1 Adler Graduate School Report to the Board's Governance Committee Written by Dr. Solange Ribeiro Contributors: Dr. Jeffrey Al

Adler Graduate School

Report to the Board’s Governance Committee

Written by Dr. Solange Ribeiro

Contributors: Dr. Jeffrey Allen and Dr. Nicole Randick

September 14, 2018

The Lifetime Value of a New AGS Student (strategy enabler)

1. The focus should be on marginal contribution – student revenues minus education-related variable costs. 2. This can be done initially as a backward-looking exercise with existing data as available and refined going forward as additional data inputs become available. The committee recognizes that the availability of data will have an impact on the creation of the LTV metric (especially cost allocations) and expects that AGS leadership will make appropriate choices and trade-offs in constructing this metric.

Return of Investment Summary

Table 1 summarizes data used in the analysis of return of investment. With a current 423 unduplicated student headcount taking a total of 4,790 credits during the year, the total revenue produced per student during their lifetime at the college (from admission to graduation) is $27, 460.30 and the total cost of this same student is $30,254.62, resulting in a lifetime loss of $2,794.32.

Table 1: Revenue and Expenses used for analysis of return of investment

Unduplicated Headcount 2017/18 Total Students 423 Credits 4,790 Per Student Revenue Per Student Annual $9,153.43 Revenue 36 mos. $27,460.30 Per Student Expense Per student Annual $10,084.87 Expense 36 mos. $30,254.62

Marketing Expense Does not include Salaries $31,836

New Student Goal 179

Marketing Expenses per new student Annual $177.85

2018-19 Budget Amount Key Metrics Avg. Credits/Student 5.03

Total Tuition Credits 6,443

Tuition Rate ($/credit) 590

Fee Rate ($/student/year) 150

Tuition and Fee Revenue 3,871,902

Other Income 124,000

TOTAL REVENUE $3,995,902

Personnel Expenses 3,237,523 Administrative (salaries + benefits) 1,336,621 Academic (salaries + benefits) 1,633,847 Other 267,055 Non-personnel Expenses (building and operations) 1,028,379

TOTAL EXPENSES 4,265,902

NET SURPLUS (DEFICIT) (270,000)

As expenses are not likely to diminish, in order to revert this negative balance, it is necessary to increase enrollment and other sources of revenue. According to the forecast for equilibrium spreadsheet provided earlier in the year by the Director of Admissions, equilibrium between revenue and expenses would be achieved in 2021, with a total number of students for Fall semester being 400 (we currently have 324 students enrolled for Fall term). Among factors contributing to future cost reduction in academic salaries, is a secondary gain associated with the substitution of a master’s thesis with a portfolio. While a master’s thesis results in a cost of $780 per student (Chairs and reader), or more when students require individualized intensive help

from the writing center, portfolios are included in advising and service loads of full-time faculty and carry no additional cost (or low cost, if part-time faculty are used as readers). Considering the unduplicated number of students as 423 students per year, this comes to a $327,600/year cost reduction.

It is important also to consider the nontangible benefits associated with the lifetime value of a student, such as referrals and visibility in the community. In the sections that follow we will discuss the forces expected to influence graduate education and mental health services in the upcoming years and provide a birds’ eye view of threats AGS will face and opportunities that are expected to be available as we consider strategies for growth.

How Will Learning be Delivered in 2025?

Context Offered by the Governance Committee

While most AGS students today participate as resident students, roughly 40% of students take an online course at some point during their engagement with the school. (Note: This statistic was provided by the previous administration and should be verified.)

The competitive landscape is a continuum of residential, blended and online delivery. Where an institution falls on this continuum is often strongly influenced by the “roots” of an individual organization. Online delivery is a necessary component but is not sufficient in plotting where a learning institution falls on this continuum.

Committee’s Request

1. Produce a competitive analysis comparing key competitors offering master’s and doctoral degrees in counseling, psychology and related fields. Identify campus and online programs and institution emphases. (See list of competitors below.) 2. Produce a point of view (POV) describing the learning experience in 2025 with a focus on delivery. The POV leveraging internal professional resources and external secondary sources, with an emphasis on external sources. The POV should focus on how the environment will differ from today, including how we may have to adapt Adlerian approaches in that prospective reality.

The POV should include an assessment of how technology will reshape the learning experience and the competitive frame? (For example, this is from the Adler University strategic plan: “For example, the ubiquitous nature of information over the internet has changed the student-faculty and student-institutional relationship in fundamental ways. Educators are now curators of information whose function has shifted to helping students analyze, evaluate, and manage the universe of information that surrounds them.”)

3. Evaluate AGS’ strengths and weaknesses relative to that 2025 point of view. How well do our current capabilities position us for success in that environment? What shortcomings exist in our offering that must be addressed to achieve competitive parity? What will be required to achieve some degree of competitive advantage in 2025?

4. What threats and opportunities for AGS are evident in the 2025 perspective? What market forces will drive that change? How might the competitive frame change among existing players? How do we expect student expectations to change? 5. In reference to these trends, provide a “ballpark” estimate of the types of investments that will be required to achieve parity in 2025? What investments will be required to achieve some level of competitive advantage?

Here is a list of schools and programs that the committee believes should be considered for inclusion in the competitive analysis, though we remain open to suggestions:

Adler University Argosy University Bethel University Capella University Minnesota State University, Mankato St. Cloud State University St. Mary’s University of Minnesota University of Minnesota University of St. Thomas Walden University

Competitive Analysis

The local market. Table 2 shows a comparison of the schools listed by the Governance Committee as our competitors. The list of competitors provided include, with the exception of Adler University, only schools in the state of Minnesota. Among the Minnesota schools, AGS is the only one to offer a master’s degree in Art Therapy. Degrees in Addictions and/or Co- Occurring disorders are only offered by AGS, MSU Moorhead, and Hezelden, while degrees aimed at preparing students to obtain licensure as Licensed Professional Counselors (under names of Clinical Mental Health Counseling or Counseling Psychology) are offered by 10 schools in addition to AGS. Marriage and Family programs are offered by AGS and 6 other schools, and School Counseling is offered by AGS and five other schools. Adler University, in Chicago, offers degrees in Art Therapy, Clinical Mental Health Counseling, and Couples and Families Therapy.

Methods of delivery vary significantly among the different schools. All Adler University programs are delivered in the Chicago campus, with Clinical Mental Health Counseling being also offered online. In Minnesota, most degree options are offered only on campus, with the following exceptions:

• Addictions: online programs by AGS (COD) and Hezelden; • CMHC: online programs offered online by AGS, Argosy, Capella, and Walden; • MFT: online programs offered by AGS, Capella, and Walden • School Counseling: online programs offered by Capella and Walden.

Table 2: General Information about Programs Offered by Each Institution

Institution Program(s) # of Type of # On-Time % Program Sem. Delivery graduates Completion employment cost ($) Credits 2017 % (months) upon (Tuition academic graduation and Fees) year AGS AT 67-69 C/H 13 31% No data 43,700* to (CMH+MFT) 42,530* (36)

CMHC 60 C/H/O 19 47% (36) 38,390*

COD 64 C/H/O 12 25% (36) 40,750*

MFT 57 C/H 27 48% (36) 36,620*

SC 50 C/H 16 75% (36) 32,490* Adler AT 63 Campus No data No data No data 80,920* University CMHC 62 Campus 68 98% 86% 80,020* + Online M(C)FT 60 Campus 13 100% 100% 78,040* Argosy MFT 57 Campus No data 64% (36) 77% 48,895** University CMHC 60 Online Bethel CMHC 60 Campus 42 No data No data 34,920** Hezelden Addictions 60 Campus No data No data No data 46,930 to 47,600* COD 60 Online Capella CMHC 60 Online 441 24% (51) 62% 43,830**

MFT 60 Online 123 7% (36) No data 44,804**

SC 47 Online 152 No data No data 37,739** (<10 students) MN S. CMHC 60 Campus 39 total 100% (36) 29,692* Mankato (CMHC + SC 50 Campus SC) 23,084* MN S. Addiction 63 Hybrid N/A+ N/A N/A 30,075* Moorhead CMHC 60 Hybrid 11 90% (36) 100% 28,800*

SC 50 Hybrid 12 92% (36) 92% 24,500*

St. Cloud CMHC 61 Campus 14 (incl. 24,324 to State U. SC) 36,953^ MFT 52-58 Campus 18 20,735 to SC 52-58 Campus 14 (incl 96% (36) 93% 25,135^ CMHC) St. Mary’s Counseling 48 Campus $25,000* U. of MN MFT 48 Campus 77 $25,200* U. of St. Counseling 48 Campus 48 41,120* Thomas Psychology U. of M SC 48 Campus 32 No data No data 68,256 to 105,648^ Walden U CMHC Online 452 25% 67% 46,990**

MFT Online 20 10% 76% 56,290**

SC Online 11% 37,205** Winona CMHC 60 Campus/ 16 26,688^ to State U. Hybrid 38,988

• *Calculated, based on cost/credit plus fees provided in the program website • **Average cost information provided by the program • ^Calculated, based on cost/credit plus fees provided in the program website; range is due to different costs for campus-based and online credits, and different cost/credit for MN residents or not.

Although Table 2 offers an extensive comparison among the Minnesota-based institutions that offer degrees in counseling, data from the professional literature in higher education indicate that this is not the best way to analyze our position among competitors. When thinking about competitors we must consider not only regional institutions but a much larger pool that includes institutions that offer online education.

