Health Services COVID-19 Association California Impact Survey Community Colleges Results
Prepared May 2020 About HSACCC
The mission of Health Services Association California Community Mission Colleges is to support and foster Statement student access to quality health service programs within the California Community Colleges HSACCC Research Committee
. Nicole Johnson, Cuesta College
. Deanna McFadden, Oxnard College
. Nancy Tamarisk, Napa Valley College
. Alex de Jounge, Hancock College
. Gerry Hinayon, San Joaquin Delta College
. Becky Perelli, HSACCC Consultant
. Sang Leng Trieu, Ohlone College Survey purpose and instrument
. Purpose: Focus on the impact "here and now" of COVID-19 on college student health services and programs
. Survey comprised of 33 items, focusing on: . Staff composition and responsibilities . Current provision of services and methods of delivery . Identified needs of students . Health fee and other financial related items . Involvement with COVID-specific responses and planning
. Survey took approximately 22 minutes to complete Methodology
. Purposive sampling based on the following criteria: . HSACCC listserv representing 63 colleges Organization membership list College health programs list by region
. Web-based survey
. Survey conducted over a 9 day period during spring semester (April 28 - May 8, 2020) Sample size & response rate
• Number of colleges in the California Community College system 114
• Number of colleges with Student Health Services 80
• Number of Student Health Services on HSACCC listserv 68
2007 • Number of colleges that responded to survey2015 2019 51
• Response rate 75%
• Results represent this proportion of all Student Health Services in the CCC system 64% Why disseminate findings?
1. Identify challenges & opportunities in pandemic response & planning as reference for future
2. Provide timely measurement of effect and response of the pandemic on CCC Student Health Services Programs Q3 & Q4: Staff Composition
Full-time Part-time
• Average: 3.35 • Average: 6.7 • Range: 0-11 • 48% colleges have between 10-19 staff • 52% colleges have 0-5 staff Q5: How has COVID-19 altered your staffing this semester?
The majority of health centers (55%) replied that they had experienced changes in staffing
Student workers - widely affected; laid off or reduced hours
Part-time staff, contract employees, mental health interns - released from work
One college - as of 5/20/2020 “all my help will be laid off”
Two colleges - will increase mental health providers Q6: Anticipation of staff changes
60%
50% 48% 44% 40%
30%
20%
10% 8%
0% Yes, I anticipate a decrease Yes, I anticipate an increase No, I anticipate staffing to stay the same Q7: Anticipation of Providing Services during Summer Session
Just over 76% of respondents indicated that their health center would provide services for Summer 2020. The majority of these indicated they would provide some type of remote services (internet based, telehealth, or Zoom); two colleges will be contracting with an outside party to provide telehealth services. Two will be open for limited services such as Allied Health physicals, TB screening, and well person visits. Only one college indicated “business as usual”.
Given the dynamic nature of guidance since this survey was completed, and the time period until Summer session(s) begin, the number of colleges providing services, both remote and limited on-site, may change. Q8: What activities/tasks are your classified staff doing while working remotely?
Online training 5%
Tech support 8%
Creating webinars 8%
Updating polices & procedures 8%
Purchasing & budgeting 12%
Outreach 12%
Creating new online materials 20%
Scheduling appointments 31%
Answering phones & emails 49%
0% 10% 20% 30% 40% 50% 60%
Q9: What activities/tasks are your student workers doing while working remotely?
Maintaining social media 2%
Working on outreach activities 4%
Attending virtual staff meetings 4%
Assisting with creation of webinars 8%
Working on online wellness activities 14%
No student workers 55%
0% 10% 20% 30% 40% 50% 60% Q10: How are communications with your program staff different than before?
80% 71% 70%
60%
50% 45%
40% 31% 30%
20% 14%
10% 2% 0% More frequent Connect as needed, in Hold virtual mtgs in Connect as needed Same as before add'l to regular mtgs same pattern as only COVID-19 before Q11: What best describes your use of telehealth/Telemental health?
100% 88% 90%
80%
70%
60%
50%
40%
30%
20% 10% 10% 2% 0% We continue to use We newly established We do not use telehealth/telemental telehealth/telemental health since telehealth/telemental health in health (Is this due to lack of we were already using response to Covid-19 resources support?) Q11: What best describes your use of Telehealth/Telemental health? Q12 Telehealth/Telemental health platform(s) health centers are using to provide services
90% 82% 80% 70% 60% 50% 40%2007 2010 2015 2019 30% 27% 20% 20% 16% 11% 12% 10% 6% 0% Zoom Cranium Cafe Doxy.me ConexED SimplePractice Chat Function of Use another the Electronic platform not Health Record listed Q13 How are health centers obtaining consent and sharing confidential health information securely?
