Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
DSpace
UBCV
Miller, Chloé Alix
Master of Arts - MA
University of British Columbia
Career service sessions, once provided by counselling psychology graduates, are now typically provided in separate career centres, by staff with employment expertise but with little mental health training. Research finds that the majority of career practitioners urgently require improved skills for identifying and referring mental health issues among their clients (Burwell & Kalbfleisch, 2007; CERIC, 2012; 2020a), as career and personal issues are often intertwined (Schaub, 2012), and myriad factors may lead clients with mental health issues to present for career sessions (Vidourek, et al., 2014). The present study used the Enhanced Critical Incident Technique to explore the experience of career practitioners in Western Canada who self-identified as having experience with recognizing mental health issues among their clients. Qualitative interviews were used to explore what helped or hindered participants in recognizing mental health issues. Experience in higher education settings was selected because mental health issues are prevalent among students, and because pre-service mental health screening is not standard practice in separated campus career service departments. Participants reported recognizing a relatively high frequency of mental issues. Critical incident findings were organized into six categories: 1.Workplace Supports, 2.CP Person-Level factors, 3.Building a Low-Pressure Relationship, 4.Using Career Theory and Career Process, 5.Active Listening, and 6.Exploring Barriers to Progress. Findings suggest that recognizing mental health issues is a proactive activity which is influenced by context, enhanced when certain permissions, training opportunities, and referral networks are in place. Findings underscored the importance of a strong working alliance, of close ties with the counselling team, of active listening, of cross-cultural competence, of gatekeeper training workshops, of the value of career theory and career tasks, and of strong knowledge about common sources of student distress. Findings highlight the important role managers can play in either curtailing or enhancing this activity. Findings suggest that recognizing mental health issues is often a natural by-product of rigorous resilience-oriented career support, aimed at uncovering any challenges to provide students with a better chance of career success across time.
RECOGNIZING MENTAL HEALTH ISSUES IN HIGHER EDUCATION CAREER SERVICE SESSIONS by Chloé Alix Miller B.A., University of British Columbia, 2003 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Counselling Psychology) The University of British Columbia (Vancouver) March 2023 © Chloé Alix Miller, 2023 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, a thesis entitled: Recognizing Mental Health Issues in Higher Education Career Service Sessions submitted by Chloé Alix Miller in partial fulfillment of the requirements for the degree of Master of Arts in Counselling Psychology Examining Committee: Dr. William (Bill) Borgen, Professor, Counselling Psychology, Faculty of Education, UBC Supervisor Dr. Marla Buchanan, Professor, Counselling Psychology, Faculty of Education, UBC Supervisory Committee Member Dr. Ishu Ishiyama, Associate Professor, Counselling Psychology, Faculty of Education, UBC Supervisory Committee Member iii Abstract Career service sessions, once provided by counselling psychology graduates, are now typically provided in separate career centres, by staff with employment expertise but with little mental health training. Research finds that the majority of career practitioners urgently require improved skills for identifying and referring mental health issues among their clients (Burwell & Kalbfleisch, 2007; CERIC, 2012; 2020a), as career and personal issues are often intertwined (Schaub, 2012), and myriad factors may lead clients with mental health issues to present for career sessions (Vidourek, et al., 2014). The present study used the Enhanced Critical Incident Technique to explore the experience of career practitioners in Western Canada who self-identified as having experience with recognizing mental health issues among their clients. Qualitative interviews were used to explore what helped or hindered participants in recognizing mental health issues. Experience in higher education settings was selected because mental health issues are prevalent among students, and because pre-service mental health screening is not standard practice in separated campus career service departments. Participants reported recognizing a relatively high frequency of mental issues. Critical incident findings were organized into six categories: 1.Workplace Supports, 2.CP Person-Level factors, 3.Building a Low-Pressure Relationship, 4.Using Career Theory and Career Process, 5.Active Listening, and 6.Exploring Barriers to Progress. Findings suggest that recognizing mental health issues is a proactive activity which is influenced by context, enhanced when certain permissions, training opportunities, and referral networks are in place. Findings underscored the importance of a strong working alliance, of close ties with the counselling team, of active listening, of cross-cultural competence, of gatekeeper training workshops, of the value of career theory and career tasks, and of strong knowledge about common sources of student distress. Findings highlight the iv important role managers can play in either curtailing or enhancing this activity. Findings suggest that recognizing mental health issues is often a natural by-product of rigorous resilience-oriented career support, aimed at uncovering any challenges to provide students with a better chance of career success across time. v Lay Summary The goal of this study was to understand what helps or hinders Career Practitioners to recognize mental health issues among their clients in campus settings. Students who seek career help often may need mental health referrals, but career staff often lack mental health training. This study used qualitative interviews and the Enhanced Critical Incident Technique to explore the experience of 11 Career Practitioners who have experience recognizing mental health issues. The findings were organized into six categories: Workplace Supports, CP Person-Level Factors, Building a Low-Pressure Relationship, Using Career Theory and Career Process, Active Listening, and Exploring Barriers to Progress. The findings suggested that having close ties with the counselling team, access to mental health workshops, and supportive managers is helpful for recognizing mental health issues, among other factors. Findings suggest that some of the things career practitioners do to improve student career success overall, may also reveal mental health issues. vi Preface This thesis is an original, unpublished, independent product of the author, Chloé Alix Miller, who completed all work, including research design, participant recruitment, data collection, analysis, and manuscript write-up. This research received ethics approval from the University of British Columbia’s Behavioural Research Ethics Board (BREB). The certificate number of the ethics certification obtained for this study under BREB was H21-01587 under the title “Recognizing Mental Health Issues in Higher Education Career Service Sessions.” vii Contents Abstract ................................................................................................................................ iii Lay Summary ........................................................................................................................ v Preface .................................................................................................................................. vi Contents ............................................................................................................................... vii List of Tables ...................................................................................................................... xiii List of Figures .................................................................................................................... xiv Glossary ............................................................................................................................... xv Acknowledgements ........................................................................................................... xvii Dedication ......................................................................................................................... xviii Chapter 1: Introduction ....................................................................................................... 1 1.1 Background ................................................................................................................... 1 1.2 Research Problem ......................................................................................................... 1 1.3 Purpose, Research Question, and Potential Contribution ............................................. 2 Chapter 2: Literature Review ............................................................................................. 4 2.1 Overview of Career and Counselling Services in Higher Education in Canada .......... 4 2.1.1 Promotion of Healthy Settings .............................................................................. 4 2.1.2 Overview of Mental Health Needs on Canadian Campuses .................................. 5 2.1.3 Overview of Career Service Needs on Canadian Campuses ................................. 8 2.1.4 Pandemic: Amplified Need ................................................................................. 10 2.1.5 Provision of Counselling Services ....................................................................... 11 2.1.6 Provision of Career Services ............................................................................... 13 viii 2.2 Avenues for Mental Health Risks Within Campus Career Sessions .......................... 17 2.2.1 Institutional Factors Which May Funnel Mental Health Issues Towards Career Services ............................................................................................................. 17 2.2.1.1 Long wait times for counselling vs. CP session self-booking. ............. 17 2.2.1.2 Poor Advertising Clarity and Confusion Over Scope of Practice. ....... 18 2.2.2 Practitioner Factors Which May Funnel Mental Health Issues Towards Career Services ............................................................................................................. 20 2.2.2.1 Low Career Competence Among Clinical Counsellors. ...................... 20 2.2.3 Client Factors Which May Funnel Mental Health Issues Towards Career Services .......................................................................................................................... 22 2.2.3.1 Stigma Against Mental Health Counselling, Preference for Coaching. 22 2.2.3.2 Suicide Risk in Low Help-Seeking. ..................................................... 24 2.2.3.3 Complex Client Loads. ......................................................................... 25 2.2.3.4 Vulnerable International Student/ Migrant Workers. ........................... 26 2.2.3.5 Integrated Nature of Client Career and Personal Issues. ...................... 29 2.2.4 Practitioner Factors Which May Amplify Mental Health Risks in Career Sessions .......................................................................................................................... 30 2.2.4.1 Variations in CP training. ..................................................................... 30 2.2.4.2 Misinformation Within Coach Training. .............................................. 32 2.2.4.3 Vague Boundaries Between Coaching and Therapy. ........................... 35 2.2.4.4 Limitations of Coaching Interventions. ................................................ 37 2.2.4.5 Presenting Issues Contraindicated for Coaching. ................................. 39 2.2.4.6 Lack of Diversity Competence. ............................................................ 41 2.2.4.7 Lack of Psychometric/Assessment Training. ....................................... 43 2.2.4.8 Limited Ethics Training. ....................................................................... 44 ix 2.2.4.9 Lack of Training on Closed-Door Sessions Risks (Transference etc.). 45 2.2.5 Administrative Factors Which May Amplify Mental Health Risks in Career Services ............................................................................................................. 47 2.2.5.1 Lack of Clinical Supervision. ............................................................... 47 2.2.5.2 Dual and Multiple Relationships. ......................................................... 48 2.2.5.3 Lack of Clear Disclosure and Consent. ................................................ 49 2.2.5.4 Lack of Case-Management Standardization. ........................................ 50 2.3 Burnout ....................................................................................................................... 51 2.4 Need for Improved Identification of Mental Health Issues in Career Services .......... 52 2.5 Research Question ...................................................................................................... 57 Chapter 3: Methods ............................................................................................................ 58 3.1 Method Justification ................................................................................................... 58 3.2 Research Philosophy and Methodology ..................................................................... 59 3.3 Data Collection Procedures ........................................................................................ 61 3.4 Participant Recruitment and Inclusion Criteria .......................................................... 62 3.5 Participant Demographics ........................................................................................... 65 3.5.1 Age, Gender, and Years of Experience ............................................................... 66 3.5.2 Ethnicity, Birthplace, Language, and Indigenous Status ..................................... 67 3.5.3 Cohorts of Students Served ................................................................................. 69 3.5.4 Workplace Settings, Institution Type/Size and Team Size ................................. 70 3.5.5 Clinical Supervision ............................................................................................ 71 3.5.6 Mental Health Screening ..................................................................................... 71 3.5.7 Booking and Fees ................................................................................................ 71 3.5.8 Educational Background ...................................................................................... 72 x 3.5.9 Career Credentials and Career Service Training ................................................. 72 3.5.10 Mental Health Training ..................................................................................... 73 3.6 Data Analysis .............................................................................................................. 75 3.7 Ethical Considerations and Security of Data .............................................................. 76 3.8 Trustworthiness and Rigour........................................................................................ 79 3.8.1 Audiotaping Interviews ....................................................................................... 79 3.8.2 Interview Fidelity ................................................................................................ 79 3.8.3 Independent Extraction of Critical Incidents ....................................................... 80 3.8.4 Exhaustiveness..................................................................................................... 80 3.8.5 Participation Rates ............................................................................................... 81 3.8.6 Placing incidents in categories by an independent judge .................................... 81 3.8.7 Cross-Checking by participants ........................................................................... 82 3.8.8 Expert Opinions ................................................................................................... 83 3.8.9 Theoretical Agreement ........................................................................................ 84 3.9 Researcher’s Subjective Stance, Positionality ........................................................... 84 3.10 Data Presentation ...................................................................................................... 86 3.11 Dissemination of Research Findings ........................................................................ 86 Chapter 4. Findings ............................................................................................................ 88 4.1 Contextual Findings .................................................................................................... 88 4.1.1 Job Title ............................................................................................................... 88 4.1.2 Job Description .................................................................................................... 90 4.1.3 Frequency of Recognizing Mental Health Issues ................................................ 92 4.1.4 Experience Recognizing Mental Health Issues/ Types of Mental Health Issues 94 xi 4.2 Critical Incident Findings ........................................................................................... 99 4.2.1 Arranging the Categories ................................................................................... 105 4.3 Helpful Incident Categories ...................................................................................... 109 4.3.1 Workplace/Institutional Factors ........................................................................ 109 4.3.2 CP Person-Level Factors ................................................................................... 114 4.3.3 In-Session Categories: Building a Low-Pressure Relationship ......................... 118 4.3.4 Use Career Theory and Career Process ............................................................. 125 4.3.5 Active Listening ................................................................................................ 128 4.3.6 Discuss and Explore Challenges and Barriers to Progress in Career and Life Goals ............................................................................................................... 131 4.4 Hindering Incident Categories .................................................................................. 132 4.4.1 Lack of Workplace/Institutional Supports ......................................................... 133 4.4.2 Difficulty Building a Relationship (Student Behaviours) ................................. 138 4.5 Wishlist Incident Categories ..................................................................................... 139 4.5.1 Wishlist Workplace/Institutional Supports ........................................................ 140 Chapter 5: Discussion ....................................................................................................... 144 5.1 Participant Demographics ......................................................................................... 144 5.2 Contextual Findings .................................................................................................. 147 5.2.1 Job Title and Job Scope ..................................................................................... 147 5.2.2 Frequency of Recognizing Mental Health Issues .............................................. 151 5.2.3 Experience Recognizing Mental Health Issues ................................................. 154 5.3 Critical Incident Findings ......................................................................................... 157 5.3.1 Workplace/Institutional Supports Category ...................................................... 158 5.3.2 CP Person-Level Factors ................................................................................... 164 xii 5.3.3 Building a Low-Pressure Relationship Category ............................................. 168 5.3.4 Using Career Theory and Career Process .......................................................... 171 5.3.5 Active Listening ................................................................................................ 174 5.3.6 Discussing Barriers/Challenges to Progress ...................................................... 176 5.4 Limitations and Areas for Future Study ................................................................... 178 5.5 Implications for Practice & Recommendations for the field .................................... 184 5.6 Conclusion ................................................................................................................ 184 References .......................................................................................................................... 187 Appendices ........................................................................................................................ 228 Appendix A: Participant Invitation Letter ...................................................................... 228 Appendix B: Recruitment Poster .................................................................................... 231 Appendix C: Research Consent Form ............................................................................ 232 Appendix D: Interview Guide ........................................................................................ 236 Appendix E: Category Tracking Table ........................................................................... 239 Appendix F: Final Categories and Descriptions ............................................................. 240 Appendix G: Categories with Subcategories .................................................................. 243 Appendix H: Sample CP Job Posting ............................................................................. 249 Appendix I: Working Alliance Course Outline .............................................................. 251 Appendix J: Recommendations for Practice .................................................................. 253 xiii List of Tables Table 1. Age, Gender of Participants ............................................................................................ 67 Table 2. Reported Languages and Ethnicity of Participants ......................................................... 68 Table 3. Cohorts/Types of Student Groups Served ...................................................................... 70 Table 4. Career Credentials and Career Specific Training of Participants ................................... 73 Table 5. Mental Health Training of Participants .......................................................................... 75 Table 6. Job Titles Reported ......................................................................................................... 90 Table 7. Job Description of Participants ....................................................................................... 92 Table 8. Frequency of Recognizing Mental Health Issues by Participants .................................. 94 Table 9. Types of Mental Health Issues Recognized in Career Sessions ..................................... 97 Table 10. Tracking Exhaustiveness of Categories ...................................................................... 100 Table 11. Initial Participation Rates............................................................................................ 101 Table 12. Refined Helpful Categories ........................................................................................ 103 Table 13. Importance of Workplace/Institutional Supports Category ........................................ 105 Table 14. Hindering Categories .................................................................................................. 133 Table 15. Wishlist Categories ..................................................................................................... 140 xiv List of Figures Figure 1. Infographic of final categories ..................................................................................... 108 xv Glossary 1. Career Practitioner (CP): For the purpose of the present study, Career Practitioner (CP) refers to any career service worker at a career service centre, regardless of their formal title or training background. This study focuses primarily on the work of CPs engaged in private client meetings centred on individual career support, as opposed to career staff providing brief one-time general information at walk-up counters, or reception (see Chapters 2, 3, 4, and 5 for further detail about terminology and titles in this sector). 2. Incident: The term ‘incident’ is used throughout this paper to describe ‘critical incidents’ drawn from participant interviews. Here the usage of the word ‘incident’ differs slightly from everyday usage. In everyday language this term typically signals an occurrence outside the norm, often with negative valence, as in a ‘police incident’ or ‘an incident at work’. In contrast, the usage of the term ‘incident’ throughout this research study draws from the Critical Incident Technique literature, which is a method of research used to identify any behaviour, element, procedure, or characteristic deemed critical for the successful accomplishment of a task (see Chapters 3, 4, and 5 for further discussion of the Critical Incident Technique and findings). What makes an incident ‘critical’ within this research method is that the incident is important for optimal accomplishment of the task. When critical incidents are analysed and organized into categories, they can inform critical behaviours, procedures, and conditions required for a given task. A ‘critical incident’ is something that has occurred, however minute, and it is considered neutral (positive or negative) and it need not be outside of the norm. In everyday language, one might consider these incidents as factors relating to accomplishment of a task. However, the word ‘factor’ xvi has a secondary meaning in research (as in the Factor Analysis Method) where it refers to a category of data items. To avoid confusion for readers with research backgrounds, the term ‘incident’ is thus used throughout to refer to incidents drawn from participant interviews, which are later organized into categories (See Chapters 3, 4, and 5). xvii Acknowledgements Firstly, I would like to thank the participants who volunteered their valuable time for this study. Their detailed stories made this research possible and their dedication to career practice is inspiring. Secondly, I would like to thank Dr. Bill Borgen for agreeing to supervise my research. Dr. Borgen’s expertise in career counselling, deep knowledge about ECIT, and kind, encouraging supervision approach has helped me immeasurably to complete this project. I would also like to thank my committee members, Dr. Marla Buchanan, and Dr. Ishu Ishiyama for their valuable time and feedback, which improved my study in important ways. I extend my thanks to research assistants Sophie Ji and Iva Erceg, and to the two field experts, for their thorough data verification checks. I am very grateful to UBC Access, in particular to my advisor, Allan Dias, and to all those who helped me with accommodations so that neither an injury nor a pandemic would stand in the way of my studies (Karen Yan, Dr. Jas Purewal, and Amy Ma). I am grateful to my mother, Ruth Payne, and my late great-aunt, Mary Garling, for their financial support, and to my good friends who have encouraged me to see this study through. I would also like to thank Dr. Maurice Levy and Dr. Hugh Neary for encouraging me to pursue graduate studies. This study was made possible by the assistance of several grants. Thank you to the National SSHRC Master’s Graduate Research Grant, the Gladys and Gerald Sankey Career Counselling Scholarship, the Faculty of Education Student Research Grant, and the Kathryn Huget Leadership Award, for seeing value in contributing to my studies and research. I also thank UBC for bursary support, including the Rudolph and Eleanor KASER Memorial Education Bursary and the Monica McLean Memorial Bursary, all of which made this study possible. xviii Dedication This research thesis is dedicated to all of the higher education staff and faculty who take the time to go over and above, to notice when a student may need extra supports relating to challenges in their lives, connecting them to services and opportunities to help them complete their studies and to reach their fullest potential. You are making a difference in the lives of many.1 Chapter 1: Introduction 1.1 Background The career service sector is important to Canada’s social and economic goals, acting as a bridge between education and labour markets, and reducing friction for youth, immigrants, and others navigating career issues. Career practitioners (CPs) play an essential role in promoting positive health, social, and economic outcomes for individuals, institutions, and communities across Canada. In the post-war era, career support in universities was provided by counselling psychology graduates, trained in both mental health and career matters; recent decades, however, have seen a steady trend of separating career and mental health services into disconnected departments, in view of cost savings and specialization. Career services are typically now offered by CPs under a range of unregulated titles, whether career counselling, advising, guidance, education, or coaching; these practitioners typically possess specific employment and labour-market expertise, but lack mental health training (Shepard & Mani, 2013). 1.2 Research Problem The separation of career and counselling service is predicated upon the assumption that career and personal matters can be easily identified and separated, thereby avoiding risk, but research indicates otherwise: National surveys find that the wide majority of career practitioners urgently require additional training to recognize mental health issues in their clients, from moderate mental health issues to crisis and suicide risk (Burton-Denmark et al., 2012; Burwell & Kalbfleisch, 2007; CERIC, 2012, 2020a, 2020b). International reviews of Canada’s career sector have highlighted a critical need for improved training standards, including improved mental health skills (Organization for Economic Cooperation and Development (OECD), 2002). Furthermore, career issues are often intertwined with complex personal life issues which require 2 personal counselling beyond employment skills (Patterson & Klein 2008; Robitscheck & DeBell, 2002; Schaub, 2012), and many career clients exhibit low help-seeking due to a variety of factors (barriers to access, stigma, cultural values, confusion about services, and low insight) (Liu, 2009; Vidourek et al., 2014). Research finds that lack of mental health training, lack of clinical supervision, lack of ethics training, and misinformation within commercial career coaching may all impede timely referrals to mental health supports (Hart et al., 2001; Sime & Jacob, 2018; Yoon et al., 2018). These factors together present amplified mental health risks within career services for both career practitioners (burnout, job strain, attrition) as well as for their clients (delayed care, deterioration). Although career training organizations recommend that career practitioners continually remain alert to mental health issues in-session which signal a need for referral (Barriga, 2021), CPs are offered little guidance on how to do so. Surveys of both CPs and their clients find low competence in identifying mental health issues and referral skills among practitioners (CERIC 2020a, 2020b). Because psychological screening pre-service can deter career clients with simple employment needs or psychological stigma (Mier et al., 2008), career guidance bodies suggest that CPs use informal probing questions throughout career sessions to identify mental health problems. However, few, if any studies have been undertaken to explore effective screening methods for use with this client population in-session. 1.3 Purpose, Research Question, and Potential Contribution The purpose of this study was to explore how some career practitioners have been able to recognize mental health issues in career service sessions. Given the marked paucity of research on this topic, an exploratory qualitative study was appropriate, for its ability to generate rich descriptive foundational data of a given phenomenon. The current study explored how those career practitioners who self-identified as having recognized mental health needs among their 3 career clients (a minority) were able to do so. This study used Enhanced Critical Incident Technique (ECIT) which is a qualitative research method often used to establish useful ways of performing a given activity, for later use in training of other practitioners (Butterfield, Borgen, Amundson, & Maglio, 2005). Participants were asked to describe instances when they recognized mental health issues in career service sessions, and to describe what helped or hindered them in this activity. Campus settings were selected for this study given that mental health problems are relatively prevalent among student populations, that students often have relatively high rates of stigma and low-help seeking, and that campus career services are typically distinct from mental health departments, where screening pre-service is rare despite complex life/career presenting concerns (American College Health Association (ACHA), 2019; Van Norman, 2016; Vidourek et al., 2014). Findings from this study could inform the sector on potential recognition approaches for use by career practitioners, as one approach to mitigating mental health risks within the field. This could help to improve referrals to concurrent counselling supports, thereby improving client outcomes, reducing job strain for CPs, and reducing risk of student/worker deterioration. 4 Chapter 2: Literature Review The following literature review summarizes the need for and provision of career and mental health services in Canadian higher education, factors which may contribute to or amplify mental health problems within career sessions, the resulting burnout of practitioners, and the need for improved identification of mental health issues in career sessions. 2.1 Overview of Career and Counselling Services in Higher Education in Canada 2.1.1 Promotion of Healthy Settings Research finds that mental and physical health issues are intertwined, that student distress may stem from many ecological areas (academic, social, environmental, mental), and that organizational settings impact individual health (Patterson & Kline, 2008). Within this view, campuses and workplaces alike should strive to be healthy settings, where well-being is woven into organizational design to prevent ill-health, as a means to prevent attrition and to promote success and productivity. Prior decades saw student health as a peripheral department, where recovery of mentally and physically ill students was perceived as a person-level issue, a view which—though now widely debunked—is still occasionally referenced by some campus administrators in defence of limited mental health spending (Fullick, 2012, 2014; Henry, 2020). Research is clear that universities have a financial and legal duty to provide services for tuition and funding received, that they are accountable for the deleterious impacts of their policies, culture, and structure upon individuals, and that students report worse mental health outcomes in several realms compared to their age-matched peers who are not studying. Furthermore, campuses which ignore structural and cultural impacts on student health risk reputational, financial, and legal liability. 5 Prevention of harm within organizations is now considered the best upstream approach to reduce psychological injury, via promotion of protective factors which improve overall well-being, and decreasing risk factors which contribute to negative outcomes (Page et al., 2013). Campus directors are encouraged to weave student health into policies, procedures, interactions, spaces, and all levels of staff and faculty training, as a foundation for positive learning outcomes. This includes consideration of food, campus safety, intramurals, and sports, of how buildings are designed, and of how schedules are structured such that cohorts can mix, where student health is considered holistically and systemically (Patterson & Kline, 2008). When student health suffers, loss of interest in learning ensues, attrition increases, and mental and physical health decline, all reducing the value of societal investments in education and the reputation of the university or college (Anderson, 2005; Keeling, 2010; National Association of Student Personal Administrators (NASPA), 2002; Ontario University and College Health Association (OUCHA), 2017). Two important elements of this approach are campus counselling and career services. 2.1.2 Overview of Mental Health Needs on Canadian Campuses The need for mental health services on North American campuses has been well-established as students contend with normative developmental changes, time away from home, competitive environments, financial and academic burdens, and critical social adjustment etc. (Heck et al., 2014). Emerging adults (18-29) report more mental health problems than any other adult age group (Cain, 2018) and a large body of literature describes the emerging mental health crisis in higher education, calling for ongoing improvement of counselling services to address increasing rates of distress, depression, anxiety, sexual assault, social problems, body image issues, addictions, and suicidality which are higher than any prior generation (Jaworska et al., 2016; Kruisselbrink-Flatt, 2013; OUCHA, 2017; Schulenberg et al., 2004). Here, mental health 6 refers to Keyes’(2007) description of optimal mental health on a continuum, from languishing to flourishing, with or without the presence of mental illness, where mental illness and mental health are related, but distinct dimensions. In terms of overall functioning, mental health comprises satisfaction with life, emotional, and psychosocial well-being, where languishing is described by low well-being, few supports, lack of agency, marginalization, low work productivity, and physical health issues impeding goals (Keyes, 2007). Individuals with poor mental health typically experience worse limitations on their daily lives, reduced work productivity, more chronic physical disease, and worse psychosocial functioning than individuals who experience episodes of mental illness but who have better overall mental health (Keyes, 2007). Targeting mental health awareness at all those involved in the campus environment is key to improving student well-being, because students turn for help not just to counsellors, but also to teachers, advisors, various staff, and recreation services when in need of support (Kitchener & Jorm, 2004; Patterson & Kline, 2008). Canadian students are more than twice as likely to report mental illness symptoms and heightened distress compared to their non-student peers (OUCHA, 2017). Suicide has been reported as the first or second cause of student death in Canada, where 16.4% of students had seriously considered suicide in the past 12 months, with 2.8% attempting, where 51.6% felt so depressed it was difficult to function, and 69.6% reported feeling very lonely (ACHA, 2019; MacKean, 2011). Graduate students report rates of depression and anxiety six times the population average, highly correlated with low work-life balance, academic demands, financial stress, and poor research supervisor relationships (Evans et al., 2018; Hyun et al., 2007). Students are impacted by a culture of overwork among faculty they interact with, who themselves experience burnout, life-balance issues, and mental health stigma in the face of 7 publish or perish, an area in urgent need of cultural change (Evans et al., 2018; Shackle, 2019). Studies in the UK and Australia have found that students in higher education report up to four times more mental ill-health than their age-matched peers who are not studying (MacKean, 2011; Warwick et al., 2008). Generational issues such as technology use also contribute to new mental health problems such as cyber addictions, cyber bullying, and problematic sexting among others (Cain, 2018; Lauckner et al., 2020; Rasmussen et al., 2020; Sibley et al., 2019.) Female students in Canada have a higher likelihood of sexual assault relative to women engaged in work environments due to a variety of campus factors from transient social networks to alcohol use (Kappler, 2018; Quinlan et al., 2016). Sexual assault can have deleterious impacts on academic, career success, and psychological functioning, including a 50% prevalence of PTSD following rape attempts, leaving only 26.9% of female students feeling safe on campus, compared to 59.2% of male students (ACHA, 2019; Chivers-Wilson, 2006; Council of Ontario Universities, 2018; Oswalt et al., 2017). This ‘epidemic of anguish’ (Wilson, 2015) may be even worse among international students who contend with additional cross-cultural issues, family, and isolation pressures (Chen et al., 2015; Liu, 2009). International and cross-cultural students are important populations in Canada, where 43% of students on Canadian campuses are from cultural groups other than ‘White European’ heritage (Statistics Canada, 2020a). Studies have found international students experience loneliness, culture shock, few meaningful relationships with host nationals, discrimination and racism, language difficulties, changing sense of identity, unrealistic expectations from self and family, financial stress, unfamiliar modes of teaching, and general adverse experiences in the host country (Russell, Thompson, &Rosenthal, 2008). Studies have found rates of anxiety and depression are triple the domestic average for some international 8 students (Han et al., 2013) with a notable gap in help-seeking until distress is severe (Russell et al., 2008). Indigenous students, for their part, often face negative stereotypes on campus reflective of Canada’s colonial legacy which persist among students and faculty, and within out-dated curriculum, leading to further marginalization and lower retention rates than their non-Indigenous peers (Gallop & Bastien, 2016). A rise in American-style litigiousness has forced many Canadian institutions to change their campus policies when students are harmed (Mullens, 2008). Most lawsuits are linked to student suicide, discrimination, negligence, confidentiality issues, and distress which causes academic or occupational harm and are typically settled out of court (Affsprung, 2010). Canadian and American court decisions have established that students can sue over poor or abusive academic supervision which causes distress and poor career outcomes (Knelman, 2012; Kwicinski, 2012; Powell, 2018). The UK has reported a surge in legal cases against universities from students claiming psychological distress and lost earnings due to lack of appropriate accommodations and support on campus (Mintz, 2017). Some suggest that universities are perceived as soft targets due to liberal values and high financial resources (Mullens, 2008), while others claim that campuses foster a culture of overwork and manufacture conditions which create mental illness, such as tight timelines and out-dated processes, unsafe campuses, and high costs (Shackle, 2019). Mental health is so important to institutional reputation that MacLean’s annual ranking of universities in Canada assesses campus mental health services and sexual assault prevention as part of its ranking, ultimately impacting campus recruitment (Dwyer, 2020). 2.1.3 Overview of Career Service Needs on Canadian Campuses Dramatic shifts in labour market trends and uncertain employment prospects relative to past generations leave colleges and universities under pressure to provide return on investment to 9 graduates (Amundson, 2006; Borgen & Hiebert, 2006). Life-long, highly developed career guidance is described by the OECD as central to building a competitive knowledge-based economy, to social inclusion, and to the advancement of employment and welfare policies (Shepard & Mani, 2013). The US Federal Reserve reports that Gen X’ers and millennials have fared worse than baby boomers at every stage of their financial lives, with current wealth levels just one seventh of boomers at age 35 (Pesce, 2019), with stark reductions in wage growth (WEF, 2020), and platform/gig economies eroding quality of employment (Vallas & Schor, 2020). The majority of Canadian students expect that their education will help provide the skills for their first jobs, and later jobs (McKinsey & Company, 2015), such that university ranking companies devote 10-23% of their rankings to job-readiness and post-degree employment outcomes (Dywer, 2020; QS World University Rankings, 2020). Public scrutiny over student debt levels and low completion and employment rates have shifted the focus towards holding universities accountable for student success, to improve retention, career fit, and outcomes (Bettinger & Baker, 2011). A 2015 study of youth employment in Canada recommended that universities make employment outcomes of their graduates their most important institutional priority (McKinsey & Company, 2015), and the OECD (2002c) recommended post-graduation employment in Canada be more closely reported and tracked. In Canada, student fees and tuition have increased 270% since 1990, correcting for inflation, such that 20% of undergraduate degree holders graduate with $25,000 in debt, and 7% have more than $50,000 in debt, requiring nearly double the amount of part-time hours to pay tuition (Royal Bank of Canada RBC, 2018). A Queen’s university study (2012) found that 61% of students surveyed were stressed about their careers, while a national study found roughly 40% 10 of students reported career and financial stress so severe it was difficult to handle (ACHA, 2019). 2.1.4 Pandemic: Amplified Need The World Bank has warned of a potential decade-long deterioration in economic conditions and increased unemployment, debt accumulation, and insolvencies, presenting new challenges for graduates, including the risk of economic scarring, whereby early-career labour market issues have life-long income effects (Stanford, 2021; World Bank, 2021). Working provides financial resources for societal inclusion, social connections, purpose, and meaning (Blustein, 2008; CERIC, 2012; 2016), while economic depressions are historically associated with increased suicides. The Great Depression saw a record high of 21.9% of deaths by suicide in the USA, with subsequent large spikes in later recessions (Center for Disease Control, 2015). A survey of CPs found that most clients were stressed during the pandemic and that 44 % of their clients were poorly or only somewhat equipped to deal with their mental health challenges (CERIC, 2020b). Eight months into the pandemic, 26,000 workplace compensation claims were logged in Canada due to serious COVID illness that left workers with chronic ongoing symptoms (Singh et al., 2020; White, 2021), with 34% of patients at heightened risk of long-COVID complications causing workplace disability (Fiorillo & Gorwood, 2020; Horesh & Brown, 2021). Canada’s chief science advisor reported that by December 2022, some 10%-20% of Covid patients in Canada continue to experience disabling symptoms, warning that the pandemic could be a ‘mass disabling event’ with far-reaching socio-economic implications (Chief Science Advisor of Canada, 2022), all of which CPs must be prepared to assist clients with. International students typically account for a capital influx of 21.6 billion to the Canadian economy (Teotonio et al., 2019) with roughly 170,000 jobs annually sustained by spending from international 11 students, impacting income tied to campuses (Statistics Canada, 2020a; Statistics Canada, 2020b). Even temporary pandemic disruptions in enrollment exacerbated a funding crisis for some higher education institutions, potentially hampering career services and increasing staff workloads (Edwards & McMoros-Santos, 2020; Faircloth, 2020) leading to hiring freezes, cancelled programs, and laid-off faculty due to lost revenue in some cases (Rutherford, 2021). 2.1.5 Provision of Counselling Services Only those with master’s level or higher training in clinical counselling (2-3 years of study) are permitted to work as mental health counsellors at campus counselling centres in Canada. This includes specific graduate-level coursework covering psychometrics, research literacy, diversity, cross-cultural competence, ethics, psychopathology, assessment, and development, as well as practiced and evaluated counselling skill demonstration with groups and individuals under clinical supervision. In Quebec, Alberta, Ontario, Nova Scotia, and New Brunswick, counselling is fully regulated and use of the title is protected, whereas in other provinces and territories regulation is underway (Canadian Counselling and Psychotherapy Association (CCPA), 2020a, 2020b). Campus counselling centres employ standard best-practice structures common to the field, underpinned by explicit ethical codes (Canadian Psychological Association (CPA), 2020). These include screening and triage processes to prioritize risk, use of confidential case-management software, clinical supervision, and referral to group or community resources. Clinicians are trained to verbally review risk in client sessions, and all suicide/homicide/self-harm risks and actions taken by counsellors are documented to manage liability and to improve client care. All client contact, from email, phone calls, and visits, are likewise documented and reviewed by supervisors to protect client/counsellor boundaries and ethics. Individual counselling is offered within a brief-term model of 4-8 sessions, with some 12 exceptions for chronically at-risk students. Some campuses offer dedicated counselling centres by faculty or student group, such as Indigenous student counselling centres, or medical school counsellors. Understanding the historical roots and intended purview of counselling psychology is particularly relevant to the current disintegration of career and counselling services today. Counselling psychology, as a discipline, is distinguished from psychiatry and clinical psychology, in that these latter fields focus on the diagnosis and treatment of mental illness and disease. In 1951, the field of counselling psychology was established with funding from the Department of Veterans Affairs and the National Mental Health Act, to support returning WWII veterans in need of mental health support and workforce integration. The focus of this new division was on hygiology (the preservation of health) not pathology (the treatment of disease), on supporting healthy individuals with various challenges and opportunities of adjustment across the lifespan. Vocational guidance and life adjustment issues would be the primary focus of counsellor training, and practice would not be contained to either personnel issues (as in HR), or guidance (as in education or vocational information giving) or clinical illness (as in hospitals) (Whiteley, 1980). A strong early emphasis was on professional standards, as the Nuremberg trials revealed the urgent need for ethical codes for all professions (Sinclair, 2020), and thus a fiduciary relationship of protecting public interests is central to counsellor training. As early as 1962, counselling centres were established in universities and colleges, where the student was seen as a client or pupil, not a patient, where the emphasis was developmental, not remedial, to help individuals more effectively and efficiently exploit their social and personal resources, while contributing to public welfare (Mitchell et al., 2019; Whitely, 1980). Contemporary counsellors focus on emotional, social, vocational, educational, health-related, developmental, 13 and organizational concerns across the lifespan (American Psychological Association (APA), 2023). Large clinical outcome studies find improvement across all mental health areas measured for students who access campus counselling services, with change scores most significant at 7-10 sessions (Kopta, et al., 2014). Students receiving counselling for suicidal ideation reduce their suicide risk to one sixth of those who do not receive counselling (Locke et al., 2012). Meta-analysis finds a range of campus counselling interventions are effective in reducing stress (Yusufov et al., 2019), whereas students in need who do not access mental health services are at higher risk of drop-out, lower academic outcomes, and unemployment (Vidourek et al., 2014). Indigenous students provided with access to culturally-specific counselling, advising, and spiritual support to built self-efficacy and maintain cultural integrity report higher retention rates (Gallop & Bastien, 2016). Client counselling outcomes vary with effectiveness of the therapist (Nissen-Lie et al., 2016; Wampold, 2000, Yusufov et al., 2019), with quality of the therapeutic alliance (Falkenström et al., 2013; Zilcha-Mano et al., 2016) and with education level of the therapist: Licenced professionals with master’s degree or higher in counselling out-perform paraprofessionals, who out-perform graduate student counsellors in improvement effects, according to some studies (Baskin et al., 2010). 2.1.6 Provision of Career Services Relative to campus counselling services, provision of campus career services is more widely varied and training is less standardized, and there are no regulations of career practice in English-speaking Canada (Quebec is an exception in Canada, where career counselling is a licensed profession) (Shepard & Mani, 2013). Career Practitioners (CPs)—an umbrella term for any individual working in career services—may have little to no formal career counselling 14 training, or as much as a doctoral degree in vocational psychology. All provinces have some form of voluntary CP training standards and programs, which include a minimum of 40 hours of study in career practice ethics and theories. Common voluntary credentials include: Certified Career Development Practitioner, Certified Career Services Provider, and Career Coach. CPs may use a variety of additional titles such as: career counsellor, career facilitator, career strategist, career advisor, career educator, career success expert, career development coach, or career management professional etc. The meaning of these terms is not standardized such that service may vary widely between providers (Burwell & Kalbfleisch, 2007). Unlike earlier generations, career and employment counselling are now typically offered in dedicated career centres which are completely separate from mental health counselling departments (Van Norman, 2016). Funding varies widely between institutions creating vast discrepancies in staff, size, and services provided; some focus primarily on employment services, while others also provide career counselling; some serve only students, some also serve alumni, while others also serve the broader community for a fee. CPs require key competencies such as knowledge of economics, workplace dynamics, demographic changes, employment trends, international relations, marketing, labour legislation, and distinct career expertise beyond mental health training (Shepard & Mani, 2013; Van Norman, 2016). CPs draw from a range of employment backgrounds, such as law, education, sports, and business, and many have specific industry experience as former hiring-managers or human resource practitioners, with valuable inside knowledge about interviews, performance management, and hiring practices etc. Campus leaders report difficulty in hiring CPs with master’s degrees in counselling who also have career expertise, due to the diversity of skills needed, and thus typically hire CPs without counsellor training (CERIC, 2019). This allows for cost savings within campus career centres, by offering 15 services on a spectrum of need by CPs with varying training and pay levels (Van Norman, 2016). There are no graduate-level university training programs in English-speaking Canada in career counselling, career practice, or career coaching, but there is a wide range of training programs at the workshop, diploma, and certificate level. These vary widely in quality, duration of study, and scope. Some have practicums, some do not, many have low or no standards for entry, and some programs, such as commercial career coaching programs may offer credentials via an online one-day course, while more rigorous CP programs take several years to complete (Burwell & Kalbfleisch, 2007). For instance, Alberta’s Certified Career Development Practitioner credential is relatively rigorous, requiring between 1600 to 6400 hours of recent paid career service experience depending on career specific education (40 hours minimum up to a Master’s Degree) (Career Development Association of Alberta (CDAA), 2017), while the CACEE Career Educator Certificate Program can be completed over just six hours of webinars (Canadian Association of Career Educators and Employers (CACEE), 2023). The Canadian Education and Research Institute for Counselling (CERIC) suggests a five part model of career counselling or coaching: mental health, decision-making, self-exploration, future thinking, and support with transitions (Schaffer & Wiens, 2019). Career is framed as a holistic concept which includes work, leisure, and study across the lifespan, which may include employment, jobs, occupations, vocation, roles, and relationships, with a focus one’s preferred future and an emphasis on adaptability (Borgen & Hiebert, 2014). The National Career Development Association (NCDA) suggests offering career service on a flexible spectrum of need, which distinguishes between brief one time open-door drop-in service, and deeper closed-door ongoing career supports. Open-door services may be offered in an open-concept setting, with walk-up counters, and do not require confidentiality or disclosure of consent, making it 16 easier for students to access timely information, feedback, or advice. These include accessing career libraries, career pamphlets, and websites, drop-in resume critiques, interview, networking, and career advising for general information, registration for career events, connecting with industry mentoring programs, and expert panel talks etc. The emphasis of open-door career services is on one-time advising and guidance, as educational activities, rather than on deeper personal support. In contrast, the NCDA describes closed-door career services as those requiring deeper ongoing support, such as career counselling or career coaching (Makela, 2009). The impact of career services on career outcomes appears positive. A 2016 survey of 11,400 recent graduates in the USA found that 50% of graduates who reported helpful career advising had a job waiting upon graduation, whereas students who did not receive helpful career advising had a job waiting only 15% of the time (Gallup 2016). Research indicates that students who receive help with articulating their goals and mapping out steps towards them, with frequent progress check-ins, report better career outcomes (Tudor, 2018). One study found career-coached students reported a 5% higher completion rate than non-coached students (Bettinger & Baker, 2011). Arizona State University, claimed that $500 invested in career coaching per semester per student, produced the same improvement in persistence and completion effects as $1000 of financial aid, but at half the cost (Ripley, 2015). Positive academic mentoring experiences for life, work, and study have been found to improve employment outcomes for Indigenous students (Stewart & Reeves, 2013). Approximately 60% of students surveyed in a national career counselling survey (CERIC, 2015) reported that career support they received was helpful for their career ambitions and problems. Studies of career adaptability skill training have been linked with positive work outcomes (Chin et al., 2018) and most students who receive career support rate it as effective (Anderson & Niles, 2000). One meta-analysis of 18 quantitative studies found 17 that career coaching produced statistically significant positive results on well-being and performance measures, albeit with some limitations relating to study size and construction (Theeboom et al., 2014). 