Delivery. AGS’ ability to offer all degrees on campus, online, or in a hybrid format (combination of online and on campus) sets us apart from a large number of programs, as in most institutions students need to choose either an on campus or an online version of the program. One of the main reasons for this forced choice is that most online counselor education programs require periods of residency, in which online students gather on campus (or another predetermined location), usually 2 or 3 times, for approximately one week each time, in the course of the program. In addition to adding to the overall cost of the program, these residencies may pose difficulties to the working student.

On the affordability front, a comparison of the cost of education provided by AGS with that of other institutions in the list of competitors provided (online degrees with the same number of credit hours), shows that our cost is significantly lower than theirs (from $5,000 to $40,000

difference). More important, however, is the difference in the percentage of students that completed the program within the expected timeframe in 2017 (Table 2).

At this point in time, and focused on the cost/benefit aspect, one of our closest external competitors is the University of the Cumberlands (UC). The university offers CACREP accredited programs in Clinical Mental Health Counseling (CMHC) and Addictions (competing with our Co-Occurring Disorders program) fully online, without a residency requirement. Programs at the UC (60 semester credit hours, like ours) are considerably less expensive than ours. Their programs were created in 2013 and obtained CACREP accreditation in 2015. In 2017 they graduated 38 students, with an on-time graduation rate of 92% and job placement rate of 100%. The advertised total cost of a master’s degree in CMHC or Addictions at the UC is $25,000. CACREP accreditation is something that we currently do not hold, so our competitive edge with this particular institution must rest on the quality of instruction, our focus on Adlerian Theory as a foundation of practice, and the student support we provide (keep in mind the CACREP establishes minimum curriculum requirements, minimum rates of faculty to students, and the existence of a plan for quality assessment, but does not interfere with program operations such as specific instructional and advising practices). Our competitive edge will increase significantly if/when we obtain CACREP accreditation, as discussed later.

Graduation rate. Graduation rate is directly related to affordability, in that the longer it takes a student to graduate the longer it takes for the student to be able to earn a living wage, keeping the student dependent on student loans for everyday living. It is also, however, a reflection of the quality of instruction and/or student support provided by the program. Although graduation rates for AGS students are lower than what we would like (see Table 2), it is significantly higher than that of other Minnesota institutions that offer online programs (with the caveat that our numbers represent both on campus and online students, as our number of fully online students does not allow for significant statistical analysis). In addition, with the introduction of the new model of proactive advising for online and on campus students recently introduced at AGS, as well as the introduction of a professional portfolio to replace the master’s thesis, it is expected that our on-time graduation rates will improve significantly.

Quality of instruction and student support. Other indicators of quality education are directly related to the quality of faculty and the institutional commitment to serve students of diverse backgrounds and with different learning styles. AGS has recently made a commitment to high quality graduate education by hiring 12 full-time faculty members, five of which hold doctoral degrees in Counselor Education and Supervision, one with an unrelated doctoral degree and 18 years of experience as a counselor educator and program evaluator, and two who hold doctoral degrees in education. Ten of the new hires carry an advising load in their respective specialty area. One counselor educator (instead of an administrative staff member as done in most online schools) directs online education and evaluation and is current on both educational technology and trends in counseling and counselor education, and another leads curriculum development. Other aspects of quality education will be discussed later.

In addition to the support offered by program advisors, students also have writing and research support available, offered by the writing center and the librarian, and technology support offered by the technology department staff and by the director of online education. As discussed by

Randick and Cummins (2018), however, virtual education no longer relies only on platforms such as Backboard and Moodle but must incorporate mobile technology, as well. We are in the process of collecting data to determine whether AGS’ human resources available in the student support and technology areas are sufficient to meet demand and whether either a re-distribution of current financial resources or additional financial resources are necessary in order to meet student needs.

Licensure considerations that impact students’ choice of program. Virginia was the first state to license professional counselors, in 1976, and California the last, in 2009. Minnesota was next to last, in 2007. One of the consequences of this wide gap is the fact that licensure laws vary significantly from state to state, resulting in lack of uniformity and cohesiveness in the profession. Recognizing that this lack of uniformity results in the profession being less strong than it could and would ideally be, an intentional effort to unify the profession started in 2005. In April 2005, the leaderships of the American Counseling Association and the American Association of State Counseling Boards met and created the 20/20: A Vision for the Future of Counseling initiative and nominated a group of seven individuals as the oversight committee. This committee, in turn, created the process to be followed by the initiative and identified 30 professional organizations to participate in this initiative. Each of these organizations sent a delegate to participate in the initiative, and the group worked until 2010 to come to a consensus about seven principles and 22 issues that must be attended to in order to achieve this professional unification (Kaplan and Gladding, 2011). Two of these identified principles, which have been the focus of 20/20 since then, refer to a unified name and scope of practice for the profession and license portability.

As discussed by Kaplan and Kraus (2018), a consensus licensure title and scope of practice have now been identified, and recommendations have been made for licensure requirements that would allow for portability of licensure from state to state. These recommended requirements, as described by Kaplan and Kraus and by the American Association of State Counseling Boards (http://www.aascb.org/aws/AASCB/pt/sp/licensure), include graduation from a CACREP- accredited program. So far, three states have adopted these recommendations (KY, NC, and OH), and as progress continues toward license portability more states are likely to follow. Lack of CACREP accreditation limits the ability of program graduates to practice in states who adopt these recommendations and is likely to increasingly limit these programs’ ability to recruit new students.

There are currently 790 CACREP-accredited master’s level counselor education programs in the nation, with 68 of these being online. As this number continues to grow (29 programs were accredited in July 2018), prospective students have plenty of choices and, as Generation Z becomes a larger portion of the population, students become more focused on their own needs and opportunities and are less likely to choose programs that limit their future possibilities.

Point of View

In recent years, higher education has shifted from an on-the-ground setting that limits students to geographically accessible programs to a technology-based distance setting that allows students to

have much broader choices. In addition to eliminating geographic boundaries, distance education also removes barriers related to the need to attend classes at pre-determined times that may not be feasible due to employment or family needs.

In 2015, the Online Learning Consortium published its 13th report on the growth of online education in the Unites States. Among other descriptive statistics, the report shows that at the time 2.8 million students were taking higher education courses exclusively online (Online Learning Consortium, 2015). Taking the conservative estimate of 4% growth per year (based on the growth between 2014 and 2015), this number today would be approximately 3.2 million. A separate survey performed in 2013 by Learning House, a consulting company that tracks students’ demands and preferences, found that 45% of online students would not even consider obtaining their degrees in a “classroom-only setting” (Learning House, 2013).

The data above support the argument made by Amirault (2012) that the traditional self-regulation exerted by institutions of higher education based on the geographical location of its competitors is no longer relevant, as education has become “borderless” and students can access the program of their choice from anywhere in the world. With these data in mind, when analyzing the external forces that may impact our success, we should consider our competitors not from a geographical perspective but rather assuming that our competitors are any institutions offering online programs. The logical corollary of this is the need to offer affordable quality online education that sets us apart from other online programs.

Looking ahead to 2025, it is necessary to consider the characteristics of Generation Z (those born in 1995 or later). While in 2017 this generation represented 25.9% of the U.S. population, the prediction is that by 2020 they will represent a full third of the country’s entire population (https://www.huffingtonpost.com/george-beall/8-key-differences-between_b_12814200.html). A more in-depth discussion of the impact this will have in the mental health job market in general will follow later; for the sake of the current argument it is important to keep in mind that this generation is less-focused and more involved in multi-tasking, tends to have a global worldview, and expects quick results. Data also show that this generation values efficiency, autonomy, and brand loyalty to them (and do not value their loyalty to the brand, being quick to change when their expectations are not met). The direct implication of these characteristics to graduate education is that not only do schools need to offer quality online education and be aware of multiple worldviews, but also be intentional and competent in keeping up with rapidly changing technology. Furthermore, to stay competitive in the graduate education market utilizing up-to- date technology and skills for educational purposes will be necessary but not sufficient: Success will also depend on the school’s ability to market efficiently in this new context in which global worldview needs to be intentionally communicated, prospective students’ time valued, and how the program will benefit graduates effectively and efficiently communicated.

