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Introduction
As a member of the Northwest Missouri State University campus community, you may be constantly interacting with students. At times you will have contact with students whose problems or behaviors cause you concern or discomfort that may interfere with your work or the education of other students. Attending to a student's concerns and providing information about campus resources can be an important intervention, which may prevent escalation of the problem or situation.
Certain signals that distressed students give out may go unnoticed for a variety of reasons. Even when we do notice them, it can be very difficult to intervene. We may feel we are "in over our heads," or we may have competing concerns such as other students waiting to see us. It is important to know that it is quite likely that the problem will not go away unless there is an intervention. Part of a good intervention requires knowing how to act during these incidents and what resources to call upon.
A student may verbalize his/her distress, show a change in academic performance or behavior, or otherwise cause concern. A student's behavior, especially if it is inconsistent with your previous observations, could constitute a "cry for help." Student distress may be due to medical, psychiatric, academic, financial, social or family factors. It is extremely important to encourage and help a student at the earliest signs of distress to seek assistance from the appropriate campus and community resources.
Protocol for Responding to a Distressed Student
This "tool kit" was created to help you when these difficult occasions arise. It offers straightforward advice, techniques and suggestions on how to cope with, intervene and assist troubled and/or difficult students in or out of the classroom. Referral identifiers include but are not limited to the following:
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Student Behaviors
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Staff / Faculty Reactions to Student's Behavior
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When you are interacting with a student in distress you may become aware of sensitive information about that student. Assisting a student who needs help often requires the sharing of relevant information with other campus professionals who need to know. To protect a student's confidentiality, it is important that sensitive or confidential information about a student is not shared with anyone who does not have a professional need to know.
Consultation and Referral
Consultation
If you are unsure about how to work with a specific student, we encourage you to consult with one of the counselors on our staff. A counselor is available to you immediately, or very soon thereafter, 8am to 5pm Monday through Friday. Call us at 660-562-1220, inform the receptionist who you are and ask to speak with an available counselor. Outside of the stated time please contact Campus Safety at 660-562-1254 and they can assist. A brief consultation may help you sort out the relevant issues and explore alternative approaches. Conveying your concern and willingness to help (including referral) is probably the most important thing you can do. Your support, encouragement and reassurance will be particularly valuable.
Referral
When you discuss a referral to counseling services with a student, it is helpful for that student to hear, in a clear and concise manner, your concerns and why you think counseling would be helpful. It is not necessary to call for an appointment, but calling ahead may ensure counselor availability. The student should come in directly and a counselor will see her/him as soon as possible. There also may be times when it is more advantageous for you to receive assistance immediately. During those times you should contact Campus Safety at 911 or 660- 562-1254. The following are concerns that require immediate intervention:
Counseling is confidential except when the student presents a danger to himself, herself or others, or when abuse of a child or elder is involved. Our individual counseling services are designed for students who can benefit from time-limited counseling. If longer-term therapy is indicated, the student may be referred to an appropriate off-campus resource.
Fees
Counseling is free to all full-time and part-time Northwest students. There is no limit to the number of sessions available to each student each semester. However, a student requiring long-term care and/or medication may be referred to off-campus resources.
Specific Situations
The next several pages will outline specific scenarios and suggestions for action.
