Health and Wellbeing Review 2018
Appendices

A1. Subject Matter Experts (SME) Meetings

Participants

A2. Interview Questions for Subject Matter Experts Meetings

Domain #1: The academic environment

1. In your opinion, on a scale of 1-5 (where 1 is low), where would Concordia rank in promoting student wellbeing in the classroom? (Why?)

a. For examples from other universities,  please see: Ryerson, University of British Columbia, University of Delaware, Simon Fraser University.

2.  What strategies, tools and training would be helpful for Concordia faculty to bring empathy into the classroom?

a.  Which methods could we action relatively quickly? (i.e. within 1 year)

3.  If Concordia were to prioritize teaching students how to lead healthy, happy, fulfilling lives, what would need to be put in place to achieve this?

4. For a variety of reasons, students don’t often have the skills to handle situation-based anxieties and stressors and exams can inadvertently test a student’s ability to handle stress instead of their knowledge.

a. What resources are available to faculty to help them manage classroom anxieties?

b. In your view, what is “best practice” in knowledge-testing / exams?

c. What are your suggestions for developing resiliency and emotional intelligence?

5. Research has supported that faculty can promote a healthy learning culture by engaging with students outside the classroom.

a. Is this relevant and feasible at Concordia?

b. Do you have an example of a university that promotes wellbeing in the classroom?

6. What are some best practices that you are aware of in this domain?

Domain #2: Concordia policies and practices that support student wellbeing

Consultants suggest that an empathy is a vital prerequisite to a thriving community. Further, in the field of wellbeing, proponents often state that “wellbeing is everyone’s responsibility” -- that is to say, we all have a role to play. Cautious voices suggest that the rallying cry must accompany clear roles and responsibilities for “everyone”, and that policy is the hardest tool to get “right”. For more information on the role of policy and procedure in developing a thriving community, please refer to Centre for Innovations in Campus Mental Health.

1.  Of the following instruments, which do you recommend for Concordia? (why)?

a. A stand-alone policy on health and wellbeing that formally outlines Concordia’s responsibilities towards the health and wellbeing of its members. This policy may centralise existing policies.

b. A statement of commitment to health and wellbeing that clearly states the value that Concordia places on its member’s health and wellbeing.

c. A list of guidelines to review existing policies and in doing so, gradually embed health and wellbeing principles into all policies.

2. Please name any Concordia policies and procedures that you are aware of that support empathy and student wellbeing for the general student population, and for students in need.

a. Is there room for improvements in our current policies and procedures (if any)?

b. What method(s) could we implement at Concordia relatively quickly? (i.e. within 1-2 years) What would it require?

c. Do we need new policies and procedures?

d. What do you think are the most effective tools  in promoting empathy and wellbeing? (policy or otherwise). Why?

3. What are some best practices that you are aware of in this domain?

Domain #3: On-campus support services related to health and wellbeing

1.  Demand for mental health services is rising, but resources are limited.

a.  In what areas of mental health is demand rising the fastest?

b.  Is demand for health services rising in other areas? (What?)

c.  If you were to take a long-term view (5-10 years), what health-related concerns do you foresee on the horizon?

2.  What are the strengths and challenges of Concordia’s health-related services for chronic or persistent illnesses and episodic or transitory illness?

a. What changes (if any) do you suggest?

b. What changes would you prioritise?

3.  What are the strengths and challenges  of Concordia’s health-related services for  crisis response?

a.  What changes (if any) do you suggest?

b.  What changes would you prioritise?

4.  How do our current health-related services and support services support changes in life milestones? (e.g. pregnancy)

5.  Concordia has a number of players in the health and wellbeing landscape. In your view, do they work well together?

a.  What opportunities might exist for them to work together better?

b.  What challenges lie ahead and how can they be overcome?

6.  Many North American models of health and wellbeing focus on Western, clinical approaches. What role do you see traditional and Eastern methods playing? How can they complement each other at Concordia?

7.  What are your thoughts on Concordia becoming a smoke-free campus?

8.  What are some best practices that you are aware of in this domain?

Domain #4: On-campus opportunities for student development (i.e.: outide of classes)

1.  What role do universities play in the personal development of students?

2.  It is common for universities to offer personal growth and development skills through Student Services units and to record these skills in cocurricular records. What are the strengths and challenges of this approach?

3.  The health benefits of sport and physical activity are becoming common knowledge. Yet, despite growing public awareness, many people do not engage in these activities.  What methods can we employ to help increase Concordia’s engagement in physical activity?