2.2 Avenues for Mental Health Risks Within Campus Career Sessions Although the separation of career and counselling services offers benefits of cost-savings and specialization, complex mental health issues may arise in career sessions via myriad pathways, exposing clients, CPs, and campuses to risk. 2.2.1 Institutional Factors Which May Funnel Mental Health Issues Towards Career Services 2.2.1.1 Long wait times for counselling vs. CP session self-booking. Student counselling appointments are often plagued by high wait-times, increasing the likelihood that CPs may face students with underserved mental health needs. Wait-times for counselling are often months long, requiring an in-person initial triage session which requires being able to wait several hours, which can be difficult for working students, followed by high wait-times for ongoing counselling, where brief-term, single session, or group therapy are the norm (Draissma & Chiasson, 2019; Kruisselbrink-Flatt, 2013). Students at some Canadian universities have mounted public protests over wait-times, reporting that they had waited up to four weeks for counselling after disclosing suicidal thoughts (Mancini & Roumeliotis, 2019). Students have reported their frustrations over friends lost to suicide on campus who faced long wait times or received rudimentary care (Wilson, 2015). Studies have found that barriers to accessing mental health services include inconvenience and difficulty getting appointments, lack of time to seek treatment, long wait times, and unwelcoming staff in counselling centers (Vidourek, 2014). In contrast, individual closed-door CP sessions typically do not require a triage or screening session prior to booking, they often have lower wait times, and often they may be self-booked online by 18 students, creating ease of access relative to counselling appointments, which may increase the likelihood that some clients presenting for CP sessions may have under-addressed mental health needs. 2.2.1.2 Poor Advertising Clarity and Confusion Over Scope of Practice. Studies find that consumers and sponsors of career services, including students and campus administrators, are confused about the training, roles, titles, and scope of skills of practitioners, which may amplify the risk of clients seeking personal support in career sessions. A manual Google search of Canadian university career centre websites found the following descriptions which appear to advertise personal life support beyond just career skills: “support for personal, life, and career goals”, “personal growth sessions”, “success sessions”, “support for confusion about where to go in life, and help with your goals” , “support growth in your personal life and career” “student success centre coaching to feel less overwhelmed, to overcome loneliness, and other issues”. A majority of campus career service webpages do not clearly delineate the limitations of CP services, training, or what career service or coaching is/is not relative to counselling. Few campus career centre websites provide links to counselling departments for mental health problems, or explain how to access each service. Furthermore, students are exposed to career coach marketing in the public marketplace, where large venture-capital firms market their services via social media, promising a “97% increase in goal attainment, 36% increase in belonging, 44% experiencing life-changing transformation” (BetterUp.com) with “change in weeks, not years” (neuroleadership.com). Evans and Lines (2014) found the entrepreneurial premise of coaching creates tensions in how coaching services are marketed, to broaden one’s clientele. Vocational scholars warn that the ill-informed public is not aware of lack of regulation 19 in the coaching field, where “anything goes and little is forbidden” in how coaching is marketed (Yoon et al., 2018, p.214), with a lack of empirical effectiveness studies, boundaries of practice, and inflated claims in coach training and marketing materials (Chung & Gfroerer, 2003). In one study it was found that male college students prefer service brochures which describe services as “coaching” or “classes” for strength and success rather than therapy (Komiya et al., 2000), and male comfort with coaching over therapy is a core advertisement of private coach training programs (Williams, 2003). Steele and colleagues (2012) found that undergraduate students believed that coaching was the same as counselling, to provide help, advice, or solutions to student problems, but with less stigma, stating “successful people tend to see coaches as there is no stigma, if they just need pushing in the right direction” p.10). In a separate study it was found that students perceived coaching as a subset within counselling, and that students assumed coaches were trained counsellors (Lustgarten et al., 2017). Kretzschmar (2010) found that most clients did not understand what coaching was, how it was performed, or the boundaries of its utility. Other studies have found that international students may not understand how to use and access counselling services unless services are explicitly advertised as being for international students (Han, et al., 2013). In a 2015 survey of workers in Canada, 58% of participants stated they would seek career support from either a career counsellor or a coach, but that 18% were not clear on how to distinguish between services or about how to access them (CERIC, 2015). Furthermore, students identified career and guidance counsellors as a helpful resource they turn to for mental health issues, including anxiety, loss of sleep, depressive symptoms, and suicide risk, if they viewed career issues as the core feature of their problems (Patterson & Klein, 2008). Niles (2003) highlighted the risk of ancillary career practitioners offering services formerly performed by trained career counsellors, as neither clients nor funders 20 understand the differences between various CP titles, despite vastly different mental health training. Vocational experts argue that counselling psychologists must improve marketing of their expertise to stakeholders, including to campus career directors (Hung, 2018; Niles et al., 2009; Yoon et al., 2018), and move their outreach into social media, alongside coaching (Lauckner et al., 2020; Nobleza et al., 2019). Greenberg suggested that psychologists employ the term emotion coaching, as therapy still implies sickness for many in the general public, whereas training and coaching do not (Greenberg, 2002; Lustgarten, et al., 2017). Berglas (2002) cautions that some clients consider coaching a more acceptable form of psychotherapy, because coaching is marketed to business leaders as a faster way to obtain quick results (Bindley, 2019). Students who turn to Wikipedia for clarity may find little to distinguish services: “Career coaching focuses on work and career and is similar to career counseling..[sic].. another common term for a career coach is "career guide".” (Wikipedia, 2021) Thus, confusion about roles and titles may increase the risk of students seeking support for complex personal mental health issues within career sessions. 2.2.2 Practitioner Factors Which May Funnel Mental Health Issues Towards Career Services 2.2.2.1 Low Career Competence Among Clinical Counsellors. Research finds that many campus mental health counsellors lack sufficient career competence, such that some clients with mental health issues report preferring support from CPs to meet their goals, regardless of mental health symptoms (Schaub, 2012). Some clients report their psychology providers are overly pessimistic about career prospects, such that the right to choose mainstream career support is viewed as an issue of equal access and avoiding discrimination (CERIC, 2012). Brown’s (2002) research on career and personal counselling found that clinical counsellors need 21 more career training, while a task force of Canadian career experts found that graduate counselling programs offer little to no career practice education, resulting in crucial gaps (Burwell & Kalbfleisch, 2007). The OECD (2002c) reported that counsellors in Canadian high schools find it difficult to maintain vocational expertise, because the majority of their time is focused on adjustment and crisis issues. Price (2009) found that counsellors without workplace expertise did not recognize the limits of their workplace competence relative to coaches with more business experience, or the risks of providing career advice without workplace competence. Schaub (2012) recommends that career and counselling staff expedite student referrals to each other, based on respective knowledge gaps. A 2018 review of Canada’s career sector found that counselling psychology graduates in Canada can obtain their professional licence with minimal to no career counselling training, with none requiring a specific career counselling practicum (Domene & Isenor, 2018). Indeed, students with career concerns at the core of their distress are typically referred out to CPs, as part of triage, such that counselling trainees may gain little experience with career issues (OECD, 2002c; Van Norman, 2016). A notable exception is Quebec, one of the only jurisdictions in the world to license the activities of guidance and career counsellors, where 12 credits in specific career issues, 2300 hours of supervised practicum, and 600 hours of career counselling experience are required to work as career counsellor (Yoon et al., 2018). Many Quebec universities offer master’s degrees in career counselling, whereas no universities in English-speaking Canada do so, and Quebec has a specific code of ethics for the practice of career counselling (Shepard & Mani, 2013). While early generations of counselling graduates spent 50% of their time and training on vocational issues, by the 1980s, multiple studies revealed negative attitudes towards career 22 counselling among new counselling graduates, with university counsellors reporting less skill in addressing career matters than prior generations of counsellors (Bluestein, 1992). Studies found fewer than half of counselling trainees had interest in performing career-related tasks, that counsellors were less willing to work on vocational issues and preferred social-emotional issues, and that counselling graduates expressed less empathy and lower quality intake for career-related concerns compared to other personal problems (Bluestein, 1992; Robitscheck & DeBell, 2002). Only 10% of participant studies in the Journal of Counseling Psychology between January 1999 and April 2001 included vocational variables, and only 6% of scientific studies in the Counseling Psychologist Journal published between 1969 to 1998 referenced vocational issues (Robitscheck & DeBell 2002). Studies of counselling graduates find that low career self-efficacy and interest are influenced by negative views expressed by some faculty that career issues are less important, by bland course instruction of out-dated test and match approaches, by disinterest for working with clients avoidant of discussing feelings (Bluestein, 1992; Heppner et al., 1996), and by lack of practicum exposure to career issues (Robitschek, & DeBell, 2002). Efforts are underway to reinvigorate career as a contextual issue in counsellor training and practice (Chen, 2013), but in the meantime, CPs may remain the preferred career support for some clients with complex mental health issues (CERIC, 2012). 2.2.3 Client Factors Which May Funnel Mental Health Issues Towards Career Services 2.2.3.1 Stigma Against Mental Health Counselling, Preference for Coaching. Research finds that many students have high stigma and avoidance against seeking mental health counselling, such that unaddressed mental health issues may be present in CP sessions. In large campus surveys, only a small fraction of students with clinical levels of mental health symptoms report seeking counselling support, with international students reporting even lower rates of 23 utilization (Eisenberg et al., 2007; Ross et al., 2020; Vidourek et al., 2014.) Studies find that campuses need to improve their ability to identify students who are vulnerable and at-risk, particularly those with emotional and psychological distress who will avoid counselling supports (Mier et al., 2008). Multiple studies have found that university students as a group stigmatize others who seek mental health services (Vidourek et al., 2014). Furthermore, studies indicate that individuals of certain cultural backgrounds may delay accessing services until symptoms reach severe levels of depression, anxiety, or suicidality and that shame, stigma, saving face, and cultural values about mental health inhibit help-seeking in some populations (Chen et al., 2009; Liu, 2009; Qian et al., 2001). This raises concern within CP sessions as the very international students who require additional career support, may have a higher likelihood of stigma, avoidance, and misunderstanding about counselling services (Blau & DiMino, 2019). Some study findings suggest that students with lower self-esteem are in a ‘double-bind’ such that they experience more self-blame for needing support, more avoidance, and more deterioration relative to students with higher self-esteem who seek help (Lannin et al., 2015). Students may fear reprisal if an abusive academic supervisor learns they have disclosed their behaviour, or fear counselling visits will appear on their transcript or academic record (Redden, 2019). Research suggests that students, particularly those with no history of counselling, need more information about the nature of counselling and potential benefits, emphasizing strength rather than weakness narratives (Shy & Waehler, 2008; Vogel & Wester, 2003). Studies have suggested that students in certain competitive faculties have much lower rates of help-seeking (business, engineering, medicine), despite high levels of depression, anxiety, suicidality, alcohol abuse, and self-injury (Lipson et al., 2016; Wilkes et al., 2019). Scholars suggest that university staff should be aware of students in faculties which are associated with higher distress, higher 24 competition, and low help-seeking, all of which are frequent in career service caseloads. Students may need education about the value of counselling, and reassurance that counselling will not appear on their transcript or impact their student visa status, and that neither their supervisor, sponsor, nor family will be informed of their use of counselling (Redden, 2019). Stigma is also high among CPs themselves: A 2012 CERIC study of CPs found that 46% reported their own mental health problems, but many reported it felt too high risk to disclose mental health issues to colleagues for fear of discrimination, jokes, and insults they had witnessed in their field. One third of CPs stated they would only disclose their mental health problems if absolutely required, due to self-stigma and workplace repercussions (CERIC, 2012). 2.2.3.2 Suicide Risk in Low Help-Seeking. Studies find that students who avoid therapeutic supports despite apparent distress are at higher risk of self-harm, which is a risk for CPs working with students who are both avoidant of counselling and dealing with career challenges. Hopelessness is a common outcome of career problems (Borgen & Amundson, 1987), and studies of university students find that those with high hopelessness and negative views about the future are significantly more likely to commit suicide (Lamis & Lester, 2013). Scholars recommend that advisors (such as CPs) be trained on early signals of emotional pain, given that invalidating, minimizing, or ignorant responses to emotional pain increase suicide risk, and early intervention at ideation stages is most effective (Burton-Denmark et al., 2012). Many students are non-cooperative and avoidant of therapeutic supports for suicide risk, as a symptom of their condition (Polychronis, 2018, 2019). The majority of students who die by suicide have not received help from a student counselling centre at any time, and have low help-seeking. Approximately 86% of student suicides in the USA in a 2017 survey were among students who had not visited the counselling centre, while a third of students receiving 25 counselling services on campus report some degree of suicidal ideation. Self-concealment tendencies have been found to intensify distress and suicidal ideation in college students (Ahmad-Stout & Nash, 2013; Shadick & Akhter, 2014). Studies of international students have found some will approach staff for personal problems rather than psychological counselling out of stigma and to respect their families, and that suicide risk is also higher for foreign-born students, who are the very students in greater need of career supports (Ahmad-Stout & Nash, 2013; Shadick & Akhter, 2014). Furthermore, CPs must be alert to typical student challenges which may arise at any point during their studies, such as relationship breakdown, loss, or academic/career failures, which for a minority of students leads to loss of emotional control, chronic anguish, and suicidality (Gilbert & Sifers, 2012). Some American campuses have implemented novel approaches to reduce suicide risk: One program uses advising staff (such as CPs) as intermediaries to perform safety plans and suicide counselling with students who refuse psychological support, under the supervision of a trained counsellor off-site (Mier et al., 2008). Other campuses provide gatekeeper training to any non-counselling staff who interact with students, helping staff to recognize distress and to learn suicide safety skills via roleplays, all with the goal of increasing referrals to counselling services. This builds upon prior research that many advisors feel discomfort, fear, doubt, and helplessness when dealing with suicidal students due to lack of counselling training (CERIC, 2012; Kitchener & Jorm, 2004; Reiff et al., 2019). 2.2.3.3 Complex Client Loads. Unlike campus mental health counsellors, campus career centres also may serve alumni or non-affiliated community members as a fee-based service. This exposes CPs to a wider range of complex client loads beyond student issues seen in student mental health clinics, such as teens and youth planning careers and academics (and complex 26 ethical boundaries with their parents). CPs may also work with older workers from many industries not typically seen in university settings, such as those with entrenched unemployment, returning veterans, laid-off oil workers, manufacturers, farmers, or others with complex issues. Rates of suicide among laid-off male oil workers in Alberta are 35% higher than the national male average, for instance, where a hyper-masculine work culture encourages suppression of emotion, and difficult labour conditions lead to high rates of substance abuse and low help-seeking (Riley, 2019). Researchers find that for every 1% increase in oil-field unemployment there is a 0.79% increase in suicide, which lags two years behind layoffs (Mouallem, 2014). Canadian farmers experience such high rates of isolation, financial risk, and anxiety related to employment and debt problems that dedicated mental health workshops have been designed to improve help-seeking and to reduce suicide risk among farmers (domore.ag). Men account for 97% of workplace deaths in Canada, due to the nature of labour conditions in certain sectors. Roughly 65% of workplace injuries are among men, predominantly in trades such as construction, manufacturing, mining, forestry, and due to exposure to asbestos, where poor working conditions are often associated with substance use and low mental health (Todd, 2012). CPs at some institutions may represent the best-in-class career service available to these off-campus community members, which may expose them to a range of complex mental health issues beyond their training. 2.2.3.4 Vulnerable International Student/ Migrant Workers. In 2017, Canada’s student visa program changed to permit work off-campus for students in ESL, vocational, or undergraduate programs, leading to the emergence of vulnerable migrant-worker students, particularly from India. Some of these students are mandated to attend career coaching to improve student outcomes, to safeguard the visa granting status (revenue stream) of the program. 27 Over the past two decades, Canada commercialized education as an export commodity, as a means to fill public funding gaps in education, and to balance trade deficits and labour force needs. The EduCanada Brand became one of Canada’s largest export industries, larger than auto parts, lumber, and aircraft combined, marketing streamlined access to permanent residence to prospective international students (Government of Canada, 2019). Advocates argue that these new visa conditions enable a form of human trafficking, which is difficult for students to escape due to language barriers, poverty, fear of enforcement, and lack of legal services (Keung et al., 2019). Students are often misled by recruiters, misinformed about their rights, the legitimacy of their program, and the cost of living or the English skills required in Canada, while institutions have insufficient supports in place to protect them (Kelly, 2022; Tomlinson, 2019). Unlike domestic students, these migrant-worker students do not qualify for mental health leaves and fear deportation if they disclose difficulties, thereby increasing their distress, leading to potential avoidance of counselling services. Unlike traditional international students, students from “higher risk, lower yield” recruitment fields often use the entirety of a family’s pooled savings to travel to Canada, with the expectation the student will lift their village out of poverty by working in Canada immediately upon arrival (Trilokekar & Kizilbash 2013, p.18). Some Indian students have reported crowded living conditions, including rotational sleeping shifts in shared rooms in order to afford housing in Canada, impacting their abilities to sleep, eat, and study properly (Kelly, 2022). This population of students is only set to grow as immigration to Canada shifts away from skilled professionals, who often struggle to obtain satisfying work commensurate with their skills (Statistics Canada, 2010), towards the “Temporary-to-Permanent immigrant pathway,” favouring international students and temporary foreign workers, who can fill low-wage labour gaps (Singer, 2022). CPs must delicately address low skills among these 28 students when they have difficulty qualifying for work in Canada, where employers have no incentive to hire under-skilled workers whom the educational institution accepted tuition from and granted a visa to. Studies of Indian international students find high risk of suicide for those who fail to graduate or gain employment, as they experience astounding financial pressures if forced to return home to pay off Canadian tuition debts with Indian currency. Inability to pay tuition, immigration denial, and gambling issues were implicated in a number of suicides of Indian students in Australia. Australia has begun training staff who interact with high risk international students on warning signs of distress, such as overworking, suspension from studies, and substance use, as well as using Chinese and Indian social media message boards to reach at-risk students (Shelton et al., 2019; Trilokekar & Kizilbash, 2013). Faculty have complained of pressures to pass desperate students with very low English skills, causing some programs to re-test English skills upon arrival due to the prevalence of false records and brides to recruiters (Teotonio et al., 2019; Todd, 2017; Tyre, 2016). Canada’s auditor general has highlighted risks of fraud and corruption within the sector (Office of the Auditor General, 2017; Teotonio et al., 2019), as migrant student-workers are too afraid to come forward to ask for help (Scott et al., 2019; Trilokekar & Kizilbash, 2013). Some international students have arrived at private colleges in Canada only to find that courses are a sham, often cancelled and with little instruction. Students are typically unable to obtain tuition refunds, and lack the English language or high school equivalency to transfer to a public community college, forcing them to work illegally if they lose their student visa status (Singh, 2023). Ireland, aware of similar problems, offers amnesty to students who come forward about employer abuse and mental health distress, even if they had falsified their records or worked outside of labour laws (Keung et al., 2019). Thus, CPs are likely to work with highly vulnerable students facing 29 unusually high career, financial, and mental health pressures, who are necessarily avoidant of counselling due to their precarious immigration situation. 2.2.3.5 Integrated Nature of Client Career and Personal Issues. Counselling and career scholars agree that personal and career issues cannot be siloed, as career concerns are often intertwined with issues of financial stress, identity, academics, self-concept, and basic personal and family needs. Large international studies find that students need life wide guidance for all areas of life, and that CPs must be able to straddle both personal and career support (Borgen &Hiebert, 2014). Brown (2002) found that a majority of campus CPs without counsellor training provided personal counselling, because career and personal issues could not be separated. In his review of career services in American colleges, Schaub (2012) found that 14% of students were explicitly receiving both personal counselling and career support within the same session, due to the interaction between vocational and psychological issues, such as career decision making, dysfunctional career thoughts, anxiety, and depression. He argued that career staff walk a “fine line” between career and personal counselling, because only 25% of campus CPs were trained counsellors (Schaub, 2012, p.212). Similar arguments have been made about academic advising, calling for stronger referral and mental health training among advising staff (Robbins, 2012), as studies find that most university administrators report feeling under-prepared and under-trained to deal with student wellness needs (Anderson & Kretovics, 2013). Studies have found vocational concerns are associated with high levels of anxiety, depression, and distress among students, but that students experiencing career distress are less likely to seek personal counselling support (Fouad et al., 2006). Chen (2008) suggests that CPs must be prepared to provide resilience coping strategies for common career emotions such as bitterness, anger, loss, worthlessness, and hopelessness, 30 which often arise after drastic life role changes and loss of professional identity. The Canadian Association of College and University Student Services (CACUSS) warns that separating students supports into artificial silos slows the continuum of care, when career and academic stress may be intrinsically tied to mental and physical health problems (MacKean, 2011), where issues in any one category can have a domino effect on overall student health and functioning (Patterson & Klein 2008). Various studies find long-term unemployment increases the risk of depression, feelings of worthlessness, and leads to higher rates of substance abuse and social isolation (Redekopp & Huston 2020). Job loss is associated with grief and hopelessness which often require emotional counselling to avoid entrenched unemployment (Borgen & Amundson, 1987). Fouad and colleagues (2016) found that more students were seeking counselling for vocational related distress over the past 13 years, and that 60% of clients presenting for career counselling were distressed, compared to 13% of the general population. Thus, the intertwined nature of personal, emotional, and career matters increases the likelihood of mental health issues presenting in CP sessions. 2.2.4 Practitioner Factors Which May Amplify Mental Health Risks in Career Sessions 2.2.4.1 Variations in CP training. Variations in training among CPs poses risk that mental health issues will remain unrecognized in session, posing risks of deterioration and delayed care. An international review of Canada’s CP sector found guidelines to be “patchy, optional, and rarely enforced” (OECD, 2002c, p.14), and they called particular attention to the risk of under-trained CPs providing career counselling and guidance to university students. The review argued that increased accountability is urgently needed to protect the public and educational investments, with clear delineation of roles and titles (advising, guidance, coaching, counselling) and clear minimum training credentials (OECD, 2001). Countries such as 31 Australia, the UK, Germany, and Norway have implemented clear training standards and requirements for each role of service (OECD 2002b,d), but Canada continues to allow CP sites to determine their own titles of practice and scope, which critics consider “chaotic” (OECD, 2002c, p.20). A 2010 task force of career service found the use of various titles in Canada to be unrestrained and arbitrary with no agreed upon meaning to the practitioner or consumer of services to delineate training required, service provided, or the scope of boundaries of services, where 37% of CPs didn’t fit into any one of the 13 titles typically used (Burwell & Kalbfleisch, 2007). While efforts are underway to establish a national framework for CPs, this has yet to be established, and there remain more than 40 organizations in Canada which support career professionals leading to a confusing array of voluntary guidelines (Shepard & Mani, 2013). Experts argue that lack of graduate career counselling training creates a vacuum, where only those with diploma, certificate, or career coach training fill the need for career counselling appointments. Hiring challenges within the field are reported as insufficient candidates with career counselling experience, difficulty in assessing competence, lack of national credentials, and limited staff training budgets (CERIC, 2019). Career service training programs emphasize employment strategies and labour market knowledge, but lack mental health or counselling training (Burwell, & Kalbfleisch, 2007). In a survey of campus CPs (CERIC, 2019) it was found that only 19% had any university level applied counselling training, whereas 79% of respondents stated they most commonly provide career counselling or career coaching (i.e. closed-door services). Additionally, 35% of CPs practiced with a bachelor’s degree or diploma or less, and that 75% wanted more training on clear credentials and scope of practice. Brown’s research found that non-licenced career practitioners without formal graduate career counselling training 32 were less likely to read career research journals, attend conferences, or agree that practice should be informed by career theory, research, and data, as their training did not focus on these areas (Brown, 2002). Hung (2018) argued that campus leaders underestimate the risks posed by well-intentioned but undertrained CPs working with vulnerable career clients. Several experts have recommended that career counsellors should have an MA degree or higher (OECD, 2004) and that career coaching should require at least a BA, but preferably an MA (Burwell et al., 2010), with Quebec serving as a model for English-Speaking Canada. Multiple scholars have argued that the rapidly changing nature of labour markets require continual upgrading of CP skills and training to reduce risks (Bimrose, 2006; Burwell & Kalbfleisch, 2007; Schaub, 2012). 2.2.4.2 Misinformation Within Coach Training. Misinformation within the career coaching sector may expose career clients with mental health needs to risk of deterioration and delayed care. Career coaching is commonly used in closed-door career service sessions, as a lower cost substitute for counselling, yet coaching does not require completion of any specific training, standardized credentialing, or membership with any coaching organization (Sass, 2016). Low barriers to entry and a lucrative unregulated training sector led to an estimated 41,300 coaches practicing worldwide by 2012, matching or outpacing those training as Career Development Practitioners (Yoon et al., 2018). Coaching as a practice is in its infancy, with the bulk of academic scholarship devoted to issues of professional identity and scope of practice (Passmore & Lai, 2019). The Global Convention on Coaching Psychology has called for urgent improvements to reduce misinformation within the commercial coaching marketplace, where ethics, standards, and regulations lag practice (Stern & Stout-Roston, 2013). Yoon et al. (2018) noted that career coaching is a high risk area internationally which has to date been ignored by regulators in both Canada and the USA. The Canadian Standards and Guidelines (S&G) still 33 provides no competency requirements or definitions for career coaching, only describing it as a parallel alternative for individual career counselling (Standards and Guidelines, 2021). Common coaching misinformation includes framing coaching as forward and solution-focused, and counselling as past-oriented, expert-driven, and problem-focused, and framing clients as whole, resourceful, and complete without any need for screening to ascertain issues which could impede coaching (Hullinger, & DiGirolamo, 2018). This philosophy assumes that clients are responsible for and capable of managing any content they bring forth in session. Coaching misinformation may be particularly pervasive within campus career services, in that organizations which sell coach training to campus leaders also publish articles about coaching, blurring the line between information and marketing. The National Association of Colleges and Employers (NACE) has featured articles claiming that some campuses use coaching exclusively with students as a new paradigm which is a more modern, student-centred, positive, future, action-oriented approach, within a partnership of equals, in contrast to career counselling, which they describe as outdated, diagnostic, biographical, focused on problems and the past, within a medical expert relationship. These writings claim that students can unlock new career opportunities via positive thinking rather than talking about problems (Brooks, 2005, 2011; Koppi, 2018). This approach may overemphasize the power of cognitive reframing, reinforce emotion avoidance, ignore systemic career barriers beyond client control, mis-portray counselling relative to coaching, and place too much locus of responsibility at the individual level, all of which can delay career progress. Research finds that both emotional processing and goal-oriented action are important, but that the latter must not precede or preclude the former depending on client need, which coach training typically does not cover (Bastian et al., 2011; Borgen & Amundson, 1987; Ford et al., 2018; Laaksonen et al, 2013; Mitchelmore, 2015) 34 In practice, coaching draws from behavioural and cognitive approaches, with a focus on action, goals, and healthy populations, as well as organizational contexts (Australian Psychological Society, 2023). Early coaching programs were specifically designed for American psychologists—who already possessed mental health screening skills-- seeking to reach new clients outside of the American private medical system under the label of coaching (Sanchez & Turner, 2003; Williams, 2010). These same programs were later marketed in the recession of the 1980s and 1990s to laid-off professionals from a range of fields, who lacked mental health training, as an entrepreneurial income opportunity (Evans & Lines, 2014). Within organizations, career coaching is used internally by human resource managers to optimize competitive performance for high-functioning leaders, or with a remedial focus for lower functioning staff, to transport them (as in a coach) from A to B (Chung & Gfrorer, 2003; Cooper, 2019; Sass, 2016). Internal career coaching naturally constrains the risk and scope of practice to job-specific tasks, unlike the “wild west” of commercial career coach training (Feldman, 2001, p.34) where a Board Certified Coach credential can be obtained over three days of online training for $2000. Many coach training programs conflate therapy with psychiatry and pathology, positioning coaching as the positive humanistic solution to the medical model, where coaching can be used with anyone from family and friends, and where no experience is needed to be a coach (Cook, 2009; Payne, 2007). The International Coaching Federation (ICF), the largest commercial coaching organization, defines coaching as: Partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential…[where] coaching clients are considered whole, resourceful, and complete...whereas psychotherapy is based on the medical model, a pathological perspective in which behaviour is regarded as 35 psychologically abnormal or unhealthy, provoking shame and inadequacy, causing a person to feel worse...labeling a person as abnormal or with a disorder contributes to the stigmatization that goes along with therapy [in contrast to coaching which does not label]. (Hullinger & DiGirolamo, 2018, pp.5-6) This misrepresents coaching as the positive solution for a proposed gap in the helping marketplace, a space which counselling psychology was in part designed to address. Experts argue that coaching is simply a repackaging of a subset of counselling and education skills under a new umbrella term, fueled by consultants or psychologists seeking to expand their client markets (Diedrich & Kilburg, 2001; Kampa-Kokesch, & Anderson, 2001). Others suggest that the dichotomy of coaching versus therapy is a false one as coaching is on a spectrum with therapy (Sass, 2016). Some suggest that coaching is one skill that can be useful in certain contexts, but may not be appropriate in others (Athanasou & Van Esbroeck, 2008). A qualitative study of 424 career coaches in the USA identified common core competencies ranging from life-balance and stress-management techniques, to goal-setting, coping with change, hiring, team-building, and leadership training (Hatala and Hinsey, 2011), but high quality studies of coaching effectiveness are limited (Passmore & Fillery-Travis, 2011). Ultimately, depending on their exposure to coaching training and marketing, some CPs without mental health training may believe that a vacuum exists in the market for positive psychology which coaching can best address, which may impact timely referrals and recognition of mental health needs. 2.2.4.3 Vague Boundaries Between Coaching and Therapy. Coach training materials specifically advise that coaches must refer out mental health issues, but research indicates that lack of counselling training makes it difficult for coaches to recognize when they are in therapeutic territory with clients. Interview studies reveal that coaches often work covertly with 36 therapeutic material, despite explicit statements to the contrary, and that boundaries in practice depend on perceptions and beliefs of individual coaches. Sime and Jacob (2018) found that coaches formed psychological hypotheses about their clients, and worked on a wide range of deep, complex emotional issues, without supervision or training to recognize there were doing so, unaware of potential risks of unsafe emotional processing, with coaching philosophy granting coaches permission to work with any content that arises, despite having no mental health training or screening in place (Sime & Jacob, 2018). Price’s (2009) study of 192 organizational coaches found 22% of coaches reported being comfortable to move outside of their area of competence and treat therapeutic issues, with no therapeutic training for clients with significant mental health challenges. The vast majority of those with no therapy training did not perceive psychological training as relevant in a coach’s appraisal in determining content and scope of practice. While coaches stated that coaching was only suited for mentally healthy clients and was more future and goal-oriented, their actual descriptions of practice revealed their work was therapeutic in nature, which they lacked psychology training to recognize (Price, 2009). Sass (2016) likewise found that non-clinically trained coaches lacked therapeutic training to recognize boundaries of practice between coaching and therapy in ethical vignettes, as well as the need for such boundaries, or psychological issues in need of referral. Human resource scholars suggest that executive coaches often act as “part consultant, part sounding board, part therapist...where coaching is a [more] acceptable form of psychotherapy” (Morris, 2000, p.2). Maxwell’s 2009 study likewise found that coaches regularly worked with deep psychological issues, because psychological issues often impede performance goals. Researchers thus recommend that coach training should include core mental health skills, and that coaching should be considered a branch of counselling psychology (Maxwell 2009; Price, 2009; Sass, 2016; Sime 37 & Jacob, 2018) Similarly, research in the UK found that staff did not understand the differences in their career service titles, and would not stop providing service to a client if switching from advice to guidance or counselling within a particular session (OECD, 2002d). The OECD found that a range of similar titles obfuscates actual service delivery, and that in practice CPs should tailor their services to client needs in session, and be afforded more training on complex mental health issues to do so (Yoon et al., 2018). Bimrose (2006) found that lack of boundaries between coaching and counselling leads to frustration and confusion in the career field in the UK, echoing disagreement over scope, boundaries, and functions of coaches versus counsellors in general (Hart et al., 2001; Williams, 2003). Those trained in both therapy and coaching warn that they offer either coaching or therapy to a client but not both, due to differences in disclosure, directiveness, and power differentials (Hart et al., 2001). Because career coaching often involves improving the marketability and employability of a client, (how can I be better?) the focus on appraisal and feedback to mold the client for hire can impair a safe therapeutic alliance for healing issues of self-worth and self-acceptance (Fennah, 2019). Thus, well-intentioned coaches may enter into therapeutic territory without awareness, exposing clients to harm and themselves to liability. 2.2.4.4 Limitations of Coaching Interventions. CPs trained only in commercial coaching may lack training to recognize issues best suited for counselling, and may have been misinformed about the limitations or risks of the formula they are trained within. Critics of coaching argue that “when all you have is a hammer, everything looks like a nail” (Berglas, 2002, p.8). Spinelli (2008) explains that career coaches often possess superior organizational knowledge, but are limited by narrow interventions best suited to superficial issues, when deeper 38 therapeutic interventions may be more effective. Brown’s study of 86 career counsellors found that a broad range of interventions were needed in addressing career matters, highlighting the risk of a narrow intervention approach (Brown, 2002). Feldman (2002) argues that career coaching is appropriate for surface work-specific skill development, but not for holistic career or personal issues, as coaching programs typically emphasize solution-focused and cognitive approaches. One NACE article advised that coaches should not “buy into” attempts to discuss negative emotion, but rather ask students “what went well? what can you do next?”(Brooks, 2011, p.32). Research is clear on both the utility and the limitations of short-term solution-focused approaches, and student well-being may suffer if not allowed to process emotion typical of career problems: A study of 198 clients with anxiety and depressive mood disorders impacting their work found that some received less benefit from solution-focused short-term therapy and would be better matched with a different therapy to avoid deterioration, delay, and suffering depending on personal and context factors (Laaksonen, et al., 2013). Reid (2016) cautions that solution-focused problem-free talk can result in selective summarizing, resulting in short-term action rather than meaningful change. Chiu (2020) cautions that it is possible to experience grief and loss, while still looking towards the future. Studies find that those who can accept and experience negative emotion, rather than avoiding or suppressing it, experience better overall psychological health (Ford et al., 2018). Mitchelmore (2015) argues that moving too quickly towards action may leave a client feeling their pain is minimized and that it is not safe to discuss difficulties. Early research finds that when clients lack safe space to process difficult emotions, the may begin to internalize feelings of low self-worth and lose sight of barriers to career goals, whereas helping clients to make sense of difficult emotion helps to regain a sense of personal 39 control, towards new plans of action (Borgen & Amundson, 1987). Four large undergraduate studies found that promotion of feeling good over feeling bad leads students to feel bad more intensely and more often (Bastian et al., 2011). Counsellors are thus recommended to normalize sharing of negative emotion for a meaningful rich life, to reduce suppression and negative outcomes. Meta-analysis into the effectiveness of CBT and other short-term low-cost reframing therapies finds no superiority over other therapies, with applicability determined by presenting issue (Wampold et al., 2017). Lastly, solution-oriented CBT may be less applicable with career clients who are more distant from labour markets, who are immigrants, offenders, or others with complex needs, where lack of employment is not based on negative thinking but rather on context (Neary, 2014). Thus, CPs trained only in solution-focused positive coaching approaches may unintentionally pose risks of client deterioration or delayed care. 2.2.4.5 Presenting Issues Contraindicated for Coaching. CPs without counselling training may not be aware that certain client issues can be worsened within a coaching approach. ADHD: ADHD is commonly diagnosed in university and work settings due to impacts on work and studies, such that some campuses have dedicated ADHD diagnosis centres (Pazol & Griggins, 2012.) Coaching which is not tailored to account for ADHD can unwittingly entrench client sense of failure, where individuals with untreated ADHD are at higher risk of school drop-out, suicide, job loss, intense emotions, anger issues, relationship problems, substance abuse, and accidents (Barkley, 2017; Pazol & Griggins, 2012; Prevatt et al., 2017). Maladaptive Perfectionism: Students with perfectionistic standards may be prevalent in coaching caseloads, where career coaching focuses on enhancing and sustaining employability, and improving how one’s performance and identity are appraised by others (Van Norman, 2016). 40 Corrie and Palmer (2014) argue that coaching psychologists must be able to identify warning signs of maladaptive perfectionism, which is a risk-factor for low help-seeking, and which typically requires long-term attachment oriented psychotherapy rather than cognitive behavioural approaches (Ward & Ashby, 2008). Clinical Narcissism: Some experts highlight the prevalence of narcissism in business coaching clients, where a drive to succeed at all cost may eventually reveal narcissistic issues, an unhealthy stress coping, where clients with narcissistic traits or self-esteem issues may be drawn to success the coach has achieved in their own lives. Behaviourism may cause the coach to focus on the problem (symptom) rather than recognizing bigger underlying issues that require therapeutic interventions (Berglas, 2002; Rook et al., 2019). Very Low Performance: Feldman (2002) suggests that career coaching with employees is contraindicated for clients facing personal or family crises, with addictive behaviours, with poor generic management skills, with plateaued performance, with discrepant core values, with borderline illegal work/study behaviour, and with those who lack of self-insight or ability to self-monitor. Sass (2016) likewise found that very low performers were contraindicated for coaching, even though performance management problems are often inappropriately off-loaded to coaches. Undermanaged Biopsychosocial Issues: The ICF (2014) posits that 25% of voluntary coaching clients may be too distressed to benefit from coaching, even though they purposely seek coaching out of stigma against counselling. Coaches are advised to track for lack of progress as a warning sign (DSM issues, under-managed health issues, crisis, intense grief etc.) that therapy referral is needed, to avoid causing harm. Trauma: Psychotherapy which does not build emotional containment and safety can lead to client deterioration, re-traumatization, and increased severity of symptoms in PTSD. Career 41 staff must be attuned to students from countries with a recent history of war or political trauma, where 20 of the top countries sending international students to North America have experienced war or political trauma in recent generations, as these students often present for career supports (Jackson & Seeman, 2008). Assertiveness: Behavioural skill training is contraindicated for certain client contexts and cultures, where increased assertiveness, for instance, may lead to increased risk of domestic violence within one’s family system. Coaches must also assess client context and individual differences and tailor workplace advice for gender and culture, where workplace behaviour rewarded for a man may be counterproductive for a woman (Gazdag, 2020). Directiveness: Enhancing self-directiveness is a cornerstone of career service practice (Shepard & Mani, 2013) but clients experiencing abuse, poverty, or other crisis in their ecosystem, or in need of expedited mental health referrals may experience delayed care within a non-directive approach. Coaching uses non-directive questioning methods to build agency (how could you find the support you need right now?); however, research finds this Western-centric approach may reduce client sense of safety in some cases (Higgins et al., 2008). International students often require directive advice about the nature of work roles and responsibilities in Canada in order to secure employment, particularly if they come from a hierarchical culture (Arthur & Flynn, 2013). 2.2.4.6 Lack of Diversity Competence. Research indicates that some CPs may lack sufficient diversity competence, presenting the risk that CP sessions may be a site of oppression in perpetuating bias and invisible barriers in the labour market. CPs have an important role to play in addressing social justice issues for underserved career clients: Student with disabilities have a nearly 10 times higher rate of unemployment (Shepard & Mani, 2013); in Canada it takes 42 a student from a low-income family four generations to attain the median national income level compared to a child from a wealthy family (World Economic Forum (WEF), 2020). Researchers find that lack of English skills, work experience, and ‘Canadianness’ impedes employment for international students, who fare worse than other immigrants, with lower job satisfaction, less use of credentials, and less pay than their peers (Arthur, 2017; Arthur & Flynn, 2013; Barriga, 2021; Scott et al., 2015; Woodend & Arthur, 2017 ). It takes 15 years for foreign-born workers to make the same amount of income as Canadian-born workers with the same education (OECD, 2002c; Fadulu, 2018; Pfeffer & Killewald, 2018) due to lack of social capital and racial discrimination in the hiring process (Kang et al., 2016; Kwak & Kim, 2019). Furthermore, Canada has more university educated workers than any other OECD country at 39%, but inclusion in the workforce and wages of women relative to education remains low (WEF, 2020). Only 6% of Indigenous young adults attend university, relative to 24% of non-Indigenous students, and Western career development services are often inappropriate for Indigenous student career needs, context, and barriers (Stewart & Reeves, 2013.) Some CPs report that international students lack skills to “sell themselves” to Canadian employers, and CPs lack cross-cultural competence to adequately help such clients within current Western-centric models (Woodend, 2018). Scholars warn that some traditional career theories and interventions contain ingrained cultural bias, where CPs can perpetuate bias and social oppression via unobtainable ideals of preferred careers, if systemic forces and barriers which render employment unequally available to different groups are ignored (Bepple, 2014). Scholars call for CPs to help diverse students build connections and resources, via volunteering, social groups, and educating faculty on means to internationalize their classrooms, to break down stereotypes which impeded access to labour markets (Arthur & Arthur, 2014; Bowering et al., 43 2020; Kwak & Kim, 2019; Woodend, 2018) and to build their cross-cultural competence via various avenues (Neault, 2006). Collins and colleagues (2015) found that the vast majority of CPs in Canada reported no practical social justice skills or means to utilize diversity skills in a culturally sensitive working alliance, and lack of organizational support for social justice training, along with low advocacy skills (Collins et al., 2015). Coaching studies emphasize the importance of culturally sensitive coaching to maintain engagement and relevance (Couch & Rose, 2020) and the ICF requires that career coaches pledge to be cross-culturally aware, but no diversity training is required to obtain coaching credentials, posing risk of client harm in session. 2.2.4.7 Lack of Psychometric/Assessment Training. Vocational scholars recommend that assessment be embedded in the career counselling process to help clients address work and personal issues in productive ways (Whiston & Raharjda, 2005). However, Oliver and Whiston (2000) highlighted the prevalence of internet-based career assessments with little available psychometric data and the need for more research into online career tools widely used, while some commonly used career assessments (MBIT) have faced criticism for lack of empirical utility in counselling (Pittenger, 2005). Within the commercial coaching industry, costly assessments with little validity evidence serve as income streams for coach trainers, which well-intentioned coaches may not be able to properly assess, exposing clients to risk of harm. Sass (2016) found that coaches without clinical psychology training did not recognize ethical risks in the misuse of assessments in vignette samples, and they were unaware of general ethical pitfalls of assessment use. She found that coaches frequently used personality assessments to identify behavioural tendencies, areas of development, and client perception, despite no reference to ethical use of assessment in coaching ethical codes. This is in contrast to trained clinical psychologist-coaches who are trained in a higher number and array of psychometric tools, 44 including their appropriate interpretation, use, and debrief, as well as in proper ethical management and care of assessment data (Sass, 2016). Thus, lack of psychometric training among CPs increases risk of harm within CP sessions where a range of assessments may be used. 2.2.4.8 Limited Ethics Training. Whereas clinical counsellors are required to undergo extensive ethics training, CP and coach training in ethics is limited and optional. CP credentials are voluntary, and require only 10 hours of introductory career ethics studies (British Columbia Career Development Association (BCCDA), 2021). The Alberta CCDP credential requires that practitioners must agree to abide by ethical standards outlined in the Canadian Standards and Guidelines (CDAA, 2017; S&G, 2023), rather that requiring rigorous training in working through ethical dilemmas. The ICF requires viewing of a 30 minute ethics video followed by a short self-quiz (ICF, 2021a). This may present ethics as a professional code of conduct, whereby one agrees to act ethically, as though ethics are black or white, rather than grey, complex, and unavoidable, as they are framed in psychology training. Most coaching programs present ethics as a checklist of items including a pledge of agreement to a standard of conduct rules, which may act as a waiver to indemnify ICF from coach liability, rather than providing practical training in how to work through complex ethical issues (Certified Coaches Federation (CCF), 2021; ICF, 2021a). Sass (2016) found that coaching ethical codes lacked specificity and do not cover a range of areas typical of coaching practice which differ from psychology, leaving coaches to determine what is harmful or unethical. She found that clinically trained psychology coaches reported twice as many ethical concerns as non-clinical trained coaches in ethical vignettes, and coaches lacked skills necessary to recognize ethical issues relating to boundary violations and pathology among others. Sass suggested that psychologist-trained coaches should work alongside the APA to establish where coaching rests on a continuum from therapy, in order to improve safety for 45 clients, coaches, and sponsors of coaching (Sass, 2016). In response to growing ethical complaints against coaches, the ICF established a complaint process against coach training providers and coaches. They advise that top ethical breaches for coaches include unclear agreements, misrepresentation of services and credentials, lack of confidentiality, conflict of interest, inappropriate relations with clients, lack of awareness regarding referrals, and not respecting client right to end coaching arrangements (ICF, 2014). Sass’ (2016) survey of 68 coaches found similar ethical issues in addition to issues with contracting, conflicts of interest, informed consent, multiple relationships, diversity issues, misuse of assessment, record keeping and supervision. In recognition of the lack of ethical resources in the career field, the NCDA published a companion ethical guide for CPs (Makela, 2009). The guide highlights the problem of varying ethical codes in the career service field, lack of practical training on how to recognize and work through ethical issues, as well as unique risks in career work as important ethical gaps within the industry. CERIC highlights that many ethical issues arise more commonly in CP sessions, such as advising clients with disabilities on when to disclose or conceal needs for accommodation in the hiring process, whitening of resumes to overcome hiring bias, and juggling multiple offers (Smith, 2020), which CPs may not be sufficiently trained in. 2.2.4.9 Lack of Training on Closed-Door Sessions Risks (Transference etc.). A variety of risks are inherent in ongoing helping relationships focused on disclosure of private hopes, dreams, and challenges, regardless of practitioner approach. These risks are covered in graduate counselling programs, but they are not covered in CP or coach training. De Hann (2011) found that many coaches lacked training and understanding of transference, countertransference, and parallel processes such as collusion, abuse of power, illusion of power, 46 and pleasing tendencies that arose and at times deteriorated coaching. De Hann argued that coaches who lack training in these areas may reinforce their own hidden agendas and miss powerful opportunities for client or coach growth, viewing clients as not ready for coaching or non-compliant. Hart et al. (2001) found that coaching sessions can bring forth powerful issues of transference and countertransference, due to highly intimate dialogues and power differentials, which coaches are not trained to recognize or address. Some practitioners and scholars argue that issues of transference are more relevant in coaching, where the self of the coach is often more “in the room” in that coaches may be expected to mentor, lead by example, and guide clients in areas they themselves have mastered (De Hann, 2011). Coaches are expected to have strong career biographies to facilitate client buy-in and progress, which may increase certain transference/counter-transference issues, which coaches may not be equipped to recognize, manage, or avoid (Spinelli, 2008). Indeed, the ICF ethical statements (item 11) claims that coaching takes place at the level of equivalence, where there is no power differential in the coaching relationship, thereby ignoring transference risks in coach training, (ICF, 2021b), which has been echoed in National Association of Colleges and Educators (NACE) newsletters for CPs which state that coaching is a relationship of equals (Koppi, 2018). Conversely, CERIC explains that power imbalances are inherent in professional/client relationships, and that the CP is accountable for managing boundary issues, given that clients may find it difficult to recognize when they initiate behaviour or make requests which violate boundaries. However, the CERIC textbook for CPs provides only introductions to ethics as a chapter overview, and transference, for instance, is not covered (Shepard & Mani, 2013). Thus, CPs may be misinformed or uninformed about transference risks inherent in closed-door career sessions, posing risk of client harm. 47 2.2.5 Administrative Factors Which May Amplify Mental Health Risks in Career Services 2.2.5.1 Lack of Clinical Supervision. Clinical supervision is a core risk-reduction component of counselling psychology practice, which is largely absent in career services. Clinical supervision is a confidential collaborative relationship intended to help supervisees maintain ethical and professional standards of practice and competence development, which is explicitly separate from managerial supervision (Gray, 2007; Tkach & DiGirolamo, 2017; Whitely, 1980; Worthington et al., 2002). CERIC suggests that CPs operate within a clear clinical supervision structure to address ethical issues (Shepard & Mani, 2013). Coaching psychology scholars propose that a networked model of supervision for coaching be used, given the multiple stakeholders and skills involved, where coaching supervision can be augmented with psychology supervision as needed based on the arising issues (Gray, 2007). Hart and colleagues (2001) argue that coaches may require supervision more than counsellors due to lack of training in ethical dilemmas, boundary/transference issues, trauma, or clinical signs of health issues (Tkach & DiGirolamo, 2017). Despite these recommendations, clinical supervision is rare in campus career services and CP sessions. The CERIC guide for best practice guide for campus career directors (Van Norman, 2016) makes no mention of clinical supervision, and supervised clinical practice is not required to work as a CP. Similarly, supervision is not required to register as a career coach via ICF, the largest international coaching body. Gray (2007) reports that a third of coaches have no supervision, and another third have only an informal peer supervisor, due to a lack of qualified coach supervisors. He argues that universities who employ coaches may not be aware of the supervision required in coaching practice. A survey of 218 coaches found that 68% of coaches in Canada and the USA deemed supervision unnecessary, believing that supervision could limit 48 creativity and freedom, violate client confidentiality, and breed conformity, revealing a misconception that supervision may be policing or managerial in nature (Salter, 2008). Day and colleagues (2008) found that coaches who lacked supervision reacted to client issues, resulting in premature coaching termination, highlighting the importance of coaches having a deep understanding of the psychology of intimate helping relationships, of having insight into their own vulnerabilities and insecurities, and of the importance of regular supervision (Day et al., 2008). An interview study of coach supervisors found that coaches frequently colluded with powerful clients, overstepped boundaries, pushed clients too far in their own agenda, and neglected issues more appropriate for therapy referral (Bachkirova, 2015). Thus, the absence of clinical supervision in campus career services, or awareness of its utility, may exacerbate mental health risks within CP sessions. 