36% of respondents are using EHR utilization appears to be the Additionally, consents obtained the Electronic Health Record most frequently utilized and verbally are recorded or portal with an additional 43% desired method for obtaining documented in the EHR (33%) stating they are working to do so secure consents
2010 2015 2019 Q14 How are health centers covering costs associated with ensuring above the security? (HIPAA compliance)
Greater than half (57%) of the 47 percent reporting “Other” state they are accessing these platforms without charge to the 60% health services program through HIPAA 55% compliant zoom through the college
50% 41% 40%
30% Several others mentioned 2007 2010 2015 CARES/emergency2019 funds; 2 received 20% grants 20% 16%
10%
0% Utilizing health fee funds Utilizing mental health N/A as we are not Other (please specify) Colleges challenged with covering the cost one-time funds currently providing of securing consents might query their services needing this respective administration as to the security. systemwide HIPAA compliant zoom Q15 Current Level of Services and Programs Being Provided
60% 53%
50%
40% 33% 200730% 2010 2015 2019 22% 20% 18%
10% 6% 2% 0% Most Some Few Limited/targeted No services Other Q16 Changes in Volume of visits
No change, 4% Marked increase, 2%
2% Only 1 campus experienced an increase
2007 2010 2015 2019 All other responding campuses Marked experienced decrease, 92% 92% decreases in visits Q17 Strategies on Marketing/Informing Students and College Community about Current Services and Availability
Specific Other ways 86% 69% 29% 29% 10% platforms • Website • Email to • Outreach to • Social media • Text • Student • Creating students staff, faculty Facebook messaging electronic videos Instagram portal • Workshops Twitter • Canvas • Participating • Wellness in town halls Central Q&A • Starfish • Student Health 101 • Constant Contact Q18 Top 3 Requests/Needs that Students are Communicating
100% Mental health and basic needs findings are in 90% line with the recently conducted Chancellor’s 90% Office/Student Senate survey of student 80% challenges which reported mental health challenges as number one (67%). 70%
60%
50% 43% 40% 37%
30% 27% 22% 18% 20% 16% 16% 14%
10%
0% Mental health Basic needs Prescription Sexual & repro Other Academic Referral for COVID-19 TB screening (food, refill health program healthcare specific info, housing) health pre- coverage testing reqs Q19 Provision of Sexual and Reproductive Health Services
70% 60% 60% 52% 52% 50%
40% 36%
30% 26% 20% 20% 16% 16%
10%
0% Birth Control Pill Emergency Initial Birth STI Screening Lab Testing Education and Referral to Other (please Refills Contraception Control Visit (HCG, STI, etc.) Counseling outside agency specify) (Rx through ONLY FamilyPACT) Written Responses
• It was noted the Health Center isn’t getting very many requests • Some are preparing for additional services-STI screens, Titers, and other labs as needed/appropriate • Initiation of BCPs only; one college noted Nexplanon only • Difficulty with ordering labs (through Quest) due to no online payment option for students • It was noted they send students to Quest with the Health Center account number. The college is charged and then they charge the student. The Health Center absorbs the $15 processing fee for now. • Partner with an outside clinic who is a FPACT provider, and they offer limited services at this time. The once a week clinics in the health center are suspended, but students can access limited services at their local clinic. • Refer lab tests to Quest • All labs are ordered in the EHR, patient is sent to Quest, all results populate in the EHR and the patient has a follow up appt • We would, but there have been no requests for it. Q20 Are you Sending 60% 57% Students to Area Labs 50% for Testing? 41% 40%
30%
20%
10%
0% Yes No A few noted they are One noted they did not Quest Lab was getting ready to offer labs prior to West Pacific (2) predominantly used provide labs; most plan COVID-19 either to use Quest
One noted they plan to We send students to a One college noted they offer labs after they range of labs, Need a better process draw and collect the develop RN protocols depending on their to collect the lab fee labs in house and a better process insurance (1) with Quest
Have not yet, but we have the ability with Planned Parenthood (1) FamPACT clients only Q21 How are Health Centers Charging Students for Labs/Other Fees
Results
38% N/A Labs are not offered Waiving Fees 58% We are charging
4% Written Responses
How Health Centers Charge Added Fees • Solutions for charging labs to students: • Bill through EMR linked to Banner or student account • Fillable consents for fees to use students’ credit cards • SHC pays for labs and post to student accounts and the school reimburses SHC. This is handled by Accounting/business office. • Partner with Quest or other Lab facilities. Students contact the Business Office, make a credit card payment, we submit the order to Quest. Quantum via Quest Lab may be used. • Family Pact Billing for Labs and SuperBill (see notes from meeting) • The District set up a process, the student emails the check and awaits processing. Once processing is complete the District will notify SHPS Director. The student will be notified to go to Quest for the service. • WestPac uses on-site cash payments so students can pay them directly. There is a small additional charge., we provide electronic lab slips. • Pay later when school reopens • Send an invoice of charges to the budgeting office who posts them to the students’ accounts • Resources • Family Pact Meeting notes and Family Pact Super Bill ONLY doing Referrals;Not providing services 1.96 Q22 Psychoeducational Groups 23.53 What Mental Additional Services 25.49 Health Services are you Support Groups (non-therapy) 33.33 Providing? Brief Assessments 52.94 Initial Intakes 64.71
Referrals To Outside Agency 86.27
Individual 88.24
0 10 20 30 40 50 60 70 80 90 100 • CBT • Sessions through outside Tel-med company • Psych services offered through different department • Prior to closure, web based individual zoom appts. • Class presentations; psychoeducational workshops; peer mentors programming (Student Wellness Advisory Group) • Zoom Workshops • Classroom presentations via Zoom • Contracted with Active Minds to provide Mental Health Workshops via Zoom • Once Telehealth we will resume all MH services and nursing consultations • Short texting encounters • Telehealth starting • Participating in Town Halls, reviewing mental wellness tips for staff and students, wellness videos in process • Mental health topic specific to workshops using Zoom Q23. What Services are the Mental Health Interns Providing?