Physical and sexual violence in early adult relationships often starts during teenage dating when adolescent boys and girls form their first conclusions about what to expect and accept from each other. In many cases, teenagers are predisposed to accept physical abuse because of exposure to it in their homes, either as victims or witnesses. Lesbians and gay males experience violence in their intimate relationships at about the same rate as heterosexuals. Only one in twenty-five adolescent victims seek professional help. Abusive relationships often involve a pattern of repeated verbal, sexual, emotional, and physical abuse that escalates the longer the relationship continues. Some of the indicators of an abusive relationship are verbal abuse; isolation from friends and loved ones; fear of the partner's temper; fear of abandonment by the partner; accepting the partner's controlling behavior; fear of intimidation; the distortion of the partner's hurtful behavior; assuming responsibility for the partner's abusive behavior; feeling trapped; and fear of leaving the abusive partner. Some abusive relationships include behaviors that are in violation of Campus Regulations and/or state laws. When you became aware that a student is in an abusive relationship:
Anxiety
Anxiety is a normal response to a perceived danger or threat to one's well-being or self-esteem. For some students, the cause of their anxiety will be clear, but for others it may be difficult to determine. It is our experience that anxiety is very often a result of the intense academic competition among students, or a fear of inadequacy regarding some academic challenge. Personal relationships may also be at the root of the concern. Regardless of the cause, one or more of the following symptoms may be experienced: rapid heart beat, chest pain or discomfort, dizziness, sweating, trembling or shaking and cold clammy hands. The student may also complain of difficulty concentrating, always being "on edge," having difficulty making decisions, sleeping problems or being too fearful to take action. In rarer cases a student may experience a panic attack in which physical symptoms occur spontaneously and intensely in such a way that the student may fear she/he is dying. The following guidelines are appropriate in most cases:
It is helpful to:
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Demanding students can be difficult to interact with because they can be intrusive and persistent. Demanding traits can be associated with anxiety, agitated depression and/or personality disorders, but also occur in the general population. Some features associated with demanding students are a sense of entitlement; an inability to empathize; a need to control; difficulty dealing with ambiguity; a strong drive for perfection; difficulty respecting structure, limits, and rules; persistence after hearing "no"; dependence on others to take care of them; and a fear of dealing with the realities of life. These students may demand a lot of time and attention. When dealing with a demanding student:
Depression
Depression and the variety of ways in which it manifests itself is part of a natural emotional and physical response to life's ups and downs. With the busy and demanding life of a college student, it is safe to assume that most students will experience periods of reactive (or situational) depression in their college careers. Major depression, however, is a "whole-body" concern involving your body, mood, thoughts and behavior. It affects the way you eat and sleep, the way you feel about yourself and the way you think about things. Major depression is not a passing blue mood. It is not a sign of personal weakness or a condition that can be wished or willed away. People with depression cannot merely "pull themselves together" and get better. It will interfere with a student's ability to function in school and social environments. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can help over 80 percent of those who suffer from depression.
Due to the opportunities for faculty and staff to observe and interact with students, they often are the first to recognize that a student is in distress. Look for a pattern of these indicators, but understand that not everyone who is depressed experiences every symptom. Some people experience a few symptoms, some many. Also, severity of symptoms varies with individuals.
Depression Symptoms
Students experiencing depression often respond well to a small amount of attention for a short period of time. Early intervention increases the chances of the student getting better sooner.
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Irrational or Inappropriate Behavior
These students have difficulty distinguishing "fantasy" from reality. Their thinking is typically illogical, confused or irrational (e.g., speech patterns that jump from one topic to another with no meaningful connection). Their emotional responses may be incongruent or inappropriate, and their behavior may be bizarre and disturbing. This student may experience hallucinations, often auditory, and may report hearing voices (e.g., someone is/will harm or control them). While this student may elicit alarm or fear from others, they generally are not dangerous or violent. However, there are some situations in which they can become violent; e.g., experiencing "command" hallucinations. These hallucinations are telling them what to do, such as "you must destroy that evil person." Contact Campus Safety immediately at 911 or 660-562-1254. If you cannot make sense of their conversation, consult with or refer them to Counseling Center.
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Mania
These students are characterized by having persistently lofty or irritable moods. During these moods they often see themselves in a grand light, sometimes believing that they are famous or that the work they are doing is awe-inspiring. They often are overly talkative with racing thoughts. Typically, their high energy interferes with their sleep. They can be very irritable and overly involved in pleasurable activities such as sex or spending money. Generally, these students are not dangerous, but caution should be taken, especially if alcohol or other drugs are involved. If they try to put their rapid thoughts and words into action, they may place themselves in unsafe situations.
