Professionally Growing up in CCMH: An Insider’s Perspective
CCMH now comprises over 625 counseling centers, and continues to grow and adapt every year to new challenges and demands by using clinically relevant research. The data gathered are immense in scope and impact, and we are also constantly trying to create practical and actionable meaning to change the field of counseling. A natural question might be: who is the “we” in CCMH, and how do “we” actually “complete” projects with the data collected?
To that end, let’s start with an introduction. My name is Henry Xiao, and I’m currently a post-doctoral fellow at Penn State’s counseling center serving as a Staff Psychologist. I’ve had the wonderful experience of working with CCMH for the past nine years. I started and maintained a graduate assistantship with CCMH throughout my Clinical Psychology program at Penn State, and have quite frankly been blown away by its exponential growth, especially in the past few years. Two anecdotes for illustration: 1) when I started with CCMH, it was a major achievement and celebration to hit 200 centers, and 2) midway through my research work, I had to learn a new statistical program because the original program was taking literal hours to complete simple descriptive analyses; the data had simply grown too large.
For the past three years, I’ve transitioned from a purely research and data oriented role with CCMH to serving more as a clinical “liaison” as a CAPS Staff member with a research focus. One of the more remarkable and eye-opening experiences I’ve had during this transition has been the in vivo clinical use of instruments like the CCAPS, SDS, and CLICC, a stark departure from only working with the numbers in raw aggregate data. Now that my many years of research work have been directly impacting and shaping my clinical work on a daily basis, I find myself better understanding the importance of the CCMH tagline, “Bringing Science and Practice Together”.
I’d like to shed some light on some of the “behind the scenes” work that CCMH does, in a Q&A fashion. I’m hopeful I can provide some information that could further guide research ideas by increasing understanding of how the research at CCMH actually happens. And also, so that we all get to know each other a bit better. College counseling is challenging, especially in the socially distant past year. I believe connection fuels growth, and my hope is that this post drives more independent interest and curiosity about how we can all contribute to the growth of CCMH.
Full disclosure, I love CCMH and its mission. I believe that CCMH is the best source of information and research for college counseling norms, trends, standards, and best practices, and it becomes increasingly clear that the work we do impacts many, and that there are numerous great questions and ideas from members that could be further explored through CCMH’s vast research potential.
Q: How is CCMH structured?
A: CCMH Executive Director Ben Locke describes CCMH as having four pillars. Being more immersed in the clinical side of CCMH in recent years has given me an appreciation of how those four pillars provide an integrated structure for the whole operation.
The first and most important pillar of CCMH is its membership. As big as CCMH feels at times, it is only made possible by its constituents. CCMH, at its core, is a grassroots member-driven practice research network that advocates and works on behalf of counseling centers. One of the most humbling realizations I’ve had as I’ve clinically worked using CCMH tools has been a recognition that my clinical work is now actively a part of, and contributing to, a nationwide effort to better understand and improve mental health services everywhere.
Next, the Business/Research Team can be thought of as the hub for the initiation and processing of actual research data. It comprises all of the core members of the CCMH team, including its researchers and staff, and also includes participation by some Penn State Counseling Center staff. Conversations typically involve exploring feasibility of projects and exploring new themes of CCMH research.
The CCMH Staff Team is the third pillar, and is responsible for the numerous operations that keep CCMH running. As in any organization, there are many logistical pieces to track in CCMH, and this team ensures that membership is tracked and that members are able to access CCMH’s many resources
Finally, the Advisory Board is a way for particularly motivated and interested staff from CCMH member counseling centers to more regularly and actively advise and participate in CCMH decision-making. To maintain a finger on the pulse on the array of college counseling experiences nationally, CCMH aims for representation of a wide diversity of centers. Members of this team serve a three-year term, meeting monthly to review and provide input on key aspects of CCMH’s processes and initiatives.
Q: Who is the “we” that makes up the different CCMH teams?
A: All the research conducted through CCMH typically comes from a small group of researchers, typically a group of 8 to 10 individuals. They are often housed in Penn State’s graduate programs in psychology, and spend substantial time learning up-to-date advanced statistical methods to meaningfully analyze the data. They present on, write about, think, eat, drink, and dream research methodology and clinically impactful research ideas, and collaborate internationally with some of the most impactful researchers in the world. It helps that the vast majority of students have come from the labs of Drs. Louis Castonguay and Jeffrey Hayes, both seminal researchers in psychotherapy process research and active guiding forces on CCMH’s Business Team. Of course, Drs. Ben Locke and Brett Scofield also continue to steer the CCMH ship, and their leadership has enabled its amazing growth.
I’d like to give a particular acknowledgment to Rebecca Janis, the current Research Data Analyst of CCMH who has used data visualization to enable clear and impactful dissemination of complicated data. I’ve known her for many years, and she is a wonderful colleague and honestly, just quite wonderfully obsessed with learning and applying new visualization techniques, to CCMH’s great benefit.
The other current researchers, Fanghui Zhao, Dever Carney, Ryan Kilcullen, Natalie Pottschmidt, and Katie Davis, all have different areas of expertise, and are wonderful colleagues and contributors as well; CCMH has always been a site where collaboration enables richness of research.
And finally, Alaina Cummins as the CCMH Research Project Manager, and Jodi Williams as the Administrative Assistant provide an indispensable fingerprint on the Business/Research Teams by documenting, tracking, and creating realistic timelines for our projects.