Having an in-depth knowledge of Adlerian Theory puts our students at an advantage, as literature supports the benefits of having a theoretical foundation in which to conceptualize client problems, answer their questions, and provide individualized treatment (Wampold, 2007). However, Individual Psychology is currently criticized as lacking evidence in the literature supporting the its efficacy in treatment of mental and behavioral disorders. Due this lack of evidence, Individual Psychology is not a universally accepted framework for diagnosis and

treatment and is not supported by managed care organizations. This, in turn, would limit our students’ ability to apply their knowledge during field experience, as well as the ability of graduates to use the approach in their professional practice, putting our students and graduates at a disadvantage in relation to students and graduates from other programs. The curriculum review currently being implemented for AGS’ clinical programs starts to change this picture, by integrating Adlerian theory and principles with DSM-5 diagnoses and with other treatment frameworks. While this represents movement toward adapting the Adlerian approach to the reality of managed care, which is likely to persist in 2025, the Adlerian community should also invest in collecting and publishing data that support the Adlerian approach to the promotion of mental and behavioral health. Authentication of online students. Concerns about whether online students are really the ones registered for the course have existed since 2008 (https://wcet.wiche.edu/sites/default/files/docs/publications/Briefing-Paper-Feb-2008.pdf), and schools have been urged to implement procedures for student identity authentication. Initially, these procedures consisted of simple measures such as substituting multiple forms of assessment for high stakes exams, increased use of writing assignments and threaded discussions (as these allows instructors to become familiar with students’ writing styles) and increasing students’ awareness of the different aspects of academic integrity. By 2014, all seven regional higher education accrediting agencies had incorporated guidelines for student identity authentication and explicitly stating as part of the Nine Hallmarks of Quality that “The institution assures the integrity of its online offerings”. As cited by Jennings, Weatherly, and Wilson (2014) institutions seeking regional accreditation must provide evidence that: • The institution has in place effective procedures through which to ensure that the student who registers in a distance education course or program is the same student who participates in and completes the course or program and receives the academic credit. The institution makes clear in writing that these processes protect student privacy and notifies students at the time of registration or enrollment of any projected additional costs associated with the verification procedures. (NOTE: This is a federal requirement. All institutions that offer distance education programs must demonstrate compliance with this requirement.); • The institution’s policies on academic integrity include explicit references to online learning; • Issues of academic integrity are discussed during the orientation for online students; • Training for faculty members engaged in online learning includes consideration of issues of academic integrity, including ways to reduce cheating.

In 2015, President Obama issued a decree requiring financial institutions engaged in online banking to institute multifactor identification practices (i.e. just having a PIN or password was determined not to provide enough security). Multi factor identification requires the use of two different forms of identity recognition, which can be summarized by the acronym HAK (H = something the person has, such as a cell phone or token; A = something people are, such as different aspects of biometrics; and K – something the person knows, such as a password or answer to identifying questions). Although this decree was not directed to education institutions, this has become best practices in the field, and a requirement for institutions that receive Federal

funding (for example, as Title IV financial aid). Some examples of this practice can be found in the websites for the University of Louisiana at Lafayette ( https://distancelearning.louisiana.edu/Authentication), Ohio University (https://www.ohio.edu/oit/accounts/multi-factor-authentication), and Columbia College (http://www.ccis.edu/online/admissions/authentication.aspx). More on this topic will be stated later.

AGS’ Strengths and Weaknesses relative to this 2025 Point of View Strengths. AGS’ main strengths related to the trends in mental health services are the curriculum and a full-time faculty aware of and committed to keeping up with the changing nature of mental health services. This is also enhanced with the ability or full-time faculty to maintain a small private practice. In aligning AGS’ counseling curriculum to meet the 2016 CACREP standards, content related to disaster, crisis (including suicide prevention and intervention), and trauma was added to existing courses and a new course was created, focused on behavior neurophysiology and the effects of trauma on the human brain. In addition, multicultural and social justice competence is being intentionally addressed, including awareness, knowledge, and skills necessary to work with persons of all cultures and identities. Field experience coordinators also intentionally pursue the development of partnerships with organizations that provide services to diverse populations, which provides opportunities for students to develop the knowledge and skills necessary to serve a variety of populations. These partnerships are also strengthened with offering ten percent tuition scholarship discounts to the employees of our community partners. In addition with the elimination of the master’s project and introduction of a professional portfolio as the capstone project, graduates will be able to highlight this competence to potential employers. The financial investment made by AGS in acquiring LiveText is a significant strength as we work toward increasing our online presence, as it allows for intentional and consistent program evaluation and the implementation of evidence-based improvement plans. In addition, LiveText provides a platform for the development of portfolios (for online and on campus students) which, as discussed above, improves both the quality of education and the percentage of on-time graduation (which is directly related to the ability of students to join the job market in a timely manner and stop relying on financial aid). Movement toward increasing the percentage of full-time faculty in relation to the total number of faculty is in itself a strength. Full-time faculty contribute to the scholarly environment of the institution, to a culture of commitment to students and to the institution, to quality control, and ultimately to the College’s good reputation (which in turn is likely to result in an increase in the number of students). Other aspects of quality education, such as preparation for functioning in a virtual world, will be discussed later. Adlerian education as a differentiator. Anecdotal information collected from alumni frequently list the didactic experience as one of the most valuable aspects of AGS’ programs. In an environment where many master’s level counselor education programs exist, and most meet the educational requirements of licensure boards, having programs that not only meet these requirements but also offer a unique experience may be an important asset. In addition, the new Applied Adlerian Psychology program fills a void in the preparation of non-clinical human services professionals. Both the new program and the unique aspect of the clinical programs

need to be highlighted in AGS marketing strategy, as they set the school apart from its competitors.

Art therapy as a competitive edge. Currently, 10 states have licensure in art therapy (Kentucky, Maryland, Mississippi, New Jersey, New Mexico, New York, Pennsylvania, Texas, Wisconsin, and Utah), and the Minnesota Art Therapy Association is actively lobbying the state legislature for the creation of an Art Therapist license in Minnesota. As listed by the Minnesota Art Therapy Association, AGS is the only institution in Minnesota offering this degree. There are six other programs available in the region, five of which are fully on campus (three in Wisconsin and two in Chicago, with one of these being offered by Adler University) (http://www.mnata.org/art-therapy-education.html) , and one hybrid program in which students take most of their classes online and attend residencies three times a year while pursuing their degree (St. Mary of the Woods College, located in Indiana). There are currently no fully online AT programs that are approved by the American Art Therapy Association (AATA) or Accredited by ACATE/CAAHEP, and few hybrid online/residential programs that are approved by the AATA (Leslie University, St. Mary’s of the Woods, Pratt Institute). There is a strong stance within the AT profession across the country (AT faculty, practitioners and students) against the fully online approach as it diminishes the interactive art making experience, along with difficulty in finding appropriate site supervision and other rationales. One fully online program is emerging, but it has not yet been accepted/approved by the professional association (Balfany, 2018, personal communication).

Looking at the hybrid art therapy program in comparison to that offered by AGS, we see that the program offered by St Mary of the Woods College consists of 54 credit hours, while AGS’ program consists of 67-69 credits, and costs approximately $4,500 less ($38,500 as compared to approximately $43,000). On the other hand, while both programs meet the educational requirements set forth by the American Art Therapy Association’s Education Standards and qualify graduates for registration with the Art Therapy Credentials Board, (as Registered Art Therapists) students who graduate from AGS’ art therapy program also meet licensure requirements as LPC/LPCC and as MFT in most states. Until Art Therapist licensure is created in Minnesota and the other 39 states in which it currently doesn’t exist, being able to obtain one of the existing licenses in the mental health field places our graduates at a clearly advantageous position. Moreover, AGS’ art therapy program continues to prepare for ACATE (Accreditation Council for Art Therapy Education) and will be positioned to meet licensure requirements in all states where art therapy becomes recognized as a profession in itself.

Weaknesses. The main weakness of and threat to AGS is the lack of program-specific accreditations and the limitation this poses to graduates’ employment. In addition, a quick comparison between the demographic composition of AGS’ student body and the population of the Twin Cities shows that we have to put more resources in recruiting students from marginalized ethnic and culturally different populations. AGS is currently not in compliance with the multi factor student identity authentication requirements. We do have student identification procedures in place, however, these do not include the use of two different forms of identification. In addition, AGS did not have a formal

new student orientation process until this past Summer, and orientation specific to online students is still under development.

Threats to AGS in the 2025 Educational Environment

External. The main external threat to AGS’ graduates in 2025 is the movement toward requiring CACREP accreditation for licensure and the rapidly growing number of CACREP- accredited programs in the country. In a competitive job market, dominated by managed health care, the possible inability to secure a license is a significant threat to AGS’ graduates. Internal. AGS has traditionally operated as a non-profit organization that happens to offer graduate degrees. To stay viable and competitive in 2025, there needs to be an identity shift in which AGS becomes a graduate education institution that happens to be a non-profit organization, leveraging the strengths of a non-profit, which runs efficiently based on sound business principles. This means we need to think as a higher education institution business enterprise, a learning organization and non-profit that raises money; even when we have the budgetary restrictions we must not be shy when considering strategies to increase revenue to invest in the delivery of a competitive educational product. Thinking as a higher education institution requires considerations about curriculum (our product), student population (our customers), pool of prospective students, employability of graduates, and ways to reduce the institution’s dependence on tuition revenue. It also requires innovative thinking and acting, which in turn requires ability and willingness to examine, and abandon as necessary, old assumptions and ways of doing things. When examining the opportunities currently available and/or likely to develop in the next 5-10 years in counselor education we must be open-minded, forward-thinking, and creative in finding ways to take advantage of these opportunities, practicing organizational learning and action (Argyris and Schon, 1978).

Opportunities for AGS in the 2015 Educational Environment

Obtaining program-specific accreditation. Ideally, AGS would pursue ACATE accreditation for its art therapy program, CACREP accreditation for the counseling programs (clinical mental health, co-occurring disorders, and marriage and family), and COAMFTE accreditation for the marriage and family program. Curriculum-wise, AGS is prepared to meet the accreditation standards of all three accreditation agencies. However, while ACATE and CACREP institutional standards are compatible with each other and can be pursued simultaneously, COAMFTE institutional standards (especially as related to faculty composition) are significantly different. This poses a challenge, related to faculty qualifications, that prevents AGS from meeting the two different standards within the current and near-future budget limitations, forcing the school to choose between CACREP and COAMFTE accreditation as the first priority. An attempt to obtain COAMFTE accreditation in 2016-2017 was unsuccessful, with a recommendation that the application be withdrawn in order to avoid denial and a report indicating that the Commission did not believe the school would be able to make the changes necessary for accreditation within a minimum period of two years. This result, added to the fact that lack of COAMFTE accreditation impacts fewer graduates and to a fewer extent than lack of

CACREP accreditation, leads to the conclusion that AGS should first seek CACREP accreditation and then take COAMFTE accreditation into consideration.