2.2.5.2 Dual and Multiple Relationships. Dual and multiple relationships are a key area of ethical risk in counselling practice, yet these are not covered in CP or coach training, despite multiple relationships being more common in coaching (Gray, 2007). Unlike clinical counsellors, CPs are often assigned to coach entire cohorts of students, and career coaching sessions are often sponsored by the faculty or program which is invested in the successful outcomes of the student, acting as the invisible third client (Gray, 2007). In such cases, coaching may be mandated to improve completion rates, reputation, and visa granting status (funding) for the program, exposing the CP to dual and multiple relationships, where the unit of confidentiality is unclear, all of which should be clarified in the disclosure and consent process (Sass, 2016). A review of coaching ethical codes found that greater specificity is needed to address multiple and dual relationships in coaching, where a majority of ethical dilemmas arise due to confidentiality issues within the triangle of sponsored coaching (Gray, 2007). Non-clinically trained coaches were not 49 able to recognize dual or multiple relationships in vignette samples, as they were not trained on the importance of separating therapeutic and non-therapeutic roles in the coaching context (Sass, 2016). Thus, lack of training on multiple relationships despite their prevalence increases risk of harm within CP sessions. 2.2.5.3 Lack of Clear Disclosure and Consent. Disclosure and consent are core elements of ethical practice in counselling psychology to protect clients from harm and to protect practitioners from liability. Studies find that consent forms are considered difficult to comprehend for the average student, especially for those for whom English is a second language (Lustgarten et al., 2017). Counselling credentialing bodies typically recommend inclusion of therapist qualifications, training, or credentials, whether a trainee is under supervision, the supervisor’s credentials, links to their credentialing bodies, and limits of confidentiality, including clarification of the unit of confidentiality in cases of dual, sponsored, or multiple clients. This is in contrast to CP sessions, where disclosure and consent may be more limited, specifically with regards to clarifying credentials, where varied titles and degrees may play upon student assumptions about training a CP may not possess, for instance, where a graduate degree in psychology or education may imply clinical training, when none was completed. CPs trained only in coaching may utilize contracting, which is used to clarify goals, but which also may be used to enhance client motivation and commitment to (purchase) coaching, rather than on ongoing consent process prioritizing client safety (Gray, 2007). Hung (2018) argues that university career centres in Canada delegate and diffuse career responsibilities to staff and peer helpers under varying nomenclature, creating risk and confusion for vulnerable students. She suggests that titles in the career sector are blurred and obfuscated, and that clients should be provided with informed consent about where their practitioner falls on 50 a spectrum of training credentialing, whether they have had no clinical supervision, no graduate training in guidance or counselling, and whether they are not accountable to any professional association for credentialing (Hung, 2018). Coaching scholars suggest that coaching disclosure should clarify whether coaches are receiving peer or group supervision from master coaches or have psychologist oversight, as well as covering the limitations of confidentiality if sponsors request knowledge of performance issues, for instance (Gray, 2007). Hart and colleagues (2001) note that lack of clarity over confidentiality and ethics are concerns in coaching, recommending that coaches delineate to clients limits of their practice and scope. The authors note that the state of Washington requires all coaches to register as counsellors due to similarity of risks (Hart et al., 2001). Thus, weak disclosure and consent may increase risks of liability, job strain, and client deterioration in CP sessions. 2.2.5.4 Lack of Case-Management Standardization. Secure case management software and standardized management of client records and note-taking are core elements of ethically safe practice in counselling psychology (Castonguay, 2013). Purpose-designed software is used to note and track all client communications, including email, phone calls, and in-person sessions, including counsellor action taken and tracking of risk, where counsellors complete specific coursework and practical training on proper record keeping, which is assessed continually under supervision, to reduce liability and to avoid client harm. The government of Quebec clearly outlines in detail how notes must be recorded in career counselling practice over 22 specific legislated items to protect clients and reduce liability (Quebec, 2020, C-26 r221), which include consent around third parties in sponsorship and destruction of records, none of which are delineated in CP practice outside of Quebec. Use of such software is not standardized or required in campus career services, such that breaches of confidentiality, lack of safe tracking, and 51 maintenance of records may occur. Training in such risks is required to build sensitivity to such risks, which campus career centre directors and CPs may not be aware of, exposing clients to additional confidentiality and boundary risks. 2.3 Burnout High prevalence of mental health issues beyond their training leave CPs at high risk of job-strain, burnout, and compassion fatigue. CERIC’s practice guidelines ask CPs to support clients with mental health issues as they pertain to career, and to nurture a warm empathic working alliance, which counsellors invest several years of practice to learn how to manage safely, yet which CP training programs may not cover in as much detail. Surveys consistently find that CPs are at high risk of compassion fatigue due to lack of mental health competence. CPs report increased disclosure of mental illness as a factor impeding client career goals, and a lack of skills, knowledge, and attitudes needed to support these issues (CERIC, 2012, 2015, 2016, 2019, 2020a, 2020b). A majority of CPs report their clients have mental health problems they are ill-equipped to handle (CERIC, 2020a, 2020b): A survey of CPs in Canada (CERIC, 2012) found that only 14% had mental health training, whereas 62% of their clients reported mental health problems. 42.7% of CPs reported they would like more training on supervision, ethical, and legal issues, 50.5% reported wanting training on stress-management, and 22.6% reported that developing emotional resilience, stress management, and coping with change were the primary career need of students at Canadian career centres (CERIC, 2019). Only 38% of clients felt CPs provided correct mental health referrals, and 50% of clients felt CPs lacked skills to support mental health issues relating to work (CERIC, 2012). Neault and Pickerell (2016) found that 50% of CPs intended to leave their field in the next year due to overwhelm, burnout, lack of supervisory support/guidance, high caseloads, poor 52 case management software, lack of work-life balance, and increasing complexity of client cases. Burwell and Kalbfleish (2007) argue that the de-professionalization of career counselling—the sense that anyone can perform the task without clinical training and that it is less important than personal counselling—leaves many under-trained CPs dealing with a range of client personal issues they are ill-equipped for. Brown’s study (2002) found that CPs without graduate counselling training reported lower self-efficacy and higher burnout rates compared to trained career counsellors. Sass (2016) found that coaches without clinical psychology training were not provided with ethical training relating to the importance of maintaining their own health and wellness, and were at higher risk of burnout in practice. 2.4 Need for Improved Identification of Mental Health Issues in Career Services Multiple approaches are needed to address the various means and pathways via which mental health risks may arise in career services; improved identification of mental health issues within CP sessions may represent one such aspect of mitigation. Screening can serve an important gatekeeping function to identify students in need of mental health support, whether in place of, or concurrent with, CP sessions. Screening for mental health counselling appointments on Canadian campuses is mandatory, to prioritize students in crisis, and to refer out those with less severe issues rooted in academics, or career, for instance (OECD, 2002c). Some research has considered more universal screening in educational settings as a method of prevention and proactive overall health, rather than only treating students who have significant distress to identify those who are struggling, and who may benefit from preventative psychosocial skill training (Dowdy et al., 2015; Kirshner, Marshall, & Poyner, 2017). Some have implemented web screening of graduate students to reach those with suicide risk who often do not seek help (Moffit et al., 2014); one university installed mental health computer kiosks across campus for 53 instant confidential “check-ups from the neck up” to improve identification of mental health needs (Schmalz, 2015). Due to an increase of students in crisis, Queen’s university revised training recommendations for counselling staff, to ensure that students be triaged by an experienced mental health nurse, and referred as necessary to clinical counselling, psychiatry, medical support or to a combination thereof, which is now common practice in larger Canadian universities (Queen’s University, 2012). Full psychological screening is also a key ethical component of career practice for licensed career counsellors in Quebec, which includes assessment of self-regulation, self-esteem, mental or neuropsychological disorders, and adjustment difficulties (Order of Career and Guidance Counsellors of Quebec (OCCOQ), 2011). Likewise, the National Career Development Association of the USA advises CPs to assess the mental health of their clients, in particular students and international students (Barriga, 2021). Yet, mental health screening is not standard practice in English-speaking Canada, where students are typically able to self-book closed-door CP sessions without any triage process, increasing the likelihood of CPs working with complex issues beyond their training. Some campus career centres may purposely not ask about mental health issues to avoid risk, which raises important legal issues of strategic or contrived ignorance, otherwise known as willful blindness (Bovensiepen & Pelkmans, 2020), when one purposely elects not to know information one could or should know, which workplace safety legislation specifically prohibits (Hall, 2015). Screening in career services is complicated by the fact that services operate on a spectrum of need, from simple drop-in resume critiques, to confidential career counselling/coaching sessions. Some studies have found that screening with psychological assessments pre-service may deter students who perceive significant stigma, which may be particularly relevant in career 54 service, where a larger proportion of campus career clients are international students or newcomers, who may be apprehensive about a focus on psychological problems (Mier et al., 2008). The NCDA thus draws a distinction between closed-door services, indicating that is the point when a referral should be made and when screening should take place, and that all career service staff providing open-door services be trained on recognizing red flags which signal a need for referral and screening at any point in the career service process (Makela, 2009). Given the wide array of career service titles in use in Canada (Burwell & Kalbfleisch, 2007), targeting training and screening requirements at those engaged in closed-door sessions may more reliably capture risk, rather than assigning requirements based on nomenclature which can be circumvented. A study of assessments in career services found that screening assessments for program/service readiness were infrequently used in English-speaking Canada, relative to exploration assessments which were widely used, even if practitioners were not trained in the use of the standardized tests (Shepard & Mani, 2013). CERIC’s textbook for career practice in Canada does not mention the use of any screening assessment or psychological assessment in career practice or readiness for service in their chapter on assessments used in career services (Shepard and Mani, 2013, chapter 17). Scholars have suggested that issues of role distinction in career services would be improved if some form of screening were in place, where a simple resume critique can quickly reveal student desperation and suicidal ideation, in urgent need of referral (Makela, 2009). Borgen and Hiebert (2014) suggested the boundaries between provision of advising (non-personalized information), guidance (tailored information), and counselling could be delineated by assessing whether information provision sufficiently meets the client’s need, or 55 whether deeper support was needed, such as emotional processing, psychoeducation, exploration of the past, family dynamics, anger, life roles, all signalling a need for personal career counselling (Borgen & Hiebert, 2014). Some campuses use length of service and privacy to delineate between open and closed-door services, where less trained staff and peer-advisors provide drop-in information appointments at open non-private counters, as a one-time only service, or with one follow-up, where clients who require ongoing private career support are referred to closed-door service (Makela, 2009). Berglas (2002) recommends that safeguards be implemented to screen clients to ensure they will benefit from coaching and to assess whether mental health issues were ignored by coaches or worsened/created by coaches. Coach training programs offer no coverage of mental health screening of clients, despite the expectation that coaches will recognize and refer out for mental health issues. Kretzschmar (2010) conducted a grounded-study into assessing readiness for coaching finding that assessing coaching readiness is rare, and there is a presumption within coaching that anyone may benefit from coaching, when in fact many clients terminate early and do not progress towards goals. The study found that some clients lacked sufficient self-esteem, emotional stability, financial, or time resources to benefit from coaching, and that coaching should not be done during times of life crisis or with clients who must devote all their time to financial survival. Coaches in the study framed coaching readiness as skills a client does or does not possess, such as the ability to shift negative mind-states of fear, anxiety, and anger, and other “emotional blockages” (p.11) in order to move forward. Coaches characterized clients who do not progress towards goals as lacking in coaching skills, and not being ready for coaching, as though a weakness or deficit at the client-level (Krestzchmar, 2010), rather than signaling limitations of coaching interventions. 56 Both CERIC and the ICF have suggested informal screening questions be used to assess mental health needs in session, but to date there is a marked paucity of research studies investigating appropriate screening tools for use by CPs without counselling training. The ICF held a voluntary conference call to address lack of screening in coaching, warning that coaching is not a panacea, and that clients should be assessed on a four-stage continuum of coachability. They suggest that up to 25% of clients who seek coaching should be referred out due to distress or clinical issues not suited to coaching (level 1), where others can receive resilience coaching (level 2), life direction coaching (level 3), or elite performance coaching (level 4). They caution that coaches must improve their referral and screening skills to recognize clients in distress, via a series of informal assessment conversations (‘how happy are you with your life right now?’), yet neither coach nor CP training textbooks cover mental health referral and screening skills to recognize boundaries of practice (Cook, 2009; ICF, 2014; Payne, 2007; Shepard & Mani, 2013). In recognition of low referral skills among coaches, the ICF published a 23-page whitepaper overviewing mental health disorders, symptoms, and the need for referrals, but with no reference to any studies of practical screening methods coaches without clinical training can use in-session. They suggest coaches informally ask clients to rate the level of their symptoms, and coach them on accessing supports or referrals if challenges are severe or ongoing. No sample of formal screening tools or training on risks are provided (Hullinger & DiGirolamo, 2018). In response to low mental health skills among CPs, CERIC published a 115-page overview of mental health disorders and skills, which trained counsellors take years of practice to master, with no explicit reference to studies of tools for use by non-clinically trained CPs (CERIC, 2016). Canada has been criticized for its over-reliance on publishing passive reading materials to address CP training gaps (Domene & Isenor 2018), which do not consolidate 57 learning or improve competence. Scholars argue instead that CPs require hands-on experiential training in counselling skills (Niles et al., 2009), as even brief experiential training has proven effective for improving referral skills among advisors (Kitchener & Jorm, 2004; Reiff et al., 2019). Thus, formal research is needed to identify appropriate practical screening tools and approaches for use by CPs without clinical counselling training, to help identify mental health issues which may present in career services. 2.5 Research Question The research question in the present study is as follows: How are some career practitioners identifying mental health issues in career service sessions? What helps or hinders them in this activity? 58 Chapter 3: Methods 3.1 Method Justification The current study aimed to generate rich descriptive data about how career practitioners identify mental health needs in career sessions. Research questions can be approached in various ways, each with their own appropriateness. Given that the current study is focused on exploring and understanding how a given activity can be successfully accomplished, Enhanced Critical Incident Technique (ECIT) is appropriate. ECIT is extensively used in counselling psychology to review effective or ineffective ways of completing an activity and of critical characteristics of activities or events (Butterfield et al., 2005). In the current study, I investigated instances when career practitioners recognized mental health issues in career sessions. Participants were asked to describe hindering, helpful, and wish list incidents associated with successful accomplishment of this activity, as outlined in ECIT literature (Butterfield et al., 2009). ECIT has been considered by some as particularly appropriate to counselling psychology research for its ability to explore key turning points in interactions or activities, particularly in foundational research (Butterfield et al., 2005). ECIT often is helpful for unearthing insights into particular elements of the psychology process, with the aim to provide tools for practitioners in session. ECIT is often also widely used in workplace settings and organizational behaviour/human resources, to assist with task analysis of key job functions for training purposes. This is especially relevant to the current study, where the focus is to better understand tools which may be useful for other career practitioners. Within ECIT, the focus is on exploring the participant’s perspective fully via a semi-structured interview format with an inductive approach. Where other qualitative methods each have their own nuanced appropriateness (grounded theory, phenomenology, case study, 59 focus groups), ECIT is particularly effective for exploring elements which add or detract from the effective performance of a specific activity. The Critical Incident Technique (CIT) was initially used for training of aviation pilots. Prior to CIT, pilot trainers formed “hunches” or opinions about whether or a not a pilot was competent, which lacked the rigour needed for life and death situations. Flanagan (1954) developed CIT to focus in on any minute observable incident—what the pilot did, heard, felt, or saw—as well as the training received, the aircraft response, and the pilot’s temperament in near-miss situations. Within this method, an incident is something which occurred or which was relevant to successful completion of the task at a given point in time. Insofar as CIT is concerned, an incident may refer to any occurrence, behaviour, or also personal characteristics, elements of a setting and so on. The critical incident data is organized into categories in order to summarize critical behaviours or conditions required for a given task. The CIT method has been successfully used in many settings to inform training of workers, aptitude tests, performance appraisal, as well as to predict conditions which can lead to success with a task. CIT studies have also been used to inform workplace policies and procedures, to design workplace tools, and to inform management training and competencies (Flanagan, 1954). 3.2 Research Philosophy and Methodology Depending on the nature of the study and how it is used, ECIT can be used in both qualitative and quantitative ways, within positivist, post-positivist, constructivist, or critical paradigms, or at different points along a spectrum between these (McDaniel et al., 2020). In the current study, ECIT is being used as a qualitative approach, in that there is focus on individual interviews (as opposed to observations) and personal retrospective accounts, where the 60 researcher has some impact on the research, and where the emphasis is on generating rich descriptive data about an activity where relatively little is known. In the current study, furthermore, ECIT was employed within a post-positivist paradigm, in that the researcher assumes that some reality exists (that clients have mental health issues in need of support, which can be recognized in session, and uncovered), and where the bias and influence of the researcher on the data is sought to be identified, acknowledged, and minimized. The emphasis was to explore and fully understand each participant’s experience as they saw it, in a semi-structured format. This is in contrast to a positivist approach, where one seeks to work deductively from an established starting point, counting, testing, measuring, and affirming a given hypothesis of one given reality. In the current study, where little is known about the given topic, working inductively was an appropriate starting point. The current study assumed that some practitioners can recognize and uncover mental health needs which exist (such as client suicidal ideation, difficulty sleeping, eating, dysregulated emotions, difficulty focusing, and difficulty with progress on essential life tasks), while also assuming that practitioner knowledge is subjective, constructed, and can be communicated, all of which fit under post-positivist philosophy. While subjective reality is acknowledged, the current study sought to explore how what are considered real mental health risks are recognized in career sessions, according to definitions of mental health issues and established mental health conventions. In other words, here ECIT asked what helps or hinders in a given activity which is not well understood (exploratory, inductive), with the assumed hypothesis that participants can access and express this knowledge via self-reflection of their success with said activity, or of their perceived ability to accomplish it, which involves a reality of mental health needs presumed to be real and existing (post-positivist). 61 I selected qualitative interviewing for its ability to generate rich descriptive data, and to go deeply with each participant into understanding their experience with identifying mental health issues in career sessions. The qualitative interview also allows for clarification, flexibility and probing, so a considerable degree of validity is obtained in understanding each participant’s experience. 3.3 Data Collection Procedures I conducted qualitative interviews via Zoom with career practitioners with work experience in campus career centres in Western Canada who self-identified as having experience with recognizing mental health needs among their career clients in the past. ECIT requires that researchers identify the objective of the activity in question, as well as intended outcomes (Butterfield et al., 2009). In this case, I assumed that some practitioners are sometimes able to recognize mental health issues among their career clients, with the intended outcome of addressing those more appropriately (whether via referral to personal counselling or other resources) and making these needs salient, towards improving client outcomes. The goal of the research interview, then, was to elicit and make salient those strategies which participants employ in-session with clients to recognize mental health issues in need of support, as well as actions they take once these have been recognized, and how this is effectuated. The emphasis was on understanding what practitioners believe helped or hindered them in recognizing mental health needs, and also what would have been helpful in this process. The interviews were semi-structured according to the ECIT framework. Participants were asked to describe their experience with identifying mental health needs in career sessions. I asked participants what helped or hindered them in recognizing mental health issues, as well as 62 whether they perceived any wish list items which could be helpful in this process, along with gathering basic contextual data, as outlined in ECIT (Butterfield et al., 2009) (see Appendix D: Interview Guide for further detail). When CIT questions are framed solely in behavioural terms focused on worker actions, such as “What did you do that was so effective for recognizing mental health issues?”, the resulting data may be contained to worker actions within their control. In contrast, when the question is broadened to include any helpful element, such as “What helped you to recognize mental health issues?”, the resulting data may yield insights into not just employee actions, but also management actions, training, resources, context and so on, which are also relevant to a task. Participants were asked to describe what led up to each incident, their experience of the incident, and the outcome of the incident. Efforts were made to cover all incidents and elements fully with each participant, providing them sufficient time and space to exhaust any relevant items and details, without rushing, via use of active listening skills, basic empathy, and curiosity. For the purpose of the current study, interviews continued until exhaustiveness, comprehensiveness, and redundancy were reached in participant data, when a sufficient number of incidents were explored where little additional novel data arose (where sufficient n refers to revelatory incidents rather than number of participants). In this case, 11 interviews were completed. Participants were provided with a $50 Amazon gift card for their participation. 3.4 Participant Recruitment and Inclusion Criteria Participants were recruited via direct email invitation letters (See Appendix A: Invitation Letter) sent to personal LinkedIn email accounts available publicly (‘InMail’). Potential participants were identified via a ‘Google search’ of English-language universities and colleges 63 in Canada which have dedicated career service centres. Staff listings were reviewed on campus websites and individual practitioner LinkedIn biographies were reviewed to assess whether they met the inclusion criteria. LinkedIn was also used to blanket search under common career practitioner job titles at all universities and colleges in Western Canada to identify potential participants. Invitations were sent to LinkedIn email addresses connected to personal LinkedIn professional profiles, where the practitioner biography indicated the practitioner had a minimum of two years of work experience in higher education career services, specifically in closed-door career sessions (prospective participants were not recruited via any institutional workplace emails, as the research focused on personal professional experience with higher education career clients past or present in any context, not on any particular employer, and thus external institutional ethics approvals did not apply). A recruitment poster was posted to the UBC Counselling Psychology Listserv and Facebook accounts, as well as to my LinkedIn site (which is visible to career practitioners unknown to me), with the intention to share the poster with career service organizations if required. This, however, was not required due to a high response rate to the direct invitation letters. Prospective participants were asked to self-identify as having been able to recognize mental health needs among their career service clients in some instances in the past. Participants were asked to complete a consent form (see Appendix C), and to confirm via email that they met all of the inclusion criteria prior to scheduling the interview. Participants were required to have experience working in a university or college career setting, preferably separate from mental health counselling (where full mental health screening and triage does not occur prior to service). Counsellors were required to speak English at the level required to complete the research 64 interview. Although a majority of career practitioners report difficulty recognizing mental health needs among their clients, some do not, and this study sought to recruit those who self-identify as having experience with recognizing mental health needs, regardless of their mental health training. Thus, no particular mental health training was required for inclusion in the study, thereby allowing for participation from a variety of career practitioners along a wide spectrum of mental health training and experience. Exploring the experiences of those with a range of training backgrounds (not just clinical counsellors) can potentially yield more practical and applicable insights to the broader group of career practitioners who typically do not stem from a clinical counselling background. Thus, efforts were made to include participants with varied training and cultural backgrounds to capture diverse experiences and perspectives, given the wide diversity of career client issues and needs in the field. Participation was open to any Career Practitioner regardless of title, education, or career credential, who provides or has recently provided individual career support sessions, given the aforedescribed issues with varied nomenclature in the field and vague boundaries of practice between titles. Following study approval by UBC research ethics board, 20 invitation letters were sent in January 2022 via LinkedIn; 17 individuals responded within a matter of days wishing to participate. Of these, it was determined via email and phone communication that two did not meet the inclusion criteria (one reported low self-efficacy with the task of identifying mental health issues, the other reported only noticing one instance of mental health issues over several years of practice). Three individuals who completed consent forms did not participate due to scheduling conflicts and difficulty with follow-up, and one cancelled the scheduled interview due to sudden illness. This left a final participant pool of 11 career practitioners who were 65 interviewed through January and February 2022. Due to the strong response rate to the recruitment letters, all other recruitment efforts were paused. The Research Ethics application included a target of 10 to 12 participants, as this would typically yield sufficient incidents to reach redundancy, because a sufficient sample size (or n) in CIT refers to the number of incidents, not participants. At the proposal stage, the research committee determined that 10 to 12 participants was an appropriate upper limit for a master’s thesis, given that the ECIT method is notoriously heavy in the data analysis stages, and that a higher number of participants may be more appropriate for a doctoral dissertation. Lastly, the final number of 11 participants seemed appropriate, given that no new novel categories were arising after just the fourth interview (refer to Chapter 4 Findings, for further detail). 3.5 Participant Demographics Participants were asked to respond to a series of demographic questions at the end of their interview about their age, ethnicity, gender, Indigenous status, birthplace, and languages spoken. Questions also touched on additional variables to better qualify the type of experiences and context they were speaking from including the following: Career settings they had worked in, cohorts of clients served/client expertise areas, relative size of departments, whether services were free or paid, whether screening was in place for bookings, whether they had ever had clinical supervision, years in higher education and career services, educational background, career specific training and credentials, and any mental health training completed (see Interview Guide Appendix E & see grid inset Table 2 for demographic summary). Also included here is information about the types of campuses that participants worked at, which was identified during the LinkedIn search of participants. 66 The final participant group was relatively diverse from a gender and age standpoint, but lacked ethnic diversity. Participants, however, had specific expertise working with diverse student groups at different types of institutions large and small, with students from various socioeconomic, cultural, and academic backgrounds. Most worked in career centres in small teams, although some worked alone. None worked in counselling departments and most had no access to clinical supervision. Most had some dedicated career training or career credential, although in some cases this was minimal. Roughly half had completed some form of brief mental health training workshops, but only one was a Registered Clinical Counsellor. All worked in settings where services were free and where appointments were direct-booked without triage or screening such that client sessions began with no prior awareness of client mental health needs. Most had some higher education, with teacher training being the most common educational background. See below sections for full demographic, client cohort, and campus type details. 3.5.1 Age, Gender, and Years of Experience Participant ages ranged from 35-59 years with a mean age of 46, and with participant ages appearing to fall into two broad generational groups: ages 35-43 (n=6) and ages 50-59 (n=5). Correspondingly, participants reported between 4 and 30 years of experience working in career services, with a mean of 12 years. When organized by generational group, the mean years of career service experience in the younger and older groups were 6 years and 21 years respectively. Similarly, years of experience employed in higher education settings ranged from 3 to 25 years across the entire participant pool, with a group mean of 12 years. Grouped by age group, the mean number of years of employment in higher education in the younger and older participants was 9 years and 23 years respectively. Thus, broadly speaking, roughly half of the 67 participants were relatively younger, newer to the field and earlier in career, while the other half were relatively older, and later in career with decades of experience. Participants reported their gender as male (n=4) and female (n=7), with the majority of male participants being in the older, more experienced participant group (3 males aged 50-59), and the majority of female participants in the younger, earlier in career group (5 females aged 32-42). Table 1. Age, Gender of Participants Ages Reported Age Mean Means Years Employed in Higher Education Mean Years Employed In Career Services 35, 36, 37, 38, 42, 43, 50, 52, 56, 57, 59 46 12 12 Younger Participants 35-43 (1 males, 6 females) 39 9 6 Older Participants 50-59 (3 male, 1 female) 55 23 21 Gender Total 4 male 7 female 3.5.2 Ethnicity, Birthplace, Language, and Indigenous Status Participants reported the following ethnicities: Caucasian (n=9), Chinese (n=1), Vietnamese (n=1). Birthplace was reported as Canada (n=8), USA (n=1), China (n=1), and Vietnam (n=1). No participants identified as Indigenous, although one specialized in working with Indigenous students (see below: Cohorts Served). Languages spoken other than English were reported as French (n=1), Mandarin Chinese (n=1), and Vietnamese (n=1). It became apparent at the recruitment stage when reviewing LinkedIn and workplace biographies that the two year minimum requirement of experience in a campus career setting limited the ethnic diversity of participants, although invitations were sent to a wider diversity of candidates not all 68 could participate (see Chapter 5 for further discussion). All participant names appearing in the findings are randomly assigned pseudonyms. The following tables present demographic information in a way that is decoupled from participant codes and pseudonyms and is presented in varied random order. Because the rarity of certain combinations of qualifiers could identify participants, the information is presented simply to capture the overall diversity of the participant pool in terms of knowledge, training, background, and experience. One purpose of these demographic questions was to act as a proxy to capture participant culture and cross-cultural competence that could be relevant to their role with students and to the data they shared. Although the ethnicity reported by participants was predominantly ‘Caucasian’, some reported that the bulk of their caseload was working with immigrants, international students, students with disabilities, or at-risk youth representing a range of cross-cultural and diversity competence (see below: Cohorts Served). Similarly, cross-cultural competence and knowledge was displayed throughout the stories they shared (see Chapter 4: Findings). Table 2. Reported Languages and Ethnicity of Participants Languages Other than English Reported Ethnicity Identify as Indigenous Vietnamese Vietnamese No Chinese Chinese No English European (Caucasian) No French Caucasian No English English (Caucasian) No English Caucasian No English Caucasian No English Caucasian No English Caucasian No English Caucasian No 69 3.5.3 Cohorts of Students Served Participants reported experience working with the following types of students: generalists serving international students, undergraduate, graduates and alumni equally (n=3), working exclusively with practicum students in a highly competitive medical health science program only (n=1), experiential learning placements only, with 80% of students being international students, and the remainder mature and domestic students of various career stages (n=1), at-risk youth exclusively aged 18-30 in transition to work programs (n=1), working with Indigenous students in experiential learning placements exclusively (n=1), working with experiential learning placements for international students and mature students in computing, science, and tech, working primarily with international students, new immigrants, mature students (n=1), working as a generalist with mature students, new immigrants, and international students (n=2), with one of these focused primarily in computing fields, working with students facing complex barriers such a developmental disabilities or physical disabilities, as well as with students in entry level tech, business, trades and health and childcare fields (n=1), and working with recent high school graduates, first and second year students, diploma and international students (n=1). There are more cohorts described than participants because some participants described prior roles they had worked in. A majority of participants reported that they were assigned to provide career support to students in specific faculties and programs and to specific cohorts of students as part of their role (n=7) 70 Table 3. Cohorts/Types of Student Groups Served Types of Student Groups specifically mentioned as a part of their work Number of Participants Undergraduates 11 International students 8 Mature students 5 Graduates 3 Alumni 3 Newcomers, immigrants 3 At-risk youth 2 Students in trades 2 Post doc 1 Staff 1 Indigenous students 1 Students facing complex barriers, developmental Disabilities 1 Health science medical students 1 3.5.4 Workplace Settings, Institution Type/Size and Team Size Participants reported working in the following types of settings: Dedicated career service centers (n=10), alone in a faculty as the sole career practitioner (n=1), on small teams of up to six career service employees (n=9), working alone as the only CP in the career centre (n=1), and working separate from the counselling department (n=11). Participants worked at the following types of campuses: Large competitive top-10 in Canada ranked public research universities (enrollment 4k-40k) offering graduate and undergraduate degrees (n=2), large public universities (ranked 30-50th in Canada) serving a broad student group (diploma, certificate, upgrading, trades, undergraduate, graduate students (n=3), large public community colleges serving diverse learners including trades, students with disabilities, English language learners, diplomas, certificates, and associate degrees (n=2), small public community college serving upgrading students, those in 71 trades, English language programs, diplomas and certificates (n=1), private university with graduate and undergraduate programs (n=1), large public polytechnical institution serving newcomers, upgrading students, but also competitive professional programs (n=2), and in an Indigenous vocational school (n=1). Some had worked in multiple campuses across their career service career (n=3), at both large and small institutions. All participants worked at institutions in British Columbia (BC) (n=7) or Alberta (AB) (n=4), although some participants in BC had prior also worked in AB (n=2). All but one participant were currently working in a campus career service position; one had recently resigned from her role. 3.5.5 Clinical Supervision Most participants reported working in settings where they had no access to clinical supervision throughout their career service career (n=8). Some reported that they were able to informally consult with a psychiatrist, counsellor, or psychologist on some campuses they had worked at from time to time (n=3), although this was not a formal clinical supervision relationship with regular case review and observation of work for training purposes. 3.5.6 Mental Health Screening All 11 participants reported that there was no mental health screening in place in their career service departments prior to booking, or at any point in the career service process. One indicated that their department has been considering mental health screening. 3.5.7 Booking and Fees All 11 participants reported that students/clients direct-book their appointments either via an online portal or by emailing the CP directly and that there is no triage process prior to booking sessions. Some reported that clients complete a checklist of career items they want to discuss 72 prior to the session (n=2), that sessions can also be booked via a reception desk (n=2), that they engaged in proactive outreach activities to encourage students to book sessions (n=4), such as career fairs, during a course, via email or other, or that students were mandated to attend sessions with the CP as part of their co-op program (n=1). All 11 participants reported that sessions are offered for free to students, and some reported that services were also free to alumni (n=2). 3.5.8 Educational Background Participants reported a range of educational backgrounds typical of the Career Practitioner field: No higher education (n=1), Bachelor’s degree (n=10) in fields including History (n=1) Music (n=1), Linguistics (n=1), Writing (n=1), Theatre (n=1) and Psychology (n=3), additional Bachelor of Education Teaching Certification (n=5), Master of Education (n=3) in Indigenous Education (n=1) or in Counselling Psychology (n=2), full clinical training and Registration as a Clinical Counsellor (n=1), graduate studies in counselling in progress (n=1), and a Certificate in Career Development at a Canadian University (n=2) . 3.5.9 Career Credentials and Career Service Training Participants reported any formal career service training they had completed and credentials they held as follows: CDP (Career Development Practitioner Certificate, BC) or CCDP (Certified Career Development Practitioner, Alberta) (n=7), CACEE (Career Educator Certificate Program) (n=1), a CDP ethics course completed but no CDP credential (n=1), private Career Coaching Training of various types and duration (one day workshop or more) (n=5), both the CDP credential and a Career Coaching certification (n=2), involvement in Career Service research (n=2), involvement in provincial and national Career Service and co-op committees and conferences (those with more seniority, later in career) (n=3), Master of Education degree with 73 Career service focus (n=1), Career Development Certificate university program (n=2), and a career counselling course as part of a counselling psychology degree (n=1). Table 4. Career Credentials and Career Specific Training of Participants Career Credential and Training Reported Number of Participants CCDP or CDP (30-40 course hours and one year or more experience to complete) 7 CACEE (6 hours ) 1 CDP Ethics Course but no credential (10 hrs) 1 Career Coach Course or workshop (1 day or more) 5 Involved in Career Service research 2 Attend Career service Conferences and Committees 3 Master of Education w Career Development Focus 1 University Certificate program in Career Development Advising (1 year 200 hours) 2 Career Counselling graduate course/training as part of Master of Counselling Psychology degree 1 3.5.10 Mental Health Training Participants reported having completed the following mental health training: No mental health training ever of any kind, no attendance of any mental health workshops (n=1), one suicide prevention workshop only, no other mental health workshops or training, but involvement with career development conferences which sometimes mention mental health (n=1), one trauma-informed workshop pertaining to sexual assault awareness, with no other mental health training or workshops attended, but regular attendance at experiential learning conferences which sometimes mention mental health (n=1), Suicide Prevention (e.g. Assist) training (1 day) (n=5), Mental Health First Aid Workshop (1-2 days) (n=3), Question Persuade Refer (QPR) Workshop (1 day) (n=3), Motivational Interviewing (n=2), Mental Health Awareness Workshop (n=1), Resilience Coaching Program (5 days, High Fidelity Wrap Around 74 for at-risk clients) (n=1), trauma-informed training (including Indigenous inter-generational trauma and sexual assault trauma) (n=3), one day training seminar specifically designed for CPs about mental health in career services (n=1), online self-study one semester course in neurodiversity (n=1), online credit-course (one semester) on Working Alliance in career service work (n=1), Crisis Line volunteer training (n=1), a basic empathy undergraduate course (n=1), counselling graduate degree (n=2), clinical counselling training as a Registered Clinical Counsellor (n=1), and counselling psychology graduate studies in progress (n=1). All of the mental health workshops (Mental health first aid, QPR, Suicide Prevention, Motivational Interviewing, Resilience, trauma-informed) were offered by the employer, whereas university level training was self-directed. Degree of mental health training was not related to time as a CP, in that those who had completed more mental health training reported having more access to training through their employer and more initiative for training, whether they were early or late in career. For instance, one participant had worked in higher education for nine years across two institutions, but had never participated in any mental health training workshop. Conversely, another participant had worked in career services for only five years but had completed free workshops through her campus on suicide prevention, mental health issues with career service clients, Motivational Interviewing, QPR, as well two self-directed university courses on mental health in career services. 75 Table 5. Mental Health Training of Participants Mental Health Training Reported Completed Number of Participants Employer Sponsored/Offered by the Campus Crisis/Suicide Intervention/Prevention (e.g. “Assist”), 1 day or less (incl. experiential practice) 5 Mental Health First Aid, 1-2 days (incl. experiential practice) 3 QPR Question Persuade Refer, 1 day or less (incl. experiential practice) 3 Trauma-Informed training, (varying duration) 3 Motivational Interviewing (several days) 2 Sexual Assault Disclosure, (duration unspecified) 1 High Fidelity Wrap Around, 5 days offsite 1 Mental Health Awareness Workshop, 1 day or less 1 Mental Health Seminar for Career Practitioners, 1 day, incl. experiential practice 1 Mental Health Training Sought out by the CP (Not Employer Sponsored) Graduate Counselling Training Full Registered Clinical Counsellor 1 Graduate Counselling Education Degree (non-clinical practice, not RCC) 1 Graduate Counselling training in progress 1 Crisis Line Volunteer Training, several weeks 1 University Course Working Alliance for Career Practitioners, one semester 1 University Course Open-Access on Neurodiversity, working with Diverse Clients, one semester 1 Undergraduate Course on Empathy Skills, one semester 1 3.6 Data Analysis Interview data was collected, analyzed, verified, and reported according to the ECIT guidelines outlined in Butterfield et al. (2009). The interviews began with contextual questions, followed by the critical incident component, and finally, demographic information was collected at the end of each interview (see Appendix E for detail of each section). The contextual data gathered at the beginning of each interview was analyzed separately via a process 76 of thematic analysis to identify themes as outlined in Braun & Clarke (2006). As contextual questions are centered around a particular topic, the thematic analysis of the contextual data was top down, or theoretically guided, which naturally involves researcher interpretation to draw out key themes which are explicitly stated verbally, in addition to those which are suggested under varying terms (Braun & Clarke, 2006). I considered themes which appeared across all of the contextual data, looking for items of interest that clustered together. This was a recursive process, beginning with close active reading of each transcript noting early patterns, followed by coding the entire set of contextual data from all interviews for interesting features and collating data for each code, gathering codes into relevant themes, and writing up themes with descriptive extracts (Braun & Clarke, 2006). Transcription data from the critical incident component of the interviews was analyzed to draw out helpful, hindering, and wishlist items, and was subsequently sorted into self-described categories, using inductive reasoning and by seeking similarities and differences among critical incident and wishlist items described by participants as outlined in Butterfield et al. (2009) (see Appendix E). I subsequently utilized the nine credibility checks outlined in ECIT (see section 3.8 below). 3.7 Ethical Considerations and Security of Data The current study was considered low-risk in terms of the research ethics application process, in part because participants were not exposed to experiences beyond what they experienced in a typical workday. However, as a safeguard, in the verbal consent process at the beginning of each interview, I reminded participants that if they experienced distress at any point in reviewing an incident, the recording could be paused, with the option to discontinue the 77 interview and/or to receive a list of community resources (see Appendix D). While no participants requested these options, this was offered to one participant who experienced brief tears when recalling a client who had died by suicide, but she clarified that she wanted to continue and did not need any resources. Additionally, participants were reminded they were able to withdraw from the study at any time and that they would have the opportunity to review the findings from their interview for accuracy/inclusion prior to the final thesis publication. Participants were also reminded they could remove any portion of their data from the study findings prior to publication. Additionally, risks relating to privacy and confidentiality of participant data, which could identify them, their workplace, or their clients, were addressed by carefully removing any geographical, contextual, or personal identifiers from the data. I found that some of the demographic details could identify the participants because of the rarity of some participant details, so I have presented the demographic and qualifying data separate from participant codes, so those combinations of features are obscured (for example, it is relatively rare in the field to have a certain type of master’s degree, expertise specialty, and a certain career credential combination so presenting these together could identify a participant even if names and locations are removed). Data security risks were managed by ensuring that only UBC approved IT cyber secure processes and software were used in accordance with the BREB approval process. In terms of power differentials, only arm’s length participants with no ties or relationship to myself were included. Attention was paid, furthermore, to recognizing risks of the interviewer biasing the interview with leading questions, and the emphasis was instead on allowing each participant to speak in depth about anything they deemed relevant to the incidents they selected to describe and 78 bring forth (Butterfield et al., 2009). ECIT requires that the researcher acknowledges and identifies their own bias, as part of reducing its impact on the study. In this case, my bias as a counselling psychology student with a background in career coaching, is that mental health issues are sometimes present, that they may be sometimes missed, and that they are important to address. Aware of these biases, I was careful to explore the same content areas in the same level of detail with all participants, keeping to the pre-established interview guide per Butterfield and colleagues (2009). The credibility checks described in section 3.8 below further reduced the risk of bias impacting the data, and indeed many of the findings were novel and surprising to me (refer to Chapter 5 Discussion). Zoom interviews were conducted utilizing enhanced Zoom secure accounts provided by UBC IT services, with auto-transcription generated via Otter.ai software using UBC secure access. I personally reviewed each transcription multiple times and corrected them for accuracy as well as to reflect upon the data, to remain ‘close to the data’ throughout the analysis process. UBC secure MS OneDrive was used for secure file sharing via CWL password accounts. All data was managed according to research ethics guidelines and UBC data security protocols; all identifying information was removed from the study content, with raw transcription and audio files saved under separate password protection and encryption on my computer using 7-zip to password protect audio files. All participant identifiers were locked in a physical filing cabinet with each participant assigned a code such that no client identification or contact information was stored in computer records. Zoom video content was deleted after 72 hours and was only used to help with non-verbal cues and technology issues during interviews, whereas raw audio and transcription data will be stored for five years on my computer under encryption and 79 password protection in accordance with UBC cyber security research requirements. A physical copy of the participant information and an electronic copy of the raw audio and transcription data will be retained separately in Dr. Borgen’s UBC office following my graduation, in a locked cabinet, and under encryption and password protection respectively. In phase two of data analysis, participants were contacted via email and were asked to verify whether written summaries of their interview and data categories represented their experience accurately. Unique passwords were created for each participant review file based on information they had shared during their interview which only they knew. 3.8 Trustworthiness and Rigour I completed the nine credibility checks outlined in ECIT by Butterfield et al. (2009) as detailed below to enhance the trustworthiness and rigour of the findings. These credibility steps were completed sequentially. 3.8.1 Audiotaping Interviews Audio-recording the interviews via Zoom, and reviewing the audio recordings repeatedly was used to contribute to descriptive validity, to ensure that what was stated and described by participants was accurately reflected in the transcripts. Recordings were transcribed verbatim in raw form, leaving common errors of speech intact to reflect participant expression. The auto-transcription files were reviewed in fine detail numerous times to correct them for accuracy. 3.8.2 Interview Fidelity An interview protocol was closely followed with each participant to ensure consistent flow of process, questions, and review with each participant to enhance thoroughness (see Appendix D). A third of the interview audio recordings selected at random were listened to by 80 my research supervisor, Dr. Bill Borgen, who is highly familiar with ECIT. Dr. Borgen listened to the audio recordings to ensure that the ECIT method was being followed, that I was not asking leading questions of participants, and that the established and agreed upon interview guide was being followed. Ensuring that the established protocols of the ECIT method are being followed contributes to the robustness of the findings. Dr. Borgen indicated that the interview protocols had been followed. 3.8.3 Independent Extraction of Critical Incidents Three of the transcripts (27%) selected at random were reviewed by a researcher independent from the study who is familiar with the ECIT method. The researcher selected was a peer student in the UBC Master of Arts program who is also completing an ECIT thesis study. This researcher independently reviewed each transcript in fine detail extracting what she perceived were helpful, hindering, and wishlist items. This list was then compared against the critical incidents I had extracted and any discrepancies were discussed. Although there were minor variations in how each coder worded the incidents they extracted or the degree of specificity in some instances, these were clarified in a brief conversation such that the concordance rate was 100% and there were no meaningful differences in extracted incidents. 3.8.4 Exhaustiveness Interviews were scheduled in a staggered manner to allow sufficient time between each interview to review audio and transcriptions to make an initial incident extraction for the purpose of tracking exhaustiveness. A table was used to track the number of helpful, hindering, and wishlist categories from each interview, and to notice when no new categories or novel data were emerging. In the present study, no new helpful categories arose after the fourth interview (refer 81 to Table 10 in Chapter 4) per Butterfield et al., (2009) but 11 interviews were completed for redundancy as these had already been scheduled. In other words, participants reported similar helpful incidents and this commonality arose early in the data collection process. The majority of incidents reported by participants were in the helpful category (what helped them to successfully recognize mental health issues) and these were relatively similar among participants, but novel wishlist items arose until the final interview as these were more varied and personalized, and no new hindering categories emerged after the ninth interview. 