Health Services Annual Report 2022-23 Prepared by David M. Worley MD

Executive Summary:

The combination of medical, counseling and health education serving a united mission, under one roof, embodies our philosophy of well-being. To support our collaborative work, we participate in monthly all staff, section and cross sectional meetings to stay abreast of what programs and services our colleagues are offering within Health Services, on campus and in the community so that we can refer students as needed and optimize service availability.

UMD Health Services used a combination of on-site and remote service delivery to meet the needs of students during the 2022-23 academic year. Medical staff and students continued to find benefit with individualized education and assessment available via phone visits so this modality remained effective and well utilized. The RN Covid Coordinator position ended in June 2022. Thankfully, Covid activity decreased during the 22-23 academic year compared with the previous two years. Health Services staff were able to meet the demand for assessment and treatment of Covid patients while also meeting the increasing demand for primary care medical services. Counseling and Health Education staff provided programming and services through remote and in person modalities as the clinic continued to transition back to more in person services.

Impact of Covid-19 on unit’s operations:

All individuals entering HS, including staff, were screened for Covid symptoms or exposure. A separate entrance and waiting area for students presenting with Covid symptoms remained in use to reduce the rate of disease transmission and exposure. These strategies along with the use of appropriate PPE resulted in zero occupational related Covid infections among HS staff for 2022-23. Our medical staff provided Covid PCR and antigen testing, assessment, treatment and guidance for students living on campus as well as off campus. Health Services Medical Director maintained regular contact with county and state departments of health, public health officials from the University of Minnesota system as well as infectious disease specialists from the local hospital systems to stay abreast of Covid-19 disease activity, emerging developments, and treatments.

HS performed 150 PCR Covid tests on UMD students between late August 2022 and early May 2023. This was a significant decline compared with the 2021-22 academic year (1,065 PCR Covid tests) but reflective of the larger role which at-home antigen testing played as the pandemic entered its final phases. These PCR tests provided results for Covid, Influenza and RSV in 90 minutes or less. Based on the rapid turnaround time for test results, HS medical staff were able to make decisions in real time for those students potentially needing isolation. In addition, free rapid antigen tests provided by system funds were available for students at Health Services as well as Housing and Residential Life. These antigen tests were instrumental in helping HS to focus its PCR testing on students with symptoms and a negative antigen test.

On May 8th, 2023, after careful consultation with Boynton Health Services, St. Luke’s Infectious Disease and CDC/MDH guidelines, Health Services was able to move to an optional masking policy for staff and patients with limited exceptions. HS was the last unit on campus to end its mandatory masking policy but this policy may return if Covid disease activity increases in the future. Staff and patient responses have been overwhelmingly positive with no adverse consequences encountered thus far.

MPox:

Working with Boynton Health Services, St. Luke’s Infectious Disease and MDH/SLCPH, UMD Health Services provided education to its medical staff on the assessment, diagnosis, treatment and PPE needed to evaluate patients for Mpox, a viral infection spread through close physical contact. This included equipping HS’ lab to collect and send specimens for testing/analysis.

In September, October and March, HS collaborated with St. Louis County Public Health (SLCPH) and ODI to provide free Mpox vaccinations for students, staff, and faculty as well as community members. These on campus clinics reached over 100 individuals.

Counseling and Health Education Highlights:

Counseling and Health Education staff worked both remotely and on-site for 2022-23 using secure University purchased laptops for remote work while continuing to meet the expectations for their respective sections despite staff vacancies. The Counseling section tracked utilization of virtual (1,482) and in-person visits (1,510) throughout the academic year using its EMR system, Titanium. These numbers represent a significant shift back toward in person services compared with 21-22. An executive functioning group started in 21-22 continued in 22-23 under the guidance of Jim Shreffler, PsyD. Arrangements were also finalized in 22-23 for Sara Cedars, MSW, LICSW to become the facilitator of the Grief Group on campus.

Collaboration and data driven programming remain the backbone of the Health Education department. Lauretta Perry served on the MPACT 25 Wellbeing committee created to address student stress and sleep. Part of this service included working with the Student Association to obtain feedback on proposed policy changes related to homework and sleep.

Health Education remained committed to maintaining campus and community relationships, returning to in-person risk reduction programming focused on alcohol, cannabis and sexual misconduct for UMD Seminar, Health/Wellness 1100 classes at UMD and at Harbor City and Marshall High Schools. In addition, biannual meetings were held with Lake Superior College and College of St. Scholastica Health Educators.

Lauretta presented at the NCAA conference for Athletic Trainers in June 2023 on prevention strategies and communication tips for conducting difficult conversations related to sex, drugs and alcohol. She also received The Most Influential or Supportive Academic Community Member Award by UMD Athletics for her work with athletes, coaches, athletic trainers and other department staff in discussing consent, bystander intervention, alcohol, cannabis and team culture.

