Interview with Jamie Davidson, Associate Vice President for Student Wellness at University of Nevada at Las Vegas

Jamie Davidson, Associate Vice President for Student Wellness at UNLV

Jamie Davidson, Associate Vice President for Student Wellness at University of Nevada at Las Vegas (UNLV), found his “sweet spot” when moving from majoring in business to becoming a psychologist. He wove together his interests in spirituality, youth ministry, and collaborative care when he came into thefield of college health.  He tells us that he continues to have a passion for helping college students as they make changes which “will lay a foundation for wellbeing for their whole lives.”  How lucky UNLV is to have him!  Read more about his journey, his philosophy of college health and his ideas for creating a truly collaborative wellness center.

Gerri:  I usually like to get a background before we get into college health topics. Where did you grow up? Where are you from?

Jamie:. Well, I was born in Flint, Michigan and my family moved to Fort Meyers, Florida when I was eight years old. I would say the bulk of my formative years took place in Florida, which was a wonderful place to grow up.  I grew up in the family business – a pool company, so honestly, we were always working.  We serviced and cleaned pools, built swimming pools and sold all manner of pool supplies. From sixth grade on, I worked every day after school and Saturdays. Mom would pick me up from school and we would go to work.  I cleaned so many swimming pools growing up that to this day I have never wanted a swimming pool at home!

Gerri: You must have been devastated to see the effect of the hurricane.

Jamie:  Oh, it’s heartbreaking. My wife’s parents and several friends still live in that area. Everyone I know had damage, but they still have their lives and you have to focus on that.

Gerri:  So true – so where did you go from Ft. Myers?

Jamie:  I went to our local community college initially to study business, so I could continue to work in the family business and eventually take over the family business as I’m an only child. Next, I went to Palm Beach Atlantic University, a Christian college in Florida. It was perfect for me, because it has about a thousand students – just the right size, where I got to know people and felt integrated and supported.

My faith is very important to me, so I considered going into the ministry and becoming a youth minister. After meeting my wife, and taking more and more psychology classes, it kind of all gelled together as “Oh, I could be a psychologist. That’s a great way of helping people.”  My father was surprised by my decision, but eventually respected it.  Dad passed away four months ago at the age of 91.

Gerri:  Oh, I’m so sorry.

Jamie:  My wife and I have been caring for both my parents at our house for the last year and a half. Dad had chronic heart disease. My mom has advanced Alzheimer’s, so we were going through the pandemic and taking care of both of them.

Gerri:  So difficult – how did you manage all of that?

Jamie:  It was a very difficult time for me. Between meeting my parents’ needs, my son’s 2^nd deployment to Iraq, surviving the pandemic, and my demanding job; this was the most stressful and overwhelming time of my life.  Talk about maxing out the life stress scale!  The love of my wife and family, an amazing team of staff at work, the satisfaction I get from serving the campus community, and my personal faith got me through this difficult time.

Gerri:  And to do it during COVID had to be very difficult.

Jamie:  Yes. We love to travel. I have been privileged to travel to quite a few other countries. I love learning about and experiencing other cultures. I’m a photographer that enjoys doing landscape and travel photography. We finally have a trip planned to Italy next year. Hopefully everything will be better and we will be able to do it.

Gerri:  Do you incorporate spirituality in your work now?

Jamie:  I do – the wellness wheel is an important conceptual model for the unit I oversee and I have found spirituality/personal faith to be an important resource for many students during difficulty times.  I continue to be active at my local church, so I think spirituality…however one defines that…is an important part of all of us.

Gerri:  Absolutely.  So, Jamie, how did you find your way into college health? Did you practice as a psychologist in Florida?

Jamie:  Yes, I received my master’s degree and worked in community mental health for two years in Orlando, Florida. Then I got my PhD and I’ve worked in many settings. I’ve done community mental health, private practice in Atlanta, Georgia, and also worked in hospitals. I tried them all, but, in the end, I decided that college health was a sweet spot for me. I loved it. I’ll be honest – what I like is that we’re seeing students when they’re young and changes they make now will be a foundation for wellbeing for their whole lives. And that part’s really rewarding, just knowing the impact that you can have.