3.8.5 Participation Rates Reporting participation rates helps to establish the strength of each category, by capturing the percentage of participants who reported incidents within any given category. ECIT typically requires a minimum cut-off point of 25% for a category to be considered meaningful. However, in this case there was a high rate of agreement among participants such that participation rates were very high for Helpful Incident Categories (refer to Table 2 in Chapter 4 below). The initial 17 helpful categories participation rates ranged from 27% to 100%. As such, categories were refined and grouped together with a cut off point of 75% to form category headings. The final six categories had a participation rate between 82%-100% (see Chapter 4 Findings below for further detail.) A cut off rate of 25% was used to refine Hindering and Wishlist Categories, which reflected participation rates between 27%-100% and 27%-72% respectively. 3.8.6 Placing incidents in categories by an independent judge I randomly selected 25% of incidents from each category and sent these to an independent judge along with a list of categories and their operational definitions. In this case, I recruited a graduate of UBC’s Master of Education program (Higher Education Administration) 82 with research experience in student mental health and professional experience in higher education student services. The independent judge then placed the random items into the categories I had provided, and I compared her results with my placement. There was a 94% concordance rate between the judge’s placement and my own, which exceeds the 80% match rate recommended for ECIT studies. Due to the large number of incidents reported by participants, 25% of incidents resulted in 153 items to place, such that a 94% match over a relatively large denominator of incidents further lends credibility to the categories. 3.8.7 Cross-Checking by participants Once the above steps were completed, an email was sent to each participant with a summary of incidents extracted from their interview, along with where those incidents fell into the refined categories, and a list of the categories with operational definitions. With regards to incidents extracted, each participant was asked: 1. Are the helpful, hindering, and wishlist items correct? 2. Is anything missing? 3. Is there anything that needs revising? 4. Do you have any other comments? With regards to the categories described, each participant was asked: 1. Do the categories make sense to you? 2. Do the category headings make sense to you and capture the meaning that the factor had for you? 3. Are there any factors in the categories that do not appear to fit from your perspective? If so, where do you think they belong? Emails were sent in July 2022 during summer holidays. Of 11 emails sent, three participants responded within a few days stating they were very pleased with the categories and incidents extracted and had no changes to make. Two auto-reply emails were received indicating the participant was on an extended holiday. Under the presumption that participants may be on 83 summer holidays, follow-up emails were sent in September to the remaining eight participants at the beginning of the fall term. One auto-reply was received indicating a high volume of emails prevented quick response times. Another participant responded indicating he had been away all summer and was very busy. In the participant consent form, and at the onset and end of each interview, participants were reminded that they could advise me if they would like to add or detract anything from their content or withdraw from the study prior to publication to UBC Open-Access. However, the majority of participants indicated that lack of time and high volume was one of their primary challenges. Thus, the busy schedule of participants may limit their follow-up. At this writing, three participants have responded. All were in agreement with the data analysis. 3.8.8 Expert Opinions Following completion of the above credibility checks, the final categories and their responding definitions were sent to two experts in the field for their review via email. The experts were selected for their experience with career services in particular and also in higher education, as experience with the topic, not the method, is required for this step per Butterfield et al. (2009). One of the experts is a career counselling expert, an adjunct professor of career counselling, a career service author with a PhD in counselling psychology, and more than 25 years in direct client practice, research, and training in the career service field. The other expert is an experienced career coach working in large campus career centre in Western Canada, with more than 12 years of experience in client sessions, student services, and with several years of managing the campus career coaching team, with specific expertise in cross-cultural student populations. She also holds a Master of Education and has Career Coach training. The experts 84 were asked to review the categories and their definitions, and to answer the following: 1. Do you find the categories useful? 2. Are you surprised by any of the categories? 3. Do you think there is anything missing based on your experience? Both experts agreed with the categories, were not surprised by the findings, and indicated they made sense based on their experience in the field and that they were useful. Both emphasized that the importance of contextual incidents being highlighted is especially important for this task, and appreciated how these were separated out in the data (see Chapter 5 Discussion). 3.8.9 Theoretical Agreement The final credibility check involved verifying the resulting six categories against the relevant theoretical literature. All of the six categories are in theoretical agreement with the scholarly literature in career counselling, coaching, counselling psychology, and mental health, and this is discussed in detail in Chapter 5 below. 3.9 Researcher’s Subjective Stance, Positionality The current study represents my final thesis project required for graduation in the MA CNPS program. This project stems in part from my own experience working in both campus career services, and campus counselling services, at two different Canadian universities. Prior to my counselling training, I worked as a career coach and manager, both internally within a large corporation and externally, in private practice. My progressive training in employee coaching, HR, external career coaching, and later counselling psychology, alerted me to gaps within my own competence at each stage of my education, as well as within the field. While working in a campus career centre, I recognized symptoms of mental health issues in-session which required additional supports and which impeded client career goals (under-managed ADHD, depression, 85 grief and loss, anxiety, perfectionism), which I prior would not have recognized. I grew concerned about these client issues going unrecognized due to a range of factors (lack of pre-service screening, lack of mental health training, low help-seeking and higher stigma relative to students who a priori voluntarily seek mental health supports) and the potential for delayed care, harm, or deterioration. Furthermore, in the absence of clinical supervision, established ethical norms, and pre-service screening, I experienced higher burnout than in the student counselling centre where screening and supervision were standard practice. Additionally, when I was in my clinical counselling practicum in a campus health centre, I was required to refer out career matters and I was not allowed to use session time for career concerns due to a scarcity of mental health resources. As a result, when I began working at the career centre, I was surprised to learn there was an entire world of career service practice and credentialing I knew little about. I noticed that client expectations differed coming into a career versus a counselling session, and so addressing mental health needs was not obvious. I wondered whether other career practitioners were identifying mental health issues in career sessions, what approaches they were using to accomplish this, and whether their knowledge and experience could be accessed to help inform the field. I come to this study as a Caucasian cis-gendered heterosexual woman born in Canada with various privileges afforded to me including educational, cultural, and economic opportunities, networks, health, and social supports. Given my own positionality and knowledge gaps, I made an effort to include as wide a variety of participants as possible to access knowledge relevant to different client groups and issues unknown to me (see further in Limitations section Chapter 5.) I do, however, have lived experience as a higher education 86 student myself, and I have faced some barriers impacting my studies including an invisible chronic injury, feeling culture shock as a foreign student abroad, rare instances of discriminatory faculty or staff, and being a minority female in a male-dominated undergraduate program. When I disclosed my struggles to campus stuff as a young adult, I, at times, received insensitive advising, which lead me to drop out; other times I received excellent advising and support, which allowed me to complete my studies. Thus, I am aware of the crucial role that campus staff play in the life trajectory of students, particularly of young adults. Furthermore, I recognize that I ‘do not know what I do not know’ when it comes to the career service field, and that my own experience is relatively narrow, and thus, I approached this research with an open mind to draw as much knowledge as possible from the experienced participants who shared their knowledge for the purpose of this study. 3.10 Data Presentation Data has been presented below in a way that summarizes contextual and ECIT findings. The Critical Incident headings are described and sample participant script is used to illuminate the categories. Tables are provided to summarize contextual and demographic content at a glance. Participants have been provided with summaries of their respective interviews and will receive a final copy of the thesis following completion. Chapter 4 outlines finding in the participants’ own language. Chapter 5 ties these findings to the literature drawing upon terminology more common in the counselling psychology field. 3.11 Dissemination of Research Findings The findings from this study add to the literature on reducing mental health risks in campus career services. These findings may have implications for career practitioners more 87 generally in a range of settings working with clients who have mental health issues. Findings may also contribute to the counselling field in terms of the utility of career theories, of goal-oriented practice with some clients, and to provide guidance to counsellors unfamiliar with the career context (see Findings Chapter 4 and Discussion Chapter 5). This thesis will be published to UBC Open Access and we hope to seek publication of a more summarized version for the field at a later date. Findings may also contribute to training materials for career service practitioners and campus leaders wishing to improve recognition of mental health issues on their campuses. 88 Chapter 4. Findings This chapter will begin with a summary of the contextual findings which resulted from questions the participants were asked at the beginning and end of their respective interviews. Following the contextual findings, the Critical Incident findings are reported. Results are discussed in further detail in Chapter 5 (Discussion) in terms of how they relate to theory and research within the field. 4.1 Contextual Findings 4.1.1 Job Title At the beginning of each interview, before beginning with the critical incident questions, participants were asked the following question: a) “Before we begin, could you please tell me your job title and describe your role?” Participants reported highly varied job titles in line with the field. Nine different job titles were provided, and a number of participants had hybrid titles and roles. There were more job titles than participants because several participants spoke of CP roles on several campuses or they had experienced job title changes in their role. When I first started it was called Career Advisor. But because I’m a Registered Clinical Counsellor it just felt better, for me, and it also better represented the work that I did with students in my own training that we change the title to Career Counsellor.—Kate, 50 So [my job title] was changed. It started as Career and Employment Advisor, and then it was changed to Career Coach.—Mary, 37 Job titles provided were as follows: Career Advisor (n=3), Career Specialist (n=2), Career Counsellor (n=2), Employment Facilitator (n=2), Career Coach (n=1), Practicum Advisor (n=1), Career and Employment Advisor (n=1), Career Development Specialist (n=1), and Career Services Coordinator (n=1). Some participants reported hybrid job titles such as: Experiential Learning Coordinator and Career Advisor (n=1), Career Advisor and Career Services 89 Coordinator (n=1), Career Coach and Facilitator of Employment Programs (n=1), and two participants indicated they were also faculty members and instructors of career development courses. There was significant variation in how participants referred to their own work. Some participants used different titles or action words (‘counselling’, ‘advising’) to refer to their own work; for instance the Career Service Coordinator often referred to himself as a Career Advisor. One of the Career Advisors was adamant that the work he and his peers perform is not just ‘advising’, it is ‘career counselling’ and, as such, he referred to himself as a Career Counsellor offering 'counselling’, despite his job title as an ‘advisor’. Indeed, a number of participants referred to their work as ‘career counselling’ in the stories and experiences they described (n=4). On the other hand, another Career Advisor was adamant that he and his colleagues are not career counsellors because ‘counselling’ implies more personal support that they do not offer, and for this reason he believes he provides only ‘advising’—despite these two participants working in very similar capacities on a daily basis. One of the career practitioners referred to his work as ‘career coaching’ exclusively, and he emphasized the importance of remaining in the ‘career coaching realm’ as opposed to the ‘career counselling realm’. Joe, 38, explained that roles and titles are a source of confusion for clients and practitioners: I called it career advising …because I’m trying to say we're not counselling, and I don't care what the Canadian government calls it, because the Canadian government's been calling us career counsellors forever, and we're not. That's an organizational thing where the big government's understanding of something is different from the counselling organization’s understanding of it, and it's also different from a lot of the career development understanding of it. I think that there needs to be some really frank discussions around that…We use the term ‘advisor’ all the time, instead of ‘counsellor’, and so the students basically just know us as the career people…There was just a weirdness where on the professional side there's sort of some strange overlap…Career development comes out of vocational advising, which is a different path, but it's really tied in closely to career counselling, [and] into counselling in general as well. They are two parallel paths that came out of similar ideas…and so it's 90 understandable that there's a lot of confusion around it. –Joe, 38 Table 6. Job Titles Reported Job Title Number of participants who held these titles past or present (thus more titles reported than participants) Career Advisor 3 Career Specialist 2 Career Counsellor 2 Employment Facilitator 2 Career Coach 1 Practicum Advisor 1 Career and Employment Advisor 1 Career Development Specialist 1 Career Services Coordinator 1 Hybrid: Experiential Learning Coordinator and Career Advisor 1 Hybrid: Career Coach and Facilitator of Employment Programs 1 Hybrid: Career Advisor and Career Services Coordinator 1 Hybrid Career Advisor and Faculty (teaching Career Development Courses) 2 4.1.2 Job Description Participants were asked to describe their job roles. Despite the wide range of job titles reported, there was marked similarity in the job functions performed and how participants described their roles. All but one of the participants explained that career exploration was a core or primary part of their role, determining career direction, career paths, career identity, preferred futures and challenges etc. (i.e. which falls between what is traditionally considered 'career guidance’ and ‘career counselling’ by the Canadian Standards and Guidelines for CPs) (n=10). Most of the participants reported they were also generalists providing full-spectrum career support (career exploration, applications, job acquisition support) (n=9). Roughly half of participants reported that employer liaison and employer relations were also part of their job 91 scope (reaching out to employers for job fairs and student work opportunities etc.) (n=6) . Roughly half reported their role included an experiential learning focus in terms of assisting students to obtain internships, volunteer opportunities, co-ops, and so on (n=6). Slightly fewer focused specifically on required co-op or practicum placements for certain programs as a core function of their job role (n=4). Some reported teaching formal credit courses on career development as part of their role (n=3), and designing and facilitating career service workshops (n=3). I’m a Career Specialist, and that is fancy way of saying that I do wear a few hats in my role and so I do a bit of employer relations, a bit of event planning, student coaching and workshop facilitation.—Sarah, 36 Primarily the focus was meeting one-on-one with students and helping them with issues surrounding job search and career exploration. So sort of everything within those realms, whether it was sort of ‘I’m not quite sure what I’m looking for, and I don't know about different career paths that I want to learn about, different options for careers and occupations and what might this look like? And how could it fit with my major and what can I do within my major?’…And then also more on the job search side of working with students on their resumes, their cover letters, preparing for job interviews…I worked with employers, I worked with events, career fairs, on-campus recruitment… projects, developing resources and materials, writing lots of workshops, presentations in classes, in conferences.—Mary, 36 We actually do a number of things in our role, so a large component is for advising and for counselling, for exploration, for planning, providing one-on-one support to the students,…over a number of months, just to help them through their career planning and helping them through the resumes, cover letters, interview preparation and getting them through that process… so a big portion of my work is one-on-one counselling. We do a lot of event planning, just to get students engaged and alumni engaged in connecting them to industry. [I also do] curriculum development or content development, resource development…career workshops and things of that nature…So there's a lot of stuff. –Lily, 43 92 Table 7. Job Description of Participants Job roles/scope description of functions, tasks included Number of participants who reported this Career Exploration included as a core function, primary function 10 Generalist (full spectrum career support, career exploration, direction, challenges, application materials, job placement) 9 Employer Liaison and Employer Relations (to develop job placement and networking opportunities for students. Job fairs, expert panel talks etc.) 6 Experiential learning focus (volunteering, internships, for wide range of students, including those not in practicum programs) 6 Co-op or Practicum Placements as a core function (for students in a specific program where practicum is required) 4 Teaching Faculty of credit courses in Career Development 3 Facilitating , Designing Career Development workshops 3 4.1.3 Frequency of Recognizing Mental Health Issues After describing their job title and role, participants were then asked the following contextual question: “Before you describe your experience, can you please tell me how often does it occur that you recognize mental health issues? How frequent is it?” Participants provided a wide range of responses from as low as a few times per year, or as high as 50% of clients (or 90% of clients facing complex barriers). Roughly half of participants reported that they recognized general mental health issues (such as general symptoms of anxiety, depression, low wellbeing etc.) very frequently, in more than 20% of clients (n=5), and roughly half reported it was infrequent, in 10% or fewer of clients (n=5). One participant did not specify and a follow-up was sent in the participant checks which is pending at this writing. Responses 93 were as follows: 50% of clients who seek career services from them (n=3); 90% of clients with developmental disabilities and complex needs also have mental health issues, and mental health issues in 30-50% of other client sessions (n=1), ‘all the time’ (n=1), 20% of students (n=1), between three clients per day and one client per week (n=1), 10% of students (n=1), one client per month (n=1), one client per term (n=1). Reported frequency seemed to correlate in some cases to mental health training of the CP and cohorts of clients they worked with. More specifically, those who had attended specific mental health workshops recently (Mental Health First Aid, QPR Question Persuade Refer etc.) reported recognizing mental health issues more frequently, and those who worked with students facing multiple barriers to employment, whether cultural, socioeconomic, developmental disabilities, or at-risk situations reported the highest frequency. Of note, the one Registered Clinical Counsellor in the participant group trained to recognize mental health issues estimated that it occurred in 20% of her clients. Table 8 below displays participant responses in descending order of frequency of recognizing mental health issues, along with the cohorts of clients served and mental health workshop completion status. 94 Table 8. Frequency of Recognizing Mental Health Issues by Participants Participant Number and Cohorts, and Mental Health Workshops Completed Status Frequency they recognized mental health issues in order of descending frequency A1 Mary: public university, competitive, grad, undergrad MH workshops YES “It happened all the time” (specification pending) D1 Holly: community college, students with complex barriers MH workshops YES “Very frequent” 90% of students in complex barriers stream 30-50% of students in regular streams B3 Gareth: community college, complex barriers MH workshops YES 50% of students in his program (at-risk youth 18-30) C4 Sarah: vocational school, varied SES and language barriers MH workshops YES “Frequently” 50% of students seen with mental health needs (anxiety symptoms etc.) C1 Kate: competitive university, grad and undergrad RCC: Registered Clinical Counsellor 20% of students who present for career sessions C2 Warren: competitive public university, undergrad MH workshops: 1 Frequent: Range from 1x per week to 3x per day Depending on time in academic year/economy D2 Isa, community college, varied barriers, entry level MH workshops: None 10% of students C3 Joe: public university, varied MH workshops NO gatekeeper workshops “Occasionally” 1x per month D3 Lily: vocational school, varied SES and barriers MH workshops: no gatekeeper workshop, but some mh training 1 per term B2 Daniel: public university, varied MH workshops unclear, Prior Counselling Education training (not RCC) A few times per year B1 Susan: top ranked university, elite health care students MH workshops YES No Response (pending participant feedback) 4.1.4 Experience Recognizing Mental Health Issues/ Types of Mental Health Issues Subsequent to the above two contextual questions, participants were asked the final contextual question: "Please tell me a bit about how your experience with recognizing mental health issues which may require support in career service sessions.” In the course of describing their experience with recognizing mental health issues, participants shared stories of client issues they had recognized, perceived, suspected or that arose. The study invitation letter and the consent materials explained the working definition of mental health issues for the purpose of this study (refer to Chapter 1 Definition of mental health 95 and Appendix A and C). In a few cases, participants had questions about this which I clarified; i.e., distinct from, for example, a student who discloses a well-managed mental illness or chronic condition for which they have sufficient supports in place that does not detract from their career session or appear to require a referral. This question thus referred to signs of mental health issues which may signal a need for referral which are interfering with student progress and career goals, which may be undermanaged, under-supported, or under-recognized. This included, for example, students evidencing overwhelm, difficulty sleeping, tears, social isolation and low wellbeing, low functioning, wanting to drop-out etc. In the majority of the stories described, participants suggested they were orienting students to access resources for these issues where the student may have been new to accessing mental health or other resources, or where the student may have had low insight about the need for supports. At the end of each interview, I verbally reviewed the types of mental health issues they had reported recognizing, and I asked participants to list any other types of issues they had recognized in the past. Participants reported the following issues that arose or that they had recognized in order of descending frequency of being mentioned: Symptoms of anxiety, life confusion, and overwhelm were reported as being extremely common (n=9), as were depressive, negative thoughts, feeling lost, and low mood (n=8). Also recognized/mentioned with moderate frequency were suicide risk (n=5), ADHD symptoms (n=5), low self-image, low self-talk, self-esteem/self-worth and imposter syndrome (n=3), cognitive difficulties and learning issues (n=3), aggression, anger, and risk of harm to others (n=2), cutting behaviours/self-harm (n=2), severe financial stress (n=2) , social isolation problems, loneliness (n=2), obsessive compulsive and rigid behaviours (n=2), and substance use issues (n=2). Physical disability (n=2), inter-personal 96 trauma history (n=1), difficulty making decisions (n=1), borderline personality disorder (n=1), and autism spectrum symptoms (n=1), were all reported as mental health issues that had arisen or been recognized in session as well. Of note, some of the issues participants reported were described as arising frequently, not just one time, but among many students they had worked with, such as signs of overwhelm, anxiety, feeling lost, and depressed. Issues recognized were signs and symptoms participants recognized, as well as the result of attentive listening, creating safety, and probing at signs of stress, which sometimes led to disclosure and naming of issues (see below Helpful Incidents). While the majority of issues described related to mental health issues and spoke to referrals to the counselling team, it is notable that participants also described any issues beyond the scope of career practice which may be impacting student career progress and causing students to struggle. These included issues requiring referral to other offices such as financial aid (for severe financial stress), learning supports (for learning differences and barriers), academic advising and registration staff, disability access services, and medical health/physician accommodations or healthcare (for injuries or other chronic conditions). They would come in to work on their resume, but as she started talking the things that would come up would be, not resume, you know? It would be ‘Well, I’m here because I need a resume, as I need a job, as I don’t know how I’m going to afford my rent next month, and I’m afraid I’m gonna be on the streets, and it’s causing me severe anxiety, which is causing me to do poorly in my schooling, which is causing me more anxiety, which is causing my mental health to plummet, which is causing my relationships to suffer, which is causing all of these other things just [to] snowball’ right? …those bigger existential questions… She probably should not have been working at all, but she was so worried, thinking she had to do everything, but she was just starting out in her first year, brand new, never away from home, very young. Experiencing all of the fears, anxieties, and newness that brings… That was a huge thing she was dealing with was just that feeling of overwhelm, I think that’s what so many students deal with.—Mary, 37 I’ve had students, maybe several students in my five years, disclose or indicate, suicidal thoughts…In those cases I do have some suicide prevention training and things like that, so I have my skills that I rely on for that…first, I always just really thank people for 97 sharing that with me and trusting me to share that information. I also talked to them about what other supports they have.--Sarah, 36 When they start talking about jumping between wildly different ideas and I’m trying to sort of pin them down to ‘Okay, well what’s the reason for wanting to do both of these things at the same time? You were really focused on this thing, now you’re really focused on this thing. What’s changed?’ and...students who are expressing that they’re having a hard time juggling everything and then…they start talking about how it's difficult for them to maintain focus on things, that they have lots of big ideas but they’re not really able to focus enough on any one of them to succeed at it…and so that, again, is something where I’ll say ‘Okay, you should probably talk to a counsellor’—Joe, 38 Table 9. Types of Mental Health Issues Recognized in Career Sessions Type of mental health or non-career issues recognized (that are interfering with student progress, undermanaged, in need of referral and supports) Number of participants who mentioned this issue was noticed in one or several clients Symptoms of Anxiety, worry, overwhelm 9 Symptoms of low mood, low energy, disengagement, feeling depressed, lost 8 Suicide Risk 5 Symptoms of ADHD 5 Low self-esteem, low self-worth, imposter syndrome 3 Cognitive and learning differences, difficulties 3 Cutting, self-harm 2 Risk of violence to others, oppositional defiance 2 Severe financial stress (lack of food, no money for bus) 2 Social isolation, loneliness 2 Obsessive, compulsive, or rigid behaviours 2 Substance use issues 2 Physical injury, disability (undermanaged) 2 Sexual abuse or trauma history 1 Autism spectrum symptoms 1 Although the present study focuses on the action of recognizing mental health issues in career service sessions, the topic of student mental health is large and multifaceted and this research question is just one piece of a larger issue. As such, some participants often went on to describe in their stories not only their experience of recognizing mental health issues, but also the series of action steps they went through after the recognition moment, in order to support 98 students. Due to the focus and limitations of this study, and the time limitations of the interview, this subsequent sequence of events was not explored in detail with participants and is not described in detail here. However, for those who did describe their full process, common subsequent steps reported were staying within limits of competence, orienting students to counselling, educating them on counselling services, and helping them to access counselling services directly with a warm referral or helping them to make appointments. Of note, most participant stories explicitly stated the importance of staying within their limits of competence, within ‘their lane’ or their scope of practice (n=6). (See Chapter 5 for discussion of future areas of study.): If they disclose something that's mental health related that's going to be where it's like ‘Okay, well, good that you've identified that. This is sort of the point where I’m going to help you to reach out to the other supports because we've got lots of supports for students, and we can make sure that you get the support that you need to thrive.’… And so I will walk them through how to do that, and how to book that appointment to work through things with a counsellor here in the in the university—Joe, 38 I never tried to push, I never tried to say ‘You need to [see a counsellor]’ I would always pose it as a question, ‘What do you feel about this? … Do you know this is available for you? Did you know you can access it for free? It’s amazing!’ Some of those would be great ways to have students be open to it… I would have to say to them, ‘There’s a Health Center on campus, you get to access that, it’s darn near impossible to find a doctor in our city right now, nobody’s taking patients, but you are a student, so you get to use the doctors on our campus.’ –Mary, 37 I always get consent from the person for whatever action I might take…and I make sure to kind of be clear about the boundary of my competence. [I say] ‘I am not a clinical counsellor and I’m not a psychologist and I would really love for you to talk to someone who has those skills to chat with you about that,’ and ‘Is that something that could be helpful for you? and, if so, could I call counselling right now and see if someone could talk to you today?’ And if they're like ‘Yeah, I’d be into that’ that's when I’ll call counselling and see if [they could see a counsellor right away].--Sarah, 36 In summary, participants job titles were highly varied, but the job scopes they described were very similar. All were involved in one-on-one career counselling/advising/guidance work. 99 Participants varied in how frequently they recognized issues; in some it was very frequently, such as several times per week, in others it was reported as less frequently, such as once per month. Participants described a wide range of mental health issues that they had recognized in career service sessions, with symptoms of worry, overwhelm or low mood being most common. Many participant stories emphasized staying within their limits of competence, and of actions taken to lower pressure upon students, and efforts to connect them to counselling or other supports. 4.2 Critical Incident Findings: For the Critical Incident components of the interview, participants were asked the following: “Now I would like to focus on times when you have recognized mental health issues in a career session. What has helped you in recognizing mental health issues in career service sessions? Can you give me a specific example of where this specific factor helped? How did it help you to recognize mental health issues?” Participants were subsequently asked to describe hindering and wishlist incidents (see below sections 4.5 and 4.6 respectively). Participant responses were coded in fine detail to extract any element, incident, or action participants signalled as important to this task. Because of the broad way that questions were framed, participants described not only their own behaviours, but also the critical behaviours of their managers, of students, as well as critical campus procedures, which they considered helpful or hindering for this task. The 11 interviews generated a total of 637 Helpful Incidents, 63 Unhelpful Incidents, and 48 Wishlist Incidents. Most participants reported between 40 and 60 helpful incidents but one reported 114. Some participants had prepared content for their interview and indicated mental health was a concern for them, as though they had a lot to share. 100 Initial categories were established iteratively after each interview, resulting originally in 17 helpful categories, 11 hindering categories, and 13 wishlist categories (See Table 1 below). Table 10. Tracking Exhaustiveness Category Legend: H = Helpful U=Unhelpful W= Wishlist Date of CI/WL Extraction Participant Code and Pseudonym Date Categorized Number of new Categories Emerged Jan 28.22 A1 Mary Jan 31.22 All new categories 16H, 9U,1W (as the first interview this was overly detailed and exhaustive; subsequent interviews were adjusted to limit time and detail; data recategorized April 1st below) Feb 2.22 B1 Susan Mar 3.22 11H 4U 5W new categories Feb 4-6.22 B2 Daniel Mar 4-7.22 3H 2U 1W new categories Feb 6-9.22 B3 Gareth Mar 7-12.22 No new Hindering 3H 1W new categories Feb 8-9.22 C1 Kate Mar 12-20.22 No new Helpful No new Wishlist 1U new category Feb 9-12.22 C2 Warren Mar 21.22 No new categories Feb 10-13, Mar 21.22 C3 Joe Mar 22.22 No new Helpful No new Unhelpful 1W new category Feb 11-16, Mar 23.22 C4 Sarah Mar 25.22 No new Helpful 3U 1W new categories Feb 14-16, Mar 25,26.22 D1 Holly Mar 26.2 No new Helpful 1U 1W new categories Feb 17-20, Mar 26-28.22 D2 Isa Mar 29.22 No new Helpful No new Hindering 1W new category Feb 18-20, Mar 29-30.22 D3 Lily Mar 30.22 No new categories Mar 31-April 1.22 Reconfigure Mary Categories based on subsequent categories A1 Mary April 1.22 No new Helpful No new Hindering 1W new category Final Count of Initial Categories after all Interviews Completed Total number of Categories after Initial Extraction: 17 Helpful 11 Hindering 13 Wishlist 101 Due to the large number of incidents extracted, and the high rate of agreement among participants, with no new novel helpful categories emerging after the fourth interview, there was a high participation rate in the initial categories (see Table 2 below). There was also a relatively high rate of agreement in subcategories (refer to Appendix G for finer detail of commonly reported incidents and subcategories which were collapsed into the larger categories). Table 11. Initial Participation Rates Category Name Participation Rate Category Name Participation Rate Helpful Categories Helpful Categories Notice actions and behavioural cues 100% Notice conflict markers (notice how things are said)_ 54% Proactively build a low pressure relationship 91% Introduce Career Theory to normalize challenges 54% Respond well to disclosure and distress 91% Worksite mental health workshops 54% Management Support /permission for mental health work 82% Use Immediacy observations and gentle probes 54% Pay very close attention 82% Offer to act as a liaison to other campus services 45% Notice Language 82% Notice supports ask about supports 45% Ask about Challenges to Career and Life Progress 82% Use Application Process as springboard for deeper discussions 27% Introduce Career Fit Discussions and Theories for deeper disclosure 73% Be willing to understand and address source of career distress to see if other stress remains 27% Very Close ties with Counselling Team 73% Categories which were very similar or adjacent to one another were grouped together resulting in six final categories. Table 12 below lists the final six categories and their 102 participation rates. The number of incidents in each category reveals how frequently incidents in this category were mentioned. In order of highest number of incidents mentioned, categories were Building a Low-Pressure Relationship (206 items), Active Listening (148 items), CP Person-Level Factors (118 items), Workplace Supports (70 items), Using Career theory and Process (54 items) and Exploring Barriers (41 items). For those incidents which were reported less frequently, the fact that nearly all participants mentioned incidents in each of these categories speaks to their importance and helpfulness with recognizing mental health issues in career service sessions. In descending order of highest participation rates, that is, participants mentioning incidents in that category, categories were as follows: Institutional/Workplace Supports (100%), CP Person-Level Factors (100%), Active Listening (100%), Building a Low-Pressure Relationship (91%), Using Career Theory and Process (82%), and Exploring Challenges (82%). Categories are presented below in the sequence described in the next section (see Limitations in Chapter 5 for further discussion of how importance of categories is computed in ECIT). 103 Table 12 Refined Helpful Categories Helpful Category Participants Participation Rate Incidents Institutional Workplace Supports • Close ties with Counselling Team 73% • Management supports and policies 82% • MH training workshops 54% 11 100% 70 CP Person-Level Factors • Strong knowledge of common student challenges/issues 100% • Prior life and work experience 82% • Personality attributes and values 64% 11 100% 118 Build a Low-Pressure Relationship • Build a low-pressure relationship 91% • Respond well to Distress 91% • Act as liaison to campus services 45% 10 91% 206 Use Career Theory and Career Process • Use Career Fit theories to deepen discussion 73% • Introduce Career Theory to normalize challenges 55% • Use application process for deeper discussion 27% 10 91% 54 Active Listening • Notice Behavioural Cues 100% • Pay very close attention 82% • Notice Language 81% • Notice Conflict Markers 54% • Use gentle Observations and Probes 54% • Notice Supports 45% • Unpack distress for Career Items 27% 11 100% 148 Explore Barriers to Progress • Ask about current challenges to progress in career/life 82% • Ask about past challenges 45% • Ask about future challenges 18% 9 82% 41 Another feature of the data analysis which underscores the importance of these categories, is that some of the factors participants mentioned as helpful were also listed as unhelpful when not in place. Only one factor in the entire data set (Zoom) was listed as both helpful and hindering, in terms of helping some students to open up and impeding openness in 104 others. In all other cases, the hindering and wishlist factors reinforced the importance of some of the helpful factors which had been mentioned, in that a ‘lack of’ the helpful factors was a hinderance, and more of the helpful factors were ‘wished for’. Of note, the hindering and wishlist factors reported were all factors outside of the participants’ control, things they were not able to improve, action, implement, or remedy themselves. These were typically manager behaviours and campus procedures. In the Workplace/Institutional Supports category (factors in place outside the session and before the session), all of the wishlist items, and nearly all of the hindering items fell into this category. In other words, when these workplace supports were in place, they were described as being helpful; when there was a lack of workplace supports, it was described as a hinderance, and many participants ‘wished’ they had more workplace supports. When framed in terms of actions, certain manager behaviours were considered helpful, while other manager behaviours were considered a hinderance, suggesting that recognizing mental health issues is also related to the proficiency and knowledge of managers with certain elements of their role. Of note, due to the process of the ECIT method, only what is elicited is reported and coded; participants are not prompted on any factor. It is important, then, not to interpret percentages as in a survey, which would yield different results, but rather to see importance in the fact that these incidents were brought to mind and shared by participants, out of all the other things they could have discussed or recalled. Thus, a given participant may indicate that ‘lack of time’, for instance, is a hinderance, but may find it obvious and redundant to state that they wish for more time in the wishlist section, if they perceive this was implied, and thus ‘wanting more time’ would not be coded in such an instance. Similarly ‘having enough time’ would only be 105 coded as helpful if a participant mentioned they had enough time, which many stated they did not (see Limitations in Chapter 5 for further discussion). Table 13 Importance of Workplace/Institutional Supports Category Workplace Supports Category Overall Helpful to have 100% Lack of Supports Hinderance 100% Want more supports 91% Close Ties with Counselling team Helpful 73% Lack of close ties Hindering 63% Want more close ties 36% Training workshops on mental health Helpful 54% Lack of training workshops Hinderance 63% Want more training workshops 73% Management Support for the Mental Health role of CPs Reported they had this, Helpful 36% Lack of Management support Hindering 36% Want more Management support 36% Sufficient Time with Students Reported they had sufficient time, helpful 18% Lack of time in session, hinderance 63% Want more time 27% Private Closed Office Helpful 45% Regular Co-Consultation Meetings Helpful 36% Zoom Helpful with some clients 18% Can be a Hinderance with some students 27% Access to student records via portals 9% Helpful 4.2.1 Arranging the Categories In ECIT, categories can be arranged in many ways. Because the ultimate frame of reference for the data is to inform the field from a standpoint of training for CPs or campuses, organizing categories in the order described below seemed useful in that it captures what is within each party’s control and responsibility at a given point in time, as well as the order of having incidents in place. Participants described incidents in-session, incidents based on prior actions and learning in the past, and incidents based on manager or organizational behaviour. For instance, a brand new CP can be taught the in-session actions, but they do not have control over 106 institutional supports or manager behaviours which may be critical antecedents. Similarly, a campus leader may expect CPs to recognize mental health issues, but this data highlights critical supports only management can provide which are beyond CP control. Therefore, the critical actions of managers and campus leaders, which together represent workplace supports, are separated out as a distinct category, because when these are not in place, they can hamper CP actions in-session. Additionally, participants described behaviours which drew upon empathy and knowledge they had developed over time, as well as temperamental characteristics, such as care, patience, flexibility, persistence, and taking initiative. These are not characteristics which can be taught in a brief training workshop; as such they are separated out into a separate category. CPs can invest in activities which build such competencies and knowledge over time, and this information may be useful in the hiring process to managers looking for certain aptitudes. Thus, this organization of categories captures what ideally is in place prior to the session, what is the responsibility of managers and campus leaders to provide and action, and what takes place in-session. The two pre-session categories above are placed ahead of the in-session categories, because the Workplace Supports and CP Characteristics may be foundational precursors to recognizing mental health issues in-session. The Workplace Supports category refers to characteristics of the campus and of actions performed by managers and campus leaders which help participants to recognize mental health issues in-session, or which impair the process of recognition when these resources and permissions are not in place. In terms of verbs, Workplace Supports are things the CP has access to, or things a manager does or provides. The workplace supports vary campus to campus and are largely beyond CP control. The CP Person-Level 107 factors category refers to personal knowledge, experience, qualities, and characteristics the participants had developed prior to the session which contribute to this task. This may involve actions in the past across time, such as obtaining teacher training, or working with students, or immigrants. CP-Level Factors are things the CP knows, or has within themselves—these competencies and traits travel within the CP to any campus. These characteristics relate to prior critical actions, such as prior work experience, prior training and education, and prior personal experience undertaken. The other four categories are actions which can be taken in-session, or in interactions with clients (see Figure 1 infographic below). These are critical client-facing behaviours which could presumably be taught in a training program. The final four categories are actions the CP takes in-session or in interactions with students, things they do in relation to clients. The in-session verbs are proactive actions they take, things they do to develop trust and safety in the relationship; information they give and questions they ask in the Career Theory Category; noticing, listening, and paying attention in the Active listening Category; and finally, exploring challenges. 108 Figure 1. Infographic of final categories. 2 Categories in place Pre-Session/Outside of Session 4 In-Session Categories Workplace Factors CP Person-Level Characteristics Actions the CP can take in-session Client interactions The final 6 categories are: Pre-Session: 1. Institutional/Workplace Factors in place prior (things they have access to prior to the session, manager actions, workplace characteristics) 2. CP Person-Level Factors developed prior (things they know or have within themselves prior to the session, personal characteristics) In-Session or Client-Facing Actions 1. Building a Low-Pressure Relationship (things they do, actions taken to build rapport, safety, trust) 2. Using Career Theory/Career Process (career information they provide, career questions they ask) 3. Active Listening (noticing, listening, attending to, gentle probing) 4. Exploring Challenges and Barriers to progress (noticing and asking about career/progress challenges specifically) One important reason for ordering the categories in this way is also to capture the order or sequence that many participants described. The in-session action categories often were described in an order based on developing safety with clients towards increasing comfort with disclosure and improving recognition of issues. First, most participants described taking care to build a relationship with safety, rapport, focused on overall wellbeing, encouraging the student to book sessions with the career practitioner, and to help them to talk about themselves freely. Next, some participants described using career theory and the career process as a tool to lower pressure 109 with clients, to normalize struggles as part of career, and to encourage deeper discussion and self-reflection as a key towards career success. This increased disclosure and salience of mental health issues. Additionally, all participants described active listening throughout the session, the many cues they noticed whether verbal or non-verbal and how they paid close attention throughout the session to student reactions, language, and actions, probing gently to understand further as needed if distress was evident. Finally, many described exploring challenges to progress, asking about any barriers in the way of career goals. Some mentioned that this discussion of challenges came at the end once a relationship and safety had been established. Category findings are presented below in order of the sequence described above; things in place prior to the session, followed by actions taken in-session. (Refer to Appendix F for a summary of the categories, their definitions, and their importance.) In summary, the arrangement of categories in this way parses out responsibility and thereby highlights critical behaviours at the procedural and management level, as well as the CP level. 4.3 Helpful Incident Categories 4.3.1 Workplace/Institutional Factors This category is defined as things the Career Practitioner has access to thanks to the employer or workplace such as a very close working relationship with the counselling team, mental health workshops provided on the job or by the employer, management supports and structural policies which support CPs in recognizing mental health issues, such as longer time for sessions, permission for repeat sessions, permission to take part in mental health training, access to a private closed office and private Zoom, access to student grades and progress portals, regular meetings with the career service team to review difficult cases, and managers who recognize the 110 importance of the CP role in student mental health. Each of these elements relates to actions taken by others, not just the CP, such as career service managers, campus leaders, those who design campus procedures, and other campus staff. Taken together, these collective critical behaviours amount to workplace supports and resources. All 11 participants (100%) reported incidents in this category, with 70 incidents reported overall across the data set. The importance and relevance of this category was also evident in the hindering and wishlist incidents, in that nearly all of the hindering incidents and all of the wishlist incidents fell into this category, as noted above. While participants can advocate for these supports and take some initiative to establish them, these elements typically depend on leadership actions, approval, or resources beyond CP control. Many participants explained that having close ties with the counselling team increases confidence to notice mental health issues given that referral supports are close by, enabling them to feel more able and willing to recognize mental health issues: We’re fortunate in our area structurally that we report to the Dean of students and, within that reporting structure is our counselling department as well… physically located five doors down from where I’m located right now…I refer [students] and if I’m worried, I will physically walk them down to the Counselling Office. I find…our counselling department’s very proactive in supplying not only us, but all faculty resources to recognize mental health with students so ad hoc training is available to all of us. --Daniel, 59 A number of participants described the importance of taking initiative to get to know the campus counsellors personally, to feel more comfortable making ‘warm referrals’, to facilitate quicker referrals, to introduce the counselling team to students, and to feel more supported in recognizing mental health issues so they won’t be left to address matters outside their competence: 111 I’m just always making sure to check in and introduce myself and let [the counselling team] know the program that I run and so they know me…I establish a really, really good relationship with them, to the point where even on opening day I sat with the wellness group instead of the career coach group…I always took that as a really an important part of the job, to know those resources… and I knew [all the counsellors] and I played [sports] with them and I made a point of getting to know them. So even to the point where I could maybe say [to a] client ‘I think you would really connect with this person, I know them.’ And I think I did that… because I was building my own team around me to help when somebody came, because I saw enough times like ‘Uh oh, this person is requiring more help than I’m trained for’ to keep inside of my lane, so I would be able to refer that person and [it’s great] when that can happen quickly. –Gareth, 52 Some participants described the value of knowing a counsellor who had career development expertise specifically, of working in tandem with them on outreach, on workshops or even switching offices, to build student comfort with mental health, to feel as a united team with the counselling department, all towards ensuring easier referrals. These stories suggested that part of what helped the participants to recognize mental health issues is to feel secure and safe that referrals will occur if they take the risk to enquire at signs of distress to recognize issues, that counsellors will be available, and that students will be comfortable to pursue the referrals, rather than leaving mental health issues with the CP: There have always been people in the counselling area work with whom I keep a close contact, so that I can refer people directly…We literally had offices beside each other… myself and the counsellor. So one day a week my office moved to a different area and the counsellor had my office …so it was an easy transition for students there because it would mean their meeting would be in the same room. [Having them next door] is an easy way of being able to build that rapport with people...One of the counsellors does have some additional training in career counselling so that’s who I generally work with and again, keep that open communication. That’s something that I initiated, because it’s somebody that I can refer people to which makes it easier… knowing who to refer them to rather than just saying ‘Oh, you need to go talk to somebody’ that is a very different attitude…it’s not just saying ‘You need to talk to somebody else’, it’s ‘You need to talk to this person. This is how you connect with them’, and maybe even bringing them to that person. – Joe, 38 I have a really good relationship with one of the psychologists in the [Counselling] Center because she has a career development background and… we invited her into 112 career services, it was called [wellness] night. [Students] could always come in… and then I would book students in to see her...That really helped because it made [it seem like] we’re all on the same team. Like I think at the university, we want everybody to be successful and so I think my friendship [with her helps]…and we would promote their workshops on how to deal with procrastination, how to deal with stress… and I would sit in and co-facilitate with her or I would just sit in on the session and just give my two-cents-worth from a career development perspective. –Warren, 52 Campus-provided mental health training workshops were frequently mentioned as helpful incidents, by increasing CP awareness of mental health issues and ability to notice, question, and refer. Some participants explained that mental health training such as QPR and Mental Health First Aid highlight the other resources for referral on campus, making it easier for CPs to stay within the career service scope of practice, to refer better and faster at more subtle signs of issues. These brief workshops helped the CP to not feel obligated to help students with things beyond their ability, to recognize the limits of their competence and to know others are there to help. Again, a part of what seemed to make these trainings helpful was how they improved the ability to refer, and thus safety about recognizing issues, rather than ignoring mental health issues out of fear of what to do or of feeling obligated or stuck to handle them on their own: That [workplace mental health] training was where I primarily learned about the extra resources we have on campus to support students and I’m not sure I would have that information as readily available to me if I hadn't gone through that additional training. I mean the resources would still exist, but I don't know how familiar I would necessarily be. That is something super valuable because… they did talk about the need to refer, and when to refer, which I think is very important in a student-facing role. Because I feel, in a sense, like quite responsible towards my students. And you want to see them be successful and you want to support them. And I feel like it could be very easy to go out of your scope of practice when a student is sharing these stories with you, so I just found the training around like knowing when, and where to refer students to be really just beneficial…because it's outside of my ability to provide them with that appropriate level of support… It makes me quicker at actually seeking out these other resources and sharing these resources with students, even when they are just giving me subtle cues. It doesn't necessarily seem like a very serious event yet. I talked to them, I think more often about the kind of additional resources we have available to them, then I think I probably would have if I hadn't done that additional training. –Susan, 35 113 Many participants emphasized specifically that having the opportunity to practice mental health recognition and referral skills was one of the most helpful parts of the training workshops, via role plays, feedback, and role modeling. The experiential practice gave them more confidence to recognize issues in sessions, as opposed to just learning from books or theory: They did a Mental Health workshop in career education and even just that recognizing like what is a more than quote-unquote ‘normal’ amount of stress around career search, [and there was] interactive practice. I think there's just no way to substitute for the practicing in different scenarios. I love hearing about theory but, at the end of the day, we need to be able to put those things into practice with our students and it really helps also to get feedback as you do that practice.