MHSC Interviews Dr. Hughes-Troutman, Director of CARE

Tiffiny Hughes-Troutman, Ph.D.
Director of the Center for Assessment, Referral, and Education (CARE)

Interviewer: Jordan McKinney

Date: 7/17/2020

Question 1:
What are some of the top problem’s students bring to CARE? What does CARE do to help students address these problems?

Dr. Hughes-Troutman:
For decades, college students have faced issues such as anxiety and depression, and what we see in CARE closely mirrors that. Interestingly, when I first started in collegiate mental health, and examined that data, depression was the number one concern. About 6 or 7 years ago anxiety became the #1 concern followed by depression. These are the top concerns we see in CARE now. Other concerns include relationship concerns, stress, and academic concerns. The shift in anxiety issues show that students are more anxious than depressed, although there can be features of both. More recently due to COVID-19 as well as other recent local and national issues related to racial injustice, anxiety has spiked. So, what we are finding is that students who already have had pre-existing anxiety and been in treatment or having anxiety and not deciding to seek treatment are now stepping forward to seek help because of these numerous stressors. I’ll also add that we predominantly help students who are having academic concerns or who speak to academic adjustment concerns that may relate to the culture and environment. Tech is also a high-stress, high-performance environment, so students come here having been at the top of their class and have very high expectations for themselves. But I think the general thread across all of that is students really want to do their best, and then feel like they’re failing if they don’t get As or if they’re not at the top of their class. I think that’s a unique cultural aspect to Tech, so independent or not of whether a student steps forth with a clinical concern, they’re always talking about the academic stress and pressure, and so that’s an underpinning.
CARE is a single point of access for mental health resources and services on and off campus, and we opened in August of last year. We are the triage, assessment, and referral department. Some students are a bit confused and think we’re another counseling center or think we are a part of the campus Counseling Center. We’re actually a separate department where students come to get an assessment and then referral to appropriate resources on and off campus. Student need to start with us to receive services from the Georgia Tech Counseling Center or Stamps Psychiatry. But in CARE the referrals include so much more than the clinical referrals because we want to support a student’s health and well-being. Students leave CARE with a customized CARE plan, or listing of resources – many resources we refer students to support their well-being including mindfulness or self-care. There also referrals to academic, career, and student services resources to their identity. At CARE we know that students’ well-being can be impacted on a number of levels, but we also want to make sure we are helping students flourish, so what CARE does is makes sure students leave with a good understanding of as many resources as possible to help, independent of whether they need a clinical resource. We strive in CARE to destigmatize and hopefully demystify the whole process, as well as to normalize it, because our whole motto is “Come to CARE” no matter what you’re facing. It doesn’t have to be a big thing. By coming to CARE we help a student get closer to the help they need, whatever that looks like for them.

Question 2:
What can students expect out of the CARE assessment process? (In other words, how are you different from the Counseling Center and how do you work together?)
a. What other resources do you refer students to?

Dr. Hughes-Troutman:
First, I do need to point out that fall operations will look different from the way we operated last year due to COVID-19, however, our service delivery will remain unchanged. Students can call us at 404-894-3498 for an appointment. We are operating primarily virtually and have successfully done so since March. Eligibility is that students have to be enrolled as a degree-seeking student at the Institute. Our services are confidential and there are no charges or fees. You fill out your paperwork, meet with a licensed clinician via the BlueJeans platform or phone, hear a recommendation on what your next step(s) are, and get a CARE Plan that identifies your next appointment. Streamlining this process in one step is really big shift for our mental health system because before CARE opened, students would access the Counseling Center and Stamps Psychiatry independently and would encounter long wait times and a prolonged period of time to get started in treatment. In CARE we collaborate with the Counseling Center and with the Psychiatry Clinic heavily to coordinate that care. Because we are operating mainly virtually, students will receive a communication about that next appointment that day or the next day. When we were operating physically, the student would leave our office that next day with their next appointment.
Regarding the distinction between CARE and the Counseling Center, the Counseling Center provides treatment and no longer provides assessments. Their services include clinical resources such as individual therapy, group therapy, workshops, and testing but they also provide outreach and other forms of prevention. They’ve always done that; the only difference is they use to do assessments too. The main idea is that since CARE is providing all the assessments now, that will open up more resources for the Counseling Center to allocate individual or group therapy appointments. So very intentionally we realize the demand on the Counseling Center, and the idea is siphon off of the assessment responsibilities of the Counseling Center to open up more slots for therapy. It’s an innovative approach that other campuses have expressed great interest in. Again, students need to start in CARE but some students don’t need counseling even though they believe they do – it’s our job to appropriately figure that out in collaboration with the student.
We also work together very collaboratively with Psychiatry. Similar to our referral relationship with the Counseling Center, students need to start in CARE in order to receive a referral to the Stamps Psychiatry Clinic. In the past, students would try to make appointments at both the Counseling Center and Psychiatry because of the long wait times in an attempt to see where they could get in first. But the unfortunate part about this was students didn’t need both and often didn’t understand the difference between the two, so there was a need for greater education on those services. The Psychiatry Clinic is staffed by board certified psychiatrists who predominately specialize in assessment, medication management and referrals. Their care coordinators are case managers who support this care and conduct an extensive amount of referrals and case management. The Counseling Center is staffed by licensed mental health professionals – psychologists, professional counselors, and social workers who are trained in psychological assessment, treatment and clinical case management. So, in the past, a student may have gone to Psychiatry just wanting to talk to someone and find out later on that the Counseling Center is a better option, or vice versa if they needed medication management. The role of CARE is to figure that out for the student, to provide education, decrease wait times, and to decrease that confusion and shuffling back and forth that students at Tech have experienced for years.