Gerri:  How did you get to UNLV?

Jamie:  Well, all psychologists have a year internship – like a mini residency which I did at Notre Dame University. But being there reminded me how much I don’t like the snow. So, I took a position at the University of Georgia for a year. And then I took the job at UNLV. UNLV initially, I’ll be completely honest, was not a place that appealed to me. The idea of Viva Las Vegas was not a place that really appealed to me. All the jobs I had applied to were on the East Coast, closer to home and family. But when I came to see UNLV in ’94, the counseling center was kind of a train wreck. My goal then was to become a counseling center director. I knew what I wanted to do. I thought, “Hey, you know, I can go there and maybe I’ll be able to move up the leadership chain, show them that I can do some things and be supportive.” I got a lot more than I bargained for. I left the University of Georgia and while on the way to Nevada, I received a call from the director saying he had taken another job and was going to another university. I still wanted the psychologist position. We had a very candid conversation. I would be the only psychologist they would have at that time. They had two master’s level providers.  It was a small center so I thought this could be a great opportunity. Within my first week, they assigned the counseling center to one of the associate vice presidents on campus and he told me his plan was to close the counseling center. I went home, and I told my wife, “I think I have just made the biggest mistake of my life.” I felt sorry for myself for a little bit, and then I requested a meeting with the AVP the next day and I said, “What would I have to do to prove the value of the counseling center to you? I cannot imagine any university without a university counseling center.” And the AVP laid it out saying “You’d have to show me that the counseling center contributes to the academic learning of students, that it has a retention impact.” These are the types of things which almost all counseling centers assess now, but back then, it was rare. So I asked, “Can I have a year to prove the value? Will you agree to fund the counseling center for a year? I’ll collect the data, and then let’s review it.” He agreed with my plan. I wasn’t exactly sure how to do it, but I like assessments, so I started assessing.

Gerri:  Was there any national data on retention related to health at that time?

Jamie:  No. I started by reaching out to past instructors and other counseling centers to colleagues that I didn’t know. They said “No, we don’t assess that.” But I thought of it being like a clinical assessment, so I had to figure out quickly, how do you assess retention? How do you assess academic contribution?  Eventually, I did find a few counseling centers that assessed these impacts and their work reinforced the approach I had planned to take, so I started collecting the data. It turns out that, as you would think, when you meet peoples’ mental health needs, they’re better able to focus on their studies. It had a fairly large impact. It surprised the AVP that retention was higher than the university’s normal retention rate – and after 28 years we’re still collecting this data.  I’ll be honest, it has served us well over the years, because not every upper administrator says, “Oh, you’re helping students, I’ll give you more funding.”  Most say, “Show me the data.” And when you have the data that show that you are helping students and advancing the university mission, it makes it a lot easier to advocate for resources.

Gerri:  Did you develop your own instruments? How did you go about assessment?

Jamie:  I developed survey questions that I thought were good at showing the impact and value of what we do. We focused on the clients who came into the counseling center. One of the interesting ironies of life is that the AVP eventually became a big advocate and was one of my mentors. Another irony is that I have held that AVP role for the last twenty years.

Gerri:  At this time, were you hired as a staff psychologist or a director?

Jamie:  No. I was originally a staff psychologist and then became the clinical coordinator within six months. Within two years, I was hired as a director.  UNLV had to do a national search, and I was still very young, compared to the average counseling center director. I loved helping the students and that still is my passion. Our area has grown a lot and now after all those years, our integrated health and counseling center includes health, counseling, health promotion, disability resource center, the care center for sexual assault survivors, military intervention services center, and student conduct, which are all focused on student wellbeing.

Gerri:  How does student conduct fit?

Jamie:  It didn’t really fit in the wellness unit at first, but it does now. It needed to originally happen for management reasons, but it turns out that it actually is a great match, as we all are contributing to campus wellbeing. Conduct issues are often the early warning systems for students who need help, when they just begin acting out, so it turned out to be a great way to loop them into counseling. We have students come to the counseling center for a consultation for mandatory assessment in relation to specific conduct issues, but not mandatory treatment.  They come in and have a conversation. They are not required to continue counseling. Many students will take advantage of the situation. They’ll be very open and I think they learn a lot as well. But it’s not going to help some students if they’re not ready to change. Staff don’t always like that the consultations are mandated but I tell them it’s an opportunity – I think that’s my community health and mental health experience.  In the community, we saw court ordered individuals and I know there was value in it, so I carried that idea over to college health.

