student expressed her views regarding this population: “This facility changed my perspective of those with addiction problems. The gentlemen were really warm, accepting and still productive in society.” Another student shared her experience:

Truly, working with the two different populations has made me more sensitive to peoples’ needs and it gave me the opportunity to actually interact with individuals who abused drugs that I don’t normally interact with on a daily basis. It was a learning experience because they are ordinary people who are nice and had ordinary problems in addition to their addiction.

The students in this course truly enjoyed their service learning experience. They were able to work with two different types of populations which gave them a realistic view of settings and populations that counselors serve, as well as an opportunity to become sensitive to and comfortable with working with culturally diverse individuals. It also gave them an opportunity to deal with fears and biases that they have regarding counseling. In addition to that, school counseling trainees were able to experience counseling in other settings. A school counseling trainee stated:

Completing service learning gave me the opportunity to work with two different groups and I had the experience of actually sitting in an environment and dealing with individuals that I may some day work with as a counselor. The exposure was great.

Furthermore, the majority of the students felt good about volunteering and helping others and pledged to continue to do volunteer work.

Practicum

At the beginning of the course, students were notified that they would be expected to participate in a semester long service learning project. They were informed that in addition to their weekly class sessions, they would be required to participate in a service learning project that would be held at an off campus site. Weekly classroom lessons included didactic instruction that focused on improvement of clinical skills, experiential learning activities, review of basic counseling techniques, and peer learning and feedback. The instructor partnered with the university’s Center for Civic and Community Engagement and reviewed a list of community and school organizations that expressed a need for social and counseling related services. The instructor collaborated with officials from the schools’ service learning center and identified prospective organizations that would allow for the integration of the course goals and also aligned with the university’s service learning mission. After a review of the list and description of the agencies, the instructor met with directors and counselors at some of these agencies and finally identified two agencies that would offer diverse experiences for the students; one was a local public school in a economically and disadvantaged area, while the other was a substance abuse treatment facility.

The instructor then conducted follow-up meetings with officials from the school and agency and the officials identified specific needs of their clients and students. The students were then divided into groups based on their experiences and placed at settings that the instructor thought would allow them to gain better overall exposure to a more diverse clientele than they would normally work with. Student participants were then allowed time in class to develop their project but were also expected to meet at other times to solidify the project. Students then worked with the clients and the students at the agency for the remainder of the semester under the supervision of the course instructor. The implemented projects covered topics such as anger management, stress management, social skills, and self-reflection exercises. The course instructor accompanied the students to the sites and participated in many of the activities to ensure proper implementation of the techniques. Students were also required to keep journals that included any personal reactions, self disclosures, feelings about the experience, and any impact of their personal and professional growth. In addition, students were required to complete a site evaluation and project evaluation, keep time logs, write an individual report, as well as conduct a group presentation on the overall experience.

Post-experience reflections indicated that students had more positive feelings toward working with diverse and challenging clients. Students also expressed decreased levels of anxiety when interacting with these individuals and expressed some degree of personal change, especially in the way they view others. Many wrote that they envisioned the experience to be totally different from what it actually was and expressed greater feelings of self-worth as a result of serving others. Examples of some of the statements include: “Words cannot express how just making a few visits can have such an impact on a person’s life. I really enjoyed my service learning experience.” “I enjoyed working with my group members because we had time where we could meet up and prepare for this experience and everything fell into place. I felt appreciated just seeing how each student was gaining something from our activities. We really made a difference.” “I like the fact that each person participated in the discussions and opened up in the group. I would love to do this another semester because the experience was better than I thought it would be.”

Students in the course also indicated that their skills were enhanced as a result of working with the “real” clients. They stated that this experience, along with the practicum requirements, helped them feel better prepared to advance to their internship. They expressed that they were able to engage in empathetic and active listening and noticed several verbal and nonverbal cues when engaging in conversations and activities with the students and clients. Many shared that the skills introduced in the classroom helped them to respond more appropriately in a therapeutic way instead of taking the comments personally and being defensive. One participant stated, “I have to say that when I first began this project, I wondered how this could benefit me. After meeting the clients and listening to their struggles, my opinion changed. I saw I had something to give.”

Limitations

Although feedback from the participants implied that the projects were very beneficial, there are limitations that must also be considered. First, the projects had a brief and short-term focus. Although students were informed of the project at the beginning of the semester, actual placement at the organizations did not begin until mid- semester. Student feedback reflected a need to have worked with the agencies and schools for a longer period of time. Also, feedback was solicited from the directors and/or counselors at the agencies and school, no feedback or evaluation was solicited from the individuals being served. The absence of this information limits the generalizability of the project and programs may need this information to assist in program and service evaluation and program improvement.

Recommendations

Implementing service learning into counselor education can be very beneficial to the students and the community. However, effective projects must have certain guidelines/components. Successful partnerships have certain qualities including the following: addressing student and community needs; sharing of knowledge, goals, and expectations; shared vision; diverse partnerships; contract or commitment to seeing the project through to completion, and communication. Additionally, each partnership must recognize areas of expertise from both sides (Bosma, Sieving, Ericson, Russ, Cavender, & Bonine, 2010) and both sides must equally contribute.

It is important to remember when integrating these service learning projects into the curriculum, instructors should note that effective projects must have certain guidelines and components. Qualities of these successful partnerships include: preparation and planning, consultation, orientation, pre-and post assessment, implementation, ongoing communication, and finally, evaluation. First, in the area of preparation, the course instructor must make contact with the participating entities and be sure the organization and university can work together to address both the community and university needs. Next, there should be consultation and an agreement for this type of collaborative project. The organizations involved should have a shared vision of the goals and expectations for the project and recognize that these diverse partnerships can offer many resources and contributions from all parties (Bosma et al., 2010). Also, in conjunction with the office of service learning, the instructor should consult with suitable agencies to explore their needs and course goals to determine the appropriateness of the collaboration. Each should have an invested interest in the project and each entity should make a commitment to seeing the project through to completion. Additionally, these partners should have a shared vision and both sides must be willing to make contributions to the success of the project.

Next, students as well as participating agencies should receive orientation about the components, goals, and expected outcomes of the service learning project. During these sessions, students and participants should be given opportunities to openly discuss questions and concerns as well as give input on the components of the project. Next, needs based assessments should be given to determine the needs of the both the agencies and the students. After the orientation is completed and needs assessments have been given, the project should be implemented to reflect the outlined goals. Throughout the project, continual feedback should be given by the students as well as the agency, on ways to improve the project. This is where ongoing communication takes place. There should also be opportunities for discussion and reflection for both the students and participants from the agency. After the project has ended, both the participating agencies and the students should evaluate the effectiveness of the project. If the results suggest positive outcomes, agency collaboration should continue and there should be a focus on project improvement. If negative outcomes are present, analysis should also be done on ways to improve future collaborations, if warranted.

Conclusion

Overall, the integration of service learning experiences in counselor education can be very beneficial. If done correctly and implemented with integrity, these experiences can lead to very viable collaborations in the service delivery of mental health services in the community, which is much needed in today’s society. Service learning also allows opportunities for students to put theory into practice and allows a better understanding of communities and individuals they will serve as future professionals. As stated in the literature, the benefits of incorporating service learning into the counselor education curriculum and courses can offer invaluable learning experiences (Burnett et al., 2004; Burnett et al., 2005; Jett & Delgado-Romero, 2009).