Resource Commitment: With the creation of a full-time faculty model, the intentional recruitment of faculty who hold doctoral degrees in Counselor Education and Supervision, and the curriculum overhaul that was started in March of this year and will be concluded by Spring 2019, AGS has made significant progress toward meeting CACREP-accreditation standards. Continued movement toward accreditation, with the necessary commitment of resources, is likely to place the school in a position that would allow us to start the process of seeking accreditation as early as Fall 2019.

The international market. As discussed above, with the expansion of online education we are no longer limited to recruiting students in the same geographical areas where the school building is located. Moreover, prospective students may live on the other side of the world. The counseling profession is exerted in many countries, in different degree of definition and development. Countries where professional counseling is practiced include, at least: Australia (Schofield, 2013), Brazil (Hutz-Midgett & Huts, 2012), Denmark (Dixon & Hansen, 2010), Iran (Fatemi, Khodayari, and Stewart, 2015), Italy (Remley, Bacchini, and Ktrieg, 2015), Jamaica (Palmer, Palmer, and Payne-Borden, 2012), Japan (Grabosky, Ishii, and Mase, 2012), Kenya (Wambu and Fisher, 2015), Malaysia (See and Ng, 2010), Nigeria (Okocha, and Alika, 2012), Romania (Szilagyi and Paredes, 2010), Russia (Currie, Kuzmina, and Nadyuk, 2012), South Africa (Maree and van der Westhuizen, 2011), South Korea (Lee, Suh, Yang, and Jang, 2012), Switzerland (Thomas and Henning, 2012), Thailand (Tuicomepee, Romano, and Pokaeo, 2012), Czech Republic (Simons, Hutchison, and Baštecká, 2012), Uganda (Senyonyi, Ochieng, and Sells, 2012), Venezuela (Vera, 2011), and Zimbabwe (Richards et al. 2012).

As one can conclude from the paragraph above, counseling is practiced in countries that cover large spectra in the areas of economic development, degree of population education, and social and religious practices. The implications of this diversity to the future of AGS include:

1) While some of these countries may have educational programs that are sufficient to meet the educational needs of prospective counselors, others are likely to fall short in their offerings. Being able to offer quality fully online programs allows us to tap into these potential markets. 2) In order to serve international students adequately, we must be proficient in multicultural and social justice competencies and must be flexible enough to accommodate challenges created by students’ specific locations (for example, ability to acquire books and secure appropriate field experience opportunities). Faculty and staff diversity contribute to this effort. 3) Tapping into this potential market requires becoming visible to potential students. One way to achieve this visibility is by obtaining approval to join the International Registry on Counselor Education Programs (IRCEP). The registry was developed by CACREP and is not an accrediting agency, but rather “an international quality assurance agency purposefully designed to recognize and empower programs for developing counselor-training curricula appropriate to their country, region and/or culture, while also recognizing the broad tenets of education and training common to

the practice of counseling, regardless of location”, as described in their website http://www.ircep.org/for-educators/. AGS’ newly designed curriculum meets all the requirements for IRCEP approval. Programs that meet the IRCEP standards are listed in the online registry, which can be a powerful marketing tool for these programs in the international market. Application for IRCEP recognition costs $1,000, which appears to be a reasonable fee for marketing internationally. Currently, 25 US institutions are listed in the registry, including MSU Mankato.

Military spouses as a special population. As discussed by a military spouse (McArthur, 2016), due to the constant geographical moving, this population depends on online programs to obtain a graduate education. In addition, veterans face a number of challenges upon re-entering the civilian population. Difficulty in finding jobs is one of these difficulties, which frequently leads to the need of obtaining further education (Falkey, 2016). AGS offers a 10% tuition discount and is listed as a military friendly school, which increases our attractiveness to the military population. However, Falkey also explains that the term “military friendly” is a self- assigned denomination that does not always describe an institution’s ability to understand military culture, and that the VA does not monitor these schools for the support they offer to veterans. Military life is highly structured (with structure being provided by others), and include detailed instructions for successful task completion, while in graduate school there is an expectation that students will be self-directed, self-motivated, and creative. Schools can develop an edge with this expanding pool of prospective students by not relying only on the “military friendly” label but communicating to this community specific ways in which they support the transition from military to higher education (for example, through advising, schedule flexibility to accommodate VA appointment, etc.). Some of our competitors do exactly that, as is the case of St Mary of the Woods (online master’s in art therapy; https://www.smwc.edu/offices- resources/offices/financial-aid/military-veteran-resources/). In order to better support students who are military spouses and veterans, and to become more attractive to this population as they choose a graduate program, we should become better educated about this culture and also be intentional in communicating this understanding in our marketing materials.

Opportunities for innovation. Fluctuating economic policies and pressures tend to influence prospective students’ decisions about pursuing a graduate degree, in ways that are not always predictable. As a consequence, colleges that are 100% dependent on tuition income for operations are in a position that makes long-term budgeting vulnerable to these fluctuations. Engaging in additional initiatives for developing an endowment that can serve as a buffer against this unpredictability. In addition, seeking and securing external funding is a good strategy to create opportunities for innovation in the areas of education and service to the community, both of which are central to the Vision and Mission of AGS. External funding for specific projects can involve grants and/or partnerships, as discussed below.

Genetic counseling as a partnership opportunity. Genetic counselors have advanced training in medical genetics and counseling to interpret genetic test results, and to guide and support patients seeking more information and making decisions related to inheritable disorders. Currently, 19 states require a license for the practice of genetic counseling, and 37 programs in the United States are accredited by the Accreditation Council for Genetic Counseling, including the University of Minnesota (accreditation is necessary for licensure). According to the Bureau

of Labor Statistics, "Employment of genetic counselors is projected to grow 41 percent from 2012 to 2022, much faster than the average for all occupations. Genetic counselors should have better than average job prospects overall." (Bureau of Labor Statistics, Occupational Outlook Handbook 2014-15). Although AGS is not and will not be able to offer a degree in genetic counseling, genetic counseling accreditation standard A1.1.2 states “The graduate degree- granting institution is the sponsoring institution that applies for accreditation. This institution assumes primary responsibility for the program, although it can partner with other institutions that are responsible for providing one or more core program components.” (http://gceducation.org/Documents/Standards%20Final%20approved%20Feb%202013.pdf). Considering the small number of accredited programs in the U.S., a partnership with a school of medicine that does not offer this degree and does not have the ability to offer the counseling component of the program may represent an opportunity for AGs in 2025.

International educational partnerships. University partnerships to offer online courses at the undergraduate level have existed both nationally and internationally since at least 2012 (Amirault, 2012). Universities located in other countries, for example Brazil (Hutz-Midgett & Huts, 2012), have indicated interest in establishing partnerships with US institutions specifically in the area of counselor education. To date, there are no data in the literature showing the existence of these partnerships, which indicates an opportunity for further exploration.

Mental Health Grants for Special Projects. Organizations such as SAMHSA (Substance Abuse and Mental Health Services Administration) regularly offer grants for the promotion of mental health and prevention projects such as suicide prevention train-the-trainer. Some of these grants are for large projects that involve partnership among several organizations, while others are of more limited scope and can be performed or coordinated by individual institutions. As an example of grants available to independent public and private colleges, in 2018 SAMHSA issued a funding opportunity announcement (FOE) for Mental Health Awareness Training Grants, each in amounts up to $125,000/year (up to a total of 3 years), in the total amount of $15,801,221. As an example of a larger grant, requiring either a large infrastructure or partnership between a college and other entities, a FOE was issued for Networking, Certifying, and Training Suicide Prevention Lifelines and Disaster Distress Helpline, for the amount of $6,130,000 (3 years). Other examples of SAMHSA grant announcements issued in 2018 can be found at https://www.samhsa.gov/grants/grant-announcements-2018.

Community counseling clinic. The new building has enough space to allow for the development of a community counseling clinic that would serve the dual purpose of serving the community by offering low cost mental health and parent training services and serving as a field experience site where students could develop their Adlerian counseling skills. A secondary gain from such a project would be the opportunity to evaluate the effectiveness of Adlerian treatment and publish these results, creating the currently lacking evidence basis for an Adlerian approach to mental health services. Possible drawbacks for this project would include the building’s location (not easily accessible to underprivileged populations) and the need for extended liability insurance beyond what is required in a purely educational setting. Many counseling programs around the country have such a clinic, and consultation with some of these programs would better inform us about risk management. Prior to initiating such a project, a market analysis to determine accessibility and need for such services in our geographical

location would need to be performed and a business plan developed to determine long-term sustainability.

Experiential application of new technology to counselor education. With the movement toward innovative online education methods and distance counseling, investment in incorporating new technology for delivery of education (e.g., enhancing collaboration and community in the virtual environment) would serve AGS and its graduates well. Research suggests that this generation of students, dubbed as the Millennial generation, and the generation that follows them (Generation Z), are the most diverse students that colleges have had to teach. Thus, we must be more diverse and creative in how we teach them, they are after all the future of the counseling profession. Students expect to interact with technology, but also be engaged with others in the learning process. With the shortage of mental health services in rural communities, and the trend toward delivery of distance health care, preparing graduates to provide distance counseling would place our graduates in an advantageous position to compete in the job market.