Gerri:  I know you have been a leader in collaboration and integrated health centers – tell me about that.

Jamie:  Yes. I was in the counseling center and I collaborated often with the health center director. We first worked together on getting a psychiatrist on campus two hours a week. The psychiatrist started under counseling and we co-funded it – it was very shared, so we started with two hours, and four hours, and then six, doing med evals and treatment meetings. We began to have meetings just with those clinicians from Health and Counseling who were involved in the treatment. But our model now is that we have two full-time psychiatrists and four residents from the med school.  We have a standing case conference every week. All of the providers in our Student Wellness Center (Health and Counseling) are there if they’re involved in care. Everyone really enjoys it because they just learn so much. We started our behavioral health team about five years ago. At the same time, we placed a psychologist in primary care – now we have two psychologists embedded there. We’re all together – only a floor apart in the same building. It makes a difference for the primary care providers to have someone who’s there, who you can meet, do a consultation, or a warm handoff. When they have free time, they do outreach and presentations and contribute to groups. We have care teams where members of both areas can be part of – like the eating disorder care team, or the transgender care team. We also have the UNLV Support Team, a behavioral intervention team (BIT) which I and a colleague started 16 years ago.

Gerri:  How many people do you have on that team?

Jamie:  The core members of our support team are myself, the counseling center director, the health center director, student conduct, housing, campus police, and a representative from the care center (interpersonal violence and sexual assault).  We have others who we invite as necessary. Athletics would come if we have a student athlete we’re talking about…military & veteran services come if we have a vet, and so on. We are able to openly collaborate across campus as this team falls outside of our HIPAA healthcare entity. We work together to identify needs and to develop interventions. One of the nice things is that I’m a psychologist, but no longer provide direct clinical services in the counseling center.  Much of the time, the counseling center director can’t say much because of privacy limitations.  Because I personally don’t know whether a student referred to the support team is a client or not, I’m more free to engage the team, ask questions, make an assessment, and guide interventions.  It will not surprise anyone that many students referred or who self-refer to the support team have some degree of suicidal ideation.  Mental health has always been a common referral reason, but now it’s also food, housing, and financial insecurity. We have set up a food pantry on campus for students who need food and community resources. In the past, we would have four or five such referrals a year and right now, we have had 87 referrals for food insecurity.

Gerri:  Do you provide primarily in-person services?

Jamie:  Well, the big game changer since 2020 and COVID-19 is telehealth.  Students like hopping on a virtual visit to see one of our health or mental health providers. There is an interesting dichotomy right now as at the health center, they see 80% in-person, 20% telehealth while at the counseling center, it’s 70% telehealth and 30% in-person. The trend is moving towards in-person, but the students receiving mental health still seem to prefer telehealth. We schedule telehealth or telemental health based on student need. The average mental health provider here has two days of telehealth that they can do in the office or at home – as long as they can prove to us they have a space conducive to doing it at home where they can ensure privacy. We’re finding that people looking for jobs want to work at least partially remotely from home.

Gerri:  What about in the health area?

Jamie:  We have some providers that don’t really enjoy doing telemedicine, so they don’t have to. If there is a need, providers in the health center can sign up for a half day of telehealth either at the office or from home. We are transitioning in the health area towards having providers come in, as much of the demand in primary care is for in-person visits.  If a student comes in and absolutely needs to be seen, or triage is overwhelmed for the day, we can have those in telehealth see them if they are on site and if their slots are not full. So having them on site gives us more flexibility.

Gerri:  So let’s talk more about integration.

