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A Research Agenda

From the outset of this project, it has been clear to the committee that determining how best to deliver mental health, substance use, and wellbeing services to the wide variety of students enrolled at the nation’s diverse array of institutions of higher education is an area badly in need of rigorous, theory-based research. What follows in this chapter are some of the key areas of research that the committee believes would help institutions of higher education better prepare for and provide mental health and substance use interventions and create environments that better support student wellbeing.

DEVELOPING, EVALUATING, AND SUSTAINING A CAMPUS CULTURE CENTERED IN WELLBEING

At the broadest level of public health and wellbeing programs and approaches, there is limited research to guide colleges and universities on ways to ensure that the entire campus, including virtual spaces, promotes wellbeing. This can vary from different definitions of wellbeing and how priorities may shift based on student demographics. Regarding institutional culture change, there is already a substantial body of research pertaining to culture change in and benefits to corporate and health care environments (Alvesson and Sveningsson, 2016; Bendak, Shikhli, and Abdel-Razek, 2020; Carlson et al., 2016; Choi, Oh, and Colbert, 2015; Edmondson and Lei, 2014; Parmelli et al., 2011). There is a need, however, to extend those type of studies to the academic environment.

• What is wellbeing in the context of institutions of higher education? Of different types of institutions?

• How can wellbeing be measured, both for the individual student and across the entire campus? What public health approaches can be used to embed a culture of wellbeing?
• What approaches will work for transmitting the concept of wellbeing across the campus, including in hybrid and virtual settings? How do approaches differ by role on campus (student, faculty, administration, and beyond)? Through rigorous trials, what could we learn about the factors and components that are needed to deliver seminars, workshops, and other training related to wellbeing?
• How effective are faculty and mentor training opportunities in shifting their mindsets and behaviors with respect to serving students? What elements or processes of professional development are most impactful?
• What approaches work for improving well-being for students who are BIPOC and from historically excluded groups? What would be the best ways to tailor those approaches to the different subpopulations of students?
• For colleges and universities that have limited community resources related to wellbeing or to enact new programs, are there approaches that have a lower cost burden? What is the current availability of existing wellness resources for students?
• Do programs that institutions of higher education have implemented to address student wellbeing in fact improve student mental health?
• Can virtual programs and mobile applications support student wellbeing and mental health? What are their limitations and appropriate uses? How can research inform strategies to increase engagement of students with digital health programs to address the fact that programs are only effective when people engage at a meaningful level, which is challenging with young people online?
• What is the impact of peer support programs on student wellbeing, mental health, and substance use?
• In terms of safety, privacy, and ethical use of social media, what training and education can colleges provide students so that they understand their rights and the risks involved?
• In the event there is a death of a student by suicide, what are the best ways to share information about the student while respecting the rights of the family and providing additional support to those who have been affected by the death?
• Trauma has interpersonal and cognitive consequences that advances in screening and evaluation are increasingly able to document and measure. Screenings also increase the understanding of the relationship between trauma and behavioral outcomes in terms of substance use, attention, self-regulation, and stress management, as well as one’s ability to access to higher-order skills necessary for academic success such as abstract thinking and problem solving. As much of the existing

• research exists in the youth and K-12 space, how can additional research understand the impact of trauma and how to support students with trauma to and through higher education?

Factors That Affect Student Mental Health, Substance Use, and Wellbeing

The available evidence suggests that the campus environment has unique characteristics that affect student mental health and wellbeing. Some of these are risk factors, such as widespread substance use, and others are protective factors, such as likelihood of being from a higher socioeconomic status than age-matched students not enrolled in higher education. Additionally, understanding which factors impact students prior to their arrival on campus may give campuses the ability to market their services and increase visibility to those who could benefit the most from a suite of wellbeing as well as other academic services. The ability to understand the factors that impact students during the time they are enrolled, including how factors may change based on their setting (in-person, hybrid, or online learning, or being primarily off campus for research), could enable institutions to amplify beneficial factors and work to reduce or eliminate detrimental factors. Answers to these questions would greatly help colleges and universities adjust their services.

