Students navigating academic and cultural readiness for higher education rely on a constellation of supports throughout their institution. Some of these supports are embedded within the student's specific community, such as their academic department, athletics program, or dormitory. This embedded role is similar to the model seen in military units and is also utilized in K-12 education. These positions go by many different names, but all can fall under a term I am introducing in this article: embedded and integrated support professional (EISP). The EISP plays a crucial role in helping students (student affairs professionals, mental health professionals, psych techs, civilian counselors, prevention assets) are unique in that they are meant to exist within the community they are charged with serving, whether credentialed as mental health providers or not, to support emotional well-being and serve to enhance success for the beneficiaries within an institution, especially high-pressure institutions focused on development or performance. They differ from centralized clinics, because they are physically located and aligned with those they are charged with supporting. Sanford's theory of challenge and support suggests success results from appropriate levels of challenge with congruent support. An EISP can offer specific support as the beneficiary embraces challenges throughout their time in the institution. EISPs can hone in on the specific needs or unique cultures of the organization and interact with all of the players within the system, which requires each practitioner to maintain resolute boundaries, develop a versatile set of skills, and practice consistent self-care.

The embedded mental health model provides a distinct benefit to an institution, but only if the embedded mental health personnel are effective, not only in their clinical function, but also in how they integrate. This requires a unique skill-set of the practitioner that can be proactively taught. The provider must demonstrate versatility, develop a clear understanding of the organization (and their place within it), be a consistent presence, set personal and professional boundaries, and integrate within the organization. Learning these skills should not have to rely on experience alone, but instead can be taught, beginning with the 4 key principles presented in this article. These 4 key principles include wisdom and lessons learned across my experiences of embedded support serving in Army Special Operations, at Harvard University, and at the U.S. Naval Academy and further informed by expert practitioners operating in large public institutions of higher education, in small private colleges, and public K-12 schools across the U.S. While the institution types are different, the 4 key principles remain constant and, if applied, will improve the effectiveness of the embedded and integrated support professional (EISP).

Embedded and Integrated Support Professionals in the Military and Higher Education

In the military, the embedded model creates the environment for mental health officers and civilian mental health professionals to learn about the community unto which they are attached. In higher education, these supporters take part in important community traditions and have an inherent knowledge of the function of the institution. These positions can be found outside the military and higher education across distinct fields and types of institutions. Embedded supports can be found in academic departments, collegiate athletics, professional sports, and K-12 education. These embedded positions are unique because unlike many other roles, they are not limited to a single credential or degree. They are filled by social workers, counselors, psychologists, as well as non-licensed professionals. These positions allow beneficiaries to gain trust and exposure not only to the EISP, but the field of mental well-being, which could open the way for increased access and efficacy.

In order for this type of model to be effective, the EISP must know how to integrate into their community. The skills required to pursue integration are universal across not only units but also types of institution or provider credential. What is true of the unique skills required of embedding in a military unit are as true for integrated mental health counselors for college athletics, academic department embedded therapists, public school social workers, and likely many other embedded positions including non-clinical positions, like resident deans. The methods for how to integrate and achieve sustainable success cannot be left to individual experience. EISPs require a unique set of skills and tacit knowledge to effectively integrate and maintain longevity. For some, these skills come naturally. For others, the strategies and challenges are overwhelming. Many of the skills, strategies, and approaches for successful execution of EISPs are consistent across types of institution or credentials of the provider.

These four key principles for EISPs and their organizations have been derived from personal experience as a military behavioral health officer, student affairs professional, and scholar, supplemented by expert-practitioner engagement. The practitioners quoted in this conceptual article were chosen with the intention to represent different types of institutions, geographic regions in the United States, and credentials. They are written to begin the conversation between experiences, such that each EISP can enter their assignment with confidence and the ability to succeed. Further study calls for the identification of common themes and common vocabulary across a wider sample to establish the baseline for a field not defined by professional credential or type of institution, but instead unified by a common set of tacit knowledge for all of those working as embedded mental well-being supports.

Principle 1: Understanding the Organization

Effective integration relies on an understanding of key stakeholders and how your role fits into the overall mission of the organization. As a military embedded behavioral health officer, I had to learn the culture, mission set, and operational demands of each unit while also determining the best way for me to work within that established system. In practice, Donna Brooks of Texas A&M and Vitina Monacello of the University of North Carolina both spoke to the importance of their physical office location to increase accessibility to the beneficiaries in alignment with the specific needs, flow, and requirements of the organization. Sara Levine, a school social worker in North Carolina, must understand not only the school culture and school policy, but also district, county, and state level considerations.

