Internal audit reveals steep decline in counselors, $250,000 worth of questionably allocated funds

Counseling Services Audit and Management Advisory Services Project #17-67. (Performed by the University of California, Davis Audit and Management Advisory Services)

Audit was done two years into $18 million UC effort to expand counseling services

This article is the third in a three-part series examining issues that counseling psychologists in the UC system are currently facing, including under-market wages, understaffing and high demand leading to systemwide recruitment and retention issues.

 

The California Aggie recently obtained and verified a copy of an internal audit of UC Davis Counseling Services performed in December of 2017 by UC Davis Audit and Management Advisory Services. This audit was performed almost two years after the start of an $18 million UC-wide effort to hire additional clinicians throughout the UC system in order to “increase access to mental health services, reduce wait times for students, and complement outreach and prevention efforts.”

The audit states that the reported numbers of staff on campus have been inflated to misrepresent the actual number, and that $250,000 worth of mental health funds (MHF) was spent by UC Davis in a manner “inconsistent with non-binding guidance” provided by the UC Office of the President. Additionally, the audit includes a graph (see above) which depicts a steep decline in the total number of counseling psychologists on staff in 2017.

Vice Chancellor of Student Affairs Adela de la Torre requested the audit be done and said it provided “good feedback.”

“We don’t necessarily need to hire more counselors,” de la Torre said in response to the audit and its findings.

In UCOP’s announcement of its four-year initiative to hire “85 clinicians across the system” in 2016, the word “will,” used to explain what the UC will do, is used eight times in the original press release. De la Torre, however, objected to the word “mandate” being used to describe the UC’s plans. She said the four-year increase in student services fees for the hiring of new clinicians to bring campuses in line with nationally-recognized staff-to-student ratios “was guidance.”

Individual student contribution to the Mental Health fee was addressed in a joint response sent via email from Assistant Vice Chancellor for Divisional Resources of Student Affairs Cory Vu, Principal Budget Analyst Laurie Carney and Campus Life Content Provider for the UC Davis News and Media Relations team Julia Ann Easley.

“For Fiscal Year 2017-18, all students pay $1128 annually, of which $113 are paid by undergraduate and graduate professional students and $100 by graduate academic students towards the Mental Health fee,” the email stated.

When asked whether the hiring of new counselors with these fees as outlined in the UC press release is an obligation of the UC campuses or an aspirational goal, UC spokesperson Stephanie Beechem said the “collaborative effort […] is ongoing.” Beechem did not respond to requests for comment as to how, specifically, UCOP is implementing the initiative.

“The [UC] has not put the effort into trying to meet their own mental health initiatives that they put out,” said Jamie McDole, the vice president of the University Professional and Technical Employees, which represents counseling psychologists. “There’s been a lot of turnover to our staffing, they’re not even close to the mental health standards they’re supposed to be achieving — of a therapist available for every 1,000 to 1,200 students. They’re failing.”

The steep decline in counseling psychologists shown on the graph (see above) was due to the termination of contract staffers at UC Davis. The audit states that ten contract employees were hired “temporarily to satisfy general under-met student need” but “only one of the ten employment contracts was renewed past June 2017.”

UPTE is currently in negotiations with the UC over its healthcare contract.

Since the existing healthcare contract does not include any contract employees, who are at-will and may be terminated without explanation, several of the UC campuses transferred their contract employees to full-time positions during bargaining with UCOP. According to McDole, however, rather than transfer UC Davis’ contract employees to full-time positions, they were terminated — “they just laid them off instead of dealing with it.”

McDole said a charge of “unfair labor practice” has been filed against UC Davis. Nan Senzaki, a senior staff member of UC Davis counseling and psychological services, commented on the hiring of the 10 contract staff members.

“Last year (2016), several […] contract staff were suddenly hired with varying levels and kinds of experience,” Senzaki said via email interview. “Although, I believe this was done with good intentions, it did not feel to me that we were providing exponentially more services commensurate with the addition of staff. I’m not confident we were being as efficient or thoughtful in what seemed a rush to increase staffing. I appreciated the additional staff, but in my experience the distribution of clinical workload was not even.”

According to Margaret Walter, the director of health and wellness at UC Davis, “the decision to end the contracts early was related to budget.”

In discussion about the SHCS budget and the funding of mental health services, Walter, who came to UC Davis in June, said that “in looking at the budget,” she “found that a lot of folks here […] didn’t quite understand how our budget worked.” Asked if there is an issue with transparency regarding the budget, de la Torre said Walter could present informational materials to the staff — Walter replied, “we have been.”