Jamie:  Sure. I have always been collaborative by nature. I think I always realized the continuum for people that you can’t separate health from mental health. We integrated in 2001, the year I was made an AVP. Having an integrated center and providing coordinated care is my passion – it’s what I like doing. And when you’re doing what you enjoy, stick with where your passion comes from.  That’s one of my retention secrets, I will make an intentional effort for staff to do what they are interested in and support their passion to the extent possible. When it aligns with our goals, it’s easy. Even when it doesn’t, I try and build in time for it.  Sometimes it turns into an awesome collaboration with other areas on campus and now people in other areas get to know our team.

Gerri:  So, back in 2001, how did you get these people to work together? Because first of all the cultures are different. We know that.

Jamie:  I held a series of two-hour-long full staff meetings every week over the summer. There were probably 26 of us initially at those meetings – now we are 130 strong.  We would get in a room and just really talk through all the issues – the advantages, the benefits, the pros and cons of working together. It always had to be student-centered. We would talk about how we feel. We all agreed that students are multidimensional and that you have to look at their emotional health and their physical health as well as their spiritual and intellectual health. We like the wellness wheel and have used that forever. But part of it is even where there is agreement, it means that you have to work differently. Mental health professionals are trained very individualistically as compared to medical people. Medical people are trained to work in teams, it’s just natural to them. And I do think training for mental health providers is changing now which is a good thing. It needs to change. In our meetings, we just started talking about our different cultures: “What was the culture of the health center like?” “What was the culture of the counseling center like?” We also talked about differences in language where mental health clinicians used the word “client” and health clinicians used the word “patient.” We talked about the values that each area held, the conceptual models, hierarchy, and practices. And we discussed our preconceptions.

Gerri:  Can you give me some examples?

Jamie:  One example is that mental health providers often mention privacy. It’s an absolute duty that we are taught from day one to protect. But that does not mean that primary care providers don’t value the privacy of their patients. The primary care providers consult when it’s benefitial to the patient and in the patient’s interest. We then addressed those misperceptions and stereotypes. There was a lot of discussion about fears of the medical model – many misconceptions. We all worked with each other and knew each other well, but we took the time to talk seriously and deeply about this. And in the end, we decided that forming a new culture was what we needed to do. There was nothing wrong with either culture, but we needed to create a new culture to establish our integrated center upon. We defined what our culture would be like, and how we would work together and respect others. It worked out well. I’m not going to say there weren’t issues that needed to be resolved over the years, but now it’s been 20 years into it and rarely does anything ever come up along these lines. Everyone keeps pushing, and intensifying, for more and more integration. You know, to me, one of the ironies is some of the psychologists who said, “I will never do this kind of work. I can’t do it. It’s unethical,” are now saying, “I love this” or “I don’t ever want work in a place where we can’t be collaborative and work with our colleagues.” And the successes rack up. You see the value, you realize how we’re helping students, and it amplifies the concept. It makes sense. I’m always saying the more points of intervention in a student’s life, the more of those dimensions on the wellness wheel you’re hitting, the more likely you have the leverage to promote change.

Gerri:  This is not an easy road.

Jamie:  Yeah. I think you have to really engage the staff mindsets and have important conversations. I will acknowledge that it was helpful that I’m a psychologist and I was a counseling center director when we were doing this. Sometimes it feels external when someone else is leading the charge, so it was kind of built in, “Oh, it must be okay if he’s a psychologist. I don’t think he would really do anything unethical.” But I think you really have to gauge the expectations, since a lot of times there is just a lack knowledge, a lack of awareness and not understanding how important collaboration really is. And even if you’re not administratively linked, there are important ways that you can collaborate.  I will say to staff, “Do you think it is inappropriate to outreach together?” “Well, no, it’s actually a good thing when we do outreach together.” Then, “How do you feel about screening? Do you think it’d be great if we screened for depression and anxiety for people who go to the health center?” “Oh, yeah, that’d be good.” “What if we shared resources like having one reception desk so you’re not paying for a front desk team.” “Oh, that’s good.” And everyone’s all about sharing psychiatry! We all need access to all those things. And then you ask, “How about a case manager? Could we share that? We both can benefit.” You start going through all those lists, and you’re like, “See? That’s integrative care. That’s what you’re fighting against.” But I think people often think it’s all or nothing. And it’s not, you know. We clearly spell out what’s shared. We use an informed consent. It’s perfectly legal. We describe it in large detail about what students can expect, and what our collaboration means. And we’re very clear about what we share. For example, we share with primary care that a student is in counseling. We share if they have suicidal ideation. Because we think that’s really important. We share if they’re seeing psychiatry at our school, and if a primary care provider wants more information, they need to get a release, which is very easy to do, because we share the same electronic health record system.  Students can have as much privacy as they want. And then we have the shared groups that are part of the behavioral health team, which is part of why we did it, so everything is open.