Audit:

Following Health Services AAAHC successful re-accreditation survey in April of 2021 the unit participated in its scheduled 7-year internal audit. The audit finished in April of 2022 and was extensive in its scope covering IT security, financials, governance, and organizational structure among other areas. HS created an Action Response Plan to address essential and significant audit findings and submitted that plan to Audit in May 2022. The timeline for resolution of all essential issues identified was July 2023. HS has worked diligently with Internal Audit as well as ITSS, HST, HIPCO and other partners to complete its Action Response Plan. HS will complete all of the audit’s essential findings by December 31st, 2023. This has been an immense undertaking. There is concern moving forward about the additional workload placed on HS staff to fulfill these ongoing, audit-mandated responsibilities.

Staffing:

The retirement incentive option (RIO) offered by the university in August of 2020 coupled with planned retirements and resignations, left Health Services with multiple staff vacancies throughout the 22-23 academic year. One staff position remained open within counseling after the resignation of a mental health therapist in September 2021 and a failed search to fill that position in summer 2022. Additional open positions remain, including Health Educator and Medical Assistant.

Health Services staff also participated in a half day, facilitated retreat in March focusing on unit gains and losses during the Covid pandemic.

Goal 2 Highlights:

To continue our collective and individual education on Goal 2, HS held monthly in-services for all staff to attend via Zoom. Topics covered in these presentations included Autism Spectrum Disorders, Domestic Violence and Safe Haven services, Human Trafficking, The Lake Superior Community Health Clinic and UMD’s Communication Science Programs and Services

In addition, Toni Anderson and Sara Cedars participated in the Student Life Unit Change Team, a group made up of Student Life staff who meet regularly to discuss innovative ways to implement Goal 2 into the daily work of Student Life units and staff. Julie Kim was a subject advisor for the Commission on Equity, Race and Ethnicity and Susan Rhoads continued her participation on the Commission on Disabilities.

HS staff were also encouraged to attend one or more topic presentations at the Diversity Summit this year and this was once again well received and utilized by HS staff. Julie Kim presented a workshop “What Does APIDA Mean To Me” with a group of UMD staff and students as part of the summit.

Finally, HS meetings continued to have regular time allotted to discuss Goal 2 initiatives or topics as part of each meeting’s agenda.

Financials:

The decline in enrollment continued into the 22-23 academic year and again adversely affected the actual disbursement (vs initial allocation) of SSF funding for Health Services. However, non-fee income was higher than budgeted resulting in a positive ending balance for the fiscal year. At the end of FY 22-23, total operational and capital reserve account balances were $1,436,209.

Department Mission:

To provide students the opportunity to develop healthy personal lifestyles, help ensure their retention at UMD and contribute to the overall excellence of their total educational experience. We will accomplish this mission by providing quality health care, counseling and education that focuses on the physical, emotional, social and intellectual wellbeing of students while being actively involved with all health issues that affect the University and community.

Department Vision:

The vision of Health Services focuses on the development of an inclusive health care model including medical, counseling and health education services which is collaborative in nature with campus and community partners. This concept is consistent with UMD’s Core Values of Engagement, Learning and Inclusiveness, Campus Goals 1,2,5 and 6 as well Division Goals 1,2,3,4 and 5.

Department Values:

Making A Difference

We value the importance of teaching and learning in the medical, mental health, business administrative, and health education interactions we have with students and staff.

Caring

We value providing compassionate, competent care for students and staff in a comfortable and welcoming environment.

Integrity

We value work and interactions with students and staff, which reflect transparency, genuine communication, a commitment to competent care, professional and personal accountability and ethical conduct.

Respect

We value and provide an inclusive, safe environment with acceptance of racial, ethnic and intersecting identities for students, staff and the Health Services team.

Relationships

We value creating and engaging in relationships with students and staff which are characterized by listening for understanding, expressing gratitude, mutual respect and whenever possible, face to face communication.

Department Goals:

Ensure that the HS facility provides an inclusive, educational and service oriented space, which supports students and staff.
Develop intentional collaborative relationships between HS, campus and community partners including health care organizations for the benefit of UMD students.
Develop and support an organizational culture, which facilitates professional and personal growth, best practices and the ideals of Goal 2.
Strive for optimal efficiency in developing accessible and high quality healthcare services while balancing the need for campus and community outreach programming.
Provide programming and services, which help students develop healthy, successful and sustainable lifestyles.
Practice responsible, transparent and accountable stewardship of fiscal, human and physical resources of UMD.

