Note: This is the final installment of a two part series on Cook Counseling Center's attempt to earn peer accreditation for the first time in more than a decade.
As Cook Counseling Center seeks accreditation from the International Association of Counseling Services, the effects of the April 16, 2007 campus shootings have altered nearly all of the center’s operations.
Yet despite concerns that have been brought up by lawsuits and investigative reports, it may turn out that changes made to the center in the shootings’ aftermath have improved the center’s chances at accreditation.
Accreditation was a goal of Cook Counseling Center before the shootings, director Chris Flynn said.
“Literally we were looking at it a week before the shootings,” said Flynn. “That process began before the shootings occurred.”
Related: Cook Counseling Center's accreditation application
The center had been preparing to send an application to the International Association of Counseling Services in the spring of 2007, but when the shootings occurred on April 16, the process was delayed.
“In an event like 4/16, which was traumatic for so many people across campus, business as usual was secondary, and what we were trying to do was make sure the students who are distressed can get the help they need,” said Rick Ferraro, associate vice president of Student Affairs and head of Schiffert Health Center.
The center finally submitted the application on December 4, 2008.
If the center passes, it would achieve accreditation for the first time since the mid-1990s.
IACS is a nonprofit group that reviews university counseling centers worldwide. The Board of Accreditation is made up of directors from IACS-accredited counseling centers, meaning that the review is a professional peer-review, as opposed to a state or federally based inspection.
“I wanted us to be accredited not because we knew that there was something flawed, but because we wanted Cook Counseling Center to represent the best of the profession,” Flynn said.
The evaluation that IACS performs does not look as intricately into the center’s past, but will focus its scrutiny on Cook’s present state.
“We’re looking at the center as it looks now — that is what is relevant, not what it looked like five years ago or even two years ago,” said Nancy Roncketti, executive director of IACS.
The positive recognition that could come from being accredited is especially important for Cook, which has been subject to intensive outside review in the months and years following the April 16 shootings. Shooter Seung-Hui Cho was a patient at Cook Counseling Center in December 2005, and was once ordered into a mental health hospital by a judge.
After thorough investigations, the Governor’s Panel Report on the shootings concluded, “The Cook Counseling Center and the university’s Care Team failed to provide needed support and services to Cho during a period of late 2005 and early 2006. The system failed for lack of resources, incorrect interpretation of privacy laws, and passivity.”
In addition, families of two of Cho’s victims, Julia Pryde and Erin Peterson, filed matching lawsuits for negligence against Cook officials and other Virginia Tech officials. While the lawsuits are ongoing, plaintiffs have dropped charges against several Cook officials, including director Chris Flynn. Currently, only former director Robert Miller is named in the suit.
Cho’s records from the center were found in Miller’s house in July 2009. In the aftermath of the shootings, investigators were told the files had been lost.
In legal statements, Miller said he accidentally removed the files when cleaning out his office at Cook Counseling Center in early 2006. Flynn became director in 2006 after Miller was reassigned.
Cho’s records were among three files found in Miller’s possession, according to Flynn.
“Of the three files, one of them had to be Mr. Cho’s,” said Flynn. “Nobody would have noticed if they had not been Cho’s.”
The Virginia state law regulates the confidentiality of medical files. However, after investigation by the Virginia Tech Police, Montgomery County commonwealth attorney Brad Finch concluded that “Miller does not appear to have acted with criminal intent in removing the files.”
“Clearly we did not want the records to be missing, and I think we did the right thing,” Flynn said.
“To my knowledge there is no wrongdoing by any of the counselors at Cook. All we can do is be honest with them, and as far as I’m
concerned we have nothing to hide.”
Roncketti and other members of IACS were unable to comment on whether this discovery would affect the center’s chances of becoming accredited.
The IACS standards state that “records must be secure and kept in a central area,” and that “all case records are the property of the counseling service.”
Because the application was submitted in December 2008 but the files were not found until July 2009, the matter is not mentioned in the application.
“I talked to the president about the suits and will continue to update her,” Flynn said.
Nonetheless, because that incident itself occurred so long before December 2008, it will likely not be a significant factor affecting the IACS review.
“It is a historical matter that does not pertain to the review that would be done here,” Ferraro said, noting while the mistake was important, it was not relevant to the accreditation process. “If somebody was not working for you, and it happened years ago, what would be your assumption?”
