Task Force on Health and Well Being: Interim Report

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Task Force on Health and Well Being: Interim Report

January 2004

In September 2003, President Tilghman appointed a Task Force on Health and Well Being and asked it to recommend answers to the following three questions:

1. How should Princeton meet the needs of its students for medical and mental health care, and to what extent should it also meet health care needs of its faculty and staff?

1. What programs, services and facilities should the University provide to promote the health and well being of its students, faculty, and staff, including programs of preventive health, health maintenance, nutrition, recreation, stress management, etc.?

1. How can the University improve the balance between family and work, for example, by offering additional day care and other family support services to members of the University community?

The task force was asked to answer each question in the context of a comprehensive plan for enhancing the health and well being of all who study and work at the University. It was asked to focus on needs currently not being met or likely to emerge in the years ahead.

The members of the task force, whose names are listed at the end of this interim report, include three faculty members, four undergraduates, two graduate students, six administrators, and two co-chairs: Janet Dickerson, vice president for campus life, and Robert Durkee, vice president and secretary of the University. The task force is very ably supported by the staff members whose names are also listed below.

The task force was asked to complete its report by the spring of 2004 if possible, but to be prepared to carry over into the fall of 2004 if necessary. This interim report describes the task force’s progress over its first four months of work. It summarizes what the task force has learned so far and some of the topics it has begun to consider. It identifies areas in which it believes the University is doing well, as well as areas where it believes significant improvement is needed. The report is organized into the following sections:

1. Overview
2. Suggested Guiding Principles
3. Initial Findings and Recommendations
4. Major Needs and Challenges
5. Work Plan for the Spring

Overview

This has been an especially hard-working task force. It met for the first time on September 22, with President Tilghman in attendance, and then held subsequent meetings on October 13, November 3, December 15, and January 12.

At its second meeting, the task force organized itself into three working groups: one on student-related issues (undergraduate and graduate), chaired by Molecular Biology Professor Liz Gavis; one on faculty and staff-related issues, chaired by Vice Provost Joann Mitchell; and one on work-life issues, including child care, chaired by Psychology Professor Eldar Shafir. Each member of the task force served on at least one working group, but many either served on more than one or attended meetings of groups in addition to the one to which they were officially assigned. During the course of the fall, the student group met 4 times; the faculty-staff group met 7 times; and the work-life group met 4 times. The group providing staff support to the task force met 8 times.

From its earliest days, the task force sought suggestions from members of the University community. It received comments following the announcement of its formation (on the University homepage and in the Princeton Weekly Bulletin), and through the “ideas and suggestions” feature on the task force’s website ( One or both of the co-chairs made presentations to the President’s Cabinet, the Trustee Committee on Student Life, Health, and Athletics, the Council of the Princeton University Community (CPUC), the Undergraduate Student Government (USG), and other groups, and other members of the task force also met with interested members of the community. Brief e-mail surveys were sent to all graduate students and all post-doctoral fellows and one of the undergraduate students on the task force asked participants at the November 4 FluFest (sponsored by University Health Services) for their ideas and suggestions.

As background for its work, the task force reviewed extensive information about University Health Services, the Student Health Plan, the University’s faculty-staff benefits program, Dining Services, Dillon Gym, and the Stephens Fitness Center. It reviewed data collected by Health Services and the Student Health Advisory Board. Some members of the task force discussed plans for focus groups and surveys with representatives from the Princeton Survey Research Center. Some visited the Princeton Fitness and Wellness Center (an affiliate of the University Medical Center at Princeton) and Momentum Fitness Center, both of which are located off of Route 206 just north of Princeton. Some met with the directors of the U-Now and University League nursery schools.

The initial goals of the task force were to: (1) develop a set of principles or values that might guide the University in its consideration of issues related to health and well being; (2) learn as much as possible about programs currently being offered or planned, and about the extent to which these programs appear to be meeting—or not meeting—the needs of students, faculty, and staff; (3) begin to develop initial findings and recommendations; and (4) identify major needs and challenges that will require further investigation and deliberation this spring.

Suggested Guiding Principles

The task force believes that as an educational institution and a residential community, Princeton University should seek to provide a campus environment and a range of programs that sustain and enhance the physical, psychological, and emotional health of undergraduate and graduate students, post-doctoral fellows, faculty, and staff, and that assist them in achieving an appropriate balance between work and personal/family life.

