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Jonathan Kandell, Ph.D. Chair, Commission for Counseling and Psychological Services American College Personnel Association  The following letter was written in response to an attack on the Association of University and College Counseling Center Directors (AUCCCD) and counseling centers as a whole by a for-profit company called the Professional Services Group, Inc. (PSG). Following the tragedy at Virginia Tech, PSG contacted the Senior Student Affairs Officers (SSAO) at many campuses promoting their assessment products. PSG’s idea, in order to increase campus safety, was to require each student to complete one of their assessments each semester (at $16 per instrument) before the student could register for classes. AUCCCD responded to PSG’s efforts by posting an open letter to SSAOs and “members of the campus community” on their website, expressing their concern over mandating such assessments and raising the issue of how difficult it is to predict violent behavior. PSG then wrote back to SSAOs blasting AUCCCD, claiming that the Directors group was “endangering” students and campuses by their opposition to mandatory screening of students. After becoming aware of the situation and doing some research of my own, I felt compelled to write my own open letter in support of AUCCCD and challenging PSG’s assertions. After running the letter by the CCAPS Directorate I had a copy posted on our website (link on the CCAPS homepage). I also sent it to the AUCCCD list to enable directors to read it. The letter, reprinted below, provides a history of what happened and my thoughts and reactions to the situation. These events remind us that we must remain ever vigilant in protecting our profession. An Open Letter to the
Association of University and College Counseling Center Directors, “First, do no harm” I am writing this letter to express my concern and dismay over the recent interchange involving the Association of University and College Counseling Center Directors (AUCCCD) that has occurred over mandatory campus screening of students. This open letter is an attempt to elucidate my concerns about this issue and to support the efforts of those who work in my chosen field, college and university counseling centers. This letter also represents the official position of the Commission for Counseling and Psychological Services (CCAPS) of the American College Personnel Association. I have more than 20 years experience working in counseling centers and am currently the Chair of the CCAPS. While AUCCCD is comprised of counseling center directors, CCAPS is the primary organization for counseling center staff at all levels. Most of us work for our AUCCCD colleagues; some of us are directors ourselves and members of AUCCCD. Upon hearing about this argument I had some initial reactions. I’ve waited to respond, however, until I did some research of my own. My goal was to attempt to figure out what each side was saying, and to put the situation in context. The following is my understanding of what is happening. History 1) At the Annual Convention of the American Psychological Association in 2005, Dr. Koltko-Rivera introduced the College Entrance Psychiatric Screen (CEPS) as a method for screening entering freshmen at colleges and universities for “serious psychiatric disorders.” This instrument, which later evolved into the College Student Psychiatric Screen™ (CSPS™), was “originally developed in 2002 for the U.S. Department of Defense as a way to screen for serious psychiatric disorders among potential recruits.” 1 Dr. Koltko-Rivera concludes the presentation by saying, “My organization, Professional Services Group, Inc., is interested in partnering with college and university counseling centers to conduct predictive (emphasis added by me) validity trials with an enhanced version of the CEPS.” I do not know if a partnering occurred with any campus counseling center, but I would think that if it had, Dr. Koltko-Rivera would have mentioned it. Given that this partnering likely did not occur, and Dr. Koltko-Rivera himself saw the need for such predictive validity trials, this raises concerns for me when he states, “because campus-wide mental health screening would be an effective means of forestalling shooting incidents …” 2 In my careful review of the information presented on the PSG website, I have not found any mention of any predictive validity studies or results, or, in fact, any validity or reliability studies beyond the initial work. If Dr. Koltko-Rivera desired such trials to measure the efficacy of his instrument in “the real world,” and if these trials did not occur, or did not provide the expected data, how can he now claim that his (or any other) campus-wide screening instrument “would be an effective means of forestalling shooting incidents?” 2) In a “White Paper” dated April 27, 2007, 11 days after the shootings at Virginia Tech, Dr. Koltko-Rivera presents his argument more fully for widespread use of the CSPS™. Included in this piece is the following quote (bolding is original, underlining by me), “The CSPS™ identifies the likely presence of five categories of major psychiatric disorders, each of which may result in the extreme violence seen in school shooting incidents.” When does “may result in … violence” become “would be an effective means of forestalling shooting incidents?” 