Insider’s Guide: Review of “The Sneaky Way Colleges Try To Sell Students Health Insurance”

This is a review from the article The Sneaky Way Colleges Try To Sell Students Health Insurance
by Ann Brenoff at the Huffington Post from October 10, 2017. Here are the Highlights:

  1. Students must have insurance to be in school. Not only do students need insurance, they need insurance that meets the school’s minimum coverage standards. This standard is different from school to school.
  2. College health plans are often already on the tuition bill. This is a classic aggressive marketing technique of forcing a customer to opt-out rather than opting in. Students must request a waiver if they have insurance that already meets the school’s requirements. A request is just an application, not a guarantee the student will be granted the waiver.
  3. Waiver’s must be requested every year. That’s right folks, not only do you have to opt-out from insurance, you have to opt-out each year.
  4. Premiums vary from campus to campus and can inflate the cost of going to college significantly. There is no standard for premiums. The average cost is $1,500 and $2,500 per year.
  5. There is often little choice. Schools often have one or very few health plans and often have health centers who do not accept anything other than the insurance they sell.
  6. Rules for waivers vary. Some schools want to see low in-network deductibles while others want to ensure there are adequate in-network providers in the school’s area.
  7. Students can take out loans (or use scholarship money) for insurance. Since insurance is a line item right next to tuition, loans and scholarships are fair game for paying for insurance.
  8. Big impact on students if the Affordable Healthcare Act changes. If the employer mandate or the coverage for kids 26 and younger is removed, the burden of insurance will pass from the large employers to the students and their families.

My opinion of the article and it’s focus is that students should definitely be mandated to have insurance while at school but there should be government oversight for what insurance is offered, how it’s disclosed to students and what provider options exist in the school’s area. Right now college insurance seems like the unregulated wild west and most families don’t even realize it. When we pay for something, we should have a right to know what we’re paying for and not be forced to opt-out. Often, this insurance payment is in addition to a ‘Health Fee’ which covers minor health and wellness interventions. For example, here at Indiana University’s counseling center (CAPS), there is a $30 fee for each session during each semester after the first two ‘free’ sessions. IU does not accept insurance and offers to provide an itemized invoice that can be sent to a student’s insurance company so the family can be reimbursed.

I recommend that if you have a kid that’s heading off to college next Fall and will likely need healthcare support for medical or mental health, do your homework to find out whether their health centers accept your insurance. Research how to complete the waiver and make sure you know how much out of pocket healthcare expenses could be.

Anxiety and 7 Ways to Help Your Struggling College Kid

As excited freshman or experienced sophomores, juniors and seniors settle in for another Fall semester around the country, I wanted to put together a quick list of 7 things parents can do to hep their college kid suffering from anxiety. It’s scary to put so much freedom and responsibility into the hands of your son or daughter when you know worry and fear is always lurking around social, academic or career decisions. Before I discuss what to do about anxiety, I think it’s important to review some details about anxiety.

Everyone feels uneasy or anxious occasionally like when we are running late for a meeting or got caught doing something we’re not supposed to. It’s a normal.

Anxiety disorders are different than regular, situational anxiousness. They are a group of mental illnesses that are characterized by intensity, duration, origin and how they impact life domains like work/school, relationships, and health.

For people who have an anxiety disorder, worry and fear are constant and overwhelming, and can be disabling. With the correct treatment, most can overcome the anxiety disorder and lead a fulfilling life.

Types of Disorders

Anxiety disorder is a broad category that includes:

  • Panic Disorder. Feeling overwhelming sense of terror or dread that seemingly strikes randomly. During a panic attack, the person may sweat, have chest pain, and feel unusually strong or irregular heartbeats. Sometimes they may feel like they’re choking or having a heart attack.
  • Social Anxiety Disorder. Also known as Social Phobia, this is when someone feels overwhelming worry or judgement while in social situations. They may obsess over others judgment or being embarrassed or ridiculed.
  • Specific Phobias. This is when someone has a very specific fear of something such as spiders, heights or flying. The fear goes beyond what’s appropriate based on actual risk and may cause them to avoid regular situations.
  • Generalized Anxiety Disorder. This is what I see most when working with college students. They describe having excessive, unrealistic worry and tension with little or no reason.