Walter added that she hoped the staff “would trust that [the money from the initiative] was spent appropriately.” The audit, Walter said, “found the money was spent appropriately as it was supposed to be.”

The audit states that $250,000 has been allocated annually to Student Judicial Affairs and the Student Disability Center for case management positions.

“As a result, fewer funds are available for recruitment of Counseling Services counselor [full time employees] FTEs,” the audit states. “Guidance published by UCOP in 2015 indicates that the funds should be used in support of the Counseling Services department. We discussed this with leadership at UCOP, who suggest that though the guidance is not binding, it demonstrates an expectation of the UC students and Regents that the funds be spent in support of undifferentiated care from a central counseling unit to which all students have access.”

The joint response from Vu, Carney and Easley states that “Student Affairs and Budget and Institutional Analysis (BIA) will seek clarification from […] UCOP regarding the funding for the positions at Office of Student Support and Judicial Affairs (OSSJA) and the Student Disability Center (SDC). Student Affairs and BIA believe the current use of funds is appropriate.”

Both positions funded with the money, at the SDC and OSSJA, are clinical psychologist positions.

The audit states that counseling services employed 28 counselors in January of 2016 — “at that time the Provost documented an agreement with the Vice Chancellor for Student Affairs to add 11 new FTEs by the end of FY 2017.”

According to Walter, there are currently 28.5 counselors at UC Davis and several open positions. Walter was asked if she agrees with de la Torre’s claim that the university does not “necessarily need to hire more counselors.”

“We do need more mental health providers,” Walter said. “In turn, we will need more counselors as well, people providing more direct clinical service to students, especially as our student body grows.”

In October of 2016, plans were announced to move the Women’s Resource and Research Center out of North Hall so counseling services could expand into the first floor. The additional space would be needed to house the estimated 11 to 12 counselors UC Davis planned to hire through the UC-wide initiative. The WRRC currently remains in North Hall, and counseling services have not drastically expanded elsewhere on campus. Director of Student Health and Counseling Services Sarah Hahn said the university is “not yet in need of additional space for counselors.”

“They needed that space for 12 new counselors,” said Samantha Chiang, a fourth-year English major and the director of the UC Davis Mental Health Initiative. “But now, they haven’t gotten any new space. Where are the 12 counselors? Also, we haven’t had a net increase of 12 counselors. [… We’ve] potentially hired more than 12 counselors but because our retention rate is so bad due to poor pay, we haven’t increased by 12. That has really been obscured from the student body. We really need to mobilize in some way to ensure that we get our money’s worth. That was supposed to go to direct counseling services. They can’t say, ‘Oh, this was for [something else].’ No, that money was earmarked for direct counseling services.”

According to UCOP, the $18 million “will support hiring 85 mental health clinicians to include psychologists, psychiatrists, psychiatric nurse practitioners and case managers.” The statement from Vu, Carney and Easley states “UCOP was not prescriptive in how the Mental Health funds were to be used other than for mental health services.”

UC Davis currently employs 3.5 psychiatrists. The UCOP-recognized ratio is one psychiatrist per 6,500 students. There are “postdoctoral psychiatry fellows from the UCD Medical Center that see clients,” Walter said, stating the university is “aware that our ratio for psychiatry needs to be addressed, especially in light of increased enrollment in the future.” Additionally, including the postdoctoral fellows in the ratio would result, Walter said, in a “psychiatry provider-to-student ratio of approximately 1:7,500.”

Another issue addressed in the audit during talks with de la Torre, Vu and Walter — and brought up repeatedly by all three — concerns low levels of productivity. The audit shows that in 2017, clinical counselors had an average of 2.26 clinical sessions per day, data based on self-reported numbers. Walter emphasized this low number of reported sessions taking place in a workday.

“My experience working at other schools has always been to use the benchmarks they put in the audit to argue for more clinicians because staff were seeing seven, eight people a day,” Walter said. “That’s been my experience at some other schools. I’ve not been on the flipside ever before. This is really unusual. Of course, there’s days when a provider will see five or six, but there’s days when they’ll see none or one. It was shocking for me.”

Senzaki commented on the audit’s findings regarding productivity — she commented after being notified that The Aggie had already obtained a copy of the audit.

