Task Force on Health and Well Being: Progress Report

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Task Force on Health and Well Being: Progress Report

April 2004

In January 2004, the Task Force on Health and Well Being issued a report that described its progress over its first four months of work. In that report, we proposed a set of principles that might guide the University in its consideration of issues related to health and well being; presented background information and some initial findings and recommendations; identified a number of major needs and challenges; and outlined a work plan for the spring. This report presents additional findings and recommendations and identifies work that the task force will do over the summer to refine its proposals and look carefully at costs, priorities, potential sources of funding, and staffing and space implications in preparation for a final report next fall.

Topics covered in the January report included University Health Services (UHS), the Student Health Plan (SHP), the employee benefits program, work-life issues, child care, and issues of particular concern to undergraduates, graduate students, post-doctoral fellows, faculty, staff, and retirees. This report will not repeat the material provided in the January report, but it does build on that report and interested readers are encouraged to refer to it. It can be found, along with this report, on the task force website at

Like the January report, this one does not attempt to be all-encompassing. One of the lessons we have learned is that there are very few University policies, services, or actions that do not in one way or another have an impact on the health and well being of members of this community. We also have learned that almost every member of the community has ideas about how the health and well being of particular individuals—or of the community as a whole—could be improved. There are a number of topics that we believe are worth further consideration and attention, but that we will not address in this report.

In some cases this is because the topic falls outside our purview or is already being addressed by others. One good example is the provision of additional,affordable, and accessible housing for graduate students and post-docs, as well as for faculty and staff. We are persuaded that the availability of sufficient affordable and accessible housingplays a significant role in the health and well being of members of our community who want to live close to campus but whose financial circumstances make it difficult for them to find such housing. The University has identified the provision of additional housing as a priority and is already developing plans to more fully meet these needs, and it has instituted several shuttle systems that connect University housing (as well as faculty/staff parking locations) to the main campus.

Other good examples are programs and strategies to address issues related to the abuse and excessive use of alcohol by undergraduates and issues related to sexual harassment and assault. These areas are being addressed by several offices and initiatives, and the task force believes that they deserve continuing and high priority attention. Similarly, the University has made significant progress in recent years in addressing issues related to the wage levels of lower paid members of the staff. Here too we believe that continuing vigilance is necessary to be sure that the University is treating all members of the community fairly and with respect.

Some of the topics that we will not address in this report will appear in our final report. One example is recommendations regarding retirees. Other topics may not be addressed in our reports, but they have received our attention, and in some cases have been referred to others who are in a better position to pursue them. One overarching recommendation that we will not repeat in each section below but that has pervaded all of our discussions involves the importance of better communicationso all members of our community are aware of the programs and benefits that are available to them; so they know how to take full advantage of them; and so there can be greater synergy in addressing issues that cross office or departmental boundaries (through collaboration, for example, between University Health Services and the fitness and wellness programs at Dillon Gym, or between UHS and the residential colleges and eating clubs). One recommendation that was made to us on several occasions is that the University make an even greater effort to inform incoming students and their parents of the health, wellness, and fitness services available to students and that the residential colleges and resident advisers make even greater efforts to reinforce this message early in the fall term. We are still developing a recommendation for a work-life office that could provide faculty and staff with information about a broad range of University and community services and programs that could help them achieve a better balance between family and work. Ithas also been suggested that the University reinforce messages about health and well being whenever possible through the home page and other means of communication.

This report begins with a brief review of our activities over these past three months. We then present recommendations in the following areas:

The Provision of Health and Wellness Services: University Health Services (5-9)

The Student Health Plan (9-12)

The Provision of Fitness and Recreation Services: Dillon Gym (12-15)

The Integration of Health, Wellness, and Fitness Services (15-16)

Nutrition (16-18)

Faculty/Staff Issues (18-21)

Post-Docs (21-22)

Child Care (22-23)

In a concluding section we outline our plans for the summer as we move toward a final report next fall.

Recent Activities

Focus Groups

The most ambitious undertaking of the task force this spring has been focus group discussions with undergraduates, graduate students, post-docs, faculty, administrative staff, bi-weekly staff, and retirees. These focus groups were designed both to inform our deliberations and to shape a survey of all of these groups that is being distributed by the SurveyResearchCenter. The results of the survey will be available to us as we continue our work this summer.

