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Amnesty for Help Seeking Behaviors: A Preliminary Review of Implementation History and Administrative BurdenA Thesis Submitted in Partial Fulfillment of theRequirements of the Renée Crown University Honors Program atSyracuse UniversityKyle RosenblumCandidate for Bachelor of Artsand Renée Crown University HonorsSpring 2020Honors Thesis in Policy StudiesThesis Advisor: _______________________ Dr. Zach Huitink, Assistant Teaching Professor, Public Administration and International Affairs Thesis Reader: _______________________ Dr. Austin Zwick, Assistant Teaching Professor, Policy StudiesHonors Director: _______________________ Dr. Danielle Smith, Director AbstractThis paper explores Syracuse University’s Amnesty for Help Seeking Behaviors policy implemented in Fall 2019 to encourage help-seeking behaviors among students in alcohol or drug-related emergencies. Responding to increasing risk of alcohol-related mortality on college campuses, many colleges and universities across the United States began implementing policies designed to reduce barriers to seeking help during alcohol or drug-related incidents; however, there is limited literature examining the success and empirical foundations of these policies. Using stratified purposive sampling, administrators of Syracuse University’s policy were interviewed and qualitative data were analyzed to examine perceived goals and measures of success for the policy, sources of administrative burden, and perceptions of the policy. Findings suggest that there are no severe sources of administrative burden and that administrator perceptions of the policy are generally positive. Further, qualitative analyses suggest the policy may have ameliorated previously existing sources of burdens and could have positive implications in student perceptions of administrators. Based on these findings and the existing literature, I offer two recommendations: to conduct and publish an empirical evaluation of the policy and to increase marketing and promotion of the policy. Executive SummaryBetween 1998 and 2014, alcohol-related poisoning deaths among 18- to 24- year-olds increased 254% per 100,000, from 207 to 891 (Hingson, Wenxing, & Smyth, 2017). There are a number of health risks presented by the prevalence of binge drinking on college campuses (National Institute on Alcohol Abuse and Alcoholism, 2020; Wechsler et al., 1995; Wechsler et al., 1994), but alcohol-related mortality presents the most severe risk of binge drinking and has resulted in a series of high-profile news stories about campus deaths due to alcohol (Larimer, 2017; New, 2014; Sink, 2004; Udell, 2019). Thus, the risk of alcohol-related mortality should be of particular concern to universities working to address alcohol and drug-related issues.In a root-cause analysis, a multitude of potential causes of alcohol-related mortality were identified. Good Samaritan policies and medical amnesty policies, referred to in this paper broadly as Help-Seeking Amnesty Policies (HSAPs), are emerging harm-reduction practices being employed by colleges and universities across the United States that attempt to address one specific root cause of alcohol-related mortality—the possibility that students fail to call for emergency services in an alcohol or drug-related medical emergency out of fear of getting in trouble. HSAPs are policies promoted by an institution of higher education which absolve students of any university-based conduct charges or judicial consequences if they seek help for themselves or a peer in an alcohol or drug-related emergency (Oster-Aaland and Eighmy, 2007). These policies attempt to remove student fears of disciplinary consequences in order to increase the likelihood that they seek help, thus reducing the risk of alcohol-related mortality. Educational interventions are typically still required to address individual students’ needs and continue to work to decrease binge drinking overall on college campuses. The first reference to a campus HSAP in the literature was in Meilman (1992), in which the author discusses Dartmouth College adopting a Good Samaritan clause in 1987 and the College of William and Mary following suit in 1990. Literature focusing on these policies began increasing in the early 2000’s, with Lewis and Marchell (2006) publishing an analysis of Cornell University’s newly adopted Medical Amnesty Protocol. In 2007, The Chronicle of Higher Education noted that dozens of colleges had implemented HSAPs (Hoover, 2007), and by 2019, an article in Inside Higher Ed suggested that most colleges have these policies in place (Anderson, 2019). This paper focuses specifically on Syracuse University’s HSAP, called Amnesty for Help Seeking Behaviors, which was implemented in the Fall of 2019. The policy is written as follows:Syracuse University encourages all community members to care for themselves and others. Therefore, when a student or student organization initiates help from a campus or community resource, involved students or organizations will generally not be subject to the University’s Code of Student Conduct. Students may be required to complete educational interventions designed to assist them in their decision-making process and/or the outcomes of their decisions and the University will generally alert emergency contacts. The University retains the right to hold individuals and organizations accountable when the health and safety of community members is at risk. (Syracuse University, Amnesty for help seeking behaviors).This policy was examined in terms of associated administrative burdens, which refers to sources of frustration in either implementing the policy (as administrators) or utilizing the policy’s intended services (as clients—i.e., students) (Burden et al., 2012). Administrative burden results from three potential areas of cost: learning costs: barriers based on the necessity to know about and understand eligibility for a policy; compliance costs: barriers caused by administrative requirements such as filling out documentation or following specific procedures; and psychological costs: barriers that exist due to stigmas about participating in a program or general stress produced by the nature of the process (Moynihan, Herd, & Harvey, 2015). Much of the literature on administrative burden examines burdens imposed on clients by government agencies. The analysis presented in this thesis extends literature on burden for administrators in a context not examined in the literature: an educational setting. Stakeholder interviews were conducted with administrators at Syracuse University through purposive stratified sampling, specifically choosing individuals to interview based on their proximity to administering aspects of the Amnesty for Help Seeking Behaviors policy. Five individuals were interviewed: one from the Department of Public Safety (DPS), which is in charge of responding to alcohol-related emergencies; two from the Dean of Students Office, which communicates with students about their conduct charges and supports them through conduct processes; and two from the Office of Student Rights and Responsibilities (OSRR), which meets with students who have conduct charges regarding alcohol or drug-related incidents, determines if amnesty applies, and assigns educational outcomes. Interviews were conducted to examine perceived goals and indicators of success as identified by the participants, assess administrative burden related to the policy, and evaluate participants’ perceptions of the policy, its strengths, and its weaknesses. Key sources of administrative burden for administrators included adapting to new policies and procedures (learning cost) (n=4), creating the new policies and procedures (compliance cost) (n=4), and discovering that students perceived the administrators as not caring about their health and well-being (psychological cost) (n=2). Key sources of perceived administrative burden for students as identified by the participants included understanding what amnesty is and when it applies (learning cost) (n=4), following through with educational sanctions (compliance cost) (n=2), and experiencing stress from the alcohol or drug-related incident itself (psychological cost) (n=2). Identified goals included encouraging help-seeking behaviors and keeping students safe (n=4), having students engage with educational interventions (n=3), and improving students’ perceptions of the administrators and their offices (n=2), while indicators to measure the policy’s success were identified as an increase in utilization of the policy by students (n=2), an increase in the number of calls for emergency services for alcohol or drug-related incidents (n=1), students’ perception of their treatment as fair (n=1), and the number of students successfully completing educational interventions (n=1). Perceptions of the policy were generally positive (n=3). Identified strengths included that the policy is more in line with the philosophy of the administrators (n=2) and that it can provide second chances to first-time offenders (n=1). Identified weaknesses included a lack of student awareness about eligibility (n=2), the belief that the policy need not exist (n=1), and the fear that students may abuse the policy (n=1). I offer two recommendations to Syracuse University based on these findings and the existing literature. First, it is important to engage in and publish research evaluating the impact of this policy to contribute to the limited existing literature and to ensure the policy is successful. Second, in order to reduce learning costs for students and increase the likelihood that the policy be used, it is necessary to improve marketing and promotion of the policy. Table of Contents TOC \h \z \t "Thesis,1,Thesis Sub,2" I. Introduction PAGEREF _Toc39590765 \h 8History of Implementation PAGEREF _Toc39590766 \h 11II. Background & Context PAGEREF _Toc39590767 \h 13III. Outline of Policy PAGEREF _Toc39590768 \h 16Policy Process PAGEREF _Toc39590769 \h 17IV. Administrative Burden PAGEREF _Toc39590770 \h 20V. Data and Methods PAGEREF _Toc39590771 \h 23Limitations PAGEREF _Toc39590772 \h 24VI. Findings PAGEREF _Toc39590773 \h 24Goals and Measures of Success PAGEREF _Toc39590774 \h 25Administrative Burden PAGEREF _Toc39590775 \h 26Perceptions, Strengths, and Weaknesses PAGEREF _Toc39590776 \h 29VII. Conclusion PAGEREF _Toc39590777 \h 30Recommendations PAGEREF _Toc39590778 \h 32References PAGEREF _Toc39590779 \h 34Appendix I PAGEREF _Toc39590780 \h 37Peer Institutions PAGEREF _Toc39590781 \h 37ACC Institutions PAGEREF _Toc39590782 \h 38Other Institutions PAGEREF _Toc39590783 \h 39I. IntroductionThe prevalence of binge drinking on college campuses is well-documented by a substantial body of literature (Hingson, 2010; Keeling, 2002; Quigley and Marlatt, 1996), as are the health risks of binge drinking in college (National Institute on Alcohol Abuse and Alcoholism, 2020; Wechsler et al., 1995; Wechsler et al., 1994). These health risks can range from minor effects on daily life to more severe, potentially fatal incidents. A study by Wechsler et al. (2000) projected that over 30,000 students likely need treatment for alcohol overdose annually in the United States, based on a self-reporting survey. The rates of hospitalizations and mortality due to alcohol-related incidents have been rising as well. Alcohol-related poisoning deaths among 18- to 24-year-olds increased 254% per 100,000 between 1998 and 2014. Hospitalizations for overdoses involving alcohol among that same group increased 26% per 100,000 over the same period and alcohol-related non-traffic deaths increased 21% per 100,000 (Hingson et al., 2017). A number of high-profile campus deaths involving alcohol (Larimer, 2017; New, 2014; Sink, 2004; Udell, 2019) have forced institutions of higher education throughout the country to grapple with how to prevent deaths, injuries, and community harm related to alcohol. The problem examined in this paper is defined as follows: college students in the United States are at risk of alcohol-related mortality. As can be observed by the root cause analysis presented in Figure 1, alcohol-related mortality among college students in the United States is a complex and multi-faceted issue with many potential causes. In fact, it is extremely likely that the interplay of a variety of identified causes contribute differently to each individual instance of alcohol-related mortality. For the purposes of this paper, the policy being analyzed attempts to address the specific root cause demonstrated in Figure 2. This specific root cause analysis suggests that one of the contributing factors to alcohol-related mortality among college students center00076657205208905Figure 100Figure 1in the US is a reluctancy to seek help during incidents involving severe intoxication out of fear of possible disciplinary sanctions. In an article about states adopting medical amnesty policies, USA Today highlights one example wherein an individual with severe alcohol poisoning refused to let anyone seek help for them because they feared that a citation for underage drinking would hurt their chances of enlisting in the army (Daves, 2015). This thinking could translate easily to college students, who may fear any damage to their ability to become employed, attend graduate school, or even successfully complete their undergraduate degree.center3321050040233608255Figure 200Figure 2History of ImplementationOne such way that colleges and universities in the United States have addressed the risk of alcohol-related mortality among their student bodies is amnesty policies. Though amnesty policies refer to several things, in this paper, I focus generally on Good Samaritan policies and medical amnesty policies, as well as Syracuse University’s Amnesty for Help Seeking Behaviors policy. These nomenclatures define slightly different categories of policies and there is variation among institutional policies of the same category. However, the goal of each policy is the same: to increase help-seeking behaviors in order to ensure students receive medical care in the event of alcohol- or drug-related incidents. For this reason, I will refer generally to these policies as examples of a Help-Seeking Amnesty Policy (HSAP). The history of HSAPs can be traced back to the introduction of the harm-reduction framework, on which HSAPs are based (Oster-Aaland and Eighmy, 2008), into public health discourse. Harm-reduction as an alternative public health strategy to prohibitive or punitive policies was initially aimed at addressing HIV/AIDS contraction rates amongst people who injected drugs (Roe, 2005). Literature and government-funded reports examining harm-reduction approaches to alcohol and drug use in a college setting increased throughout the 1990’s (Dejong et al., 1998; Kivlahan et al., 1990; Onken, Blaine, & Boren, 1993; Paglia and Room, 1999). Until the 2000’s, literature on HSAPs was scarce, though Meilman (1992) describes Dartmouth College adopting a Good Samaritan