25 answered, 25 skipped due to No Intern Program Individual Sessions Support Groups (Non-therapy) Psychoeducational Groups Brief Assessments Initial Intakes Referral to Outside Agency Q24 Provision of Tobacco Cessation Services for Students
80%
70% 69%
60%
50% 2007 40% 2010 2015 2019 31% 30%
20%
10%
0% Yes No Description of Cessation Services and Resources
Current provisions Plans in progress
• Ash Kickers Quit Smoking Program (via Zoom) • Developing partnership with county public health • Part of individual mental health counseling sessions • Creation of a smoking/vaping cessation 2007 2010 2015module to be offered in Canvas2019 (on demand) • Telehealth appointments with NPs
• Resources on websites
• Referrals to county public health
• Smoking Cessation Counseling with CYAN Q25 Implementation of Peer Service-Related Activities
60% 56%
50%
40% 200730% 2010 2015 2019 19% 19% 20% 10% 10%
0% Active Minds NAMI on Campus Outreach None Description of Peer Service-Related Activities
Student Wellness Student Health 101 Virtual Workshops Class Presentations Ambassadors Program
2007 2010 2015 2019 Collaborative Adressing basic Wellness checks for events with other Tobacco-Free needs with Equity and by peer campus Student Club Center ambassadors departments Q26 Current Provision of Clinical Teaching
Yes, 6% Examples
• Nursing students working through 2007 2010 2015 telehealth 2019for clinical hours No, 92% • Zoom exams with providers Q27 Health Fee Charged to Online Students
90% 82% 80%
70%
60%
50%
40% 200730% 2010 2015 2019 20% 10% 10% 8%
0% Yes No No, but there are plans to charge these students Q28 Request to Return Health Fees Collected this Term
80%
70% 67%
60%
50%
40% 2007 31%2010 2015 2019 30%
20%
10%
0% Yes No Q28 Request to Return Health Fees Collected this Term
COMMENTS Students who withdrew from classes for the semester were refunded 56% of the health fee (8 Survey indicates that respondents reported this). telehealth & Increase in number of students requesting a waivers (3); granted for Title 5-eligible exemptions only. telemental health is being provided by IMPLICATIONS HSACCC could assist in clarifying to college leadership and the greater college community as to online 88%, and additional 2 offerings provided by Student Health Services Programs. are in progress to use Robust presence of online information and resources is provided to all students, including those who in near future. are ONLINE only (90% of SHSPs reported this per HSACCC Annual Survey 2018-2019).
HSACCC2007 could further advocate that the2010 health fee be charged to online students2015 at those 2019 colleges/districts that currently do not.