At the risk of oversimplification, the undergraduate focus groups emphasized the importance of better communication about what is available at UHS and under the SHP; the importance of expanding and improving mental health services, dental care, and access to fitness facilities; and the importance of addressing issues related to stress reduction and nutrition. Undergraduates were interested in an integrated health-wellness-fitness center, especially if it served to encourage students to make a more significant commitment to healthier living patterns.

Major themes that emerged from the graduate student groups were the importance of adequate and affordable housing close to campus; concerns about some of the provisions of the student health plan and the cost for dependents; a desire to improve dining and nutrition; an interest in providing some decentralization in fitness/wellness programs (e.g., providing some programs at the Graduate College and incorporating some fitness facilities into graduate housing areas); and concerns about the status of post-enrolled graduate students.

In the focus groups with administrators and bi-weekly staff, major themes included a desire for respect and appreciation for what they do; for greater flexibility in hours of work and in uses of vacation time and sick leave; and for a stronger institutional message that it is acceptable, even desirable, to take time during the day for exercise or renewal. Stress was identified as the most pressing employee health issue. There was also considerable interest in expanding the health care plans to cover preventative care, including incentives for exhibiting healthy behaviors (exercising, smoking cessation, weight loss);in increasing staff access to Dillon through expanded hours and reduced fees; and in additional work/life services. Interest in an integrated wellness center was mixed with caution about too much centralization.

Faculty expressed concern about the needs of graduate students and post-docs; interest in a more creative flex-time program for staff that would better serve faculty needs; and support for greater efforts to educate the community about health care, wellness, and health insurance options. Faculty ranked parking as one of the most vexing quality of life concerns on campus.

Surveys

In addition to conducting its own survey among students, faculty, staff, and retirees on a range of health and well being issues, the task force recommended that the University contract with an outside company (Bright Horizons) to help it conduct a comprehensive child care needs assessment. Bright Horizons is one of the most highly regarded companies in the child care field, and it has a consulting division that has performed similar assessments for a number of our peer institutions (including Yale and Duke) and for several major New Jersey companies. As part of this assessment, Bright Horizons will be conducting a survey about child care needs and issues among faculty and staff, graduate students, and post-docs. We expect to receive its report over the summer. The task force conducted a user survey at Dillon Gym in late February to learn more about who uses Dillon and for what purposes.

Site Visit

A delegation of students and staff visited the University of California at Berkeley and Stanford in late January. Again at the risk of oversimplifying, the Berkeley visitallowed for inspection of a facility that does link health care and wellness programs; contracts with outside specialists for onsite visits at a lower cost than outside visits; offers a variety of screening programs for faculty and staff; has put together an extensive community network of work-life organizations; and has a standing work-life committee that meets regularly and identifies priority issues. With respect to child care, Berkeley provides 250 spaces for the children of students and 48 spaces for faculty and staff.

Stanford's work-life office includes 2.5 full time equivalents (FTEs), who devote about 70% of their time to child care, 20% to elder care, and 10% to other services. Stanford provides 565 on-campus day care spaces in 6 facilities. It also provides child care subsidies, up to $5,000 per family, that can be used anywhere, at a total cost of over $1 million a year. Stanford has a large health promotion staff dedicated to student health issues and 4 FTEs in their employee assistance program.The EAP program offers counseling, workshops, and support groups for drugs and alcohol, grief, anger management, skill building, racial issues, writing improvement, etc.The group found Stanford's health center, and the process by which it was planned,very appealing. The architect for the center, Curtis Snyder ’68 P’06, specializes in campus health facilities. While on campus for Alumni Day he met with several members of the task force and gave a presentation about his work.

