Margaret Higham, MD (Tufts University) Margaret Ross, MD (Boston University) Tanya Sullivan, FNP-BC (Wellesley College)

 Margaret Higham, MD ◦ Medical Director of Tufts University Health Service  Margaret Ross, MD ◦ Psychiatrist, Director of Behavioral Medicine, Boston University  Tanya Sullivan, FNP-BC ◦ Associate Director, Wellesley College Health Service

 Late 2011 hospitalized with acute mania  New meds, needing blood levels checked  Mother with newly diagnosed illness  He wants to go to the other side of the world….

 Identify the dilemmas faced by travel abroad programs in managing complex medical and mental health conditions among participants  Describe processes and protocols at two universities to proactively identify medical and mental health conditions which might impact a student’s experience abroad

 Discuss real life examples to illustrate how the principles above may be put into action  List some guiding principles  Discuss some open questions: ◦ Can you prevent a student from going? ◦ How much information may be shared with SA programs? ◦ What are the values of consent forms and contracts? ◦ How and when do you bring the family into discussion?

 Study abroad has become “expected”, a selling point for the college, a “perk”  US commitment to accommodation and inclusion (Americans with Disabilities Act)  Millennial Generation of Students  The Shrinking Globe  HIPAA, FERPA, issues of confidentiality  Insurance issues

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs Where are the possible points of INTERVENTION ?

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs ANTICIPATORY GUIDANCE

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs TARGETED ANTICIPATORY GUIDANCE

 Point of Intervention:  Health and Counseling Letter to Applicants  “Clearance process” overview  Website links  Deadlines  Accountability

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs

 Pre-Travel Health Screening Form  Consent / Authorization through Study Abroad Office, Health & Counseling  Chart review/ clinician visit ◦ Student and destination dependent

 Clinician visits ◦ Nontraditional or developing countries ◦ Medical +/- mental health needs  OR  RN Chart Review & Clearance ◦ Uncomplicated & low risk  Mental Health Referral ◦ Clinician initiated ◦ Consent form  Outside Clinician Option ◦ Internal review by Health / Counseling

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs

 Shared spreadsheet maintained by Office of International Studies  No medical/MH details shared  Consequences of noncompliance- ◦ study abroad process placed on hold  Identification of resources

Created and Managed by Office of International Studies- Google Drive Program App Submit Date Health Form Health Clearance Stone Clearance Leave Form Pre- Departure Quiz Contract & Waiver due 6/15/13 due 10/1/13 due 11/1/13 due 6/15/13 9/12/13 9/15/13 X due 11/1/13 due 6/15/139/12/139/15/1310/15/13RECEIVEDPASSEDRECEIVED

 10 Sites, Over 350 Tufts Students  Students Required to have “Physical Exam”  Step back, Re-evaluate!

 Provide necessary site specific info  Identify medical issues needing accommodation  Appropriate use of scarce resources  “Do Something” about mental health

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs ANTICIPATORY GUIDANCE

 General information  Site specific information  Highlight significant LIMITATIONS

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs “Medical Evaluation”

 Basic Advice for All—more efficiently  Identify Vulnerable Students  Individualized in Depth Assessment  Development of Individualized Support Plan

 Different presentations depending on destination  Structured Power Point  Health Risks/Health Resources  Identify Vulnerable Students  Getting Students to Attend

 Student Medical Questionnaire  Mental Health Consultation Process  Distribute AT Group Visit

 What Supports/Accommodations Needed?  Be realistic—Not the Same as in US  Housing Accommodations?  Academic Supports?  Local Specialist?  How to Get Medications?

 Not “Clearance”  “CONSULTATION”  Goal is to Anticipate Needs, Provide Supports  Clinician Introduced, Normalized  FAQ for Mental Health Included

 The Student Doesn’t Disclose?  Counselor Doesn’t Think Student Should Travel?  …Sometimes We Can Talk a Student Out of Going Abroad

Student Researches Study Abroad ApplicationAcceptance Study Abroad Office Information Student Departs CLOSING THE LOOP

 What is their Value?  Pros and Cons  Case Example

 Disability Service  Program Director  Outside Providers  General Counsel  Colleagues

 Can you prevent a student from going if they really want to?  How much information can Health and Counseling Services share with Study Abroad Programs?  What are the values of consent forms, and contracts?  How and when do you bring the family into the discussion? When do you bring the student home?

Relationships Individualized assessment and planning Interdisciplinary Communication Systems Policies & procedures Pre-Departure planning team Harm Reduction Cannot always prevent disaster CAN reduce risk

Tanya Sullivan, FNP-BC Margaret Ross, MD Margaret Higham, MD