There’s nothing held back. Students, by and large, do not have concerns about this. In the more than 20 years of doing it, I can still count on one hand the number of students that have been concerned and asked not to share information with health.  There is a misconception that a primary care provider is going to want to read the whole file. In truth, they have 15 minutes, and so much to do. They just want the facts, right? “What do I need to know that could be impacting the condition I’m seeing?” And that’s it.

Gerri:  How did you get buy-in for a shared electronic health record system?

Jamie:  I believe if you’re going to be integrated, you have to have a shared record. It’s almost required in my mind. How can you collaborate if you don’t have the shared way of sharing patient information with appropriate safeguards and a release of information has been signed? So again, I always focus on the benefits for our clients/patients. I realize learning a new system is not easy for providers – I would never make a change in health records during the year. We did it during the summer. And I tell the staff, “We’re going to hire lots of people to come in and help and train you.” You need to understand that it’s a stressor on staff when you change. You need to share information to do collaborative care. And then you just figure out what’s the most efficient way to do that. And then you just pick the product that works best.  All the mental health providers, psychologists and psychiatrists can see anything in the health record. If someone’s a part of a treatment team, there’s a permission that all members of the treatment team can see everything. It’s the only way you can do care. But again, it’s all patient/client permission-based. So anyone seeing psychiatry or behavioral health services, it’s all open by agreement. All providers can see everything. It works well for us. And if a student doesn’t like that, they can choose not to have information shared. Students are always willing to sign the releases.

Gerri:  So going back to 2001, were there any people that were very  against it?

Jamie:  Yes, and we had a few counseling staff who left. There was no ill will. I said that we’re moving in this direction. I made it so they could leave and save face. The last thing I wanted is people who were going to fight it tooth and nail hanging around, to be completely honest. Those who left could leave and feel good about it. And we all totally respected it. Very few people left. Those who were on the fence are all doing it now and people come here to work because they want to work in an integrated system. You know, that’s the irony, “I want to come, because I want to work in the integrated model.”

Gerri:  Any final thoughts?

Jamie:  I want to add this, Gerri, because we all are very concerned about burnout, right? Especially healthcare providers. Burnout with COVID hit everyone hard, but I think what we don’t realize is that part of it is that when you are collaboratively working as a team, you’re sharing the load. And I really think it makes a difference.  I haven’t looked for research on this or seen it, it’s just more my experience and the experience of our staff, that it really helps, because we’re not carrying that burden alone, we’re doing it with a team. And I think that offers tremendous benefits.  We’ve also noticed a general trend that high utilizers of healthcare, when their mental health needs are managed, their utilization of primary care tends to decrease.

Many counseling centers have session limits. We have a limit of 10 sessions per year right now, but we’re really quite flexible on it and if a provider says, “I would like additional sessions to see the student, here’s where I think they’ll benefit,” we know there are some students who just really need the care and it’s essential. For instance, if they had a sexual assault experience, that’s not necessarily going to resolve really quickly, or if some people have serious mental health concerns, but they’re doing well in their classes, and we just need to see them. “Well, can we see them monthly?” “Would that work?” Or “Can we spread out the sessions?” We try and think, “Is there an alternative way to get there?”  If students don’t want to be in groups, we don’t want them there either, because it’s usually not a great experience for the others. We also have a lot of online resources with information and techniques to help students, including videos on how to do relaxation.

Gerri:  What are the top mental health issues that you have seen in 2022?