Risks

Early signs of anxiety are super subtle and include distractability, avoidance and sleeplessness. Students with anxiety disorders often report to me that semesters generally start fine but as papers, tests and social pressures mount, their anxiety builds to the point where they start consider drastic changes like dropping out of school. Untreated anxiety can lead to depression, severe drug use and in some instance, suicide. Anxiety and depression seem to be best friends, often presenting together in college students I’ve worked with. 

What to Do

Though anxiety disorders can make someone feel hopeless, there are very effective treatments and interventions we can implement to get their life back on track. Here are the 7 I think are most important for parents to be aware of if they need help with their college kid.

1. Counseling

Right out of the gate, the first thing parents should do is link their child with a) campus health services (often called Counseling and Psychological Services or CAPS) and b) a therapist or counseling like me specializing in college student anxiety in the community close to campus. Ideally, find a therapist/counselor that uses Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT). Waiting until the first big meltdown could be too late. Loads of freshman fail to share their struggles with their parents until Thanksgiving and Christmas which, by then, is too late in their minds and they end up not returning for their Spring semester. Invest the time on the front end.

2. Scheduling

Anxiety is fed by fear. Fear is often the by-product of lack of predictability about social events, academic outcomes, and career failures. One solution is increasing predictability. I accomplish this with students by teaching them to download the semester schedule onto their phone calendars before the semester starts. Next, after they’ve received their syllabi, I coach them to put in every single date for every single assignment/test possible. This also includes social events and any non-academic stuff they know about. This may sound like it could be overwhelming, but I’d rather have them feel a bit overwhelmed when looking at the calendars rather than anxious about remember when that next big thing is due.

3. Resources

Not the most used suggestion but one we have to put here – make sure your son or daughter has a list or access to resources that can help them reduce stressors or mitigate things when they’re already starting to spiral down. These resources could include the academic supports found at nearly every university or within the community. Universities have a vested interest in making sure your son or daughter doesn’t bail at semester’s end. Another form of ‘resource’ is the on-call list. Create a formal or informal list of people they can call/text when they are starting to feel overwhelmed. I am on-call for all of my clients and often receive texts from students the night before big tests asking for help in quiet their brains down. I call them or text back strategies and remind them to call if they want to talk through things in more detail. Just knowing there is a safety net and team of support can have a dramatic reduction effect on anxiety.

4. Medication

I am super conservative with medication use and recommendations for students I work with at Indiana University. But, with that said, we also recognize that some folks simply need a bit more support than what counseling and academic support can provide alone. If your college does not have a psychiatrist on staff, we highly recommend finding one in the local community. We rarely encourage use of primary care physicians or nurse practitioners for medication management since they are not specifically trained to diagnose and medically treat those suffering from anxiety. You also want your college kid to work with someone who genuinely understands the risk of some medications that have the potential for addiction. Good kids get hooked on meds the same as bad kids. It’s also important to avoid illegal or non-prescribed drugs (like the roommate’s Xanax).

5. Meditation

I recommend to nearly every client to start participating in weekly yoga, meditation or mindfullness classes. This is an evidence-based approach with only positive side-effects. Plus, every college offers these in their wellness programs for free so encourage your kid to take advantage and put it into the calendar. Meditation, counseling and medication are an incredibly complimentary approach to combating anxiety.

6. Sleep

Not easy when kids have more freedom than ever away from home but we nonetheless push parents to encourage sleep. Not binge sleeping but a healthy 8 hours per night. The ideal for anxiety reduction is a steady sleep pattern so that bedtime and wake time are pretty standard every day. Staying up late on Thursday, Friday and Saturday, sleeping in till 1:00pm and then dragging out of bed Monday morning for an 8:50am class is terrible for anxiety.  Sleep meds only make things worse and really should only be taken with the psychiatrists oversight.

7. Exercise

Encourage your kid to sign up for the intramural leagues, especially for sports where there is little standing around time. Distraction and flow experience are essential in helping him or her focus on non-academic activities. It’s also a great way for them to be social without needing a drink in their hand.

