In March 2020, Tufts Health and Wellness sent an email inviting students to participate in Kognito: a 30-40-minute online mental health education program that teaches students, staff and faculty how to engage a student who approaches them with mental health-related distress. In the program, the user interacts with a simulated student, and has the opportunity to observe the impact of different responses on the student’s body language, verbal communication and the overall progress of the conversations.
Nearly a year later, a mental health task force composed of students and members of departments within Health and Wellness — including Counseling and Mental Health Services — is revitalizing the program at Tufts. It comes at a time when increased isolation, loss of employment and loved ones and illness-related anxiety pose major threats to the mental well-being of the Tufts community.
Michelle Bowdler, executive director of Health and Wellness, used a phrase that has become a catch-all term to describe the events of the past twelve months: “How many times can we say this is ‘an unprecedented time?'”
But while Kognito is especially well-suited to the current socially distanced conditions of the world, the implementation of the program at Tufts has been on the docket since early 2020, and is the culmination of a recent movement towards improving mental health services on campus that began almost four years ago.
“It was a combination of [interest] from faculty, staff, and students who over time had said to us that they were interested in developing more skills in terms of if somebody was struggling … [they wanted] to feel like they knew who and how to refer [them to],” Bowdler said. “We had done some work particularly with faculty on how to help a student in distress, but they were still looking for a little bit more practical information on top of what the counseling center already does with training.”
The opportunity to offer this information came in 2017, when a private donor approached Health and Wellness with funds to be allocated toward mental health projects. For the first three years these funds supported mindfulness and meditation programs, aimed at stress and anxiety reduction. In the last year, the donor expressed interest in a project that would destigmatize mental health and make people more comfortable if their peers approached them with concerns.
The mental health task force proposed Kognito to the donor, singling it out as one of few evidence-based mental health training programs that was, at the time, listed on the National Registry of Evidence-Based Programs and Practices — a federal database of mental health and substance abuse treatment programs backed by scientific research. The registry has since been suspended by federal health officials.
In addition to higher education programming, Kognito offers mental health education and training for educators working with preschoolers through twelfth graders, healthcare workers and government or nonprofit organization employees. The program also features specific training modules for mental health-related issues like bullying, management of chronic disease and substance abuse. According to Bowdler, one of the most valuable aspects of the program is its role-play feature.
“I [found that feature] was particularly important for people who may not feel like they’re equipped. Students are going to professors with [mental health] concerns, so to show that [certain] kinds of responses can shut someone down and that some other [responses] might be more helpful — I found that as important as anything else,” Bowdler said.
Kognito is intended to supplement existing mental health education and programming at Tufts, all of which were converted to virtual formats this school year. For students, Counseling and Mental Health Services conducts an orientation program for first-years and facilitates mental health training for resident assistants prior to the start of a school year. For faculty, Counseling and Mental Health Servicesand other Health and Wellness Center professionals administer “gatekeeper training,” a 60-90-minute program that has taken place across departments for several years.
“[Gatekeeper training] is really a term for helping people understand what services are available at [Counseling and Mental Health Services], when something qualifies as a mental health emergency, and how to give an appropriate referral that is most likely to help someone get the help that they need,” Bowdler said. The training is intended to make professors effective liaisons between Counseling and Mental Health Servicesand the student body.
Still, the mental health professionals advocating for Kognito describe it as an addendum, and not a replacement for any existing programming. Newly appointed Mental Health Promotion Specialist Erica Schonman, whose work on campus will include outreach and the creation and implementation of mental health education programs, starting with Kognito, emphasized this point.
“I think this is a tool that they can add into their toolbox to help their peers,” Schonman said. “This alone will not solve all of the mental health problems on campus, but it is one tool that can help.”
Bowdler echoed these sentiments.
“I feel like we do have a campus that cares a lot about the student experience,” Bowdler said. “I have really been heartened by the concern that both faculty and students have come to us with, and parents saying, we would like to know that issues of mental health are being addressed from all angles … So [Kognito] is just an additional tool at a really important time that we hope people will at least take a look at. And if it helps them have some additional tools for themselves and others, great.”
Another one of Kognito’s positive qualities is a facet of its digital nature.
“It’s self-paced, so students who may not have time to do it all at once can start, log out, log back in, et cetera,” Schonman said.
Bowdler added that another perk of the program is that users can return and review the techniques they learned at their convenience.
Perhaps the most interesting element of Kognito is the feedback feature. At the end of a module, Kognito asks for feedback about the relevance and efficacy of certain responses and scenarios, and over time modifies the program to meet the needs and address the concerns of users.
“My understanding is that [Kognito] is a program that has continued to evolve to incorporate that kind of feedback. The program that you see today is not the same program that it was a year ago, or two years ago, or so on,” Schonman said.“So I do highly recommend that folks share their feedback because it’s an evolving program.”
Though many members of the mental health task force that brought Kognito at Tufts into fruition are employees under the Health and Wellness umbrella, the role of students and student groups like Active Minds at Tufts was key in the implementation of Kognito.