3) Around the same time, PSG releases a pamphlet aimed at campus administrators entitled, “Taking Steps to Help Prevent the Next Campus Shooting Incident: The Application of Psychological Screening Technology.” 3 In this pamphlet PSG makes the argument for mandatory screening of all college students, a proposal stated even more strongly on the PSG website, “If local laws make it possible, we recommend that colleges and universities require all students to complete the CSPS™ as a condition of enrollment on an annual basis.” 4 4) On July 12, 2007 AUCCCD reacts to this call for mandatory campus screening by releasing a statement on their website. 5 This statement, also targeted to administrators, notes that “some individuals and companies are marketing assessment instruments to screen students for mental health concerns to ‘prevent’ another violent incident from occurring” and raises several concerns about the prospects of mandatory assessment. The statement does not mention PSG or any specific individual/organization. It does, however, suggest that administrators should think carefully before instituting such a screening. 5) In response to AUCCCD’s statement of caution regarding mandatory campus screening, Dr. Koltko-Rivera posts a response of his own dated July 27, 2007. 6 The main points of this reply are then sent to “members of the higher education community” (primarily upper-level administrators) in the July 30, 2007 letter I mentioned above. 2 In my opinion, Dr. Koltko-Rivera’s tone in these rebuttals escalates significantly and appears defensive. In both replies Dr. Koltko-Rivera states that AUCCCD advises against (or does not recommend) campus-wide mental health screenings. This is not necessarily the case. Again, AUCCCD does recommend caution, but does not rule out the use of campus-wide screening. AUCCCD seems to be saying that we should not overreact to the shooting at Virginia Tech and look for easy answers via a mandatory mental health screening of students. We should, instead, think carefully as to whether this is the road, as counseling center and campus professionals, we wish to travel. Thoughts Given the above sequence of events, several thoughts run through my mind: 1) I appreciate PSG’s right to create a screening instrument, and to make a profit from it. I even allow for their right to market such an instrument in an appropriate manner. I personally, however, find the timing of PSG’s marketing blitz in the immediate wake of an unspeakable tragedy to be opportunistic at best, manipulative and crass at worst. 2) The CSPS™ was created in 2002 to screen for serious psychiatric disorders among military recruits. As with screening among police officers, I not only have no concerns about the need for such screening, I laud PSG for developing such an instrument. In 2005 a version for college students was created, and then released in 2006. I can understand the desire for a new market (especially with declining military recruitment numbers), but the campus population has at least some major differences from those in the military. If someone will not only have access to firearms, but will be required to carry one (or more), and to use them, I certainly would want to be as careful as possible in determining the emotional stability of the person. Mandatory assessment in this case is completely warranted, or as Dr. Koltko-Rivera likes to say, “Screening makes sense.” On the other hand, I don’t believe that the requirement to carry a textbook or laptop equates to the requirement for carrying a gun. 3) When the CSPS™ was developed and presented at the 2005 APA convention, no mention of it’s utility in preventing violence (or any mention of violence at all) was made. Only in the materials after the Virginia Tech shootings is such a claim made. Since there do not seem to be any predictive validity tests to determine the efficacy of such an instrument in the field (as opposed to the norm group), it makes me wonder about the true efficacy of the instrument. I certainly do not claim that the instrument has no value. In fact, it could be a very helpful tool. What troubles me is that it has not undergone the independent scrutiny that such instruments need (e.g., not in Buros’ Mental Measurement Yearbook), especially when it is being suggested that every college student be forced to take it “as a condition of enrollment on an annual basis.” 4 4) Dr. Koltko-Rivera implies an understanding of the college counseling environment by virtue of his having “had the privilege of serving on the counseling center staff of a great university and a small college.” 2 A review of his vita, however, shows his college counseling center experience limited to a practicum course at the New York University counseling center and a one-year, part-time position at the counseling center at Manhattanville College (1989-1990). While having any counseling center experience is certainly better than none, I find it difficult to believe that Dr. Koltko-Rivera has a better sense of what is needed on campuses than those who have spent their careers helping college students, such as the members of AUCCCD and CCAPS. 