Other Activities

Members of the task force discussed their initial report with the CPUC in February and have continued to receive comments through the task forcewebsite. They met with an outside expert on student health plans, who suggested that the University think about increasing the premiums for its SHP (which are significantly lower than our peer institutions) and use the additional revenues to improve mental health and prescription drug coverage (areas in which Princeton lags behind its peers) and to reduce fees for dependent coverage. He also suggested that we think about a model that other universities have adopted, under which UHS might purchase some percentage of time of local physicians to practice on campus as part of the overall UHS program. (This is a topic we plan to explore further over the summer.) Members of the task force also have met with providers of employee assistance programs and work-life services, and with an expert on prescription drug programs. At its February meeting, the task force reviewed the SHP and met with Stu Orefice, the director of Dining Services, to learn about initiatives under way in that department to provide nutritional information to students and to create healthier menus. At its March meeting, the task force reviewed programming at Dillon gym and devoted several hours to the initial preparation of this report.

Throughout the spring there has been clear evidence of community interest in the work of the task force. There seems to be wide recognition that both University Health Services (located at McCoshHealthCenter) and Dillon gym are straining at the seams, and that this will only increase when the University adds additional students. There is strong support not only for enhancing ourclinical programs (especially with respect to mental health), but for improving our fitness, wellness, prevention, and health education programs, expanding opportunities for healthy eating, improving the Student Health Plan, and significantly expanding access to child care.

The Provision of Health and Wellness Services: University Health Services

Our January report documented the significant, growing, and too-often unmet demands on UHS and on the McCoshHealthCenter that serves as its primary location. Our continuing review persuades us that UHS needs enhanced staffing in a number of critical clinical, administrative, and support positions to meet a demand for services that already is growing, and is likely to grow even more when the University begins to increase the size of the undergraduate student body in 2007. (At that time the University will also introduce four-year residential colleges, and we hope that the planning for those colleges will explore opportunities for UHS to provide additional health education, disease prevention, and wellness programs in the colleges.) Our recommendations below focus only on what we believe to be the University’s immediate and mid-term needs for medical, mental health, health education, and support services. They are consistent with other recommendations in recent years from the UHS’s outside advisory council and the Student Health Advisory Board.

We also recommend that UHS strongly consider providing some urgent primary care for faculty and staff at McCoshHealthCenter and provide a meaningful program of annual health screenings for faculty and staff (e.g., cancer prevention, diabetes, cardiovascular health screening, hypertension, etc.).

Mental Health Services

Like other colleges and universities, Princeton has seen a dramatic increase in recent years in the demand for mental health services by undergraduates and graduate students and in the severity of mental health conditions that need to be treated. This academic year alone, Princeton students have been hospitalized off campus 18 times for serious mental health disorders, andpsychiatry-related admissions to the UHS inpatient service, which increased by 111% between academic years 2001-02 and 2002-03, are up 43% this year. There is also a growing demand for a full range of mental health services: following a 33% growth over the past three years, individual therapy sessions are up by 15% this year in the Counseling and Psychological Services (CPS) unit at UHS; psychiatric consultations, which grew by 80% in the past three years and are being capped this year for budgetary reasons, are up an additional 8% this year; and the Crisis Team, a new service instituted this year, is unable to meet the daily demand for urgent evaluation appointments and at one point this spring the wait for an elective counseling appointment approached 30 days. UHS is currently providing onsite office space to two private practice psychiatrists in order to offer additional access to mental health services for Princeton students, but this is not sufficient to meet the demand. Benchmarking reveals that Princeton lags behind many of its sister institutions in employing salaried staff psychiatrists in their mental health units.

Recommendations for Mental Health Services

• Provide an emergency infusion of funding to provide more psychiatric consultation hours in the immediate short term. (Such funding has been approved by the provost for the remainder of this semester.)
• Create permanent, full time psychiatry positions within the CPS unit at UHS within the next 12 months.
• Increase CPS staff positions and duty time to provide additional emergency assessment, crisis intervention, substance abuse services, and group and individual therapy services as well as positions devoted to education, outreach, screening, and prevention related to depression, eating disorders, alcohol, and other drug and stress-related disorders.

Medical Services

The total number of outpatient encounters at UHS, which includes urgent care, scheduled appointments, and after hours care, has increased by 20% in the past three years, and demand for inpatient care services has increased as well. This year, urgent care encounters are up by 27%, after hour visits have increased by 54%, and inpatient admissions are 52% higher.