“Last year there was a big faculty meeting where Active Minds presented on some recommendations that they were hoping faculty could implement related to mental health,” Bowdler said. “The faculty heard students present some data about what students who have mental health issues worry about [and] what they want professors to know.”
Active Minds’ recommendations were met with overwhelmingly positive reception from faculty members.
“They practically gave them a standing ovation,” Bowdler said. “Some of them raised their hands and said … ‘I think all of us want to feel like we’re well-equipped and want to do right by our students, and so we don’t feel defensive, we actually feel like this is something we care deeply about, we care deeply about our students, and we welcome the training, and we welcome feedback.’ It was a really wonderful meeting.”
The ideas behind Kognito fit perfectly within the goals of Active Minds, a student group dedicated to reducing stigma surrounding mental illness and promoting positive self-care strategies through various educational programs, according to co-President Sarah Beatty. Outside of giving presentations at faculty meetings, Active Minds works to share resources and coordinate mental health education and self-care programming for the student body.
According to Beatty, Active Minds plans to be an advocate for the program this semester.
“We’ve taken it upon ourselves to all go through the program and really understand it so we can figure out ways to promote it, and promote it in an accurate manner,” Beatty said. “[We can identity] some of the gaps we can fill for further education on how to help people and help our friends who might be struggling.”
Though mental health struggles are common on college campuses, it goes without saying that the experiences and mental health concerns of students are unique and differ between individuals. Although Tufts has not purchased all of the training modules, Kognito does offer programs specifically about mental health-related discussions for LGBTQ+ students, which includes educational information about sexual orientation and gender identity. Another module focuses on trauma-informed policing with indigenous youth.
Despite growing scientific literature about the impact of race-related stress or trauma on the mental health of people of color, Kognito does not include a module for race-related psychological distress scenarios.
Schonman said that while Kognito does not explicitly provide guidance for helping students or peers with race-related trauma, many of the skills they learn in the general training can be applied to such situations. “Skills like non-judgmental listening, recognizing signs of distress, and encouraging help-seeking could be useful for students dealing with many kinds of mental health stressors, including race-related psychological distress,” Schonman said.
Schonman emphasized that students, faculty and staff should use their discretion when attempting to help their students in this way. “Even though the skills might be transferable, before speaking with someone experiencing race-related trauma – or any other type of distress – you may need to think critically about how to tailor or tweak these skills to fit the situation.”
At this point in time, Kognito training is optional, though it is “strongly recommended,” Bowdler said. Part of Schonman’s role as Mental Health Promotion Specialist is promoting the program. Though participation was low when Kognito was first introduced, the task force is hopeful that those numbers will uptick in the future.
“We really did chalk up the initial lack of interest to the fact that we sent out this email right before people quickly had to leave campus, and we felt like people had too much on their minds over the summer to be sending out [another] Kognito message,” Bowdler said. “So we [planned] a reminder, and we’ve recently [sent] it out, to say, ‘You know what, we actually want more people to be looking at this.’”
The most recent email communication about the program was sent to students last month on Jan. 8.
While Bowdler explained that the program is not mandatory, to avoid burdening students during an already difficult school year, Beatty asserts that it ought to be.
“I think it should be required. I absolutely do,” Beatty said. “I think that, department to department it differs, but there is still an issue with a lot of students feeling unheard by professors, and feeling like professors might not quite understand positive ways to communicate with students who feel the need to disclose what they’re going through.”
Beatty also commended the program for its ability to condense several important techniques into a relatively short amount of training time.
“I think empathy is a skill that is really important to practice. Even if you’re a psychology professor that has a ton of experience with this, it’s sometimes nice to go back to basics and be like, ‘Yeah, of course,’” Beatty said. “Humans are unpredictable, and every situation is different. But as a baseline, it is great, and we’re so impressed.”
In terms of long-term goals, Schonman expressed an interest in seeing significant participation growth on all three campuses.
“I would love to see the numbers of folks — staff, faculty, students — who are choosing to participate in Kognito increase,” Schonman said. “And with that, I think having more open conversations about mental health, or about helping students in distress [will follow]. That may be a hard thing to quantify, but I think it’s something that you can feel on a campus. You can tell from the conversations folks are having … how that’s impacting the campus climate.”
Kognito’s implementation is a part of an ongoing trend toward approaching mental health at Tufts from a “public health perspective,” Bowdler explained.
“We’re public health people — it’s not just about treatment, it’s about education and prevention, and community,” Bowdler said. “This is not just about teaching everyone how to refer to the counseling center, but to think about issues like self-soothing, self-compassion, and [to remind ourselves] — as Active Minds says — ‘you are enough, you are enough,’ and really trying to destigmatize mental health and mental illness as something that people would be reluctant to talk about or feel ashamed, when they shouldn’t be.”
You can access Kognito through the Counseling and Mental Health Services website.