clause in 1987 and the College of William and Mary following suit with a similar policy in 1990, indicating these institutions as some of the earliest, if not the first, adopters of HSAPs. Literature specifically focusing on campus HSAPs increased in the 2000’s (Lewis and Marchell, 2006; O’Malley, 2002; Oster-Asland and Eighmy, 2008). Lewis and Marchell (2006), analyzing Cornell University’s Medical Amnesty Protocol, published one of the only comprehensive analyses of a campus HSAP that exists. The authors broadly define the purpose of this policy as aiming to “eliminate or reduce judicial consequences for students involved in alcohol-related medical emergencies” (Lewis and Marchell, 2006, p. 330), a definition consistent with existing literature. These policies may apply to individuals requiring medical attention, peers seeking medical services on behalf of another individual, and organizations involved in the incident. Oster-Asland and Eighmy (2008) further identify five key assumptions that these policies operate under, listed as follows:Students can identify the symptoms of alcohol poisoningStudents understand the risk associated with the symptoms of alcohol poisoningStudents responsible for help-seeking are sober enough to adequately judge the level of risk involvedStudents are currently not calling for help due to fear of getting in trouble with the universityStudents will be more likely to call for help if they are assured that they will not get in troubleThese assumptions present a particular challenge to the success of HSAPs—not only must barriers to calling for help be removed, but universities must also ensure students are equipped with the knowledge, resources, and ability to assess and respond to emergency situations. Though the definition and assumptions are restricted to alcohol-related medical emergencies, many colleges and universities have extended their policies to include drug-related medical emergencies as well (Appendix I). There has not been a comprehensive review of the history of HSAPs on college campuses to date; however, the literature suggests these policies began increasing in popularity at colleges and universities throughout the United States during the 2000’s. One potential reason for this timing may be that in 1998, the United States Congress amended the Higher Education Act of 1965 to encourage institutions of higher education to develop new strategies for addressing alcohol and drug abuse (Bergen-Cico, Urtz, & Barreto, 2004). In a 2007 article from The Chronicle of Higher Education, the author estimates that “…dozens of colleges have adopted medical-amnesty exemptions…”, referring to these policies (Hoover, 2007). By 2019, Inside Higher Ed notes that “most colleges have medical amnesty policies in place to protect students from university discipline when they call emergency services…”, citing Students for Sensible Drug Policy, an international non-profit that advocates for drug policy reform (Anderson, 2019). This thesis describes the history of implementation of an HSAP at Syracuse University, outlines the policy as written, discusses the relevance of administrative burden to policy implementation, and analyzes qualitative findings from stakeholder interviews with key university administrators using a purposive stratified sampling method. The findings include identification of goals and measures of success for the policy, a breakdown of perceived administrative burdens on behalf of both administrators and students, and perceptions of the policy, its strengths, and its weaknesses. Implications of these findings are discussed along with recommendations for the future. II. Background & ContextSyracuse University is a private, four-year university situated in central New York with an enrollment of about 22,000 students, including 15,000 undergraduates. In the Fall of 1999, following an increasing prevalence and severity of alcohol- and drug-related conduct issues, Syracuse University implemented a 12-Point Plan for Substance Abuse Prevention and Health Enhancement (SAPHE). This plan was in accordance with the then emerging public health literature focused on harm-reduction strategies and comprehensive environmental approaches to addressing alcohol and other drug (AOD) misuse on college campuses. Coupled with this plan was a three-year longitudinal study by Bergen-Cico, Urtz, & Barreto (2004) assessing the effectiveness of the plan in relation to correlating changes in AOD incidents and campus perceptions. The study found that the environmental approach to reducing AOD issues on campus was correlated with largely positive outcomes, both in the frequency of AOD incidents and the campus perceptions toward the new policies. More importantly, the plan itself demonstrated an institutional commitment to harm-reduction strategies in addressing AOD and led to the creation or pre-cursor of several important campus institutions that exist today, including the Options program, which provides educational interventions, and a peer educator group focusing on preventative health education.Twenty years after the implementation of the SAPHE plan, Syracuse University formally implemented a Help Seeking Amnesty Policy. The history of the development of this policy is examined through news stories archived by Syracuse University’s student newspaper, The Daily Orange, and internal documents of Syracuse University’s Student Association. A 2015 article in USA Today notes that a rise in student advocacy had begun to influence the adoption of state and college policies promoting HSAPs (Daves, 2015). Syracuse University’s own history of student advocacy on this issue can be traced back to the Fall of 2009, when a Junior in the College of Visual and Performing Arts started a chapter of Students for Sensible Drug Policy (SSDP) (Janis, 2009). The SSDP chapter, aided by the national parent organization, began to advocate for an HSAP modeled from that presented in Lewis and Marchell (2006) (Montalvo, 2010). The issue quickly gained prominence on campus, garnering the attention of the undergraduate Student Association (SA) (Leveille, 2010), The Daily Orange Editorial Board (The Daily Orange Editorial Board, 2011), and even an SU alum who worked with addiction in a medical setting (Letter to the Editor, 2011). The university formed a campus task force in 2011 dedicated to examining the policy and providing recommendations for future steps (Leveille, 2011). The task force ultimately rejected the SSDP chapter’s proposal for a new policy, citing a lack of empirical backing for medical amnesty policies and potentially conflicting university messaging, but committed to updating the policy to encourage help-seeking behaviors and reducing some of the more severe punishments outlined under the previous AOD policy (Barillari, 2012).Over the following years, HSAPs generally increased in prevalence on college campuses throughout the country. A limited analysis of the prevalence of HSAPs at colleges relevant to Syracuse University was conducted in 2018. Colleges were divided into three sub-groups: peer institutions (a loosely defined group with similar attributes to Syracuse University that allow for comparison research on key university initiatives); members of the Atlantic Coast Conference (ACC; the athletic conference in which Syracuse University takes part); and other institutions (a group of colleges chosen that did not fit the former categories but were included either due to a notable policy or relevance to key stakeholders