—Sarah, 36 Some participants explained that management support and structures which allow CPs to spend time in building relationships, to practice ‘holistic career service’ focused on the whole person, not just on metrics, helps them to recognize mental health issues. Some reported that their campuses have a strong mental health focus, and that leaders who understand the connection between career and mental health are helpful and important, increasing their ability to recognize mental health issues: I also had strong leadership in my department, who made it a point to make sure that we knew those [other campus] services, and could accurately and appropriately make referrals, which was phenomenal and not every department had that…My first boss in the role, she was wonderful in just her whole approach… I never, ever felt like my job was just to get that resume done, I always felt like my job was to help the student and whatever that meant. Because to help the student was not always to get that resume written. [It helps] when leadership recognizes that it is about a holistic student approach. – Mary, 37 To summarize, participant descriptions of helpful incidents in the Workplace Supports Category included the value of working very closely with the counselling team, to feel secure and confident that referrals could be accomplished, thereby lowering the risk of recognizing 114 mental health issues and having to address them on one’s own. Descriptions included the value of mental health training workshops with experiential training, where recognition and referral skills could be practiced and role-played, as well as clarity on campus resources and mental health awareness. Supportive leaders who permit CPs to engage in training opportunities or in longer sessions with students with a holistic career and wellbeing focus were also reported by some as helpful workplace incidents. 4.3.2 CP Person-Level Factors This category is defined as things the Career Practitioner knows or has within themselves which they bring to the role, such as personal characteristics, passion for career work, being a naturally empathic, caring, flexible person. This includes comfort and willingness to support students over time and comfort to discuss mental health flags for referral, and cross-cultural competence. This includes prior personal, work experience, or training, such as in teaching, campus roles, work with youth, with immigrants, prior counselling training or counselling volunteer work, or personal life experience with mental health issues. This also includes having strong knowledge and awareness of common student challenges such as overwhelm, high pressure, high stress times in degree, lack of supports, isolation, suicide risk, ADHD, autism spectrum issues, international cross-cultural student issues, fear and shyness about seeking mental health services, and awareness that career and personal issues are often interconnected. Taken together, these are characteristics and knowledge of the CP, which are in place before the client session occurs and which presumably cannot be taught in a brief workshop. However, this data highlights some specific actions which may contribute to developing these competencies and this knowledge over time (working as a sports coach, working with at-risk youth, working 115 with immigrants or in other student-facing roles etc.). All 11 participants (100%) mentioned elements in this category for a total of 118 incidents extracted from transcripts referring to CP-Personal level factors which helped participants to recognize mental health issues. Some participants explained that being a naturally positive, hopeful, empathic person, with a respect for individual differences, and with a passion for career service work, helps them to notice issues: You know, just thinking about being really optimistic for each student and accepting where people are… language, how people dress, all of those things help, respect for the trade, you know? Like gosh, an expression I’ve always held on to is…‘It would be very quiet, if only the best birds could sing in the forest.’… I had a colleague of mine, she said ‘You fascinate me. Every student that you see walks out of your office two inches taller.’ Isn't that so nice? It was the nicest thing anyone has ever said to me… It's way too addictive this work [career services], it's awesome, that’s why I’ve been here way too long (laugh) –Holly, 57 I just shudder to think that there might be people out there [campus staff] who don't really care about students or don't have some of the counselling skills, and are not ‘being there’ because I have had students tell me like, ‘No one has talked to me like this’ kind of thing, or like, ‘I’ve never told anyone this.’ And it's like, ‘Why?’ [and the student says] ‘Well no one's asked me how I’m doing. Like I know people who have told me about their experience as a student where no one has asked them how they are, or shown any care for them in their time as a student, and it really shattered my heart. And the more I realized that some students have that experience, I just want to create the most gentle, compassionate space for them…so really trying to build people up. Generally speaking, student self-confidence is pretty low. So at every single appointment [I’m] like, ‘How can I build this person up as much as possible?’ –Sarah, 36 A number of participants described that caring about student success in their career post-graduation, and caring about student wellbeing and emotional experience in the session, beyond simply their basic job task of completing a resume, helps to notice mental health issues: My big thing often is… about setting people up for success… I want them to feel like they’re safe enough and equipped enough to be successful [after their studies], not just throw them off the plank [with a resume]… My mom trained me at an early age to be empathetic… I think it is so important for people to be very empathetic but also to stay in their lane… I think you should really try to have as much understanding…because a lot 116 of times, let's face it, that's why they're probably here to see you, not because it's been super easy. –Gareth, 52 It sounds kind of not very humble to say this, but… I think I’ve just always been quite an empathetic person… I think it just made students more willing to open up, and more willing to share and they felt safer. Because I think if they felt that I was a genuine and empathetic person then they felt more willing to talk to me or more open, like, ‘Okay, this is somebody who actually cares about me and who truly wants to help me’ and that's the truth, so I just tried to find ways to show that. ---Mary, 37 Many participants explained that prior life and work experience increased their knowledge and ability to recognize mental health issues. A number of participants described how teacher training helped them to recognize issues, or that experience in other student-facing roles on campus, or prior work with immigrants or youth helped them to notice when students needed something beyond career support: I don't think I [would have been able to recognize mental health issues] without the training that high school teachers get around when you need to refer a student to a mental health professional. I think it would be a lot harder for me. So people who didn't come out of education, I think may have a harder time in that area…probably explains why everybody in our department, who does this work, was a teacher at one point (laugh). –Joe, 38 Some participants explained that time on the job as a CP helped them to notice that mental health issues were more common in career sessions. Kate, the only Registered Clinical Counsellor in the group, reported that she was surprised to find mental health issues arising so often in her career sessions: I think my attention grew the longer I practiced [as a Career Practitioner], the more aware I was. I don't think I expected [mental health issues in career service] going in. So [my attention to] mental health issues grew the longer I did the [career service] job. I thought it would be very separate.—Kate, 50 All participants’ stories exhibited strong knowledge of common student issues along with awareness and sensitivity about common sources of student distress, a combination of knowing 117 and caring. Most participants told stories of students under intense career, academic, personal, and family pressures. Many participants also displayed high cross-cultural competence—whether from being an immigrant themselves or from experience working with high numbers of cross-cultural clients. These stories described challenges that students face and the extra lengths the participants go to in order to support them as part of a strong working relationship, which often leads to disclosure or recognition of mental health issues: One of my concentration portfolios right now is English language development and there's a lot of anxiety and just a lot of older, mature students that are trying to [get a job]. They're sad because their credentials aren't recognized. And with those students where I just have to have multiple appointments, lots and lots of ‘time in’ until they get a job. I picture maybe, not 30 appointments but, it's getting up there, like 20 appointments, [until] one of those tends to get back into their career field. But there's progress; it takes probably seven or eight job postings related to the field.—Holly, 57 A large portion of the students that access our services are international students, and a lot of the time, they feel they just don’t know how to navigate their surroundings and community and what to do…a lot of challenges being newcomers and… acclimating to a new country and new communities… [Eventually they tell me] how isolated they are, just feeling lonely, or they just feel a lot of pressure…I kinda understand where they’re coming from. Coming from maybe Japan or Iran, you’re either ‘this or that.’…Depending on your socioeconomic status, you don’t really have a choice in the matter. [Your career] is kind of given to you or expected of you—Lily, 43 Some international students…because of cultural differences and different backgrounds …they may experience anxiety and also depression. However, this cultural piece that’s preventing them from showing this openly to everybody… I come from a different culture, so I definitely have the experience and also the opportunity to see how people react to things differently. I definitely know that some international students do need a lot of help, however, they don't ask for any help, they act very normal, however…deep inside they need that support…You can definitely tell that they're not engaging at all. However, they are perfectly polite, they are very nice, they are just not progressing. –Isa, 42 To summarize, participant descriptions of helpful incidents in the CP Person-Level category included being an empathic caring person, with a passion for career work. Stories also highlighted strong knowledge of common student issues, cross-cultural competence, as well as 118 specific personal and work backgrounds which were helpful, such as teaching, other campus roles, or working with youth or immigrants. 4.3.3 In-Session Categories: Building a Low-Pressure Relationship This category is presented as the first of the in-session action categories, because some participants described this as a primary initial task which lays the foundation for the in-session work. Some of these relationship-building activities happen before the session such as outreach, or setting the physical office space with a purposeful intent to build safety for students. This category is defined as proactive actions taken to build relationships, such as outreach activities, being available for appointments, telling the student a bit about the CP and their own career journey, including prior CP career challenges. This includes focusing on holistic wellbeing of the student, always starting with a brief chit-chat to ensure the student is doing ok, reducing power differentials, building trust and rapport, being flexible and aware all students need different things, being non-critical of career tasks, following the student’s goals and agenda, never pushing, being a useful and knowledgeable liaison for career and campus resources. This also includes responding well when distress is apparent, pausing, normalizing, validating, slowing down, making space for tears, offering extra time and career support as needed, staying in the career practice lane, going over and above to help students with challenges affecting their success, and gently providing information about counselling services. 10 of the 11 participants (91%) emphasized the importance of building a relationship, with by far the most incidents reported (206) falling into this category. Many described the importance of getting students talking about themselves as much as possible, helping them to feel more comfortable to share, that the stronger the relationship, the 119 more students share, the higher the likelihood of noticing mental health issues. Some participants described creative ways that they proactively built small connection points to help students to open up, and to feel more comfortable to share their concerns: I mean you can't get to know someone in 30 seconds, but I think you can just try to set them at ease, make them feel comfortable. And I guess that's what I would try to do. I did little things like even… I’m a hockey fan…So when I first started… I got [some hockey items for my office] ‘cuz I figured that might make some of the guys a little bit more open to talking with me because hockey's a good connection point… It actually did sometimes get them talking to me… If I saw them holding a textbook, I might ask them about that particular class. And if I can see that they just came from the gym, I might ask them, ‘How was your workout?’ or…when we're looking at their resume, if maybe they worked at a shop that I like or something I’d say ‘Oh I love that place, how do you like working there?’ Just little points of connection to make it feel a little bit more like you're talking to a human. Little ways to just have it feel a little bit more friendly, a little bit more personable. –Mary, 37 Some participants described a need to market their services to busy students, to encourage students to access career services, as part of relationship building, via outreach, such as through social media, emails, and workshops, as a foundation of the relationship: Well, the most helpful thing is having relationships with students. You know, to see a student in a group setting or whatever, and then they make a one-on-one appointment. Honestly, that is the very best thing that we can do is to encourage all students that we’re here for help throughout their lifetime for free with any career management issues…We do lots and lots of classroom workshops… Once we've had that chance to have a touchstone in the classroom, then, at least we've got a name out there, we’ve got a face... We do Instagram outreach as well for the College…and so that helps to get our faces out there as well. So the students understand that there is career services. --Holly, 57 Some participants used humour and careful self-disclosure as part of reducing pressure in the session: I tell my story with students who are lost, to let them know that [the certificates and degrees] you see behind me on this shelf [aren’t] really indicative of the struggles I had when I was younger, so I do tend to when appropriate, share that story that I’m a high school dropout…and then I struggled probably till my early 20s. And when students see us as professors they don't see that we had this life, [they think] we had it all figured out, apparently I went from kindergarten to this job, with no chaos (laugh). [In high school] 120 they gave some arbitrary psychometric test to my generation, it was called ‘Choices.’ I was supposed to be a garbage man [sic], which was very inspiring to finish high school when they get that sort of diagnosis. (laugh) So I explained a little bit of that to them.—Daniel, 59 Many participants explained the importance of not rushing into career tasks, of always taking time to get to the know the client first, and to assess if they are ‘doing ok’ at the beginning of every session. Gareth and Warren, both with decades of experience, emphasized the importance of not jumping in to fix career problems as something that helps them to notice issues: My experience tells me that people want to be seen, heard, and understood…Sometimes, which makes sense in a career coaching or career advising session, there's a need to fix or to solve a problem instantly. Whereas I think if we rushed to that, we may miss some of the other things that are going on. So as a career coach, and my coach training is, it's really to ask questions and allow time for that space to kind of just get to know that person, to get a concept of where they're coming from.---Gareth, 56 I always asked like ‘How are you? How are you doing? How are you feeling?’ I always check in, too, depending on the day of the week. I met with a couple students on Monday, and you know ‘How was your weekend? How are you doing? How are things?’...and they talk about the stuff they're doing in school but I’m like. ‘No, no, no, how are you doing, are you happy?’ So I kind of just bring it to a head there sometimes and if they're like ‘Well, I’m not doing too good’ or whatever, I will refer them to our [Counselling] Centre or let them know that ‘You have free sessions with our [Counselling] Center if you want. Were you aware of that?’—Warren, 52 A number of participants saw this brief five minute “chit chat” at the beginning of each session as a division point before getting into the ‘real career content’. This brief check-in was underscored as something which helped some participants to notice issues and also to ensure that the student is ready and able to tackle career tasks, while also contributing to relationship building: Definitely [I] have a lot of patience… In every meeting with students, I always like to chit chat a little bit, before going to the real session and just see that the student is doing 121 okay. And it’s [checking that they] feel comfortable and in a comfortable space and [are] ready to share. Because sometimes you can just tell right away, because we have a student…who just came in here… very anxious for something else, not even career…We offered water and everything just to calm him down. That extra care is really important, and sometimes… if they’re not ready to share, it’s probably [best] not [to] rush into the real [career task] content. And maybe just back off a little bit and then make sure that a student can take a few deep breaths and just to calm down, and then move on.– Isa, 42 An important part of building a safe trusting relationship was often reported as slowing down when signs of distress do arise in session, and recognizing that career tasks are best done when a student is not in distress. Many participants described offering more time or supplementary career sessions at signs of distress, being flexible, helpful, and offering clients choice, and respecting their agency as to whether they wanted to proceed and what they want to focus on in-session as things which help to build safety to share: [I would tell students] ‘You know what you just said to me [that you feel overwhelmed], I don't think resumes are relevant anymore …let's talk about this for a moment.’ And if they do want to continue talking about [the resume] they brought in, of course I will do that, but I just want to kind of carve out some space to show how important what they told me was. And see if we can deal with that and then oftentimes I will say like ‘Let's make another appointment to continue talking about your resume or your job search.’ And just talking about how job search or resume writing is gonna be really challenging if you're having this sort of burden or these types of challenges. And that [seeing a counsellor] could be a priority instead the resume.—Sarah, 36 Just connecting to them at that moment, and not trying to say ‘Okay, let's move on to resumes now’, until they're ready. [Instead, I] say ‘Do you want to talk about resumes or things like that?’ Always ask for permission, I guess… Just giving them the space to do what they need to do until they’re ready. —Lily, 43 Many participants evidenced a willingness to go over and above their typical work, or outside of the typical program parameters or policies if a student was overwhelmed or struggling, to make student wellbeing a priority, as something that contributed to building a safe relationship: 122 [After the student revealed their distress] I just offered them an additional meeting time with me at a later time, still ahead of the application deadline to ensure that you’re not missing out on any opportunities and I reassured them that, although we do have this practicum process in place, the goal of the faculty is always to have a placement for every student… So if they needed to step away from the process at this point, to focus on some of these other commitments and relieve some of that stress and anxiety, that I would definitely work with them over the next few months leading up to spring/summer to ensure they had a valuable placement in place for the semester, even if we had to source it outside of this typical process that we follow, and just kind of walk them through some alternatives.—Susan, 35 Some participants described that maintaining a non-judgemental stance about career tasks and lack of progress helped some of the students to feel more safe to share and to return for repeat sessions, to work with the CP over time, enhancing the safe relationship: If you look at their resume, this is a human being here, right? So don't get your pen and say ‘Oh that's wrong, why would you put that there?’ Right? That to me is a little bit insensitive to the human as a total and it's important… that we're aware of some of those challenges that people face when they're looking for ‘jobs, jobs, jobs,’ seeing how much stress is involved in it.—Gareth, 52 There's one concept [I learned about called] ‘unconditional positive regard’. I’m not sure if it's just for career practitioners or if it’s for any helping profession. [It] is a really helpful one for me and it just helps me stay in a very compassionate headspace with people. It is super easy to get frustrated with people when you're in any helping profession, I think when, you know, ‘I already told you this. We've talked about this before, I showed you that example,’ so really trying to stay away from criticism that is not kind or necessary. And just always whatever the person has done it's ‘good enough.’ If they didn't do that thing they said they were going to do, no problem. Honestly, just trying to never visibly be frustrated or impatient. It is the thing that helps me the most because what happens there is, people are more likely to talk about what's really going on, or what is really impacting their career growth or working towards their career goals, and so it creates a bit of trust there and it also just helps me to I think more meaningfully understand what's really impacting the person and how I can help and what other supports they might need to be successful in what they're trying to do.—Sarah, 36 Many participants seemed aware that mental health issues may be just beneath the surface, with numerous stories of students suddenly bursting into tears at the slightest show of care. As such, they prepared their office with physical items such as Kleenex, water, and referral 123 cards to other services as physical signals of creating a safe space, and were prepared to slow down at the earliest sign of distress as part of relationship building. You know this might be the first time they've actually had someone say ‘How are you doing?’ and then kaboom! [tears] so… I do typically stop [and] I softly suggest… ‘Maybe career planning is not the most important thing going on your life right now.’ Well, I don’t say it like that actually but I suggest, ‘I know my colleagues in counselling may be able to have a bigger conversation about the emotional side of what you’re going through that could be a more appropriate first step.’ I keep Kleenex on my desk.—Daniel, 59 The importance of following student pacing and agency was repeatedly mentioned as a key part of the safe relationship by a number of participants, of not pushing the student too fast on career tasks, of not getting lost in the CP’s achievement goals or targets, of pulling back as needed, and of staying present with the client as something that helps them to recognize issues: Kind of those open-ended questions and then I can assess where we go next. And it’s always, I think in my mind, if it’s a green light, then okay let’s, you know, ‘check, check, check’… like an airplane, right? Everything seems good here, let’s go fix our resume or do some job searching. I think that’s really important…So maybe on the yellow light, we can kind of just take a pause, take a deep breath and say ‘Okay, you know what? Let’s just take a little bit of time here’ Feels like [I’m] getting a little bit out of [my] lane or [the client is] stressed a little bit, so that’s okay, [so I ask] “Are you okay? [Those check-ins] are really, really important. In our desire to help and achieve, to check the boxes off, sometimes we just ignore those [mental health issues] and again there’s constraints of time, and all that other stuff. I think that’s really important to me, just to make sure that I constantly [ask myself] ‘Am I leading too much? This person is stressed and I need to back off and let them know that that’s fine.’ --Gareth, 56 Multiple participants explained that offering to liaise to other campus services and being knowledgeable about other student services was an important helpful behaviour for recognizing mental health issues. On the one hand, knowledge of other services reinforced the relationship, making the CP even more useful and helpful to the student, increasing the likelihood of more visits, of a stronger relationship and of more opportunities to notice issues. At the same time, using discussion of other services allowed for emphasis of the CPs limits of competence, which 124 increases likelihood of disclosure of needs beyond the career service realm: One thing I was always very comfortable with was saying ‘These are the parameters of what I do, and my scope of practice.’ And I just explained…‘This is what I can help you with, and this is where we might need to find some extra resources for you, but that’s okay, because those resources are here.’ And so, ‘If you need other things we can get those for you and there’s tons of support.’ And I think one of the most difficult things for students at any post secondary is that they do not know the resources that are there for them…because the university system is big and scary for students. It’s convoluted, they don’t know what they need, they don’t know where to get it, they don’t always know… what the problem is. Like the student who came in thinking what she needed was a resume, when really she need a lot of other things [like to see a counsellor, a physician, or financial aid]…I think students, need to be heard, I think students need to have people help them navigate, because there’s wonderful resources at every [institution] but they don’t know how to get them, they don’t know how to find them, they don’t know how to get the help that they need, and so, then they don’t access them.--Mary, 37 In addition to being knowledgeable about campus services, some participants emphasized the importance of being useful in the career realm, of being knowledgeable about career information and advice, of workplace trends, salary negotiations and so on, so that students see value in their session and take tangible items away that are tailored to them. Some participants describe busy students who do not want their time wasted. Ensuring usefulness, and tailoring career knowledge to different student needs, further builds the relationship and the likelihood of repeat sessions, thus creating more opportunities to notice mental health issues: I really make that space about the student’s needs and I’m just here as a facilitator. [I will say] 'You’re here to see me, so it gives me satisfaction, knowing that before you walked away from this session you got something out of it.’ Make good use of their time, don’t waste their time…‘I want this to be about you, not about me delivering information on the slide. I will do that, you know, whatever, but I will make sure that by the time you leave, you have something tangible or something that you can take away.’–Lily, 42 I think the more knowledge that you have, the more students trust you, and the more they’re willing to open up, and the more that they see you as a professional, and someone who’s actually going to be valuable and not waste their time. Because students hate getting their time wasted. And they hate being sent here, there, and everywhere and not getting what they need. So they’re going to be way more willing to share and actually feel like ‘Oh, if I go to that [Career Practitioner] I’m going to get something valuable.’ –125 Mary, 37 To summarize, participant descriptions of helpful incidents in the Building a Low-Pressure Relationship Category included proactive, intentional activities they engaged in to build safety and trust, to encourage the student to book sessions and to speak as much as possible. This included building safety and connection points in the physical space, of making themselves known and available via outreach, and then once the session began, getting to know the student beyond just career. And then over time, checking in with how the student is holistically at the start of each subsequent session, ensuring they are “ok” before tackling career tasks, as well as following agency and pacing throughout all sessions, and being non-judgemental about career tasks. If any distress does arise, many participants described slowing down, validating, and offering alternatives and extra time. Finally, being useful, knowledgeable and competent about career matters and campus services, and explicitly offering to liaise to other services, were described by some as helpful behaviours in the Relationship category. 4.3.4 Use Career Theory and Career Process This is presented as the second in-session action category, in that some participants described introducing career theory or process early on to set a low-pressure tone and to normalize challenges. This category is defined as introducing career theories (chaos, happenstance, emotional resilience, emotional intelligence), introducing career fit theories (exploring interests, values, motivators, skills, strengths, career identity theories including life roles, relationships), career assessments and protocols to stimulate career self-exploration and self-reflection, discussion of family influence on career, and use of career task processes such as resumes, applications, interview preparation, and strategizing towards career goals. 10 of the 11 126 (91%) participants mentioned incidents in this category with a total of 54 incidents mentioned. Some participants explained how introducing career theories helps to normalize challenges and failure as part of a successful career, and thus may increase disclosure of mental health issues. Each participant who described using career theory had their own unique approach, with no two describing the same theories, but many seemed to describe a similar purpose of using theory to lower pressure and normalize challenges: I explain chaos theory to the students, as the attempt to sort of bring the conversation down a little bit to help them relax…because life happens and [the] pandemic is a really good example right now, of chaos theory. No one saw the pandemic coming. So I tend to talk to students ‘Let’s back this up.’ There’s a lot of pressure from parents… they want to see those five year plans, and I often say that parents hate chaos theory, because we’re saying it’s okay to be a little confused…There’s a visible relaxation and you almost see the student relax and almost ‘Wow’… They think they’re not normal, that everybody has a plan, but they don’t, as we know. That has worked really well.—Daniel, 59 We're human beings, and we think and worry too much… A lot of students think they're in bad shape…They're like ‘Well, I haven't really done anything career, and I don’t know what I want to do, is it too late?’ and I’m like ‘No, it's not too late, I mean it's never too late, there's no starting line when it comes to your career’…With society it's always ‘If you haven't picked your career path by the time you're 18 that’s a mistake’ and I’m like 'No that's not a mistake, it's okay not to know, and it's good, not knowing, actually.’ I always say to students ‘Try stuff out in your 20’s and then really your career doesn't start until you're 30 anyway, I think your 20s is your try stuff decade.’…I’m a big John Krumboltz fan, from the career development theories [so I tell students] ‘I don't think you get to pick your career, I think your career picks you.’…So what you want to do is, surround yourself with people you want to hang out with and work with. —Warren, 52 Some participants described how doing career self-exploration using career fit theories focused on strengths, identity, and roles can be a springboard for deeper discussion, and for disclosure of challenges, making mental health issues more easy to recognize. Again, no two participants used the same method of career self-exploration; each had their own process. Some had designed their own set protocol of career exploration questions which often happened to make mental health issues more salient in the course of discussion. The repeated emphasis 127 among many participants appeared to be to get the students talking about themselves as much as possible, which often lead to recognizing mental health issues: You might have heard this acronym before, V.I.P.S. So, values, interests, personality and skills, so I’m talking about things that really matter to them. When we talk about values and things that they’re interested in, things that they are motivated to be involved in, personality, so oftentimes I would ask if they’d taken any Myers Briggs assessment or any other kind of assessment where they’d learned about what motivates them and what their preferences are, and, that kind of thing. And then skills or strengths like, what did they do well? Where have they excelled? So it’s very focused on the individual and reflecting on how they see themselves, and so that can be a real window into maybe struggles that they’re having as well. --Kate, 50 The [career exploration] questions that I use with students are quite broad and so they move students between a lot of different areas of their life, and thinking about where they’ve come through and what they like about what they have done in the past, and what they like about themselves, what they like about the people around them… They’re really designed around helping them to talk a lot about themselves…about what they enjoy and what they have done. What they feel is ‘them.’ It’s all about them telling me their story about themselves and how they see themselves in it…What connections do they have with various communities…their intellectual strengths, and how they see themselves emotionally, and what they feel they're good at… And so, if they keep focusing in on one thing [or a negative thing] that's a bit of a sign that…they need some time to talk with [a counsellor]. –Joe, 38 Several participants explained that using the career application process (resume, interview preparation) often helped them to recognize mental health issues. Strategizing around how to build impactful, unique application materials helped some participants to get to know clients, thereby contributing to the relationship, leading to more disclosure or noticing of issues. It’s just about having a connection… that has helped me recognizing the mental health [issues], and as they’re more comfortable talking to [me], they will come to share…As you get to know who they are, then what’s important to them and their values and why they decided to pursue that [thing on their resume], and you can see these based on their extracurricular activities [on their resume] or whatever. Then you can kind of tailor that [resume] conversation to what kind of things they can put in their resume and cover letters so they are coming across as more authentic. [It has a dual benefit of getting to know the client and improving the resume], I mean not in all cases, but that’s my hope, that it’s not a cookie cutter resume and cover letter.—Lily, 43 Likewise, the process of working together as an ally ‘on their team’ to strategize about 128 application materials against any challenges in the way of the student’s career goals sometimes lead to disclosure of mental health issues: [If they left a past job or were let go, we talk about] how we’re going to strategize. So we do move it into a conversation around how we’re going to strategize rolling out interview answers and responses…And often students will self-disclose that they have been battling with depression or anxiety or borderline personality disorder, you know something that’s [caused career challenges], I think only three times I’ve been told, I’m an alcoholic and that’s interfering. --Holly, 57 To summarize, participant descriptions of helpful incidents in the Using Career Theory and Career Process Category included introducing career theories to reduce pressure and to normalize challenges, using career exploration as a springboard for deeper discussion and self-reflection, and partnering with students on application materials to strategize or reinforce the relationship, all helping them to recognize mental health issues. 4.3.5 Active Listening This is presented as the third in-session action category, in that many participants described first setting the foundation for a relationship and some described setting the tone with career theory or process, and from there paying very close attention throughout. That said, close attentive listening is occurring at all points of interactions with clients; it is presented as third in-session category only in that one first needs the client to come in for sessions in order to have things to notice. This category is defined as paying very close attention, listening closely to everything the client says, noticing differences from a student’s norm, using intuition if something doesn’t feel right, noticing lost, confused, overwhelmed language, noticing negative or personal focus of conversation, noticing repetition or patterns of returning to certain personal topics, noticing talk of workplace conflicts, noticing conflict markers, and noticing difference between what is said and how it is said. This includes noticing non-verbal cues such as anger, 129 tears, low energy, low vocal tone, noticing anxious talk, agitation, euphoria, noticing problems focusing, atypical eye contact or body movements, disengagement, grooming, noticing too many sessions, too much follow through or too little, and noticing atypical reactions/stress about career tasks. This includes stating observations of what is noticed and using gentle probes to understand stress further, paying close attention to responses to understand sources of distress better, noticing lack of supports, lack of financial supports, and unpacking sources of distress and actioning CP items to notice if distress remains. All of the 11 participants (100%) reported incidents in this category, with the second highest amount of incidents mentioned at 148. Participants described paying close attention to student behaviour and progress, and being willing to probe gently to assess for career or mental health referral needs: A client had come for a meeting unprepared in many aspects, so they didn’t put really any effort into..[the resume].. which kind of gave me an indication that they were maybe disengaged from the process. And then, when I met with them, just their body language, and the tone of their voice just sounded very tired. And so, I thought that maybe, something is going on in the process that they’re kind of disconnecting from. And so I just, through conversation, ask them for some further details, you know ‘You kind of sound a little bit low energy for today’s meeting’ is what I said, [and the student replied] ‘Well yeah, I’m struggling right now.’—Susan, 35 Many participants describe paying very close attention to language, to words and speech which often signal overwhelm in the career context such as feeling lost, under pressure, wanting to give up, and lack of identity. Some described sensing a language divide between when conversations are truly about career direction and self in career, versus larger personal problems and identity issues which are beyond the career realm: [I notice] when I’m working with students and obviously the conversation is not really about career, it’s about stress and deeper issues that are happening and that comes out a number of ways…Also I look through any verbal clues that really we’re not talking about career planning, we’re talking about, ‘I have no idea what’s going on in my life and I’m very upset about this. I’m thinking about dropping out of school or my parents are putting 130 on a lot of pressure’, so over the years there’s just patterns that you typically pick up on. When I hear that, I do typically stop and I typically just say ‘You mentioned you’re quite upset and thinking about dropping out, can you tell me a little more about that?”…Usually there’s a feeling of loss, ‘I have no idea what I’m doing here, I’ve no idea where I’m going’-–Daniel, 59 [If they can’t identify anything they liked] and if they talk about themselves in a negative way, that’s when it’s like, ‘Okay, well, there’s something here and it's probably not something to do with your career planning…If you’re unable to identify a time when you ‘felt you’ that’s not a career development concern here that’s, ‘You need to talk to somebody who can actually walk you through why you feel like this about yourself.’ --Joe, 38 When you start hearing, ‘I can't do this’… I kind of joke around a bit and say that there's depression, right? and then there's, something which I call ‘job search depression.’ You're just like ‘I’ll never find a job, I’m useless, nobody will hire me.’ So that's the negative, unmotivated, and desperate. So that’s not depression, but that’s what I would call ‘job search depression’ …[and you need to] be the opposite: positive, persistent, and patient… Because looking for a job and networking and trying to find your career is hard, really hard work… Persistence, is the key I think to career success, I think all the students that I’ve helped that have had amazing careers are the ones that have been persistent. I think it trumps everything else, including talent.--Warren, 52 A number of participants described feeling a ‘shift in the room’ or ‘feeling it in the air’ that a student is struggling, paying very close attention to subtle body language, noticing a difference between how things are said and what is said, and the importance of gentle probes to understand the client better, and listening to answers. Kate, the only RCC in the group, describes: Really paying attention to what we would call a non-verbal expression… So they’re talking about something really hard and sad, and they've got a big smile on their face, or they have a really hard time making eye contact. So things that are non-verbal that tell you that there's more going on there, they might have like a nervous kind of phrase that they're saying, or they're just having a hard time. Just you can tell that there's some conflict going on for them and they're what they're saying doesn't necessarily match how they're saying it. They're feeling really uncomfortable…You can kind of feel the anxiety if someone has anxiety, like, what they do with their hands.. if they're really fidgety, if they're breathing is shallow.. And depression is similar, like if their mood seems really low and they forget what they were saying mid sentence, or they're not really answering your questions in an engaged way…[That’s] something that I’d want to talk about… I wouldn't avoid the conversation if I felt like a student was showing signs of having a mental health struggle, I would ask them like, ‘It seems like this is hard for you, have you 131 thought about maybe doing some counselling?’--Kate, 50 To summarize, descriptions of helpful incidents in the Active Listening category included paying close attention throughout all client interactions to language, behaviour, body language, noticing common signs of disengagement or overwhelm in the career context such as being lost, and being willing to make gentle probes for greater clarity about student stress or behaviour, and paying very close attention to responses. 4.3.6 Discuss and Explore Challenges and Barriers to Progress in Career and Life Goals This is presented as the final of the four in-session categories, because some participants indicated that discussion of challenges came only once they had built a level of rapport with clients. This category is defined as discussing past, present, and future challenges in the way of career, academic, or life goals, tracking and noticing lack of progress, and parsing out CP action items to see if lack of progress remains. Nine of the 11 (82%) participants reported incidents in this category, for a total of 41 incidents mentioned. Some participants described how goal-oriented discussion of challenges or barriers to career success makes mental health issues more salient, increases likelihood of disclosure, including when co-strategizing around accommodations, application efforts, or supports needed to meet career goals. Gareth, 52, who specializes in working with at-risk youth, explained: Simply by asking some things like ‘What are the challenges you’ve encountered? And what do you think are some barriers to success that you’ve been through? What has worked for you?’… In the coaching field, that appreciative inquiry of really figuring out what’s working, and what’s been a challenge. I always think that’s so important…A lot of them would say it felt like a burden [to hide their challenges] and kinda a release to let me know that ‘There are things here that I’m dealing with and that’s nice I’m glad you know that and understand that’…So we can work together with them [on accommodations]. We also place students, so I’ve been able to find jobs for people and find employers that are really receptive to that and even help [the student] to broker ‘How do I talk about some of these mental health challenges I’ve had?’ So that the employer 132 really understands like this person may need [some accommodations] and once that is open and honest and occurs and then [the student] can be now successful…Whereas they’ve gone to other places where that conversation hasn’t occurred or they haven’t felt like they can broker that themselves. I think that’s also important to [feel] like someone else’s on their team. And someone else can help kind of acquire that new possibility for them—Gareth, 56 Typically questions about challenges would come once some rapport and safety had been established near the end of the session: There was a few different kind of flags that I would notice with students and one of the questions I always asked…near the end of our first session was, ‘Is there anything that might get in the way of you moving forward or making a decision about what to study or what to do, for a future career?’ And oftentimes I would hear ‘Oh, I have a really hard time making decisions’ or ‘I have a lot of anxiety and so, this process is hard for me.’ I would start to hear things like that. – Kate, 50 Providing extra career support for lack of career task progress helped some participants to notice if lack of progress remained and was not a training issue, signalling potential mental health or other issues. Job search is very, very stressful. And that’s not something that gets talked about a lot in school… And just talking about like what is an okay level of stress, what is too much stress for that person, how can we break things down into smaller steps? And just assuring them that I’m there for them every step of the way, as long as we can still work through that career-related task or goal that we’re concentrating on. [But] when a person really cannot, or isn’t in a position to learn or move forward, generally to me that’s indicative of something more substantial…I think a person with generally okay mental health will say something like ‘Yeah, let’s try that, I have the ability to move forward and think it’s possible to overcome this barrier.” And I feel like someone with lower mental health is like “I can’t do this. Just no way.”—Sarah, 36 To summarize, participant descriptions of helpful incidents in the Discussing Challenges category included direct discussion of past, present, and future barriers in the way of career goals, as well as noticing challenges or barriers directly impeding progress, and providing extra support for challenges to see if lack of progress still remains. 4.4 Hindering Incident Categories 133 Once each participant had no more helpful incidents to report, they were then asked: “Now I would like to focus on things that have made it more difficult for you to recognize mental health issues in career sessions? What types of things have occurred that made it more difficult to recognize mental health issues? What were some challenges with recognizing mental health needs?” Nearly all of the hindering incidents reported fell into the Lack of Workplace/Institutional Supports category. The remaining hindering incidents fell into the Student Factors Category, such as reticence to share, busy schedules and appointment no shows, which made establishing a relationship difficult (this was placed under the Relationship Category). Table 14 Hindering Categories Category Participants Participation Rate Incidents Lack of /Insufficient Institutional Workplace Supports • Lack of close ties with Counselling Team 63% • Lack of mental health training workshops 63% • Lack of Management Support 36% • Insufficient Time with Clients 63% • Zoom Limitations 27% 11 100% 43 Difficulty in Building a Relationship • Student Factors 82% (Reticence to Share 54%, Hard to keep track of students, lack of follow through, 36% 9 82% 20 4.4.1 Lack of Workplace/Institutional Supports Nearly all of the hindering items fell into the Workplace/Institutional Supports category. 134 All 11 (100%) participants mentioned ‘lack of’ certain manager behaviours, or campus resources in this category as unhelpful, with 43 items in this category, echoing the helpful incidents mentioned. In other words, not having access to supportive management behaviours and campus resources was a hinderance, further underscoring the importance of workplace supports in recognizing mental health. Many participants explained that lack of mental health training workshops leaves them doubtful of their skills, so they may ignore signs of mental health issues out of lack of ability: I’ve got a 40 minute appointment. Sometimes I might notice something and I’ll go, ‘I’m just gonna leave it.’…So there’s definitely times, where I just go, well, ‘I’ll just let that go for now.’ But it’s also sometimes not knowing, feeling like I don’t have the skills to try to identify things. That can definitely be part of the issue, not knowing if I have the right skills to help a person with that, not knowing if that’s going to derail our meeting in a way that’s unhelpful for the person. So definitely doubting my skills and abilities.-- Sarah, 36 It used to seem like that’s out of your lane, so [the managers think] there’s no sense getting training. My analogy is always, ‘Why do we say First Aid and Assist training is good for so many people? It’s good to have that knowledge to be able to refer’… [My colleagues who didn’t get the training workshop] were craving for more resources..[they said] ‘I would like more information please, and maybe not just out of a book, or I’d like more info about this, not that I’m gonna fix it or be a psychologist, just so that I can be aware of it, and understand this is what’s happening here and there’s ways for me to help bring that situation down [for the student and refer].’ –Gareth, 52 Some explained that lack of training and experiential practice makes it difficult for CPs to even recognize that mental health issues may be present: I have [career service] colleagues who did not go through the teaching system or even a counselling background, who tell us they they’ve never had a [client with a mental health issue] ever, and I think, in this case, how could you not? And I just think, maybe they’re really focused on career, a resume, interview prep, or whatever…They just don’t have the training…it’s a comfort level. [When I first started], I had no experience, I was scared every time [of bringing things up]. So I guess with a colleague [without experiential training] even to go there would be really uncomfortable, just to bring it up. And it’s still not comfortable, [even for me]. –Daniel, 59 135 And not having the right tools of training. Like we don’t know what to say at that moment, I know a lot of people don’t know…what are the appropriate things to say in that moment, you don’t want to say the wrong thing…Sometimes students tell us something and we just don’t know how to respond appropriately and that is very challenging…For those that…haven’t [had any mental health training] then it’s kind of challenging to know what to say to help. People want to help, but they don’t know how to help–Lily, 43 Those participants who did not have close ties with the counselling team, reported that lack of close ties was a hinderance, as it seems some campuses have more siloed services than others, in that not feeling confident that issues can be easily referred may lessen the likelihood of being willing to recognize issues in the first place: Well, I know that every institution has counsellors. However, not every institution, like all the departments are working too closely. And so, because I have experienced working with other institutions, I can sort of compare my experiences, because at my last experience at [the smaller university], I think all the departments were kind of closer, so it’s easier to access other departments, and then [to] offer collective help to students. It definitely takes teamwork sometimes to help students because sometimes it’s beyond our training…However, [this community college where I work now] is much bigger. Sometimes I found each department is siloed. So we don’t really know who to contact or, you know, we don’t know what they do. Definitely this division [makes it more difficult for me].—Isa, 42 If I was kind of thrust into a job and I’m asking well ‘Why don’t you tell me your life story?’ And then, all of a sudden boom! [mental health issues] right? That can be so overwhelming and I’d be like ‘Oh my God, like, what kind of job did I get myself into?’ So the hindrance would be like not having resources, not having access to resources, feeling like you’re all alone and that you don’t have the ability to refer systemically.--Gareth, 52 Daniel, who sits on national and provincial CP committees, explains that some of his colleagues struggle on campuses when counselling and career services don’t work as closely together: Sometimes there’s a tension between counselling departments and career development…I think it’s the intersection of career planning and personal planning. There’s not a line...I subscribed to life as a circle, not the old Piaget, Ericsson gang, the stage approach to life…So I think the tension is with some people that feel I shouldn’t be talking about 136 personal planning and counsellors shouldn’t be talking about career planning because that’s my job. So I think that’s the tension, between those two departments. I think some schools have structurally set them up very distinct from each other and that causes some concerns and tension in the system as well. ---Daniel, 59 Many participants explained that lack of time with students, budget cuts, high volume and heavy workload makes recognizing mental health issues more difficult: [My campus] had a lot of budget cuts and I would say we’re probably at a point in our office where we’re understaffed for the volume of students. And admissions are rising so that’s a real challenge because I don’t always feel like I have as much time with students having these meaningful conversations, where some of these details might come out…they feel a lot more rushed. And there’s an opportunity maybe to miss some of the more subtle cues that I would otherwise pick up on.-- Susan, 35 I think it’s getting worse because funding cuts are making staffing levels shorter and shorter and I used to have an hour with my students…I think service levels are half an hour now…The more time you can spend with students, the more you’re going to have the opportunity for it to come up, right? The more you can build a relationship with a student, the better. So when you can’t build a relationship, when you don’t have a lot of time with them, that’s going to make it harder. -–Mary, 37 If it’s on a busy day when you have 10 students and 30 minute appointments, I might miss some stuff…This really happened overnight, we went from maybe 1000 international students to now 4500 with no support really. Because the recruitment of international students is a financial need. And then, all of a sudden, it happened slowly, like a slow moving snowball is slowly getting bigger and bigger we didn’t notice it until we sort of reflected back at the end of the year to look at our numbers… I would say 80% of our appointments now are international, but we still have 4000 domestic students. [Volume is] our big struggle right now-–Daniel. 59 A few participants touched on the need for their own mental health limits in the role, as heavy workload impacts their ability to recognize mental health issues: If I had to make one more observation, it would be on my mental health and my colleagues’ mental. [We are often very stressed] and like that’s gotta diminish your ability to identify other people's issues and be able to be present in some scenarios…and showing up for people's mental health necessarily. It definitely can feel like on days where my mental health is lower, my skills in identifying challenges are lower for sure.—Sarah, 36 Some participants described a lack of support from leadership as a hindering incident, 137 specifically managers who didn’t understand or recognize the mental health component of career service work. Mary recently left her role after six years as a CP, and she felt the new campus leadership structure no longer valued holistic career service work: When it comes down to only metric driven leadership, metrics don’t always tell the full story… number of clients seen, number of resumes reviewed, number of whatever. Sometimes, the more qualitative feedback is a better indicator of the level of service students are getting…The leadership that doesn’t support that [holistic career approach], they don’t see that mental health plays into that…[Students] struggle so much with things like anxiety, depression, feeling intense pressure, feeling this imposter syndrome. Feeling the intense pressure to achieve, and when we solve that career piece, a lot of those other things start to click into place, if they have appropriate mental health supports to bolster them. In most [campuses] everybody is in this toxic spin of crisis, crisis, crisis, so we throw more money and more resources at crisis and we pull away from everything else, as we know, nobody has any resources. And all we get is cuts and cuts and cuts. It’s not just in [my province], it’s across the whole country.–Mary, 37 Some participants described that campus leaders don’t understand the CP role in mental health, that they are not permitted to partake in trainings on mental health or to have larger career discussions with clients, which makes recognizing issues more difficult: Not allowing people to take the training…not being supported. Thinking about colleagues I work with…I think they’ve sometimes felt that it feels like that’s not supported or even encouraged [to take] those professional development opportunities…This in the fight of career coaches…There’s metrics, of course, which I believe in, and outcomes, but I think sometimes we need to be able to have a conversation, the career conversation. To help move our clients and serve them best and not just, you know, ‘resume?’ check, ‘interview? mock interview?’ check, right? That kind of stuff…We almost have to fight…for the role of a career coach versus a job placement office…[My manager might say disapprovingly] ‘You seem like you took a lot of time with that student.’ I did it because I think they need it.—Gareth, 56 A few participants explained that lack of feedback, guidance, or supervision to help with the mental health components of career sessions makes it difficult to recognize issues in students: When you’re alone in these appointments…you’re always kind of like ‘Did I just do that right?’ It’s like there’s no one there. There’s no one there to say ‘No, next time do this’. There’s no one there to watch and give feedback [about mental health recognition skills]…ever. So like, we have no idea, often. I meet with hundreds of students a year and 138 I’m kind of left to my own devices to sort of give feedback to myself. So we don’t have a supervisor reviewing what I’ve done to say, ‘next time, try this’—Sarah, 36 4.4.2 Difficulty Building a Relationship (Student Behaviours) Nine of the 11 participants (82%) reported incidents (20 incidents mentioned) relating to student behaviours which made it difficult to recognize mental health issues. Although these are student behaviours, I have placed them under the building a relationship category, as they appear to interfere with the ability to build a relationship. A number of participants explained that students may have reticence to share, that they are extremely busy, and it can be difficult to keep track of students if they don’t come for appointments: If I’ve seen a student in distress…and I’ve asked him to please let me know how things go for you and you don't hear back from them, they kind of disappeared or you provide them with suggestions and they’re resistant to listen to how they could [access supports]. That would be kind of frustrating. And I understand everyone has their own space or pace to kind of move forward, if they're not ready, they're not ready. They’re not obligated to, but we do have some concern for them, we want to know that they’re ok, so when we don’t hear back from them it can be frustrating.