1. What? Me Worry?! Anticipatory Guidance for the College Bound Adolescent with a Mental Health Disorder
AANP Presentation
Susan J. Calloway, PhD, FNP-BC, PMHNP-BC
Frontier Nursing University

2. I have no conflicts of interest to disclose
Disclosures
I have no conflicts of interest to disclose

3. Objectives
Analyze challenges facing the college bound adolescent with a mental health disorder
Identify factors which should be considered when selecting a university
Describe self-management strategies for the college bound adolescent
Utilize a worksheet to provide guidance to the adolescent

4. College student mental health
Suicide is the 3rd leading cause of death of college students CDC, 2012
43.8% of college students reported treatment for a mental health disorder either currently or in the past Kessler, et al, 2005
45% of those with a mental health disorder met criteria for 2 or more disorders with severity & co-morbidity correlated Kessler, et al, 2005
What is transition care? Blum RW et al 1993
The purposeful, planned movement of adolescents & young adults with chronic physical & medical conditions from a child-centered to an adult-oriented health care system.” Society for Adolescent Medicine

5. College student mental health
73 % of students with a mental health condition experienced a mental health crisis on campus. Yet, 34.2 % reported that their college did not know about the crisis NAMI, 2012

6. College student mental health
75% of lifetime cases of mental health conditions begin by age 24 NIMH, 2005
64 % of young adults who withdrew from college or did not attend cite a mental health issue as the cause NAMI, 2012

7. College student mental health
Depression, bipolar disorder and posttraumatic stress disorder are primary diagnoses of these young adults
40 % of students with diagnosable mental health conditions did not seek help.
57 % did not request accommodations
NAMI, 2012

8. Case Presentation-Megan
17 years of age
H/O eating disorder, depression & anxiety
Treated with an SSRI for 5 years
CBT for 4 years

9. Megan’s Current State of Mental Health
In top 5% of class academically
Lead in school musical
Year book editor
Show choir chair
Forensics awards
Volunteer at summer youth camps

10. Why anticipatory Guidance/Transition Care?
“Success depends upon previous preparation, and without such preparation there is sure to be failure.” Confuscius
Adolescents with chronic conditions at higher risk in transitioning to adult health care. Rosen, et al. 2003
Each adolescent & family should have a coordinator & advocate who helps to facilitate the transition experience. Rosen, et al, 2003

11. Two Focus Areas for Guidance
Evaluating external support systems
Evaluating internal support systems
University policies
& services
Community services
Self-management skills
A.G. should begin when the high school student begins to investigate different colleges & universities

12. External Support Systems
1. The geographical distance from home &
accessibility of public transportation
2. Are students required to live in a dormitory
setting?
3. How much privacy will the student have? Any
requirements related to noise level?
4. How are roommates assigned/process for
changing roommates?

13. External Support Systems
5. Mental health training for staff?
6. Suicide prevention programs?
7. Peer-run student mental health
organization?
8. Mental health information during
orientation, campus-wide events?
Students have emphasized the critical need for the following services and supports to be available on campus:23
Mental health training for faculty, staff and students
Suicide prevention programs
Peer-run, student mental health organizations
Mental health information during campus tours, orientation, health classes and other campus-wide events
Walk-in student health centers, 24-hour crisis hotlines, ongoing individual counseling services, screening and evaluation services and comprehensive referrals to off-campus services and supports

14. 9. Office of Student Disabilities
a. Qualifications of the director b. What services/accommodations are provided for students? c. Requirements for registering a student disability? d. When does this form need to be submitted frequency of renewal?

15. . The Office of Student Disabilities Contd.
e. How are faculty notified of the disability &
required accommodations?
f. The type of formal training of faculty re: student
disability accommodations
g. The type of formal training given to residence
hall directors re: students with mental health
issues

16. External Support Systems
10. The campus student health center
a. Primary care provider(s) availability
b. Do they treat mental health disorders
c. Are they willing to refill medications prescribed by someone else?
d. Availability of a PMHNP or psychiatrist

17. External Support Systems
11. The campus counseling center
a. Integrated within the university health center ?
b. Number & qualifications of therapists/ counselors
c. Is the counseling center accredited?
d. Approximate wait time for an appointment?
e. How are appointments made?
f. Do student workers have access to client records? Calloway , Kelly, Ward-Smith, 2012

18. External Support Systems
12. Where is the nearest support group such as AA?
a. Is there an AA group on campus
b. Are there campus activities designed to support the student in recovery?
13. Where is the nearest pharmacy?
Do they deliver to campus?

19. Internal Support Systems; Self-Management Strategies
1. Encourage the adolescent to begin making own appointments
2. Make sure there is private time allocated during the office visit without the parent, regardless of presenting health issue
3. Begin developing habit of tracking mood
The Optimism App
4. Encourage self-management of medication adherence & med refill requests

20. SELF-MANAGEMENT STRATEGIES
5. Assist in Identifying internal factors that suggest high risk for declining mental health, ie. lack of sleep, missing classes, disordered eating
6. Sleep hygiene
7. Avoiding high Cho, high fat foods
8. Limit ETOH Intake- No >2 Drinks 2X/ Wk For
Females & 3 Drinks 3 X/ WK For Males

21. SELF-MANAGEMENT STRATEGIES
9. Responsible sexual practices
10. Self-advocacy with faculty, Office Of Student
Disabilities, Director Of Student Life
11. Importance of maintaining a schedule
12. Provide electronic resources such as mood tracking apps,relaxation strategies, on-line CBT, Mindfulness activities
13. Provide a method for the adolescent to contact you

22. SELF-MANAGEMENT STRATEGIES
14. Schedule an appointment with a counselor soon after arriving on campus & schedule follow-up appointments
15. Obtain a copy of medical record & bring to student health center
Join at least one campus
organization

23. F/U of Christy two years after starting college
Christy did not receive anticipatory guidance
Began losing sleep, eating sporadically
Her depression & anxiety worsened
She started failing classes due to absences
The university’s counselor at told her to “get her act together” when she went for help
So what will be your response to Pat Summit today?

24. F/U of Christy two years after starting college
The office of student disabilities did not view a mental health disorder as a viable disability & would not advocate for her
She made an unsuccessful suicide attempt
She transferred to a large university with
numerous support systems &
completed her degree

25. Questions?

26. References
Arnett JJ. (2011). Emerging adulthood(s): the cultural psychology of a new life stage. In: Jensen LA, ed. Bridging Cultural and Developmental Approaches to Psychology: New Syntheses In Theory, Research, and Policy. Oxford, UK: Oxford University Press,
Calloway, S., Kelly, P.J. & Ward-Smith, P. (2012). Barriers to help-seeking for psychological distress among rural college students. The Journal of Rural Mental Health, 36(1), 3-10.
 Centers for Disease Control (2012). Retrieved from

27. References
Cooley WC, Sagerman PJ; American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians; Transitions Clinical Report Authoring Group (2011). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 128(1),
Kessler RC, Chiu WT, Demler O, Walters EE.(2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6),
National Alliance on Mental Illness (2012). College students speak: survey report on mental health. Retrieved from

28. References
National Institute on Mental Health (2005, June 6). Mental illness exacts heavy toll, beginning in youth. Retrieved from news/2005/mental-illness-exacts-heavy-toll-beginning-in- youth.shtml.
Rosen, D.S., Blum RW, Britto, M., Sawyer, S.M. & Siegel, D.M. (2003).Transition to adult health care for adolescents and young adults with chronic conditions. A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33,