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PREPARING FOR COLLEGE
Elizabeth Gobbi MD FAPA, Staff Psychiatrist Northwestern University offers suggestions for parents and high school students preparing for college.
High School Graduation ≠ Graduation from Treatment
University counseling centers tell us that many college students who "crash" or relapse in college during freshman year and require time off for treatment would have been successful if their treatment hadn't been interrupted. By planning for "continuity of care", (ie the coordinated hand off from one professional to the next) families can exponentially increase the chances of their son or daughter having a successful transition to independent adult living in college. The following is a list of students who should strongly consider planning for treatment in college:
- Students psychiatrically hospitalized in high school (with a special emphasis on hospitalization within a year of graduation)
- ALL Students on psychotropic medication
- Students treated for eating disorders in high school
- Students treated for substance abuse in high school
- Students diagnosed with bipolar disorder or who had a psychotic episode (including schizophrenia)
- Students who had a suicide attempt or history of self- injury in high school
- Students "unable to cooperate with their own treatment" in high school
- Students who went untreated in high school (depression, eating disorders, etc) because of family's cultural bias against mental health treatment
- Students who received "special services" in high school
Families Need to be Educated (These are not good reasons for stopping treatment)
- Therapists often "side" with the student in planning a "graduation" from treatment. This may be a lack of knowledge on the part of the therapist about the multiple layers of stress in college; competitive academics, pressure to keep up grades to get into graduate school, social pressure to binge drink and "hook up", etc.
- Students have a tremendous fear of getting to know a new therapist or doctor (especially if they've been happy with the old one).
- Students always "promise" they'll get back into treatment "if there's a problem"
(College counseling centers tell us that even a heartfelt promise may result in a long delay before a student recognizes the problem. A student may not seek help until after academic failure, OR until the emotional issue results in a disciplinary problem. Colleges have supports in place, but a problem is necessary to trigger their intervention ).
- Parents are tired: tired of paying for treatment, tired of arguing with their child about treatment, tired of guiding, shaping, setting limits.
- Everyone wants to "turn a new leaf", "start over", "Be Normal" in college.
What is a Family to do???
Comeup with a plan!! "Hoping for the Best" is not a plan. "Doing the minimum or nothing until there is a problem" is not a plan.
- Reasearch treatment options at college
- Do the math (if a family "cannot afford medical insurance or treatment" at a given school, they've chosen the wrong school!)
- Consider the big picture when choosing a school (ie, factors other than US News Ranking, and SAT/ACT scores)
I. Good University/College Counseling Centers
- Have a culturally diverse staff.
- Educate professors, coaches about services so that they become part of the "safety net".
- Provide Consultation/Liason to professors and administrators.
- Have a policy/procedure regarding "medical leaves" (ie leaves from school for psychological reasons). Does the school provide tuition refund if a student needs to withdraw in the middle of the semester? What is the "medical clearance process" for returning students?
- Provide workshops and "developmental programming" on things like "stress management", "coming out", "body image", "long distance relationships", "breaking up is hard to do", "communicating with confidence" (assertiveness training), "emotional intelligence", "reverse culture shock" (for students returning from study abroad) etc.
- Provide outreach programming to special populations (student athletes, multicultural students less likely to seek services on their own, fraternities, etc.).
- Have psychiatrists on staff (provide medication monitoring).
- Often have an "APA (American Psychological Association) accredited training program", or psychiatry residents.
- Provide or work with a "health education program" to provide programming around sexual health, decreasing binge drinking, etc.
- Involve students in a "Student Advisory Board", or "Peer counseling program" (What is the supervision of peer programs?)
- Participate in training residence hall staff, participate in new student orientations across campus (including graduate schools).
- Work with the Administration/Dean of Students to provide "mandated assessments" when a student is identified as having a problem. Most do not provide mandated treatment.
- Offer "crisis services" through some kind of "after hours on call" or hotline.
- Offer therapy groups.
- Provide a "robust website" in order to reach students who have a hard time walking in for services
- Have some kind of a "central tracking system" to follow high risk students ("Severe and Urgent" list, "Morning Report", etc.)
- Have a relationship with local hospitals and clinics to refer students who need more intensive services.
- Coordinate treatment between multiple providers when that is the standard of care (ie for a student with an eating disorder, coordinate treatment between a physician, therapist, nutritionist, and psychiatrist)
Students who have used "more intensive services" such as hospitalization, eating disorder treatment programs, substance abuse treatment programs, partial hospitalization ("day hospital"), DBT (Dialectical Behavioral Treatment) programs, 12-Step programs, etc. should be researching the availability of these services in the college community.
II. Do the math! (Families need to ask about these issues when initially "checking out" colleges):
- What is the price of student health insurance, deductible, co-pays, etc.
- Does the student insurance include mental health benefits?
- Does the family insurance have benefits out-of-state?
- Should a student with a history of psychological treatment consider buying student insurance in addition to parent's insurance?
- Should the family appeal the financial aid award to cover the price of medical insurance or treatment if the student needs that?
- Does the college counseling center charge a fee?
- Is there a session limit?
- Can you pay for extra sessions after reaching the limit?
- Does the insurance cover prescriptions?