4.  When it comes to extra-curriculars, it’s common to hear “It’s hard to bring myself to go. But when I do, I really enjoy myself. My challenge is getting off the couch.”  Similarly: “I want to go, and I know it’s good for me, but I can’t seem to bring myself to go”. How do we help people overcome their own resistance?

5.  Healthy eating is foundational to a healthy body and mind. How do we teach students that eating well can be easy, enjoyable, and most importantly, cost-effective?

6.  What are some best practices that you are aware of in this domain?

Domain #5: Campus spaces that promote health and wellbeing

1.  What are examples of physical spaces that promote wellbeing? Does Concordia have examples of this?

2.  What are changes that Concordia can do to alter its spaces to promote wellbeing? (either now, or in future plans)?

3. Smoking legislations require a 9 meter smoke-free radius around doors and windows. How do we maintain a smoke-free perimeter?

4.  Where do you see as Concordia’s biggest challenges in providing accessible spaces?

5.  Are there any federal and provincial legislation in accessibility (current or imminent) that we should be mindful of?

6.  What are some best practices that you are aware of in this domain?

Domain #6: Opportunities for students to connect and interact on-campus

1. What opportunities currently exist for students to feel a sense of belonging to Concordia?

2. A research study of opioid use found that “if we want to have less opioid use, we have to figure out how to have more love.” The finding is transferrable to almost any health concern including suicidality.

a. What practical things could we implement at Concordia to “promote more love”?

b. How can these initiatives be promoted across campus?

3.  What are some best practices that you are aware of in this domain?

A3. Subject Matter Experts Meetings Findings

Domain #1

Overall, the Domain #1 meetings encouraged a shift away from the “survival of the fittest” mentality to make room for a culture and ethos towards health and wellbeing that would be enacted within the classroom and across-campus. Faculty and student training would need to be involved in creating this atmosphere.

Domain #2

The two Domain #2 meetings asked for a value statement of health and wellbeing from Concordia University, but argued that this would need to be backed up with practical guidelines for how to actually create this culture. The Policy on Student Involuntary Leave of Absence (POSILA) and the sexual assault policy were proposed as good examples. 

Domain #3

The three domain #3 meetings showed that there is a lack of personnel and resources for many of students’ different needs. Possible solutions were proposed, such as a campus-wide mind-bodysoul approach to student health, preventative measures, and partnerships with services external to Concordia. Concordians suggested the need for partnerships with others who can provide ancillary services (e.g. peer mental health supporters, Creative Arts Therapy, etc.) Other connections (Jack.org, Chime-In, Creative Arts Therapy, CSU Nightline) have been useful.

Domain #4

The three Domain #4 meetings looked at how  a shift in Concordia’s attitude towards health  and wellness needs to change both in policy and  in practice. Building healthy habits into curriculums and the university community was suggested as one of the most important ways to enact these ideals. Other examples included providing affordable healthy food options and offering more accessible gym hours/scheduling. Participants  also encouraged a shift away from focusing exclusively on evaluating academics, and consider other valuable areas such as self-care and extracurricular involvement as well.

Domain # 5

A number of services external to Concordia were named in these meetings, however some of them also showed to have longer wait times than what students can already access at Concordia. They emphasized the importance of having accessible community spaces for students to meet. Participants also showed a desire for an accessible list of services that students could see that would provide information such as what resources are available for students without medicare cards. Many external services were listed, including CLSC, Tel Aide, Alcochoix, Pavillion Foster, Services Generaux, GMF, Suicide Action Montreal, Project Access, Tracom crisis centre, Greater Montreal Reference Cenre, and Youth Services.

Domain # 6

The meetings around Domain 6 generated a lot of ideas, many of which cross over with the previous domains. The overall emphasis was on having places (digital and physical where students can connect) and making sure that their engagement is valued alongside their academic pursuits. Participants emphasized the following:

• Need a central wellbeing web page to create a comprehensive centralized list of programs and activities offered at the university and track participation. Could list all activities and include social media information as a way for students to digitally connect.
• Emphasize connections and community – connect students to each other, to faculty, groups, services, volunteer, and extracurricular opportunities. Host community kitchen events, aspirational dinners, groups that promote healthy activities. Shift evaluation so that these kinds of engagement activities are also valued.
• Train staff, faculty, and TAs so that connections can be fostered in the classroom.
• Create physical spaces on campus where people can gather and connect.