Another suit also is pending against the center. The parents of Daniel Kim, a Tech student who committed suicide on December 9, 2007, filed a suit alleging negligence against the center. They claim that the university did not respond appropriately to a warning sent by Kim’s friend that Kim may be suicidal. Proceedings have still not yet begun in that case.
Flynn said the intense scrutiny directed at Cook in the past few years may have strengthened Cook Counseling Center.
“I suspect that no counseling center has been looked at more intently, and I would hope that students would not feel that it needed it, but be reassured that it meets the standards of the profession,” Flynn said.
In the hectic years since the original application was prepared in early 2007, the inquiries that were made into the events of April 16 led the center to make several major changes to its operations.
“Our counseling center has been through significant challenges since 2007,” Flynn said. “We updated to make sure that our policies were in congruence with IACS standards.”
Prior to 2007, the center had a policy of refusing to accept court-ordered involuntary referrals. “All clients who are served at the Center must be willing to receive services and must come voluntarily,” the old policy stated.
The center now accepts referrals.
According to the 2009 National Survey of Counseling Directors, only nine percent of counseling centers across the country refused to accept mandatory commitment orders, as Tech did before 2007. The majority accepts mandatory cases only for an initial assessment but not for long term counseling.
“Counseling is not discipline, and we don’t want to be confused with that,” Flynn said.
Virginia state law can require that a person receive outpatient treatment from a counseling service, but prior to 2007 there was no system in place to determine which area service would provide that treatment. It was also unclear about who had the responsibility for confirming that the patient continued attending counseling.
This was an especially unclear distinction on college campuses. There was no policy dictating whether following up with Cho was the responsibility of Cook or the New River Valley Community Services Board after he was hospitalized at St. Albans.
The findings of the Inspector General’s report state that prior to 2007, “It was the policy of the Cook Counseling Center to allow patients to decide whether to make a follow up appointment. According to the existing Cook Counseling Center records, one was not ever scheduled by Cho. Because Cook Counseling Center had accepted Cho as a voluntary patient, no notice was given to the CSB, the court, St. Albans, or Virginia Tech officials that Cho never returned to Cook Counseling Center.”
“The law was very unclear about who had the responsibility for those patients,” Flynn said.
Cho was one of the patients who fell through the cracks in the legal system.
The Inspector General’s report therefore recommended that “university counseling centers develop a written policy regarding whether or not the center will accept referrals for court ordered involuntary treatment.”
In November 2009, a follow-up report was issued which confirmed that the center had indeed tried to implement these changes.
Cook had developed and signed a “memorandum of understanding” with the local New River Valley Community Services Board that outlined how the two mental health facilities would coordinate and implement referrals for involuntary treatment made by the courts.
The 2009 report stated that this change “indicates an openness on the part of the Cook Counseling Center to accept involuntary referrals.”
In spite of the legal changes, Flynn said that the center has not actually dealt with any mandatory outpatient commitment orders since 2007.
The community services board is also responsible for confirming that the person receives counseling, and for notifying the courts if he or she does not comply. Officials of the Community Services Board were also named as defendants in the April 16 lawsuits, but were dropped from the suits in preliminary proceedings.
“We are not the ones responsible if the student refuses to come in,” Flynn said. “Now it is clear that the community services board has that responsibility.”
IACS does not wish for counseling centers to be involved in administrative decisions, but recognizes that in some cases mandatory commitment may be the best solution, according to Flynn.
Another important change at the center was the addition of six counselors to the staff. In 2007, only 10 counselors were employed at the center, meaning each counselor was responsible for almost 3,000 total university students.
There are now 16 counselors, with a counselor to student ratio of roughly 1:1,800 students, according to Flynn.
“So far, the administration has been very sensitive to the issue of mental health counseling and so the cuts have had no affect on our budget,” Flynn said, noting that the center, which has also seen a 60 percent increase in caseloads since 2007, can always use more counselors.
“We don’t anticipate losing any positions; in fact, we’ve asked to add another position this year,” Flynn said.
Flynn also said he and provost Mark McNamee have discussed adding one new position per year for the next four years.
The staff additions will help the center to more closely approach IACS’s recommended ratio of one counselor to every 1,000-1,500 students.
The center has also expanded to open a satellite clinic, originally located on 400 Turner Street until it was moved to East Eggleston Hall in November 2009.
The information on the application includes thorough descriptions of the center’s roles, its policies, its ethical standards and its staff. According to Roncketti, the entire process can take more than a year.