Jamie:  In 2022, the big ones we’re seeing are anxiety, depression, relationships, in addition to food, housing, and financial insecurity. The pandemic was the perfect storm developmentally. When you think about students, there were impacts on forming relationships with social distancing and remote learning. Your sense of self, anxiety and uncertainty about where things are going. Graduation’s canceled or held virtually. You’re working towards independence but living at home with your parents and it’s hard to find a job, because people aren’t hiring now. And so, careers are put on hold. We see a lot of students who are suffering from these developmental impacts. And there’s a real sense of grief.  “I didn’t get to do this and felt robbed, because my senior year in high school was supposed to be wonderful, and it wasn’t.” So we’re supporting a lot of those students that have that sense of grief.

Gerri:  Have you done any specific things to help staff that are approaching burnout?

Jamie:  We’re trying to pay attention. We’re trying to make it okay, and encourage them to say, “I need a day off.” Encouraging them to take time, to get away.  Or it’s like, “Hey, I have something I bet you’ll enjoy.” This applies also to doing things on campus. “You know, student affairs need someone to do this.” Give them a breather. And we’re trying to recognize their contributions. We often forget about front desk staff, but they set the tone and play a big role. We want them to feel valued and know the role they’re playing in making us all look good.

Gerri:  I heard that you and your university are looked at as a role model. Do you have any groups of college health directors that get together?

Jamie:  What I love about college health is we’re all willing to share. I love that we all learn with and from each other. This past year, our former chancellor started a mental health taskforce for the state institutions of higher ed and now I’m co-chairing it with the counseling director from UNR (University of Nevada, Reno). We’re trying to work to set a minimum standards level, share knowledge, and share expertise. There are schools that don’t have counseling centers. Counseling at some of the schools is 10% of someone’s job. We have six institutions meeting.

One other trend we are seeing is the need to address the wellbeing and mental health of faculty and staff. Many of our college mental health providers only serve students. In our health center, we have a faculty and staff clinic where we have provided healthcare to employees for 10 years now. We have a separate reception area for them and it works really well. During the pandemic, we opened our online resources to faculty and staff as well and 1,600 faculty and staff started using it. Actually, we had more faculty and staff using it than students, which is kind of ironic. And now we have a new taskforce on campus that’s just focused on faculty and staff.  This was started by our provost and I am co-chairing it with the vice president for human resources as we try to figure out what we can do for faculty and staff wellbeing. We are looking at our policies and how they impact students and we are advocating for mental health days for students when needed. Maybe we should do that for faculty and staff, too.

I went camping this past weekend. It wasn’t a convenient time, but staff were encouraging me, and I said, “Okay.” I do feel sharper when I come back, so…I have to be a role model.  It felt good to get outside. That’s always been my go-to way of de-stressing and being with family – we like to go camping whenever we can. It felt good, because honestly, I haven’t taken time off in a year and a half.  We went to Joshua Tree National Park in California. It’s very beautiful out there.  I love tents. I love cooking outside. That’s exactly how I like to do it. I also try to exercise in our rec center where our wellness center is located.

Gerri:  Is there any advice you would give to administrators who are trying to implement collaborative practice at their institution?

Jamie:  They should look at the ACHA (American College Health Association) white paper which I helped write in 2010: Considerations for Integration of Counseling and Health Services on College and University Campuses https://www.acha.org/documents/resources/guidelines/ACHA_Considerations_for_Integration_of_Counseling_White_Paper_Mar2010.pdf.

Micky Sharma from Ohio State and I then presented sessions on this white paper at the ACHA and AUCCCD (Association of College Counseling Center Directors) annual meetings and more directors became interested in collaboration. There are reports of improvements after integration – staff communication went up.  There were improvements in comprehensiveness, utilization, quality of services, and in client satisfaction. “Start these steps. Do them. Build on it. Maybe down the road you’ll decide to take it to the next step.” Focus on what is best for your students. When you have someone who’s interested and a competent leader, anyone can really do it. You just need to take the time to hear, listen, meet the needs, reassure, re-examine, adjust practices as you go.

Gerri:  Jamie, thank you so much for taking the time with me today.  Your passion for the health and wellbeing of your students is definitely contagious – you have indeed found your niche in college health! You have brought your caring nature and spirituality into your development of a collaborative integrative team and your game plan for creating it will help countless numbers of our college administrators and health and counseling directors. UNLV is very fortunate to have you in this role!