Unit Objectives and Assessment Results from 2022-23:

1. Satisfactorily complete all Essential items on the Audit Response Action Plan by 6/30/23

Maps to Department Goals of 3, 4, 5, and 6.
Assessment Strategy: Document completion with Internal Audit Team of Essential findings by stated date.
Status of Objective: Partially met. All Essential items with the exception of two items on the Audit Response Action Plan were completed by 6/30/23. The remaining two Essential items have an anticipated completion date of 9/30/23. Significant items are still in progress but Audit requires no specific timeline for these items to be completed.

2. Equip all staff who may work remotely with University issued laptop computers to ensure a secure working environment.

Maps to Department Goals of 4 and 6.
Assessment Strategy: Ascertain staff members with remote work potential and order laptop computers from UMD ITSS for those staff, equip those laptops with all University issued security and operating systems and distribute these laptops to staff by 8/15/22.
Status of Objective: Fully met. All staff with any remote work potential were equipped with laptops as specified above by 8/15/22. The HS Director wrote a policy regarding the use of University issued laptops for remote work in July 2022. The policy was distributed to all staff via email and is available on the S drive library of policies.

3. Complete an Inclusivity Scan of the HS building using the standardized checklist found on the Commission on Disabilities website. Address any issues identified by 6/30/23.

Maps to Department Goals of 1 and 3.
Assessment Strategy: Obtain a copy of the scan checklist and complete the assessment. For any issues that are not compliant, address these by the deadline noted. Submit finished work for certification with the Commission on Disabilities.
Status of Objective: Fully met. The inclusivity scan was completed in June 2022. It revealed the need for bariatric furniture in the counseling waiting area along with medical exam rooms. Furniture ordered in June 2023 and arrived later in the summer of 2023.

4. Complete eCW portal training for staff and develop processes for portal features.

Maps to Department Goal 4.
Assessment Strategy: Create written processes, train staff and document understanding by staff.
Status of Objective: Partially met. Some portal features were activated and some staff have completed training in using these features. Given the ongoing transition from pandemic focused care back to primary medical care services as well as completion of essential audit findings, staff resources did not allow for training all staff in use of eCW’s portal features. It is expected that during the 23-24 academic year, training will be completed for all staff and features of the portal will be available for students to use.

5. Develop an Action Plan to address one area of improvement noted on the most recent Employee Engagement Survey.

Maps to Department Goals of 1, 3 and 6.
Assessment Strategy: Management team will review unit results and select one item consistently rated by staff as an area needing improvement (My unit removes barriers to working effectively). PSC will gather input from unit sections on this topic and bring ideas forward to the All Staff meeting to discuss the final plan by spring 2023.
Status of Objective: Fully Met. Google Document created for all staff who have any remote work capacity, which lists the preferred method of contacting staff person if not in the office as well as guidelines for response (email, phone call and time expectations for response) to inquiry posed by staff working in the office.

6. Search for and hire a qualified mental health therapist by August 2022.

Maps to Department Goals of 1, 4, and 6.
Assessment Strategy: Assemble HS team to review applicant materials, interview applicants and hire a qualified applicant by fall 2022.
Status of Objective: Not met. Search process yielded several highly qualified applicants but no applicant was hired due to inability to offer a competitive salary for the position. A temporary position was approved using former HS staff who had retired. Search restarted in summer 2023 with updated and more competitive salary offering.

7. Install, train and utilize electronic signature pads for use of in-person registration

Maps to Department Goals 3 and 6.
Assessment Strategy: Electronic signature pads ordered and connected to each registration workstation. Train registration staff with documentation of training. Monitor use of signature pads compared to paper forms.
Status of Objective: Fully met. Signature pads ordered in July 2022, support staff trained 8/15/22 and signature pads used with no issues identified. Paper is no longer used.

8. Provide training to HS counseling staff to support their role as confidential resources for potential sexual misconduct/assault re spondents. Training consists of 1-2 one-hour sessions.

Maps To Department Goals 1, 3 and 4.
Assessment Strategy: Completion of training for counseling staff.
Status of Objective: Fully met. Health Ed staff provided a one-hour training on January 25, 2023.

9. Provide and promote a weekly executive functioning group (Get It Done) for students. Update the counseling website to include resources for all students in these skill areas.

Maps To Department Goals 2 and 5.
Assessment Strategy: Track weekly group meeting occurrence through Titanium. Completion of website updates fall semester to include information specific to the group and information about executive functioning.
Status of Objective: Fully met. This group met for 27 sessions between the dates of 9/8/22 and 4/27/23 with 99 student contacts during these sessions. The Health Services website was updated a number of times during the 22-23 academic year adding more information related to executive functioning challenges and skills to improve performance.

10. Promote and provide ongoing opportunities for discussion and exploration of equity, diversity and inclusion into regularly scheduled counseling section and counseling clinical meetings.