• How has the COVID-19 pandemic affected the wellbeing and mental health of students?
• What is the link between student wellbeing and educational outcomes?
• What are the long-term consequences of remote/virtual learning on student mental health and wellbeing? The long-term impacts of COVID on the college experience should be studied over time.
• What risk and protective factors in the campus environment impact undergraduate and graduate student mental health, substance use, and wellbeing?
• What role does prior or current exposure to trauma play in student wellbeing and mental health?
• What are productive and effective ways to engage families in addressing student issues of mental health, substance use, and wellbeing?
• What role does injury (including traumatic brain injury, etc.) resulting from sports and/or combat exposure among veterans play in student wellbeing and mental health?
• What roles do post-graduate stressors play in student wellbeing and mental health?
• What roles do individual and cognitive factors play in student wellbeing and mental health?
• What roles do the social and environmental determinants of health play in student wellbeing and mental health?

• What is the comorbidity between mental health and substance use, and how does comorbidity affect treatment outcomes?
• How has the increase in vaping tobacco products affected student mental health?
• What changes have states that have changed laws around marijuana use (legalization and decriminalization) seen in the student and non-student population? How have use rates correlated with other health outcomes? Are there new public health, prevention, addiction, and recovery services in these states?
• What can predominantly white institutions learn from Minority Serving Institutions (MSIs) with respect to wellbeing of students who are BIPOC?

POLICIES THAT PROMOTE POSITIVE STUDENT MENTAL HEALTH AND WELLBEING AND LOW LEVELS OF SUBSTANCE USE

The impact of federal, state, and local regulations related to higher education policies would benefit from additional research to determine whether they are having the desired impacts and whether they might be at risk for harming students.

• How do policies related to health leave impact students? Do the policies comply with the Americans with Disabilities Act? What are the best approaches in terms of providing guidance to students, ongoing support when students are on leave, and return to campus? What student outcomes and experiences are associated with different admission and mental health leave of absence policies? How does this vary between undergraduate and graduate students?
• Are there ways, beyond the updated joint guidance document the Department of Education issued in December 2019,¹ to provide clearer guidance to colleges and universities regarding management of student treatment records and compliance with federal regulations such as Family Educational Rights and Privacy Act and Health Insurance Portability and Accountability Act ? How can colleges and universities providing services to students based on the ADA and Title IX do so with clarity and support in mind, rather than with compliance as the driving factor?
• How has higher education used local, state, and federal programs to address student insecurities regarding basic needs such as food and housing insecurity? Are there ways for more partnerships to ensure basic provisions for students?
• How can policymakers better understand and address the issues caused by state-specific licensing and the boundaries created? How can policymakers

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¹ Available at https://studentprivacy.ed.gov/resources/joint-guidance-application-ferpa-and-hipaa-student-health-records (accessed September 23, 2020).

• address barriers to providing effective telehealth, including across state lines? Are there ways that lawmakers can evaluate the impact of the temporary waivers granted during COVID-19 and ensure that effective measures are continued?
• How can campus leadership improve how they use research evidence to inform their decisions about programs and policies?
• What are the impacts of federal, state, and local investments on student mental health, substance use, and wellbeing? What are the academic and lifelong impacts of these investments?
• What are the impacts of federal and state policies on the resources, services, and outcomes for MSIs, notably historically designated Historically Black Colleges and Universities and Tribal Colleges and Universities ? Are there ways to understand federal and state policies related to higher education and the impacts on MSIs?
• How can more providers gain evidence-based training, education, licensure, and ongoing professional development to serve the needs of students?