Ok folks. Hope this helps you figure out the best way to help that college kid who may be struggling as you’re getting through the fear of letting go. It’s an exciting time and, with the right strategies in the beginning, can be the start to a fantastic semester.

Mental Health Support on College Campuses: What Parents Need to Know

Most larger universities like Indiana University (close to where my office is located) have health programs called CAPS which stands for Counseling and Psychological Service. They are often staffed with licensed therapists/counselors and psychiatrists with a range of experience and expertise. Their primary goal is to act as a stabilizing resource for most mental/behavioral health or substance use issues. Many university CAPS typically offer individual, group and couples counseling along with occassional free workshops. Here’s the list from IU CAPS on what they typical help with:

  • Academic Concerns
  • Relationship Concerns
  • Stress Management
  • Power and Privilege
  • Time Management Help
  • Sleeping Issues
  • Adjusting to College Life
  • Anxiety
  • Depression
  • Substance Use
  • Body Image, Eating, and Exercise Concerns
  • Sexual Assault or Abuse

They have the same confidentiality requirements as counselors like me off campus but are limited in many ways. CAPS limits the number of unpaid sessions (IU CAPS allows for two) and mandates that a student must be working with one of their counselors if they want to meet with a psychiatrist for medication management/evaluation. Here’s a breakdown of IU CAPS fees:

COUNSELING  With IU Health Fee  W/O IU Health Fee
First two sessions (per semester) No charge $55 per session
Additional full sessions $30 per session $55 per session
Additional half sessions $20 per half session $35 per half session
Additional group counseling $15 per 60 min. session

$17 per 90 min. session

$29 per 60 min. session

$35 per 90 min. session

PSYCHIATRY
First visit $55 $105
Follow-up visit $30 per visit $55 per visit

IU CAPS does not accept insurance but does provide a super detailed invoice to be submitted to a student’s insurance company for reimbursement.
Over the last few years, I’ve noticed many CAPS programs around the country have had a huge increase in demand for their services while also having budget cuts or mediocre increases that leave them without the full team of professionals they need for each semester. At IU CAPS, every one counselor is responsible for 2,110 students (yikes!). This is not a new problem at IU and not isolated to IU.

So what can a parent or student do? If CAPS doesn’t seem like a good option, look for a therapist/counselor convenient to campus who specializes in college students. Therapists should be flexible to accommodate busy course loads and social events. In my practice, I have extended evening and weekend hours since many students a slammed with class 9-4pm most days. It’s also important that the therapist be willing to talk with parents and provide updates and suggestions. Parents can sometimes feel like their kids are a million miles away. A good therapist can often act as a bridge and lower the anxiety associated with having kids at school.

Finally, talk with CAPS (or encourage your son or daughter to) the first week of school. It’s easier to cancel an appointment than to stand in line after all the students are back on campus. The intake process should be thorough and your kid shoul feel like the therapist/counselor will really understand their issues and help.

How to Prepare Your College Student for the Semester

Holy moly, it’s almost August again and classes are just around the corner. Time to dust off the ‘how to’ guides for parents. Here are a few favorite tips from the last few years that parents have found helpful.

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  1. Organization. Organization is a concept, not a tool. Identify tools they can and will use. Make sure they are using the calendar app on their phone. Have them figure out the best use of online tools the school provides. Many students need the help of a counselor they see 1-2x per month to help oversee their organization habits and tools. Get this all figured out before the car is packed.
  2. GPA. Talk about what, if any, expectations you have for overall as well as per-course GPA. It’s a bit late to tell them at Thanksgiving dinner you wanted to see a 3.75 GPA for the semester. Best to discuss this in July and August. Make it realistic but also challenging. They are not going on vacation. They are coming to school to earn a degree and have some fun (after the work is done).
  3. Appointments. What ever appointments need to happen leading up to or during the school year, have your little college kid get them setup and on the calendar now. It’s not too early to get the dentist appointment scheduled. If they take any type of medication, do not assume they can just have a walk-in appointment for a refill. Get this scheduled now (especially if they need to find and work with a psychiatrist for antidepressants or antianxiety meds).
  4. Contact. How long is too long before you start to worry? Make it clear that if you text/call them, you expect a response (even a lame one) within XX hours. Stick to it. We all know they will get busy (or sleepy or drunk or distracted) but having you worry day after day is unnecessary if they simply check in regularly.
  5. Scheduling. Kind of along the same line as appointments above, one of the most powerful sessions I have with students leading up to classes cranking is sitting down with their schedule and putting EVERY assignment, test, meeting, etc. into their calendar. Most professors post their syllabus on the school’s intranet and every student has access. Every syllabus is required to have all dates/times of classes as well as assignments and tests.
    But wait, there’s more!
    After we plug in all the items from the syllabus, we reverse-engineer. For example, if Mary has a test September 18 for Calc, we schedule back one week for studying (start September 11). For each day, we carve out 1 hour for studying (eg. Mon, Sept 11 3:00pm-4:00pm Review Calc). This makes it so each study session is a known, expected quantity with a specific day and time.For more insider tips, tricks and ways to support your college kid, contact me