to whom the research would be presented). In total, the AOD policies for 31 schools and Syracuse University were examined for the presence and extent of HSAPs (n=13 peer institutions, n=14 ACC schools, n=7 ‘other’ institutions). Three institutions were cross listed in peer institutions and ACC schools but were not duplicated in final counts. If an institution had a HSAP, it was evaluated on five measures:Does the policy cover alcohol-related incidents?Does the policy cover drug-related incidents?Does the policy apply to individuals in need of medical attention?Does the policy apply to individuals calling for help on behalf of a peer?Does the policy apply to organizations present at the incident?Data were collected through examinations of institutions’ websites and Codes of Student Conduct and occasionally informational interviews. The full outline of results can be found in Appendix I. In total, not including Syracuse University, 29 of the 31 institutions had full or limited HSAPs (93.5%)—27 institutions with full policies (87.1%) and 2 institutions with limited policies (6.5%). In the peer institution sub-group, including cross-listed schools, all 13 sampled institutions had HSAPs (100%). In the ACC sub-group, including cross-listed schools, 11 institutions had full policies (78.6%), 2 institutions had limited policies (14.3%), and 1 institution did not have a policy (7.1%). In the ‘other’ institution sub-group, 6 institutions had full policies (85.7%) and 1 institution did not have a policy (14.3%). In 2019, this research was presented to the Syracuse University Board of Trustees, Chancellor, and Dean of Students, prompting discussion about the possibility to implement a HSAP (initially proposed as medical amnesty and later changed to help-seeking amnesty) at Syracuse University. The policy was drafted over the summer of 2019 by the Dean of Students Office in conjunction with other campus departments and was formally adopted in Fall 2019. The following section describes the new policy and outlines the full process. III. Outline of PolicyThe Help-Seeking Amnesty Policy is broadly outlined on Syracuse University’s student conduct website, entitled “Amnesty for Help Seeking Behaviors”. The policy, as written, is as follows:Syracuse University encourages all community members to care for themselves and others. Therefore, when a student or student organization initiates help from a campus or community resource, involved students or organizations will generally not be subject to the University’s Code of Student Conduct. Students may be required to complete educational interventions designed to assist them in their decision-making process and/or the outcomes of their decisions and the University will generally alert emergency contacts. The University retains the right to hold individuals and organizations accountable when the health and safety of community members is at risk. (Syracuse University, Amnesty for help seeking behaviors).The policy is worded with vague language like “generally” to provide flexibility in implementation and to account for situations in which amnesty should not be applied even though a student may be eligible, particularly when “the health and safety of community members is at risk”. Policy ProcessThe amnesty process outlined in the Amnesty for Help Seeking Behaviors policy is initiated from the moment a student seeks help for themselves or another student who has an alcohol or drug-related emergency. When a student calls either the Syracuse University Ambulance (SUA) or the Syracuse University Department of Public Safety (DPS) to seek help for an alcohol- or drug-related emergency, they will be considered for amnesty. The DPS officer at the scene writes a situation report describing the incident and typically noting whether or not a student called for help (other ways DPS or SUA may be notified to an incident include finding a student intoxicated or receiving calls from non-student residents of Syracuse). Once these reports are received by the Dean of Students Office, a case manager within the Dean of Students Office sends an email to the student cited detailing the conduct charges filed against them, outlining next steps in the conduct process, and offering to be a source of support should the student have any questions or just want to talk. The situation reports are then sent to Syracuse University’s Office of Student Rights and Responsibilities (OSRR), the primary conduct office on campus. The staff examines each case involving alcohol or other drugs to determine whether amnesty applies—primarily based on whether it was a student who sought help. Every student, regardless of whether amnesty applies, receives a letter notifying them that they need to set up a meeting with a staff member from OSRR to discuss what happened, reflect on their experience, ensure their well-being, and map next steps. These meetings including guiding questions for the OSRR staff to direct the conversation, one of which includes inquiring whether the student or a peer sought help resulting in the notification of campus emergency services. This serves to both confirm amnesty for cases already believed to be qualified or qualify new cases for amnesty where eligibility was not apparent from the initial report. Students who qualify for amnesty do not receive any judicial sanctions. Instead, the staff member in OSRR recommends an educational or behavioral intervention tailored to the specific individual’s needs. There are no enforcement mechanisms to ensure students complete their assigned educational or behavioral outcomes; however, OSRR is notified whether a student completed any items referred out (i.e. completion of programs through Counseling Services). A visual of this process is outlined in Figure 3, below.center00062255404723765Figure 3*00Figure 3*2286005208905*Gray boxes indicate actions taken by students. Blue boxes indicate actions taken by administrators.00*Gray boxes indicate actions taken by students. Blue boxes indicate actions taken by administrators.center236156500In total, this process is completed typically around two to three weeks after the incident in question. Both the Dean of Students Office and OSRR stress the importance of providing support to and assessing the well-being of students throughout the process. Additionally, students are allowed to have another individual accompany them to their meeting with OSRR as a source of support. Amnesty for organizations also exists under this policy, but because alcohol and drug-related emergencies involving student organizations are more infrequent and more complex than cases about individuals, the process is not specifically outlined. Students cited for conduct charges related to alcohol or other drugs but who are ineligible for amnesty follow additional mandated procedures not outlined in this paper. In order for this process to operate as intended, administrators and students alike must be able to navigate through procedures with minimal barriers that may otherwise impede or prevent the success of the policy, a concept referred to as administrative burden.IV. Administrative BurdenFor any policy to be effective, the targeted population must be able to overcome barriers to engaging with the policy and successfully receiving the benefits it was intended to provide. Burden et al. (2012) describe this concept, administrative burden, as an individual’s experience of policy implementation as onerous. The perception of burdens as onerous affects an individual’s likelihood