--- Lily, 42 When we were all 100% online [during the pandemic] my attendance rate was at 90%. And the reason was because I would pick up the phone and say ‘Hi, are you having trouble with your video link?’ (laugh) So that was how we connected. Now we're back in person, although our appointments are still online, I’m thinking our attendance has dropped to like 60% [because students are out again and busy]--Holly, 57 A number of participants explained that some faculties require very high workloads such that busy schedules and low wellbeing are normalized, making insight and mental health conversations difficult: [This institution] is pretty famous for the stress it puts on students…they think it’s just the norm. The rest of their classmates are stressed out, they’re sleep deprived, they’re really stressed out all the time and I think that normalizes things. It might prevent people from being able to acknowledge it, it doesn’t matter how many…posters [the institution] puts up [which say] ‘Look after your mental health’. The students are taking 10 courses, 139 they are absolutely putting their mental health second, and there’s just no way around that. And so the real message that they’re getting is that ‘You’re going to have to sacrifice your sleep, or your well being, or seeing your family, in order to get through this program.’…Students themselves are not aware of a lot of mental health and mental illness, so if they’re not aware of it, it can make it really challenging…so it doesn’t make it very easy for us to have those conversations…They’re like ‘Oh that’s not normal? Or not ok?’ ---Sarah, 36 A number of participants reported that some students clearly want to keep emotions contained and will put a positive front forward, hiding their distress, thus making it difficult to recognize mental health issues: There are times when you don't see it. One that still hurts all these years later, is there was a student that I saw and we were doing like career planning, just had one appointment with her, spent an hour with her. We did great career planning, she was talking about the future, she was hopeful, she was excited, she was happy, we just had this lovely appointment… Six or seven weeks later, I got an email from the registrar's office saying that they just wanted to inform all of the service providers on campus who had had interactions with this student, that the student had suddenly died by suicide…I’m surprised all these years later, it still gets me. I just remember being shocked (pause, tears) Because I had no clue…You don't always see it, you can't always see it, there aren't always signs. So that was a hard one…There was not good support on my campus for [us staff] when that happened.-- Mary, 37 To summarize, participant descriptions of hindering incidents included primarily items in the Workplace Supports category, namely lack of sufficient time with students, lack of close ties with the counselling team, lack of management support, and lack of access to mental health training workshops. Other unhelpful incidents mentioned included student characteristics such as busy schedules and reticence to share, which made recognizing mental health issues more difficult. 4.5 Wishlist Incident Categories Once participants had no more hindering incidents to describe, they were each asked about wishlist items: “Are there other things that could have helped you to recognize mental 140 health issues in career sessions? What could help you recognize mental health issues in career service sessions?” All of the Wishlist Items reported fell into the Workplace Supports Category, such as more mental health workshops, specifically annual mandatory training as part of their credentialling and employment, experiential training with practice, role play, and feedback, more time with students, interconnected close ties with other students services, and leadership respect for the mental health role of career services (see Table 5 Below). All 11 participants (100%) mentioned incidents in this category (48 items), again echoing helping and hindering categories; in other words, many participants wished they had more of the same workplace characteristics which they or others had described as helpful. Table 15. Wishlist Categories Category Participants Participation Rate Incidents Institutional Workplace Supports • Closer Ties with Counselling Team 36% • More mental health Training Workshops 72% • More Management Support 36% • More Time with Students 27% 11 100% 48 4.5.1 Wishlist Workplace/Institutional Supports Participants who had not received much mental health training explained that receiving more training on how to recognize mental health issues would be helpful, so they can recognize when to refer better: I think that it's something where knowing what that point is. Like, I’ve, over the years sort of worked out, okay, this is the line… and figure out where that line is. But also knowing which things are probably going to be leading in that direction would be really 141 helpful. Then they start talking about certain ways that they think about themselves with certain things, about their experiences knowing, hey, this is probably going to cross over into one of those lines where you need to refer them. Having that knowledge will be really helpful. At what point…are they looking not for help to identify knowing more about themselves and where they want to go, and at what point are they wanting to know more about 'How do I improve my mental health because of this?’ Things like that, so what that line is. The ‘Okay, you're no longer talking about career advising, now [this is] when you talk to a counsellor. And that's not me.’—Joe, 38 Some participants described some things they wish they had learned earlier such as the importance of building ties with counsellors, or specific training courses that have been helpful to them: I wish I’d seen [trauma-informed training] a lot earlier. And those kind of trauma-informed career workshops, [to make sure I’m] not pushing people too fast, too far, really gauging [where the client is at]…client-centered practice—Holly, 56 When I was a new…I didn't reach out to the counselling department and work closely with them. We were really, at the time, quite independent and, as a new practitioner I didn't reach out to them at all. I sort of did try to do stuff all on my own. So, even though I knew there was a counselling department on campus, once we were structurally changed, that's when we started working more closely with counselling. If I were to do anything different, I would have gotten in touch with the counselling department earlier in my career, and I would have organized joint meetings to talk about these issues with the counselling department as well. –Daniel, 59 Many participants wished that mental health training was mandated, and organized by upper management or CP organizations. Several participants suggested that annual refreshers, at a minimum, would be useful to help CPs improve their ability to recognize issues in need of referral: My schedule is so busy that I won’t set aside time to learn it unless I have to, unless it’s a priority. We always have so much on the go, so unless our department says ‘Okay we’re gonna have training on this topic and at this set time,’ [it’s too difficult]. So that would be helpful…I think, maybe a couple of sessions, you know like for an hour and a half. So training, and scripts, maybe scenarios, doing role play and I think for practitioners, organizations, setting aside time for that. We're all so busy with our work, but this call has to come from upper management, where they carve out time for their staff to exercise or recognize mental health…Two sessions, maybe once a year, at least just recognizing 142 mental health is an important topic that is something we should talk about, and have more exposure to. –Lily, 43 I think the mental health training we receive should be ongoing. Well I’m pretty sure I could sign up for it again, but there's no push at the faculty level to kind of go on an annual basis or anything like that. You know, information around mental health is always changing. And I think it would be really valuable if it was like getting recertified in First Aid. Like, go annually, and have a little refresher and learn about new topics that have come up in the area or new resources that might exist for students, I think that'd be a really beneficial tool, just to make sure you know all of our staff are up to date with what exists for students, and how to approach different scenarios. –Susan, 35 A number of participants suggested that mental health training should be a required part of the Career Practitioner designation, whether in a university program, or as part of annual re-certification. Some suggested that mental health training should be a required competency to practice, and that it should be part of onboarding for new staff and annual workplace requirements: I’m a CCDP right?...I think every three years, you have to recertify. What I would love to see, [is] the things that that you're checking off like, ‘Did you go to conferences? Presentations? Did you read a book?’ And I think a lot of us do this in the first place anyways, but did you do like mental wellness research? Like, what have you done for resiliency?…I am just thinking when the last time I renewed, it was last year, I wasn't asked those questions [about mental health]. I think that should be part of who we are, but I think the challenge of that, as a group, is that, obviously, the credentials and training come from so many different areas…So I think the opportunity every year to kind of [complete some refresher] of reminders, new research, training ideas, resources every year…especially if you’re working in a university setting.–Gareth, 52 Like the one thing I wish [is that] every career practitioner had a higher level of training in [mental health] and there was maybe a higher level, a higher standard potentially of practitioners. I really kind of fell into it and, to be honest, I don't have as many [trainings], as much of a background, as some of my colleagues do…Like once a year would be like the minimum, I would say. And even if that’s like a one day thing, I think it’s a significant enough issue, it warrants [that]. I would rather spend more time on that, then learning the latest resume designs, I can look that up on the internet (laugh). [Mental health] is a pretty big topic and it’s inextricably linked to careers. Like careers are so linked to every other part of our lives, you can’t just separate out our careers from everything else as much…For sure we do get those students who are very neatly compartmentalised…but those people barely exist in the world.—Sarah, 36 143 A few participants wished that the central role of career service in mental health was better acknowledged systemically, that campus services were working more in concert with one another, with the importance of holistic career service respected: The career is what brings it all together, that is the central piece of what we're doing at university, it's why students go there…for their career path…So why not have that be the center of services? Make that central and then have mental health supports come and support career development, and have financial aid support that with work-integrated learning, and working with employers, and have all of the other services work together in helping students meet their goals, which is their career path, which is about their life planning…When you don't have the career piece in place, we can keep working on their mental health supports, but it's like that center part is missing, and they still don't know what the hell they are working towards, so they don’t have a goal. So we can keep working on the anxiety, the depression, the relationship issues, [but if] people don't know why they're there, and they don't know what they're doing it for, and they still leave thinking ‘What the hell did I just do with the last four years of my life?’ I still don’t know where I am or what I am doing.’ So I just wish there was a bit of a different shift in the focus—Mary, 37 To summarize, all of the wishlist items mentioned by participants fell into the Workplace Supports Category. These included, among others, closer ties with the counselling team, and more training, specifically annual, mandatory experiential mental health workshops for all CPs. The above extracts in each category are but highlights from a larger amount of data. For further detail of items mentioned in each category, please refer to Appendix G. 144 Chapter 5: Discussion The purpose of this study was to understand what helps Career Practitioners to recognize mental health issues in higher education career service sessions. This chapter begins with a discussion of how the major findings compare to the existing literature in relevant fields of career development, counselling psychology, coaching, and mental health. Demographic features, contextual and critical incident findings are examined and situated within the relevant literature in order of their presentation previously in Chapter 4. This chapter will conclude with a discussion of study limitations and directions for future research. 5.1 Participant Demographics The present study aimed to explore behaviours which are accessible to typical Career Practitioners who do not necessarily have counsellor training and who are experienced in the career service context. This is important because career sessions differ from personal counselling sessions in numerous crucial ways: Career sessions are often learning-focused and career-task focused on specific measurable outcomes, with the CP teaching core skills of resumes, networking, interviewing and so on, with some expectation of appraisal and feedback of how the student may be perceived in the world of work. Unlike counselling, there is typically no screening, no clinical supervision, and no stated client expectation to discuss mental health issues. In some cases, the CP is required to pass or fail their clients in internships or career courses, and the CP’s job performance may in part be tied to student success metrics (See Appendix H: Sample campus CP job description). Indeed, the Canadian Standards and Guidelines describes being ‘results-oriented’ as one of the primary attitudes needed for competent CP practice (S&G, 2021). These dynamics add additional complexity to the task of 145 recognizing mental health issues in career service settings. Thus, it is important that the present study explored the experience of typical CPs who work in dedicated career service settings. Demographic features of the 11 participants were compared to a series of national surveys of CPs in the field (CERIC 2011, 2015, 2019, 2020, 2022), and were overall reflective of national norms, in that average age, educational background (Bachelor’s degree), gender, and years of experience of the participants was similar to those reported in Canadian National Career Service Surveys. The participants in the present study included more males than average (only 67% female), and more highly experienced practitioners than average, with a mean of 21 years experience among the older participants. A relatively high number of participants also had either the CDP or CCDP credential (n=7), both of which are relatively rigorous, and which is higher than national averages; just 12% of CPs nationally reported partaking in such training (CERIC, 2022a). The self-selection effect of experience and ability with what many CPs find a difficult task, may explain the higher number of years of experience and career credentials in the participant group. Nationally, only 12% of CPs report a counselling psychology background, (CERIC, 2019), and similarly, only one participant in the present study was a trained Registered Clinical Counsellor (RCC). Mental health training was varied in the participant group ranging mostly from none to several brief workshops (Mental Health First Aid, Question Persuade Refer (QPR), Assist Suicide Prevention). These workshops typically emphasize limits of practice, campus resources, and practicing referral skills over the course of a few hours to a few days and are provided by the campus typically within working hours. This is also reflective of national surveys which report that brief in-person employer-provided workshops are by far the most commonly sought out 146 trainings by CPs (51%), due to budget and time constraints (CERIC, 2019). All participants worked separately from the counselling department, most without clinical supervision, and none used mental health screening prior to sessions, such that clients may present with myriad unrecognized issues. This is reflective of the field, where pre-service psychological screening is considered a deterrent to seeking career support and CPs are advised to informally screen in-session for referral needs (Makela, 2009; Mier et al., 2008). This highlights the importance of CPs being able to recognize mental health issues in session, underscoring the value of research in this area. The ethnic diversity of participants was limited, which also reflects data gaps in the career service field more generally. Although more ethnically diverse candidates were invited to participate, a number of those invited were not available to schedule an interview. Ultimately, all but two of the participants interviewed reported ‘White’ ethnicity. However, most participants reported working with international students, immigrants, and newcomers as a core focus of their role, and some had experience working with Indigenous students. It became apparent at the recruitment stage that the two-year minimum experience requirement limited the ethnic diversity of participants, and removing this requirement may be useful in future studies. It is difficult to compare the ethnic diversity of the participant group to national data because diversity data is not gathered in CERIC national surveys (A. Manolio, personal communication, November 4, 2022), nor is it gathered by the Alberta (P. Yerama, personal communication, November 4, 2022) or BC Career Service associations (no information published, pending email reply). Understanding equity and inclusion variables is especially important in this sector, as CPs are the very people tasked to help clients with diverse needs and backgrounds to overcome systemic employment 147 barriers. To address this gap, CERIC (2022b) is undertaking its first national diversity study to better understand the diversity characteristics of CPs which is set for release in 2024. In summary, participants in the present study appeared to have the types of education other CPs often have, the level of mental health training other CPs often have, and they worked in the types of settings campus CPs often work in. This is important because ECIT seeks to explore the experience of those in the best position to have knowledge of the task in question. Since recognition of mental health issues occurs in private client sessions, out of supervisor view, CPs who report success with this task are the best able to report upon it. Participants were drawn from a wide variety of campus sizes and types, in large urban centres, in small cities, and in some cases, in rural communities. They had experience working with many different types of students, from recent high school graduates, to mature students, from newcomers, to at-risk youth, to elite health science students, all of which adds richness to the findings. The fact that participants worked with such a wide variety of students and at different types of institutions, yet reported similar helpful, hindering, and wishlist incidents, also adds applicability to the findings. Findings from the present study may also be of value to clinical counsellors unfamiliar with working within the distinct parameters of career service settings. 5.2 Contextual Findings 5.2.1 Job Title and Job Scope Participants reported up to 13 different job titles to describe very similar job functions. No more than three participants reported the same job title, but their job scope and tasks were described in similar terms whether they were titled a Career Advisor, Specialist, Coach, Counsellor, and so on. This is reflective of problems in the career service field and of various 148 calls to standardize titles and scope of practice (Burwell & Kalbfleisch, 2007; OECD, 2002c). The majority of participants worked as generalists, insofar as helping clients with any career-related goal, whether career direction and exploration, job acquisition, experiential learning opportunities, or problems relating to their careers, with one-on-one career sessions a core focus of their work. These activities were described as ‘career counselling’ by four participants, and as ‘coaching’ or ‘advising’ by other participants. Of note, not a single participant used the term ‘guidance’ when describing their work. Career experts themselves use varying terms to describe CP work (career development, educational and vocational guidance, and vocational counselling) and some argue career practice is a teaching role, to help students learn skills they will need to be successful over time in the workforce (Gysbers, 2008). Savikas (2008) suggested that different activities are suited to different economic eras and shifting needs over time from agricultural (mentoring), industrial (guidance), globalization (career counselling) and deconstruction of traditional work (coaching for self-construction). However, it appeared by the participant stories that they were providing a combination of advising, guidance, and career counselling, as defined by Borgen and Hiebert (2014). Furthermore, these traditional career service activities often appeared to be provided within a coaching framework, or under a coaching umbrella. A coaching framework is evidenced by focusing on external behaviours, on career goals, and actions moving forward, on helping a client move from A to B (Chung & Gfrorer, 2003). Some participants mentioned ‘learning goals’ or ‘learning outcomes’ for client sessions and key metrics and deliverables, things they wanted the client to be able to learn in-session and perform on their own. The participant excerpt below exemplifies the future-orientation typical of coaching, of a focus on action forward, on teaching 149 skills, and on addressing barriers to progress. Within coaching, lack of progress is often deemed a signal for referral (ICF, 2014): I may say, “So do you think you could reach out to this person on LinkedIn that you talked to… after [us] talking about how to do that? Is that something you feel like you're able to do?”…As long as we can still work through that career related task or goal that we're concentrating on I feel like we're within the realm of normal…. Just checking in “Did you do that [career fair] you wanted to do?” And when they say “No, I didn't do it” I'll say “okay well, what do you think got in your way there?...What do you think prevented you from doing that?” and whatever it is they say totally makes sense, like, “I was tired”, fair enough… I say “No problem, what can I do to support you next time? Is there another career fair coming up? How can I better support you? Sounded like it was really intimidating, maybe we can work together more on preparing, so you feel more confident and less intimidated? Could that be helpful for you? And if they're like “No, I just don't think I can” you know, like how are we moving forward with this?—Sarah, 36 The coaching orientation evident in many participant stories also appeared to be grounded in a relational style and focused on holistic wellbeing as a foundation of career success and resilience over time. Participants seemed to purposely seek out honest and open discussion of difficulties as necessary elements to increase career success, as opposed to older ‘positive thinking/law of attraction’ career coaching models, which argued that discussing challenges and negative career emotions should be avoided (Brooks, 2005, 2011; Koppi, 2018). Indeed, a number of participants used the word ‘holistic’ to explain that student wellbeing must be considered overall in service of best career outcomes. Additionally, it appeared that the deeper ‘career counselling’ tasks were parsed in two, with career identity and career direction elements remaining within career services, and with more complex personal matters referred to mental health counsellors, as one participant described below: The career counselling ‘who-I-am self part’ gets mixed up…It is counselling but counsellors don’t want to do it. So ‘who I am in the world’ and ‘where do I want to go’ stays with career [practitioners], who have less training. And so they see that already as being ‘Well no, you're not just helping them with their application documents and looking at labor market information, you're helping them with figuring out what their 150 ‘self’ is and what that means for career paths and what that means for identifying directions to go in.’ … Advising [is] prescriptive course talk ‘in the now’, but career talk is ‘future’ and once students are in ‘future’ they talk about barriers and that opens things up—talking about challenges to goals, and preferred future…When they look beyond [the] present, [students] start talking about things they feel are holding them back. [But] when a personal counselling-related thing is holding them back in their in their career planning or in their work, [that is when I refer them to a counsellor].—Joe, 38 Lack of agreement over job titles and scope of work makes it difficult for the general public to have any clear understanding of expectation of basic qualification standards for CPs they interact with (Arthur, 2008). This is relevant in campus settings where many students are multilingual and multicultural; for example, ‘counselling’ and ‘guidance’ have different meanings and scope of work when translated into German and French (Esbroeck & Athanasou, 2008). One participant in the present study explained that students ‘know’ to see counsellors for personal problems, but research indicates that students are often confused about the differences between counsellors and coaches. One study found that nearly half of 167 students who were exposed to the term coaching 28 times in service brochures believed the brochure was about counselling, as though coaching and counselling were interchangeable (Shy & Whaeler, 2008). Furthermore, among all the campuses where participants in the present study had worked, not one campus career centre website delineated the limitations of career support sessions relative to counselling, and none provided links to the mental health counselling department. This further exemplifies the likelihood of mental health issues being present in career sessions and stresses the need for CPs to be able to recognize mental health issues. Additionally, participant descriptions of their job activities often revealed deep knowledge about labour market activities, employment strategies, hiring trends, and connection to employers, beyond what typical mental health counsellors may be exposed to. This reflects 151 expert writings on career service in Canada which suggest the CP role is often well-fulfilled by someone with a background other than counselling psychology (Arthur, 2008). The Standards and Guidelines for career service outlines several core competencies required of a CP, which extend beyond counselling, including activities such as engagement with industry and policy makers (S&G, 2021). Experts suggest that because career counselling and career practicum is somewhat devalued in counsellor education, it should not be assumed that counsellors have the skills necessary to provide competent career development support (Arthur, 2008). The rich career service knowledge described by many participants in the present study thus underscores the bilateral value and low-cost opportunity of cross-training with the campus counselling team, to improve referrals between departments, and knowledge of each other’s scope of practice, which has been suggested in other studies (Schaub, 2012). Finally, the varied job titles and descriptive words provided by participants in the present study highlights the fact that career and personal issues are often intertwined, and cannot be easily separated (Brown, 2002), as was stated by one participant: [Career] is not one thing, it's not something that you can really separate [from personal issues]. When I would talk to students about career planning I would often say ‘You know, this is life planning, so we can't separate it as one little piece that's distinct from everything else in your life, we have to look at it holistically.’—Mary, 37 5.2.2 Frequency of Recognizing Mental Health Issues Participants were varied in how often they recognized mental health issues. Roughly half suggested it was frequent, in 20-50% of their clients; the other participants reported it as infrequent, in fewer than 10% of clients. This data should be interpreted with caution in that each participant’s understanding of mental health issues or how they described frequency was varied. However, the wide variation in frequency reported is in line with the literature which finds that 152 practitioners differ in their ability to recognize issues as a function of their mental health training (Sass, 2016; Sime & Jacob, 2018). In the present study, many of those who reported the highest frequency of mental health issues among students had completed the Mental Health First Aid or QPR course, whereas those who reported it as less frequent, had less mental health training overall (albeit with some exceptions). The variation could also be explained by differences in the types of students the participants were working with, some facing more barriers than others. At the very least, the high numbers reported by some participants point to the importance of studies in this area more broadly, especially given the fact that some CPs do not recognize mental health issues at all. For example, some of the CPs who were sent invitation letters, explained they had never recognized mental health issues, or it had happened only one time over many years, and thus they could not participate. This suggests that mental health issues are frequently being missed, because surveys find high prevalence of distress, anxiety, and depression in career service clients (Schaub, 2012). Indeed, one participant expressed worry that his colleagues had never recognized a mental health issue in a career session. The participant with the most training on recognizing issues (the Registered Clinical Counsellor) estimated that 20% of career clients required a mental health referral, explaining that career sessions can be perceived as a lower barrier form of mental health support for those reticent about seeing a counsellor: I could say in about 20% of the students I saw across the board, I would recognize there was some underlying mental health issues that were maybe contributing to the anxiety or stress they were feeling around some of the decisions that they had to make. So often career counselling can kind of be a low barrier safe kind of way to come and explore something tangible when you know something's just not quite right in what you're currently doing, so it's kind of a gateway into having conversations that are a little bit more focused and personal.—Kate, 50, RCC 153 Other ‘gatekeeper’ studies find similar results. There is a growing recognition that gatekeepers—those who are the first point of contact with the public in a range of fields—should be more integrated into mental health referral networks, to help address risk sooner, before it becomes more severe. A study of debt counsellors in Australia, who work with farmers facing financial hardship, found on average that 20% of clients were deemed in need of mental health supports. Debt counsellors reported difficulty ‘unraveling the strands’ (Fuller & Broadbent, 2006, p.81) between mental health issues and financial hardship, with some reporting most clients needed mental health supports, and others reporting it was infrequent. Additionally, mental health myths, stigma, and fear of doing harm may be an impediment to recognizing mental health issues for some CPs and campus staff. For instance, during the recruitment process for the present study, one prospective participant (who did not participate due to lack of experience recognizing issues) explained that her philosophy was not to coddle students, that she had a perception that students of this generation were too soft. She explained that she worried that showing regard for emotional issues might not prepare students for the workplace; i.e., she felt a duty to ‘toughen’ students as a career skill. Indeed, some argue that accommodating mental health issues socializes students to be “fragile flowers” rather than resilient (Wente, 2017), which are often inter-generational critiques, suggesting that “university’s not meant to be easy” (Wente, 2012). Some campus leaders seem to endorse this perspective, placing responsibility for mental health issues with students and communities more broadly (Henry, 2020). Yet, higher education experts explain that university life creates unhealthy stressful conditions and that mental health accommodations are only reflective of progressive labour 154 norms (Abdelmahmoud, 2017; Fullick, 2012). Higher education experts argue that campus leaders minimize mental health responsibility at their own peril, because the link between retention, campus revenue, completion and mental health problems has been well-established; i.e., preventing and addressing mental health problems makes good business sense (Ketchen-Lipson et al., 2019). As one higher education health scholar states: Suggesting that the problem lies with individuals’ interpretations of their circumstances, rather than being (also) a structural and cultural one, is dismissive of the elements in an equation that may be beyond the individual’s control (Fullick, 2012). Thus, it may be that existing values and attitudes towards mental health are an important precursor to recognizing mental health issues. More studies are needed to explore stigma among campus staff, career service managers, and CPs, by providing a safe, judgement-free forum for expression of concerns, reservations, beliefs, and reasons for not recognizing mental health issues, if any. Overall, participant stories in the present study seemed to exemplify a pro-accommodation belief system; whereby accommodation is perceived to enhance success and resilience, not fragility, therefore making recognition of mental health issues a worthwhile endeavour. This is likely due to self-selection effects; i.e., those who believe mental health is valid and important for success, may recognize issues more and volunteer for a study on mental health. The extent to which this attitude is shared more broadly among CPs is worthy of exploration. Further studies might also explore positive downstream ‘success stories’ of CPs recognizing mental health issues, which some participants alluded to, towards dispelling concerns that accommodations cause harm. 5.2.3 Experience Recognizing Mental Health Issues 155 Participants described various ways in which recognition arose; sometimes they would notice cues of being overwhelmed in a client which they would attend to and question further. Other times recognition would arise as a result of questions they asked in the career realm; other times it would result from noticing differences in the client’s norm over time and asking gentle probing questions. For example, one participant reached out to a high achieving student, who was uncharacteristically calling in sick to her practicum often. The student revealed she was in counselling for a traumatic event which the male practicum supervisor was triggering. The CP arranged a new practicum under a female supervisor, and the problem was resolved. The initial act of noticing, care, enquiry, safety and reassurance led to recognition which may otherwise have been missed, causing a talented student to struggle academically due to non-academic issues. Most stories described students who were not already receiving personal counselling, and who may lack insight about their mental health needs. Some participants described a need to market counselling services, to reduce stigma, and to orient students towards mental health services. Other gatekeeper studies have found a need to normalize help-seeking, to expose reticent clients to counselling services, and to explain how they may benefit from services (Fuller & Broadbent, 2006). For example, a video information program has been designed for Canadian farmers, who are at high risk of suicide, to communicate the value of seeking counselling and how to recognize when one needs help, with the goal to make mental health discussion as common as “talking about the weather” (AgSafeBC, 2023; VanBerkel, 2021). Other studies find that students who do not seek help question the severity of their needs, prefer to deal with their issues themselves, don’t have time, or believe their symptoms are normal, even if they meet the 156 criteria for clinical depression or anxiety on screening tests (Eisenberg et al., 2012). The 2020 Healthy Minds Survey of 32,754 higher education students in North America found that 13% of students said they hadn’t accessed counselling services because they didn’t know where to go, 17% said it was too costly, 7% could not get an appointment, 18% did not have enough time, and 4% felt counsellors would not understand them. Roughly 40% preferred to turn to family and friends for support, and 40% perceived they did not need support for their mental health issues (Healthy Minds Network (HMN), 2020). Additionally, the American Council of Education (ACE) reports that 50% of students believe, incorrectly, that people think less of someone who receives mental health treatment (Ketchen Lipson, et al., 2019.) Participants in the present study reported recognizing symptoms of anxiety, overwhelm, and depression most commonly (n=9), followed by symptoms of ADHD (n=5), suicidal risk (n=5), low self-esteem (n=3), cognitive issues (n=3), isolation and loneliness among others. This reflects large scale studies which find 39% of students meet the criteria for depression, 34% for anxiety, 11% for eating disorders, 23% for self-injury in the past year, 13% reported suicidal ideation (6% planning, 1% attempt), roughly 40% report feeling isolated, and 7% report neurodevelopmental diagnosis or disability. Roughly 30% report that their mental health issues impaired their academic functioning or more days per month (Healthy Minds Network, 2020). The relative severity of some issues noticed by participants in the present study such as self-harm, aggression, or suicidal ideation further stresses the importance of mental health studies in career services. This is especially important because studies find that cross-cultural students have both a higher need and lower utilization of psychological services (Eisenberg et al., 2012; Hunt et al., 2015; Lipson et al., 2022), and participants in the present study indicated that international 157 students and newcomers formed a large proportion of their caseloads. In addition, many participants overtly expressed a strong commitment to staying within one’s scope of practice. Furthermore, no participants made claims that coaching could address any issue, and respect for the need to refer to counselling services was evident. Again, this is likely due to self-selection effects, and the extent to which the wider population of CPs hold these values should be explored. However, some studies on scope of practice find differences between what participants self-report and what actually occurs in session in observational or vignette studies (Sime & Jacob, 2018). One participant in the present study, who had the most extensive coaching training, explained that he was careful to stay within ‘coaching enquiry’ to discuss personal challenges, rather than venturing into the counselling realm, but the meaning of this delineation was not explored. Another participant, who had completed an empathy training course but no gatekeeper referral workshops, described some counselling-like instances of helping clients with difficult emotions, exemplifying the importance of gatekeeper referral training in particular. Further studies are needed to explore scope of practice in Career Services, how it is defined, where the lines are drawn, and individual CP views on when to refer, including observational, transcript, client-report, and vignette study data. Lastly, some participants described what actions they take to support student mental health and career success in general terms beyond the scope of this study. Exploring the ‘real-life’ experience of practitioners in greater detail may be extremely valuable to the field, as a practical adjunct to more theoretical training texts. 5.3 Critical Incident Findings Participants were asked to describe what helped or hindered them in recognizing mental 158 health issues. Participant responses were coded into six categories as follows: (Developed pre-session) 1.Workplace Supports, 2.CP-Person Level Factors, (In-session Actions) 3.Building a Low-Pressure Relationship, 4.Using Career Theory and Career Process, 5.Active Listening, and 6.Exploring Challenges to Progress. After just the fourth interview, there were no new novel helpful data categories arising, indicating that participants were sharing very similar things about what helped or hindered them with this task, which adds credibility to the findings. 5.3.1 Workplace/Institutional Supports Category This category highlights the importance of context; what is available to participants outside of the career session, what is in place before the session occurs, and the extent of supports available to CPs, all of which may impact their ability to recognize mental health issues inside the session. This included having access to campus mental health training workshops to develop their recognition and referral skills, managerial permission to take time with clients to implement those skills, and very close ties with the counselling team to provide confidence that if recognition skills are used, that clients can be successfully referred. Lack in any of these areas could hinder recognition of mental health issues even for a highly skilled CP, and highlights the surprising extent to which recognition of mental health issues may be in part contingent upon certain contextual characteristics and manager actions, rather than merely being an in-session activity based on CP competence. From the vantage point of the CP, these incidents, when taken together, amount to workplace supports and characteristics of the campus. But it is important to note, as the Critical Incident Technique highlights, that many workplace supports are comprised of individual actions across time, on the part of managers, leaders, and policy makers. Because campus managers and 159 leaders may view themselves and their institutions as supportive in many general ways, this data is especially useful because it pinpoints specific critical manager actions and campus procedures which can help or hinder recognition of mental health issues, which can be a target for training (see section 5.5 Implications for Practice below). Given the nature of manager-employee dynamics, a manager need only faintly express their displeasure relating to employee actions in any one instance, for the employee to permanently alter course. Rare is the employee who will persist in attempting to influence management or workplace policies, or take initiative to spearhead new workplace processes. Managers usually have power over compensation, advancement, recommendation letters and so on, so employees will be less likely to recognize mental health issues if it means risking subordination, loss of approval, or over-stepping authority. In this regard, the power of even subtle, one-time manager behaviours which constrain mental health activities cannot be underestimated. This highlights how important it may be that CP managers have at least the same level of mental health awareness training afforded to CPs. Some job tasks and job settings allow for a wider margin for error, but others do not. Indeed, CIT was specifically designed to pinpoint any subtle action which could signal disaster in a flight situation (Flanagan, 1954). In the same way, recognizing mental health issues involves subtle interpersonal workplace and client-CP dynamics, which may be sensitive to one-time mis-steps. Indeed, one of the participants had recently resigned from her role out of dissatisfaction, because her new manager was focused only on metrics, and did not value or permit holistic career service work. In other words, even with significant CP knowledge, proficiency, and training, it may not take much for a given workplace policy or manager to hamper a CP’s ability to recognize mental health issues. All 11 participants reported helpful incidents in this category 160 (70 incidents total), 10 participants also reported that lack of managerial support, lack of time, or lack of training was a hinderance (43 incidents reported), and all 11 participants wished for more workplace supports (48 incidents reported). Some participants who had worked in multiple campuses explained that they had an easier time recognizing mental health issues at some campuses over others based on differences in management policies, permissions, and institutional structure. Some described a strong institutional focus on mental health that permeated campus policies, while others described mixed-messages, including management dissuading CPs from obtaining mental health training or from having mental health related conversations. Some participants reported that campuses were siloed and the participant didn’t know the counselling team, making referrals more difficult. Some participants reported that programs have such burdensome courseloads that students normalize poor mental health and have no time for sessions or mental health discussions. Participants described various novel ways they built close ties with the counselling team in order to improve their ability to recognize mental health issues. This included trading offices on a regular schedule, establishing personal friendships with counsellors, joining sports teams with counsellors, knowing all counsellors by name, working with select counsellors who have career expertise, having regular inter-departmental meetings to share updates and resources, co-hosting outreach events or hybrid mental health and career workshops, hosting counsellor drop-in’s in the career centre and so on. Not only does the aim appear to be to support the CP in making referrals, but also to increase the likelihood that students will accept the referral (i.e. building familiarity for students with mental health, reducing barriers). Other gatekeeper studies have found a correlation between referral networks and 161 recognition of mental health issues. A meta-analysis of family doctors in the UK found that only 30% of youth mental health conditions were diagnosed due to lack of mental health referral networks, lack of confidence, lack of time, and cost limitations, with lack of referral networks endorsed as the primary barrier (O'Brien et al., 2016). A survey of debt counsellors found that those who had devoted time to developing strong referral networks had an easy time making referrals, and 91% of respondents wished for stronger referral ties (Fuller & Broadbent, 2006). A pilot program found that pharmacists hesitated to recognize mental health issues due lack of time, fear of making things worse, and uncertainty about what to do if they notice issues (Grund, 2021). These studies suggest that the willingness and ability to recognize issues (upstream) may be partly dependent upon the availability of referral supports and likelihood of clients accepting referral (downstream). If a CP believes that a referral cannot be easily made, whether due to student reticence or difficulty contacting counsellors, or if a CP does not feel permitted to take session time for mental health, then the CP may choose to ignore subtle signs and cues, opting to ‘let it go’ as one participant described, for fear of derailing the career session. Some of the participants in the present study also mentioned the value of having regular debrief meetings with their CP colleagues to discuss difficult cases or to obtain input from a counsellor in some instances. Although not formal supervisory relationships, the opportunity to debrief and receive guidance has been found to be useful in the counselling literature, especially to build confidence with new and challenging tasks (Wheeler & Richards, 2007). Furthermore, work optimization theories suggest that optimal work engagement is found when challenge and capacity are optimized, when the resources and skills required are sufficient for the job task (Neault, 2002). Some participants mentioned the importance of supportive management, and the 162 negative impact of unsupportive management. Neault and Pickerell (2016) highlighted a lack of qualified managers in the career service sector, who may come from the HR or business field with little understanding of CP work. The cost of low mental health knowledge among leaders has been well-noted, and has downstream effects on help-seeking and stigma within all levels of organizations (Britt et al., 2012; Shann et al., 2019). The issue of reducing mental health stigma is complex, particularly in organizations which are understaffed or underfunded, which creates pressures for staff to suppress mental health needs (Ricciardelli et al., 2020). The American Council on Education (ACE) encourages campus leaders to proactively reduce mental health stigma for the economic wellbeing of their institutions, because students with mental health difficulties are more likely to drop out than students with low GPA alone, and low mental health contributes to low GPA, and to lapses in enrollment (Ketchen-Lipson, et al., 2019). Likewise, mental health symptoms are correlated with more academic dissatisfaction and lack of persistence (Lipson & Eisenberg, 2018). Yet some participants described the initiative to get mental health training as their own, and that there was “no push” from management, making it harder to find time for training. Many participants reported that brief campus-provided Mental Health training workshops were helpful, especially those with experiential practice components. This is in line with studies which have found that just one hour of experiential QPR training increases the likelihood of questioning clients in a campus setting about signs of suicide risk, and of referral (Aldrish et al., 2018) and that improvements in self-efficacy with questioning and referring skills, mental health knowledge, and help-providing are increased in both short and long term follow-up (Litteken, & Sale, 2018). Importantly, studies find that the effectiveness of such training is mediated by the 163 degree of trainee participation specifically; i.e., the opportunity to practice (Peterson et al., 2021.) One study found that pharmacists who received brief QPR training and updated referral contacts were able to help increase referrals for patients showing suicide risk factors, by being a primary contact point for the public, identifying risk before it became more severe (Grund, 2021). A number of participants in the present study wished that mental health workshops were annual and mandatory for all staff, along with regular refreshers from the counselling team. This echoes the Healthy Minds Faculty Survey of 1685 faculty members across the USA which found that 73% of faculty wanted more mental health training, 73% wanted more information about campus resources for students, 61% believed mental health training should be mandatory, yet 72% had not completed any gatekeeper training, despite those who had taken it reporting it was helpful. The study authors recommended general mental health training for common student issues, not just for suicide, be offered to all staff (HMN, 2022). This further underscores the importance of training campus staff on available student resources, on what each student department offers and how to reach them, as this may not be obvious. Learning about campus resources was described as helpful by several participants in the present study. Fully exploiting on-campus cross-training and co-working opportunities between counselling and career service departments may represent valuable low-cost ‘low-hanging fruit’ for CP leadership to improve recognition of mental health issues, via the approaches described by participants. Incorporating mental health learning goals and activities into job mandates and performance targets for CPs and CP managers alike may reduce tension between metrics and mental health activities, so that best practices in mental health can be recognized, tracked, and 164 rewarded. Framing gatekeeper training as ‘referral training’ and making it mandatory and recurring at all staff levels (not just those who are student-facing) is worthy of exploration, because managers can exert powerful influence on how client-facing roles are performed. Finally, some participants described insufficient supports for their own mental health and risk of burn-out, with case loads of 700 client meetings per year, 80-100 per month, or being the only CP for 20,000 students, all in addition to their other job duties, such as teaching in some cases. This is reflected in studies of faculty which find that 45% want more supports for their own mental health, and 21% feel that student distress had taken a toll on their own mental health (HMN, 2022). This underscores the importance of governmental investments in education more broadly which is a nation-wide issue beyond the scope of this study. 5.3.2 CP Person-Level Factors This category refers to personal characteristics and prior knowledge which the participant brings to their role. Characteristics in this category include a passion for career work, an empathic and caring personality, willingness to go over and above to help students, prior training and life experience, cross-cultural competence, and strong knowledge of common student issues. All 11 participants reported helpful characteristics in this category (118 incidents). It is not surprising that a number of participants in the present study reported that empathic caring helped them with recognizing mental health issues. Empathy is considered a key component of effective mental health work in many social and health care disciplines, and studies find that the ability to understand a client’s emotions, cognitions, and behaviours is an important communication skill linked to positive change outcomes (Moudatsou et al., 2020). However, empathy is not listed as a core competency in the Canadian Standards & Guidelines 165 (2021) for career practice, which instead lists being insightful, honest, open-minded, and results-oriented as important attitudes. Empathy is, however, described as crucial in other Career Development texts (Walters et al., 2013). Studies on empathy find that it varies between individuals, with some struggling to express it, and that training to reinforce empathic skills is often necessary (Moudatsou et al., 2020), which may be an area of exploration for future CP studies. Some participants reported that prior work as a teacher, with youth, in other student-facing roles, or as a CP over time, helped them to recognize mental health issues. Teaching is consistently reported nationally as one of the most common educational background of CPs (CERIC 2011, 2015, 2019), and it may be that experience in settings which are low barrier (such as K-12 schooling, at-risk youth programs) and which include a wide group of learners, could expose CPs to higher prevalence of mental health issues. Of note, all of the participants reported educational backgrounds in fields which were either people-related (teaching, psychology, athletics, marketing) or creative/communications (music, theatre, literature, linguistics). One study found that Arts and Humanities Faculty members reach out to discuss mental health issues with students 13% more often than professors in STEM fields (HMN, 2022), although this could be due to a number of confounding factors. One study of faculty and staff in higher education found that both knowledge of campus resources and the ability to recognize mental health issues increased with years of experience working on campus (HMN, 2022). Of note, most participants in the present study did not describe detailed knowledge of specific mental health disorders by name or symptomatology; rather many described strong knowledge and respect for the various ways in which student life can cause distress. This calls 166 into question the appropriateness of CERIC’s mental health manual for CPs (CERIC, 2016), which somewhat exhaustively details names and symptoms of various disorders, in that no participants described this type of detail as helpful, and some explicitly stated that any guides need to be brief quick-reference materials. This data suggests that CPs may not need to know specifically what condition a student is experiencing, but rather merely that something may require referral which is beyond the scope of career services. Thus, familiarity and attunement to common sources of distress, difficulties, and risk within one’s client population may be more important than knowledge of mental health disorders more generally. Indeed, Grund (2021) argues that wellbeing promotion and suicide prevention is ‘everyone’s business’ not just mental health professionals--because any public-facing worker has a duty to know the common challenges in their client population, and the cues to question, refer, and connect clients at risk to care. Referrals were generally portrayed by participants in the present study as adjunct simultaneous supports to help students overcome life barriers to reach career success, not things that halted the career service process. Appendix G provides more detail about knowledge participants described, which may be of value to hiring managers and CPs alike, to identify prior learning and experience which may help with this task. Many participants in the present study evidenced strong cross-cultural knowledge, and expressed empathy for cross-cultural students. However, Arthur (2008) notes that self-reported diversity competence may not translate in practice to social justice skills needed to help clients overcome employment barriers, and there is no required CP diversity training or monitoring of how to apply these skills in practice. That said, a few participants explicitly described the extra lengths they went to in directly supporting clients with language barriers and foreign credentials. 167 Cross-cultural competence may have implications for student mental health because studies find that international students are more likely to access supports for career and academic concerns, rather than for mental health, and if their career service experience is positive, it may improve their help-seeking towards mental health services in future (Leong & Arpana, 2008). Scholars argue that effective cross-cultural career counselling is grounded first in the working relationship and understanding the client’s unique values, perspective, goals, and experiences, which may be very different from the CP’s own (Leong & Arpana, 2008). It may be that awareness of issues faced by newcomers may improve recognition of distress, while also creating safety whereby the client can more freely share their distress. The centrality of both cross-cultural and mental health skills likely needs to be emphasized in CP core competencies, because the personal and social lives of new immigrants often depend upon their adjustment to work life in Canada, and many are still rejected for not being ‘Canadian enough’ by prejudiced employers (Chen, 2008). Neault (2006) suggests that ethnic diversity on the part of the CP is not required to effectively help clients of different cultures from one’s own; rather, what matters most is developing cross-cultural competence. Indeed, many studies find that international students need support building Canadian cultural capital from service providers with in-depth knowledge about Canadian culture and workplace norms (Arthur, 2017; 2018; Arthur & Arthur, 2014; Bowering et al., 2020; Kwak & Kim, 2019; Trilokekar et al., 2019; Woodend, 2018). Studies on the ethnicity of practitioner relative to client preference are mixed, finding that a proportion of international students feel more comfortable disclosing distress to a practitioner who does not share their cultural background, and that cross-cultural competence, not linguistic skills or ethnicity, are most associated with a strong working alliance, higher help-seeking, and positive 168 outcomes (Chen et al., 2009). Studies with immigrants have found similarly that cross-cultural knowledge, not necessarily linguistic skill or ethnicity, are most important to working alliance outcomes (Shen et al., 2006). However, other studies in the USA have found that some students will avoid working with ‘White’ counsellors due to past experiences with racism (Bank, 2020). This highlights the importance of diversity training for counsellors and CPs, and the ability of CPs to communicate their limits of competence, as one participant in the present study described: I have a student, she was an alumni, she actually reaches out to me [rather than her counsellor], and when she had a mental health break down …when I meet with her it's very tense and I really just try to listen to her, but she's like ‘You come from your from Vietnam and I’m from Vietnam, you totally understand my background and how the communication works within family and just the culture around communication and mental health’…When she tells me all these crazy things that's happening in her family, I mean she was seeing a counsellor [but she wanted to talk to me], you know, I’ve reiterated that I’m not a professional counsellor, I’m a career counsellor.”