CU Boulder Assistant Professor Tamar Kodish is leveraging modern technology to break down barriers to mental health resources at community colleges

Mental health is a significant topic of concern on many college campuses these days. Recent estimates suggest that approximately one in three students at four-year colleges and universities experience mental health issues such as anxiety and depression.   

At community colleges, however, that number could be as high as one in two students. 

“Community college students tend to face a lot more contextual stressors,” says Tamar Kodish, assistant professor in the University of Colorado Boulder Department of Psychology and Neuroscience. “There are much higher rates of food insecurity and houselessness. And they are significantly more likely to come from lower socioeconomic backgrounds, or to be racial and ethnic minorities.” 

Psychology and neuroscience Assistant Professor Tamar Kodish used a human-centered approach to design a text messaging strategy to encourage students to use free mental health resources. (Photo courtesy Tamar Kodish)

Through prior research, Kodish became interested in exploring different strategies to encourage community college students to access available mental health resources on campus. She began asking, “What can we do to try to improve engagement in mental health services for people who might be at risk of not getting care that they need?” 

That question led to a research study, recently published in the journal JMIR Formative Research, examining how the right text messages, sent to students at the right time, could be key to ensuring valuable mental health resources reach the students who may need it most.     

Taking a STAND for mental health 

Kodish, who received her PhD in clinical psychology from UCLA, received funding for the pilot project through UCLA’s STAND ALACRITY Center, a research center under the UCLA Depression Grand Challenge (DGC). The Center’s aim is to improve the mental health care available to community college students through a new model called STAND. Center researchers are studying how to improve/optimize STAND through a research program at East Los Angeles College. 

STAND—which is short for Screening and Treatment for Anxiety and Depression—is an adaptable, scalable system of care that includes screening, treatment and ongoing monitoring of mood and symptoms of depression and anxiety.

Students who choose to engage with STAND first answer different questions about their mental health through an online assessment; based on their responses, they’re triaged into one of three levels of treatment. 

Students who have mild symptoms of depression and anxiety are given a self-guided, online wellness program, while those with moderate symptoms receive a digital mental health program, including peer-to-peer coaching support from certified STAND coaches. 

Students with severe symptoms are eligible to get clinical therapy—sometimes with psychiatric support—that’s delivered remotely. DGC researchers are testing new approaches to allocating treatment by creating a data-driven algorithm that accounts not only for symptom severity but also for other social and structural factors, like food and housing security.

 

An example of a text message Kodish’s team developed—alongside community college students—to help identify the barriers and stigmas around receiving mental health care. Students would then receive tailored responses based on their selection. (Illustration courtesy of Tamar Kodish)

Research has shown that the STAND approach works. In a 2023 study, more than 500 UCLA students who engaged with one of the three levels of care showed measurable improvement in depression and anxiety scores. 

Encouraging uptake, increasing engagement 

Those 500 students, however, were just a portion of the 3,500-plus students who initially took the online screening. 

“We found that only 14% of students who were eligible for STAND services actually got started with treatment, so we were losing tons of people along the way,” says Kodish. That led her and her colleagues to explore new ways of keeping people from falling off the continuum of care. 

Kodish was also interested in seeing how this engagement might differ at a community college, since the previous study, like many others, was only conducted at a four-year university. "We don't know nearly as much about community college students,” says Kodish. “They're a super underrepresented, and super diverse, group.” 

So Kodish headed to East Los Angeles College (ELAC)—where the STAND at ELAC program had been underway since 2022—armed with a new idea for reaching students where they are. “I got really interested in text messaging as a potential approach based on what I had seen in the literature, and from what I knew from talking to college students.”   

She began by inviting students on campus to focus groups and asked open-ended questions about what they saw as barriers to engaging with the STAND resources. The goal was to find ways to communicate with students who either dropped off in the middle of taking the STAND screening or completed the screening but didn’t engage with the resources that were delivered to them. 

A blueprint for eye-catching texts 

“Overall, students were really enthusiastic about using text messaging,” says Kodish. “They felt like it was feasible, it was easy, it was convenient and it would fit into their lives.” 

After the focus groups, she asked a subset of those students—19 in all—to help design the messages themselves. “They definitely wanted something that was multimedia,” says Kodish. “They said, ‘They can't be too long, they can't be too spammy, and they need to have imagery and videos to draw you in and differentiate them from other random messages.’”

Kodish’s team took their directives, drafted the look and content of the messages and then returned them to the students for further input before incorporating them into the STAND protocol.

While the current study doesn’t explore how to keep students engaged once they’re in treatment, Kodish says she believes this initial “uptake” phase of the process is still vitally important. “If you don't get people's foot in the door, then sustainment doesn't even matter,” she says. 

Personally, Kodish hopes as many students as possible at least take the online screening offered by the program. “They’re getting really valuable information,” says Kodish. “Even if they have mild symptoms or no symptoms, they're getting some information about their mental health status that they might not otherwise have.” 

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