of accessing services, a program’s likelihood of successfully achieving intended outcomes, and overall perception of the administrative body overseeing the policy. Administrative burden can be experienced in three categories, as defined by Moynihan, Herd, & Harvey (2015): learning costs, compliance costs, and psychological costs.Learning costs are barriers to accessing services based on the necessity to be aware of the existence of the service, eligibility requirements, and methods of access. In the case of help-seeking amnesty policies, students must be aware that their campus has an HSAP in place and be knowledgeable enough about the substance of the policy to understand what steps to take to ensure they are eligible for amnesty (ex: seeking help on behalf of themselves or a peer). This also includes knowing which services to contact, how to contact them, and perhaps most importantly, when to contact them. The literature has shown that most college students have taken care of a peer during an alcohol-related event, but that these students generally do not seek outside help (Wechsler, Nelson, & Weitzman, 2000; Colby, Raymond, & Colby, 2000; Oster-Aaland et al., 2009). This means that students taking care of their intoxicated peers must themselves be able to determine when or if emergency medical services are needed. Lewis and Marchell (2006) found that the top reason for not calling for help was exactly that—being unsure as to whether help was required. This is a learning cost that students must be able to overcome in order to successfully engage with services offered through HSAPs. Compliance costs are barriers resulting from following administrative requirements, including completing documentation and correctly following necessary procedures. Cornell University’s HSAP, for example, requires students eligible for amnesty through their Medical Amnesty Protocol to complete psycho-educational interventions (Lewis and Marchell, 2006). Other potential sources of compliance costs for HSAPs in addition to completing educational interventions include responding to communications from the university’s conduct office, scheduling necessary conduct meetings, and completing any documentation about the alcohol-related event as required by first responders or conduct offices. Psychological costs arise from stigmas of participating in a program, a sense of a loss of individual autonomy to an administrative body, and stresses associated from involvement in the process itself. Because substance use is correlated to co-occurring mental health disorders and stress (Cranford, Eisenberg, & Serras, 2009; O’Hare, 1998; O’Hara, Armeli, & Tennen, 2014) as well as other serious health problems like injuries or risky sexual behavior (National Institute on Alcohol Abuse and Alcoholism, 2020; Wechsler et al., 1995; Wechsler et al., 1994), discussions with conduct offices or counseling professionals as part of HSAPs may exact a psychological toll. Another potential source of psychological costs may stem from the fear of disciplinary actions resulting from seeking help, a cost which HSAPs attempt to eradicate (Lewis and Marchell, 2006; Oster-Aaland et al., 2007).While administrative burden generally refers to the experiences of a target population in interacting with a service or program, the concept is also applicable to the administrators of a policy themselves. Perceived administrative burden in this case is associated with increased opposition to a policy (Burden et al., 2012) and a decreased organizational commitment and effort (Moynihan, Herd, & Harvey, 2015). It is also important to note that some forms of administrative burden are necessary or even desirable (Moynihan, Herd, & Harvey, 2015). For example, educational interventions required by HSAPs pose a compliance cost to students but are necessary to address the student’s well-being and to ensure that the policy remains in line with university values. In the following sections, I further analyze the implementation of Syracuse University’s HSAP and examine perceived administrative burdens of the policy.V. Data and MethodsData were conducted through stakeholder interviews from a sample of administrators at Syracuse University selected through purposive stratified sampling. Strata were chosen based on relevance to the Amnesty for Help Seeking Behaviors policy, including: one representative from the Department of Public Safety, responsible for responding to alcohol-related events and submitting situation reports; two representatives from the Dean of Students Office, responsible for communicating with and supporting students throughout the conduct process; and two representatives from the Office of Student Rights and Responsibilities, responsible for meeting with students, assessing eligibility for amnesty, and assigning educational outcomes. The roles of these administrators in reference to the policy process are illustrated in Figure 3. Due to ongoing circumstances involving COVID-19, interview designs varied. Two interviews were conducted in-person, two were conducted via video conferencing tools, and one was conducted via e-mail response. Interviews were semi-structured and focused generally on administrators’ roles and their perception of the policy’s goals, measures of success, and associated administrative burden. Written notes were used to summarize the responses of participants during in-person and video conference interviews. These notes along with the recorded responses from the e-mail interview were analyzed for themes relating to perceived goals and measures of success of the policy, the three costs of administrative burden (learning, compliance, and psychological), and general perceptions of the policy. Participants were specifically asked about their perceptions of policy goals and measures of success as well as administrative burden; however, general perceptions of the policy were extrapolated based on responses provided throughout each interview. Discussions relevant to each theme were extracted from interviews and similar responses were combined. LimitationsThere are several limitations to this study. The small number of key stakeholders interviewed as participants reduces generalizability of and presents a larger opportunity for error in the qualitative findings. Since quantitative data were not accessible for the purposes of this study, it is difficult to validate the implications presented by the qualitative findings. Furthermore, due to confidentiality issues and practical concerns surrounding COVID-19, students involved in the amnesty process were not interviewed. All findings related to administrative burdens for students are based on the perceptions of administrators on behalf of students. Future studies should seek to expand the number of participants interviewed, analyze quantitative data, and include students in qualitative data collection. At the time of this study, the policy has only been implemented for less than a year. The policy being still in an early implementation stage, findings presented in this study should be considered as preliminary and should be supplemented by continuous assessment of the policy over time. VI. FindingsRelevant administrators to the Amnesty for Help Seeking Behavior policy were identified based on their level of involvement in the policy process. Interviews were conducted to gather anecdotal data to answer three broad questions: What are the perceived goals and indicators of success for the policy?What sources of administrative