Indiana University Students: Anxiety, Depression and Drug Use (and how to fix them)

Since moving to Bloomington, home of Indiana University, a few things have become clear. One – everyone here wears red clothing, drives a red car or paints a room in their house red. They don’t mess around with school pride.

Second thing I’ve noticed is the super-driven nature of IU students. They are high achievers and have big goals. Awesome. Big goals are great. Unfortunately, these same students are often not equipped for the challenges of living on their own and the intense academic load. Anxiety, depression and drug use are common here (as with most other big schools). Since there are so few counselors/psychotherapists in the area, I see a heavy load of students, especially when the pressure starts to creep in around mid-September. The partying picks up, parents are gone and classes start to dial-up intensity. It’s a toxic mix.

A great place to start is IU.

IU offers respite in the form of their counseling center (CAPS) but it’s a) triaging a problem, b) only short term and c) often doesn’t get to the underlying issues which are often years in the making. Don’t get me wrong, CAPS does a great job and the best they can considering how underfunded they are. The first two sessions for each semester are free. Each following session is $30. They generally have a waitlist so I recommend that students sign-up early.

CAPS also offers psychiatric care for those needing medical attention, like help or oversight with medication. The wait list is often even longer since there are fewer psychiatrists than counselors. Psychiatric visits are not covered under student health fees so insurance or out of pocket payment is expected.

For those struggling with more serious drug issues, IU offers OASIS/Journey. Students that sign-up for Journey get an assessment to determine the best level of care. Staff then decide between two evidence-based interventions in both group and individual settings, the Journey Program operates under 3 phases, designed to provide progressively more attention based on the student’s need.

Students referred from the Office of Student Ethics are charged $200. Alcohol and drug charges are applied separately. If a student was found responsible for both an alcohol and drug policy violation within the same incident, they get billed $400. For non-offense participants,they get charged a one-time fee of $25.00 after their first visit.

If IU doesn’t have the availability or discretion you and your family needs, reach out to me. If I can’t help, I’m happy to provide insight into other providers in the area who can.

The best thing for parents to do is start searching for professional support either through IU or the community in July and August. Getting appointments set and providers lined-up will be much easier when the semester has not started. Once the semester starts, a good counselor will work closely with parents and the school to ensure that everyone is aware of progress and prepared in case the students experiences more severe issues.

Hopefully, your son and daughter will not need any of this but if they do, act early and expect everyone to act as a team.

Spring Semester Planning for Kids Returning to College

You made it! The kids made it home, the in-laws were tolerable and there weren’t a ton of gifts that needed returning. Now that everyone is headed back to campus, it’s time to either let that old anxiety creep in or spend some time on the front end helping your son or daughter develop a plan to be successful for Spring Semester.

Money

If you have not learned by now, discuss how much you are giving to your kid and when you’ll give it to them. You don’t want to find yourself in a defensive position Sunday night while your son is blowing up your phone begging for their regular spending money to be put into their account early. I recommend putting money into the account 2x/month. Put it on them to create a budget which factors in their books, fun money and any other expenses. I also recommend a limit is set for any credit cards and deciding who and when it will be paid off.