Mental Health, Substance Use, and Wellbeing Collaborations between Higher Education and Community Providers

The earlier chapters of the report include recommendations that encourage campuses to commit extensive energy and resources to raising awareness of the offices, programs, and scope of care so that students know where to seek services where they are in need and know the level of care available. Students also have a responsibility before arriving to campus to gain a broad understanding of the health, wellbeing, and academic support services available to them. As the report states, there is a tension that colleges and universities must tread in the provision of mental health, substance use, and wellbeing services. Overall, the state of health and mental health care in the United States is limited in terms of providers that take insurance, the cost of copays, the availability of mental health specialists, and the availability of providers within a given area. In addition, higher education institutions have seen cuts in their budgets overall throughout recent decades. This means that students seeking services are looking to two systems, higher education and the U.S. medical system, that have may not have the resources students need. Addressing the U.S. mental health care system was out of the scope of this report; however, additional research for leaders in higher education to develop appropriate partnerships with community providers would be useful.

• What is the role of local hospitals and providers providing mental health services to the student population?
• What are the ways in which colleges and universities can receive reimbursement from health insurance companies for their provision of health care services to students?

• What is the most effective way to provide mental health services to specific populations of students, including, but not limited to:
  • Black, Indigenous, and people of color (BIPOC)
  • Students with disabilities and disabled students
  • First-generation students
  • International students and students without documentation
  • Student-athletes
  • Graduate students
  • Medical and other professional school students (e.g., nursing, pharmacy)
  • Post-traditional and non-traditional students
  • Sexual and gender minorities
  • Student survivors of trauma
  • Student military service members and veterans
• How can trauma-informed frameworks be integrated into other functional areas within higher education (e.g., teaching, mentoring, communications)? What are the outcomes?
• In terms of trauma-informed care for survivors of sexual assault and harassment, how can additional research provide more information around the sexual harassment experiences of women who are BIPOC and from other historically excluded groups? What kinds of policies, procedures, trainings, and interventions can prevent sexually harassing behavior, decrease the perceived organizational tolerance for sexually harassing behavior, and reduce harm to those who report incidents? How can organizations provide protection to those who experience sexually harassing behavior, associated retaliation, and the impact of harassment in the ambient environment?
• How should institutions of higher education best provide recovery programs for students returning to campus after a leave of absence?
• What is the impact of policies and programs initiated to support student wellbeing and mental health during the COVID-19 pandemic?
• In what ways can telehealth and virtual therapy provide evidence-based, high-quality mental health services in the higher education environment? Are there differential outcomes across student groups and for students with different concerns or problems?
• How effective and efficient are alternative strategies for implementing tiered systems of care, such as triaging, identifying needs, and filtering and engaging with appropriate level of care? Are there settings or groups of students where these strategies are more effective?

Addressing the Limited Data and Research Related to Mental Health, Substance Use, and Wellbeing in Higher Education

One of the major challenges noted across the report is the limited data related to these issues in a higher education setting. In addition to the broad challenges, there are certain types of institutions that have greater data gaps such as HBCUs, TCUs, and community colleges. There are also groups that would benefit from datasets that have greater capacity for disaggregation across a number of dimensions. The lack of data seriously undermines meaningful, substantial discourse describing data-driven reforms at the federal and institutional level; this problem is particularly acute for students attending HBCUs, TCUs, and community colleges. Researchers pointing to lack of data also identify the culture of the two-year college, which by and large is not set up to support a research friendly culture.

• Collect more longitudinal data that can be disaggregated in terms of
  • Institutional and program types such as community colleges, MSIs, graduate programs, and medical programs
  • Student identities including gender, race and ethnicity, disability, first-generation, nation of origin, documentation, student-athletes, post-traditional and non-traditional students, students with dependents, sexual and gender minorities, and military service and veteran status
  • Previous experiences with mental health, substance use, and trauma
  • Differences in student mental health and substance use issues by discipline and professional field
• Explore models of research partnership between under-resourced institutions, such as community colleges, and researchers at well-resourced institutions that can develop meaningful data for under-resourced institutions
• Develop, support, and maintain an ongoing, longitudinal national monitoring system that identifies student death by suicide
• Conduct systematic evaluation of the outcomes of specific mental health services and programs

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