burden exist or were ameliorated as part of the policy? What are the administrative perceptions of the policy and its strengths or weaknesses?Goals and Measures of SuccessParticipants were asked to describe what they believed the goal of the policy was and what they would identify as being an indicator that would demonstrate the policy’s success. Participants were largely in agreement over the goals of the policy. Three main goals were identified. The most common goal of the policy was to encourage help-seeking behaviors on the part of students and thus keep students safe (n=4). This identified goal is consistent with that identified in the literature (Lewis and Marchell, 2006; Oster-Aaland et al., 2007). The other identified goals of the policy were to encourage students to engage with educational interventions (n=3) and to improve students’ perceptions of the administrators and their departments as sources of support (n=2). Participant views on what measures would indicate the success of the policy were more mixed. The most commonly identified measure of success was identified as the frequency with which the policy is used by students, with higher frequency indicating greater success (n=2). Related to this measure, another participant identified increased numbers of calls for emergency services during alcohol- or drug-related incidents as indicative of success (n=1). Other identified metrics of success included students’ perception of their treatment through the process as fair (n=1) and the number of students that successfully complete assigned educational interventions (n=1). Quantitative data would be needed to assess each of these measures.Administrative BurdenParticipants were asked to identify sources of administrative burden for themselves in implementing the policy and perceived sources of administrative burden for students in using the policy based on provided definitions of learning costs, compliance costs, and psychological costs. If, in the course of an interview, participants referred to a source of administrative burden without explicitly identifying it as so, these sources were still coded and included in final analyses. Learning costs. The most commonly identified source of learning costs for administrators was adapting to new roles and procedures in light of the new policy (n=4). One participant identified the need to adapt to new notification letters, new documentation, new structures and systems, and shifts in how inter-departmental conversations about the conduct proceed. In addition, participants identified a learning cost associated with determining application of amnesty in cases where eligibility is uncertain or other factors are involved which add complexity to the conversation (n=2). The policy states that students will “generally not be subject” to the Code of Conduct if students meet the help-seeking criteria. This specific language provides OSRR with flexibility in ensuring that students do not abuse the policy and in accounting for extraneous variables that may complicate a case. However, it also results in a learning cost because, as one participant describes, it creates gray areas that must be examined to determine eligibility. Lipsky (1980) maintains that this sort of discretion exercised by administrators is an inherent part of the roles and responsibilities of street level bureaucrats—those administrators that directly interact with clients (i.e. the students) in dispensing benefits or procedures of a policy. The most commonly perceived learning cost for students was the need to understand what amnesty is and when it applies (n=4). This is consistent with the literature that identifies knowledge of a policy and eligibility requirements as the primary source of learning costs (Moynihan, Herd, & Harvey, 2015). It is also important to note that the policy’s vague language may pose additional difficulties to students in understanding eligibility. Though being knowledgeable about the policy was identified as an important learning cost for students, two participants who identified this cost also noted that since the policy was implemented, students appear to have gained a better understanding of what the policy is. Two other perceived learning costs for students included the need for students to be able to differentiate between the various offices involved in the process (ex: Dean of Students Office vs OSRR) (n=1) and understanding the difference between punitive outcomes and educational outcomes (n=1). Compliance costs. Similar to the learning cost identified by administrators of adapting to new procedures as a result of the policy, a commonly identified compliance cost for administrators was having to actually create those new procedures and documentation and follow them accordingly (n=4). One specific example noted by several participants was the necessity for DPS to alter its situation reports to specifically include information on help-seeking behaviors employed by the students involved—information not previously recorded. Another source of compliance costs, though not specific to just amnesty cases, was reading the situation reports for alcohol- or drug-related incidents that are then used to determine conduct charges or amnesty eligibility (n=4). Finally, some participants noted that a compliance cost exists in the necessity to monitor the policy, especially while still relatively new, to determine effectiveness or areas for improvement (n=2).Perceived compliance costs for students were limited, the most common being following through with assigned outcome measures (i.e. educational interventions) (n=2). Based on participants’ description of the policy, other sources of compliance cost can be inferred to include reading email notifications of the process and setting up and following through with a meeting with OSRR.Psychological costs. A notable psychological cost for administrators was identified as students’ general perception that the administrators’ roles were exclusively to get them in trouble, rather than caring about the students’ health and well-being (n=2). One participant specifically recounted a time in which they expressed their genuine care and concern for a student’s well-being but were met with skepticism as a result of the student being required to go through the conduct process. Another psychological cost identified was just generally seeing students struggle (n=1). Both of these identified costs are not specific to the HSAP itself, but rather to the administrator’s roles. Interestingly, one participant suggested that the policy actually removed a psychological cost that previously existed. The participant explained that many administrators had a ‘philosophy’ of amnesty prior to the implementation of the HSAP, believing that certain cases warranted amnesty considerations—but there was no formal policy permitting the application of amnesty. The implementation of the HSAP removes discrepancies between an administrator’s desire to apply amnesty and the lack of a policy to provide an avenue to do so formally. The only perceived psychological cost for students was going through the process in general (n=2). As one participant noted, students who go through the process have visible struggles and often catastrophize their situation. Given the literature that demonstrates negative correlates between drinking and co-occurring health risks (Cranford, Eisenberg, & Serras, 2009; O’Hare, 1998; O’Hara, Armeli, & Tennen, 2014; National Institute on Alcohol Abuse and Alcoholism, 