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.