Question 3:
In your opinion, how has the stigma around mental health and resources on campus negatively impacted student treatment?

Dr. Hughes-Troutman:
Unfortunately, mental health stigma is a real problem. To a large degree, it doesn’t exist for other types of illnesses. A student wouldn’t hesitate to go to Stamps if there was an ache or pain or if they needed treatment for a chronic physical health condition, but they do hesitate or are ashamed to talk to someone about something happening mentally. So, there’s a distinction between the mental and physical that we still have unfortunately. We know that when you have a clinical depression, your brain looks different. So, education on the etiology mental health may also help with the conversation. Because stigma, students do not step forward and receive help or delay seeking help to the extent that it becomes an impairment. They may have sought help earlier if there was less of a stigma. Unfortunately, stigma is real and strong, and I know that there is a lot of interest and engagement in conversations on trying to fight that.
I think one strategy that helps is peer to peer messaging, as well as projects such as the one that you are doing now through MHSC that helps de-stigmatize mental health. It helps to put a name to the face and helps students say to other students that it’s okay to reach out for help. That’s important because messages, we know from research, are better heard from peers than from professionals. My staff or I can go out and talk all day to students about the importance of going to CARE, but if you hear it from a student who’s gone to seek help or who had a positive experience, it’s going to make such a big difference. But even with that, stigma is still difficult to combat and on campus we are engaged in a lot to help with that. The Counseling Center is spearheading a partnership with the JED Foundation, so we are a JED campus to help us reduce barriers to access and to help with peer to peer messaging. There are a lot of wonderful programs we’ve done at Tech. In 2018, I spearheaded he first Fresh Check Day, which was a peer-to-peer suicide prevention mental health event. The idea for this was to really fight stigma. Health Initiatives sponsored this event again last year, and it was very successful. Another example of effective stigma prevention is through the Active Minds organization and NAMI. Given the fact that at Tech students already have such high expectations of themselves and already expect themselves to perform at the top, so when they are encountering a mental illness – maybe even for the first time at 18 or 19 years of age – it’s even harder for them to step forward. I think that underscores why we are doing all that we can to fight the stigma.


Question 4:
What can people staying at home do to keep their minds healthy?

Dr. Hughes-Troutman:
Given the COVID-19 pandemic, there’s a lot of messaging about social distancing. Physical distancing is important for our health and safety, but social connection is more important than ever. We need to find ways to stay connected as best as we can because students are facing a lot of isolation and loneliness- which in fact is an epidemic itself. This was an issue before COVID-19, and now that
COVID-19 has happened there’s less of an opportunity to connect in person, so I think the message needs to drift to the importance of staying connected, the importance of having virtual meetings and meet up groups, and whatever other ways we can continue to engage. I’m aware that Zoom and BlueJeans can create virtual fatigue, which is a very real thing, and the quarantine fatigue is real as well. Of course, it’s important to practice safety and well-being, especially now that we are seeing spikes in COVID-19, so it doesn’t diminish the fact that we are still practicing physical distance which is why it’s so important to find a way to do it virtually and stay in touch. In terms of mental health support, it is positive that we are all doing virtual telebehavioral health now. CARE, the Counseling Center, and the Stamps Psychiatry Clinic provide treatment through BlueJeans and/or telephone, so that’s still an abundance of available resources for students who need formal treatment and resources.
I acknowledge and realize that these are really tough times because students may be at home with less than ideal living situations or living in places that they did not anticipate being in. Certainly, practice self-care, and while being safe – get outside and take part in some physical activity, as it’s so important and critical for everyone’s mental health. Also make sure to get enough sleep, as well as engage in other self-care practices- including grounding yourself through mindfulness. I think the last main point to mention is the cognitive issue of feeling like this pandemic will last forever, but it will not. We will get through this, as our health officials are working really hard for solutions to help with a number of these issues. I also think it’s important to mention to those who need formal treatment that it will always be there. It may not be face-to-face, but its still there virtually – and what we are hearing from students is that they’re pleased with seeing our practitioners through BlueJeans. While it isn’t the exact same, it simulates the therapeutic environment well it and it is most importantly safer for everyone involved.