A4. National Health Survey Data Summary

In 2013, 32 post-secondary institutions across Canada conducted the National College Health Assessment. A sample of findings is below:

Diagnosed conditions:
% students reported being diagnosed or treated by health professional within the past 12 months:

Alcohol and Drug Use:
% students self-reported the following:

Academic Impacts:
% students reported the following impacted their academic performance within the past 12 months:

Note: There is collinearity between these factors. For example stress can directly impact the other three.

% students reported the following within the past 30 days:

% students felt it was “traumatic” or “difficult to handle the following within the past 12 months:

% students who felt their level of stress within the past 12 months was:

A5. Ideas Cafés Questions and Findings

Café #1 – held on November 8  – Focused on Domains 1 and 5

Question 1: What are the characteristics of a healthy learning environment that supports student wellbeing and intellectual rigour?

• Encourage community over isolation.
• Promote peer, faculty, mentor relationships.
• Empower students and give them the tools they need to promote health and wellness.
• Incorporate self-care practices into the curriculum. (Address unprotected sex, drug use (opioid crisis), depression, anxiety.)
• Reduce stress and promote health.
• More available healthy snacks.
• Universal break once a day so that students can connect with people reliably and have more opportunities for collaboration.
• Fall reading week.
• Weekend shuttle bus.
• Pace out exams better.

Question 2: How can Concordia’s physical spaces promote accessibility and be designed for wellbeing?

• Design spaces that are welcoming. Promote diversity and accessibility.
• Support the health and wellness of staff and faculty.
• Create and promote an accessible way for students and faculty to access health and wellness information.

Café #2 – held on November 14 - Focused on Domains 2 and 3

Question 1: What services and supports are key for student health and wellbeing?

• Create an accessible way for students and faculty to know about the services that are available.
• Establish a culture of health and wellbeing.
• Take care of both students and faculty.
• Train faculty for how to engage with students who need support and promote wellness in the classroom.
• Peer to peer support for both staff and students.
• Student ambassadors.

Question 2: What policies and procedures best favour student health and wellbeing?

Policies and procedures that reduce stress and allow for flexibility.

• Reduce exam period stress by adjusting scheduling or changing expectations.
• Universal breaks so that students are encouraged to explore the services offered on campus and make use of the ones they believe would suit their needs.
• Make policies and procedures less restrictive and inaccessible.
• Train faculty and students on self-care and promoting wellness.
• Make wellbeing a part of Concordia’s strategic direction.

Question 3: If you had a magic wand, and could create one thing to positively impact student health and wellbeing, what might you create?

• Normalize wellness and asking for help. Build a community of care and a culture of wellness.
• Establish a feeling of ‘home,’ security and wellness.
• Promote wellbeing beyond academics.
• Encourage empathy and compassion as values. Promote self-care and taking care of each other.
• Physical spaces where students can meet, connect, collaborate.

Café #3 – held on November 23 - Focused on domains 4 and 6

Question 1: What opportunities for personal development can nurture a student’s holistic growth and wellbeing?

• Encourage community and challenge isolation.
• Mentorships and peer to peer networks.
• Social media.
• Opportunities for experiential learning
• Engagement with the world builds a sense of optimism and hope.
• Promote abroad (Canada has much less than peer countries).
• Student-run forum for addressing issues.
• Promoting happiness, engagement and care. Being a caring institute.
• More acknowledgement for services already offered.
• Provide more front line and preventative services.
• Experiment with other forms of evaluation and assessment to decrease competitive atmosphere.
• Improve information accessibility.
• Need centralized location where all information is available and to promote it.
• Use social media.
• Inform staff and faculty about what is available.

Question 2: What kind of connections to campus can best sustain a sense of belonging and wellbeing?

• Communication and connection.
• Have a constant contact (advisor, faculty, staff) for each student.
• Mentorships, student ambassadors, peer to peer relationships.
• Encourage extra-curricular and community activities.
• Reach out to students who don’t come to events.
• Institutional responsibility.
• Create spaces where students feel welcome to spend time around campus.
• Incorporate events, programs, resources into the structure of the institution.
• Better access to non-academic resources.
• Promote connections between faculties.
• Encourage and train faculty to prioritize students’ welfare.
• Promote connection and wellness as the culture of Concordia.
• Inter-disciplinary spaces to host various connecting activities open to everyone.
• Art hives/tech sandboxes. Places where people can connect while tending to their own wellbeing.
• Reach out to people who feel “lost in the crowd.”
• Create accessible physical spaces to encourage connection and communication.