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Substance Abuse
We are all aware of the toll that abuse of alcohol and other drugs can take on individuals, families, friends, and colleagues. In a recent survey of college presidents, alcohol abuse was identified as the campus life issue of greatest concern. The costs are staggering in terms of academic failure, vandalism, sexual assault and other consequences.
Warning Signals of Alcohol and Drug Abuse
There are many signs of alcohol and drug use, abuse and addiction. None of these signs alone are conclusive proof of an alcohol or drug problem. Other conditions could be responsible for unusual behavior, such as an illness or reaction to a legally prescribed drug. Any one, or a combination, of these could be cause for alarm and could signal problems in general, as well as a substance abuse problem.
Impairment of Mental Alertness
Lack of concentration, short-term memory loss, memory loss of recent events, confusion and inability to follow directions.
Impairment of Mood
Depression, extreme mood swings, flat or unresponsive behavior, hyperactivity, loss of interest in one's work/school results and nervousness.
Impairment of Motor Behavior
Hand tremors, loss of balance, loss of coordination, staggering, inability to work normally, slurred speech and passing out from alcohol or drug use.
Impairment of Interpersonal Relationships
Detachment from or drastic change in social relationships, becoming a loner or becoming secretive, attempt to avoid friends or co-workers, loss of interest in appearance, change of friends, extreme change in interests or tendency to lose temper, being argumentative or borrowing and not repaying money.
Violation of College Rules, Impairment of Academic and Work Performance
Inability to perform work assignments at usual level of competence, missed deadlines, missed appointments, classes or meetings; increased absenteeism or lateness; frequent trips from assigned or expected work area; accidents in the lab; complaining or feeling ill as an excuse for poor performance; coming to class, practice or work intoxicated/high; legal or judicial problems associated with alcohol or other drug use; not scheduling morning classes; neglected school or work obligations for two or more days in a row. (Some individuals with substance abuse problems are still able to perform at a high academic level.)
Other signs include:
Getting a person to seek help may be a challenge. Here are a few hints for getting the message across:
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Suicidal
It is not uncommon for students to engage in some degree of suicidal thinking. As a member of the campus community, you may be in contact with students who have expressed these thoughts to you. It is important that you do not simply overlook these comments as the student may be reaching out to you.
Suicidal risk is based on observing not just one but a constellation of clues. These clues fall into the following categories:
Situational Clues
Depressive Symptoms
(several symptoms present)
Verbal Clues
Something a person says, overtly or covertly, that communicates suicidal ideation and intent:
Behavioral Clues
Something the person does that communicates a self-destructive motive:
The following are some of the areas that counselors explore with students to help determine the level of risk. It is not recommended that you use these techniques, but only be aware that they are used in a professional counseling setting.
Factual Information to Assess
Precipitant for the crisis
Evidence for suicidality
Method
Someone with a specific plan and who has access to the means for suicide is a high suicide risk.
Resources
Other Clues to Consider
Social Withdrawal
Not attending classes, sitting alone at meals or not going to meals, staying isolated in dorm room.
Preparatory Behavior
Giving away possessions, making plans to "be away."
Feelings Expressed
Helplessness (exhaustion, failure), frustration (rage, anger), sadness (depression, confusion).
Depression
Eating and sleeping much less or much more than usual; apathetic, unhappy.
Psychotic States
Grossly bizarre or inappropriate behaviors, out of touch with reality, uncontrollable violence.
Substance Abuse
Alcohol and/or other drugs; food, e.g., overeating or loss of appetite.
It is helpful to:
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Suspicious
Usually these students complain about something other than their psychological difficulties. They are tense, cautious, mistrustful and may have few friends. These students tend to interpret a minor oversight as significant personal rejection and often overreact to insignificant occurrences. They see themselves as the focal point of everyone's behavior, and think that everything that happens has special meaning. Usually they are overly concerned with fairness and being treated equally. They project blame onto others and will express anger. Many times they will feel worthless and inadequate.
It is helpful to:
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Verbally Aggressive and Potential Violent Behavior
Many campuses are concerned with the number of incidents regarding strong verbal aggression and violent behavior. It is helpful to know some indicators for this type of behavior and develop personal action plans should it occur.
