what the service is called, there are ethical and legal reasons to
keep a record. Though most students are not curious about
recordkeeping, some are hesitant to come to counseling
precisely because of fears about records and notes. Student
support staff across the university regularly keep notes, many
of which can be accessed by other colleagues in the same
office who might help the student at a later date. In consultation with the university’s legal department, a system was
devised at Cornell to interface with the health center’s existing
recordkeeping methods, thus preventing the logistical quagmire of parallel systems.
This challenge was resolved, in part, by the fact that all
college students complete a health history form. This is the
first item in any student’s medical record, and at Cornell its
completion generates the opening of a “chart.” In each chart
a section is provided for third-party correspondence,
including faxes from other doctors and evaluations for
disability by outside psychologists. This part of the chart is
considered “non-releasable,” meaning records requested by
the student, or anyone else with the student’s consent, would
not include these materials. Notes about CCI consultations
Overburdening Existing Services
A common campus concern is that alternative programs will
“find” more students in need of care, which could overwhelm
existing clinical systems. It is true that Let’s Talk and CCI do
reach students who otherwise would not have sought care.
(Cornell found that more than half of the students served
by these programs are under-represented minority students
or international students, compared to approximately one-third of students in traditional counseling.) However, these
programs also serve a preventive function, reaching students
before they require ongoing counseling or medication. Often
students who might have waited until the point of crisis
receive help before a crisis develops.
Funding Issues
The financial burden of developing programs such as Let’s Talk
and CCI cannot fall solely on the counseling center. The center
must have the full support of the division of student affairs to
be effective. The vice president of student affairs, as well as the
dean of students, must be willing to advocate for additional
resources for program development. Though opportunities
Though most students are not curious about
recordkeeping, some are hesitant to come to
counseling precisely because of fears about
records and notes.
and Let’s Talk visits are kept in this section of the chart. Much
like the notes that academic advisors keep, which are not part
of a student’s official record, these notes are only accessible to
designated health center staff. This system creates a necessary
firewall between the student’s official, releasable, medical
record and notes on informal, nonclinical contacts. Students
rarely ask about recordkeeping, but if they do, a description
of this system and confirmation that these alternative
programs are not cited as therapy sessions usually allay any
lingering concerns.
No matter how much reassurance about confidentiality is
provided, some students simply will not meet with a counselor
if they know a record is kept. To address these concerns, a
chart is created for hypothetical students called “anonymous.”
Clinicians keep notes on their contacts with students who
visit Let’s Talk in this chart, allowing clinicians to monitor the
work they have done and record any information for future
contacts. Once an anonymous student is engaged and is less
wary of the process, he or she may be willing to provide more
personal information. At this time, notes from the anonymous
chart are copied to the third-party correspondence section of
the student’s official record.
may arise to shift existing resources for such efforts, these
programs are likely to be more successful and sustainable when
developed and funded with additional resources. If overburdened counseling services are asked to completely shoulder
the financial weight, these programs are likely to fail.
Students Can Be Reached
Let’s Talk and CCI are designed to reach those students
that senior student affairs officers consider to be of
greatest concern: students who are in emotional distress
but “won’t walk in” for counseling. The success of the Cornell
programs should encourage other colleges and universities
to think beyond traditional mental health services as the sole
source of support for these students. LE
Matthew S. Boone is the coordinator of the Let’s Talk program offered
through counseling and psychological services at Cornell University.
Gregory T. Eells is the director of counseling and psychological services at
Cornell University and president of the Association for University and
College Counseling Center Directors.
