A Comparison of College Counseling Center Characteristics at Two-Year/Community Colleges Versus Four-Year Institutions

Mar

College counseling centers have historically served as the primary psychological treatment resource in institutions of higher education that support the emotional and personal development of college students during their academic journey. National research has demonstrated that counseling centers are effective in treating students with a broad range of concerns (McAleavey et al., 2019), as well as promoting student success and persistence in school (Trusty et al., 2024).

While the importance and benefit of mental health services in colleges have been widely documented, there has been limited research examining differences in services between the various types of institutions, particularly two-year/community colleges and four-year institutions. Understanding the counseling services offered by community colleges is vital since these institutions serve approximately 40% of U.S. undergraduates and play a key role in increasing access to higher education for a broad range of students (Community College Research Center, 2025).

Reports have highlighted the mental needs and gaps in services experienced by community colleges (2024 Michigan Mental Health Landscape Report). Lipson et al. (2021) discovered that mental health challenges were prominent at both community colleges and four-year institutions, however, community college students were more likely to experience financial distress and diminished access to care. Similarly, Sontag-Padilla et al. (2023) noted the limited resources available at community colleges, which can compound the problems of addressing student needs. As such, counseling centers at community colleges face unique challenges in supporting students and navigating potential resource limitations.

To better understand the differences in counseling center services provided within two-year/community colleges and four-year institutions, we examined data from the Center for Collegiate Mental Health (CCMH). Specifically, various center characteristics were evaluated pertaining to connections with professional organizations and policies/practices related to the management of supply/demand for services, as these factors may reveal the need for additional supports for these centers. The following questions were asked:

Do two-year/community colleges and four-year institutions differ by:

Professional Organization Affiliations?
Contracts with 3^rd-Party Vendors?
Center Policies and Practices?
Utilization Rates and Clinician Caseloads?

Data used for the current study was collected from the annual CCMH renewal form that covered the 2024-2025 academic year. A total of 739 counseling centers were utilized in this study, which included 62 (8.4%) two-year/community colleges and 677 (91.6%) four-year institutions. The annual renewal survey collects a wide range of data about centers, including broader institutional characteristics, the counseling centers’ affiliations with professional memberships, existing contracts with specific telehealth, peer support, crisis intervention, and screening vendors, policies and practices that are implemented at the center, and information pertaining to utilization and counselor caseloads (i.e., The Clinical Load Index). In the current study, the institutional status was determined by the counseling center administrators completing the survey. They were provided a comprehensive list of institution types and asked to select all that apply, which included the options of a four-year College/University, two-year college/university, and community college. For the current analyses, the categories of two-year college/university and community college were combined.

Professional Organization Affiliations

Two-year/community colleges were substantially less likely than four-year institutions to participate in professional organizations, including operating an APA accredited internship program, receiving International Accreditation of Counseling Services (IACS) accreditation status, or participating in the Association for College Counseling Center Directors (AUCCCD).

Contracts with 3rd-Party Vendors

Two-year/community colleges were less likely than four-year institutions to contract with third-party vendors who offer traditional clinical services, such as individual counseling, psychiatric care, crisis, and intensive outpatient services. However, they were slightly more likely to engage in contracts with industry vendors who offer peer support, coaching, and mental health screening services.

Center Policies and Practices

Two-year/community colleges were comparatively more likely to contain center policies that include session limits for individual counseling, scheduling practices that reduce the frequency of appointments (scheduling bi-weekly or beyond), a full one-hour appointment as the first clinical appointment (compared to a screening-triage system), and participation in a co-responder model where a center clinician accompanies campus safety officials to respond to a crisis. They were less likely to operate with an absorption model of care (staff required to absorb clients in caseload regardless of space available) or have a dedicated staff member for community referrals and case management.

Utilization Rates and Clinician Caseloads

Two-year/community colleges, on average, had clinical contact with a lower proportion (3.8%) of the student body compared to four-year institutions (10.7%).

The Clinical Load Index (CLI) was developed in 2018-2019 to provide a more accurate and consistently comparable supply-demand metric that describes the landscape of counseling center staffing levels. CLI scores can be conceptually thought of as the “average annual caseload” for a “standardized counselor” within a counseling center, or the average number of clients a typical full-time counselor would see in a year at that center. Results from the survey demonstrated that two-year/community colleges were slightly more likely to have higher counselor caseloads (Average CLI = 96) compared to four-year institutions (Average CLI = 93).