2020; Wechsler et al., 1995; Wechsler et al., 1994), it is reasonable to conclude that students who had an incident related to alcohol or other drugs will also face psychological stress, though this is not a cost stemming from the policy itself. Rather, going through the policy process required to receive amnesty may exacerbate this psychological cost as a result of having to discuss the incident in depth with university administrators. Perceptions, Strengths, and WeaknessesThe final question explored through stakeholder interviews was how administrators perceived the policy and what they believed to be the policy’s strengths and weaknesses. Overall, perceptions of the policy were generally positive (n=3), coded as such based on the participants’ language in talking about the policy. Of the three participants who were identified as having positive perceptions of the policy, one referred to their desire to apply amnesty to more cases, one described the positive impacts they believe the policy will have on students, and one described the success of the policy so far. Of the other two participants interviewed, one indicated a neutral perception (n=1) and one indicated a slightly negative perception (n=1). The participant indicating a negative perception of the policy described their belief that the policy is unnecessary, specifically asserting that “if students truly cared about their peers” they would call for help regardless of potential consequences. Three anecdotal strengths of the policy were identified. The most commonly identified strength was that the policy is generally in alignment with the views and philosophy of administrators (n=2). As discussed under psychological costs, one participant noted the desire of administrators to have an amnesty provision even before the policy was implemented. Another identified strength included the ability to provide a second chance to first-time offenders (n=1). One participant also noted that despite the fact that no enforcement mechanisms are in place to ensure students who receive amnesty complete educational interventions, students have mostly been successful in following through with their educational outcomes. This suggests a strength in the policy’s ability maintain an educational focus that complements the HSAP (n=1). The primary weakness identified was that students generally aren’t aware whether amnesty applies to their situation until their meeting with OSRR, unless they are told by DPS (n=2). Other identified weaknesses of the policy were the belief that the policy need not exist (n=1) and the fear that students may abuse the policy (n=1). VII. ConclusionAs of Fall 2019, Syracuse University has joined the many colleges and universities across the nation employing Help Seeking Amnesty Policies in a harm-reduction, environmental approach to addressing alcohol and drug misuse on campuses. As part of the implementation of this policy, it is important to understand the administrative burden associated both with administering the policy as an administrator and experiencing the policy as a student. The greater in number and in severity of burdens that exist relative to a policy, the less effective the policy will be in achieving its intended goals. However, based on stakeholder interviews, there does not appear to be any significant burdens that are not inherent to the policy, and in fact, some participants identified barriers which had been removed due to the new policy.The psychological cost identified suggesting that students misperceive offices like OSRR as existing exclusively to discipline students (n=2) has potentially significant implications for this policy. Colby, Raymond, & Colby (2000) evaluated a campus policy mandating temporary suspension pending treatment for substance misuse. Despite the university implementing the policy out of concern for its students, students in the study expressed skepticism that concern was the motivation behind the policy and believed the policy exclusively existed to deter drunkenness (Colby, Raymond, & Colby, 2000). In the same study, involvement with college officials was one of the top reasons that students caring for an intoxicated peer did not seek additional help. It is worth exploring to what extent student perceptions of a university’s motivation behind a policy influence their perceptions of college officials as a whole and thus their likelihood to seek help. As noted by one participant in regard to Syracuse University’s policy, students who go through the conduct process for alcohol- or drug-related offenses have sometimes expressed disbelief that the administrators actually cared about their health and well-being. Two participants additionally identified improving student perceptions of their offices as a goal of the policy. With the Amnesty for Help Seeking Behaviors policy providing an avenue through which students can still receive educational interventions without going through the conduct process, will it improve student perceptions of the motivations of college officials? If so, the policy may achieve the goal of improving student perceptions of administrators.Burden et al. (2012) found that perceived administrative burden among the administrators of a policy has important implications, such as influencing the potential for administrators to shift responsibilities, view policies negatively, and execute erroneous discretionary judgements. It is important, then, to note that a perceived strength of Syracuse University’s HSAP as identified by two participants is that the policy aligns with a philosophy some administrators have generally held even prior to the policy’s implementation. The potential psychological cost ameliorated by implementing a policy more in line with administrators’ philosophies may have larger, positive effects in the role of the administrators. This study employed a qualitative method in order to compile a baseline examination of Syracuse University’s Amnesty for Help Seeking Behaviors policy in its first year of implementation. Based on information gathered through this study, I have included recommendations related to the policy. RecommendationsOSRR should collaborate with faculty and staff researchers to engage in and publish research evaluating the impact of the Amnesty for Help Seeking Behaviors policy. Even as HSAPs have increasingly been adopted by colleges and universities throughout the country, there remains a critical need for more literature examining the empirical merits of such policies (Oster-Aaland and Eighmy, 2007; Lewis and Marchell, 2006; Bergen-Cico, Urtz, & Barreto, 2004; Martinez, Johnson, & Jones, 2018). Given the limitations of this study, there is much more room to explore the impacts and implications of this policy with greater empirical validity and wider generalizability. Bergen-Cico et al. (2004) provide a historical precedent for collaboration between Syracuse University faculty and staff to collaborate in assessing alcohol- and other drug-related policies. Furthermore, this study did not examine student perceptions of the policy. As indicated in this study, students at Syracuse University have misperceptions of offices involved in addressing campus alcohol- and other drug-related issues as being exclusively disciplinary in nature and disregarding students’ health and well-being. These misperceptions may further impact help-seeking behavior on campus (Colby, Raymond, & Colby, 2000). It is important to gather data on student perceptions overtime to determine how this policy may