As an EISP you have unique insight into the needs of the students in their specific context. Noah Goss-Woliner, director of Mental Health with University of Montana Athletics, references not only his own experience as a student-athlete but also as a coach, providing him with insight into the athlete experience. Goss-Woliner also uses this experience to influence how he works with higher ed leadership.

In every organization in which I have been an EISP, I have advised leadership and consulted on organizational policy. Major Brandon Watties of the U.S. Army and I teach new EISPs the importance of becoming an asset to leadership by learning the role to play within the organization and capitalizing on the unique and often singular perspective EISPs bring. In this training, we emphasize that EISPs must first educate themselves on the organization, communicate their capabilities to key stakeholders, and demonstrate their abilities before being able to fully integrate. We have developed a framework with which new EISPs can navigate becoming an asset to their organization. Beneficiary-centered care is a key theme in embedded work, which requires a deep knowledge of the organizational culture, the people within the organization, and where an EISP fits within it.

Principle 2: Presence, Flexibility, and Versatility (and Boundaries)

An EISP's job does not begin and end with each session but exists every moment they are in the community and they must be a consistent presence. At the Naval Academy Preparatory School (NAPS), this involved going to basketball games and community events. In the Army, this included deployments and physical training. EISP's are sometimes providing therapy in their office, while other times providing non-clinical support with chance encounters. Levine, of North Carolina Public Schools, references that the benefit of being embedded is that, within this position, you have a unique opportunity to see clients throughout their day and in many distinct contexts. Goss-Woliner, of the University of Montana Athletics, differentiates his work occurring in confidential and non-confidential spaces, noting how these must be navigated appropriately.

Brooks, of Texas A&M, references hopping into other responsibilities and roles (within reason) to demonstrate to beneficiaries that EISPs are part of the community. Maddie Kinker, a counselor in a public school in Massachusetts, is assigned to one cohort of students as they advance through grades, allowing unique, first-hand, detailed knowledge of not only their environment but their trajectory and growth. When the walls of the clinic do not define the boundary of EISP work, it calls for strong boundaries and clear communication with students and the leadership of the institution.

Principle 3: Longevity

Potential for burnout is a common theme in EISP positions. When EISPs are embedded in a community, charged with supporting all those within it, and they are effective in the role, people will seek them out. Levine notes that she and her peers in other institutions with similar positions become the de facto go-to people whenever a student or teacher experiences an emotional or potentially concerning event. There are structural factors within institutions that can exacerbate these difficulties. Many students are on the same schedule, bottlenecking all student meeting availability to just a few hours a day. For live-in EISP roles, they are seemingly always on, requiring one's own perception of their on-and-off time.

Stevie Zatarain, a former commons residential director at a residential college, discusses the importance of private time or time away from the community to re-center. There can be a desire to be everything the unit needs all the time, but it is important to consider that consistency is key and that relies on an intentional pace.

Principle 4: Authenticity is Essential

Trust serves as a theme across all the key principles but originates with authenticity. Academic departments, collegiate athletics, or military units have unique cultures and often competitive selection criteria. EISPs are guests in those communities. When interviewing to join NAPS, I was asked: "This is a STEM school, you are not a scientist, how can you possibly know how to support our students?" I responded, perhaps too flippantly, "I don't need to be better than your students at chemistry, to know how to support them." I continued this same mindset when I was embedded with Green Berets in the Army. I did not need to be a Green Beret to support them, but knowing their culture and my place in it was essential. What I did need to be was authentic. If the role EISP is to be a resource within a unique environment, those who define the environment need to understand who is supporting their community. In certain organizations, mental health or help-seeking can be highly stigmatized. Embedding a provider within an organization allows individuals the opportunity to seek mental health services or refer others to get to know the provider and see through experience the range of what that provider can contribute.

There is a common question when new embedded providers enter their positions; Why is there a therapist in my unit, my department, or my school? Ultimately, it is to help the mission by providing accessible and specialized support to its beneficiaries. These embedded roles come with incredible opportunities and distinct challenges. Those stepping into these roles must understand that to embed in a community requires skills that overlap with clinic-based therapists as well as unique requirements such as building trust, establishing clear boundaries, maintaining flexibility and versatility, and understanding the organization. Integrated and embedded behavioral health providers can be difference makers not only for the beneficiaries they are there to support, but to the overall objective of the institution.

Article Topics

Military Friendly Institutions Serving Military in HigherEd Veterans Academic Success

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