MATT GENTRY The Roanoke Times

Thomas E. Cook Counseling Center Director Chris Flynn and staff counselor DaHyun Chun talk about the center's new facilities in the New Town Shopping Center on Prices Fork Road.

MATT GENTRY The Roanoke Times

Chris Flynn, director of the Thomas E. Cook Counseling Center at Virginia Tech, helped establish changes after the shootings.

BLACKSBURG -- With about 4,000 undergraduates receiving diplomas this weekend, Virginia Tech's student body will shift further away from the group that was on campus during the April 16, 2007, shootings. But one person at the center of the incident's aftermath continues to have his job shaped by it some two years later.

"The tragedy at Virginia Tech has changed the face of college mental health across the United States and the world," said Chris Flynn, director of Tech's Thomas E. Cook Counseling Center. "If I had a nickel for every time someone said 'post-Virginia Tech,' I'd be a wealthy man."

Senior Conor Bracken noticed the change firsthand. He visited the center as a freshman in the spring of 2006, had a few discussions with a counselor and stopped going. When he returned to the center in the fall of 2007, he said, he noticed more students in the waiting room and a new atmosphere.

"Due to the shooting, it seemed that everyone was a lot more sensitive, in a good way," he said. "Not that they weren't before. But it was definitely more pronounced."

Flynn, who became director of the center in 2006, can point out more than a dozen changes since Seung-Hui Cho killed 32 people and himself -- from the way center employees communicate with those inside and outside the university to the size of its staff to procedures for dealing with troubled students.

But the changes don't stop with Virginia Tech.

"I can't think of anything in my professional lifetime that's been bigger," said Terry DiNuzzo, president of the International Association of Counseling Services, which accredits university counseling services.

DiNuzzo, who has been in counseling for 30 years and is counseling center director at the University of North Florida in Jacksonville, said the shootings refocused attention on counseling resources and communication about troubled students.

Tech is trying to regain its accreditation from IACS after going several years without it. One change that should help is the addition of five counselors, which moved the counselor-to-student ratio at Tech to 1 per 1,800. The association's standard is between 1,000 and 1,500 students per counselor with the most recent IACS survey pegging the national average at 1,906.

"We have to make sure that we have enough staff so that we don't have waiting lists where students might fall through the cracks or might not be seen in a timely way," DiNuzzo said.

Direct questions

Much of the criticism directed at Tech since the shootings was that Cho fell through the cracks despite multiple encounters with Cook's staff.

Named as a defendant in two lawsuits filed by victims' families last month that claim Tech did not do enough to stop Cho from his rampage, Flynn said he could not address the legal claims. But he did discuss changes at the center and the effects he believes they have had.

Students who seek counseling are seen within 24 hours, Flynn said. A larger staff allows for longer, in-person "triage" appointments -- initial meetings to gauge a student's level of distress and plan treatment.

Records of Cho's triage appointments were lost or destroyed -- a point emphasized in the lawsuits. Today, such records are stored electronically at Cook.

Bracken didn't go into detail about the issues affecting him but said he was neither suicidal nor a threat to others.

He said he knew people wounded and killed in the shootings, which "just kind of threw my whole conception of the world into a tizzy."

But he didn't have to bring the shootings up during his triage. The counselor asked about them in a straightforward way, which conveyed to Bracken a sense of urgency.

"They tried to get to the heart of what the problem was a little faster," he said. "There were definitely more direct questions."

Clarifying code

The new counselor positions and the addition of a case manager position have helped close some communication gaps that a state panel report on the shootings says led to a failure to "connect the dots" about Cho. The case manager is responsible for follow-up on students and communicating between the center and a team of Tech officials that meets to discuss troubled students.

DiNuzzo said schools throughout the country are forming these centralized teams of officials to deal with troubled students. Tech had one team in place at the time of the shootings, dubbed the Care Team. It has since added a threat assessment team to deal with students deemed to be a possible danger to themselves or others. Threat assessment teams are now mandated by Virginia law for the state's public universities.

Communication with groups outside the university is another focal point in reports on the shootings as well as the lawsuits, which names Harvey Barker, executive director of the New River Valley Community Services Board, as a defendant.

Barker said his agency has a stronger relationship with Cook today than it did two years ago. Cho came to the attention of the board in December 2005 after reports that he was suicidal. He was screened by a mental health professional, who recommended he be hospitalized. After spending a night in Carilion Saint Albans Behavioral Health, Cho was discharged and received a court order for outpatient therapy that he never received.

State code was changed after the shootings to clarify the mandatory treatment process, and Barker said a board representative is at every commitment hearing. Cook will now see students ordered for mandatory treatment through community services, something it did not do before the shootings.

The new state code spells out specific timelines and responsibilities in the treatment process and gives providers and agencies more opportunity to work together. But there are still enforcement and tracking issues involving outpatient commitments, and the cumbersome law makes mandatory outpatient treatment an unattractive option, Barker said.

"Clarifying the outpatient law gives a false sense of security," he said. "It helps, but it doesn't guarantee anything."

Increased demand

After the tragedy the number of students visiting the counseling center increased, as Flynn anticipated. They plateaued this year after a significant jump in 2007-08, but the number of visits per student continues to climb. Flynn said he sees this as a positive sign that highlights the increased availability and effectiveness of the counseling.

The center is also attempting to reach out more to faculty who have concerns about students. Many of the complaints in the lawsuits echo criticisms in a recently released book on the shootings written by Tech English professor Lucinda Roy. In "No Right to Remain Silent," Roy expresses frustration at what she saw as a lack of response to concerns she and colleagues passed on to officials at the center. Flynn said faculty help determine the state of mind of a patient and factor in to assessments.

More information is flowing to the center from outside the university as well, Flynn said. The university's student orientation now emphasizes to parents the importance of sharing information about their children with university officials. Schools systems have been quicker to alert the university about concerns they have with students about to enroll at Tech.

But the nature of the information and client confidentiality still impede communication. Flynn said that private counselors, for good reason, are loathe to have information about their clients tracked.

"If they had a problem in elementary school it doesn't mean they'll have a problem when they're in college, and so they don't want it to become part of a student's record all the way through," he said.

While federal privacy laws received a lot of attention since the shootings, Flynn said they've always allowed for communication in emergencies.

"In a health and safety emergency we're not bound or restricted by any law," he said. "In fact, the law actually mandates that you do whatever is necessary to get the student help."

But a tragedy on the campus in January served as a reminder that laws and additional resources guarantee nothing.

Tech doctoral candidate Haiyang Zhu was charged with first-degree murder related to the death of another student on Jan. 21 in the Graduate Life Center. A search warrant affidavit filed days later revealed Zhu had visited the counseling center.

Flynn would not comment on Zhu or his visit to Cook but said officials cannot prevent all deaths from occurring, no matter how vigilant they are.

"But you want, we certainly, we would love for there to never be another suicide or homicide by a Virginia Tech student," he said. "That's clearly our goal. You want to do everything that's humanly possible to protect the students."