Development of a Speakers Bureau. Disasters and crises have become frequent events in American life, and organizations are not always prepared to respond to these situations. Being able to provide human resources for immediate response would serve the dual purpose of serving community institutions and increasing AGS visibility in the community.

Types of Investments that will be required to achieve parity in 2025

In order to achieve and/or maintain parity with competitors within the 2025 educational context AGS will need to invest in human and technological resources. Development of partnerships (locally, nationally, and internationally) that allow for more efficient use of resources will also be indicated.

Human resources that will be necessary for viability and growth in 2025 include: • faculty that meets CACREP qualifications for core faculty to teach at least 51% of the total credits taught in the counseling program (and, possibly, faculty that meets COAMFTE requirements, if a decision is made to re-apply for this accreditation); • at least one marketing professional highly skilled in electronic marketing strategies for national and international markets; • at least one professional with expertise in technology (our current technology staff is skilled in hardware but falls short on knowledge about new software and its application to education; both sets of skills are necessary in today’s educational environment); human resources in technology also include the need for researching student authentication platforms and staying current with policies specific to online education; • enough human resources time to search for grant and partnership opportunities, prepare grant applications and/or establish partnerships, and administer projects that evolve from these opportunities.

Additional resources that will be necessary to stay compliant with Federal and regional accreditation guidelines may include the use of commercial technology for student authentication.

As stated above, our international market may be expanding with prospective students who may live on the other side of the world. It may be necessary to invest in relationships with other universities around the world, partnering and working together to explore the field of counseling from different geographic regions. By investing in going abroad, faculty and students would have the opportunity to explore new cultures, customs, and styles of education.

Are we Preparing Students to Participate in the Market of Tomorrow?

Context offered by the Governance Committee

This topic deals with the “business” side of delivering behavioral health care. Among the trends of interest are:

• Health care providers around the country have entered an era of business integration in the pursuit of scale and scope in service offerings. The integration imperative also has been encouraged by federal policy initiatives that have created financial incentives for providers to integrate, especially with a focus on services supported by Medicare and Medicaid. • Third party payers (insurance, government, etc.) are increasingly shaping access to care and the type of care delivered. Additionally, the current fee for service system probably undervalues behavioral health services which are generally cognitive and time based, as opposed to procedure based. • Mental health and substance use providers often lack up-to-date training in delivery of empirically supported treatments. Small independent practitioners are often not prepared to work effectively in teams or collaborative settings with medical care providers.

Committee’s Request

1. Produce a point of view (POV) describing the potential impact of these trends on the delivery of care and on the potential impact on programs and curriculum. The POV leveraging internal professional resources and external secondary sources, with an emphasis on external sources. The POV should focus on how the environment will differ from today, including how we may have to adapt Adlerian approaches in that prospective reality. 2. Evaluate AGS’ strengths and weaknesses relative to that 2025 point of view. How well do our current capabilities position us for success in that environment? What shortcomings exist in our offering that must be addressed to achieve competitive parity? What will be required to achieve some degree of competitive advantage in 2025? 3. What threats and opportunities for AGS are evident in the 2025 perspective? What market forces will drive that change? How might the competitive frame change among existing players? How might expectations changes among student and other stakeholders such as internship sites in the future? 4. In reference to these trends, provide a “ballpark” estimate of the types of investments that will be required to achieve parity in 2025? What investments will be required to achieve some level of competitive advantage?

Point of View

The three trends identified by the Committee as relevant to the practice of professional counseling today, and likely in 2025, are complex and must be analyzed in a broad context that includes legislature, counselor preparation, and managed care, based on Dynamic Modeling and understanding the systems inputs and demands (Allen, 1998). In order to examine these issues in a meaningful way it is necessary to understand 1) the licensure laws that regulate the counseling profession; 2) the counseling profession in context (i.e. ways in which counselors contribute to the mental health community) and the current trends in the profession; and 3) the influence of managed care. These topics will be the focus of the discussion that follows.

Ability to practice. AGS prepares students to work in two main areas: professional counseling and psychotherapy, and non-clinical human services. Clinical programs include Art Therapy, Clinical Mental Health, Co-Occurring Disorders, Marriage and Family Therapy, and School Counseling.

The newly created non-clinical program, Applied Adlerian Psychology, will prepare human services professionals for leadership positions that can benefit from an Adlerian orientation and strength-based skills that facilitate organizational and community development. This is a 38 semester-credits program and was recently approved by the Higher Learning Commission (HLC). The White Paper submitted to the HLC with the application for approval highlights the types of professions that will be available for graduates of this program.

Clinical programs prepare students to qualify for professional counselor and/or marriage and family therapist licensure and AGS’ school counseling program prepares students for school counselor licensure in the state of Minnesota. Graduates of the art therapy program are qualified to seek licensure as professional counselors of marriage and family therapists, depending on the track they chose, and for the registered art therapist credential. The curriculum of the clinical programs has been aligned with the standards established for counselor preparation by CACREP, which are considered the gold standards in counselor education.

First step: obtaining licensure: Marriage and family therapy licensure requirements vary considerably from state to state, with one state (NJ) requiring only a master’s degree in MFT (with no specification of minimum credit hours or curriculum requirements), eight states requiring COAMFTE or CACREP standards, including the requirement of 60 semester credits, one state requiring COAMFTE accreditation (MS), and the remaining states falling all over the spectrum as they require a number of credits that goes from 44 to 60 semester credits and have different levels of curriculum expectations (all less exacting than those set forth by CACREP or COAMFTE). This means that AGS graduates from the marriage and family specialty are currently able to obtain MFT licensure in 49 states (the exception being MS, which requires graduation from a COAMFTE-accredited program).

Professional Counselor licensure also varies considerably from state to state, including the fact that some states (as is the case in Minnesota) have two tiers of licenses. As discussed earlier, there is a concerted effort to unify the profession under one name (one license) and equal requirements across the nation. Although this effort is far from achieving its final goal,

significant progress has been made in recent years and licensure requirements are not as disparate as they are for MFT licensure. Currently, 34 states require graduation from a 60- semester credits mental health counseling program; 9 states accept 48 semester credit programs, and 7 states to not specify the minimum number of credit hours. Fourteen states require curriculum academically equivalent to CACREP standards. More importantly, however, the movement toward licensure portability has started to have the intended effect of leading licensure boards to establish minimum requirements that meet the highest standards and therefore elevate the quality of client care and the standing of the profession among other mental health professions. As a result, three states (KY, NC, and OH) have already approved legislation that requires those seeking Professional Counselor licensure to have graduated from CACREP- accredited programs. Other states have established especial requirements for graduates of programs that are not CACREP-accredited that make licensure for these graduates almost impossible: FL requires that these graduates have had a minimum of 1,000 hours as part of their graduate program, IL requires they have had a minimum of 24 semester hours of residency, and RI requires they have had a full year of “full-time” (20 hours/week) residency. In this current landscape, AGS graduates seeking licensure as professional counselors (LPC/LPCC/CMHC) are prevented from obtaining a license in three states and highly unlikely to succeed in the same effort in three other states (as the extra field experience required by FL, IL, and RI must be obtained as part of the master’s program); unless a student knows ahead of time that they may choose to practice in one of these three states, it is unlikely they will sign up for the extra field experience. This scenario is likely to continue to evolve between now and 2025, further limiting the number of states where AGS graduates are allowed to practice if AGS does not secure CACREP accreditation.

Graduates from AGS’ Art Therapy and Co-Occurring Disorders programs seek and qualify for licensure as clinical mental health counselors or marriage and family therapists (depending on the track they choose) in Minnesota and other states that do not require CACREP or COAMFTE program accreditation. As there is a strong push for the establishment of licensure specific for art therapists, the profession and laws regulating the practice of art therapy are expected to be established in the upcoming years. It is also likely that licensure will require graduation from an ACATE-accredited program.

Boards of Education in several states have already started to require graduation from CACREP- accredited programs (the MN Board of Teaching started to move in this direction a couple of years ago, but this movement has been at least temporarily stalled). Whether this movement acquires enough traction and follows the path taken by clinical licensure boards is not clear at this time.

Ability to Provide Services in diverse settings and to diverse Populations. Regardless of whether graduates are able to secure licensure in the state of their choice, accreditation impacts the ability of licensed counselors to practice the profession, and this impact is likely to increase by 2025.

Military veterans and active military and their families constitute a significant portion of the U. S. population. With the high indexes of post-traumatic stress disorder and suicide among this population, in addition to the high incidence of adjustment disorders triggered by prolonged

separation and/or re-entering into civil life, the need for mental health services among this population is high. The Veterans Administration and TRICARE require that Mental Health Counselors graduate from CACREP-accredited programs (Department of Veterans Affairs, 2018a) and Licensed Marriage and Family Therapists graduate from COAMFTE-accredited programs (Department of Veterans Affairs, 2018b) in order to qualify as service providers for military veterans and for active military personnel and their families.