Collectively, these somewhat inverse findings indicate two-year/community colleges generally serve a lower percentage of the total student body compared to four-year institutions, while the clinicians working within centers housed at two-year/community colleges have marginally higher annual caseloads of students. Counseling center utilization rates are commonly influenced by residential and commuter factors, and two-year/community typically have higher rates of commuter students, which can reduce their access of services. Additionally, while utilization rates are lower, on average, at two-year/community colleges, clinician caseloads are primarily affected by staffing levels in relation to the actual number of students receiving services.

Takeaways

Summary

College counseling centers housed within two-year/community colleges, compared to four-year institutions, are less likely to be affiliated with professional organizations or contract with third-party vendors for traditional clinical services. However, they are more likely to utilize third-party services that offer non-clinical care, such as peer support and coaching.

Centers operating within two-year/community colleges were comparatively more likely to have traditional one-hour intake sessions as the first point of contact, schedule routine appointments more infrequently, contain service limits for individual counseling, carry slightly higher caseloads of clients, and offer a co-responder model of care where a mental health clinician accompanies police/public safety officials with crises or mental health calls. They had clinical contact with a lower percentage of the general student body and were substantially less likely to have a dedicated staff member for case management within the counseling center.

Considerations

The current study highlighted some notable differences in counseling center characteristics and practices between those operating within two-year/community colleges and four-year institutions. Additionally, a relatively recent national investigation conducted by the American College Counseling Association (ACCA, 2023) offered foundational knowledge regarding the services provided by centers housed within two-year/community colleges. When comparing a specific institution to a national sample of colleges/universities, though, it is critical to understand if the local programs and systems are meeting student needs and/or if there are resources available to address critical disparities. This can be accomplished by conducting needs assessments at your institutions to identify areas of concerns, completing an inventory of existing resources available that might address the areas of need, and conducting an evaluation to determine if the available services are providing the necessary support to students. It is important to be cautious and considerate about making significant decisions regarding policies and practices at an institution based on the national findings presented in this analysis.

Given the gap in affiliations with professional organizations, such as AUCCCD and IACS, two-year/community colleges might consider investigating the benefits of professional memberships. AUCCCD is a professional organization dedicated to promoting counseling center director development and success, and IACS allows centers to validate compliance with best practices and strengthen operations as needed. Moreover, the investment of connection with professional organizations, in general, can have tremendous positive impacts on the college/university community, counseling center staff, and importantly, the students they treat. If your center is interested in exploring AUCCCD and/or IACS membership, they can be contacted here:

Counseling centers operating within two-year/community colleges and four-year institutions differ, on average, in several critical areas of center practices: At two-year colleges, they provide treatment to a substantially lower proportion of the student body, while clinician caseloads are slightly higher, the dose of services is more diffuse (i.e., meeting bi-weekly), clinicians are more likely to serve as co-responders to mental health crises with public safety officers, and the centers are less likely to have a dedicated case manager. Based on these key differences, the following are important considerations pertaining to the counseling center and adjunctive support services offered at two-year institutions:

There is a potentially significant portion of the student body at two-year colleges who might not be receiving needed mental health services. Therefore, it could be important for those institutions to better understand the comprehensive mental health needs within their student population through robust information gathering, such as general student body screening practices. Many colleges implement these mental health screens through surveys such as The Healthy Minds Survey, Hope Center Survey of Student Basic Needs, or the Counseling Center Assessment of Psychological Symptom (CCAPS) – Screen via CCMH.

Centers at two-year colleges are offering appointments less frequently than four-year colleges. While this practice might be appropriate based on local systems, center staffing, and student schedules, research conducted within four-year institutions research has discovered that infrequent dosage can be less effective in improving students’ symptoms, which in turn, can negatively affect persistence in school (Trusty et al., 2024). Although two-year/community colleges may have established short-term service models with an efficient referral process to community and external providers, it might be important to consult with the counseling centers to determine whether their treatment model is providing the necessary level of care that students need to be successful, including if service expectations of the collegiate community are appropriately aligned with the current staffing levels of the center (CCMH, 2021).