improve perceptions. Finally, in order to address the identified weakness that students may abuse the policy, the policy should be continuously monitored for such behaviors.The Dean of Students Office should work with health and wellness offices on campus to improve marketing and promotion of the policy. As identified by participants in this study and supported by the literature, the most significant learning cost for students in accessing this policy is knowing that the policy exists and what the eligibility requirements are. Though one participant suggested that students have been more knowledgeable of the policy, another participant suggested that one improvement to be made was to ensure that students were aware of the policy from day one on campus. First-year students are especially at risk for heavy drinking behaviors (National Institute on Alcohol Abuse and Alcoholism, 2020; Bergen-Cico et al., 2004; Martinez et al., 2018). This suggests a particular need to market this policy in the early days of first-year students’ transition to campus to build help-seeking behavior tendencies as soon as possible and reduce harm among an at-risk demographic. Educational content could be delivered through orientation sessions for new students, promotional materials distributed throughout campus, and training sessions delivered to student groups by staff or peer educators. Improved education about the policy would also help to ameliorate the identified weakness that confusion among students about the policy still exists (n=2).ReferencesAnderson, G. (2019, December 6). Get help or let them die? Inside Higher Ed. , R. (2012, February 20). Student Association: Medical amnesty policy to take effect. The Daily Orange. , D., Urtz, A., & Barreto, C. (2004). Longitudinal assessment of the effectiveness of environmental management and enforcement strategies on college student substance abuse behaviors. NASPA Journal, 41(2), 235-262. , B. C., Canon, D. T., Mayer, K. R., & Moynihan, D. P. (2012). The effect of administrative burden on bureaucratic perception of policies: Evidence from election administration. Public Administration Review, 72(5), 741-751. , J. J., Raymond, G. A., & Colby, S. M. (2000). Evaluation of a college policy mandating treatment for students with substantiated drinking problems. Journal of College Student Development, 41(4), 395-404. 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Magnitude and trends in heavy episodic drinking, alcohol-impaired driving, and alcohol-related mortality and overdose hospitalizations among emerging adults of college ages 18-24 in the United States, 1998-2014. Journal of Studies on Alcohol and Drugs, 78(4), 540-548. Hoover, E. (2007). More colleges offer ‘amnesty’ for drinking violations. The Chronicle of Higher Education, 54(17), A1-23. Janis, S. (2009, October 14). Student group to promote sustainable substance abuse policies. The Daily Orange. , R. P. (2002). Binge drinking and the college environment. Journal of American College Health, 50(5), 197-201. , D. R., Marlatt, G. A., Fromme, K., Coppel, D. B., & Williams, E. (1990). Secondary prevention with college drinkers: Evaluation of an alcohol skills training program. Journal of Consulting and Clinical Psychology, 58(6), 805-810. , S. (2017, February 8). A Penn State student fell down the stairs at a fraternity—and for nearly 12 hours, no one called police. Washington Post. to the Editor. (2011, February 19). Letter to the Editor: University needs medical amnesty policy to protect students’ lives. The Daily Orange. , L. (2010, March 1). Student Association passes resolution showing support for medical amnesty policy. The Daily Orange. , L. (2011, February 16). Calling out: Students, administration continue discussion on medical amnesty policy. The Daily Orange. , D. K. and Marchell, T. C. (2006). Safety first: A medical amnesty approach to alcohol poisoning at a U.S. university. International Journal of Drug Policy, 17(4), 329-338. Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in public services. Russell Sage Foundation.Meilman, P. W. (1992). College health services should promote good samaritan rules as part of university alcohol policies. Journal of American College Health, 40(6), 299-301. Montalvo, J. (2010, February 10). Don’t ask, do tell. The Daily Orange. , D., Herd, P., & Harvey, H. (2015). Administrative burden: Learning, psychological, and compliance costs in citizen-state interactions. Journal of Public Administration Research and Theory, 25(1), 43-69. National Institute on Alcohol Abuse and Alcoholism. (2020, February). College drinking. NIH. , J. (2014, September 19). Lives cut short. Inside Higher Ed. ’Hara, R. E., Armeli, S., & Tennen, H. (2014). Drinking-to-cope motivation and negative mood-drinking contingencies in a daily diary study of college students. Journal of Studies on Alcohol and Drugs, 75(4), 606-614. ’Hare, T. (1998). Alcohol expectancies and excessive drinking contexts in young adults. Social Work Research, 22(1), 44-50. ’Malley, D. (2002, May 4). An examination of factors influencing college students’ self-reported likelihood of calling for assistance for a fellow student who has engaged in high-risk alcohol consumption [Presentation]. 14th National Symposium on Doctoral Research in Social Work, The Ohio State University, Columbus, Ohio. , L. S., Blaine, J. D., & Boren, J. J. (1993). Behavioral treatments for drug abuse and dependence. National Institute on Drug Abuse. qt5mf53471.pdfOster-Asland, L. and Eighmy, M. A. (2007). Medical amnesty policies: Research is needed. NASPA Journal, 44(4), 715-727. Oster-Aaland, L., Lewis, M. A., Neighbors, C., Vangsness, J., & Larimer, M. E. (2009). Alcohol poisoning among college students turning 21: Do they recognize the symptoms and how do they help? Journal of Studies on Alcohol and Drugs, Supplement, (16), 122-130. , A. and Room, R. (1999). Preventing substance use problems among youth: A literature review & recommendations. The Journal of Primary Prevention, 20(1), 3-50. a:1021302302085Quigley, L. A. and Marlatt, G. A. (1996). Drinking among young adults: Prevalence, patterns, and consequences. Alcohol Health and Research World, 20(3), 185-191.Roe, G. (2005). Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction. Critical Public Health, 15(3), 243-250. Sink, M. (2004, November 9). Drinking deaths draw attention to old campus problem. The New York Times. University. Amnesty for help seeking behaviors. Syracuse University Office of Students Rights and Responsibilities. Amnesty%20for%20Help%20Seeking%20Behaviors.htmlUdell, E. (2019, August 28). 15 years after Sam Spady’s alcohol poisoning death at Colorado State University, college drinking still at issue. The Coloradoan. , H., Davenport, A., Dowdall, G., Moeykens, B., & Castillo, S. (1994). Health and behavioral consequences of binge drinking in college: A national survey of students at 140 campuses. The Journal of the American Medical Association, 272(21), 1672-1677. , H., Dowdall, G., Davenport, A., & Castillo, S. (1995). Correlates of college student binge drinking. American Journal of Public Health, 85(7), 921-926. , H., Nelson, T., & Weitzman, E. (2000). From knowledge to action: How Harvard's college alcohol study can help your campus design a campaign against student alcohol abuse. Change: The Magazine of Higher Learning, 32(1), 38-43. -42862583439000Appendix IPeer InstitutionsACC Institutions-71437553022500Other Institutions ................
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