Question 3: If you had a magic wand, and could create one thing to positively impact student health and wellbeing, what might you create?

• Reduce competitive academic attitude.
• Make education with, not for, students. Focus on student interests.
• Promote practicum opportunities and extra-curricular activities.
• Have a universal break time each day.
• Encourage faculty to consider students’ wellbeing, while also finding a way to reduce stress and care for faculty.
• Reconsider evaluation practices and promote learning without grade value. No grade curve, eliminate class averages.
• Better bursaries and funding. Free tuition.

A6. Senate Priorities from Ideas Cafés

• A culture change is needed to include everyone collectively making a commitment to health and wellbeing of our students.
• Fall break (longer break around thanksgiving).
• More student engagement in planning health and wellbeing services. The idea of a student council to advise on programs was suggested.
• More recreation options available on campus.
• Importance of destigmatizing mental health so people will access the support and services they need.
• Staffing and support needed to support more programming and services to support health and wellbeing.
• Curriculum in health and lifestyle (either courses for academic credit or webinars  and online units that could be imbedded in course material. Health literacy for the community was highlighted.
• Need to improve processes to avoid the “Concordia Run around” for students and also to cut the red tape on processes.
• Need to work towards an environment free of harassment.
• Desire to have peaceful spaces.
• Need to learn more about services offered to support student health and wellbeing. ("We need a system to better connect with each other on campus.")
• Cyber networks, social media and phone free spaces were all mentioned. The senate discussed correlations between anxiety and digital networks.
• Lifelong learning and the opportunity to build skills to transition out of university is needed.
• Look at the policies we have to support health and wellbeing (for example: medical notes when a student is ill and testing during the week before final exams).

A7. Keeling & Associates Literature Review Findings Summary

Promoting Healthy Classrooms and a Healthy Exam Culture

K&A’s findings suggested training for faculty, so that they can be better equipped to understand students’ needs and demonstrate their empathy in the classroom. They also proposed embedding more counsellors (such as social work professionals or peer counsellors) throughout the university to provide more resources for students.

Substance (mis)use

K&A state that banning alcohol or drug use has not been an effective strategy overall, neither has purely educational approaches to reducing use. The most effective approach is use of multiple methods and having ways of encouraging recovery for students who have had difficulty with drug and alcohol use. Peer participation in prevention and recovery has been shown to work at other universities.

Responding to Students in crisis

K&A’s findings suggest training for employees who come in most contact with students (faculty, staff, administrators, peers, and especially medical and mental health providers) to prevent crises. Crisis hotlines, peer support programs, suicide education, increased training of healthcare personnel, increased social connections for students, and gatekeeper training have all been useful practices in crisis prevention.

Health and Wellbeing among on-campus  residence populations

Without creating full-time dedicated medical services for students in residence, K&A suggest peer, faculty, or self-identification of difficulties as well as more thorough empathy training for all these people. However, Counsellor in Residence (CIR) programs that place professional counsellors in residence halls seem to be the most successful practices.

Student health and wellbeing of indigenous populations

K&A’s findings suggest that the community and cultural identity of indigenous populations must be considered in order to develop holistic approaches to best serve indigenous students. Student clubs, elder counselling programs, indigenous advisors, transition programs, and the creation of resources for indigenous students on campus are all recommended practices.

Health and wellbeing for international student populations

K&A recommends training front line staff to support international students with mental health challenges, establishing group counselling for international students, hiring diverse counsellors, and developing peer education programs, including “buddy  systems.” These resources need to be easily  accessible and destigmatized.

Supporting non-health service points 

K&A recommends providing gatekeeper training to people who work at non-health service points so that they can successfully identify and respond to students with mental health concerns. “Early Alert” systems, established protocol for nonhealth personnel interventions, and training of people across campus are all useful practices.

Encourage practices in preventative health

For successful preventative health practices, K&A proposes a public health orientation, university-wide health education in lifestyles/diet/social media habits, the accessibility of preventative health information, student organizations focused around campus health, an office for health promotion, toolkits for managing a student lifestyle, mindful practices/spaces, and an available sex health educator. Their findings suggest that these practices are most helpful when tailored around the different needs of students.

What is the average provider: student ratio of Health and Wellness services across Canada and the United States?

K&A’s findings suggest that there is no widely accepted best practice or recommended ratio of disability/accessibility services professionals to students. In the field of counselling, the International Association of Counselling Services recommends 1 FTE mental health professional per 1,000 – 1,500 FTE students. In Health Services, a physician to student ratio of 1:2,500 tends to serve most Canadian and American campuses.