Centers housed within two-year/community colleges are operating within a co-responder model, where they are either assisting public safety officials or directly responding to mental health crises calls, at double the rate of four-year institutions. When considering the collective needs of the campus community, the various roles clinicians are being requested to perform should be carefully considered to determine if policies/practices are aligned with the institutional priorities, comply with best practices and standards of care, appropriately include buffers that prevent clinician burnout and moral injury, and invest necessary resources to serve all areas of essential need.

If it is determined that more mental health treatment capacity is needed at two-year institutions, additional on-site counseling center staff could be considered. The Clinical Load Index is a CCMH tool that can help centers plan for staffing needs based on demand for services. As previously described, demand for services differ between two-year/community colleges and four-year institutions where a lower proportion of students at two-year/community colleges seek services at the center. Demand differences can be attributed to numerous factors, such as work and travel schedules, familiarity with services, and other barriers to care. Partnering with a telehealth vendor that is familiar with higher education could be an additional option, which could be particularly helpful for students who might commute, have numerous scheduling conflicts, and experience other obstacles to accessing treatment.

Case Managers serve a critical and specialized function at counseling centers by connecting students to necessary clinical and non-clinical resources, and centers within two-year institutions are substantially less likely to have these dedicated positions. While counselors might currently fulfill this challenging dual role of therapist and case manager at many two-year colleges, increasing staffing for dedicated case management services could help students access needed comprehensive care, as well as improve their likelihood of success in school. Given how many students with mental health challenges also face basic need insecurity (CCMH, 2025), coupled with the fact that rates of basic need insecurity are higher at two-year institutions compared to four-year institutions (The Hope Center for Student Basic Needs, 2025), further case management capacity could be an important addition to two-year institutions.

Although the sample size of 62 two-year/community colleges used in the current study was considerable, there was only a very small subset of these schools who provided CCMH with deidentified clinical data to make comparisons. If more student level data becomes available at two-year/community colleges in the future, it will be critical for further research to examine different in student symptoms and concerns between the types of institutions.

References

American College Counseling Association (2023). Community College Survey. Retrieved: https://www.collegecounseling.org/page-18283

Ammann A, Rhodes T, Choi, S, Abelson S, Smith SN. 2024 Michigan Mental Health Landscape Report. Mental Health Improvement through Community Colleges; 2025. https://mentalhealthcc.orgCenter for Collegiate Mental Health. (2020, January). 2019 Annual Report (Publication No. STA 20-244).

Center for Collegiate Mental Health. (2020, January). 2019 Annual Report (Publication No. STA 20-244).

Center for Collegiate Mental Health (August, 2021). The alignment model: Using the Clinical Load Index (CLI) to guide counseling center staffing. Retrieved: https://ccmh.psu.edu/index.php?option=com_dailyplanetblog&view=entry&year=2021&month=08&day=20&id=18:the-alignment-model-using-the-clinical-load-index-cli-to-guide-counseling-center-staffing

Center for Collegiate Mental Health. (2026, January). 2025 Annual Report (Publication No. STA 26-012)

Community College Research Center (December, 2025). An introduction to community colleges and their students.

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McAleavey, A. A., Youn, S., Xiao, H., Castonguay, L. G., Hayes, J. A., & Locke, B. D. (2019). Effectiveness of routine psychotherapy: Method matters. Psychotherapy Research, 29(2), 139-156. doi.org/10.1080/10503307.2017.1395921

Sontag-Padilla L, Williams D, Kosiewicz H, Daugherty L, Kane H, Gripshover S, Miller T. Supporting the Mental Health Needs of Community College Students. Rand Health Q. 2023 Sep 15;10(4):6. PMID: 37720074; PMCID: PMC10501829.

The Hope Center 2023-2024 Student Basic Needs Survey Report. (February 26, 2025). The Hope Center for Student Basic Needs at Temple University.

Trusty, W. T., Scofield, B. E., Janis, R. A., Cummins, A. L., & White, T. D. (2024). Psychotherapy dose, clinical outcome, and academic withdrawal at university counseling centers. Psychological Services. Advance online publication. https://dx.doi.org/10.1037/ser0000895

Authors:

Brett E. Scofield, Ph.D. is the Associate Director at Penn State Counseling and Psychological Services (CAPS) and Executive Director at Center for Collegiate Mental Health (CCMH).
Sara Abelson, Ph.D. is an Assistant Professor in the Department of Urban Health and Population Science at Temple University Lewis Katz School of Medicine and a Senior Director at The Hope Center for Student Basic Needs.

Published March 30, 2026

Updated April 2, 2026