Question 5:
Can students still call CARE during this pandemic and receive care?
What if they are not actively enrolled in classes in the summer?

Dr. Hughes-Troutman:
All students need to do is call us at (404) 894-3498 and say is that they need to talk to someone. There will be a couple of questions we will ask them to get started followed by some online paperwork. Now if you are physically located in Georgia you will be connected with a case manager or a physician that will conduct a full assessment either through the telephone or through BlueJeans, which ever the student prefers. So, they’ll get a full assessment and then a referral to appropriate resources, as well as a CARE plan that will be sent electronically. If the student is located physically out of the state of Georgia, they can still call us and get a brief consultation and referral. We wanted to extend this to students because we realize, due to COVID-19, some students have to go home or out of the state, so we wanted to make sure we were extending flexibility and still providing that student with that appointment. We wanted to make sure we were practicing good clinical care without exclusion, but at the same time to get the full assessment our scope of service is still with in-state students. Really all they need to do is call us. Now that the fall semester has started, we are back on campus but because the need for us to practicing physical distancing and safety, we will have an appointment-based model and students will need to still call.


Question 6:
What inspired you to go into a profession helping college students?

Dr. Hughes-Troutman:
When I was an undergraduate, I was considering going to medical school to become a psychiatrist or going to graduate school to become a psychologist. I made that decision relatively late in my senior undergraduate year, but I ultimately decided to go to graduate school because I wanted to talk to individuals about their problems and have always enjoyed talking and listening to stories. I felt that would be a better fit for me rather than going to medical school and primarily prescribing medication. So, I went to graduate school and got my Ph.D. in counseling psychology from the University of Illinois at Urbana-Champaign. I completed practicum which are training experiences through the college counseling center and in a clinic that served college students, and I also taught courses as a teaching assistant. Additionally, I worked for the Graduate College as a graduate assistant in a bridge program helping to bring more ethic minority students to the university. My internship was at Virginia Tech in their Counseling Center and I liked that a lot and felt like it was a good fit for me. I didn’t want to go to private practice, and I decided that college counseling was a good fit for me. Also working in an academic environment enables you to practice, supervise, work on committees and conduct preventative outreach. I’ve always liked school and so it was really a good fit for me to be in that type of environment where research is going on and there’s so much intellectual capital.
Post-graduate school, my first positions were at the Georgia Tech Counseling Center as a postdoc and staff psychologist. I also served as an Assistant Director of Outreach and Wellness there. Then I worked in Health Initiatives as Director of Health Behavior for two years, and in that role supervised VOICE sexual violence prevention and advocacy team as well as spearheaded “positive psychology” initiatives which focuses on resilience, mindfulness, optimism and happiness. I worked to coordinated those program on campus with faculty and staff and students. Then in June 2019, I accepted the role of Inaugural Director of CARE. Because I have worked at Tech for a number of years in different departments, this role was an easy transition because I know the campus mental health system and a lot of resources. It’s very rewarding to help students. I also enjoy serving the Institute on other levels. I served as co-lead for Institute Strategic Planning’s ‘Cultivate Well-being’ theme which is one of President Cabrera’s strategic teams that’s wrapping up Phase 2. So, my work allows me to do what I like to do, not just clinically, but to continue to make an impact on students’ well-being on a broader level.

Question 7:
What is one of the most rewarding things about being a case manager/psychologist, etc.?

Dr. Hughes-Troutman:
I am a psychologist, so I think one of the most rewarding things is just seeing a student feel better and just getting the chance to meet with students and shape their path or perspective a bit. Students at Tech are very bright and very resourceful. When they step forward to see us, they are really doubting themselves or disappointed at some level .So, what’s rewarding for me most is me being able to provide that perspective and saying “ You can do it” or “ You are resilient” or acknowledging that it is a temporary struggle and there is always help. And then being able to follow up with a student and see them feel better. At CARE we have the unique ability to do that. As I mentioned we do provide case management, it’s not just that one appointment, so we do follow up with students. We check in to see how they’re doing, make sure they get the help that they needed, and most importantly we get to hear their stories. Seeing the trajectory or path that student took to meet their goals, get better, and see that it is okay and that they’re strong ia an amazing part of my role.

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