Other managed care organizations do not hold the same requirements at this time; however, some of these organizations have already stopped credentialing of new providers in many urban areas, as their panels are full. As the number of CACREP-accredited programs continues to increase, with well over 50% of the programs offered nationwide holding accreditation at this time (Neukrug, 2016), it is reasonable to conclude that by 2025 graduates from non-accredited programs will have a hard time joining panels of mental health service providers for managed health care organizations.

Medicare parity. Medicare currently reimburses psychiatrists, doctoral level psychologists, clinical social workers, and psychiatric nurses for outpatient behavioral health services. Although educational and training requirements for professional counselor and marriage and family therapist licensure are comparable to those of the other two master level professions, Medicare does not recognize professional counselors and marriage and family therapists as independent practitioners. The legislature to change this scenario was introduced in 2001, and since then both chambers of Congress have passed stand-alone bills adding counselors to Medicare. Unfortunately, no single bill has been approved by both the House and the Senate. The American Counseling Association, the National Board of Certified Counselors, and the American Association for Marriage and Family Therapists continue to work diligently for the passing of parity laws, with the last bill being introduced to House in June 2016 and a companion bill introduced to the Senate in September of the same year (http://www.nbcc.org/GovtAffairs/Medicare). At this time, it is not possible to determine if or when professional counselors and marriage and family therapists will obtain Medicare parity and what educational requirements will be included in the approved parity bills.

Counselors in managerial positions in human services agencies. Clinical supervision is a main focus of all doctoral programs in counselor education and supervision, an integral component of all master level counseling programs, and a requirement for licensure in the clinical professions. However, there are significant differences between clinical supervision and managerial leadership. Although this has been recognized for more than a decade (Curtis & Sherlock, 2006), master level counseling programs continue to focus on the clinical aspects of the profession and counselors who assume managerial leadership positions in human services agencies and schools frequently lack any training in areas relevant to these positions. As with all other master level programs, AGS’ programs focus on the clinical aspects of the profession and on meeting the academic requirements for licensure and does not prepare students for managerial leadership.

Current trends and opportunities in the counseling profession. In addition to the restrictions created by licensure laws, some other trends in mental health and the counseling profession are likely to impact AGS’ graduates in 2025, including preparation to provide

treatment following disasters and in crisis situations, as well as trauma informed treatment, LGBTQ+ affirming treatment, life coaching, and distance counseling.

Life coaching is a practice modality that does not address underlying causes of self-defeating behaviors and focuses on solutions. This is not considered a mental health service, and therefore is not reimbursed by managed care organizations. While this is a limitation, it also offers advantages, such as attractiveness to clients for whom mental health counseling carries a stigma, and the fact that it can be less structured and involves less paperwork. Some agencies, such as those who provide services for persons who have serious mental illnesses, frequently employ unlicensed counselors to provide life coaching services. Because life coaching is not regulated by licensure boards, this is a field that is wide open to graduates from programs that are not accredited by CACREP and/or COAMFTE. Another area with similar possibilities include parenting/family education in partnership with churches, hospitals, human services agencies, family court, and department of human resources.

In addition to trends specific to the mental health professions, it is important to consider the changing demographic composition of the Unites States. According to the Pew Research Center (http://www.pewresearch.org/fact-tank/2018/04/25/7-demographic-trends-shaping-the-u-s-and- the-world-in-2018/), millennials (22 to 37 year-olds in 2018) will outnumber baby boomers in 2019, the number of Americans living in multigenerational homes continues to increase (20% of the population in 2016), motherhood and family size have reversed the course of recent decades and are on the rise (both among married and never-married women), and the number of migrants has reached record levels worldwide. Although the data presented show a decline of the number of immigrants to the U.S since 2016 (especially in relation to Muslim individuals), in years prior this number was on the rise, indicating that the current decline is likely a result of current immigration policies. Whether these immigration policies will remain in effect between now and 2025 remains to be seen. Finally, the PEW report shows that the number of foreign students in the U.S. doubled between 2008 and 2016, from 179,000 to 364,000. These demographic data suggest that the job market for counselors and marriage and family therapists is likely to increase in years to come, as changes in cultural norms tend to lead to increased anxiety, adjustment difficulties, and family conflicts. The nature of mental health and human services needed is also likely to change as a consequence of these demographic changes, as ability to provide services in a multicultural context becomes an imperative.

The counseling profession faces a challenge related to multicultural and social justice competence. Professional organizations and counselor education programs in the Western world have taken a social justice position and developed codes of ethics that support underprivileged communities, and affirm inclusivity, gender equality, acceptance of all gender identities and types of personal partnerships, and freedom of and from religion. Counselors who develop their professional identity within this context are likely to have difficulty in providing unconditional acceptance and practicing within the worldview of clients who belong to cultures in which one or more of these values are not present. Problems arise not only when there are clear macro-group differences (such as when counseling clients who belong to cultures in which men and women are not allowed to participate in joint social events, or in which homosexuality is punishable by death, or which do not allow for choice of religion), but even when the macro-norms are similar but the differences within group are significant due to religion, ethnicity, or other culture-

syntonic behaviors. AGS and the majority of other counselor education programs strive to intentionally develop their students’ awareness, knowledge, and skills to work within the worldview of their clients. However, challenges remain in even attracting cross-cultural clients. One way to prepare students to attract and serve populations whose values and beliefs may be dystonic with those embraced by the profession as whole is to intentionally recruit students from within these populations. Intentional recruitment of counseling students from within these marginalized populations is necessary in order to better serve these communities.

Research published by the Huffington Post in November 2017 discusses the growth and characteristics of Generation Z (persons born in 1995 or later), who will be the population between ages 22 and 30 in 2025 (https://www.huffingtonpost.com/george-beall/8-key- differences-between_b_12814200.html). This generation represented 25.9% of the total U.S. population in 2017, is expected to outnumber the Millennials by 2019, and will represent one third of the country’s population by 2020. Understanding the characteristics of this population is critical to being able to adapt the educational and mental health market of 2025.

AGS’ Strengths and Weaknesses relative to this 2025 Point of View Strengths. AGS’ main strengths related to the trends in mental health services are the curriculum and a full-time faculty aware of and committed to keeping up with the changing nature of mental health services. This is also enhanced with the ability or full-time faculty to maintain a small private practice. In aligning AGS’ counseling curriculum to meet the 2016 CACREP standards, content related to disaster, crisis (including suicide prevention and intervention), and trauma was added to existing courses and a new course was created, focused on behavior neurophysiology and the effects of trauma on the human brain. In addition, multicultural and social justice competence is being intentionally addressed, including awareness, knowledge, and skills necessary to work with persons of all cultures and identities. Field experience coordinators also intentionally pursue the development of partnerships with organizations that provide services to diverse populations, which provides opportunities for students to develop the knowledge and skills necessary to serve a variety of populations. These partnerships are also strengthened with offering ten percent tuition scholarship discounts to the employees of our community partners. In addition, with the elimination of the master’s project and introduction of a professional portfolio as the capstone project, graduates will be able to highlight this competence to potential employers. Another strength built into programs is preparations for functioning in a virtual world, which will be discussed in the next section. Weaknesses. The main weakness of and threat to AGS is the lack of program-specific accreditations and the limitation this poses to graduates’ employment. In addition, a quick comparison between the demographic composition of AGS’ student body and the population of the Twin Cities shows that we have not done a good job in recruiting students from marginalized ethnic and culturally different populations. Threats and Opportunities Related to this 2025 Point of View Threats. The main external threat to AGS’ graduates in 2025 is the movement toward requiring CACREP accreditation for licensure and the rapidly growing number of CACREP- accredited programs in the country. In a competitive job market, dominated by managed health care, the possible inability to secure a license is a significant threat to AGS’ graduates.

Opportunities. While keeping the number of credits required for the degree within the range of other programs is a significant consideration, offering elective courses on managerial strategies would provide AGS graduates with an edge over graduates from other counselor education programs. AGS could also consider developing an online certificate that combines some aspects of the new master’s degree in Applied Adlerian Psychology with a couple of courses specific to management strategies, which could be globally marketed to graduates of counseling programs. Offering train-the-trainer parenting programs based on Children: The Challenge, free parent training to community organizations (such as churches and community centers), or classroom management courses (either as a master level course or through the Institute) would help us accomplish our mission and would increase AGS’ visibility in the community.

What Will the “Digital Future” Mean to our Graduates?

Context Offered by the Governance Committee

Advances in technology have the potential to enhance access to and quality and cost efficiency of behavioral health and mental health care. Among the areas of interest are:

• Electronic Health Records - Quality and cost efficiency of care rely on effective and efficient communication among providers and on the smooth flow of information into and among medical records. • Technology-Enabled Therapy for Behavioral and Mental Health - With proper patient selection and appropriate strategies for successful engagement, patients who have less complicated psychiatric needs can derive clinical benefit at lower cost while overcoming the logistical hurdles to access, including basic availability of clinicians in a locale. • Algorithmic Approaches and Artificial Intelligence - Evidence based therapies could lead to systems, methods and computer products for monitoring, diagnosing and treating behavioral health conditions. Will the integration of other medical information (e.g. genomics) create more robust diagnostic models?

While these topics are still formative, the committee believes that both will help shape the future of the delivery.

Committee’s Request

3. What threats and opportunities for AGS are evident in the 2025 perspective? What market forces will drive that change? How might the competitive frame change among existing players? How might expectations changes among student and other stakeholders such as internship sites in the future? 4. In reference to these trends, provide a “ballpark” estimate of the types of investments that will be required to achieve parity in 2025? What investments will be required to achieve some level of competitive advantage?