“….the health fee may be charged to students who take only online classes or who attend classes at sites away from where the health services center is physically located. The health fee is not designated as a “use” fee, and it appears that so long as the statutory exemptions are offered to all affected students, the fact that their classes may not be physically proximate to a student health center does not remove the fee obligation.” (Student Fee Handbook, Legal Opinion 12_09) Q29 Advisory Role of Student Health Services Director/Coordinator
6 out of 7 directors (86%) are participating in newly formed COVID-19 task force 60% 57% at their college/district
50%
40%
30% 1 in 10 who are participating 22% are leading the effort 20% 2007 2010 2015 14% 2019
10% 8%
0% I am leading the effort with I am a participant in the I am a participant in the Other (please specify) a newly formed task force effort with a newly formed effort as part of Directors/Coordinators are task force participatory governance key subject matter experts in and already standing groups advising the college-wide (i.e. no new group was planning process formed specifically to address Covid-19) Q30 Activities Student Health Services Programs are involved in specific to COVID-19
90% . 80% 80% 80% Referrals, keeping updated via 70% trainings, working w/nursing program to support the effort through clinicals, 60% 52% emphasizing SH101 as excellent 50% resource, expecting to be vaccine site 50%
40%
30% 24% 2007 2010 18% 2015 2019These activities reflect the strong 20% public health approach of health 10% services programs in providing education and health risk prevention, 0% as well as maintaining community Educating individual Information Following up on Assisting with contact Directly Preparing for the partnerships critical for responding to students on ways to gathering and specific tracing of communicating with college to potentially infectious diseases on behalf of the prevent virus educating the college students/employees students/employees county public health serve as a transmission within community about who have been known to be infected officer/staff region/area test site entire college/district their respective living Covid-19 identified as regarding specific situations potentially exposed cases to Covid-19 Q31 Long term plans to address campus closures
Re-opening Adjusting Telehealth Guidance
• Developing plans for • Adjusting as new • Developing, • Looking to guidance reopening information comes in establishing & from CDC, County • 14% state limited expanding remote and Local Health 2007onsite is likely 2010 2015telehealth services 2019Departments for the long term Q32 Planning for Re-Opening
OPERATIONS FACILITY SERVICES ADMINISTRATIVE Staffing considerations – staggering staff, limiting Secure facility – lock doors Consider hybrid of services Partnering with all college to hours, daily screening of staff, daily health logs as needed support wellness and safety Hours of operation Plexiglass sneeze guards Routine IZs, TB screening/testing Prevention marketing; campus communications Appointments – require and stagger, limit number in Distancing markers Ensure addressing students with Ensure administration given time period specific program requirements understands SHS is expected to serve students, not employees Supplies and equipment – Reconfigure spaces Nurse consultation Ensure legal compliance PPE, non-touch thermometers, disinfectants Triage - consider phone assessment, in-person HEPA filter installation Continue/expand telehealth assessment2007 2010 2015 2019 Plan for positives - Increase handwashing Increase health education and stations trainings; campuswide promotion of staying safe and well Safety Trainings – PPE, proper/increase disinfecting, Signage/Posters Establish mindfulness offerings strict handwashing, require masks for patients & staff
Update communicable disease protocols Disinfecting
Develop/Establish Policies and Procedures with tools. * Of note, since the completion Flowchart/algorithms – Covid-19 Checklist – of this survey there has been assessment/screening, care, isolation, tracing tracking much additional discourse in Planning for Re-Opening Q33: Success stories: What’s working during this unprecedented time It is gratifying to have the community relationships I have created over the years come to our advantage at this time. I can contact our PHO, County Sup of Schools easily to work together and problem solve. Also, our President is including me as a content expert (public health) to provide key Success guidance in our COVID-19 task force. While not ideal, working in the Zoom environment keeps us stories connected. We partnered with a local health care provider and they plan to open up a clinic inside our college.
Online professional development staff and IT dept did an amazing job of getting us functional in less Partnerships than 2 wks!!
Our district has 4 colleges with health centers. This situation has allowed us to work as a team and support one another more than we ever have before. We meet daily and have a united front to the administration through our district wide director. In addition, addressing online students’ needs is now at the forefront which is long overdue. Telemental health is new and a great success. We hope to continue this, and add telehealth to our services, even when we "come back".
Students are doing really well with TMH! They like it and support the research that shows it is Success rated as well as in-person sessions. The biggest problem is finding a quiet private space to stories have the appt. and our college made a "Wifi Lot" for students to use and connect to wifi. This means that for many of our students with multiple family members, roommates, etc. they can drive or walk to the designated parking lot and have a private TMH session with one of our counselors. It has worked really well for our students!!
I am happy we found a way to do TB Risk Assessments for students and employees (HR reimburses us) using Adobe DocuSign and telephone/zoom consults. The college had very old Online paper processes and it has forced us to improve our processes and adopt new technology. Services We have found our health education program very successful with faculty supportive and engaged by offering extra credit to students who attend. One-on-one tele-therapy continues as well with students receptive. We have found our health education program very successful with faculty supportive and engaged by offering extra credit to students who attend. One-on-one tele-therapy continues as well with students receptive. Success stories Using Zoom for workshops such as weekly guided meditation; our acupuncturist discussing posture and wellness, counselors discussing grief and coping skills. Well attended and a good way to connect with students and staff.
Our Active Minds Club has continued weekly meetings via ZOOM. They initiated collaboration with our local CSU Active Minds Club in hosting a peer-to-peer Active Minds V-A-R training open Online to all students via ZOOM.
Workshops Our wellness ambassadors held a "mental health movie night" and hosted a Netflix party last Friday night. It had 80 participants! Students want to continue to engage with each other. Now what?
Host a COVID Produce an Disseminate results forum to discuss executive summary to select implications of survey results stakeholders