The most accurate predictor of violent behavior is past violent behavior. If an individual has a history of such behavior, she/he is more likely than someone with no history to engage in it again. Since it is unusual for you as a faculty or staff to be privy to such information, it is necessary for you to be attentive to current behavior.
Frequently, assaultive behavior is predicted on the basis of observing hostile, suspicious and agitated behavior. In the absence of the above symptoms, the presence of hyper-vigilance (i.e., frequent or sudden eye movement), extreme dependency or delusions and hallucinations may be causal factors. Other signs and symptoms that may indicate a loss of control are fearfulness or anger. Verbal communication may be loud and pressured.
In the face of this behavior you should try to remain calm. Taking some deep breaths will help, as will relaxing the muscles. This stance is seen as "controlled tension." Your posture should be alert with your hands in front of you. Keep your voice low and be aware of everything in the room.
The Assault Cycle
As violence escalates the aggressor reacts to the perceived threat with physical, psychological and behavioral responses that often follow a path of progression. This assault cycle has six phases:
•1. The Triggering Event
Here the aggressor perceives a serious threat to her/himself. This perception may not make sense to you, but it is very real to the aggressor. The triggering event can be perceived by the aggressor as:
•2. The Escalation Phase
Here the aggressor's mind and body prepare to fight. She/he may challenge the potential victim, especially if the victim is associated with the perceived threat.
•3. The Verbal Aggression Phase
The most common occurrence of assaultive behavior on our campus is the verbal threat or some other form of confrontational language.
•4. The Crisis Point Phase
The aggressor acts violently against the perceived threat.
•5. The Recovery Phase
The confrontation appears to have passed, even temporarily. The aggressor's body relaxes and his/her mind decreases vigilance.
•6. Post-Crisis Depression Phase
Fatigue, depression and guilt appear afterward, as the physical and emotional aspects of the crisis peak. The body and mind return to a more stable base level.
Comments About This Model
It is helpful to:
It is not helpful to:
Campus Safety at 911 or 660-562-1254 is a good resource and should be called at any time during the cycle. Finally, and for your own well-being, take these threats seriously and be prepared to act accordingly.
Please contact the Counseling Center at 660-562-1220 for assistance with debriefing of the incident for those involved.
Departmental Safety Plan
As a result of certain kinds of behavior from students, it may be necessary to set up a departmental safety plan. For example, if you think that a student has been threatening you in the past and she/he shows up at your office, you may need help in dealing with the student. Quite often it is the people you work with, and those in the closest physical proximity, who can provide the help you need. The following section will help you define a security plan for your department.
Security Plan
First and foremost, call on Campus Safety to help with setting up a plan. The following are the kinds of behavior you should be concerned with:
There are at least three types of responses open to you:
Questions to Consider as You Develop Your Departmental Safety Plan
An Example of a Possible Scenario
You are a receptionist at a window in the business office. One week ago, a student waiting in line began speaking very loudly and abusively about how the business office "screwed up," and now he has to pay for it. By the time the student reached your window he was quite agitated. As you tried to explain to the student what he needed to do, he said "the next time I'm here, I'm gonna blow up the place." Today he is at your window again.
This scenario (or one that may be more appropriate for your specific department) discussed in your group setting can help you prepare and implement a safety plan.
Quick Reference Guide
#1 Priority-SAFETY OF ALL PERSONS
ACUTE INCIDENT
(Suicide attempt, violent/aggressive behavior, student in extreme distress)
Call Campus Safety at 911 or 660-562-1254 immediately
BEHAVIOR OF CONCERN
(Abusive Dating Relationships, Anxiety, Demanding Behavior, Depression, Irrational or Inappropriate Behavior, Mania, Substance Abuse, Suicidal, Suspicious)
Consult the Assisting the "Emotionally Distressed Student Guide."
Consider contacting counseling services at the Wellness Center (660) 562-1220;
Campus Safety at (660) 562-1254 or Student Affairs (660) 562-1242