Organization

Talk about starting the semester off with everything in it’s place – clothing, car, computer. Let’s make sure everything is reviewed, updated and ready to go. While we’re at it, let’s pull up the calendar and start looking into the future to see when things will need to be re-updated. Get the oil change scheduled, even if it’s two months out. Get the printer cartridge in your Amazon Wish List so that you can move it to the cart quickly when your printer gives you a frowny face.

Scheduling

Speaking of calendars, let’s go ahead and talk scheduling more in-depth. I recommend to every college student they use the following strategy: Get all your syllabi, Put all dates for tests, papers, office hours, etc on your calendar. For tests, count back from the test date one week and put schedule study times (no longer than 90 min). Do the same for papers. Break down writing the paper into reasonable and realistic chunks of time and put them on your calendar. Theme: Put everything on your calendar, everything. If your son or daughter are in greek life, there are a ton of events that can be put on the calendar. Same with internships or study abroad – break down all the details so that you can see things from 10,000 ft.

Travel/Visiting Home

Plan out whatever travel including home visits your kid will have mor might have. If travel plans are only possible and not 100%, put a question mark after it so at least everyone knows that period of time is possibly accounted for.

GPA 

If your kid’s GPA got beatin up a bit in the Fall, it’s probably a good idea to identify a reasonable expectation for the Spring. If your son or daughter limped home with C’s and D’s, ask what is a realistic GPA for which to aim. Talk about it but make it clear there needs to be something concrete. . Along with identifying a GPA to aim for, talk about specific strategies that will be used to support them. All colleges have student support and academic support options. For instance, here in Bloomington, Indiana University has a solid Academic Support Center with a ton of resources that work well for thousands of students struggling academically.

Graduation/End of Semester

Part of that schedule should also have details that show your finals and last day of classes. Put details about studying for finals, having family in town, etc. If your son or daughter is graduating, figure out details early in the semester since 1) things get crazy busy/expensive during graduation and 2) hotel rooms get sold-out.

On Campus Help

Besides hooking up with academic support, it’s not a bad idea to find a counselor/life coach that can act as liaison between home and school. This professional should provide regular updates to parents, meet and be available as often as needed. They should be well-versed in young adult issues like anxiety, depression and ADHD. Universities often have counseling centers on campus that provide individual counseling for about six sessions and then they refer to a community professional. They might have ideas about professionals near your kid’s school that can offer support.

Final bit of advice – trust your kids and trust the process. With a bit of planning, your kid’s semester will have highs and lows but ultimately, they’ll finish the semester better than they started it.

Rewards, Consequences, Punishment…What’s the Best Way to Parent Teens and College Kids?

A simpler what to think of this post is “How to Change Behavior.” That’s really the primary function of a reward or consequence.

There are more books on how to change kids’ behavior than just about any other topic. Ironically (or sadly), they all say the same thing. Punishment does not work; rewards work consequences for choices work. How can this be? Let’s kick the tires on the history and research behind this. If you hate history and research, jump ahead a few pages to the ‘how-to’ portion.

Context: Let’s Look Back First

For thousands of years before the Industrial Revolution, children were assets in an agrarian system (most humans up to that point farmed). We had lots and lots of kids since a) children were relatively cheap labor, b) most died during childbirth or as children and c) adult children became financial support systems for parents – the more children parents had, the more financial support and broader financial base.

In 1916, Congress passed the the first federal child labor law. However, pressure from big companies forced the U.S. Supreme Court to strike down the law two years later. Following the Great Depression adults had become so desperate for jobs that they would work for the same wage as children.

In 1938, President Roosevelt signed the Fair Labor Standards Act, which limited most forms of child labor (but excluded agricultural work). This was the beginning of our modern view of children needing protection, love and nurturing. A pendulum was set in motion.

In 1946, another revolution took place. Dr. Benjamin Spock published his first book titled Dr. Spock’s Baby & Child Care (also titled The Common Sense Book of Baby and Child Care). Though a medical doctor by education and training, Dr. Spock’s books put children at the center of parenting rather than the adults. He encouraged responding to and engaging with babies and children rather than ignoring which was the advice up to then. The pendulum’s momentum builds.