Point of View

The context offered by the Committee is accurate, however not complete. The “digital future” already does and will continue to impact the delivery of mental health and behavioral services. This must, however, also be considered within the context of who will be receiving and providing these services.

Distance Counseling. Telephone has played a role in mental health for a very long time (for example, as a suicide prevention hotline created in London in the 1950s) and web-based applications were being used as early as the mid 1990s. An article addressing services that involved the use of telephone, teleconferencing, or the internet first appeared in the American Mental Health Counselors Association Standards of Practice in 1999, which stated simply that counselors using these delivery methods should “take responsible steps to ensure the competence of their work and protect patients, clients, students, research participants, and others from harm”. By 2008, according to Centore and Milacci (2008), nearly 1,000 mental health professionals were engaged in what at the time was referred to as webcounseling, etherapy, ecounseling, or cybercounseling. In the years since, telehealth has become ubiquitous and the term telemental health has been developed as the universal term referring to mental health services offered through the use of distance technology. More recently, Moore et al., (2017) described the use of The Recovery Line, an automated self-management CBT counseling service that provides relapse prevention skills outside the walls of the counseling office. The current edition of the American Counseling Association Code of Ethics and Standards of Practice (ACA, 2014) has an entire section, with a total of 21 articles, covering the delivery of distance counseling. In addition, as indicated by the context provided by the committee, the health industry has, in the last decade, moved to a system of electronic records that allows for more efficient coordination of care.

With the growth of telemental health, state counseling boards have had to examine strategies for assuring competent client care. As a result, most states have developed rules establishing that counselors must be licensed in the state in order to provide tegmental health services to state residents. In addition, some states also require that counselors be licensed in the state in order to offer services to clients who are not residents but are in the state at the time services are offered. These laws, which vary from state to state, the ethical considerations related to the provision of distance counseling services, and the fact that counselor education programs have yet to implement curricula that prepare students on methods and skills specific to this type of delivery (Pipoly, 2013), led to the development of counselor certification in telemental health. Examples of this certification can be found at https://telementalhealthtraining.com and http://www.cce-

global.org/Credentialing/DCC. To date, there are no reports of counselor education programs that intentionally focus on distance relationship-building and therapeutic skills.

2025 Clients and Service Providers. Although the literature pinpointing the exact dates separating Millennials from Generation Z varies between 1995 and 2001, the majority of the agencies studying age groups tends to refer to Generation Z (also termed iGeneration) as those born between the years 2000 and 2015. Using these definitions, one would determine that in 2025 the oldest Millennials (born between 1980 and 1995-2000, depending on the source) will be 50 years old, the youngest Millennials and oldest Generation Z will be 26 and 25 respectively, and the youngest Generation Z will be 10 years old. According to the U. S. Census Bureau, in 2030 21% of the U. S. population will be under the age of 18, 58% will be between 18 and 64 years-old, and 21% of the population will be 65 or older (https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf). With nearly 70% of the population being Millennials or Generation Zs in 2030, it is important that we understand the characteristics of these generations in order to determine their impact on the delivery of mental health services in 2025.

These two generations share a number of characteristics, and also differ in a number of others. As an example, both grew up in a world in which technology plays an important role; on the other hand, while many Millennials lived through the shift from dial-up internet to a totally digital world, members of Generation Z are true digital natives who are accustomed to being able to connect to anyone or anything, anywhere in the world, immediately. As such, constantly switching between activities and constantly checking for application updates is Generation Z’s natural way of life. A good example was provided by an 18 year-old interviewed by The new York Times (https://www.nytimes.com/2015/09/20/fashion/move-over-millennials-here-comes- generation-z.html?_r=0):

“We are the first true digital natives. I can almost simultaneously create a document, edit it, post a photo on Instagram and talk on the phone, all from the user-friendly interface of my iPhone.”

Having adult generation Z clients or employees will require adaptability, understanding of this orientation to life, flexibility to engagement in relationships and tasks that can be switched from in-person, to a computer, to mobile applications, and commitment to staying up to date on technology developments.

Millennials and Generation Z also have specific socio-cultural characteristics that must be considered. While Millennials came of age in the economically stable 1990s, Generation Z observed, and are likely to have experienced, the effects the 2008 financial crisis had on families. Also, while Millennials grew up in a relatively safe world, pre 9/11, Generation Z has no memory of a world where terrorist attacks are not a constant concern. In addition, the U. S. Census Bureau reports that “More than half of the growth in the total population of the United States between 2000 and 2010 was due to the increase in the Hispanic population” (https://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf) and that by 2030, approximately 16% of the U. S. population will be foreign born (up from 13% in 2014) (https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf).

Furthermore, having grown up with an African American President in office and inclusive gender and marriage rights, Generation Z sees these events as natural and expected, rather than historical breakthroughs. These experiences translate into significantly different worldviews that will impact Generation Z in the work place and as clients:

• While Millennial value inclusivity and collaboration, Generation Z is much more competitive and values individuality and independence; • Generation Z values their privacy more than Millennials, and are engaged in establishing their own branding from an early age; • Generation Z value safety (both physical and financial), are price-conscious and concerned about their future prospects, and are entrepreneurial (in a Huffington Post survey, 72% of the high schoolers interviewed said they want to have their own business) (https://www.huffingtonpost.com/george-beall/8-key-differences- between_b_12814200.html). • Generation Z is even more “global” and accepting than Millennials. • Generation Z is dependent on their digital devices, find difficulty functioning without their digital devices, and a full 40% of the respondents to survey mentioned above self-identified as “addicted” to their electronic devices.

These generation characteristics and the cultural diversity of the U.S population will have significant impact on the delivery of mental health services, both related to the types of presenting issues and to expectations contributed by clients, as well as the characteristics of individual providers and workplaces. Counselor education programs need to keep these trends in mind in order to meet students’ expectations and to prepare students to meet their own clients and/or employers’ needs and expectations upon graduation.

Counselors as members of multidisciplinary teams. The interconnectedness of mind and body and how this connection affects the prevention and development of diseases has become clear in the last decade, which in turn has resulted in the development of interdisciplinary teams that integrate biopsychosocial processes to the prevention, diagnosis, and treatment of physical and behavioral disorders. Counselors now play an integral role in programs that include but are not limited to disaster response, PTSD treatment, suicide prevention, genetic counseling, adaptation to the onset of sudden disability, treatment compliance, and end of life teams.

As reported above, the “older adult” population (those 65 and older) is expected to represent 21% of the total U. S. population in 2030. The need for specialized and integrated health care for this population has been officially recognized since 2008 (American Psychological Association, Presidential Task Force on Integrated Health Care for an Aging Population, 2008), which opens opportunities for mental health counselors that have not been intentionally explored. As discussed by Goldsmith and Kurpius (2015), these opportunities do not come without challenges. Older adults face developmental challenges particular to this life stage, frequently deal with depression and anxiety, and are frequently diagnosed with one or more physical illnesses. While counseling skills taught in most counselor education programs include advocacy and other skills that can be easily applied to care coordination, individual and family support, and crisis management, this application is not intentionally addressed in the programs (AGS included) and

graduates of these programs do not usually have experience working in hospital settings and working with physicians and nurses. The American Counseling Association Code of Ethics and Standards of Practice (American Counseling Association, 2014) clearly states that counselors must only practice in areas in which they are competent, i.e. they must have knowledge, skills, and supervised experience in the settings and types of clients with whom they intend to work and with the modality of care to be delivered. In order to provide opportunities to new graduates to take advantage of this growing market, counselor education programs need to become more intentional in providing academic training specific to this population, as well as internship opportunities in hospital settings.

AGS’ Strengths and Weaknesses relative to this 2025 Point of View Strengths. Several aspects of the curriculum support graduates in acquiring competence for professional practice in this predicted 2025 environment. These include: • Practice in evidence-based treatment planning and the use of electronic records. • Use of technology in the delivery of education (even on-campus courses require the use of Moodle and other technology for assignment completion, record keeping, and portfolio development). • Faculty modeling of distance relationship-building behaviors, through the use of Zoom for advising and course delivery. • Clinical ethics courses provide opportunity for in-depth exploration of sections of the Code of Ethics related to distance counseling and areas of competence, and students are trained in ethical decision-making models that help them decide the limits of their competence. Weaknesses. AGS’ academic programs do not intentionally focus on developing students’ skills to provide distance counseling. We also do not offer courses specific to work with the geriatric population, and do not have partnerships with hospitals for internships. Threats and Opportunities Related to this 2025 Point of View Threats. The main threat is, again, related to specific program accreditation. As we move to an online educational environment and recruit students from other states, our competitors become all programs (on-campus and online) who are nationally accredited. This affects our ability to establish partnerships with internship sites in general. In addition, because risk management is one of the main concerns of hospitals and other care facilities, our efforts to secure internship opportunities in these institutions are likely to be hindered by lack of national accreditation, affecting our students’ ability to acquire skills and experience as members of multidisciplinary teams. Opportunities. In addition to seeking national accreditation for all clinical programs, opportunities specific to this part of the 2025 scenario include: • Development of courses focused specifically on telemental health, which can be offered as electives to our own students and marketed as individual courses or