Maps to Department Goals 1 and 3.
Assessment Strategy: Time provided monthly in either the section or clinical counseling meetings for team members to lead a discussion on a specified topic. This will be measured through review of counseling meeting minutes (section/clinical).
Status of Objective: Fully met. Time was set aside in the CS Section meetings for different providers to sign up and share regarding various DEI topics.
Topics covered and documented in meeting minutes included:
Psychological and Social Psychology theories and ways that they intersect (currently and historically) with the ways that we view and treat clients in therapy.
Information about a multi day training in the Twin Cities about working with Latinex people. Information shared about culture, how it affects seeking help and culturally specific programming available in the Twin Cities.
Information shared about the APIDA collective that includes the campus and broader Duluth community.
Staff members shared information about the workshops they attended at the CERE Summit including key takeaways that influence our work.
Discussion about a workshop (video) through the Bakken Center “An Approach to Healing Intergenerational Trauma”
The history of TPAC in the twin ports and ways that the community is reaching out to support young people including college students at UMD.

11. Eighty percent of Medical section staff will attend a MDH sponsored training in October 2022 entitled “CUES Intimate Partner Violence Screening Training for Campus Healthcare Providers”. Use this information to develop a screening tool for sexual violence and harassment, with implementation by January 2023.

Maps to Department Goals 2 and 3.
Assessment Strategy: Track the number of staff who attend the training. Develop and implement a screening tool for Intimate Partner Violence.
Status of Objective: Partially met: 7 of 9 medical staff (78%) attended the virtual training sponsored by MDH. No progress made on the development and implementation of a screening tool.

Unit Objectives for 2023-24

1. Objective: Prepare for and successfully attain re-accreditation status with AAAHC in September 2023.

Maps to Department Goals: 1, 2,3,4,5 and 6.
Assessment Strategy: Review application materials, AAAHC current standards and submit survey application. Hold annual HS review of policies and procedures in August 2023. Meet with AAAHC surveyor 9/28-29/23 for onsite survey.

2. Objective: Complete staff training for eCW portal and initiate access for patients of some features during 23-24 academic year.

Maps to Department Goals: 4
Assessment Strategy: Use previously written portal training processes to finish training all HS staff who use eCW and document training. Open some features of the portal for patient use during the 23-24 academic year.

3. Objective: Hire a new mental health therapist for 23-24 academic year.

Maps to Department Goals 1, 4, 5 and 6.
Assessment Strategy: Assemble HS team to review applicant materials, interview applicants and hire a qualified applicant by Fall 2023.

4. Objective: Counseling staff will expand their outreach to incoming students through participation in Bulldog Welcome Week Workshops the fall of 2023.

Maps to Department Goals 1, 2, and 5
Assessment Strategy: Counseling staff will work together to create and submit 1-2 workshop ideas to the planning committee. Select staff will work collaboratively to further develop, implement, and conduct approved workshop(s) in the fall of 2023.

5. Objective: Explore the option of expanding the Mental Health Advocates training program on the Duluth Campus.

Maps to Department Goals 1, 2, 3, 4, and 5
Assessment Strategy Counseling director will work with Kate Elwell (Boynton) and Jeanne Williamson (UM Morris) to update faculty/staff training modules to be UMD specific during the 2023-24 academic year. A decision will be made about a launch to faculty and staff the following year.

6. Objective: Hire a new Medical Assistant for 23-24 academic year.

Maps to Department Goals: 1, 4, 5 and 6.
Assessment Strategy: Assemble HS team to review applicant materials, interview applicants and hire a qualified applicant by Fall 2023.

7. Objective: Design and Implement an electronic 2023-cannabis survey to include timely questions related to state legalization of recreational cannabis. The survey will be designed in Qualtrics and will be administered to approximately 3,000 UMD students.

Maps To Department Goals: 5
Assessment Strategy: Survey administered. Share data findings from the 2023 cannabis survey with relevant stakeholders (Alcohol/Drug Advisory committee and UMD Seminar class presentations). Data shared at ADAC meeting and embedded in curriculum for Risk Reduction presentations offered to UMD Seminar classes.

8. Objective: Set a timeline for a new building feasibility study and secure the cost internally using capital reserves.

Maps to Department Goals: 1, 4, and 6.
Assessment Strategy: Work with VC SL, Director of SL Auxiliary Services, FM and CPM office to set a timeline for a feasibility study for a new HS building and complete Capital Need ID Form fall 2023. .

9. Objective: Implement Universal Hepatitis B Screening QI project based on 2023 CDC recommendations.

Maps to Department Goals: 1, 3 and 4.
Assessment Strategy: Educate medical staff on new Hep B screening guidelines using a formal presentation done by Dr. Jenna Clappier. Add pertinent information regarding screening to the HS webpage and make Hep B screening materials available to students in the building. Choose visit codes for which screening will be offered and track compliance following AAAHC QI program standards.