Finally, we add in money and work. In the early 80’s, adults were working more, making more money and, as a result, needing to leave their children at home (the so-called ‘latch-key’ kids). Children would get dropped off from the bus and walk into an empty home. Cartoons and snacks were gorged upon till mom and dad came home. Guilt stricken parents with extra cash (…or more accurately extra room on their new credit cards) went and bought Ataris, Nintendos and the new wave of electronics and toys for kids. We were now descending into entitlement. About this time, school districts were changing punishment in schools (no more spankings).

How can old-school grandma and grandpa who raised 15 kids have been so wrong? All the kids turned out great, right? Well, let’s break this down a bit. First of all, it was a different time. No devices, internet and certainly little to no advertising directed towards children. All marketing was targeting stay at home mothers.

I also want to point out that most of these old school versions of parenting created some pretty nasty problems which is why the fastest growing demographics for substance abuse treatment are the Baby Boomers and the elderly. Old school punishment, drinking habits, and expectations led to a generation that was not well-equipped to handle stressors.

Now for the Goods

Here are the best ways to change behavior and encourage healthy choices. I’ve taught these, studied these and continue to stand by these effective strategies:

Commit to the Path

  1. Drawn into accidentally energizing and rewarding negativity leads to a battle – Be intentional about being positive
  2. Intentionally energize and nurture success
  3. Provide a true and deep consequence when a rule is broken – something that is proportional to the infraction
  4. Reward for what you want to see.
  5. Ignore behaviors you want see less of.

Establish Expectations and Boundaries

  1. Detailed rules/expectations and no grey area – kids are MASTER negotiators and litigators
  2. Chores and Expectations – daily schedule or list
  3. Bonus behaviors – Things you wish to increase
  4. Menu of privileges – Can include anything beyond basic needs
  5. Extend Structure – At school, friends house, soccer practice, etc.

Consequences

  1. Relentless pursuit of positives: Biased towards seeing your kid’s great choices.
  2. Strictness and Clarity: Be like a videogame – if a rule is broken, a consequence is administered no matter how you are feeling.
  3. No Leaking: Accidentally rewarding behavior with negative energy but they contribute to your kid behaving badly.
  4. Finite: Consequences do not expand and are tied to a specific behavior/event.

Rewards

  1. Catch them doing things right: When I run parent groups I ask parents to list the amount of things they caught their kids doing wrong in the last month. Easy list to make. Then I ask them to list three things they caught them doing right. Much harder. We are programmed to find faults in this attempt to modify kids behaviors towards compliance – making bad choices is the loud, obvious indication they are out of line. We we fail to see are the million little choices they make each day which are well-thought out and positive. Focus on those. Highlight those. “Hey Julian, I noticed you put the dishes away without anyone asking you to do it. Great job.” …And then move on. No need to get mushy and turn it into an Oprah interview about thoughts and feelings.
  2. Types of rewards: Your eye contact and facial expression are huge rewards for younger kids. Rather than giving kids an iPhone or XBox, I encourage parents to give time on each device or toy as a reward. Have you ever kept the car you rented at the airport? No, you paid them to borrow it for a specific amount of time and then returned it. There are few instances where I encourage parents to buy something to give to their kids as a reward. Time, praise, and access to cool things is often way better for everyone.
  3. Negotiating: If you find yourself constantly reminder, encouraging, begging, etc. for you kids to do A so they get access to B, you are violating your own rules. You are now negotiating.
  4. List of Rewards: In 2007, one parent I was working with could not understand why their teenage son was not motivated by the reward of time on their Blackberry (same year iPhone introduced). If they are not doing chores, getting good grades or engaging in the behavior you want to see, your rewards may be incongruent with their desires. Ask them to tell you what they’re into. Maybe its an allowance, money for iTunes or they want to borrow the car.

And Lastly…Own Your Home

This is a hard one for parents (… and most kids) but until responsibility for the mortgage, bills and everything that makes a home function is shared among all family members – parents rule. There is no such thing as the ‘kid’s’ room. Everything, every room, every toy, every piece of clothing is the parents’. Great parents allow their kids to use those things. Remember…privilges are not rights and kids get to own their choices, not their TV.

Good Luck.