I am deeply concerned with the apparent misrepresentation of the [data] despite disclaimers in the audit report,” Senzaki said via email. “I fear it has the potential to be interpreted that we are all grossly underperforming and underutilized in all areas of service. This type of data continues to undermine morale, is misrepresentative and distracts from more meaningful and important conversations with how to provide competent mental health services which meets student/campus community needs. It does not address retention of staff and sustainable measures of performance and productivity. There are many components to this discussion. From my reality and experience, some staff provide way more direct clinical hours than other staff.”

De la Torre talked about a “productivity issue” which can be addressed by a “need to redistribute the workload.” Senzaki, however, who has just begun her 18th year working at UC Davis, said that how productivity is being measured is flawed.

“These low numbers have in the past, resulted in a pattern of management often directing pressure at North Hall clinical staff to pick up the pace (productivity) vs. looking at all the other apparent issues with utilization within various programs, management, the system and data,” Senzaki said via email. “In other words, if we are defining “apples” and more specifically, “MacIntosh apples” as one variety of an apple (representing direct counseling contact or sessions=clinical), you can’t also include all varieties of “apples” along with “oranges,” “pears” and “peaches” (representing all the other functions and duties one might include in mental health services) and then create a hybrid and assume you have a legitimate measure of standard productivity. It begins to minimize our sincere efforts and our diverse roles within supporting and providing various facets of mental health services.”

The university has plans to hire one additional counselor each year for the next three years. Asked if the university has, during the time of the four-year UC-wide initiative, hired significantly more counselors, de la Torre instead stressed the importance of diversity.

“I think there’s something more important that I have seen in the last few years and that is the diversity of counselors,” de la Torre said. “I can honestly say, as a faculty member for 15 years, the biggest complaint that was against counseling was quite frankly the lack of diversity of the counseling staff. We can talk about hiring more, it’s like hiring more faculty. But if it’s the same person, meaning the same demographic, that doesn’t address the fact that we need diverse ones. It’s a trade-off. Then the question becomes to the students, ‘Is it important for you to have that diversity?’ And that’s a really good question to ask, ‘Are you willing to give that up?’”

UC Davis does send monthly reports to UCOP concerning the university’s progress with additional hiring and the allocation of the mental health fund. The audit, however, addresses misinformation within UC Davis’ reports.

“Data are currently being reported with the intent to show how the new MHF funds are used, [which] does not take into account whether the funds are used to increase net counselor FTEs, but rather aims to show that the funds are not used elsewhere and are not being accumulated as reserves,” the audit states. “A conflicting interpretation is that the data are meant to show how many FTEs have been added using the new MHF funds. The most recent reports claim new counselor positions, several of which we found to have been existing positions, but whose funding sources had been shifted to the new MHF. We conclude that these reports do accurately report a new use of MHF funds, but that they do not satisfy the intended purpose of showing net increase in total counselor FTEs. Rather, they tend to suggest an inflated number of new positions added.”

In response to these findings, Walter said UCOP now “knows where people are.” Another issue in the audit addresses the fact that counseling services is currently “operating without a strategic plan.”

“One of the [needs] is a strategic plan — how would we start [one], especially in light [that] the chancellor doesn’t want us to have a strategic plan until his strategic plan is done,” Walter said. “We have to hold off on this as the greater UC Davis strategic plan is unfolding, but we could do some groundwork right now. It will help us not just preserve the things we’re doing well, but add things that we want and realize that we can lose some things.”

A spokesperson for Chancellor Gary May said that May’s chief of staff indicated that no such directive came from the Chancellor’s office.

Walter later said via email that “current strategic planning efforts of the Chancellor will not delay us, and I’m sure they will all align once complete.”

In January, Dr. Greg Eells, the director of counseling and psychological services at Cornell University, came to UC Davis to perform a needs assessment using the findings of the audit. Eells last performed a needs assessment for the university in 2013.

The Aggie obtained a copy of Eells’ findings in 2013. The assessment recommended additional hiring of staff to meet nationally-recognized ratios and student demand, the development of guidelines for clinical productivity as well as “relationship building […] to shift the culture of ‘they’ to one of ‘we’ where staff within CAPS and across the broader SHCS feel committed to the singular mission of providing integrated care to UC Davis students.”

In reference of the recommendations and findings of the 2013 Needs Assessment, Walter said she thinks “it’s interesting that things come up in the audit that were also true four years ago.”

A town hall on mental health is scheduled for Tuesday, Feb. 13 at the ARC Ballroom at 7 p.m.

 

Written by: Hannah Holzer — campus@theaggie.org