Among other things, this requires:

• An affirmative effort by the University to create a campus environment that is safe, secure, supportive of those in need, and as free as possible of preventable health risks (as achieved through health education programs, disease detection and prevention and management of chronic illnesses, environmental safety programs, and other measures).

• A commitment by members of the campus community to conduct themselves in ways that sustain their health and well being as well as the health and well being of others. As a community we depend on faculty and staff with supervisory responsibilities to look out for the health and well being of those they supervise, and on more senior students to serve as appropriate role models and help provide a healthy campus climate for students who are newer members of our community.

• Providing undergraduate and graduate students and post-doctoral fellows with readily available information about medical, wellness, and fitness issues or other matters related to their health and well being; providing faculty and staff with readily available information about the University’s benefits programs and other services related to health, fitness, and well being; and providing all members of the community with information about ways to improve individual and community health and well being, including information about health maintenance, disease prevention and management, early detection of chronic illness, and the benefits of regular exercise, good nutrition, and personal renewal.

• Integrative strategies of preventive health care and wellness that encourage healthy living. The task force believes that such strategies will have a long-term positive impact on the ability of students to learn and to participate fully in campus life, of faculty to teach and conduct research, and of members of the staff to support the educational mission of the University and achieve fulfillment in their work.

• For students, the University should encourage healthy patterns of living (which includes appropriate housing and healthy dining options); provide informed access to affordable, timely, and quality care for physical, psychological, and emotional health (including care for students who are on campus outside of the academic year and for dependents); and provide high quality health education programs, reliable evidence-based information, and assistance about medical, lifestyle, and health and fitness issues.

• For faculty and staff, the University should provide adequate wages and a competitive benefits program that includes access to medical (including mental health) care and programs that support healthy lifestyles, improve fitness and well being, and provide needed family/life services. Providing access to appropriate services and programs requires the ready availability of information about such services and programs and constant attention to the different circumstances and life stages of different members of the University community and to such considerations as affordability, work schedules, and ease of access. Special attention should be paid to those whose household incomes place them at risk of significant financial hardship.

• The University should assist students, post-doctoral fellows, faculty, and staff to obtain high quality and affordable child care through a combination of University-provided and/or contracted day care, referral to outside day care providers, identification of emergency care options, and other services, and should adopt policies that assist mothers and fathers to meet their child care responsibilities as well as their workplace commitments. The University also would be well served by providing assistance to members of the campus community in identifying and arranging high quality elder care and other family care services.

• In matters related to scheduling (in the workplace and for the educational program), the University should assist members of the community to achieve an appropriate balance between work and personal/family life.

Initial Findings and Recommendations

One message that has come through loud and clear in the early work of the task force is the degree to which members of the community are unaware of many of the programs and services already available to them in the areas of health, fitness, and well being. At the same time, significant deficiencies and ample room for improvement have also been identified. In this section of our interim report we will share some of what we have learned, while also outlining some initial findings and recommendations. In areas where Princeton already offers strong programs, we aim to suggest ways in which it can build on those strengths. In areas where Princeton lags behind other universities or employers[1] or is falling short of the guiding principles we have proposed, we aim to identify a range of options and priorities, recognizing that choices will have to be made and tradeoffs assessed. In most cases we need to do additional work before we can make final recommendations; we propose a tentative plan for pursuing this additional work in the final section of this report.

This section is divided into the following subcategories: University Health Services; the Student Health Plan; the Employee Benefits Program; undergraduates; graduate students; post-doctoral fellows; faculty and staff; retirees; work-life issues; and child care.

University Health Services

University Health Services (UHS) is a fully accredited health care facility that provides a broad range of health services to Princeton undergraduates and graduate students and their dependents age 12 and over (and to Princeton Theological Seminary students and their dependents). In a given year, it will serve 80% of all undergraduates and graduate students. UHS also provides some health care services for Princeton employees (faculty and staff).