—Lily, 43 5.3.3 Building a Low-Pressure Relationship Category 10 of the 11 participants in the present study described the importance of building a safe relationship as a foundation to recognizing mental health issues in career service sessions. This category had by far the most incidents mentioned (206 incidents) and nine participants also explained that student characteristics (20 incidents mentioned) such as reticence to share, low insight, or busy schedules impeded recognizing issues by impairing relationship-building. Some participants described proactive efforts to introduce themselves and their services to students, whether online or in-person at events or in classrooms, encouraging students to book sessions with them, and having flexible appointment times. The need for outreach is noted in the literature: Research finds that only half of students know about career services, and only half of those who report career distress have used career services (Fouad et al., 2006). Many participants also described the importance of a brief ‘chit chat’ for five minutes before every session to check 169 in on student wellbeing, of creating connection points, and of displaying competence in both career and campus matters to increase the likelihood of students returning for repeat sessions. Although participants did not overall use the following psychology terms to describe their work, many of their stories described various elements which are central to counselling psychology (Egan & Reese, 2018) such as working alliance, use of immediacy (commenting on the here and now in session), attunement (close tracking of the client), judicious self-disclosure (selective sharing in service of the client’s goals), rapport, active listening, psychoeducation, unconditional positive regard, limits of competence, building agency, respect for individual differences, matching client pacing, slowing down at signs of distress, and using multi-modal approaches based on student need. This highlights the remarkable means that participants have devised to build effective working relationships through their experience and training. In one of the exceptions, a participant explained that formal education about the concept of unconditional positive regard in a Career Service Working Alliance course was the most helpful thing in her practice (See Appendix I: Course Overview). She explained that it transformed her appraisal of career tasks, moving from frustration and blame, to seeking understanding and building safety for clients to share their authentic challenges. Studies on the effectiveness of career counselling consistently find that a strong working alliance is a predictor of better outcomes, in terms of aligning client-CP agreement about goals, interventions, and tasks (Masdonati et al., 2014) and the working alliance is an important variable for the satisfaction and outcomes of career counselling interventions (Masdonati et al., 2009). Studies also find that working alliance ratings increase over time (Elad-Strenger, & Littman-Ovadia, 2012), as some participants in the present study described, the more a CP sees 170 the client, the more able they are to build a relationship, and thus recognize mental health issues. Although more outcome studies are needed, research finds that the impact of a strong working alliance has a similar impact on career counselling outcomes as personal psychotherapy outcomes (Whiston et al., 2016). Some career experts describe learning about a working alliance as an ongoing process, a shift from “managing others, to managing yourself with others” (Walters et al., 2013, p.154). The Canadian Standards & Guidelines outlines seven competencies which underpin effective client relationships (S&G, 2021), the first being ‘mattering’. Career scholars have highlighted the importance of various types of mattering in establishing a working alliance, such as visibility, active listening, and offering help (Amundson et al., 2009) which are influenced by many of the small gestures some participants described such as offering a glass of water, a comfortable chair, and providing a warm welcome. These relationship building activities appear to be undertaken towards the primary goal of successful career outcomes, not solely for the purpose of recognizing mental health issues. This suggests that at least some of the activities which make for optimal career outcomes (uncovering authentic preferences, goals, learning needs, and challenges) may be one and the same as those which happen to also illuminate mental health needs. It appeared that many participants had managed to balance the teaching and appraisal components of their role with the subtleties of being welcoming and non-judgemental. The career-specific ways participants described relationship building (see detail Appendix G and Chapter 4) may be of benefit to CPs wishing to improve their skills in this area, as well as to counsellors less familiar with career service contexts. This delicate yet central process may be 171 difficult for novice CPs, and thus providing training such as a CP Working Alliance course may be helpful. Ideally, training on building rapport can be paired with gatekeeper referral training to keep CPs firmly outside of therapeutic territory, because some career texts are overly vague in this regard, encouraging CPs to “meet client needs for validation and affection” which could be problematic (Walters et al., 2013, p.157). 5.3.4 Using Career Theory and Career Process 10 of the 11 participants reported incidents in this category, with 54 incidents mentioned. A number of participants described introducing career theories proactively early in the CP relationship, as a means of normalizing failure and the value of emotion-related talk as part of career success. For some, they introduced chaos and happenstance especially when students appeared to be struggling. Specifically, chaos theory, planned happenstance, career resilience, emotional intelligence, hope, identity, and flow theories were mentioned, all of which emphasize change, openness to possibilities, and flexibility. Although none used the term, it appears that these participants are not just using theory to provide career information, but also as what psychologists call ‘psychoeducation’, the practice of educating a client about their condition (in this case, career challenges), including common etiology, progression, prognosis, and treatment (Sarkhel et al., 2020). A few participants explained that they judiciously used humorous examples of past career chaos, failure, or happenstance in their own lives, or in the lives of celebrities, to help educate students about the common pathways to career overwhelm, hopelessness, or ‘job search depression’. They used career theories to explain to students how to instead remain persistent, hopeful, and motivated. Psychoeducation has been found to help modify attitudes and behaviours and to promote a client’s ability to address symptoms (Bonsack 172 et al., 2015) . Research finds that teaching happenstance skills and tolerance of uncertainty has been associated with positive career outcomes for recent graduates. A study of 60 university students found superior outcomes with chaos theory interventions when compared to ‘trait and match’ or controls, finding longer lasting effects of career counselling satisfaction, self-efficacy with career decision making, and lower dysfunctional career thoughts in the chaos intervention group (Kim et al., 2015 ; Kim et al., 2016). Experts suggest that building skills for adaptability, uncertainty, chance, and failure are useful for best career outcomes (McKay et al., 2005). Developing resilience skills and emotional intelligence for career success is also recommended by experts in particular to assist clients who may face life and employment barriers over time (Rickwood et al., 2004) or for those in high-pressure careers with high risk of burnout (Taylor, 2022). However, less is written about the utility of modern career theories in terms of helping to recognize mental health issues. It stands to reason that theoretical approaches which emphasize and normalize uncertainty, set-backs, and difficulties as part of success may lay the groundwork for disclosure of such challenges. Studies of undergraduate students have found that when students were exposed to emotion-normalizing supports, where negative emotions were framed as expected and helpful to share as part of striving towards success, it resulted in healthier coping with emotion and a reduction in negative effects. In contrast, when students perceived expectations to be happy and not show distress as part of striving towards success, they felt sad more frequently and intensely, via suppression and negative self-appraisal of their difficulties (Bastian et al., 2011). A study exploring views about help-seeking in undergraduates found that fear of discussing emotions was correlated with low help-seeking especially in male clients, and 173 recommend that practitioners proactively normalize negative emotions in order to increase help-seeking (Komiya et al., 2000). Thus, introducing career theories and emotional resilience as part of success may help to recognize mental health issues in two ways; by increasing comfort with negative emotional disclosure among clients, and by increasing openness to referrals and help-seeking, making it easier for CPs to engage in recognition activities, such as probing about subtle cues. Framing difficult emotions as valuable in relation to agentic goals, may shift discussion of difficulties from a weakness to a strength narrative and may assist with healthier coping and less self-blame. As one participant in the present study explained, he often sees students “visibly relax” with relief after he explains chaos theory, when they realize that their career difficulties are shared by many. A number of participants reported using career self-exploration methods as a springboard for deeper discussion, often leading to recognition of mental health issues. Of note, only two participants in the present study mentioned the use of formal quantitative assessments, which is surprising given the prominence of assessment in career development practice (S&G, 2021), and only two reported following a set protocol of exploration questions. The vast majority of participants described using open qualitative methods for self-exploration with clients, which some experts argue creates a more active role for clients and can enhance the working alliance (McKay et al., 2005). A number of participants explained that asking about family impact on career often helped them recognize mental health issues, one describing it as “an in” to revealing deeper distress, family pressures or conflict surrounding the student’s career. This is reminiscent of genogram-type work focused on family impact on one’s beliefs, values, and identity which 174 has been found to be a rich learning experience in counselling settings (Lim, 2008). A number of participants also reported that collaborating on employment acquisition tasks (resume, interview, networking prep) helped to recognize mental health issues. The resume can provide quick access to connection points for relationship building, and strategizing over gaps in work history or interview skills can reveal personal hurdles. In these tasks, the focus may be on a third location rather than merely face to face discussion, in the same way that using timelines and other externalizing devices has been found useful in therapeutic contexts (Boisvert, & Ahmed, 2018). It may be that strategizing together with the client as a team to overcome “weak” areas towards a shared goal (their employment), may help to counter the evaluative dynamics of the CP role, and lead to more disclosure. The benefit of using certain career theories to facilitate disclosure of mental health difficulties as a form of psychoeducation may point to a novel area of study. Investigating whether career theories could be applied to reduce mental health stigma in other goal-oriented settings, such as teaching, athletics, corporations, the military, trades, or academic advising, and beyond, is worth exploring. This data also highlights the valuable tools CPs have at their disposal which form an everyday part of career practice, (resumes, role play for interviews, strategizing, career exploration) which can be useful to recognize mental health issues. Whether or not any of these tools could be useful in other settings is worthy of exploration. 5.3.5 Active Listening Although no participants used the term, all 11 described common activities and behaviours reflective of active listening. Active listening is an important part of relationship building, but the sheer volume of specific cues participants noticed and described is worthy of its 175 own category, illuminating how distress can become apparent in career sessions specifically. Participants described 148 incidents including paying close attention, noticing differences from the client’s norm, noticing certain non-verbal and verbal cues and behaviours, noticing differences between how things are said and what is said, being willing and able to state observations (immediacy), and making gentle probes about signs of distress, normalizing, validating, and comparing to baseline. Active listening is a core skill taught and practiced in psychotherapy training, and is used in many helping fields. It is a process of closely ‘tuning in’ to the client’s emotions, thoughts, behaviours, needs, and perspective, putting one’s own needs aside to truly seek understanding, and to reflect this understanding back to the client via empathic statements, body language, and para-verbals. It is an active process, which also involves the use of gentle probes and statements to help clarify and deepen understanding of the client’s situation (Egan & Reese, 2018). The Canadian Handbook for Career Development Practice describes active listening as a key building block to building an effective working relationship with clients. This emphasizes empathic listening, and remaining focused on the client rather than taking direction of the conversation, to create a safe and respectful environment that encourages clients to share (Walters et al., 2013). CERIC suggests that active listening is essential for building trust and rapport with clients, so it may be that behaviours in this category help to recognize mental health issues in two ways: by directly noticing, and also via enhancing the relationship, leading the client to safely reveal more of their challenges. As one participant described, students often feel safer to share when they feel “seen, heard, and understood.” Although active listening is central to recognizing mental health issues, it is placed after the prior categories because without time 176 for sessions or proactive efforts to build a relationship, there are fewer opportunities to notice cues. Career experts note that lack of time is a common impediment to active listening in client sessions (Walters et al., 2013), which a number of participants in the present study also reported. Probing deeper to enquire about signs of distress appears to be a choice point in-session, which participants may decide to undertake only if they are able (resources, time, skills), permitted (management approvals) and supported (referral networks) in doing. And so, having permissions and resources in place for session time, proactive relationship building and session booking, and normalizing failure as part of career, may all be helpful precursors which contribute to establishing an environment wherein more can be noticed, and where CPs feel safe to implement active listening skills. Detailed findings from this category may be particularly useful to novice CPs wanting to improve their recognition skills in the career context, as they are more tailored to career sessions and less focused on counselling terminology and therapeutic contexts (see Appendix G). Findings may also be useful to mental health counsellors less familiar with how distress can arise in career settings. 5.3.6 Discussing Barriers/Challenges to Progress Nine of the 11 participants in the present study mentioned incidents (41 incidents) in this category. Many participants explained that discussing past, present and future challenges in the way of career, academic, or life goals was helpful for recognizing mental health issues. Some mentioned this involved carefully timed barrier-related questions, tracking and noticing lack of progress, and parsing out CP action items to see if lack of progress remained. It is important to note that no participants reported directly asking about mental health challenges. Rather, 177 questions were consistently framed as barriers to progress, or challenges in the way of one’s goals. These types of agentic conversations are reflective of a coaching-oriented style which is focused squarely on movement towards goals and identifying and understanding anything in the way of said goals. Some researchers have found that framing supports as coaching towards goals is helpful for encouraging some students with stigma against mental health issues to accept supports (Komiya, et al., 2000). Some counsellors find that using agentic language and goal-oriented coaching is especially helpful with counselling clients unfamiliar with emotional therapeutic supports, to reveal barriers and targets for change, or for those with stigma against mental health services (Williams, 2003). Some studies suggest that being able to frame supports as coaching can lead to better outcomes for certain clients (Shy & Whaehler, 2008). Coaching experts suggest that noticing lack of progress towards goals can be a warning sign of mental health or other issues which require referral (ICF, 2014). A number of participants in the present study described proactively tracking and noticing progress or lack thereof, whether via student portals where they could track grades, work applications, attendance records in practicum, site supervisor reports, or work acquisition, or comparing their progress on career tasks to student norms. One participant explained that she had administrative access to an online portal where she could track student grades, assignments, and job applications, and this helped her to notice when students were struggling. Although it raises privacy issues, a few other participants wished for greater access to client information in other departments, or combined ‘units of confidentiality’, which may be an area to explore. In a number of cases, the participant described a willingness to go over and above, to provide extra career or contextual support for a student facing a barrier to help discern if barriers remained, to better understand the source of the 178 career barrier, which may signal a need for a mental health referral. A willingness to go over and above completing basic job tasks in service of the client’s career goals and holistic wellbeing was evident in many participant stories. This category is ordered last in that a number of participants explained that asking about barriers directly is best done sensitively once rapport has been established. 5.4 Limitations and Areas for Future Study This research project is a small qualitative study and thus results cannot be generalized; future studies could explore the same question on a larger scale, and extend to survey and short answer studies. Participants were limited to Western Canada, and to large institutions with more than 5k in student enrollment. Undertaking similar studies focused on Indigenous students, trade schools, small private vocational colleges, and jurisdictions beyond Western Canada would be useful to identify strategies helpful for various student groups. The ECIT method captures what is elicited, rather than prompting endorsement of other potentially valuable elements, as a survey might. In ECIT, one tabulates the number of incidents and participation rates, but not participant time spent describing each incident, vocal emphasis, diction, or order of incidents, all of which could signal importance to a participant. Thus, exploring this topic using different research methods may provide additional insights. Participant descriptions of highly varied titles for similar work underscore the need for my more research in this area. Protecting the use of the “career counsellor” title, and reserving it for those with formal graduate counsellor training and career expertise is worth consideration, given client confusion over titles and training. Emphasizing the provincial Career Development Practitioner pathway (or equivalent) as a minimum foundation for hiring and training of CPs (for 179 those providing career advising and guidance) is also worthy of exploration. Expanding the CDP credential to cover the working alliance, diversity and inclusion, and more rigorous evaluation components are all worthy of consideration. Delineating at which point more complex career and personal matters should be referred to career counsellors needs to be clarified for the field. Additional career training for clinical counsellors is needed in graduate programs, so that counsellors can handle complex issues which intersect with career concerns, beyond advising, guidance, and career exploration (such as bullying and work, ill health and work, trauma and work, culture and work and so on). Given confusion over roles and titles, campuses should ensure that their website landing pages delineate the limitations of career (and other student) services, with direct links to the student counselling department page for personal issues. Participants were both invited, and self-selected, so the extent to which certain variables such as empathic personality, passion for career work, and valuing mental health are reflective of the field is unknown; wider scale studies are needed. The participant group lacked ethnic diversity, although participants described strong cross-cultural knowledge, and this study did not gather data on pay or other equity variables such as disability, which although outside the prevue of this study, would have been interesting to tabulate relative to gender and seniority, because pay nearly doubles with advanced CP service in some settings. National and provincial surveys are urgently needed to understand the equity and inclusion variables of CPs in Canada, as well as their diversity training, and competence. Variables such as pay, gender, years of service, disability, ethnicity, education, languages spoken, and so on should be included in surveys by CERIC and provincial CDP bodies, and should be made transparently available to the field. More studies are needed to explore the experience of culturally and ethnically diverse CPs with 180 this task. It is not enough to invite ethnically diverse participants as I did in this study; ideally recruitment can continue until a sufficient number of ethnically diverse participants has been reached, only then proceeding to invite participants of “White European” ethnicity. Additionally, recruitment criteria should be broadened to include any CP working with students in any vocational setting, irrespective of years of service, because some CPs may have higher exposure to mental health issues based on their client population, and some CPs may recognize issues better than others based on factors beyond their tenure in any CP role. Furthermore, this issue should be explored in CP settings beyond higher education, such a community employment agencies working with immigrants, retirees, and those who are laid off, where mental health issues may be prevalent. The present study also used only self-reported retrospective data; future studies could triangulate results with client reports, managerial reports, transcript and vignette studies, referral metrics, and client outcomes. For instance, studies based on client reports could be undertaken to assess the mental health and diversity competence of CPs from the standpoint of client experience. Interviews were limited in time to a maximum of 1.5 hours but a few participants could have spoken longer, so repeat interview studies may have been warranted. The way that participants conceptualized the construct of ‘mental health issues’ may have varied from one participant to another, confounding frequency and reported prevalence. However, all participants reported that they recognized mental health issues in multiple instances, and some participants described certain mental health issues as highly prevalent among their clients, such as anxiety and depression. Further studies are needed to understand how often students are presenting for career service sessions with underlying mental health needs, along with identifying the most 181 common types of issues and their severity. Additionally, studies are needed to understand what helps or hinders CPs to orient students towards mental health help-seeking, after the initial recognition step has occurred. In terms of data analysis, all participants were provided several opportunities to communicate if they wished to add or change anything in their data, or withdraw from the study at any time. Only three participants responded to confirm they had reviewed how their data was coded, and a fourth responded that he had been very busy. However, all who did respond had nothing to add to the data summaries, and both experts who reviewed the categories agreed that it matched their experience. Given the importance of workplace and management supports highlighted by participants, future studies are needed to explore the mental health beliefs, training, philosophies and challenges of career service managers and campus leaders, as these leaders may exert invisible constraints upon the ability of CPs to recognize mental health issues. Furthermore, most participants had no access to a formal clinical supervision relationship, and whether or not they had ever had their client-facing work observed to ensure competence is unclear. The rarity of clinical supervision in career services is likely a systemic issue, as the majority of participants did not understand what this type of supervision referred to when asked. Studies are needed to survey the extent to which any Canadian campus or other career service setting offers clinical supervision, and to explore knowledge about clinical supervision among CPs and their site managers. The present study focused only on recognition of issues, but participants alluded to other things they do in the realms of general mental health promotion, as well as many things they do to support career success. Future studies designed to record the general knowledge of 182 experienced practitioners more in depth may be valuable for training novice CPs. No participants described a formal consent process as helpful in establishing rapport or for recognizing mental health issues. However, two participants described informally explaining the limits of their role at the onset, as well as touching on confidentiality with clients to build safety. One participant reported that he often told clients in his introduction that personal issues may arise in career sessions, and that he has many referral resources if needed. In this author’s experience, the introductory informed consent and confidentiality process can be a powerful opportunity to establish rapport, to communicate credentials, scope of practice, and willingness to refer as needed, and to understand client needs, all helpful towards recognizing mental health issues. Studies about the use of formal consent processes in career service and its usefulness for recognizing mental health issues, if any, are warranted. No participants explicitly mentioned using drawings, diagrams, figurines, spatial movement (two chair) or other areas of focus with clients to externalize goals, strengths, and challenges. Externalizing issues to create distance from one’s problems, using different ‘channels of experience’ with certain clients (Mars, 2012), or ‘walking out career problems’ in physical space (Amundson et al., 2017) may be useful with some clients. Studies investigating these alternative methods for recognizing mental health issues in career settings are worth exploring. No participant mentioned any formal mental health assessments, or direct questioning of mental health issues, although many explicitly ask how students are doing overall. In this author’s experience, brief informal ranking questions (“if you had to say out of 10 how you are doing overall..”) can be useful about both career and personal life more generally once rapport has been established, if handled carefully, and can be used to assess goals, risk, and to track 183 progress in each session as part of ‘contracting’. Exploring this type of brief questioning may also represent an avenue for future study. The extent to which any career centres screen out for mental health issues at intake, and how, needs to be explored. More targeted studies which pilot mental health screening pre or post-session with career service clients may be warranted. Studies may also explore client impressions of the screening process on help-seeking and likeliness to continue with career service, as well as experience with mental health services and understanding of career versus counselling services in order to understand trends in help seeking and any degree of deterrence screening may pose. Ideally, any studies of screening in-session should emphasize brief informal approaches which do not require counsellor training or mental health knowledge, and which are practical and easy to use in career service settings. Future client studies could also explore pre-service expectations of career sessions, understanding of roles and titles, and prior experience with counselling or career support, towards understanding confusion over services, and rates of help-seeking, insight, and potential stigma. Finally, some participants touched on risk of burn-out and lack of mental health supports for themselves in their role. One participant described lack of support for staff when a student died by suicide, another explained that CP mental health suffered due to workloads impairing their abilities to support students, and another wished for mental health training for CP wellbeing. Many participants emphasized the importance of a holistic client focus in career services, with the word ‘holistic’ arising often. But lack of manager support for holistic career sessions appears to add to CP stress, in an already overburdened role, with one participant recently resigning following a change in management. Time limitations precluded exploration of this issue in more detail, but the wellbeing and workload of CPs is an important issue to explore 184 in more depth. More studies are needed to understand CP experiences with job stress, workload, management support, burn-out, salary, plans for their own careers, access to training, and their ability to support student wellbeing in the face of these workplace challenges. 5.5 Implications for Practice & Recommendations for the field A summary list of recommendations for practice organized by job role has been compiled in Appendix J. These recommendations are based on the existing literature as well as findings from the present study. Since these findings need to be replicated and triangulated per the previous section (see 5.4 limitations), these recommendations should be considered provisional. This summary of recommendations may be useful to those seeking to recognize mental health issues and to reduce mental health risks among students, such as campus leaders, career service managers, CPs, counsellors, and career services bodies (see Appendix J for detail). 5.6 Conclusion Career Practitioners with work experience in different campuses in Western Canada described what helps or hinders them in recognizing mental health issues in career service sessions. Participants reported a relatively high frequency of recognizing mental health issues common in college and university settings and of varying risk, highlighting the importance of studies in this area. Interview data was coded using ECIT and organized into six categories which all had high participation rates: (Developed Pre-session): 1.Workplace Supports, 2.CP-Person level Characteristics; (In-session Actions): 3.Building a Low-Pressure Relationship, 4.Using Career Theory and Process, 5.Active Listening, and 6.Exploring Barriers to Progress. Helpful incidents were reported in all six categories, but all of the wishlist and nearly all of the hindering incidents were in the category of Workplace Supports. Data from this study suggests 185 that recognizing mental health issues is not merely a passive in-session activity contingent upon CP skills. Rather, it is a proactive activity which is influenced by context, enhanced when certain permissions, training opportunities, and referral networks are in place. When these are in place, along with CP personality characteristics (empathy, engagement, past education), CPs may be more likely to engage in activities which can increase the likelihood of mental health issues being recognized, as opposed to ignoring subtle cues. This study highlights the important role that managers can play in either curtailing or enhancing CP recognition skills, and the value of mental health training workshops (gatekeeper training) for all staff levels, as well as the crucial importance of close working relationships with the counselling team, to enhance ease of referrals. Participant stories suggested some low-cost pathways to enhance workplace supports, and highlighted the centrality of a strong working alliance, of active listening, of cross-cultural competence, of a goal-oriented framework, and the value of using career theory and career tasks towards helping to recognize mental health issues. Many participants did not exhibit clinical knowledge of specific mental health terms or conditions; rather they displayed strong knowledge about and respect for common sources of student distress more broadly. Participant stories seemed to suggest that recognizing mental health issues is often a natural by-product of rigorous resilience-oriented career support, aimed at uncovering any challenges to provide students with a better chance of career success across time, evidencing pro-accommodation attitudes. By many participant accounts, the activity of recognizing mental health issues does not seem to detract from career success, but rather likely adds to it. Findings from this study provide detailed examples of how mental health issues often arise in career settings. 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C., Hungr, C., Eubanks, C., Safran, J., & Winston, A. (2016). The relationship between alliance and outcome: Analysis of a two-person perspective on alliance and session outcome. Journal of Consulting and Clinical Psychology, 84(6), 484-496. doi:10.1037/ccp0000058 228 Appendices Appendix A: Participant Invitation Letter THE UNIVERSITY OF BRITISH COLUMBIA Date:[--] Re: Invitation to participate in a research study relating to your experience with recognizing mental health issues in higher education career service sessions. Dear [name of invitee], My name is Chloé Miller, and I am a graduate student in the University of British Columbia’s Counselling Psychology MA Program. I am conducting a qualitative interview study to explore how some career practitioners have been able to recognize mental health needs among their career service clients. For the purpose of this study, mental health refers to social, personal, emotional, developmental and life concerns beyond career/employment matters, such as anxiety, depression, dysregulated emotions, relationship breakdown, grief, crisis, undermanaged mental or physical illness, suicidal ideation, and so on. You are being invited to participate in this study because you have been identified as a career practitioner working in a career service with experience in higher education settings who may meet the participant criteria for this study. I am inviting practitioners to participate who self-identify as having experience with recognizing mental health issues in career service sessions which may require support, in some instances in the past. This study will form my final research thesis project. Research indicates that many career service clients have unaddressed mental health issues, but that a majority of practitioners lack mental health training to recognize mental health issues in need of referral. While a majority of career practitioners report low competence with recognizing mental health needs among their clients and making referrals, some career practitioners have been able to recognize mental health needs among their career clients in some instances. The aim of this study is to explore how some career practitioners are able to identify mental health needs which may require support among their career clients. If you self-identify with having been able to recognize mental health needs in career service sessions in some instances, I invite you to participate in this study. Results from this study could potentially inform future research on training of career practitioners in general. Participants will be asked to describe their experience with students coming forth for career support, when they felt the student needed more emotional/mental health counselling as well. Participants will be asked to describe specific incidents when they identified mental health needs among career service clients which may require support and what they did, and to explore what helped or hindered them in this process, and what could have helped them in this process. The focus of the interview is on your general experience as a professional rather than on procedures of your present employer. There is no explicit mental health Faculty of Education Department of Educational and Counselling Psychology, and Special Education 2125 Main Mall Vancouver, BC Canada V6T 1Z4 Phone 604 822 0242 Fax 604 822 3302 www.ecps.educ.ubc.ca 229 training or education required to participate in this study. We are seeking participants from a range of educational and experience backgrounds to explore approaches which may be beneficial to practitioners in general. Participation is open to any Career Practitioner regardless of title, education, or career credential, who has experience providing individual career support in higher education settings. A minimum of two years experience providing individual confidential career support sessions in a closed-door setting is required (as opposed to walk-up counter information provision) in higher education. Participation in this study involves completing a Zoom interview for roughly 45minutes to one hour. Participation is entirely voluntary, can be withdrawn at any time, and all data will be anonymized. Participants are provided with a $50 Amazon gift card for their time. Your participation in this study has the potential to help improve identification of mental health issues within career services across Canada, which may help to improve client outcomes, reduce client deterioration, and avoid burn-out for career practitioners in the field. Participation Criteria: • Must be a career practitioner with experience in higher education career service • Minimum of two years providing closed-door private confidential career support to higher education students (as opposed to open walk-up drop-in counters for employment information) • There is no explicit mental health training or education required to participate in this study • Participation is open to any Career Practitioner regardless of title, education, or career credential, who has provided individual career support sessions in higher education for two years or more in private closed-door sessions • We are seeking participants from a wide range of diverse educational and experience backgrounds, working with a diverse range of student groups and needs. • We are seeking participants who self-identify as having been able to recognize mental health issues in career service sessions which may require support in some instances in the past. If this describes you, we invite you to participate. If you would like to participate in this study, or have any questions, please read the attached information and consent form, and contact me at the below email or phone number. Please note this study has been reviewed and approved by UBC Research Ethics Board. If you would like me to contact your present employer for approval please advise. Please note, however, that this study does not focus on procedures of your employer, but rather on your personal professional experience working in-session with career clients in general in any Canadian higher education context past or present. Interviews can be scheduled during work hours, evenings, or weekends to accommodate your schedule. Please feel free to forward this letter to anyone who you believe may be qualified and interested to participate in this study, and they can contact me directly. (Please do not send me their contact information). Thank you in advance for your time and consideration. Sincerely, Chloé Alix Miller, BA, MA Candidate, UBC Counselling Psychology General Contact Information: Co-Investigator: (Primary Contact) Chloé Miller (she/her/hers) MA Student UBC Counselling Psychology 230 Principal Investigator: Dr. Bill Borgen, PhD, RPsych (he/him/his) Professor and Director of Phd Program UBC Faculty of Education, Counselling Psychology 231 Appendix B: Recruitment Poster 232 Appendix C: Research Consent Form THE UNIVERSITY OF BRITISH COLUMBIA Recognizing Mental Health Issues in Higher Education Career Service Sessions Principal Investigator: Dr. William (Bill) A. Borgen, PhD, RPsych, Professor, Director of CNPS PHD Program, and Director of Clinics, UBC, Counselling Psychology, Faculty of Education. Co-Investigator: Chloé Alix Miller, graduate student, Counselling Psychology Master of Arts Program, Faculty of Education, UBC. Purpose: Why are we doing this study? We are completing this study to learn more about how some career practitioners are able to identify mental health issues within career sessions, which may signal a need for referral to mental health supports. For the purpose of this study, mental health refers to social, emotional, developmental, and personal life concerns beyond career and employment matters, such as anxiety, depression, dysregulated emotions, relationship breakdown, grief, distress, crisis, undermanaged mental or physical illness, suicidal ideation, and so on. Research indicates that many clients who present for career support have unrecognized or under-addressed mental health issues. In many cases, this may be due to stigma, low insight, confusion over services, or difficulties accessing mental health services. Career guidance bodies suggest career practitioners must remain alert to signs that mental health supports are needed, but studies indicate that a majority of career service staff report difficulty in recognizing and referring mental health needs among their career clients. We want to learn more about ways that some career practitioners have been able to identify mental health issues within career sessions in some instances, which could inform training for career practitioners in general. Experience with higher education career clients has been selected for this study because this client group reports relatively high levels of mental health issues, relatively low levels of mental health help-seeking and high stigma compared to those who present for personal counselling, and because campus career services typically do not include pre-service triage or psychological screening. This study will help us learn more about potential in-session methods which may improve identification of mental health needs in clients who present for career support. Low mental health screening skills contribute to Faculty of Education Department of Educational and Counselling Psychology, and Special Education 2125 Main Mall Vancouver, BC Canada V6T 1Z4 Phone 604 822 0242 Fax 604 822 3302 www.ecps.educ.ubc.ca 233 risks of delayed care, client deterioration, as well as practitioner burn-out. You are being invited to take part in this research study because you may meet the eligibility criteria below: Recruitment/Participation Criteria: • Must be a career practitioner with experience in higher education career service • Minimum of two years providing closed-door private confidential career support to higher education students (as opposed to open walk-up drop-in counters for employment information) • There is no explicit mental health training or education required to participate in this study • Participation is open to any Career Practitioner regardless of title, education, or career credential, who has provided individual career support sessions in higher education for two years or more in private closed-door sessions • We are seeking participants from a wide range of diverse educational and experience backgrounds, working with a diverse range of student groups and needs • We are seeking participants who self-identify as having been able to recognize mental health issues in career service sessions which may require support in some instances in the past If this describes you, we invite you to participate Study Procedures: Your participation in this study involves participation in a recorded Zoom interview that will take approximately 45 minutes to 1 hour. In the interview I will ask you to describe any instances when you identified or suspected mental health issues in need of support during career service sessions. You will be asked to describe your experience with students coming forth for career support, when you felt the student needed more emotional/mental health counselling as well. I will ask you to describe what you did, what helped or hindered you in this process, as well as any elements you believe could be helpful in this process. You will be asked to describe your experience as a career practitioner in general terms, and no identifying client information is required. The purpose of this study is not to focus on procedures at your present institution of employment, but rather on your general experience as a career practitioner working with higher education students seeking career support. Your interview will be recorded via Zoom, with the video content deleted after 72 hours. I will make a transcript of your audio interview which I will analyze using Critical Incident Technique. As part of the data analysis process, I will later ask you to briefly review my written summary of factors from our interview to confirm it meets your agreement and inclusion in the study findings; this can be done via telephone or email. I will identify common factors among interview participants which could inform future training for career practitioners in general in efforts to improve recognition and referral skills among career practitioners. Study Results: The results of this study will be reported in my graduate thesis and may also be published in journal articles and books. At the end of this research, I will send you a copy of the study findings, if you would like to receive this. 234 Potential Risks: There are no anticipated risks related to this study. You will be asked to describe experiences which are typical of your daily work, and no confidential or identifying information is required. All identifying information pertaining to you, your client, and your place of work will be anonymized from the data. You will not be asked to describe procedures unique to your current employment institution, but rather to speak about your experience in general as a career practitioner working with career service clients. If at any point in the interview you experience stress or distress in reviewing an incident, the recording can be paused as needed, and I will ask you if you would like to continue, and I will offer community supports as needed. Potential Benefits: Participating in this research may present potential benefits. Some possible benefits include the experience of sharing one’s story, of being heard and understood as an expert clinician working in career services. Other potential benefits include contributing one’s knowledge to potentially improve the skills of other career service workers. Improved identification of mental health needs in career sessions may reduce client risk of deterioration, improve client outcomes, and reduce burn-out among career service practitioners who lack mental health screening skills. Confidentiality: Your confidentiality will be respected. Participants will not be identified by name in any reports of the completed study. All personal, geographical, or institutional identifying information will be removed from the data, and you will be coded with a number. Your assigned code will be hand-written, then stored in a locked filing cabinet. Only the Principle investigator, Dr. Bill Borgen, and the co-investigator, Chloé Miller, will have access to the coded data information, and it will not be included in the final reports or transcription data. The audio recording and transcription data will be stored on Chloé Miller’s computer under encryption and with a unique password. Open Access: Once my thesis has been defended it will be available on the UBC Open Access Institutional Repository of research available at the following link: https://circle.ubc.ca/ Remuneration/Compensation: You will be provided a $50 Amazon gift card for your participation time in this study. Contact for information about the study: If you have any further questions relating to this study, or you wish to have further information about this study, you can contact Chloé Miller. Contact for complaints: If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 235 Participant Consent and Signature: Taking part in this study is entirely voluntary. You have the right to refuse to participate in this study, and also to withdraw from this study at any time, with no reason required. After your consent, participation, and eligibility have been confirmed for this study, Chloé will contact you to schedule a convenient interview time. This consent form will also be verbally reviewed at the beginning of the interview and questions can be addressed at any time. Your signature below indicates that you have received a copy of this consent form for your own records. ____________________________________________________ Participant Signature Date ____________________________________________________ Printed Name of the Participant signing above Your signature indicates that you consent to participate in this study. ____________________________________________________ Participant Signature Date ____________________________________________________ Printed Name of the Participant signing above Your signature below indicates that you consent to having your interview recorded via Zoom: ___________________________________________________________________ Participant Signature Date ____________________________________________________ Printed name of subject signing above 236 Appendix D: Interview Guide Participant #:______________________ Date:____________________ Interview Start Time:________________ Onset: Greeting and thank for participation Confirm participant name is not showing on Zoom screen for privacy Begin recording, verify recording is working and verbal consent review. Clarifying questions (warm up, if need to pause or stop for break or washroom please don’t hesitate) 1. Contextual Component: Preamble: As you know I am investigating the ways in which career practitioners have recognized mental health issues in career service sessions. The purpose of this interview is to collect information about instances when you recognized mental health issues in career sessions, and what helped and hindered you in that process. a. Before we begin, could you please tell me your job title and describe your role? b. Before you describe your experience, could you please tell me how often you recognized mental health issues? How frequently did it occur? c. Please tell me about how you have been able to recognize mental health issues which may require support in career sessions? And what did you do? 2. Critical Incident Component: Now I would like to focus on times when you have recognized mental health issues in a career session. What has helped you in recognizing mental health issues in career service sessions (Probe: what was the incident/ element? Can you give me a specific example of where this specific factor helped? How did it help you to recognize mental health issues?) Helpful Incident (HE) & and what it meant to the participant (what do you mean by…) Importance (How did it help? Tell me what it was about …that you find so helpful). Example: (What led up to it? What was the outcome of the incident?) Now I would like to focus on things that have made it more difficult for you to recognize mental health issues in career sessions? (Alternative: what types of things have occurred that made it more difficult to recognize mental health issues? What were some challenges with recognizing mental health needs?) Hindering Incident (HI) & What it meant to participant (what do you mean by...?) Importance (How did it hinder? Tell me what it was about…that you found so Example: What led up to the Incident? Describe the incident. What was the outcome of the 237 unhelpful?) incident?) Summarize what has been discussed up to this point with the participant as a transition to the next question: We’ve talked about what has helped you to recognize mental health issues (name them), and some things that have made it more difficult for you to identify mental health issues (name them). Are there other things that could have helped you to recognize mental health issues in career sessions? (Alternative: I wonder what else might be helpful to you that you don’t have access to?) Wishlist item (WI) & What it meant to participant (what do you mean by…?) Importance (how would it help? Tell me what it was about…that you find so helpful?) Example: What led up to the Incident. Describe the incident. What was the outcome of the incident?) a. Have you always been able to recognize mental health issues in career sessions? Yes No b. If not, when did this change for you? c. What happened that caused you to begin to recognize mental health issues? 3. Demographics Component When did you begin working in the career service field?___________ Job Title__________ What tasks does your role include?____________________________ Services offered in the Career Service department________________ What is the process for clients to book sessions with you?__________ Is there any screening process before clients meet with you? Y N If Yes, what does that entail?_____________ Is there any in-session formal mental health screening?___Y N If Yes, what does that entail?_________ Are sessions open-door or closed-door (private room)?_____________ Is clinical supervision provided?____________ What are some of the types of mental health issues you have identified in career sessions? 238 _____________________________________________________________________ Type of department in which the participant works (faculty specific? Cohort specific?) _______________________________ Cohorts of Clients you work with:_______________________ Are sessions free or is there a fee for service? sponsored sessions by faculty or program? ____________________________ Age___________ Gender__________ How would you describe your ethnicity?________ Do you identify as an Indigenous Person?________ Country of Birth (if not Canada, length of time in Canada___ 1st Language____ Other languages_____) Educational Background_________ Nature of career service training or education____________ Nature of mental health training or education________________ Other career or mental health experience___________________ Career Credentials or Training____________ Mental Health Credentials or Training___________ Wrap up: • Thank participant • Remind of confidentiality and ask if any questions • Remind I will follow up for participant data checks • Remind can contact me with questions and withdraw data at any time Interview Time End:______________ Length of Interview:______________ Interviewer’s Name:______________ 239 Appendix E: Category Tracking Table Sample Table for Tracking the Emergence of New Categories Date of CI/WL Extraction Participant# Date Categorized New Categories Emerged? 240 Appendix F: Final Categories and Descriptions Final Categories and Their Operational Descriptions Legend: CNPS (Counselling Psychology) CP (Career Practitioner) MH (Mental Health) 1. Workplace/Institutional Factors : things the Career Practitioner has access to thanks to the employer or workplace such as a very close working relationship with the counselling team, mental health workshops provided on the job or by the employer for CPs, management supports and structural policies which support the CP in recognizing mental health issues, such as longer time for sessions, permission for repeat sessions, permission for additional training, access to private closed offices and private Zoom, access to student grades and progress portals, regular meetings with the Career Service team to review difficult cases, managers who recognize the Importance of the CP role in student mental health ---How Institutional Factors Help CPs to Recognize Mental Health Issues: Mental health Workshops increase awareness and ability to notice, question, and refer, close ties with counselling team increase confidence to notice mental health issues given that referral supports are close by, management support and structures help CPs to spend time in building relationships and to have the resources needed to recognize mental health issues when they arise. 2. CP Person-Level Factors : things the Career Practitioner knows or has within themselves which they bring to the role, such as personal characteristics, passion for career work, being a naturally empathic caring flexible person, comfort and willingness to support students over time and to discuss/notice mental health flags for referral, cross-cultural competence, and prior personal, work experience or training , such as in teaching, campus roles, work with youth, immigrants, prior counselling training or counselling volunteer work, or personal life experience with mental health issues, and strong knowledge and awareness of common student challenges such as overwhelm, high pressure, high stress times in degree, lack of supports, isolation, suicide risk, ADHD autism spectrum issues, international student issues, fear and shyness about seeking mental health services, awareness that career and personal issues are often interconnected. -----How this Helps to Recognize Mental Health Issues: Having passion for helping students helps to build relationships and notice issues, cross-cultural competence helps students of other cultures to feel understood, increasing disclosure, prior life and work experience increases CP ability to recognize mental health issues, strong knowledge of common student issues increases awareness and sensitivity about student mental health issues, increasing the likelihood of recognizing and taking actions that lead to salience or disclosure. In-Session Behaviours (Actions the Career Practitioner can take in session, or in Client interactions) 3. Build a low-pressure welcoming helpful safe working Relationship: outreach activities, being available for appointments, telling the student a bit about the CP and their own career journey, including prior CP career challenges, focusing on holistic wellbeing of the student, always starting with a brief chit chat to ensure student is doing ok, reducing power 241 differentials, building trust and rapport, being flexible and aware all students need different things, being non critical of career tasks, following the student’s goals and agenda, never pushing, being a useful and knowledgeable liaison for career and campus resources, responding well when distress is apparent, pausing, normalizing, validating, slowing down, making space for tears, offering water, Kleenex, offering extra time and career support as needed, staying in the career practice Lane, going over and above to help students with challenges affecting their success, gently providing information about counselling services -----How this helps to Recognize Mental Health Issues: Proactively building trust, safety, mattering and rapport increases likelihood of disclosure, and the more useful the CP is to the student with career or campus resources, the more the student returns, the stronger the relationship, the more they share, the higher the likelihood of noticing mental health issues. Offering to liaise to other services and emphasizing limits of competence increases likelihood of disclosure of non-career needs. 4. Use Career Theory and Career Task Process: such as introducing chaos, happenstance, emotional resilience career theories, career fit theories such exploring interests, values, motivators, skills, career strengths, career identity theories including life roles, relationships, career assessments and protocols to explore self-reflection, family influence on career concepts, and use of career task processes such as resumes, applications, interview preparation, strategizing for career goals etc. -- How Career Theory/Career Tasks help To Recognize mental health Issues: Providing psychoeducation about career theory normalizes challenges/failure as part of career success, encourages emotion talk as part of career success, encourages deeper self-reflection talk for career fit, increases likelihood of disclosure and of salience of mental health challenges when strategizing for career applications as a team with the client. 