5) Finally, I started this document with the quote, “First, do no harm.” The message that it sends is the fundamental principle of healers, one that is learned through training and is part of, directly or indirectly, the ethical codes of all the healing professions. Assessment instruments, when used appropriately, can be powerful tools in the diagnosis and treatment of many psychological conditions. However, what is often ignored is the realization that assessment is not a “neutral” activity, one having no impact on the person being assessed. Rather than a neutral act, assessment is an intervention into a person or a system. Some simple examples of this include: 1) the individual who knows the facts but does poorly on tests due to the act of testing, and 2) the “Hawthorne Effect,” a phenomenon first demonstrated at the Hawthorne automobile plant that demonstrated that the simple act of observing and measuring a worker’s performance, no matter what changes were made in the environment to impact said performance, increased production. As with Heisenberg’s Uncertainty Principle, the Hawthorne Effect shows that the mere act of observation alters that which is observed. The above is not to suggest that we should never observe or assess. As counselors, we are continually assessing our clients, whether it’s through the counseling interview or by an assessment instrument. Even mandatory screening, as in the case of the military recruits noted above, can be useful. However, simply screening everyone in a predominantly healthy population so as to find those who fit a certain unhealthy profile seems to me to be a dangerous practice. One danger is the inevitable possibility of the instrument producing “false positive” results, in other words, one where the student does not have a serious psychiatric disorder, but the instrument says they do. Dr. Koltko-Rivera claims that his instrument provides fewer “false positives” than other instruments. This may be true, but he does not present any comparisons to other instruments. But let’s assume that Dr. Koltko-Rivera’s claim is true, and that the rate of false positives is .1%. What this means is that aside from the students who would legitimately test positive on one or more of the scales, .1% of the students forced to complete the test (35 on my campus alone), ones who do not have the serious psychiatric disorders Dr. Koltko-Rivera discusses, would then be followed-up by counseling center staff for further assessment and possible treatment. To me, this is a PR debacle of the first order. Many students don’t trust mental health professionals easily. This would be proof that their suspicions were right. A student might easily factor the requirement of being screened into their enrollment decisions and vote with their feet. Of course, this does not even account for students who, generally being adolescents and young adults in the throes of questioning authority, may very well “fake bad,” “fake good,” or answer completely randomly, that is, if they complete the instrument at all. Since the screening is “mandatory,” what is the consequence for not completing it, or failing to complete it in an appropriate manner? Dr. Koltko-Rivera suggests that students should not be allowed to register or attend classes. Is this an appropriate consequence for this “crime?” Since we are considering screening all the students, because there may be some who could shoot someone, what about screening all the faculty and staff, as well? Considering the incidence of psychological disorders throughout all members of the population, to be safe, shouldn’t everyone on campus be assessed for serious psychiatric disorders and forced to quit their job if they refuse the screening, or refuse treatment if one of their scales exceeds the cutoff? Why should we treat students any different than we treat ourselves? In fact, this line of thinking argues that, if we really want to feel safe, all members of our society should be screened for psychiatric disorders. Violence is certainly not limited to campuses, or those aged 18-22. My other concern relates to the whole notion of labeling. Labeling has been shown to have a detrimental impact in many situations, including the classroom and the mental health professional’s office. One of the reasons that we don’t give our clients test results without a professional interpretation is that the scales (e.g., Schizophrenia, Psychopathic Deviance) can easily be misinterpreted. To insist that all students should take instruments that risk their being labeled with a psychiatric disorder, when no indication for such action is warranted, to me seems the antithesis of the “First, do no harm” doctrine. Labels, especially psychiatric diagnoses, can stick with the student throughout the remainder of their lives. Assessment and intervention is appropriate when the likely gain outweighs the cost. It is not appropriate to find the proverbial “needle in the haystack.” Similar to treating the water supply with antidepressants because some sufferers of depression may not be taking their meds, forcing assessment on all just to ferret out a few, whose psychiatric disorder only “may result in the extreme violence seen in school shooting incidents,” to me seems to be a very high cost to pay. Ultimately, no one wants a repeat of the Virginia Tech tragedy. We should all be concerned about the welfare of our students and our campuses. To engage in knee-jerk reactions due to fear, however, seems the exact opposite of what intelligent and rational people should do. My hope is that cooler heads prevail from what has become an ugly situation.
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