Q: What do the data actually look like?
A: It’s immense. Every year through the annual report, we report on numbers of unique clients and centers, and that all translates to nearly 1.5 million lines of data every year. It typically is analyzed in a “long format”, allowing clients in the data to occupy as many lines as they’ve had appointments. Part of what makes all of this work is the standardization of the forms within CCMH, including the CCAPS and SDS. There’s almost 400 variables in the data, including string variables. Of note, this past year, CCMH has surpassed a combined total of one million clients; that’s a lot of clients served over the past decade!
Q: What are some difficulties in using the data?
A: I think one of the biggest difficulties in conducting research within CCMH involves operationalization of constructs. There are plenty of questions to be explored within the data, and how those studies are developed requires a nuanced understanding of the research data alongside clinical practice. A fair amount of the difficulty actually comes from the differential use of the CCMH data forms across its membership, with centers ranging from administration of the CCAPS at every session, to only once per client. In the same vein, not all centers use all the existing Data Forms; the Termination Form and CLICC come to mind.
Then there’s the question of how to actually use the data. To illustrate the complicated nature of these decisions, one can simply imagine trying to study which clients “get better”. The operationalization of this suddenly becomes very amorphous. Do we measure using only change on the Distress Index Subscale? What about change on the client’s highest subscale score? How are multiple elevated subscales handled? How much does the number of sessions attended matter? If a client returns for multiple rounds of therapy, which one do we choose? How do we account for inconsistently spaced CCAPS? And so forth.
This data-cleaning process is in essence the trimming down of clients to best represent and shed light on any given research question, and is a tricky balancing act: how do we best combine existing variables to examine a population, while also maintaining the integrity of and not “cherry-picking” our data? Each decision in the data-cleaning process is an attempt to most accurately reflect clinical reality, and this may not match every center’s daily operations, which is why we are also becoming more interested in center level variables, like the Clinical Load Index (CLI).
Q: How do projects take on life?
A: There are many pathways to a completed project. CCMH is constantly discussing ideas and exploring clinically impactful questions. Aside from the core Business/Research Team, the CCMH Advisory Board helps provide invaluable feedback. Additionally, CCMH holds regular Research Meetings, inviting Penn State clinical staff to participate and contribute to research ideas to ensure that the research ideas are grounded with clinical roots. Brett Scofield likes to describe the CCMH Business/Research Team as a think tank, and I’m inclined to agree; projects are given life if and only if they have the potential to inform, shift, or advocate for clinical practice on a national scale.
Q: Anything else “behind-the-scenes”?
A: I want to also just extend gratitude to Alaina Cummins, Research Project Manager, and Jodi Williams, Administrative Assistant. It seems impossible, but these two help manage and keep track of all the data and operational aspects of a 625+ counseling centers. While it is easy to focus on the research projects and data form developments that CCMH team is continuously working on, this is only made possible with a strong foundation of managing memberships, keeping track of research ideas and progress, IRBs, CCMH member surveys, and other “behind-the-scenes” work that Alaina and Jodi tirelessly complete.
Along these lines, I think it’s also important to voice that change can be difficult. Any change can potentially impact all CCMH centers, and decisions for changes are not made lightly. As mentioned previously, there are several teams trying to balance feasibility with clinical practice.
Q: How can I help CCMH?
A: Simply being part of this practice-research network fosters its growth; thank you for your support and membership! Contributing data, through completion of the membership renewal process and/or contribution of clinical data depending on the electronic medical record being used, is a way to ensure that your center’s information is a part of CCMH’s continued efforts towards improving counseling center services, including our recent work on the CLI and research on center utilization and self-advocacy.
There are also two more specific ways to help current CCMH initiatives.
- First, taking time to complete the CLI capacity tracking forms, which improves the ability of centers to understand their staffing levels and allows centers to more easily provide CLI data to CCMH. In my time with CCMH, I have come to appreciate more the difficult and sometimes seemingly impossible decisions that a center must make in terms of provision of service to their student population. Learning more about client outcomes is extremely important, and I would argue that understanding therapist/center level variables are equally essential. In the same way that research on a specific student population helps us provide better treatment to students, research on therapists, staff, and center level characteristics helps provide an understanding of the context in which the treatment can occur most effectively. Your decision to provide that information accurately to CCMH is invaluable for future self-advocacy efforts. For example, these data could help us better answer the question of how we make center-wide decisions as to how services are delivered.
- Secondly, it is helpful to review the frequency with which the CCAPS is administered to students. The CCAPS and the feedback provided on the profile report were designed and calculated based on use at every session. We understand that centers vary in their use and want to pass along that administration at every session gives clinicians the best recurrent information on client change and areas of concern, all while also providing the best form of data towards understanding client change on a national scale.
Finally, if you find yourself having feedback or questions, you can send them in to [email protected]; feedback is always appreciated. Additionally, the Advisory Board cycles and interviews for new members every year (members rotate through and serve for three years). If you are wanting a more hands on and involved presence in CCMH, this could be a great option!
Thank you for your time and attention! I hope that this was helpful in shedding some light on who makes up CCMH, and how the research is conducted. If this blog was helpful to you, or if you had any additional thoughts for the future of CCMH, we would love to hear from you! We hope that CCMH and its tools have been useful for your center’s practice, and look forward to seeing this national partnership continue to grow!