5. Active Listening: Paying very close attention in session, listening closely to everything the client says, noticing differences from student norm, using intuition if something doesn’t feel right, noticing lost, confused, overwhelmed language, noticing negative or personal focus of conversation, noticing repetition or patterns of returning to certain personal topics, noticing talk of workplace conflicts, noticing conflict markers, noticing difference between what is said and how it is said, noticing non-verbal cues such as anger, tears, low energy, low vocal tone, noticing anxious talk, agitation, euphoria, noticing problems focusing, atypical eye contact or body movements, disengagement, grooming, noticing too many sessions, too much follow through or too little, noticing atypical reactions/stress about career tasks, stating observations of what is noticed and using gentle probes to understand stress further, paying close attention to responses to understand source of distress better, noticing lack of social and financial supports, unpacking source of distress and actioning CP items and noticing if distress remains ---How Active Listening helps to Recognize Mental Health Issues: Paying very close attention to behaviour and language increases likelihood of noticing mental health issues, making gentle observation statements, probes, and paying close attention to responses make distress and needs for referral more clear, unpacking stress to identify any career action items CP can take helps to make any residual distress and mental health needs more apparent. 242 6. Discuss and Explore Challenges and Barriers to Progress in Career and Life Goals: such as discussing past, present and future challenges in the way of career, academic, or life goals, track and notice lack of progress, parsing out CP action items to see if lack of progress remains ---How this helps to Recognize Mental health issues: Goal-oriented discussion of challenges or barriers to career success makes mental health issues more salient, increases likelihood of disclosure, including when co-strategizing around accommodations, application efforts, or supports needed to meet career goals. Providing extra career support for lack of career task progress helps CP to notice if lack of progress/challenges remain and is not a training issue, signalling potential mental health or other issues. 243 Appendix G: Categories with Subcategories Factors which help Career Practitioners (CPs) to recognize Mental Health issues in Higher Education Career Service Sessions Part I: Factors in Place Prior to Session: Institutional Factors and CP-Level Factors 1. 100% Institutional Supports/Factors (such as Close Ties with the Counselling Team and Other Student Offices, Workplace Mental Health Workshops, Management Supports and Structural Policies which support CP in recognizing mental health issues) Helpful 100% Hindering (lack of) 100% Wishlist 91% A. Very Close Ties with the Counselling Team 73% (helpful) 63%-lack of (hindering) 36% want more of (wishlist) B. On the Job Workplace Mental Health Training Workshops & CP Ongoing Training 54% (helpful) 63%-lack of (hindering) 72%-want more of (wishlist) C. Management Support, Policies, Structures (private office, sufficient session time, co-consultation meetings, zoom, access to grades, Leadership Support for mental health role of CP) 82% Ci. Closed Private Office 45% Cii. Management Support for Student Mental Health and CP role in Mental Health 36% (helpful) 36%-lack of (hindering) 36%-want more of (wishlist) Ciii. Regular Co-Consultation Meetings with other CPs 36% Civ. Time with Students in Sessions (45mins+) and for Several Repeat Sessions 18% (helpful: had enough time) 63%-lack of (hindering) 27%-want more of (wishlist) Cv. Zoom 18% 27% (hindering with some students) Cvi. Access to Student Records and Bookings via Portal 9% 2. 100% CP Person-Level Factors (such as personal characteristics, passion for career work, empathy, cross-cultural competence and prior personal, work experience or training , such as teaching, campus roles, work with youth, immigrants, prior counselling training, or personal experience with mental health issues, strong knowledge of common sources of student distress). A. Personal Qualities and Values of the CP 64% Passion, Gratitude for Career Role 45% Courageous (to have mental health conversations) 27% Empathic Caring Personality 18% Coming from a Different Culture 18% Taking Initiative to Build mental health Contacts and Knowledge 18% Respect for Individual differences 18% 244 Persistence, Flexibility 9% B. Prior life and work experience of the CP, prior training (as a teacher, in student affairs, working with youth, with immigrants, in CP roles over time, personal life experience with mental health, prior coursework in counselling skills) 82% As a Teacher 27% In Other Campus Roles, Student Affairs 27% Personal Life Experience with Mental Health 27% On the Job CP Experience over time in various roles 27% University Coursework in Counsellor training/Skills 27% With At-Risk Youth and general Youth 18% With Newcomers, Immigrants, International Students 9% C. Strong Knowledge and Awareness of Common Student Issues and Challenges 100% Be Aware Students May be Lonely, Under Supported, Overwhelmed and high stress times in degree 64% Difficulty adjusting to Campus Life 18% Many Students are Lonely, Isolated 18% Certain times of year, economic cycles are higher stress 18% Be Aware Personal and Mental Health Issues are Often Intertwined 64% Be Aware of Suicide Risk Signs and Neurodiversity Signs 54% Suicide Risk Signs and Despair 27% Signs of Neurodiversity, Autism Spectrum 18% Maladaptive Perfectionism 9% Signs of undiagnosed worse in higher education ADHD 9% Be Aware Students May Feel Shy or Stigma About Seeking Supports 54% Each Student May Need Very Different Things 36% Many Students Are Under Extreme Family Pressures 36% Be Aware of Common International Students and Immigrant Challenges 27% Part II: In-Session Factors and Actions (Factors within CP control in Session, Actions CP can take in-session or in Client Interactions) 3. 91% Build a low-pressure welcoming helpful safe working Relationship (Working Alliance) (such as outreach activities, focusing on holistic wellbeing, reducing power differentials, building trust and rapport, being flexible with individual differences, being non critical of career tasks, following student agency, never pushing, being a useful and knowledgeable liaison for career and campus resources, responding well to distress, normalizing, offering extra time and career support as needed, staying in CP lane, being aware and sensitive to common student challenges and stressors). A. Proactively Build a low-pressure positive Relationship 91% Pre-Session Relationship Building Actions (Outreach Activities, Office set up etc.) 45% 245 Outreach events, workshops 27% Be available and flexible for booking appointment times, over various means 27% Set up physical office items (Kleenex, cards, connection points, water) 27% Online outreach, emails, social media 18% In-Session Relationship Building Actions 82% Start with 5 Minute Holistic Chit Chat, “how are you?” before career task 73% Build Trust and Rapport 73% Be non-judgemental, and self-aware, non-critical (Unconditional Positive Regard) of career tasks 73% Focus on student agency, follow their agenda, pace 63% Reduce power differentials, use judicious self-disclosure, humour 27% Review Confidentiality 27% Be Useful, Competent with career tasks, Don’t Waste Student Time 27% Be Sensitive and Understanding about Common Student Challenges (isolation, overwhelm, international student issues, family pressures, ADHD, Stigma) 100% -- 82% hindering Relationship Factors (student reticence to share, stigma, student busy schedule, lack of follow through) B. Respond Well to Disclosure and Signs of Distress 91% Be Willing to Provide Extra Support to Students in Distress or w Extra Needs 73% Thank Student for Sharing, Normalize Emotions, Challenges, Reassure 63% Pause and Slow Down at Signs of Distress 63% Gently Orient to Mental Health Services, Never Push 63% Follow Up 55% Allow Space for Tears, Do Not Gloss Over 45% Offer to Reschedule another career session, offer Extra Time 36% C. Act as a Liaison to Other Campus Services, Be Competent and Useful 45% Stay in CP Lane, Re-iterate Boundaries of Practice as Entry to Discuss CNPS services 45% Establish Oneself as Knowledge Resources of Campus Services 27% 4. 91% Use Career Theory and the Career Task Process: (such as Chaos, Happenstance, Emotional Resilience Career theories, Career Fit theories, Career Strengths, Career Identity, Career Assessment and Protocols, Family influence on Career concepts, and use Career Task Processes such as resumes, applications, interview preparation etc.) A. Introduce Career Theory to Normalize Challenges, Failures, Emotions in Career Journey (Chaos Theory, Happenstance, Emotional Resilience, EQ in Career) 55% Emotional Resilience Theories of Career, EQ in Career, Emotion Talk 45% 246 Chaos Theory, Happenstance, Challenges and Failures Normal in Career for Success 27% B. Introduce Career Fit Theories/Protocols to Stimulate Deeper Self-Reflection Talk (Interests, Values, Strengths, Identity, Family Influence on Career, Career Assessments and Protocol) 73% Motivators, Interests, Values 54% Discuss Family Impact on Career 54% Strengths, Self-Efficacy 36% Assessments 18% Career Exploration Protocol 18% Career Flow, Identity 9% C. Use Resume/Application Process and Strategizing as a Springboard for Deeper Career Planning Discussion 27% 5. 100% Active Listening (such as Listening closely, paying very close attention to language and behaviour, noticing lost, overwhelmed, negative talk, conflict markers, changes from student norm, stating observations and using gentle probes if difficulties are apparent, paying close attention to responses to understand source of distress better, noticing lack of supports) A. Pay Very Close Attention (Attunement) 82% Track Closely 82% Compare to Student’s Baseline 27% Use Intuition to Sense Mental Health Issues 27% B. Notice Language, What student says 81% Notice a More Personal or Mental Health Focus in Talk 45% Notice Pressure Talk 36% Notice Negative Self-Talk and Negative General Talk 27% Notice Confusion/Lost Talk 27% Notice Repetitions, Patterns 27% Notice Workplace Problems/Conflicts Talk 18% C. Notice Conflict Markers, Difference between what and how things are said 54% D. Notice Behavioural Cues, Actions 100% Tears, Distress 45% Low Vocal Tone, Low Energy 45% Anger, Frustration, Agitation, Risk to Self and Others 36% Atypical Response to Career Tasks 36% Too Many Sessions (overreliance on CP) or Too Little Follow Through 36% Atypical Body Movements (ringing hands, pacing) 27% Focus Problems 18% 247 Euphoria, Substance use 18% Atypical Eye Contact 18% Disengagement 18% Over Checking, Rigid, Obsessive Behaviour 9% Perfectionism 9% Poor Grooming 9% Socio Economic Cues (no money for food, transit) 9% E. Use Here and Now Immediacy (Make gentle comments on Observations and Gently Probe to Understand needs and distress) 54% F. Notice Supports, Ask about Supports 45% G. Unpack Source of Distress, Action CP Items, Notice if Distress Remains 27% 6. Notice and Discuss Barriers to progress/success in life and Career (such as Discussing Past, Present and Future challenges in the way of career, academic, or life goals, track and notice lack of progress, parse out CP action items to see if lack of progress remains) 82% A. Ask about Current Challenges to Career/Life Progress 82% Challenges with Career Task 72% Challenges with Academics 36% Proactively Track Progress and Challenges 27% Be Willing to Parse out CP Action Items 27% B. Explore Past Challenges to Career Progress 45% C. Explore Future Challenges to Career Progress 18% Factors that Hinder, make it harder for CPs to Recognize Mental Health Issues in Career Service Sessions Part I. Institutional Factors 100% 1. Time: Not Enough Time with Students, Budget Constraints, Volume 63% 2. Lack of Workplace Mental Health Training 63% Fear of Doing Harm due to Lack of Training 27% 2. Siloed Structure of CP and Other Campus Departments 63% A. Lack of Close ties with Counselling Team 36% B. Privacy Concerns 9% 248 C. Counselling Wait times, Access Issues 18% 4. Lack of Management Support for CP/Career Role in Student Wellbeing and Mental health 36% Lack of Clinical Supervision, Feedback, Guidance on Skills, Oversight 9% 5. Zoom (not in person session) 27% Part II: Student Factors 82% 6. Student Factors 82% A. Student Reticence to Share, Stigma, Shyness, Busy-ness 54% B. Lack of Student Follow Through, Hard to Keep Track of Students 36% Wishlist Items That Would have Helped or Which Could Help CPs to Recognize Mental Health Issues in Higher Education Career Service Sessions Institutional Factors 91% 1. More Training 72% A. More Mental Health Training for CPs and Campus Staff, 64% Ai. Include mandatory, at minimum annual mental health training workshop or as part of CCDP credential 45% Aii. Include experiential practice, feedback, role play, scenarios 18% B. Quick Reference Mental Health Tools & Resources for CPs 18% 2. Closer Ties with Counselling Team and Other Student Services, less Siloed 36% 3. More Leadership Support for centrality of CP role in Mental Health 36% 4. More Time with Clients 27% 249 Appendix H: Sample CP Job Posting Retrieved from: https://www.douglascollegecareers.ca/postings/10185 Position Title: Career Coach/Resource Centre Advisor (Douglas College Dec 2022) The Role Representing Douglas College at the Aldergrove WorkBC Centres the Career Coach/Resource Centre Advisor will coordinate and organize all resource information as well as deliver Intake and Case Management Services to help Clients achieve and maintain sustainable labour market attachments. Responsibilities • Assist with greeting clients and visitors ensuring clients sign-in, answer queries and direct appropriately • Support Clients in accessing all relevant resources, including any specific resources that may be identified for individual clients and direct and refer the Client to other programs and resources • Receive and review applications for services from the Online Employment Services Portal; • Provide assistance with the online application starting with obtaining a Basic BCEID; • Conduct Client Needs Assessment (CNA) in accordance with Work BC guidelines for case management interventions or services to determine employment readiness and need for case managed services; • Provide clients with career planning assistance providing referral(s) to workshops or other community agencies; • Maintain contact with the Client to support, motivate, and monitor the Client’s progress; • Work with any Client who achieves employment, achieves sustainable employment or obtains a community attachment and establish, in accordance with WorkBC Policy, a sustainment plan for the Client’s Employment, Sustainable Employment or Community Attachment; • Assist clients through one to one coaching with resume writing, job search techniques, career planning materials, assessment tools and other ESC resources; • Implement the results of the Needs Determination to create, in collaboration with the Client, a realistic and achievable Action Plan; • Determine eligibility for financial supports and services; • Maintain regular contact with the Client to support, motivate, and monitor the Client’s progress • Ensure that upon assessment, clients are provided with the full spectrum of services available to them, as per WorkBC Policy, and that Action Plans are updated/renewed and signed accordingly • Complete reports such as monthly Client Success Stories as per the requirement of the ESC and submit for review to the Centre Manager; • Provide Job Sustainment Services, in accordance with WorkBC Policy, to any Client who achieves either Employment, Sustainable Employment or secures Community Attachment • Review monthly your individual Key Performance Measures (KPM) to ensure that you are providing the right services at the right time for Clients with the Centre Manager • Meet or Exceed Service Utilization targets for the following services: Skills Training, Wage Subsidy, and Self Employment • Ensure that all required documentation is in place to support the start and completion of the 250 agreed upon intervention (Client Milestones); To Be Successful in this Role You Will Need • Post-Secondary diploma/degree, in employment services related field or equivalent level of experience; • Certified Career Development Practitioner (CCDP) Certification an asset; • Commitment to continuous learning and development; • Ability to exhibit respect for clients, client diversity, and community partners; • Strong oral and written communication and interpersonal skills; • Excellent computer skills: MS Office Suite, database entry and the use of online-demand meeting applications and desk-top sharing; • Knowledge of local labour market and labour market trends; • Knowledge of WorkBC and its mandate an asset; • Satisfactory completion of a criminal records check. • Experience providing customer service and resolving issues in person & virtual service delivery environment; • Experience working with individuals with complex barriers and a wide range of cultural backgrounds; 251 Appendix I: Working Alliance Course Outline Retrieved from: https://www.athabascau.ca/syllabi/psyc/psyc405.html#content-section-outline Psychology (PSYC) 405 Athabasca University (Online) Creating A Working Alliance (Revision 5) Register by Jan. 10 to start by Feb. 1 Delivery mode: Individualized study online or Grouped study with Video component (Overseas students, please contact the University Library before registering in a course that has an audio/visual component) Credits: 3 Areas of study: Arts or Social Science Overview This course is intended to be of benefit to people who work with individuals seeking career development assistance, career professionals who want ideas for dealing with their clients, or groups of people who share a common interest in issues related to career development. The course is based on the premise that, regardless of their work settings, all career development professionals work with others to help produce change. Regardless of the context, it is important for all career development practitioners to be able to establish collaborative working relationships that are founded on mutual trust and respect. In these interactions, career professionals must be able to help their clients to: • identify the nature of the desired change and develop appropriate action plans; and • implement a strategy for producing the desired change 252 Psychology 405 focuses on the first step in the above process; that is, creating a working alliance with a person, group, or agency that will facilitate the ultimate goal of developing and implementing an intervention plan. The course describes the knowledge and skills career development practitioners need to achieve these ends. Outline • Unit 1: Understanding the Working Alliance • Unit 2: Basic Communication Skills • Unit 3: More Communication Skills • Unit 4: Collaboration • Unit 5: Problem Solving and Decision Making • Unit 6: Partnerships and Groups • Unit 7: Basic Group Facilitation Skills 253 Appendix J: Recommendations for Practice Recognizing Mental Health Issues in Career Services The following recommendations are based on the existing literature as well as findings from the present study, and should be considered provisional until further studies are completed. Suggestions are organized in terms of key actions in each job role which may support the recognition of mental health issues in career service sessions, and help to reduce risks to student and staff mental health. Senior Campus Leaders: • Be familiar with the link between student mental health, retention, and campus revenue. (see: American Council on Education Report for Campus Leaders, 2019) • Be familiar with student mental health risks (see: Health Minds Network Reports for campus staff, 2022; National Surveys on Student Mental Health NCHA 2019, OUCHA, 2017) • Be familiar with reputational and litigation risks relating to student mental health (see: Affsprung 2010, Mullens, 20008) • Promote student mental health investments as sound business strategy to stakeholders. Commit to creating a “healthy setting” focused on prevention (see Patterson & Kline, 2008. See National Standards on Psychological Health and Safety at Work 2012, Mental Health Commission of Canada) • Focus on action, and measurement. Work with Human Resources to incorporate measurable mental health activities into staff and faculty job mandates and performance appraisal across the institution (such as required gatekeeper training). Consider ways to build mental health and other “people” variables into job metrics. Consider a “change-management” process to ensure engagement if this represents a paradigm shift for some staff. Ensure that any job mandate changes consider healthy workloads; find creative means to improve and measure mental health competencies without creating a large time or cost burden. • Work with Human Resources to design a basic training workshop on effective management skills and ethics for any staff member advancing to a role which has a supervision component. Include managerial skills to reduce staff burn-out such as professional communication skills, not contacting staff on personal phone numbers or emails, or outside of office hours, unless in emergencies, managing workloads, 254 engagement and morale etc. Explore best practices (contracts and training) for faculty and students in academic supervision/research dynamics (Van Scherpenberg et al., 2021) • Consider brief mandatory mental health workshops for staff, at on-boarding, and once every 2-3 years. (Mental Health First Aid, Question Persuade Refer, Assist, in addition to other workplace health training such as anti-harassment and bullying, diversity and inclusion, Indigenous Reconciliation etc.). Emphasize mental health workshops with experiential components, so staff can practice skills. Consider mandatory gatekeeper training for managers with student-facing reports, for staff who influence campus policy, and for front-line staff (including faculty). Ensure the ‘push’ to carve out training time comes from management, and does not rely on employee initiative. Recognize and reward employee initiative which is in line with larger campus goals. • Consider funding core trainings and credentials for career service staff. (Provincial Career Development Practitioner credential, gatekeeper training, consider extra funding CPs can apply for if they show initiative). (May help with retention). • Consider extending case management software license (already in use in counselling services) to career service team to reduce risk. Consider funding EAP and other supports for staff mental health. Have staff support system in place if a student dies by suicide. Consider funding repeat career service sessions of at least 45 mins in duration. Have senior counselling services team member provide training on secure management of client records, note taking, and client communications using the case management software to reduce risk. • Publicly recognize CP managers, CPs (and other staff, faculty) for various mental health, diversity, and inclusion initiatives in their team which support a healthy workplace and campus (per below). • Encourage all faculties to allow Career and Counselling staff to do classroom outreach visits. • Consider offering career development credit courses (job acquisition skills, resilience, and career adaptability skills) and mental health resilience credit courses (for example see: Lawrence University “do nothing” course) for students for prevention and best career outcomes. Consider credit for social or community activities (such as clubs, volunteering, cross-cultural activities etc.). Consider holistic factors such as affordable on campus housing, tuition, and transit times and their relation to lack of time for wellbeing/social activities among students. Consider structure of typical courseloads in intensive programs from a wellbeing lens. • Recognize and track performance of Career and Counselling managers for various career cross-working activities as described below. Consider funding (lunch, events) opportunities for staff to interact interdepartmentally (to improve referrals, layering students in support, and to emphasize scope of practice). 255 • Consider surveys of student wellbeing, of staff reservations around mental health initiatives, and to track student career resilience post degree (including career adaptability skills, career outcomes in short and medium term). (Can add to ROI for prospective students, and for marketing, reputational purposes) • Consider locating student counselling and career service departments near to one another on campus (and also registration, learning supports, disability access, social work, medical, ombudsperson and other student services). Consider shared reporting structure and shared unit of confidentiality for some services which work closely with one another (medical and counselling for instance). Consider having a “Wellness Centre” with a shared waiting room for medical and counselling services to reduce stigma. • Consider offering an Indigenous students’ centre, so students can access culturally appropriate supports, counselling, mentorship, access to elders etc. (see Simon Fraser University) • Consider funding a computer portal for experiential work programs (practicums, internships, co-ops) so CPs can easily track student applications, progress, assignments, or lack of progress, as well as unfilled job openings. • Ensure Career Services and other student services have umbrella supervision with a senior Counselling team member for complex cases. Consider requiring dedicated counselling staff to provide umbrella support to higher risk services such as academic advising, international student support, student residence advisors, careers, and disability services. • Ensure co-consultation time is available for CPs with their colleagues to reduce burnout for front-line staff, and that mentoring/supervision relationship is separate from managerial supervision. • Ensure that landing pages of key student service websites delineate nature of services, limitations, with links to the counselling department for personal matters. Remove barriers for booking counselling appointments wherever possible. Consider Zoom or phone initial bookings and triage if students have busy schedules (as opposed to long in-person waits during class or work hours). • Consider a dedicated suicide risk reduction team separate from the Counselling Department to support staff and faculty dealing with high risk students. • Consider proactive outreach and introduction about rights and counselling services for vulnerable migrant students, as part of their program welcome process, including in languages other than English, emphasizing their visa status will not be affected. Require this of programs which receive most of their revenue from international students (certificate, diploma programs). Consider availability of housing, transit etc. for low-income students new to Canada, relative to enrollment numbers. Consider trusted third party English testing prior to arrival to avoid risk of failure and suicide risk for students 256 with falsified records and desperate visa/financial situations. Be aware of fraud and exploitation risks in the sector and have contingency plans in place for students in need. Follow best practices with regards to use of reputable international recruiters to reduce risk of harm to prospective students. • Ensure sufficient mental health resources (self-help, group, EAP) are in place before implementing initiatives to increase referrals to counselling services. (Emphasize prevention not just crisis response). Ensure lists are readily available to students about free National (wellnesstogether.ca), community, and campus mental health resources. Consider low cost outside the office supports such as e-chat, apps, and message boards, where students interact in various languages. Make use of peer and practicum support where possible. • Stay abreast of best practices and research in the field on reducing mental health risks; consider tracking experience on campus and contributing to the research literature. Seek input from all levels of campus staff to inform policies for a healthy campus and workplace. Make student and staff wellbeing a major priority considered as a foundation of campus policies. • Recognize managers and staff who evidence a track record of building strong positive working relationships for staff retention, promotion, and for student success. Recognize that efficiency is not just based on lowest use of service time, but also on costs which are avoided (student crisis, suicide, litigation, reputational loss, tuition loss, staff turnover). Encourage repeated use of career and other student services as an aspect of relationship building for prevention and risk management (within healthy workload limits, at staff discretion), and to reduce reliance on costly crisis supports. Career Service Managers: • Require all reporting employees to learn about and know other student services well, to reduce friction with referrals and to avoid unnecessary student stress (admissions, registration, ombudsperson, counselling, medical, athletics, housing, social work, disability and learning supports, language supports, financial services etc.). Emphasize the importance of CPs offering to act as a liaison point, connecting students to other resources if needed. Carve out time for this training as part of onboarding. Devise creative ways to assist with this knowledge acquisition and close working with other student services. Carve out time twice annually with various departments for co-working, co-learning activities. Consider one or two CP representatives to rotate through cross-departmental meetings to report back. Arrange for CPs to give talks to other departments about their expertise and career service offerings for referrals. Consider having senior 257 CPs provide training talks to the Counselling team to update on key issues and practice in the career field. • Use social media for staff introductions and outreach, arrange for several outreach classroom visits per month by CPs, ensure website staff bios have pictures of CPs and details, encourage easy booking for sessions. Ensure CPs are proactive and flexible for student bookings via many pathways (phone, email, portal, in person at reception, short notice, repeat bookings at staff discretion, based on healthy workload limits). Ensure staff bios reflect strengths as well as limitations (if no clinical training) so students are clear about distinctions between counselling and career services. Clarify any potential confusing degrees (i.e. psychology) if they do not have a clinical counselling component. If staff list formal credentials, consider hyperlinking to credentialing body or explain the credential if name is unclear or misleading (i.e. one day course vs 2 year course). • Require all CPs to complete gatekeeper referral training (Mental health First Aid, QPR) once annually (or mental health refresher) not limited to suicide assist, including CPs with clinical counselling training (to emphasize scope of role and referral resources). Carve out time to ensure gatekeeper training and annual mental health refreshers occur. Coordinate mental health talks from campus counsellors or other experts. Include gatekeeper training in on-boarding process (along with other key workplace trainings which emphasize experiential practice). Emphasize staying within scope of practice and referral training. Devise creative low-cost means to support learning in this area using existing campus resources, free open-access courses, or reading materials. • Carve out time for monthly co-consultation meetings among CPs or as needed to reduce risk of burnout; invite a counselling colleague where possible to consult on more difficult cases (ensure confidentiality limits are met if separate units of confidentiality). Allow for these to occur separate from managerial supervision if it facilitates more disclosure. • Review dual and multiple relationships present with certain funders of campus career programs. Work with senior counselling colleagues for training on this and ensure CPs are trained on this. Implement a career-specific consent process, which clarifies dual relationships (if a department which sponsored career support for students is expecting feedback about the students). Ensure that CP training is clarified verbally during consent, so that any lack of clinical counselling training is made clear. Clarify in consent whether there is supervision and the nature of any training or credential. Highlight CP strengths (to generate safety, buy-in) and limitations (to reduce risk, to introduce other services, to avoid confusion). • Ensure resource plans are in place to support staff in times of crisis such as student death by suicide. • Require CPs who offer private client sessions to complete provincial CDP credential or equivalent basic ethics and theory training (over time), emphasizing basic ethics course at 258 a minimum within first three months of hire. Encourage staff to complete additional training and pursue funding approval for their courses (Working Alliance for CPs (Athabasca), Neurodiversity (UBC Open Access), Mental health for CPs, High Fidelity Wrap Around for at-risk youth, Career Resiliency, Career Coaching Programs, CP Conferences, Trauma-informed practice, Diversity, Indigenous Reconciliation, Certificate in Career Development etc.) Recognize CPs who go over and above to complete other mental health, career, or diversity training. Maintain a list of recommended trainings for self-study. Ensure this is tracked as one metric on annual performance reviews. Ensure that your own mental health training meets or exceeds basic CP requirements (i.e., at a minimum, complete gatekeeper training courses and CDP core courses). • Identify or develop other training courses for CPs on mental health, ethics, and other diversity issues in career service, using an evidence-based approach. Seek CP feedback on additional training they most need or would like. • Organize and facilitate cross-working and cross-training initiatives with the counselling team, especially with counsellors who have experience in careers. Consider monthly mental health drop-ins at career centre, workshops co-hosted by careers and counselling team, monthly office-swap to orient students to counsellors, seating career staff with counsellors at welcome and outreach events etc. Establish an umbrella supervision relationship with a senior counsellor/psychologist on staff to assist with difficult cases with meetings by-annually and so CPs are able to consult when needed (within limits of confidentiality). • Be familiar with career resilience theories, adaptability theories, pathways for student distress, and critical in-session CP actions to support best career and wellbeing outcomes. • Ensure each CP has clear list of all student resources contacts for smooth referral process. Ensure CP has ideally been introduced to counsellors and knows them by name and vice versa, so they can refer students to individual staff rather than to general staff. Ensure each CP understands ethical risks associated with referrals (obtain permission from client to walk them to counselling etc.). • Actively encourage holistic student sessions for best student career outcomes and mental health outcomes. Aim for career resilience among students and ROI for the long term reputational goals of the campus. Ensure mental health and career resilience activities are included on CP job metrics (not just number of resumes etc.). Consider qualitative in addition to quantitative metrics and “people” variables in annual staff performance reviews which promote a healthy workplace and student success. Ensure that student and staff wellbeing are foundational considerations of the department’s activities. • Ensure that CPs have access to a private closed office (or break out space), with sessions at least 45 minutes as needed. Allow CP to design office as a welcoming space to reflect their personality to help with relationship building and talking points. Consider offering 259 tea or water, Kleenex, table so staff can work on career tasks with clients. Have cards and referral pamphlets on hand in each office. Maintain a list of free community counselling and other resources for students. Consider cross-cultural and access elements in designing office space to be welcoming to a diversity of students. • Provide CPs training on in-session mental health recognition activities and rigorous career supports per below. Draw from the valuable front-line experience of CPs for cross-training within the team. Emphasize holistic, relationship-based career service sessions for best outcomes. Be familiar with the research on effective career support and best outcomes. Encourage CPs to draw upon their preferred career theories and exploration methods best suited to their personal advising style (grounded in the actions outlined in Appendix G, for rigorous relational support for career resilience). • Hire CPs who evidence ability to establish and nurture effective working relationships, and knowledge of common worker, adult, and student issues in their past work, experience, or training, or willingness to develop these. Hire CPs who evidence cross-cultural competence, experience, or clear willingness and action steps to develop these within the near term. Allow CPs some autonomy in determining whether some higher risk students require extra career sessions. • Keep track of client use of service, including early termination (of multi-session programs, notice any unusually high patterns of early termination), of consults and sale of sessions (in fee for service settings), number of sessions. Consider post-service client surveys. Consider fee-for-service for non-affiliated community members depending on budgetary needs. Recognize and reward evidence of strong relationship building as part of student success. Permit and promote the ability of students to stay in touch with CP for timely career support, or for short-notice drop-ins (if CP wants to offer this to certain students, dependent on their workload and judgement, at CP’s discretion). Recognize that efficiency is not just based on lowest use of service time, but also on costs which are avoided (student crisis, suicide, litigation, reputational loss, tuition loss, staff turnover). Encourage repeated use of services as an aspect of prevention and risk management (within healthy CP workload limits, at CP’s discretion), to reduce reliance on costly crisis resources. • Ensure landing page of campus career centre describes the limitations and functions of CPs, and provide a link to the counselling department, with details about how to book counselling appointments for more personal issues. Consider multi-lingual scripts for higher risk content linking to the counselling page for key student populations. • Role model mental health breaks, core holiday time, ensure CPs are aware of EAP resources for staff. 260 • Consider organizing social/celebration events with other student services to provide opportunities to mingle and work in concert. • Provide updated list of staff contacts to other departments and maintain regularly updated list of staff names and contacts in other departments (accounting for annual turn-over, practicum student rotations etc.). • Consider an intake form to highlight career needs upon booking (career exploration, interview prep, career problems, job applications etc.). Consider brief query about level of career stress in general terms (low, medium, high) and overall stress (low, medium, high). • Carefully appraise any career assessments or coach training programs used in the department, and assess for misinformation. Encourage all CPs to use a critical literacy lens when appraising career assessment tools and training programs in the coaching marketplace. Provide training on ethical risks of web-based career assessments with little psychometric evidence; consult with senior counselling member with psychometrics training for guidance on this. Include diversity limitations of assessments. • Collaborate with faculties to devise creative opportunities for international students and newcomers to build Canadian social capital on and off campus as career support outside the office, and for students facing multiple barriers to employment. • Be aware of risks in the vulnerable migrant-worker sector. • Consult with CPs to draw ideas from their front-line experience about how to reduce student stress and improve career outcomes, as well as to prevent burnout in their own roles. • Consider annual ethics refresher training for the CP team, to review key career service ethical issues, evolving ethical challenges in the field, and complex case vignettes. Engage senior CPs in training design and facilitation for their peers. • If new to a formal managerial role, seek out brief management coursework or workshops on best practices to foster positive leadership skills and nurturing employee engagement. Learn managerial skills to reduce staff burnout and turn over such as staff communication policies outside of business hours, managing team workloads and morale etc. Recognize and reward strong performance for ongoing motivation and retention. • Be mindful of CP workloads; for new tasks added, consider what needs to be removed. Devise creative means to build CP competencies which do not pose a significant time or cost burden. Ensure the ‘push’ for annual mental health and diversity training comes from management, and the time is provided, rather than relying on CP initiative and time outside of work. Reward and recognize CPs who do take initiative for contributing to student mental health, a healthy workplace, diversity competence, or other ongoing training. 261 Student Counselling Services Department: • Ensure multi-lingual self-serve psychoeducational resources are available for clients on common student issues. (see University of Alberta, Student counselling centre website). • Follow best practices and research for prevention. Provide groups and create prevention activities, such as pet care groups, music and food groups, social clubs which build social capital and buffer against mental health issues, without being directly focused on mental health (in view of waitlists for counselling sessions). • Consider student self-surveys to assess risk. Consider a chat option via online or social media to reach at-risk students, and/or outreach on international student online message boards. Do classroom outreach in particular with international students, newcomers, and highly competitive programs, clarifying the nature of services and that they are available for all students (not just domestic students). Clarify and explain confidentiality and that counselling will not impact visa status. Frame counselling via a strength and success narrative, rather than weakness. Consider drawing on career theory (chaos, happenstance, emotional resilience) to normal challenges and EQ as part of success. Consider emotion coaching language relating to success for students with stigma against help-seeking. • Work closely with Career Services and other student services for cross-training etc. Have counsellors learn about CP services and expertise for referrals and scope of practice. • Ensure counsellors on staff are very familiar with other student resources and policies on campus, in order to reduce friction and avoid unnecessary stress for students (admissions, registration, varsity athletics policies, ombudsperson, disability supports, learning supports, health, housing, social work etc.) • Seek ideas from the front-line counselling team and consider contributing knowledge to the research literature and to senior leadership about improving student and staff mental health. Seek input from counsellors about most needed ongoing training workshops. Engage counsellors in designing and facilitating training talks for their peers and for other campus staff. Ensure ongoing mandatory diversity training for all counsellors. Career Practitioners: • Invest in opportunities to build touch and go empathy skills (If CP has counsellor training, be mindful of staying limited to touch-and-go empathy and referring early). • Invest in opportunities to learn about common sources of student challenges and distress. • Invest in opportunities to learn about Indigenous students, trades students, international and cross-cultural students, students with disabilities etc.; students with different backgrounds from one’s own. 262 • Invest in opportunities to learn about student mental health risks particularly in the career realm. Understand the link between student mental health, retention, and campus revenue. Take mental health risks seriously. Understand the benefit of supporting mental health for career resilience outcomes. Understand the unique stressors contemporary students face, relative to prior decades. Understand the unique stressors newcomers and international students face. • Complete the provincial CDP credential or equivalent. • Complete a course on Working Alliance for CPs • Complete Mental Health first Aid, QPR workshops • Complete an Indigenous Reconciliation workshop and a trauma-informed workshop. • Complete suicide assist workshops, and any other mental health workshops available on an annual basis. • Attend cross-training and co-working opportunities with counselling team (and other services) • Show initiative for ongoing learning and experience relating to mental health in careers, career services, diversity issues etc. Consider attending career conferences, contributing to research. Stay abreast of best practice in the field. Seek funding support where possible for continuing education. • Stay up to date on the latest career services trends and skills to support student employment. • Be aware of workplace challenges which can arise in some academic supervisor/researcher dynamics. Stay abreast of best practices to support student wellbeing in research work. • Maintain strong close ties with the counselling team, be familiar with how to make referrals, maintain active list of counsellor names and numbers, updating regularly, consider social activities with counsellors and other student affairs staff. Be able to recommend certain counsellors by name whom you know, as opposed to suggesting a student speak with a counsellor in general terms (aim for warm personalized referrals). • Focus on building low-pressure safe working relationships with students as a foundation via actions outlined in Appendix G. Focus on holistic career sessions, always assessing how student is doing overall at onset with a brief chit chat. • Use career theories which focus on adaptability, accepting change, failure, chaos, emotional intelligence, and emotional resilience to welcome disclosure of difficulties. Use self-reflective questions in career exploration. Approach resume and career tasks non-judgementally to be an ally with client and to enhance the relationship (Appendix G) • Implement active listening. Learn the common ways in which mental health issues often arise in career services (Appendix G) 263 • Ask about barriers to progress and challenges in a non-judgemental way, in a strength-based coaching goal-oriented way (Appendix G) • Stay firmly within scope of practice. Use touch and go empathy only (do not deepen or explore emotions, but be willing to understand source of distress to identify any career service needs and referral needs), speak about campus resources early, explain ability and willingness to refer. Know other campus resources well. • Be willing to provide training talks to counselling team, to counselling students, and to other staff about CP expertise and career centre offerings to encourage referrals back and forth. • Be willing to conduct classroom outreach visits to describe career services. Devise engaging creative workshop content to highlight value of CP offerings and the importance of emotional intelligence, resilience in career. • Consider a strength-based coaching orientation focused on career goals. • Consider use of formal tools to help clients determine service needs as well as resilience strengths and growth edges (towards normalizing mental health talk and emotional resilience) • Use confidentiality and consent process at onset to describe credentials, expertise, scope of practice, campus resources (including counselling vs. career services), willingness to refer as needed, nature of career and personal issues often intersecting, and to clarify student session goals. • Attend co-consultation meetings and seek clinical supervision or EAP supports when needed. Attend to your own limits and mental health as a priority. If workload is maxed, consult with management about what should be dropped when a new task item is assigned. Keep track of ideas and methods to increase efficiency and reduce time burden in the role such as standardized note taking, electronic records etc. • Be familiar with the common challenges and risks faced by migrant-worker student populations, as well as ongoing changes to visa and immigration pathways which impact newcomers in order to support wellbeing promotion and prevention of additional distress. • Explore means to help international students and newcomers to build Canadian social capital on and off campus to support their career goals. • Contribute your front-line experience and ideas to management, researchers, and the field around improving student career and wellbeing outcomes. • Permit and promote the ability of students to stay in touch with you for brief timely career support, or for short-notice drop-ins (at your discretion, based on healthy workloads). Recognize that campus efficiency is not only based on lowest use of service time, but also on costs which are avoided (student crisis, suicide, litigation, reputational loss, tuition loss, attrition, staff turnover) and best student outcomes over time. Focus on staff and student wellbeing as a foundation of campus goals. 264 Career Service Credentialling Bodies (Provincial): • Consider expanding CDP credential to include a Working Alliance Course for CPs, including a mock practice component (recorded and appraised by the learner, and or a peer, and or a teacher) to demonstrate skills. • Consider expanding CDP to include a diversity and inclusion course. • Consider expanding CDP to include a mental health course specific to the career context (emphasizing referrals) • Consider requiring a 3rd party experiential mental health workshop as a required component (such as Mental Health First Aid) to obtain the CDP credential. • Consider requiring an Indigenous Reconciliation workshop or training as part of the CDP credential. • Consider designing a Coaching skills module (strength based, goal oriented) as an optional part of the CDP credential (or provide a list of trusted 3rd party coaching programs) • Include mandatory mental health and diversity continuing education activities each three years as part of re-certification (attending mental health workshops, talks, doing readings and so on) • Consider requiring CDPs to maintain list of mental health and diversity and inclusion resources for client referrals and to provide proof of this for certification. • Maintain data on the equity and inclusion details of all CDP credential holders. • Ensure ethics course covers common career service ethical issues, including dual and multiple relationships, whitening of resumes, disclosure of disability etc., consent and confidentiality, as well as means to work through ethical dilemmas. Include coverage of secure storage of client records, note taking and logging of client communications, use of case management software, and the value of clinical supervision. Include common risks of client sessions including imbalance of power, transference, counter-transference and the importance of careful terminations for vulnerable clients after multiple sessions. Have an evaluation component to ensure understanding of key ethical issues. • Consider maintaining a directory of master’s level clinical counsellors with career expertise who are available for umbrella supervision by phone or Zoom for complex career counselling issues. • Consider including coursework using case studies of complex case studies asking CDP students to determine when to refer to a master’s level career counsellor, why, and how. • Ensure coursework has sufficient evaluation components to ensure understanding and grasp of material 265 National Career Service Bodies: • Consider protecting the use of the title Career Counsellor due to confusion over roles. Consider using the CDP title (or equivalent) for all practitioners, with the career counsellor title reserved only for those with formal Counselling training (clinical counselling psychology graduate training program) in addition to the CDP or other formal career service training. • Consider what minimum of career service training and experience is required of master’s level clinical counsellors to establish and claim career counselling expertise (outside of Quebec). Establish what minimum of career training and expertise is required to provide umbrella supervision in career counselling cases. • Define career coaching and its limitations. Require CDP or equivalent for career coaches. • Consider delineating the CDP role for advising, guidance, and low-risk career exploration elements of career counselling and career coaching, with more complex mental health-related career counselling matters referred to Registered Counsellors with career expertise. • Recommend at least umbrella clinical supervision for CP practice and some component of supervision in training for CDP credential. • Consider having credentialing organizations unite at the provincial level to build a more rigorous CDP credentialing process. • Delineate with clear examples the types of presenting issues which should be referred to masters level Career Counsellors, and the types of lower risk career counselling issues appropriate for experienced CDPs (career exploration, career identity, self in the world, life/work planning, preferred futures). Draw on the experience of senior CPs and experienced master’s level career counsellors to design learning activities based on complex case studies for CDP students to determine when to refer to a master’s level career counsellors, why, and how. Work with senior experienced CPs and master’s level carer counsellors to determine scope of practice, and where the line of referral is (straight forward life/career planning versus intertwined career and personal problems, and mental health issues). • Consider making specific recommendations about use of secure case management software, logging of client communications, and safe storage of client records as part of Standards and Guidelines for CP practice. • Gather and publish data on equity, inclusion, and diversity variables of CPs relative to pay and seniority in the field. Gather detailed data on diversity training, mental health 266 training, career service training, and any credentials held. Gather data on access to clinical (separate from managerial) supervision. Conduct studies about beliefs or reservations about mental health issues and stigma in the sector. Coaching Certification Organizations: • Consider requiring completion of a 3rd party experiential gatekeeper mental health training to emphasize referrals (Mental health First Aid, QPR) as part of coaching credential. • Require coaches to maintain list of mental health resources for client referrals and to provide proof of this for certification. • Consider recommending umbrella supervision with both senior coaches and counsellors for complex cases. • Develop rigorous ethics training on the risks and limitations of coaching. Include ethical vignettes and an evaluation component. Develop a clear consent and confidentiality process which delineates the nature and limitations of coaching, which clarifies any clinical supervision being provided, as well as the nature of any credentials and training of the coach, including the amount of clinical training (or lack thereof) and duration of training. • Consider skill demonstration and evaluation around complex cases and referrals for mental health issues. • Provide clear examples as part of training and credentialing of issues to refer to mental health professionals. • Remove language in any marketing or training materials which equates psychology with pathology. Explain where coaching rests on a continuing with counselling psychology, clinical psychology and other disciplines. Update materials based on the research literature to accurately represent the power imbalances and risks inherent in coaching. Clarify that the philosophy of being “whole, resourceful, and complete” does not mean that coaching is suited for any topic. Clarify with clear examples when mental health screening is needed. • Consider making specific recommendations about use of secure case management software, logging of client communications, and safe storage of client records as part of coaching practice. Graduate Counselling Psychology Training Programs (outside of Quebec): • Consider including brief training, practice, and coursework on coaching psychology methods as one among many other counselling interventions, including coverage of coaching risks and limitations. 267 • Include career variables as key issue in case studies throughout coursework intersecting with other issues. • Emphasize career as an issue of power, identity, societal inclusion, social justice, agency, health, diversity, purpose, and life meaning. Highlight the ways in which access to work can be a mental health intervention, and a protective factor for wellbeing (see Redekopp & Huston 2020) • Consider even brief career practicums with diverse clients as part of training, such as immigrant and refugee services, or vocational rehabilitation. • Consider inviting presentations from CPs on campus to speak about the career development field for referral purposes, and scope of practice, as part of the career counselling course. CPs could describe the nature of their work, their expertise, their credential pathways, their work with employers, their services, challenging client cases, labour trends and challenges, along with suggested readings or resources for counselling students wishing to learn more. CPs could also describe the types of complex career issues they often refer and the expertise they seek (and need) from counselling colleagues. • Consider low-cost means to continue building counselling trainee career competence using existing resources. For instance, consider offering an optional self-study concentration in career counselling for graduate students interested in this area. Courses could be supplemented by elective coursework from other faculties (organizational behaviour/HR, workplace law, sociology, social psychology, economics, international relations, education, communications, business, marketing, or any discipline which could inform career counselling, as approved by the CNPS department). Brief practicums could be accomplished in campus career centres as part of cross-working. Additional research papers could be completed on a self-study basis under the guidance of a faculty member with career expertise, for counsellor trainees seeking extra exposure in this area. • Consider designing and delivering high quality certificate or diploma programs for the CP training marketplace specific to career settings (ethics, diversity, mental health, theory, working alliance specific to career contexts) which qualify for the CDP. (See University of Calgary, Dalhousie University, and Simon Fraser University CDP Certificates). Consider also designing graduate level career modules which would be appropriate for trained mental health counsellors wishing to improve their career service competence. Consider designing open-access or low-barrier continuing education courses on topics relevant to CP practice. • Consider anonymously surveying counselling graduate students at the beginning, mid-point, and end of their program on ranking their interest areas within counselling, self-rated competence, and additional training wanted. Consider contributing to the literature relating to novel ways to increase career counselling interest and competence. 268 Government • Work with migrant student worker advocacy organizations (OneVoiceCanada.org, MigrantWorkersAlliance.org) to understand problems and risks in the private college sector. Devise means to reduce corruption in the sector, consider potential amnesty programs for students who are misled or exploited, and consider revoking visa granting status for some colleges. Enhance audit and oversight in this sector, with particular attention to private colleges. Provide clarification to students before they leave their home country about their rights, about the private colleges which do not lead to a Permanent Residence pathway, about resources in Canada, as well as about complaint processes if they are exploited, as part of the visa application and granting process. • Work with campus leaders and stakeholders to ensure funding of public higher education meets needs. Reduce reliance on international student tuition or require that enrollment is commensurate with student service funding to reduce staff and student mental health risks.
Thesis/Dissertation
eng
Counselling Psychology
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Borgen, William A.
Recognizing mental health issues in higher education career service sessions
Text