The total staffing of UHS in 2003-04 is 62.92 full time equivalents (FTEs). This includes physicians (not all full time), nurse practitioners, physician’s assistants, registered nurses, psychologists, psychiatrists, social workers, athletic trainers, physical therapists, and technical and administrative personnel (including one excellent but less-than-full-time health educator). UHS’s primary location is McCosh Health Center, constructed as an infirmary in 1925. Physical therapy is provided at Dillon Gym for non-varsity athletes, while athletic medicine, athletic training, and physical therapy for athletes are provided at Caldwell Field House.

During the academic year, UHS is open 24 hours a day, 7 days a week for urgent care and for inpatient services. (McCosh has 17 inpatient beds and a “parent’s suite “ for parents who wish to stay overnight while their son or daughter is an inpatient or hospitalized locally.) All offices are open daily Monday through Friday from 8:45 a.m. to 4:45 p.m., except Tuesday when they open at 10:15 a.m. During summer and winter break, outpatient services are available during regular business hours but there is no inpatient care or after hours emergency care. Students who need care after hours or on weekends are referred to the local hospital, where they and their insurance coverage are responsible for all costs. This practice can result in significant charges, especially for graduate students who are on campus during the summer.

Undergraduates and graduate students receive a variety of services for no direct cost, including medical office visits (primary care and urgent care), mental health services (including individual or group psychological counseling[2], crisis intervention, evaluation for psychotropic medication, eating disorders evaluation and treatment, alcohol and other drug evaluation and treatment, and sexual harassment/assault advising), travel planning, immunization and allergy shots, inpatient stays, sexual education, counseling, and health services (SECH), x-rays, and some lab tests. Students are charged fees for some specialized services, including some laboratory tests, contraceptives, vaccines, orthopedic supplies, etc.

UHS provides referrals for off-campus care when necessary and assists students with health care needs that are not provided by UHS or covered by their insurance. It sponsors a wide range of health promotion and outreach programs, and conducts regular surveys to assess student health and well being at Princeton (see below). UHS has a small employee health staff that provides evaluation, treatment, referral, and review of work-related injuries or illness; conducts medical surveillance programs (e.g., asbestos program, animal workers program, commercial driver’s license physicals and drug testing, etc.); manages temporary disabilities; provides lab, x-ray, and physical therapy services in conjunction with work-related injuries/illness; and provides travel planning and immunizations. UHS also offers health promotion initiatives such as cardiac risk assessments; smoking cessation programs; hypertension, depression, or anxiety screening; mammography; and others, including the increasingly popular annual flu clinic (FluFest) which this year offered health and fitness screenings and fitness demonstrations while providing flu shots to more than 3,500 members of the University community.

As the charts on the next page indicate, the demands on University Health Services have been increasing dramatically in recent years. The total number of patient encounters increased from 47,440 in 2000-01 to 60,988 last year (2002-03). Compared to the prior year, last year saw increases of 13% in sexual health visits; 17% in counseling session visits; 25% in psychiatric visits; and 111% in inpatient stays for depression, anxiety, fatigue, and psychotic episodes. There was also an 8% increase in employee health encounters.

The charts also indicate that so far this year, on a year-to-date basis through October, individual counseling sessions are up another 33%; psychiatric consultations are up 37%; inpatient admissions for psychiatric reasons are up 127%; after hours urgent care is up 46%; and employee health visits are up 41%. In addition, demand for high acuity mental health services has continued to grow, with 15 off-campus psychiatric hospitalizations for serious overdose and suicidality, psychotic episodes, and severe eating disorders.

Despite these dramatic increases in demand, accompanied by only modest increases in staffing (+ 0.33 FTE last year), both student and employee measures of satisfaction with UHS are very positive. The Student Health Advisory Board conducts surveys twice a year using an instrument designed in consultation with the Survey Research Center at Princeton. For a week each fall and spring, all students and staff receive a questionnaire to complete anonymously after their visits. Typically, more than 98% of those surveyed express satisfaction with their visit and a similar percentage say that, based on the quality of the care they received, they would “recommend this service and treatment to a fellow student or co-worker.”

UHS periodically conducts surveys of students to assess their health and well being, and these survey results over recent years provide useful information about the extent to which students engage in excessive and abusive use of alcohol; suffer from depression; are exposed to incidents of attempted suicide; suffer from eating disorders; and feel overwhelmed by stress.