A8. Keeling & Associates Trend Analysis (2015-2016)

Physical Health

• Student self-reports of their health are declining. US scores slightly higher than Canada.
• Sleep health: An increasing number of students are not sleeping enough. Family support and school climate improve sleep behaviour.
• Healthy eating, weight, and nutrition: Many students do not eat properly. Concordia should be prepared for body insecurity issues in students. Youth obesity rates remain unchanged. Low income houses struggle to receive healthy foods. But Concordia does rank higher than other Canadian and US schools for consumption of fruits and vegetables.
• Physical activity and recreation: Sedentary behaviours have increased and low levels of physical activity impact sleep, nutrition, social relationships, mental health and wellbeing.
• Injury: Many injuries come from physical activity.
• Sexual health: STI rates have increased in Canada. The overwhelming majority of Canadian youth use contraception. Concordia students reported the highest rates of experiencing verbal threats but the lowest levels of sexual touching or penetration without consent.

Mental Health and Wellness

• Mental health: There has been an increase of students coming to post-secondary institutions with previously diagnosed mental illnesses. Diagnoses start earlier and have also increased. According to an Ontario study, the rates of anxiety, depression, and suicidal thoughts have increased recently. Concordia should expect this as a continuing challenge and to provide mental health care. In 2013 and 2016, Concordia students reported that finances, career-related issues, and intimate relationships were traumatic or difficult to handle more frequently than Canadian or US students.
• Suicide and self-harm: The number of hospitalizations for intentional self-harm has increased by 102% since 2010. This is one of the leading causes of death for school-age (10-19) children and adolescents in Canada. These students will soon enter university
• Alcohol and substance use: In 2013, more Concordia students reported use of alcohol in the past 10-29 days than the Canadian and US averages. Concordia students are less likely to drink and drive. Non-consensual sex while drinking is a problem that Concordia students report more frequently (2.1%).
• Spiritual health: The importance of spiritual health for students decreases with age. Students rate connections to self and connections to others as most important.

Social Health

• School or campus climate: Being welcomed is an important measure related to both emotional health and social wellbeing. Students’ sense of feeling accepted declines over time. Among schoolage youth, bullying is a growing concern in Canada, especially with cyberbullying among girls. Sexual harassment increases with age. Girls report being victimized more than boys.
• Cyberactivity: Reliance on mobile devices and computers is a growing public health concern in Canada. Evidence exists for an association between screen time and body mass index.

A9. Action Plan

A10. Documents and Articles consulted as Part of Review

Concordia Documents

• “How to Effectively Set, Achieve and Maintain Health Goals.” 

External Documents

• Beaulieu, Teresa. “Exploring Indigenous and Western Therapeutic Integration: Perspectives and Experiences of Indigenous Elders.” Thesis. 
• “Building Social Connections” – Clemson University 
• “Canadian Health Promoting Universities and Colleges Network.” Okanagan Charter. 
• “Enhancing Student Engagement and Social Connections at California State University, Fullerton” 
• “Enhancing Student Wellbeing” – resources for university educators. 
• “Guidelines on Student Mental Health Policies and Procedures for Higher Education.” Centre for Innovation in Campus Mental Health.
• “How to make campus environments more inviting to students” – University Affairs 
• “Mental Wellbeing in the Classroom” from Ryerson University’s Learning and Teaching Office
• “Principles for Enhancing Well-being through Physical Spaces at SFU.” Simon Fraser University. 
• “Project identifies teaching practices that promote student wellbeing.” University of British Columbia
• Ramsdell, Dustin. “Using Podcasts to Increase College Student Engagement.” 
• “Relationships and Social Connections” – NYU 
• Schreiner, Laurie A., Eileen Hulme, Roderick Hetzel, and Shane J. Lopex. Positive Psychology on Campus. The Oxford Handbook of Positive Psychology (2 ed.), July 2009. 
• “Teaching Practices that Promote Student Wellbeing” from UBC Wellbeing
• “The Engelhard Project: Voice from a Decade of Connecting Life and Learning.” GeorgeTown.
• The Importance of Social Connection in College” – NorthBridge College Success Program.
• “ThriveRU” – Ryserson University 
• “What is a Healthy Campus Community?” Simon Fraser University Student Services. 

Media Articles

• “Simon Fraser University: Making Connection to Well-Being in Learning Environments.” Bringing Theory to Practice.