certificates to students in other programs or licensed professionals who did/do not have opportunity to develop these competencies as part of their graduate programs. • Development of courses focused on geriatric counseling and on the role of counselors as part of multidisciplinary teams (which would include courses on advocacy and consultation, health issues typical of the older population, health care management, prevention and psychoeducational strategies, and crisis intervention). • Development of partnerships with hospitals and other health care organizations for internship. Types of investments that will be required to achieve parity in 2025 How can we create systems, methods, and computer products for monitoring, diagnosing and treating behavioral health conditions? In 2012 a group of academic scholars in Counselor Education gave their predictions of the future of counseling. Among their predictions they discussed the need to invest in technology and research how the “artificial counselor” may become the first line of defense for potential clients. AGS may need to invest in looking at how this trend may apply to our future. One suggestion would be to create a mobile app for AGS. Within this app we can define Adler’s contributions to the field of counseling and psychotherapy. Additionally, we can describe different mental illnesses and wellness techniques through an Adlerian lens. For example, we might define depression through an Adlerian lens and then describe examples of what Mental Health would look like through this same lens. Instead of creating a virtual counselor, we would be meeting the future needs of how people might seek information and self-monitor their own wellness. Students prefer a lot of interactivity, the use of mobile tools, and social networking. The need to invest in following technological trends is of utmost importance since they change rapidly from year to year. For example, PEW Research Center (May 2018) did a study of social media trends in 2018. What they found was that Facebook, once known as the number one social media platform, dropped to number four, with YouTube, Instagram, and Snapchat coming in ahead as most used social media platforms. Ranked below Facebook included Twitter, Tumblr, and Reddit. By capitalizing on these trends Adler can connect with current and prospective students. This type of information has been found to reach people before e-mail and is described as having a more personal feel. Another innovation can be to use these platforms to send out wellness and mental health information to community members. With the growing trend of “self- help” resources, a presence in this market would be beneficial to all.

References

AASCB 5-year plan on license portability (2015). Retrieved from http://www.aascb.org/aws/AASCB/asset_manager/get_file/117304?ver=2936

American Counseling Association. (2014). Code of Ethics and Standards of Practice. Alexandria, VA: ACA

American Psychological Association, Presidential Task Force on Integrated Health Care for an Aging Population. (2008). Blueprint for change: Achieving integrated health care for an aging population. Washington, DC: Author.

Allen, J. (1998). Human Service Theory and Action: An Applied Model for Community Services, Health Care, Education, Corrections, and Long Term Care, Thesis, University of Minnesota, 5- 8.

Amirault, R. J. (2012). Distance learning in the 21st century university – key issues for leaders and faculty. The Quarterly Review of Distance Education, 13, 253-265.

Argyris, C., & Schön, D. (1978). Organizational learning: A theory of action perspective, Reading, Mass: Addison Wesley, 2-3

Centore, A. J. and Milacci, F. (2008). A Study of Mental Health Counselors’ Use of and Perspectives on Distance Counseling. Journal of Mental Health Counseling, 30, 267- 282.

Currie, C. L., Kuzmina, M. V., and Nadyuk, R. I. (2012). The Counseling Profession in Russia: Historical Roots, Current Trends, and Future Perspectives. Journal of Counseling and Development, 90, 488-493.

Curtis, R. and Sherlock, J. J. (2006). Wearing Two Hats: Counselors Working as Managerial Leaders in Agencies and Schools. Journal of Counseling and Development, 84, 120-126.

Department of Veterans Affairs (2018a). VA Handbook 5005/106, Transmittal Sheet April 3, 2018.

Department of Veterans Affairs (2018b). VA Handbook 5005/101 Transmittal Sheet April 18, 2018.

Dixon, A. L. and Hansen, N. H. (2010). Past, present, and future: professional counseling in Denmark. Journal of Counseling and Development, 88, 38-42.

Falkey, M. E. (2016). An Emerging Population: Student Veterans in Higher Education in the 21st Century. Journal of Academic Administration in Higher Education, 12, 27-39.

Fatemi, A., Khodayara, L. , and Stewart, A. (2015). Counseling in Iran: history, current status, and future trends. Journal of Counseling and Development, 93, 105-113.

Grabosky, T. K., Ishii, H., and Mase, S. (2012). The Development of the Counseling Profession in Japan: past, present, and future. Journal of Counseling and Development, 90, 221-226.

Goldsmith, J. S. and Kurpius, S. E. R. (2015). Older Adults and Integrated Health Settings: Opportunities and Challenges for Mental Health Counselors. Journal of Mental Health Counseling, 37, 124-137.

Hutz-Midgett, A. and Hutz, C. (2012). Counseling in Brazil – past, present, and future. Journal of Counseling and Development, 90, 238-241.

Jennings, S. E., Weatherly, M. G., and Wilson, S. A. (2014). Online Integrity: Student Authentication in an Online Course. Faculty Publications. Paper 432. http://scholarworks.sfasu.edu/forestry/432. Retrieved September 13, 2018.

Kaplan, D. M. & Kraus, K. L. (2018). Building Blocks to Portability: Culmination of the 20/20 Initiative. Journal of Counseling and Development, 96, 223-228.

Kaplan, D. M. & Gladding, S. T. (2011). A Vision for the Future of Counseling: The 20/20 Principles for Unifying and Strengthening the Profession. Journal of Counseling and Development, 89, 367-372.

Learning House. 2013. Online Students 2013 – comprehensive data on demands and preferences. Retrieved from https://www.learninghouse.com/knowledge-center/infographics/ocs2013- infographic/

Lee, S. M., Suh, S., Yang, E., and Jang, Y. J. (2012). History, Current Status, and Future Prospects of Counseling in South Korea. Journal of Counseling and Development, 90, 494-499.

Maree, J. G. and van der Westhuizen, C. N. (2011). Professional Counseling in South Africa: A Landscape Under Construction. Journal of Counseling and Development, 89, 105-111.

McArthur, A. (2016). Online Graduate Programs through the Eyes of a Military Spouse. TechTrends, 60, 523–524.

Moore, B. A., Buono, F. D., Printz, D. B., Lloyd, D. P., Fiellin, D. A., Cutter, C. J., & ... Barry, D. T. (2017). Customized recommendations and reminder text messages for automated, computer-based treatment during methadone. Experimental and Clinical Psychopharmacology, 25(6), 485-495. doi:10.1037/pha0000149

Nassar, S. C. and Niles, S. G. (2018). Orientation to Professional Counseling. Past, Present, and Future Trends. Alexandris, VA: American Counseling Association.

Neukrug, E. (2016). A brief orientation to counseling: Professional identity, history, and standards (2nd ed). Cengage Learning. Boston, MA.

Okocha, A. A. G. and Alika, A. H. (2012) Professional Counseling in Nigeria: past, present, and future. Journal of Counseling and Development, 90, 362-366.

Online learning Consortium. (2015). 2015 Online report card – tracking online education in the United States.

Palmer, G. P., Palmer, R. W., and Payne-Borden, J. (2012). Evolution of counseling In Jamaica: past, present, and future. Journal of Counseling and Development, 90, 97-101.

Pew Research Center. (May 31, 2018). Teens, Social Media, & Technology 2018. Retrieved from http://www.pewinternet.org/2018/05/31/teens-social-media-technology-2018/

Randick, N. M. & Cummins, D. R. (2018). Gemeinschaftsgefühl Going Virtual: Creating Community, Connection, and Collaboration in the Online Education of Future Counselors.North American Society for Individual Psychology 2018 Annual Conference. Toronto, Canada.

Remley Jr., T. P., Bacchini, E., and Krieg, P. (2010). Counseling in Italy. Journal of Counseling and Development, 88, 28-32.

Richards, K. A. M., Zivave, A. T., Govere, S. M., Mphande, J., and Dupwa, B. (2012). Counseling in Zimbabwe: History, Current Status, and Future Trends. Journal of Counseling and Development, 90, 102-106.

Schofield, M. J. (2013). Counseling in Australia – past, present, and future. Journal of Counseling and Development, 91, 234-239.

See, C. M. and Ng, K-M. (2010). Counseling in Malaysia: History, Current Status, and Future Trends. Journal of Counseling and Development, 88, 18-22.

Senyonyi, R. M., Ochieng, L. O., and Sells, J. (2012). The Development of Professional Counseling in Uganda: Current Status and Future Trends. Journal of Counseling and Development, 90, 500-504.

Simons, J. D., Hutchison, B., and Baštecká, Z. (2012). Counseling in the Czech Republic: History, Status, and Future. Journal of Counseling and Development, 90, 233-237.

Spurgeon, C. (2012). Counselor identity – A national imperative. Journal of Professional Counseling, Practice, Theory, and Research, 40, 25-37.

Szilagyi, A. and Paredes, D. M. (2010). Professional Counseling in Romania: an introduction. Journal of Counseling and Development, 88, 23-27.

Thomas, R. and Henning, S. (2012). Counseling in Switzerland: Past, Present, and Future. Journal of Counseling and Development, 90, 505-509.

Tuicomepee, A., Romano, J. L., and Pokaeo, S. (2012). Counseling in Thailand: Development from a Buddhist Perspective. Journal of Counseling and Development, 90, 357-361.

Vera, G. D. (2011). Venezuelan Counseling: Advancement and Current Challenges. The Professional Counselor, 1, 5-9.

Wambu, G. W. and Fisher, T. A. (2015). School Guidance and Counseling in Kenya: Historical Development, Current Status, and Future Prospects. Journal of Education and Practice, 6, 93-102.

Wampold, B. E. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62(8), 857-873.