- Is prescription coverage "tiered" (ie one co-pay for generic, one copay for preferred meds, high copay for newer expensive meds, some meds not covered at all?)
- Does any insurance cover treatment for a student doing an internship in another state, study abroad?
III. Look at the big picture (beyond college rankings)
- What are campus resources; including mental health?
- What are the community mental health resources?
- Are there special programs for students with Learning Disabilities, ADD?
- Student body size
- Can parents visit for a weekend to see how things are? (financial concerns)
- What is the availability of social activities outside the Greek system. Can a student "fit in", "feel accepted" without belonging to a sorority or fraternity (both of which may have issues with binge drinking )?
- Is there availability of freshman dorms, substance free dorms?
- What is the age and training of residence hall staff ?(BIG difference between a college junior living in the dorm as a "Residence Assistant" vs. a grad student or other adult living in the residence hall as residence hall staff).
- Semester System vs. Quarter System (The quarter system is very unforgiving if a student has a setback and cannot function for a week or two).
- Is there a smoothly operating campus judiciary (increases the likelihood of problems being handled quickly and fairly before a situation is "out-of-control")?
- Is there a Parent Orientation?
- Is there Minority mentoring/outreach?
What Can Families do to Prepare?
I. Encourage parents to teach their students how to take charge of treatment during senior year of high school (just as they should be teaching students to wake themselves up for school, do laundry, balance a checkbook, balance homework and internet time, ask for help at school on their own etc.).
- Students should call therapists and doctors by themselves to schedule appointments (including cancelling in advance to avoid being charged for a missed appointment).
- Students should drive themselves to appointments.
- Students should be able to take medication on their own.
- Students should pick up refills at the pharmacy.
- Students should fill out forms for mail-order pharmacy and send in refill requests.
II. When is parent involvement in college Healthy?
- If your student should be in therapy for at least the first semester of college, make sure it happens!
- Ask the College Counseling Center if they treat the problem your student has.
- If they don't, or if services are severely limited, ask "Which therapist/psychiatrist in the community would you refer a member of your family to?"
- "Switching therapists/treatment providers" is ALWAYS a problem. If your student needs long term treatment (for a problem like bipolar disorder or an eating disorder), DO NOT plan to "use the 12 free sessions at the college counseling center, then switch to a community provider". This goes back to "Do the Math" on finances.
- Consider going to meet the therapist with your student during new student week (which would involve calling the community therapist or college counseling center a month before arriving).
- Ask to sign a "limited release" so that you can be told if your student misses multiple appointments, drops out of treatment, or is in danger (if a "safety risk" exists). This allows the student to keep private their love life!
- Make sure releases are signed at home and at school for the old therapist/psychiatrist to talk to the new therapist/psychiatrist.
- Make sure the student goes to disability services if needed.
- Educate yourself about campus and community resources. Go online.
- Consider "adjunctive treatment" (such as an eating disorder group, AA, etc., if there is any reason to believe a student needs it).
- If there are "sneaking suspicions" that a graduating senior has a problem (depression, an eating disorder, binge drinking, etc) get an evaluation before college, and DO SOMETHING!
- Consider deferring college for a year for students who are not stable. (ie. students whose medication is still being adjusted, students with recent suicidal or self-injurious behavior, students in an eating disorder or substance abuse disorder that has not been in remission for a year before college, students recently (within the last year) diagnosed bipolar, schizophrenic, etc. AS WELL AS all students who simply have not been able to cooperate with taking medication or engaging in treatment.)
- Visit "at risk students" in October (ie don't wait for Thanksgiving break!)
- If the student is in treatment fall semester and then wants to "graduate out of treatment", ask to meet with your student and the therapist in order to understand if this decision is really advisable (This can occur by having a conference call with the therapist with the student in the office on speaker phone.)
- Do not invoke the "No Backsies Rule" (in other words, if your student needs a medical leave for psychiatric reasons to regain stability, or stay alive, help make that happen.)
- Talk to your child about the difference between being a helicopter parent, and concerned about their health and safety.
III. What can students do to prepare?
Students do not "flunk out of college" because they're not smart enough: they leave because of a "deficit of emotional intelligence", ie they did not take good enough care of themselves, and did not seek help in a timely way.
Multicultural students whose family and/or cultural are not educated about psychological concerns and available "help" (treatment) are at special risk (including students whose religion advises against using the services of mental health professionals).
All High School students need to be educated about
- The importance of "self care" at college.
- Sleep deprivation unglues many college students.
- Nutrition matters!
- "Recreational substance use" often results in unprotected sex, missed classes, ( not to mention legal problems, accidental injury, date rape, etc).
- All students will benefit from an "exercise program".
- Don't suffer alone! Don't wait! Successful students educate themselves about campus resources at college , and take the initiative to use them.
- Counseling and Psychological Services
- Career Services
- On campus tutoring (usually at multiple sites)
- Disability Services (students are required to "self-identify" a disability in order for a university to be legally required to provide accommodations, including for ADD...)
- International student center (legal help, tutoring, etc.)
- Multicultural Center (campus resources including mentoring, programming, assistance meeting dietary needs etc.)
- Religious organizations for students where this has been a big social support in the past.
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